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1. A 16-year-old girl presents to the ED after overdosing on medications she takes for rheumatoid arthritis. In the ED she has lightheadedness and runs of nonsustained ventricular tachycardia. 2. A 22-year-old man presents to the ED from prison after swallowing 50 bags of heroin and ten tablets of ecstasy. One hour after the ingestion, he is found unresponsive in his cell and requires naloxone. 3. A 66-year-old man presents to the ED with bilateral hand pain. He reports that earlier the same day he was cleaning coins at his home.

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1. Three workers at a leather tanning facility collapse at work. Two recover upon removal from the room, one is intubated on the scene. Medical toxicology is consulted upon arrival to the emergency department. 2. A 23 month-old girl is found with a tablet of a weight loss supplement. She presents to the ED with vomiting and the following vital signs: BP, 114/86 mmHg; HR, 93/min; RR, 26/min; SaO2, 100% RA. 3. A 30-year-old man presents to the ED with 3 days of weight gain, swelling, and headache after taking a compounded pharmaceutical pill.

1. A 36-year-old man reports nausea, vomiting, and diarrhea after using an over-the-counter remedy for toothache. 2. A 35-year-old and a 20-year-old are found collapsed in a tanker. The younger patient is pronounced dead on scene and the older patient is transported to the hospital unconscious. He is noted to be covered in a "liquidy black silt." 3. A 62-year-old with end-stage liver disease presents with critical hyperkalemia a week after starting a new medication.

Presented by John W. Downs, MD, MPH, FACP, FACOEM, Chief of Occupational & Environmental Medicine, Walter Reed National Military Medical Center.

ACMT members Gillian Beauchamp, MD, and Elizabeth (Elissa) Moore, DO deliver evidence-based medical toxicology core content and trending topics in easily digestible bites. Visit toxinten.com and follow on Twitter @toxinten.

ACMT members Gillian Beauchamp, MD, and Elizabeth (Elissa) Moore, DO deliver evidence-based medical toxicology core content and trending topics in easily digestible bites. Visit toxinten.com and follow on Twitter @toxinten.

ACMT members Gillian Beauchamp, MD, and Elizabeth (Elissa) Moore, DO deliver evidence-based medical toxicology core content and trending topics in easily digestible bites. Visit toxinten.com and follow on Twitter @toxinten.

1. A cluster of sailors become ill while stationed in the Pacific Ocean. 2. A 26-year-old man celebrates the 20th of April all day. The next day he is brought to the emergency department with ataxia and weakness. He progresses to coma over the next several days. 3. Several tourists die while vacationing in the Dominican Republic. Is it poisoning? Story reference here.

1. A 19-year-old woman experiences status epilepticus after receiving a medication in the outpatient gastroenterology clinic. 2. A 59-year-old man with alcohol and opioid use disorder, on methadone, receives a benzodiazepine and haloperidol for agitation in the ED. He is subsequently admitted to the hospital floor for the management of ethanol withdrawal. On day 1 of hospitalization he suffers a cardiac arrest. 3. A pilot and first officer develop dizziness, headache, and nausea while in the cockpit of an aircraft that is undergoing maintenance.

1. A 57-year-old female flight attendant develops perioral paresthesias while on an airplane. On ED presentation her vitals are: BP, 125/75 mmHg; HR, 65/min; afebrile. 2. A 36-year-old man presents with altered mental status after ingesting a veterinary medication. 3. A 47-year-old man presents with concerns of episodic ataxia, slurred speech, and agitation occurring several times a month over the past year.

1. A 75-year-old woman is prescribed metolazone, which she took daily for 2 weeks. Shortly thereafter she presents to the ED with pneumonia and pancytopenia. A prescribing error is identified. 2. A newborn inadvertently receives a medication in the delivery room that was intended for his mother. The error is discovered minutes later and the infant is asymptomatic. 3. A law enforcement officer brushes a powdered drug off his shirt with his bare hand. He passes out soon after.