Comparison of two-bag and three-bag acetylcysteine regimens in the treatment of paracetamol poisoning: a systematic review and meta-analysis.

Introduction: Worldwide, paracetamol poisoning is a common cause of acute liver failure and referral to transplant centers. Acetylcysteine has long been the mainstay of treatment, but recent literature suggests that a simplification of the "three-bag" method may decrease adverse effects. Our primary hypothesis is that a simplified dosing regimen (two-bag regimen) is non-inferior to the three-bag method in preventing liver injury.

Does occupational exposure to fentanyl cause illness? A systematic review.

Introduction: The opioid epidemic in the United States continues to result in an increasing number of deaths and is increasingly dominated by fentanyl and fentanyl analogs. As a result, first responders are likely to come into contact with fentanyl-containing substances daily. Concerns persist regarding occupational exposure resulting in intoxication.

A systematic review of second line therapies in toxic seizures.

Background: Seizures are a common manifestation of toxic exposures requiring immediate and possibly ongoing management. Guidelines recommend benzodiazepines as first-line therapy for toxic seizures; however, there is a paucity of literature regarding optimal secondary treatment. We systematically evaluated the available literature for second-line treatment of toxic seizures.

A 29-year analysis of acute peak salicylate concentrations in fatalities reported to United States poison centers.

Background/objectives: The threshold salicylate concentration commonly recommended to initiate extracorporeal elimination, in the absence of significant end-organ toxicity, is 100 mg/dL. Unfortunately, the grade of evidence to support this decision is low. Our primary aim is to describe highest reported salicylate concentrations in patients who died from acute salicylate ingestions.

New Psychoactive Substances in Pediatric Patients.

New psychoactive substances (NPS), namely cannabinoids, cathinones, and opioids, have surged in popularity among school-age children, resulting in serious morbidity and mortality globally. In the last decade, there has been a rapid evolution of NPS resulting in hundreds of new compounds. Little to no evidence for humans is available on most compounds.

Levetiracetam in toxic seizures.

Background/objectives: The use of levetiracetam (LEV) in the management of drug-induced seizures has not been systematically investigated. Repetitive and continuous seizures that do not respond to benzodiazepines require second line therapy. Levetiracetam has a unique receptor binding site, rapid absorption, no known cardiac effects at therapeutic doses, and is theoretically a good candidate for use in drug-induced seizures.

A systematic analysis of methylene blue for drug-induced shock.

Context: Pharmacologically induced shock can be refractory to standard resuscitation. Methylene blue (MB) acts to prevent nitric oxide-mediated vasodilation and may be a potential treatment for refractory shock.

Objective: A systematic analysis of the literature to evaluate MB in pharmacologically induced shock.

Non-native (exotic) snake envenomations in the U.S., 2005-2011.

Non-native (exotic) snakes are a problematic source of envenomation worldwide. This manuscript describes the current demographics, outcomes and challenges of non-native snakebites in the United States (U.S.

A 9-state analysis of designer stimulant, "bath salt," hospital visits reported to poison control centers.

Study Objective: A new generation of designer stimulants marketed as "bath salts" emerged in late 2010. The goal is to describe the epidemiologic emergence of designer stimulants in 9 states in the Midwest.

Methods: A retrospective review of the National Poison Data System was performed between November 1, 2010, and November 30, 2011.

Passive multistate surveillance for neutropenia after use of cocaine or heroin possibly contaminated with levamisole.

Study Objective: To characterize the demographic, clinical, and epidemiologic features of levamisole-associated neutropenia in cocaine or heroin users.

Methods: State health departments were recruited for participation when the Centers for Disease Control and Prevention (CDC) was notified of potential cases by a clinician, a health department official, or a poison center between October 15, 2009, and May 31, 2010. A case was defined as a person with an absolute neutrophil count less than 1,000 cells/μL (or a WBC count <2,000 cells/μL) and a self-reported history or laboratory confirmation of cocaine or heroin use.

Lethal serotonin syndrome after methylone and butylone ingestion.

Introduction: A new generation of designer phenethylamines have emerged and aggressively marketed as "legal highs." The drugs are labeled "not for human consumption" to avoid widespread recognition and prosecution under the existing analog drug laws. The newest generation includes methylone and butylone.