About

James A. Chenoweth, M.D., M.A.S., is an Associate Professor and the Director of Toxicology Research at UC Davis Health. His educational background includes a B.A. in Biology from Union College, Lincoln NE, and an M.D. from Loma Linda University School of Medicine. He completed his residency in Emergency Medicine at UC Davis Medical Center, followed by fellowships in Medical Toxicology and SAEM Research at the same institution. Dr. Chenoweth specializes in toxicology and emergency medicine, with a focus on drug overdoses, toxic ingestions, and the pharmacological management of conditions such as asthma-chronic obstructive pulmonary disease overlap syndrome. His research contributions include case reports and studies on toxicology, drug interactions, and clinical management, and he has been recognized with awards such as the Excellence in Emergency Medicine faculty award and membership in the Alpha Omega Alpha Honor Society.

Research topics

• Medicine
• Internal medicine
• Emergency medicine
• Toxicology
• Pharmacology
• Family medicine
• Intensive care medicine
• Medical emergency
• Physical therapy
• Organic chemistry
• Pediatrics
• Chemistry
• Anesthesia
• Demography
• Surgery
• Psychiatry
• Biology

Selected publications

• Unmasking the Hidden Risk of Systemic Toxicity from Topical Salicylates

  Western Journal of Emergency Medicine · 2025-09-01

  articleOpen access

  INTRODUCTION: Topical salicylates are commonly found in over-the-counter medications and are applied for pain relief or to treat dermatologic conditions. While generally considered safe, they can cause systemic toxicity under certain conditions. We conducted a systematic review of topical salicylate toxicity. This comprehensive review of previously reported cases highlights the risks, clinical presentations, and management considerations of systemic toxicity from topical salicylates. METHODS: We present a new case of topical salicylate toxicity and conducted a comprehensive systematic literature search from 1952-2024 using PubMed, Google, and Google Scholar. Our search was supplemented by cross-referencing previous studies to identify cases and reviews of topical salicylate toxicity. We then performed a descriptive analysis of the cases, summarizing key information such as clinical presentation, blood levels, and outcomes. Findings were used to contextualize the risks and clinical manifestations of topical salicylate toxicity. RESULTS: A total of 44 cases of topical salicylate toxicity, including our index case, were identified and included in our analysis. Most cases involved patients > 40 years of age, but all age ranges were represented, including neonates. The most frequently reported symptoms included tachypnea (32.5%) and vomiting (25.5%). The new case was an elderly male with further altered mental status from baseline dementia and elevated anion gap. CONCLUSION: Both the new case and the literature review emphasize the continued potential systemic risks of topical salicylates among a broad demographic. Given the variable presentations, clinicians should maintain a high index of suspicion for salicylate toxicity in patients with unexplained altered metabolic and/or mental status. Early consideration, recognition, and intervention of topical salicylates-induced toxicity is essential for good outcomes. As many of these products are heavily advertised, patient education on the appropriate use of topical salicylates may be crucial to prevent inadvertent toxicity.

  PublisherOA PDFDOI

• Peripheral Vasopressor Use in Early Sepsis-Induced Hypotension

  JAMA Network Open · 2025-08-27 · 12 citations

  articleOpen access

  Importance: Evidence supporting the safety of infusing vasopressors through peripheral intravenous catheters (peripheral vasopressors) is largely derived from single-center studies, limiting generalizability. Objective: To evaluate factors associated with vasopressor route selection and assess safety and clinical outcomes of peripheral vasopressor administration in early sepsis resuscitation. Design, Setting, and Participants: This prospective cohort study is a secondary analysis of the Crystalloid Liberal vs Early Vasopressors in Sepsis (CLOVERS) trial conducted in 60 US hospitals from March 2018 to February 2022. Patients in CLOVERS who received vasopressors within 24 hours of enrollment and did not have central venous access at enrollment were included. Data were analyzed from January 2023 to June 2025. Exposure: Route of vasopressor initiation (central or peripheral). Main Outcomes and Measures: The primary analysis evaluated the route of vasopressor initiation, while the secondary analysis assessed continuation of peripheral vasopressors beyond 6 hours. Univariable and multivariable analyses of factors associated with vasopressor route were conducted, as was a multivariable analysis to evaluate the association of route with outcomes, including 90-day mortality. Descriptive statistics were used to summarize 28-day peripheral vasopressor and central venous catheter (CVC) complications. Results: Of 1563 patients in CLOVERS, 582 (37.2%) received vasopressors and met study inclusion criteria. Included patients had a median (IQR) age of 63 (52-72) years, and 267 (45.9%) were female, 96 (16.5%) were African American, 416 (71.5%) were White, and 70 (12.0%) were another race or had unreported race. Vasopressors were initiated via peripheral catheter in 490 patients (84.2%) and via central venous access in 92 patients (15.8%). Study site was the only factor independently associated with route of initiation (median odds ratio, 3.48; 95% CI, 1.57-5.38). In adjusted analyses, peripheral vs central initiation was associated with statistically comparable 90-day mortality (128 participants [26.1%] vs 34 participants [37.0%]; adjusted odds ratio, 0.67; 95% CI, 0.39-1.16). Peripheral vasopressors were continued beyond 6 hours in 333 of 490 patients (68.0%). Peripheral vasopressor complications were rare and low-grade (3 of 490 patients [0.6%]), with no cases of ulceration or tissue injury. In contrast, there were 14 complications from CVC placement occurring in 12 of 322 patients (3.7%) who had CVCs placed in the first 72 hours. Conclusions and Relevance: In this prospective cohort study of the CLOVERS trial, peripheral administration of vasopressors was common and was associated with low complication rates. These findings support the safety and feasibility of short-term peripheral vasopressor use in early sepsis resuscitation.

  PublisherOA PDFDOI

• New psychoactive substances in roadway crash victims in California

  Frontiers in Toxicology · 2025-06-25 · 2 citations

  articleOpen accessSenior authorCorresponding

  Background: Motor vehicle crashes (MVCs) are a major global health concern. While alcohol continues to be a significant contributor to MVCs, the role of illicit and prescription drugs has increased in the last 4 decades. Moreover, the proliferation of new psychoactive substances (NPS) in the United States since 2010 has reshaped recreational drug use. Despite this, its contribution to MVCs has not been systematically evaluated. In this study, we report the prevalence of NPS in roadway crash victims in California. Methods: Serum samples from 1000 roadway crash victims were collected and analyzed using liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF/MS) against a comprehensive database of 1314 drugs, including 1008 NPS, and quantitative analysis was performed using isotope dilution. Alcohol was quantified in an autoanalyzer using an enzymatic method employing alcohol dehydrogenase. Results: Eight NPS (detection frequency = 26) were confirmed and quantified in 17 cases. Like current nationwide NPS surveillance studies, bromazolam, para-fluorofentanyl, and mitragynine were most frequently detected. NPS were detected in polypharmacy use, with traditional recreational drugs such as fentanyl, methamphetamine, and delta-9 THC most frequently co-detected. The serum geometric means detected for bromazolam (5.41 ng/mL; range: 0.22-26.59), para-fluorofentanyl (0.45 ng/mL; range: 0.28-2.02) and mitragynine (7.02; range: 0.55-90.55) were lower than those reported for overdose and death cases. Discussion: This study is the first to report quantitative levels of multiple NPS and multiple NPS classes in a large US roadway crash survey, with the high detection of CNS depressants and their co-occurrence with traditional recreational drugs highlighting the need for expanded NPS testing, roadside testing strategies, and guidelines for determining drug-induced impairment; the quantitative data may be valuable in establishing these guidelines.

  PublisherOA PDFDOI

• Cost-Effective Drug Testing: Analytical Methodology, Best Practices, and Clinical Utility

  The Journal of Applied Laboratory Medicine · 2025-01-01 · 6 citations

  review1st authorCorresponding

  BACKGROUND: Drug overdose-related deaths continue to increase globally. Testing demands have likewise increased, prompting healthcare facilities to adopt a range of methods, from simple point-of-care immunoassays to comprehensive chromatographic and mass spectrometry-based techniques. Each of these testing methods has trade-offs related to cost, performance, speed, and convenience, requiring healthcare facilities to carefully determine the best options to meet their clinical needs. Unfortunately, current testing practices may result in unnecessary costs and certain methods, such as immunoassays, have significant limitations that affect their clinical utility. As such, the goal of this review is to frame the current state of drug testing and related cost-effectiveness and patient centered approaches to address this evolving public health challenge. CONTENT: This review discusses the current state of substance use mortality/morbidity, the economic impact of substance use disorders, provides an overview of testing methods and their relative cost-benefit, solutions to improve test utilization and cost-effectiveness, and finally, future threats and new opportunities that can improve the clinical utility of these tests. SUMMARY: The cost-effectiveness of drugs of abuse testing revolves around proper test utilization, including understanding what test is being ordered, its limitations, understanding results, and ordering testing when it can provide actionable information. Fundamental principles of test utilization such as education, clinical informatics, and optimizing test panels remain essential. Future threats in this space include new compounds and regulatory changes. However, novel solutions such as new noninvasive sample types, automation, and artificial intelligence can play a significant role in improving overall test utilization practices.

  PublisherDOI

• Toxicity Following Tranexamic Acid Overdose

  Journal of Medical Toxicology · 2024-02-09 · 2 citations

  letterOpen access1st authorCorresponding
  PublisherOA PDFDOI

• A standardized protocol using clinical adjudication to define true infection status in patients presenting to the emergency department with suspected infections and/or sepsis

  Diagnostic Microbiology and Infectious Disease · 2024-05-31 · 13 citations

  article
  PublisherDOI

• Acute exposure to hydrazine reported to four United States regional poison centers: reconsidering a paradigm

  Clinical Toxicology · 2024-05-03 · 12 citations

  articleOpen access

  INTRODUCTION: Exposures to hydrazines occur during aeronautic and space operations and pose a potential risk to personnel. Historically, extensive preparatory countermeasures have been taken due to concern for severe toxicity. This study seeks to better understand manifestations of acute occupational exposures to hydrazine to guide recommendations for management. MATERIALS AND METHODS: A retrospective database review of records from four United States regional poison centers was conducted of all human exposures to hydrazine, monomethylhydrazine, or 1,1-dimethylhydrazine over two decades. Following case abstraction, descriptive statistics were performed to characterize demographics, manifestations, treatments, and outcomes. RESULTS: One hundred and thirty-five cases were identified, and most were adult males exposed to inhaled hydrazine propellant vapors. Fifty-seven percent of patients were asymptomatic following exposure; otherwise, common symptoms were dyspnea, throat irritation, cough, ocular irritation, and headache. All patients were evacuated or received decontamination, with a few reports of symptomatic treatments, including oxygen supplementation and salbutamol (albuterol). Patients usually recovered quickly and were released after a brief healthcare facility evaluation or observed locally. No patients developed delayed symptoms. Symptoms of severe toxicity were not observed, and there were no deaths. DISCUSSION: Acute exposures to hydrazines during operations within the aerospace industry appear to be limited primarily to mucosal and mild pulmonary irritation without significant neurologic, hepatic, or hematologic toxicity. These findings are contrary to previously established expectations and may be related to low-level exposures or possibly due to current emergency countermeasures. CONCLUSIONS: Care in occupational hydrazine exposure will focus on evacuation, decontamination, and symptomatic management of chemical irritant properties of hydrazines. It is reasonable to manage mild cases outside of a healthcare facility. Continued endeavors in human space exploration and habitation will increase the risk of these exposures, making it imperative that clinicians be comfortable with the care and management of these patients.

  PublisherDOI

• The Toxicology Investigators Consortium 2022 Annual Report

  Journal of Medical Toxicology · 2023 · 16 citations

  • Medicine
  • Emergency medicine
  • Family medicine
  PublisherOA PDFDOI

• Assessment of Symptom, Disability, and Financial Trajectories in Patients Hospitalized for COVID-19 at 6 Months

  JAMA Network Open · 2023 · 60 citations

  • Medicine
  • Physical therapy
  • Pediatrics

  Importance: Individuals who survived COVID-19 often report persistent symptoms, disabilities, and financial consequences. However, national longitudinal estimates of symptom burden remain limited. Objective: To measure the incidence and changes over time in symptoms, disability, and financial status after COVID-19-related hospitalization. Design, Setting, and Participants: A national US multicenter prospective cohort study with 1-, 3-, and 6-month postdischarge visits was conducted at 44 sites participating in the National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Network's Biology and Longitudinal Epidemiology: COVID-19 Observational (BLUE CORAL) study. Participants included hospitalized English- or Spanish-speaking adults without severe prehospitalization disabilities or cognitive impairment. Participants were enrolled between August 24, 2020, and July 20, 2021, with follow-up occurring through March 30, 2022. Exposure: Hospitalization for COVID-19 as identified with a positive SARS-CoV-2 molecular test. Main Outcomes and Measures: New or worsened cardiopulmonary symptoms, financial problems, functional impairments, perceived return to baseline health, and quality of life. Logistic regression was used to identify factors associated with new cardiopulmonary symptoms or financial problems at 6 months. Results: A total of 825 adults (444 [54.0%] were male, and 379 [46.0%] were female) met eligibility criteria and completed at least 1 follow-up survey. Median age was 56 (IQR, 43-66) years; 253 (30.7%) participants were Hispanic, 145 (17.6%) were non-Hispanic Black, and 360 (43.6%) were non-Hispanic White. Symptoms, disabilities, and financial problems remained highly prevalent among hospitalization survivors at month 6. Rates increased between months 1 and 6 for cardiopulmonary symptoms (from 67.3% to 75.4%; P = .001) and fatigue (from 40.7% to 50.8%; P < .001). Decreases were noted over the same interval for prevalent financial problems (from 66.1% to 56.4%; P < .001) and functional limitations (from 55.3% to 47.3%; P = .004). Participants not reporting problems at month 1 often reported new symptoms (60.0%), financial problems (23.7%), disabilities (23.8%), or fatigue (41.4%) at month 6. Conclusions and Relevance: The findings of this cohort study of people discharged after COVID-19 hospitalization suggest that recovery in symptoms, functional status, and fatigue was limited at 6 months, and some participants reported new problems 6 months after hospital discharge.

  PublisherOA PDFDOI

• Expanding access to buprenorphine/naloxone in the emergency department

  Canadian Journal of Emergency Medicine · 2023-06-30 · 1 citations

  editorialOpen access
  PublisherOA PDFDOI

Frequent coauthors

• Timothy E. Albertson

  University of California Davis Medical Center

  72 shared

• Robert G. Hendrickson

  Oregon Health & Science University

  58 shared

• Mark E. Sutter

  University of California, Davis

  52 shared

• Neeraj Chhabra

  University of Illinois Chicago

  52 shared

• Devanshi Seth

  University of Sydney

  50 shared

• Kim Aldy

  American College of Medical Toxicology

  43 shared

• Paul M. Wax

  American College of Medical Toxicology

  43 shared

• John Michael Rague

  Denver Health Medical Center

  41 shared

Labs

• Toxicology Research - UC Davis Medical Center Emergency Medicine DepartmentPI

Awards & honors

• Excellence in Emergency Medicine faculty award at Loma Linda…
• Admitted into membership of Alpha Omega Alpha Honor Society…