The Toxicology Investigators Consortium Case Registry—the 2021 Annual Report

Abstract

The Toxicology Investigators Consortium (ToxIC) Core Registry was established by the American College of Medical Toxicology in 2010. The Core Registry collects data from participating sites with the agreement that all bedside and telehealth medical toxicology consultations will be entered. This twelfth annual report summarizes the registry’s 2021 data and activity with its additional 8552 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from January 1 to December 31, 2021. Detailed data was collected from these cases and aggregated to provide information, which included demographics, reason for medical toxicology evaluation, agent and agent class, clinical signs and symptoms, treatments and antidotes administered, mortality, and whether life support was withdrawn. Gender distribution included 50.4% of cases in females, 48.2% of cases in males, and 1.4% of cases in transgender or gender non-conforming individuals. Non-opioid analgesics were the most commonly reported agent class (14.9%), followed by opioids (13.1%). Acetaminophen was the most common agent reported. Fentanyl was the most common opioid reported and was responsible for the greatest number of fatalities. There were 120 fatalities, comprising 1.4% of all cases. Major trends in demographics and exposure characteristics remained similar to past years’ reports. Sub-analyses were conducted to describe new demographic characteristics, including marital status, housing status and military service, the continued COVID-19 pandemic and related toxicologic exposures, and novel substances of exposure. Supplementary Information The online version contains supplementary material available at 10.1007/s13181-022-00910-6.

Postmortem toxicology findings from the Camden Opioid Research Initiative

“…The toxicology analysis revealed the presence of multiple compounds in postmortem blood samples from every decedent, with a median of nine compounds per sample (range [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Eighteen of the compounds represent pairs of active drugs/analytes and respective metabolites, such as fentanyl-norfentanyl, where fentanyl is the un-metabolized HPSO, and norfentanyl is its metabolite.…”

“…Fentanyl and fentanyl analogs have become even more prevalent since the start of the COVID-19 pandemic [7][8][9][10][11]. In 2021, fentanyl overtook heroin for the first time as the most common opioid agent in toxicology reports [12].…”

pyHeart4Fish: Chamber-specific heart phenotype quantification of zebrafish in high-content screens

“…DLX was the most commonly prescribed SNRIs for pain control and mood disorders in the U.S. in 2017 ( Goldstein et al, 2004 ; Agency for Healthcare Research and Quality, 2017 ; Park et al, 2020 ). According to the Toxicology Investigators Consortium, SNRIs caused 10.6% of antidepressant-related toxic events in 2021 ( Love et al, 2022 ). Data on the treatment outcomes of DLX during pregnancy is controversial, yet several studies demonstrate that it causes congenital cardiovascular malformations in neonates ( Diav-Citrin et al, 2008 ; Merlob et al, 2009 ; Jimenez-Solem et al, 2012 ; Knudsen et al, 2014 ; Ornoy and Koren, 2019 ; Park et al, 2020 ).…”