ACEP ID:

Toxicology

Editor’s Welcome

Welcome to the first newsletter of 2020!

In this edition, we have a few interesting articles regarding some frustrating pathophysiology problems; these will answer the questions of why patients with salicylate overdoses get symptoms of hypoglycemia without actually being hypoglycemic, and why patients getting NAC have a lower rate of anaphylactoid reaction with higher serum acetaminophen concentrations. Also included is a case presentation of Angel’s Trumpet used as a recreational drug.

I want to take a moment to address something relevant to all readers of this newsletter that lies at the intersection of toxicology and the ongoing SARS-CoV-2 pandemic. There have been multiple reports of misinformation surrounding use of drugs and other xenobiotics by the lay public to treat (or prevent) the disease, and the misuse that this poor information may cause has been fatal. The most prominent example I am aware of is a large number of deaths in Iran secondary to methanol poisoning. Initially reported as a cluster of 44 deaths due to bootleg alcohol consumption, the death count has now reached 180 as of March 19th.1,2 Another example - a popular meme spreading around social media sites recommends gargling with warm water and salt or vinegar as a remedy.3 There has also been discussion generated about the use of ibuprofen to treat symptoms of Covid-19 and whether this might worsen outcomes, on a purely theoretical basis; this was included in a Lancet correspondence article and also in a bulletin recommendation from the French Ministry of Health.4,5 The WHO has more recently come out with a statement saying there is no scientific evidence to back any recommendation to avoid ibuprofen.6

It should not be a surprise to any reader of this newsletter that misinformation surrounding medication use is prevalent during this time. Rapidly changing information and recommendations are difficult enough for healthcare providers to keep up with; this is even more challenging for the lay public who will receive more of their information from social media and have less ability to assess the quality of evidence they are receiving. My intent in including this in the newsletter is not to make any specific recommendations, but to make you aware of the very real potential for needing to address misinformation as the pandemic continues.

Stay safe,

Justin Corcoran

Medical Toxicology Fellow

ACEP Toxicology Section Newsletter Editor

 

  1. Ahmet Dursun. Iran: Death toll from toxic alcohol rises to 180 [Internet]. 2020 [cited 2020 Mar 19];Available from: https://www.aa.com.tr/en/health/iran-death-toll-from-toxic-alcohol-rises-to-180/1771659
  2. Joshua Bote. 44 dead in Iran from drinking toxic alcohol fake coronavirus cure [Internet]. USA Today. 2020 [cited 2020 Mar 19];Available from: https://www.usatoday.com/story/news/world/2020/03/10/44-dead-iran-drinking-toxic-alcohol-fake-coronavirus-cure/5009761002/
  3. Arjun Deodia. Fact Check: No, gargling with warm salt water can’t save you from coronavirus - Fact Check News [Internet]. India Today. 2020 [cited 2020 Mar 19];Available from: https://www.indiatoday.in/fact-check/story/fact-check-no-gargling-with-warm-salt-water-can-t-save-you-from-coronavirus-1656600-2020-03-17
  4. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med [Internet] 2020 [cited 2020 Mar 19];Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213260020301168
  5. Actualisation recommandations Covid 19 [Internet]. Site Ministère Santé. [cited 2020 Mar 19];Available from: https://dgs-urgent.sante.gouv.fr/dgsurgent/inter/detailsMessageBuilder.do?id=30500&cmd=visualiserMessage
  6. WHO clarifies guidance on ibuprofen, says there’s no evidence it can worsen COVID-19 | CBC News [Internet]. [cited 2020 Mar 19];Available from: https://www.cbc.ca/news/health/ibuprofen-covid-19-novel-coronavirus-1.5501496

 

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