Question Of The Day

A 25-year-old patient presents with severe abdominal pain, vomiting, and confusion after ingesting an unknown substance. Blood tests reveal metabolic acidosis and an elevated anion gap. His urine sample demonstrates the presence of needle-shaped, birefringent crystals under polarized light. Which substance has the patient likely…

Historical QOD 2/5/2009: What is the difference in risk for sudden cardiac death in users of typical antipsychotic drugs versus the risk for sudden death in users of atypical antipsychotic drugs? Current users of typical and of atypical antipschyotic drugs have similar, dose related increased…

Which hepatic zone is initially affected first during an acute acetaminophen poisoning? Hepatic zone III is where toxicity is noted first due to the higher concentration of CYP enzymes (more oxidative metabolism) compared to the other two zones. Necrosis of these hepatocytes is responsible for…

What strategy has been suggested that may slow the progression of tissue injury after button battery ingestion? According to the cited reference, administration of honey 10mL (2 teaspoons) every 10 minutes for up to 6 doses can slow progression of tissue injury prior to definitive…

In foodborne botulism, a patient symptoms may include blurred vision, difficulty swallowing and muscle weakness. What is botulinum toxin’s primary effect at the cellular level? Botulinum toxin’s primary effect at the cellular level is to block the release of acetylcholine at the neuromuscular junction which…

Carbon monoxide poisoning occurs very rapidly in high concentrations. What toxin can cause the delayed release to prolonged carbon monoxide toxicity? Methylene chloride can be found in paint strippers, aerosol paints, and metal cleaning solutions. Methylene chloride toxins may produce carbon monoxide through their metabolic…

Historical QOD 2/4/2009: What are the reported risks for infants born to mothers who took an SSRI during the third trimester? Higher risk of requiring treatment in an ICU possibly related to a withdrawal reaction and of developing persistent pulmonary hypertension. The Medical Letter, 50(1299),…

What is 1,4-butanediol and its mechanism of action as a substance of abuse? 1,4-butanediol (BD) is an industrial chemical that individuals use as a source of gamma-hydroxybutyrate (GHB). After oral ingestion, BD is rapidly converted into GHB by alcohol dehydrogenase and aldehyde dehydrogenase. As a…

How do Amanita muscaria-containing gummies cause their effects? Recently, supplements containing Amanita muscaria extracts have been used for their psychedelic effects. The main psychoactive components from these mushrooms are muscimol and ibotenic acid. Ibotenic acid and muscimol are derivatives of glutamic acid and gamma-aminobutyric acid…

What toxic substance sometimes found in nail polish remover may cause coma? While acetone is commonly found in nail polish remover, Gamma-butyrolactone (GBL) has also been found in nail polish remover and reported to cause CNS depression in small children taking exploratory ingestions.  While GBL…