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1. A 60-year-old man presents to the ED after a snakebite to the ankle. He has rapid cardiovascular decompensation, progressing to cardiopulmonary arrest. 2. A 38-year-old Eastern European woman and a 59-year-old South Asian man present independently to the ED with the sudden onset of vomiting, diarrhea, and abdominal pain followed by acute hepatic injury. 3. A 13-year-old boy with spasticity for which he has an intrathecal baclofen pump presents with myoclonus and agitation. His vital signs are: BP, 136/77; HR, 107; RR, 19; T, afebrile.

This month's topic is the Toxikon Consortium. The articles will be reviewed by the Toxikon Consortium, led by Steven E. Aks.

Presented by Adam Algren, MD Associate Professor of Emergency Medicine and Pediatrics, Truman Medical Center/Children's Mercy Hospital.

1. A previously healthy 4-year-old girl presents with left upper arm pain and swelling after a possible insect or spider bite. Within 24 hours she develops massive hemolysis and is transferred to the PICU. 2. A 16-year-old girl with developmental delay on lithium presents with a serum lithium concentration of 4 mEq/L and creatinine of 6 mg/dL. Although on a stable dose of lithium, the foster mother states that the lithium level was ‘high’ two months earlier but no dose adjustments were made. 3. 28-year-old nurse is splashed in one eye with 5-10 mL of a cisplatin solution meant for intravenous administration. She is 3 months pregnant.