JoVE Visualize What is visualize?
Stop Reading. Start Watching.
Advanced Search
Stop Reading. Start Watching.
Regular Search
Find video protocols related to scientific articles indexed in Pubmed.
Current European data collection on emergency department presentations with acute recreational drug toxicity: Gaps and national variations.
Clin Toxicol (Phila)
PUBLISHED: 11-01-2014
Show Abstract
Hide Abstract
Background. The number of new (novel) psychoactive substances (NPS) available in the illegal market is increasing; however, current monitoring of the drug situation in Europe focuses mainly on classical drugs of abuse, with limited emphasis on clinical presentation in the emergency department (ED). The European Drug Emergencies Network (Euro-DEN) is a European Commission-funded project that aims to improve the knowledge of acute drug toxicity of both classical recreational drugs and NPS. As a baseline for this project, we performed a study to establish which data are currently being collected and reported in Europe on ED presentations with acute toxicity related to NPS and classical drugs of abuse. Methods. We used a three-pronged approach to identify any systematic collection of data on NPS toxicity in Europe by i) performing a literature search, ii) utilising an online survey of the European Monitoring Centre for Drugs and Drug Addiction Re seau Europe en d'Information sur les Drogues et les Toxicomanies national focal points and iii) exploiting the knowledge and resources of the Euro-DEN network members. Results. The literature search revealed 21 papers appropriate for assessment, but only one described a systematic collection of clinical data on NPS. Twenty-seven of thirty countries responded to the online survey. More than half of all the countries (52%) did not perform any registration at all of such data, 37% collected systematic clinical data on NPS at a national level, while 44% collected data on classical drugs. A few examples for good practice of systematic collection of clinical data on ED presentations due to acute toxicity were identified. Conclusion. The systematic collection of data on ED presentation of toxicity related to NPS and classical drugs in Europe is scarce; the existing collection is limited to single centres, single countries, groups of patients or not focused on novel drugs; the collection of data is highly variable between the different countries. Euro-DEN, a European Commission funded project, aims at closing some of these gaps.
Related JoVE Video
Description of 3,180 Courses of Chelation with Dimercaptosuccinic Acid in Children ?5 y with Severe Lead Poisoning in Zamfara, Northern Nigeria: A Retrospective Analysis of Programme Data.
PLoS Med.
PUBLISHED: 10-01-2014
Show Abstract
Hide Abstract
In 2010, Médecins Sans Frontières (MSF) discovered extensive lead poisoning impacting several thousand children in rural northern Nigeria. An estimated 400 fatalities had occurred over 3 mo. The US Centers for Disease Control and Prevention (CDC) confirmed widespread contamination from lead-rich ore being processed for gold, and environmental management was begun. MSF commenced a medical management programme that included treatment with the oral chelating agent 2,3-dimercaptosuccinic acid (DMSA, succimer). Here we describe and evaluate the changes in venous blood lead level (VBLL) associated with DMSA treatment in the largest cohort of children ?5 y of age with severe paediatric lead intoxication reported to date to our knowledge.
Related JoVE Video
Incidence and management of N-acetylcysteine-related anaphylactoid reactions during the management of acute paracetamol overdose.
Eur J Emerg Med
PUBLISHED: 09-30-2014
Show Abstract
Hide Abstract
Adverse drug reactions (ADRs) to N-acetylcysteine (NAC) treatment for paracetamol overdose are typically anaphylactoid in origin and occur in 2-48% of treated patients. We explored the incidence and management of NAC ADR in our unit.
Related JoVE Video
Using Internet Snapshot Surveys to Enhance Our Understanding of the Availability of the Novel Psychoactive Substance 4-Methylaminorex and 4,4'-Dimethylaminorex.
J Med Toxicol
PUBLISHED: 08-29-2014
Show Abstract
Hide Abstract
4,4'-Dimethylaminorex is a stimulant novel psychoactive substance (NPS) first detected in Europe in November 2012. It is a derivative of 4-methylaminorex, a substance controlled under Schedule 1 of the 1971 United Nations Convention on Psychotropic Substances. There is currently no information on the availability or cost of these substances from Internet suppliers. An Internet snapshot study was undertaken in English using established European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) methodology to determine the availability of 4-methylaminorex and 4,4'-dimethylaminorex in April 2014. Twenty Internet sites selling 4-methylaminorex were identified, 18 selling in US dollars and two in GB Pound Sterling. Fourteen (70 %) Internet sites had a minimum purchase amount of ?10 g (compared to user doses of 10-25 mg). For the 18 suppliers selling in US$, 9 quoted a fixed price per gram irrespective of the amount ordered and 11 had a reducing price per gram with increasing purchase quantity (US$30.8?±?34.2/g for 1 g purchase to US$15.2?±?20.3/g for 1 kg purchase). Only one Internet site selling 4,4'-dimethylaminorex was identified, selling in Euros. The minimum purchase quantity was 500 mg. The price per gram reduced from 36.08/g for a 500 mg purchase to 2.20/g for a 100 g purchase. This Internet snapshot demonstrated that there was a greater availability from Internet suppliers of products advertised as 4-methylaminorex than 4,4'-dimethylaminorex, despite the 4-methylaminorex being an internationally controlled substance. Whilst this may reflect misunderstanding by suppliers, it has the potential to put those purchasing at risk of contravening border control and/or local law enforcement legislation. The use of methodology such as Internet snapshot surveys is of increasing interest to clinical/medical toxicologists in their understanding of the supply, availability and cost of novel psychoactive substances.
Related JoVE Video
Ethnic differences in self-poisoning across South London.
Crisis
PUBLISHED: 08-13-2014
Show Abstract
Hide Abstract
Self-poisoning (overdose) is the commonest form of self-harm cases presenting to acute secondary care services in the UK, where there has been limited investigation of self-harm in black and minority ethnic communities. London has the UK's most ethnically diverse areas but presents challenges in resident-based data collection due to the large number of hospitals.
Related JoVE Video
Using Drug-Intoxicated Deaths as Potential Organ Donors: Impression of Attendees at the American College of Medical Toxicology 2014 Annual Scientific Meeting.
J Med Toxicol
PUBLISHED: 07-16-2014
Show Abstract
Hide Abstract
Over the last decade, there has been a reduction of organ donation from intracranial haemorrhage-, stroke- and blunt trauma-related deaths in the USA. There has been a corresponding increase in the use of drug-intoxicated patients as organ donors from 2.1 % in 2003 to 6.8 % in 2013.
Related JoVE Video
Guidelines for reporting case studies on extracorporeal treatments in poisonings: methodology.
Semin Dial
PUBLISHED: 05-29-2014
Show Abstract
Hide Abstract
A literature review performed by the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup highlighted deficiencies in the existing literature, especially the reporting of case studies. Although general reporting guidelines exist for case studies, there are none in the specific field of extracorporeal treatments in toxicology. Our goal was to construct and propose a checklist that systematically outlines the minimum essential items to be reported in a case study of poisoned patients undergoing extracorporeal treatments. Through a modified two-round Delphi technique, panelists (mostly chosen from the EXTRIP workgroup) were asked to vote on the pertinence of a set of items to identify those considered minimally essential for reporting complete and accurate case reports. Furthermore, independent raters validated the clarity of each selected items between each round of voting. All case reports containing data on extracorporeal treatments in poisoning published in Medline in 2011 were reviewed during the external validation rounds. Twenty-one panelists (20 from the EXTRIP workgroup and an invited expert on pharmacology reporting guidelines) participated in the modified Delphi technique. This group included journal editors and experts in nephrology, clinical toxicology, critical care medicine, emergency medicine, and clinical pharmacology. Three independent raters participated in the validation rounds. Panelists voted on a total of 144 items in the first round and 137 items in the second round, with response rates of 96.3% and 98.3%, respectively. Twenty case reports were evaluated at each validation round and the independent raters' response rate was 99.6% and 98.8% per validation round. The final checklist consists of 114 items considered essential for case study reporting. This methodology of alternate voting and external validation rounds was useful in developing the first reporting guideline for case studies in the field of extracorporeal treatments in poisoning. We believe that this guideline will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports may provide early signals of effectiveness and/or harm, thereby improving healthcare decision-making.
Related JoVE Video
Acute toxicity associated with analytically confirmed recreational use of methiopropamine (1-(thiophen-2-yl)-2-methylaminopropane).
J Med Toxicol
PUBLISHED: 04-08-2014
Show Abstract
Hide Abstract
Methiopropamine use in Europe has been detected since January 2011, but there is limited information on its acute toxicity. Here, we describe a case of analytically confirmed methiopropamine acute toxicity.
Related JoVE Video
Effect of the UK's revised paracetamol poisoning management guidelines on admissions, adverse reactions and costs of treatment.
Br J Clin Pharmacol
PUBLISHED: 01-31-2014
Show Abstract
Hide Abstract
In September 2012 the UK's Commission on Human Medicines (CHM) recommended changes in the management of paracetamol poisoning: use of a single '100?mg?l(-1) ' nomogram treatment line, ceasing risk assessment, treating all staggered/uncertain ingestions and increasing the duration of the initial acetylcysteine (NAC) infusion from 15 to 60?min. We evaluated the effect of this on presentation, admission, treatment, adverse reactions and costs of paracetamol poisoning.
Related JoVE Video
Association of blood lead level with neurological features in 972 children affected by an acute severe lead poisoning outbreak in Zamfara State, northern Nigeria.
PLoS ONE
PUBLISHED: 01-01-2014
Show Abstract
Hide Abstract
In 2010, Médecins Sans Frontières (MSF) investigated reports of high mortality in young children in Zamfara State, Nigeria, leading to confirmation of villages with widespread acute severe lead poisoning. In a retrospective analysis, we aimed to determine venous blood lead level (VBLL) thresholds and risk factors for encephalopathy using MSF programmatic data from the first year of the outbreak response.
Related JoVE Video
Challenges in the diagnosis of ethylene glycol poisoning.
Ann. Clin. Biochem.
PUBLISHED: 11-11-2013
Show Abstract
Hide Abstract
Ethylene glycol poisoning, while uncommon, is clinically significant due to the associated risk of severe morbidity or lethality and it continues to occur in many countries around the world. The clinical presentation of ethylene glycol toxicity, while classically described in three phases, varies widely and when combined with the range of differential diagnoses that must be considered makes diagnosis challenging. Early and accurate detection is important in these patients, however, as there is a need to start antidotal treatment early to prevent serious harm. In this article, we will review the literature and provide guidance regarding the diagnosis of ethylene glycol poisoning. While gas chromatography is the gold standard, the usefulness of this test is hampered by delays in access due to availability. Consequently, there are several surrogate markers that can give an indication of ethylene glycol exposure but these must be interpreted with caution and within the clinical context. An in-depth review of these tests, particularly the detection of a raised osmolar gap or an raised anion gap acidosis, will form the main focus of this article.
Related JoVE Video
Five-year trends in self-reported recreational drugs associated with presentation to a UK emergency department with suspected drug-related toxicity.
Eur J Emerg Med
PUBLISHED: 10-23-2013
Show Abstract
Hide Abstract
User surveys show that there have been significant changes over the last decade in the recreational drugs that are available and being used. This study aims to determine whether there have been similar trends in the drug(s) used by individuals presenting to the emergency department (ED) with acute recreational drug toxicity.
Related JoVE Video
Using Internet Snapshot Surveys to Enhance Our Understanding of the Availability of the Novel Psychoactive Substance Alpha-methyltryptamine (AMT).
Subst Use Misuse
PUBLISHED: 07-04-2013
Show Abstract
Hide Abstract
Alpha-methyltryptamine (AMT) is a novel psychoactive substance available over the Internet. This study used European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) Internet snapshot methodology to investigate the availability and cost of AMT in March/October 2012. From March to October 2012, there was a decrease in the number of Internet sites selling AMT (44 to 31). AMT powder was cheaper in "bulk" (100 g) than in "recreational-user" (100 mg) quantities, and there was a decrease in price. Data from Internet snapshot surveys complement and allow triangulation of data from other sources to build a more detailed picture on availability and use of novel psychoactive substances.
Related JoVE Video
Acute psychosis associated with recreational use of benzofuran 6-(2-aminopropyl)benzofuran (6-APB) and cannabis.
J Med Toxicol
PUBLISHED: 06-05-2013
Show Abstract
Hide Abstract
There is evidence from around Europe of the availability and use of 6-(2-aminopropyl)benzofuran (6-APB) as a recreational drug. However, there is currently limited information on the acute toxicity of this compound. We describe here a case of acute toxicity associated with recreational use of legal high (6-APB) and cannabis, in which the comprehensive toxicological analysis confirmed the presence of a significant amount of 6-APB together with metabolites of both tetrahydrocannabinol and the synthetic cannabinoid receptor agonist (JWH-122).
Related JoVE Video
Do novel psychoactive substances displace established club drugs, supplement them or act as drugs of initiation? The relationship between mephedrone, ecstasy and cocaine.
Eur Addict Res
PUBLISHED: 04-22-2013
Show Abstract
Hide Abstract
To assess whether novel psychoactive substances (NPS) displace established club drugs, supplement them or act as drugs of initiation via a study of the relationship between mephedrone, ecstasy pills, cocaine and MDMA powder amongst club-goers considered to be early adopters of psychostimulant/club drug trends.
Related JoVE Video
Psychiatric aspects of acute withdrawal from gamma-hydroxybutyrate (GHB) and its analogue gamma-butyrolactone (GBL): implications for psychiatry services in the general hospital.
Int J Psychiatry Clin Pract
PUBLISHED: 04-12-2013
Show Abstract
Hide Abstract
The objective of this study was to describe the psychiatric symptoms, management and outcomes in a consecutive series of patients being managed medically for symptoms of withdrawal from gamma-hydroxybutyrate (GHB) and its analogue gamma-butyrolactone (GBL) in a general hospital setting.
Related JoVE Video
Determining the volume of toxic liquid ingestions in adults: accuracy of estimates by healthcare professionals and members of the public.
Clin Toxicol (Phila)
PUBLISHED: 01-17-2013
Show Abstract
Hide Abstract
Ingestion of toxic liquids is common, and the volume ingested is often important for clinical decision-making. However, the accuracy and interpretation of volume estimates in the context of toxicological exposures is poorly characterised in adult practice.
Related JoVE Video
Dissemination and uptake of a new treatment pathway for paracetamol poisoning in the UK: a survey of healthcare professionals.
Br J Clin Pharmacol
PUBLISHED: 01-10-2013
Show Abstract
Hide Abstract
On 3 September 2012, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) notified healthcare professionals of immediate changes to the intravenous acetylcysteine license terms, altering the treatment pathway for paracetamol poisoning. We sought to evaluate awareness of this amongst healthcare professionals.
Related JoVE Video
Energy-1 (NRG-1): dont believe what the newspapers say about it being legal.
Emerg Med J
PUBLISHED: 11-22-2011
Show Abstract
Hide Abstract
A 31-year-old man purchased the legal high Energy-1 (NRG-1) over the internet; this was advertised as containing the compound naphthylpyrovalerone (NPV), which at the time was currently legally available in the UK. He ingested 1 g of this substance and developed a prolonged high associated with palpitations, sweating and insomnia. Analysis of both the powder and serum samples from the patient demonstrated that he ingested two classified recreational drugs ?-keto-N-methylbenzodioxolylpropylamine (butylone) and methylenedioxypyrovalerone (MDPV) rather than the legal substance NPV. Users of legal highs need to be aware that legal highs purchased over the internet may contain illegal substances and therefore they may be liable for prosecution if found in possession of these substances. Future educational campaigns aimed at recreational drug and legal high users should include reference to the potential legal implications of buying these substances.
Related JoVE Video
Emergency department presentations in determining the effectiveness of drug control in the United Kingdom: mephedrone (4-methylmethcathinone) control appears to be effective using this model.
Emerg Med J
PUBLISHED: 10-27-2011
Show Abstract
Hide Abstract
Mephedrone (4-methylmethcathinone) and related cathinones were controlled in the United Kingdom on 16 April 2010. An analysis of presentations to the emergency department of patients with acute toxicity related to the use of mephedrone demonstrated that there was a peak in presentations prior to and a significant fall in presentations following the control of mephedrone. This suggests that the control of mephedrone in the United Kingdom may have been effective in reducing the acute harm associated with the drug.
Related JoVE Video
Acute toxicity associated with the recreational use of the ketamine derivative methoxetamine.
Eur. J. Clin. Pharmacol.
PUBLISHED: 10-25-2011
Show Abstract
Hide Abstract
Long-term regular use of ketamine has been reported to be associated with severe symptomatic urinary tract problems. Methoxetamine, an arylcyclohexylamine derivative of ketamine, is marketed as a "bladder safe" derivative of ketamine, and no cases of acute toxicity following analytically confirmed methoxetamine use have been reported to date. We report here a case series of three individuals with acute toxicity related to the analytically confirmed use of methoxetamine.
Related JoVE Video
A case series of individuals with analytically confirmed acute diphenyl-2-pyrrolidinemethanol (D2PM) toxicity.
Eur. J. Clin. Pharmacol.
PUBLISHED: 08-23-2011
Show Abstract
Hide Abstract
There is increasing interest in the use of pipradrol and pipradrol derivatives, such as diphenylproplinol [diphenyl-2-pyrrolidinemethanol (D2PM)] and desoxypipradrol [2-diphenylmethylpiperidine (2-DPMP)], as recreational drugs. There is limited information on the acute toxicity related to both D2PM and 2-DPMP. We report here a case series of five individuals with acute toxicity related to the use of D2PM.
Related JoVE Video
Risk of caffeine toxicity associated with the use of legal highs (novel psychoactive substances).
Eur. J. Clin. Pharmacol.
PUBLISHED: 08-11-2011
Show Abstract
Hide Abstract
Caffeine has desired stimulant effects similar to but weaker than both classical recreational drugs and novel psychoactive substances. This study was undertaken to determine the caffeine content of a sample of novel psychoactive substances, and we discuss the implications for the management of acute recreational drug toxicity.
Related JoVE Video
2,4-dinitrophenol (DNP): a weight loss agent with significant acute toxicity and risk of death.
J Med Toxicol
PUBLISHED: 07-09-2011
Show Abstract
Hide Abstract
2,4-Dinitrophenol (DNP) is reported to cause rapid loss of weight, but unfortunately is associated with an unacceptably high rate of significant adverse effects. DNP is sold mostly over the internet under a number of different names as a weight loss/slimming aid. It causes uncoupling of oxidative phosphorylation; the classic symptom complex associated with toxicity of phenol-based products such as DNP is a combination of hyperthermia, tachycardia, diaphoresis and tachypnoea, eventually leading to death. Fatalities related to exposure to DNP have been reported since the turn of the twentieth century. To date, there have been 62 published deaths in the medical literature attributed to DNP. In this review, we will describe the pattern and pathophysiology of DNP toxicity and summarise the previous fatalities associated with exposure to DNP.
Related JoVE Video
Outbreak of fatal childhood lead poisoning related to artisanal gold mining in northwestern Nigeria, 2010.
Environ. Health Perspect.
PUBLISHED: 05-19-2011
Show Abstract
Hide Abstract
In May 2010, a team of national and international organizations was assembled to investigate childrens deaths due to lead poisoning in villages in northwestern Nigeria.
Related JoVE Video
Acute toxicity and withdrawal syndromes related to ?-hydroxybutyrate (GHB) and its analogues ?-butyrolactone (GBL) and 1,4-butanediol (1,4-BD).
Drug Test Anal
PUBLISHED: 03-21-2011
Show Abstract
Hide Abstract
Gamma-hydroxybutyrate (GHB) has been used as a recreational drug since the 1990s and over the last few years there has been increasing use of its analogues gamma-butyrolactone (GBL) and to a lesser extent 1,4-butanediol (1,4BD). This review will summarize the literature on the pharmacology of these compounds; the patterns and management of acute toxicity associated with their use; and the clinical patterns of presentation and management of chronic dependency associated with GHB and its analogues.
Related JoVE Video
Methaemoglobinaemia associated with the use of cocaine and volatile nitrites as recreational drugs: a review.
Br J Clin Pharmacol
PUBLISHED: 03-01-2011
Show Abstract
Hide Abstract
Methaemoglobinaemia can cause significant tissue hypoxia, leading to severe, potentially life-threatening clinical features and/or death. Over recent years there have been increasing reports of methaemoglobinaemia related to recreational drug use. There have been 25 articles describing methaemoglobinaemia related to recreational use of volatile nitrites (poppers) and more recently, four reports of methaemoglobinaemia in association with recreational cocaine use. In this article we discuss the mechanisms by which methaemoglobinaemia occurs in relation to the use of both volatile nitrites and cocaine, and summarize the published cases of recreational drug-related methaemoglobinaemia. The volatile nitrites can cause methaemoglobinaemia directly through their activity as oxidizing agents. However, with cocaine, methaemoglobinaemia is related to adulterants such as local anaesthetics or phenacetin, rather than to the cocaine itself. Clinicians managing patients with acute recreational drug toxicity should be aware of the potential for methaemoglobinaemia in these patients, particularly in patients with cyanosis or unexplained low oxygen saturations on pulse oximetry, and ensure that appropriate and timely management is provided, including, where appropriate, the use of methylthioninium chloride (methylene blue).
Related JoVE Video
Understanding lactic acidosis in paracetamol (acetaminophen) poisoning.
Br J Clin Pharmacol
PUBLISHED: 02-25-2011
Show Abstract
Hide Abstract
Paracetamol (acetaminophen) is one of the most commonly taken drugs in overdose in many areas of the world, and the most common cause of acute liver failure in both the UK and USA. Paracetamol poisoning can result in lactic acidosis in two different scenarios. First, early in the course of poisoning and before the onset of hepatotoxicity in patients with massive ingestion; a lactic acidosis is usually associated with coma. Experimental evidence from studies in whole animals, perfused liver slices and cell cultures has shown that the toxic metabolite of paracetamol, N-acetyl-p-benzo-quinone imine, inhibits electron transfer in the mitochondrial respiratory chain and thus inhibits aerobic respiration. This occurs only at very high concentrations of paracetamol, and precedes cellular injury by several hours. The second scenario in which lactic acidosis can occur is later in the course of paracetamol poisoning as a consequence of established liver failure. In these patients lactate is elevated primarily because of reduced hepatic clearance, but in shocked patients there may also be a contribution of peripheral anaerobic respiration because of tissue hypoperfusion. In patients admitted to a liver unit with paracetamol hepatotoxicity, the post-resuscitation arterial lactate concentration has been shown to be a strong predictor of mortality, and is included in the modified Kings College criteria for consideration of liver transplantation. We would therefore recommend that post-resuscitation lactate is measured in all patients with a severe paracetamol overdose resulting in either reduced conscious level or hepatic failure.
Related JoVE Video
The impact of changes in UK classification of the synthetic cannabinoid receptor agonists in Spice.
Int. J. Drug Policy
PUBLISHED: 02-21-2011
Show Abstract
Hide Abstract
Spice is the iconic brand name of a smokeable herbal mixture containing synthetic cannabinoid receptor agonists. It has been available on the Internet/in head shops in Europe since at least 2006. The synthetic cannabinoid receptor agonist constituents of Spice were classified in the UK as Class B agents in December 2009. This study assessed the impact of this legislation on the synthetic cannabinoid receptor agonists present in Spice products and whether new synthetic cannabinoid receptor agonists outside of the legislation are now available.
Related JoVE Video
The pharmacology and toxicology of the synthetic cathinone mephedrone (4-methylmethcathinone).
Drug Test Anal
PUBLISHED: 01-18-2011
Show Abstract
Hide Abstract
Mephedrone (4-methylmethcathinone) is a synthetic cathinone that is used as a recreational drug. It has been available since 2007 but its availability and use increased significantly during 2009 and 2010. In this review article we will summarize the available literature on the sources, availability, and prevalence of the use of mephedrone. We will also discuss the pharmacology of mephedrone, the patterns of acute toxicity associated with its use, the reports of fatalities associated with its use, and the potential for mephedrone dependence.
Related JoVE Video
The epidemiology and patterns of acute and chronic toxicity associated with recreational ketamine use.
Emerg Health Threats J
PUBLISHED: 01-13-2011
Show Abstract
Hide Abstract
Ketamine was originally synthesised for use as a dissociative anaesthetic, and it remains widely used legitimately for this indication. However, there is increasing evidence of non-medical recreational use of ketamine, particularly in individuals who frequent the night-time economy. The population-level and sub-population (clubbers) prevalence of recreational use of ketamine is not known but is likely to be similar, or slightly lower than, that of other recreational drugs such as cocaine, MDMA, and amphetamine. The predominant features of acute toxicity associated with the recreational use of ketamine are neuro-behavioural abnormalities such as agitation, hallucinations, anxiety, and psychosis. Secondary to these, individuals put themselves at greater risk of physical harm/trauma. Cardiovascular features (hypertension and tachycardia) occur less frequently and the risk of death from recreational use is low and is predominately due to the physical harm/trauma. Long-term recreational use of ketamine can be associated with the development of psychological dependence and tolerance. There are reports of gastro-intestinal toxicity, particularly abdominal pain and abnormal liver function tests, and of neuropsychiatric disorders, typically a schizophrenia-like syndrome, in long-term users. Finally, there are increasing reports of urological disorders, particularly haemorrhagic cystitis, associated with long-term use. The management of these problems associated with the long-term use of ketamine is largely supportive and abstinence from ongoing exposure to ketamine. In this review we will collate the available information on the epidemiology of recreational use of ketamine and describe the patterns of acute and chronic toxicity associated with its recreational use and the management of this toxicity.
Related JoVE Video
Energy-1 (NRG-1): dont believe what the newspapers say about it being legal.
BMJ Case Rep
PUBLISHED: 01-01-2011
Show Abstract
Hide Abstract
A 31-year-old man purchased the legal high Energy-1 (NRG-1) over the internet; this was advertised as containing the compound naphthylpyrovalerone (NPV), which at the time was currently legally available in the UK. He ingested 1 g of this substance and developed a prolonged high associated with palpitations, sweating and insomnia. Analysis of both the powder and serum samples from the patient demonstrated that he ingested two classified recreational drugs ?-keto-N-methylbenzodioxolylpropylamine (butylone) and methylenedioxypyrovalerone (MDPV) rather than the legal substance NPV. Users of legal highs need to be aware that legal highs purchased over the internet may contain illegal substances and therefore they may be liable for prosecution if found in possession of these substances. Future educational campaigns aimed at recreational drug and legal high users should include reference to the potential legal implications of buying these substances.
Related JoVE Video
Case series of individuals with analytically confirmed acute mephedrone toxicity.
Clin Toxicol (Phila)
PUBLISHED: 12-22-2010
Show Abstract
Hide Abstract
Previous reports of acute toxicity/harm associated with mephedrone use have been based on self-reported mephedrone use; toxicological screening has not been undertaken in these cases to determine whether mephedrone has been used.
Related JoVE Video
Sparkle lamp ingestion: a rare cause of death.
Clin Toxicol (Phila)
PUBLISHED: 10-26-2010
Show Abstract
Hide Abstract
A 51-year-old man was brought to the emergency department after he had drunk 200 mL of fluid from a decorative sparkle lamp. His calcium level was 4.99 mmol/L with a blood gas pH of 7.21. His calcium levels were corrected and his acidosis improved, but his stay in the intensive care department was complicated on day 10 by upper gastrointestinal hemorrhage because of caustic erosions in his stomach. Ten days after admission, he had an emergency right hemicolectomy during which residual luminescent particles were found to have eroded through his cecal mucosa. He eventually died 15 days after admission because of disseminated intravascular coagulopathy and refractory septic shock. This case demonstrates the potential for fatal toxicity associated with ingestion of a common household item.
Related JoVE Video
Variability in the 3,4-methylenedioxymethamphetamine content of ecstasy tablets in the UK.
Emerg Med J
PUBLISHED: 08-19-2010
Show Abstract
Hide Abstract
Toxicity, such as hyperpyrexia, associated with the use of 3,4-methylenedioxymethamphetamine (MDMA; ecstasy) appears to be related to serum MDMA concentrations. However, there does not appear to be a similar association with the number of tablets ingested, suggesting variation in the tablet content of MDMA. Although work has shown this variation in other areas of the world, no studies have reported on the variation of MDMA content in UK ecstasy tablets.
Related JoVE Video
Analysis of recreational drug samples obtained from patients presenting to a busy inner-city emergency department: a pilot study adding to knowledge on local recreational drug use.
Emerg Med J
PUBLISHED: 08-15-2010
Show Abstract
Hide Abstract
Routine toxicological screening is not undertaken in individuals presenting to emergency departments (ED) with acute recreational drug toxicity, because it does not usually alter an individual patients management. Localised information on the types of recreational drugs being used is often not available. The pilot study described here looks at the analysis of presumed recreational drugs in the possession of individuals presenting to the ED with acute recreational drug toxicity.
Related JoVE Video
ICD-10 coding: poor identification of recreational drug presentations to a large emergency department.
Emerg Med J
PUBLISHED: 07-26-2010
Show Abstract
Hide Abstract
Hospital episode statistics (HES) and other health service utilisation data are based upon International Classification of Disease version 10 (ICD-10) diagnostic clinical codes used in relation to presentations to hospital. No previous studies have reported the validity of clinical coding in identifying patients who present with acute recreational drug toxicity.
Related JoVE Video
Putting cocaine use and cocaine-associated cardiac arrhythmias into epidemiological and clinical perspective.
Br J Clin Pharmacol
PUBLISHED: 06-25-2010
Show Abstract
Hide Abstract
This is the first article in a series of three articles on cocaine-related cardiac arrhythmias, following on from the 2008 British Pharmacological Society Winter Meeting Clinical Section Symposium entitled Cocaine induced cardiac arrhythmias - from ion channel to clinical treatment. We will summarize the epidemiology of cocaine use across the world and in particular will focus on UK, Europe and US use prevalence data. We will discuss the acute cardiac and non-cardiac toxicity associated with cocaine and highlight the lack of data on the true UK prevalence of acute cocaine toxicity and on the incidence of cocaine-related cardiac arrhythmias.
Related JoVE Video
Use of high-resolution accurate mass spectrometry to detect reported and previously unreported cannabinomimetics in "herbal high" products.
J Anal Toxicol
PUBLISHED: 06-10-2010
Show Abstract
Hide Abstract
A range of "Herbal High" products were tested for synthetic cannabinoids (cannabinomimetics) to qualitatively determine and compare their individual and relative content. Liquid chromatography-high resolution accurate mass spectrometry was used to rapidly screen samples for a range of cannabinomimetics using mono-isotopic masses derived from the elemental composition of target analytes. A screening database of over 140 compounds was rapidly created. This approach, combined with further tandem mass spectrometric experiments, also facilitated the detection and identification of compounds for which reference materials were not available. Previously reported cannabinomimetics, including JWH-018 and CP47,497 and its homologues, were detected in varying relative proportions along with several tentatively identified unreported cannabinomimetics. In some countries, the decision has been made to include these substances within their drug control legislation, and other countries are considering similar action. The currently applied drug screening techniques are unlikely to be effective in providing scientific evidence to support their identification in seized products. The application of high-resolution accurate mass spectrometry offers a solution. In addition, the technology provides a relatively simple and quick method for screening products, building substance databases, and even identifying novel substances using a combination of accurate mass derived elemental composition and fragment ions combined with fragmentation prediction software.
Related JoVE Video
Patient knowledge of the paracetamol content of over-the-counter (OTC) analgesics, cough/cold remedies and prescription medications.
Emerg Med J
PUBLISHED: 06-07-2010
Show Abstract
Hide Abstract
To test, by completion of a simple questionnaire, patient knowledge of whether 15 commonly used over-the-counter and prescription analgesics and cough/cold remedies contained paracetamol and patient knowledge of the 4 g maximum daily dose of paracetamol.
Related JoVE Video
Availability of and use of Intralipid (lipid rescue therapy, lipid emulsion) in England and Wales.
Emerg Med J
PUBLISHED: 05-13-2010
Show Abstract
Hide Abstract
There is increasing evidence for the use of Intralipid in the management of acute local anaesthetic toxicity. This is supported by the recent Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines for the management of local anaesthetic toxicity. Acute hospitals in England and Wales were surveyed to determine the proportion that currently stocked Intralipid, the locations of stocks within the hospital, guidelines related to its use and previous use in the last 12 months. The majority of hospitals surveyed stocked Intralipid in multiple locations, although not in all areas using high volumes of local anaesthetics. Guidelines were typically in place, although these were often local rather than those from the AAGBI. Use in the last 12 months was uncommon, but typically information was not available on indications for its use. More systematic data collection is required on the safety and efficacy of Intralipid in the management of acute drug toxicity.
Related JoVE Video
Factitiously elevated blood chromium.
Clin Toxicol (Phila)
PUBLISHED: 04-13-2010
Show Abstract
Hide Abstract
Chromium toxicity is rare in individuals who do not have a history of occupational or deliberate exposure to chromium or chromium-containing compounds.
Related JoVE Video
Propafenone poisoning--a case report with plasma propafenone concentrations.
J Med Toxicol
PUBLISHED: 04-08-2010
Show Abstract
Hide Abstract
Propafenone is an anti-arrhythmic drug used in the management of supraventricular and ventricular arrhythmias. It is metabolised through cytochrome P450 2D6 pathways; the major metabolites possess anti-arrhythmic activity. The cytochrome P450 CYP2D6 is coded by more than 70 alleles resulting in great genetic polymorphism of CYP2D6 isoenzymes, and up to 7% of Caucasian population are poor metabolisers. This case report describes a patient with severe overdose of propafenone who presented with coma, seizures and cardiotoxicity. The patient was managed with intravenous glucagon, hypertonic sodium bicarbonate, hypertonic saline and inotropic support. The propafenone and its 5-hydroxypropafenone (5-OHP) metabolite were measured by high-performance liquid chromatography with ultraviolet detection (no assay was available at the time to measure N-despropyl propafenone concentrations). Toxicological screen showed propafenone concentrations at a maximum of 1.26 mg/L at 9-10 h post-presentation, falling to 0.25 mg/L at 27-28 h post-presentation. No propafenone metabolite 5-OHP was detected in any sample analysed. No antidepressant or analgesic drugs were detected in toxicological screen. Propafenone overdose has been reported to be associated with features of severe cardiovascular and CNS toxicity. Aggressive treatment, meticulous monitoring and supportive care was associated with a good outcome in this case.
Related JoVE Video
Significant pregabalin toxicity managed with supportive care alone.
J Med Toxicol
PUBLISHED: 04-08-2010
Show Abstract
Hide Abstract
There are two previously reported cases describing the management of pregabalin self-poisoning and one further case of management of therapeutic pregabalin accumulation. The peak reported pregabalin concentrations in these cases ranged from 13 mg/L to approximately 60 mg/L. Previous case reports have suggested that both supportive care and enhanced elimination are appropriate managements for pregabalin toxicity. A 54-year-old male presented following ingestion of 8.4 g of pregabalin. Initially, he had no clinical features of toxicity, although he developed significant neurological depression and coma approximately 3 h post-ingestion. He was managed with supportive care (including endotracheal intubation and mechanical ventilation) until his level of consciousness improved. Subsequent toxicological screening confirmed isolated pregabalin ingestion, with a serum pregabalin concentration of 66.5 mg/L at the time he clinically deteriorated. The pharmacokinetic properties of pregabalin indicate the potential value of extra-corporeal elimination methods such as haemodialysis. Clinical toxicologists should be aware that whilst there is a pharmacokinetic basis for the use of extra-corporeal methods in those with severe toxicity arising from excessive plasma pregabalin concentrations, there are case reports, including this one, where patients have been managed with supportive measures only.
Related JoVE Video
Recreational use of mephedrone (4-methylmethcathinone, 4-MMC) with associated sympathomimetic toxicity.
J Med Toxicol
PUBLISHED: 04-02-2010
Show Abstract
Hide Abstract
Cathinone is a pharmacologically active alkaloid that can be extracted from the leaves of the khat plant (Catha edulis). There are synthetic derivatives of cathinone entering the recreational drug market, including mephedrone (4-methylmethcathinone, 4-MMC). There are discrepancies in the legal status of both the khat plant and its extracted alkaloids between the UK and the USA.
Related JoVE Video
A modified low-cost colorimetric method for paracetamol (acetaminophen) measurement in plasma.
Clin Toxicol (Phila)
PUBLISHED: 01-26-2010
Show Abstract
Hide Abstract
Despite a significant increase in the number of patients with paracetamol poisoning in the developing world, plasma paracetamol assays are not widely available. The purpose of this study was to assess a low-cost modified colorimetric paracetamol assay that has the potential to be performed in small laboratories with restricted resources.
Related JoVE Video
Epidemiology of recreational drug toxicity in a nightclub environment.
Subst Use Misuse
PUBLISHED: 11-27-2009
Show Abstract
Hide Abstract
Data on 173 individuals with recreational drug toxicity requiring "medical" assistance in a large urban nightclub was collected from September 2007 to January 2008. Clubbers required assistance following use of a variety of recreational drugs, particularly gamma-hydroxybutyrate (GHB), gammabutyrolactone (GBL), and ketamine. The majority of individuals were not first-time recreational drug users, and a significant proportion have recurrent recreational drug toxicity requiring assistance. Limitations related to data collection are discussed. Further studies are needed to investigate the use brief interventions in those with problem recreational drug use within the nightclub environment.
Related JoVE Video
Delayed onset of seizures and toxicity associated with recreational use of Bromo-dragonFLY.
J Med Toxicol
PUBLISHED: 10-31-2009
Show Abstract
Hide Abstract
Many countries have specific legislation, such as the Controlled Substances Act (1970) in the United States and the Misuse of Drugs Act (1971) in the United Kingdom to control recreational drugs. There is a growing market and supply of "novel" recreational drugs, which include the misuse of pharmaceutical compounds and research chemicals. These are often not covered under current legislation, despite the fact that they often have both similar chemical structures and/or clinical effects to controlled recreational drugs.
Related JoVE Video
Life-threatening organ failure after lamotrigine therapy.
Pediatr. Neurol.
PUBLISHED: 04-22-2009
Show Abstract
Hide Abstract
We describe an 11-year-old girl with a seizure disorder who developed fever, rash, rhabdomyolysis, and multiorgan failure 2 weeks after commencing a transition from sodium valproate to lamotrigine therapy. To our knowledge, this patient represents the most severe life-threatening hypersensitivity lamotrigine reaction described in the pediatric literature. We recommend caution when prescribing lamotrigine to children on concomitant sodium valproate, and immediate discontinuation of lamotrigine and the provision of aggressive supportive care in patients with features of lamotrigine hypersensitivity.
Related JoVE Video
Management of cocaine-induced cardiac arrhythmias due to cardiac ion channel dysfunction.
Clin Toxicol (Phila)
PUBLISHED: 02-10-2009
Show Abstract
Hide Abstract
Cocaine use is common in many areas of the world, particularly the United States and Western Europe. Toxicity following the use of cocaine is associated with a wide range of clinical features. In this review, we will focus on the cocaine-associated cardiac arrhythmias and, in particular, some of the controversies in their etiology and management. Cocaine can produce arrhythmias either through the production of myocardial ischemia or as a direct result of ion channel alterations. Excessive catecholamines, combined with sodium and potassium channel blockades, give rise to a wide variety of supra-ventricular and ventricular rhythms. The animal and human evidence for ion channel dysfunction is reviewed, and the effects of catecholamines are followed from the cardiac action potential to the development of arrhythmias. Finally, theoretical constructs are combined with existing evidence to develop a rational treatment strategy for patients with cocaine-induced cardiac arrhythmias. In particular, we review the evidence concerning the controversies relating to the use of lidocaine in comparison with sodium bicarbonate, in terms of QRS prolongation secondary to sodium channel blockade.
Related JoVE Video
First European case of convulsions related to analytically confirmed use of the synthetic cannabinoid receptor agonist AM-2201.
Eur. J. Clin. Pharmacol.
Show Abstract
Hide Abstract
There is increasing reported use of synthetic cannabinoid receptor agonists (SCRA) across Europe. To date, there is limited information on the acute toxicity (harm) related to the use of these products. We describe here a case in which an individual developed convulsions related to the use of the SCRA AM-2201.
Related JoVE Video
Use and acute toxicity associated with the novel psychoactive substances diphenylprolinol (D2PM) and desoxypipradrol (2-DPMP).
Clin Toxicol (Phila)
Show Abstract
Hide Abstract
Over the last decade there has been greater use of novel psychoactive substances (legal highs) across Europe and the United States, including increasing reports of use of diphenylprolinol (D2PM) and desoxypipradrol (2-DPMP). This review will discuss the pharmacology and mechanisms of action of these two compounds, available data on their sources and prevalence of use and reports of acute toxicity and fatalities associated with their use.
Related JoVE Video
National audit of antidote stocking in acute hospitals in the UK.
Emerg Med J
Show Abstract
Hide Abstract
Inadequate stocking of essential antidotes in hospitals for the treatment of poisoned patients has been reported worldwide. Joint National Poisons Information Service (NPIS)/College of Emergency Medicine (CEM) guidelines for antidote stocking in UK emergency departments and acute hospitals were published in 2008.
Related JoVE Video
First reported case in the UK of acute prolonged neuropsychiatric toxicity associated with analytically confirmed recreational use of phenazepam.
Eur. J. Clin. Pharmacol.
Show Abstract
Hide Abstract
There is increasing evidence from around Europe of the availability and misuse of long-acting benzodiazepines such as phenazepam. There is little information on the acute toxicity of these compounds; we describe here a case of analytically confirmed phenazepam-related acute toxicity.
Related JoVE Video
Extracorporeal treatment for thallium poisoning: recommendations from the EXTRIP Workgroup.
Clin J Am Soc Nephrol
Show Abstract
Hide Abstract
The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl).
Related JoVE Video
Novel psychoactive substances: how to understand the acute toxicity associated with the use of these substances.
Ther Drug Monit
Show Abstract
Hide Abstract
Since the turn of the 21st century, there has been an increase in the availability and use of novel psychoactive substances (also known as "legal highs") across Europe. Currently, there is limited information available on the potential acute toxicity (harms) associated with the use of these novel psychoactive substances. There are a number of potential data sources that can provide information on the acute toxicity associated with their use: (1) user reports on Internet discussion fora; (2) subpopulation level surveys of self-reported harms/unwanted effects (3) regional or national poisons information service accesses for support on presentations to healthcare facilities relating to acute toxicity; (4) case reports/series based on self-reported use or analytically confirmed use; and (5) human volunteer studies assessing potential acute toxicological effects. Each of these data sources has its own limitations, particularly those that are based on self-reported use because there are a number of European studies that show that there is inconsistency in the substance(s) in the "drug" that an individual uses. However, by using a multilayered approach of combining different sources, it is possible to reduce the overall impact of the limitations of any one individual data source. In this review article, we will combine information from these different data sources to describe the pattern of acute toxicity associated with 4 novel psychoactive substances: 1-benzylpiperazine, mephedrone (4-methylmethcathinone), synthetic cannabinoid receptor agonists, and methoxetamine.
Related JoVE Video
Methoxetamine associated reversible cerebellar toxicity: three cases with analytical confirmation.
Clin Toxicol (Phila)
Show Abstract
Hide Abstract
There have been recent concerns about increasing use and accessibility of methoxetamine, a ketamine derivative. Few data are available to describe the clinical features associated with methoxetamine exposure. We report three cases that presented to hospital with acute neurological toxicity associated with analytically confirmed methoxetamine exposure.
Related JoVE Video
The EXTRIP (EXtracorporeal TReatments In Poisoning) workgroup: guideline methodology.
Clin Toxicol (Phila)
Show Abstract
Hide Abstract
Extracorporeal treatments (ECTRs), such as hemodialysis and hemoperfusion, are used in poisoning despite a lack of controlled human trials demonstrating efficacy. To provide uniform recommendations, the EXTRIP group was formed as an international collaboration among recognized experts from nephrology, clinical toxicology, critical care, or pharmacology and supported by over 30 professional societies. For every poison, the clinical benefit of ECTR is weighed against associated complications, alternative therapies, and costs. Rigorous methodology, using the AGREE instrument, was developed and ratified. Methods rely on evidence appraisal and, in the absence of robust studies, on a thorough and transparent process of consensus statements. Twenty-four poisons were chosen according to their frequency, available evidence, and relevance. A systematic literature search was performed in order to retrieve all original publications regardless of language. Data were extracted on a standardized instrument. Quality of the evidence was assessed by GRADE as: High = A, Moderate = B, Low = C, Very Low = D. For every poison, dialyzability was assessed and clinical effect of ECTR summarized. All pertinent documents were submitted to the workgroup with a list of statements for vote (general statement, indications, timing, ECTR choice). A modified Delphi method with two voting rounds was used, between which deliberation was required. Each statement was voted on a Likert scale (1-9) to establish the strength of recommendation. This approach will permit the production of the first important practice guidelines on this topic.
Related JoVE Video
Mephedrone (4-methylmethcathinone): what is new in our understanding of its use and toxicity.
Prog. Neuropsychopharmacol. Biol. Psychiatry
Show Abstract
Hide Abstract
Mephedrone (4-methylmethcathinone) is a synthetic cathinone that has been used as a recreational drug in Europe and elsewhere in the world since 2007. In addition to published scientific papers there are a number of different data sources available which provide information on the sources, availability and prevalence of use of mephedrone. Whilst there are no formal human studies to determine the acute toxicity of mephedrone, there is a range of different levels of data available which describe the acute toxicity of mephedrone. These include user Internet discussion fora, sub-population level surveys of user previous experiences of acute toxicity and individual case reports and case series of toxicity related to both self-reported and analytically confirmed mephedrone use. In this review article we describe how through the process of data triangulation using a combination of these different sources, it is possible to develop an understanding of the acute toxicity of mephedrone. This demonstrates that mephedrone has a pattern of acute toxicity that is similar to other stimulant drugs such as MDMA, amphetamine and cocaine.
Related JoVE Video
Paracetamol toxicity: What would be the implications of a change in UK treatment guidelines?
Eur. J. Clin. Pharmacol.
Show Abstract
Hide Abstract
Treatment of single-time-point ingestion acute paracetamol (acetaminophen) poisoning with N-acetylcysteine (NAC) is guided by plotting a timed plasma paracetamol concentration on established nomograms. Guidelines in the UK differ from those in the U.S. and Australasia by having two treatment lines on the nomogram. Patients deemed to be at normal risk of hepatotoxicity are treated using the treatment line starting at 200 mg/L at 4 h post-ingestion; those at higher risk are treated using the high risk treatment line starting at 100 mg/L at 4 h post-ingestion.
Related JoVE Video
A healthy volunteer study to investigate trace element contamination of blood samples by stainless steel venepuncture needles.
Clin Toxicol (Phila)
Show Abstract
Hide Abstract
The trace elements cobalt (Co), chromium (Cr), manganese (Mn) and nickel (Ni) are normally present at low concentrations in blood. There has been a concern that stainless steel venepuncture needles typically used for collection of blood samples may contaminate these samples, leading to the masking of deficiency states or causing potential clinical confusion as to whether an individual has a "toxic" concentration.
Related JoVE Video
Management of acute paracetamol (acetaminophen) toxicity: a standardised proforma improves risk assessment and overall risk stratification by emergency medicine doctors.
Emerg Med J
Show Abstract
Hide Abstract
Paracetamol (acetaminophen) poisoning is the most common toxicological presentation in the UK. Doctors managing patients with paracetamol poisoning need to assess the risk of their patient developing hepatotoxicity before determining appropriate treatment. Patients deemed to be at high risk of hepatotoxicity have lower treatment thresholds than those deemed to be at normal risk. Errors in this process can lead to harmful or potentially fatal under or over treatment.
Related JoVE Video

What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.