Systemic Toxicity after Rattlesnake Envenomation in Patients Using Angiotensin Converting Enzyme Inhibitors: A North American Snakebite Registry Study.

Background: Some North American rattlesnake venoms and angiotensin converting enzyme inhibitor (ACEI) medications each increase bradykinin levels in humans, with clinical effects attributable to bradykinin described in exposed populations. Influence of ACEI exposure on persons with snake envenomation has not been studied. We used data from the ACMT North American Snakebite Registry (NASBR) to determine if use of ACEI medications at the time of rattlesnake envenomation is associated with increased rate of systemic toxicity.

Risk of Delayed Intubation After Presumed Opioid Overdose in the Emergency Department.

Study Objective: The objective of this study was to evaluate the optimal duration of monitoring for patients with presumed opioid overdoses prior to a non-ICU admission, particularly in the context of the increasing prevalence of fentanyl analogs and other potent synthetic opioids. Given the critical role of emergency physicians in managing this public health crisis, the study aims to inform clinical decisionmaking regarding patient disposition after the initial overdose treatment.

Methods: The Fentalog Study, conducted through the American College of Medical Toxicology's Toxicology Investigators Consortium, is a prospective, multi-institutional project designed to identify patients presenting to the emergency department with acute opioid overdose, gather clinical details, and confirm substances through biologic testing.

Wearable technology and daily diaries for studying mental health: lessons learned from pilot studies in Kampala, Uganda.

Wearable technology and daily diaries offer insights into everyday behaviors that can further health research and treatment globally. However, the use of these methodologies outside of high-income settings has been limited. We conducted two pilot studies that enrolled 60 young women in the urban slums of Kampala, Uganda to understand design considerations associated with using wearable technology and daily diaries in this context.

Medical Toxicology Consultations and Mortality Among Patients With Poisonings in the PICU.

Importance: Poisonings are a leading cause of preventable mortality and morbidity among children. Pediatric poisonings are commonly managed in pediatric intensive care units (PICUs) and may require complex treatment and specialized evaluation. Physicians specializing in medical toxicology are trained to treat poisoned patients of all ages; however, they are not universally part of the medical staff across hospital systems.

Welcome to the 2025 ACMT Annual Scientific Meeting.

These are the selected abstracts for the 2025 American College of Medical Toxicology (ACMT) Annual Scientific Meeting, which will take place from April 4-6, 2025, in Vancouver, Canada. This year's accepted abstracts include original research studies, including contributions from the Toxicology Investigators Consortium (ToxIC), and clinically significant case reports highlighting unique toxicologic phenomena. These presentations reflect the continued growth and impact of toxicology research, providing attendees with valuable insights into emerging trends, novel treatment strategies, and evolving best practices in the field.

Manual Ventilation Performance With Safety Device in Normal Versus Decreased Lung Compliance: A Single-Center Simulation Study.

Resuscitator bags are commonly utilized in acute care settings; however, poor performance occurs irrespective of a provider's qualifications or experience. A new flow-limiting device (Sotair by SafeBVM, Boston, Massachusetts) limits inspiratory flow during manual ventilation, thus minimizing peak inspiratory pressures. This study examined the differences in flow, pressure, and tidal volume (V) during ventilation with a manual resuscitator connected to the flow-limiting device versus a mechanical ventilator.

Cigarette Smoking Patterns Among Racial and Ethnic Groups With Chronic Lung Diseases During the COVID-19 Pandemic.

Introduction: Chronic obstructive pulmonary disease and asthma are significant respiratory conditions that contribute to substantial morbidity and mortality globally. Chronic obstructive pulmonary disease remains the third most prevalent cause of death worldwide, with 90% of chronic obstructive pulmonary disease deaths attributed to combustible cigarette smoking. Asthma, although often less fatal, leads to considerable health burdens, particularly among marginalized populations who are at higher risk for both more severe chronic obstructive pulmonary disease and asthma outcomes.

Alcohol marketing as a commercial determinant of health: daily diary insights from young women in Kampala.

Alcohol marketing, as a commercial determinant of health, presents an emerging threat to global health and is of particular importance in low-resource settings. This study is composed of data from 'The Onward Project On Wellbeing and Adversity' (TOPOWA) project, a multicomponent prospective cohort study examining the mechanistic pathways of adverse mental health conditions among women aged 18 to 24 years living in the Kampala slums in Uganda. The cohort consists of 300 women recruited in 2023 from three study sites (i.

Tramadol as a fentanyl adulterant: Prevalence and management in a ToxIC Fentalog study prospective cohort.

Background: Tramadol is an adulterant of illicit opioids. As it is a serotonin-norepinephrine reuptake inhibitor as well as a μ-opioid agonist, tramadol adulteration may worsen overdose signs and symptoms or affect the amount of naloxone patients receive.

Methods: This is a multicenter, prospective cohort of adult patients with suspected opioid overdoses who presented to one of eight United States emergency departments and were included in the Toxicology Investigators Consortium's Fentalog Study.

Self-Harm as a Contributor to the Opioid Epidemic: Data From the Toxicology Investigators Consortium Registry.

Objectives: Although considerable focus has been placed on understanding the causes of opioid drug overdoses, the intentions for such overdoses are not well characterized. We investigated the motivations behind nonfatal opioid exposures resulting in serious adverse health outcomes.

Methods: We analyzed prospectively collected data on nonfatal opioid overdoses in the multicenter Toxicology Investigators Consortium (ToxIC) Core Registry between 2014 and 2021.

Profiles of polysubstance use among people reporting past 12-month sleep-motivated nonmedical use of prescription tranquilizers/sedatives.

Background And Objectives: Nonmedical use of prescription tranquilizers/sedatives (NMUPTS) is associated with a 15-times increased likelihood of polysubstance use (PSU). This is correlated with an increased risk for use disorders and death, therefore, to inform prevention efforts, we identified PSU profiles among adults reporting sleep-related NMUPTS.

Methods: National Survey on Drug Use and Health 2015-2019 participants with past 12-month sleep-related NMUPTS and use of an additional drug(s) (n = 2603) were studied.

Feasibility and acceptability of wearable devices and daily diaries to assess sleep and other health indicators among young women in the slums of Kampala, Uganda.

Background: Individuals in Uganda's urban slums have unmet mental health needs due to limited healthcare infrastructure, poor environmental conditions, and extreme poverty. Researchers often use wearable devices to measure factors associated with mental health including sleep, physical activity, and exposure to environmental stressors. However, the use of wearables for research purposes in low-resource settings is limited.

Alcohol Use among Young Women in Kampala City: Comparing Self-Reported Survey Data with Presence of Urinary Ethyl Glucuronide Metabolite.

This study sought to determine the level of concordance between self-reported alcohol use and the presence of its urinary ethyl glucuronide (EtG) metabolite in women living in urban Kampala. In 2023, we recruited 300 young women, ages 18 to 24 years, to participate in a prospective cohort study across three sites in urban Kampala (i.e.

Differences in Drug Poisonings Among Those Who Identify as Transgender Compared to Cisgender: An Analysis of the Toxicology Investigators Consortium (ToxIC) Core Registry, United States 2017-2021.

Purpose: In this manuscript, the abbreviation TG is defined as persons who identify as transgender, GNC is defined as persons who identify as gender nonconforming, and CG is defined as persons who identify as cisgender. TG and GNC (e.g.

Advancing mHealth Research in Low-Resource Settings: Young Women's Insights and Implementation Challenges with Wearable Smartwatch Devices in Uganda.

In many regions globally, including low-resource settings, there is a growing trend towards using mHealth technology, such as wearable sensors, to enhance health behaviors and outcomes. However, adoption of such devices in research conducted in low-resource settings lags behind use in high-resource areas. Moreover, there is a scarcity of research that specifically examines the user experience, readiness for and challenges of integrating wearable sensors into health research and community interventions in low-resource settings specifically.

The American College of Medical Toxicology Annual Scientific Meeting: A Look Back and the Path Forward.

More than 20 years that have elapsed since the inaugural American College of Medical Toxicology Spring Conference in 2002. During this time, the now ACMT Annual Scientific Meeting has grown in many ways, as demonstrated by the increase in attendance and abstract submissions, and diversification of educational offerings, and partners. Most importantly, the scientific rigor and presentation of new knowledge has continued to mature, and the conference is now firmly rooted in the annual educational schedule for medical toxicologists.

Evolving trends of pharmaceutical poisonings associated with QRS complex prolongation.

Introduction: Tricyclic antidepressants often cause drug-induced QRS complex prolongation in overdose but are now less commonly prescribed. We sought to determine, among a contemporary cohort of patients, the pharmaceuticals independently associated with QRS complex prolongation in acute overdose.

Methods: We performed secondary analysis of data from the Toxicology Investigators Consortium (ToxIC) Core Registry.

Adaptation of SafeCare, an evidence-based parenting program, for caregivers of infants in the neonatal intensive care unit.

Background: While there are several parenting programs for NICU caregivers, no studies, to our knowledge, have developed parenting programs aimed at preventing child maltreatment that specifically address these parental factors: parental stress, parental self-efficacy, and positive parent-infant interaction.

Objectives: The objectives of this study were to: 1) Identify adaptations and/or augmentations needed to optimize SafeCare® for NICU caregivers, and 2) Examine the acceptability and preliminary effects of the adapted SafeCare NICU (SCNC) program with NICU caregivers.

Methods: This study consisted of two phases: formative (phase one) and pilot (phase two).

From Patient Registry to Multi-Center Research Consortium: the Toxicology Investigators Consortium (ToxIC) Turns Fifteen.

The Toxicology Investigators Consortium (ToxIC) was launched as a prospective multi-center registry of cases who receive medical toxicology consultations. Now, with over 100,000 cases, the Core Registry continues to address many medical toxicology research questions and has served as the foundation for multiple sub-registries, including the North American Snakebite Registry and the Medications for Opioid Use Disorder sub-registry. ToxIC also has evolved a portfolio of non-registry-based projects utilizing medical toxicology physician site principal investigators who enroll patients through emergency departments, irrespective of whether they received a medical toxicology consultation.

Predicting adverse cardiovascular events in emergency department patients with bupropion overdose.

Objectives: Bupropion toxicity can lead to adverse cardiovascular events (ACVE), but delayed onset of toxicity makes risk stratification difficult. This study aimed to validate previously defined predictors of ACVE and identify novel predictors among patients presenting to the emergency department (ED) after bupropion overdose.

Methods: This secondary analysis of prospective data from the Toxicology Investigators Consortium Core Registry analyzed adult acute or acute-on-chronic bupropion exposures from 2015 to 2018.

American College of Medical Toxicology Research Agenda 2024-2030.

ACMT recognizes the pivotal role of high-quality research in advancing medical science. As such, the establishment of a formal research agenda for ACMT is a leap forward in communicating the priorities of the College, its members, and the patient populations we serve. This thoughtfully crafted agenda will serve as a strategic compass for ACMT, guiding our pursuit of scientific discovery, fostering innovation, and enhancing outcomes for patients and communities affected by poisonings and exposures.