March 19, 2026

Pediatric Emergencies from Cannabinoid Exposure

Unexplained Hypoxia, Seizures, and Ingestion

Talks and panels from the Occupational & Environmental Toxicology Boot Camp

Missed Diagnoses and Misleading Drugs

Protecting Pediatric Patients from Poisoning: Production, Packaging & Purpose

Clinical Cannabis Considerations in Children, Harvard Medical Toxicology Fellowship Program

Toxic Disasters in the Newborn! An Approach to the Problem

1. A 52-year-old man experiences cardiac arrest after an accident at a chemical plant. ROSC was obtained by EMS. He presents to the ED intubated and in a wide-complex tachycardia. 2. A 55-year-old man with a history of OUD, COPD, presents to ED in opioid withdrawal (COWS 17). Last use of opioid was 1 day earlier. He receives buprenorphine 32 mg over four hours. The patient becomes increasingly hypoxic throughout the night and is intubated for presumed pneumonia. 3. An 8-year-old boy presents after receiving “dipirona monoidratada” drops by his grandmother for fever. He is now complaining of abdominal pain.

1. A 22-year-old, 32-week pregnant woman presents to the ED after an intentional ingestion of an insecticide called "Sniper." Her initial vital signs are: BP, 126/78 mmHg; HR, 96/min; RR, 26/min; T, 98.9F; O2 Sat, 98% (RA). She has increased salivation per the treating physician. 2. A 16-year-old girl presents with a presumed pseudoephedrine overdose. Her vital signs are HR 137, BP 198/158, RR 30, T 36.7. After an observation period of 5 days she has not improved. 3. A 39-year-old man is transferred from a treatment center to the ED for opioid withdrawal and intractable vomiting Several hours after arrival at the treatment center that morning, he developed worsening opioid withdrawal for which he received methadone (30mg) but immediately vomited and became "shaky." His initial vital signs are: BP, 153/95 mmHg; P, 83/min; RR, 22/min; T, 99 F; Sp02, 96%

1. A 7-day-old boy in the NICU is receiving TPN and dopamine through a left forearm peripheral IV that is noted to have extravasated. This is suspected to have begun two 2 hours earlier. 2. A 30-year-old man is cleaning his saltwater tank when "something" gets in his eye. Four hours later he develops a fever, cough, and shortness of breath. 3. A 38-year-old woman on INH monotherapy for latent TB presents with RUQ abdominal pain. She is noted to have: AST 545, ALT 130, AlkPhos 156, nl bilirubin. A RUQ sonogram is negative.

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 Flint Lead Crisis. The articles will be reviewed by Wayne State University Toxicology Fellowship, led by Dr. Andrew King.

This month's topic is On Shaky Ground: Predicting Seizures in Bupropion Toxicity. The articles will be reviewed by the Harvard Medical Toxicology Fellowship Program, led by Dr. Michele Burns.

1. A 65-year-old woman with cerebral palsy presents to the ED with severe facial swelling and scalp irritation after having her hair dyed at a salon two days prior. 2. A 3-year-old boy is found by EMS to have an altered mental status. His finger stick is 43 mg/dL for which glucagon is administered. In the ED his repeat glucose is 65. 3. A 5-year-old boy swallows a cluster of small magnetic balls. Initial endoscopic removal fails, he remains asymptomatic, and he is discharged after passing 1.

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 7-week-old infant born full-term is diagnosed with COVID-19 at 6 weeks of age. The mother states that the infant is not breast feeding well. 2. A couple presents with bradycardia (HR 48 and 53) and hypotension (BP: low 80s/mid-50s) shortly after drinking tea to which they had added a teaspoonful of a sweetener they purchased from overseas. 3. A 36-year-old woman presents to the ED with abdominal pain and an abnormal ECG several hours after initiation of an elective termination of pregnancy.

1. A 15-year-old girl with depression and recent prior overdose arrives at a local hospital with seizures. An ECG shows a wide QRS (125 ms) with RBBB and QTc 495 ms. 2. A 17-year-old girl is found unresponsive with urinary incontinence next to an empty bottle of an over-the-counter medication. She is intubated by the paramedics. On arrival to the ED her vitals signs are: BP, 118/72 mmHg, P, 117/min; RR, 22/min; T, 97.2F; O2 sat 96%. An ECG is notable for a QRS of 106 msec and a QTc of 560 msec. 3. A 59-year-old HIV-positive man presents to the ED with seizures, shock, and agonal breathing. Fingerstick glucose is undetectable in the field. His vital signs on arrival: BP, 59/35 mmHg; HR, 79/min; RR, 6/min; T, 97.6F; O2 sat, 94%. The patient is intubated and fluid resuscitated.

This month's topic is Alternate Antidotes for Methemoglobinemia. The articles will be reviewed and led by the Albert Einstein Program in Medical Toxicology.

Pregnancy, Opioid Use Disorder and Complicated NAS

1. A 17-year-old girl presents to a community hospital in status epilepticus and hypotensive after an intentional ingestion of her medication. She is intubated and requires vasopressors. 2. A 33-year-old man presents to an ED from a detox center complaining of worsening withdrawal despite treatment at the center. 3. A nine-month-old boy presents to the ED with symptoms of a viral infection, irritability, and inconsolability. His vital signs are: BP, 101/67; HR, 110; RR, 28; O2 sat, 100% RA; T, 98.9 F. Weight and height are below the 3rd percentile.