The lipid partition constant and volume of distribution can likely be used to predict the efficacy of lipid infusion in reversing the cardiac toxicity induced by anesthetics or other medications.

The American College of Medical Toxicology established the Toxicology Investigators Consortium (ToxIC) Case Registry in 2010. The Registry contains all medical toxicology consultations performed at participating sites. The Registry has continued to grow since its inception, and as of December 31, 2015, contains 43,099 cases. This is the sixth annual report of the ToxIC Registry, summarizing the additional 8115 cases entered in 2015. Cases were identified by a query of the Registry for all cases entered between January 1 and December 31, 2015. Specific data reviewed for analysis included demographics (age, race, gender), source of consultation, reason for consultation, agents and agent classes involved in exposures, signs, symptoms, clinical findings, fatalities, and treatment. By the end of 2015, there were 50 active sites, consisting of 101 separate health-care facilities; 51.2 % of cases involved females. Adults between the ages of 19 and 65 made up the majority (64.2 %) of Registry cases. Caucasian race was the most commonly reported (55.6 %); 9.6 % of cases were identified as Hispanic ethnicity. Inpatient and emergency department referrals were by far the most common referral sources (92.9 %). Intentional pharmaceutical exposures remained the most frequent reason for consultation, making up 52.3 % of cases. Of these intentional pharmaceutical exposures, 69 % represented an attempt at self-harm, and 85.6 % of these were a suicide attempt. Nonopioid analgesics, sedative-hypnotics, and antidepressant agents were the most commonly reported agent classes in 2015. Almost one-third of Registry cases involved a diagnosed toxidrome (32.8 %), with a sedative-hypnotic toxidrome being the most frequently described. Significant vital sign abnormalities were recorded in 25.3 % of cases. There were 98 fatalities reported in the Registry (1.2 %). Adverse drug reactions were reported in 4.3 % of cases. Toxicological treatment was given in 65.3 % of cases, with 33.0 % receiving specific antidotal therapy. Exposure characteristics and trends overall were similar to prior years. While treatment interventions were required in the majority of cases, fatalities were rare.

the California Poison Control System-San Francisco division identified 8 patients who experienced adverse effects associated with the ingestion of counterfeit alprazolam tablets found to contain fentanyl and, in some cases, etizolam. The identification of these patients resulted in a coordinated response that included state and local public health departments, a toxicology laboratory, and media outlets, and resulted in an investigation by local law enforcement agencies.

Study objective: To describe the clinical characteristics of patients with Ecstasy (MDMA)-associated hyponatremia (serum sodium less than 130 mmol/L) reported to the California Poison Control System (CPCS) over a five-year period and to determine if a gender difference exists among patients with Ecstasy-associated hyponatremia. Methods:We performed a retrospective review of cases involving Ecstasy intoxication reported to the CPCS and recorded in its computerized database from January 1, 2000 through October 9, 2005 We excluded all "information only" calls, cases managed at home, cases with no gender specified and cases in which the outcome was coded as "no effect", "unrelated -probably not responsible", "confirmed non-exposure", "judged as non-toxic-expect no effect", and "minimal clinical effects possible". Confirmation of exposure to MDMA was based on the history of use and, when available, urine toxicology screen testing positive for MDMA or amphetamine derivatives. Hyponatremia was defined as a measured serum sodium less than 130 mmol/L.Results: A total of 1,436 cases involving Ecstasy were reported to the CPCS over the 5-year study period, of which 891 were excluded based on the criteria described above. Of the 545 cases that met inclusion criteria, 296 (54.3%) were females and 249 (45.7%) were males. There were 188 cases (34.5%) with a documented serum sodium, including 73/188 (38.8%) with hyponatremia (Na < 130 mmol/L). Of the 73 subjects with hyponatremia, there were 55 (75.3%) females and 18 (24.7%) males; of the 115 non-hyponatremic subjects 50 (43.5%) were female and 65 (56.5%) male. There was no observed gender difference in the ascertainment of serum sodium levels. Among patients with a documented serum sodium level, female gender was 3 associated with increased odds of hyponatremia by univariate analysis (OR 3.97; 95% CI 2.08 -7.59). Conclusion:Female gender was associated with increased odds of hyponatremia among persons with Ecstasy intoxication and a documented serum sodium level reported to CPCS from 2000 -2005. Multiple potential study confounders, including spectrum bias, incomplete laboratory data and individual differences in subject characteristics prevent determination of causality regarding gender differences in the incidence of Ecstasy-associated hyponatremia and its complications.