About

Alyrene A. Dorey, MD, is a member of the clinical faculty at the University of Utah, where she educates medical students, residents, and fellows in Emergency Medicine and Medical Toxicology. She completed her medical education at the University of Colorado and subsequently attended the University of California - Davis for her Emergency Medicine residency. Following her residency, she completed a fellowship in Medical Toxicology. Dr. Dorey is boarded in both Emergency Medicine and Medical Toxicology and serves as a course director for the Emergency Medicine Clerkship and an elective course in Medical Toxicology within the School of Medicine. Her professional interests include pharmacotherapy, quality improvement, and addiction medicine. She conducts research in medical toxicology and opioid use disorder, contributing to the understanding and treatment of toxicological emergencies and substance use issues. Her work encompasses clinical research, case reports, and scholarly publications in the fields of emergency medicine and toxicology, emphasizing her expertise in managing complex poisoning cases, overdose treatment, and toxicological interventions.

Research topics

• Medicine
• Medical emergency
• Internal medicine
• Developmental psychology
• Surgery
• Anesthesia
• Dermatology

Selected publications

• Investigator- and Site-Level Outcomes of Participation in an ED-Based Clinical Trial

  JAMA Network Open · 2026-02-09

  articleOpen access

  This survey study examines outcomes related to training, clinical practice, professional advancement, and institutional change among sites participating in a clinical trial evaluating emergency department (ED) buprenorphine.

  PublisherOA PDFDOI

• Emergency Department–Initiated Buprenorphine for Opioid Use Disorder

  JAMA · 2026-02-11 · 4 citations

  articleOpen access

  Importance: Extended-release injectable buprenorphine may expand the reach of initiating medications for opioid use disorder in high-risk and hard-to-reach individuals who visit the emergency department (ED) and can be administered in low levels of withdrawal. Objective: To compare the effect of ED-initiated 7-day extended-release injectable buprenorphine vs sublingual buprenorphine on treatment engagement at 7 days. Design, Setting, and Participants: Multicenter randomized clinical trial enrolling adult patients presenting to the ED with untreated opioid use disorder and a Clinical Opiate Withdrawal Scale (COWS) score of 4 or higher across 29 EDs in the US from July 12, 2020, to August 21, 2024. Final follow-up was completed on October 24, 2024. Interventions: Patients were randomized to receive a 24-mg injection of extended-release buprenorphine (equivalent to 16 mg/d) or sublingual buprenorphine, which included either self-administration instructions if the COWS score was less than 8 or administration of 8 mg of sublingual buprenorphine in the ED if the COWS score was 8 or higher. All sublingual buprenorphine group patients received a 7-day prescription for 16 mg/d. Both groups were provided referral for ongoing medication with a scheduled appointment within 7 days. Main Outcomes and Measures: Engagement in opioid use disorder treatment on day 7 was the primary outcome. Secondary outcomes included engagement at 30 days, precipitated withdrawal and overdose events, craving scores, days of illicit opioid use, and patient satisfaction with treatment. Results: Among 2000 patients randomized, 6 who were enrolled twice were excluded, resulting in 991 in the extended-release group and 1003 in the sublingual group. The median age was 37 (IQR, 30-47) years, 68% were male, 31% had an initial COWS score of 4 to 7, and 76% tested positive for fentanyl. The adjusted proportion of engagement in opioid use disorder treatment at 7 days was 40.5% with extended-release buprenorphine vs 38.5% with sublingual buprenorphine (adjusted difference, 1.6%; 95% CI, -2.8% to 6.0%). Engagement at 30 days was similar, with adjusted proportions of 43.8% with extended-release buprenorphine vs 44.9% with sublingual buprenorphine (adjusted difference, -1.5%; 95% CI, -6.2% to 3.2%). Precipitated withdrawal was rare: 6 (0.6%) with extended-release buprenorphine and 8 (0.8%) with sublingual buprenorphine. Overdose events within 30 days occurred in 18 participants (2.3%) in each group. Patients receiving extended-release buprenorphine reported lower mean craving scores at 7 days vs those receiving sublingual buprenorphine (scale, 0-100; mean score, 26.5 vs 30.2, respectively; adjusted mean difference, -3.85; 95% CI, -7.08 to -0.63), fewer days of illicit opioid use in the past 7 days (adjusted ratio of means, 0.77; 95% CI, 0.68-0.95), and better treatment satisfaction scores (scale, 1-5; adjusted mean difference, 0.13; 95% CI, 0.01-0.25). Conclusions and Relevance: No difference was detected in opioid use disorder treatment engagement on day 7 between the 7-day extended-release and sublingual buprenorphine groups. Both buprenorphine formulations were well tolerated; precipitated withdrawal was rare despite a high prevalence of fentanyl. Trial Registration: ClinicalTrials.gov Identifier: NCT04225598.

  PublisherOA PDFDOI

• Severe hypoglycemia and hypothermia in massive metformin overdose

  Clinical Toxicology · 2025-03-06 · 3 citations

  article

  INTRODUCTION: Metformin is a biguanide medication thought to contribute to increased insulin sensitivity. It does not induce insulin release or act via insulin receptors, so it is not considered a common cause of hypoglycemia, even in overdose. However, massive metformin overdoses may be associated with severe hypoglycemia as well as hypothermia. METHODS: Four patients who had hypoglycemia after metformin overdoses are presented. None had access to other diabetic medications or a known diagnosis of diabetes mellitus. RESULTS: Severe hypoglycemia (blood glucose concentration <2.2 mmol/L [<39.6 mg/dL]) in all patients was diagnosed on presentation or within 9 h of initial presentation. Peak serum lactate concentrations were observed after hypoglycemia in each patient. Three patients developed hypothermia. Three patients received extracorporeal therapy; hemodialysis (one), continuous kidney replacement therapy (one), both modalities (one). One patient died. The remainder were discharged home within 2-6 days of presentation. DISCUSSION: The complex mechanisms of metformin may explain the observed progression of manifestations following large metformin overdoses. CONCLUSION: Large metformin ingestions exceeding 60 g can be associated with critically low serum glucose concentrations concurrently with or preceding increases in serum lactate concentrations. Hypothermia may also occur. Further study is needed to determine the exact mechanisms and true incidence of this manifestation, which may be underrecognized.

  PublisherDOI

• Habits of Good Medical Students - A Qualitative Analysis of What Students Attribute to their Success Professionally and Academically

  Research Square · 2025-06-17

  preprintOpen access
  PublisherOA PDFDOI

• Thermal injury after “huffing” compressed air duster: a case report

  Toxicology Communications · 2024-07-26

  articleOpen accessSenior authorCorresponding

  Recreational abuse of compressed air duster has been associated with cardiac toxicity, central nervous system depression, local tissue damage, seizures, and death. We describe a 30-year-old man who reported huffing four bottles of canned air duster to “get high.” In addition to blistering on his dominant hand, he developed pain and swelling of the lips and tongue, followed by difficulty speaking and swallowing. He underwent endotracheal intubation for anticipated airway failure and was treated for an allergic reaction. Fiberoptic bronchoscopy and computed tomography scan of the neck demonstrated unaffected posterior oropharynx and airways. He was extubated on hospital day 2 and subsequently made a full recovery. Patients with oropharyngeal and dermal injury after abuse of compressed air duster are likely suffering a thermally-mediated injury. Outcomes are generally good with minimal intervention. Routine treatment for an allergic reaction is unnecessary.

  PublisherOA PDFDOI

• Assessment of high-dose acetylcysteine in acute high-risk paracetamol (acetaminophen) ingestion

  Clinical Toxicology · 2024-07-25 · 6 citations

  articleSenior author

  BACKGROUND: Prompt acetylcysteine treatment with standard doses (300 mg/kg over 21 h in divided doses) is almost universally effective in preventing hepatotoxicity after paracetamol (acetaminophen) overdose. However, hepatotoxicity is reported despite early treatment when paracetamol concentrations exceed 300 mg/L (1,985 μmol/L) at 4 h. Prior studies evaluating high-dose acetylcysteine to treat high-risk ingestions have shown mixed results. We compared outcomes in patients with high-risk ingestions receiving standard or high-dose acetylcysteine. METHODS: Records from a single poison center were reviewed from 1 January 2017 to 31 December 2022. We included cases of acute paracetamol ingestion treated with intravenous acetylcysteine with an initial paracetamol concentration above the "300 mg/L" (1,985 μmol/L) line on the Rumack-Matthew nomogram. We compared standard and high-dose acetylcysteine groups by odds ratios and multivariable logistic regression. We defined hepatotoxicity as aminotransferase activity >1,000 U/L. RESULTS: We included 190 cases. Fifty-six percent received standard-dose acetylcysteine while 44% received high-dose acetylcysteine. Treatment within 8 h yielded no difference in hepatotoxicity between groups (odds ratio 1.67, 95% CI 0.067-42.3). Among patients treated after 8 h, hepatoxicity was more common in the high-dose group (odds ratio 3.39, 95% CI 1.25-9.2) though odds of liver failure were similar (odds ratio 2.78, 95% CI 0.89-8.69). Eighty-eight percent of patients with hepatotoxicity had elevated aminotransferase activity at presentation. No patient died or received a liver transplant. DISCUSSION: Rates of hepatotoxicity were low in patients treated within 8 h regardless of acetylcysteine dose. Unexpectedly, high-dose acetylcysteine treatment was associated with an increased odds of hepatoxicity in those treated after 8 h, but most had abnormal aminotransferase activities at presentation and there was no difference in rates of liver failure. Limitations include the use of retrospective, voluntarily reported poison center data. CONCLUSIONS: Prompt treatment with acetylcysteine, regardless of dose, prevented hepatotoxicity in high-risk paracetamol ingestion.

  PublisherDOI

• Near-Fatal Spice Intoxication of a Toddler

  PEDIATRICS · 2021 · 3 citations

  • Medicine
  • Medical emergency
  • Developmental psychology

  Synthetic cannabinoids are a heterogenous group of novel, legally regulated psychoactive substances that can result in broad, multisystemic, dangerous effects. Despite growing literature regarding synthetic cannabinoid toxicity, little is known about the extent of these effects in young children. Caregivers of drug-endangered children may not provide an accurate history of exposure when children present with symptoms of intoxication, and lack of swift detection on routine urine drug screens may further obscure and delay the diagnosis. Clinical recognition carries forensic relevance that may support interventions to aid in protecting vulnerable children. We describe a case of near-fatal child maltreatment due to supervisory neglect resulting from ingestion of an increasingly common synthetic cannabinoid. Furthermore, we highlight clinical findings that should increase a physician's index of suspicion for synthetic cannabinoid toxicity, even in the absence of a history of exposure.

  PublisherDOI

• Angioedema and Dual Nurse Flight Crew Cricothyrotomy After Envenomation by a Severed Rattlesnake Head

  Air Medical Journal · 2020 · 2 citations

  • Medicine
  • Anesthesia
  • Surgery
  PublisherDOI

• Acute and Chronic Carbon Monoxide Toxicity from Tobacco Smoking

  Military Medicine · 2019-10-31 · 45 citations

  article1st authorCorresponding

  INTRODUCTION: Carbon monoxide (CO) is produced from incomplete combustion of hydrocarbons and is a by-product of tobacco smoking. Chronic cigarette smokers often have carboxyhemoglobin (COHb) concentrations as high as 10%. We report a case of severely elevated COHb and polycythemia because of tobacco smoking and provide a review of the literature regarding elevated COHb in smokers. MATERIALS AND METHODS: A comprehensive search of PubMed and Google Scholar was performed looking for articles on tobacco smoking and CO, COHb, CO poisoning, cigarettes, pipes, cigars and water pipes/hookah smokers. RESULT: COHb levels in frequent cigarette smokers generally range from 4.2% presmoking to 8.6% postsmoking. A heavy cigarette smoker presented twice with symptoms of CO toxicity and was found to have levels 21.8 to 24.2%. Cigar smokers have been found to have COHb ranging as high as 13.0 to 38.6% in case reports. Waterpipe or "hookah" smokers generally have COHb levels 10.1% +/-2.5% and case reports, and series of even higher levels associated with CO toxicity symptoms are common. Waterpipe smokers have been found to have COHb levels as high as 39.2% after smoking. CONCLUSIONS: Many active duty military and military veterans are tobacco smokers and these patients and their health care providers should be aware of the adverse effects of CO toxicity from tobacco smoking. Patients may have symptoms such as headaches, syncope, and ataxia in the setting of acute CO toxicity; however, the chronic effects of CO may not be completely understood. Future work could explore chronic CO toxicity and its effects on strength and exercise tolerance in military personnel and provide education to service members, veterans, and health care providers.

  PublisherDOI

• Are Emergency Medicine Residents Prepared to Meet the Ethical Challenges of Clinical Practice? Findings from an Exploratory National Survey

  AEM Education and Training · 2018-08-07 · 7 citations

  articleOpen access

  BACKGROUND: Although the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine require clinical ethics education in residency training, instruction varies widely. We assessed the educational preparedness of trainees in emergency medicine to address ethics challenges common to their field. METHODS: The survey assessed two outcomes: 1) knowledge of specific ethical challenges and 2) perceived educational preparedness, across five ethics areas: 1) informed consent and decisional-capacity assessment, 2) surrogate decision making, 3) interpretation of advanced directives, 4) withdrawing and/or withholding life support, and 5) presumed consent for emergency treatment. Clinical vignettes, revised through expert panel review and pilot testing, were utilized to evaluate these areas. The final instrument was administered via Web link to emergency medicine residents and recent graduates through adverts within Emergency Medicine Residency Association and Society for Academic Emergency Medicine (SAEM) newsletters and social media platforms. Additionally, targeted e-mails through the Council of Residency Directors in Emergency Medicine, the Clerkship Directors of Emergency Medicine, and the SAEM Ethics Committee listservs encouraged survey distribution. Analyses involved one-way analysis of variance for overall knowledge scores and chi-square tests for categorical outcomes. Multivariable regression models tested associations between respondent characteristics and outcomes. RESULTS: There were 302 participants of which 34% reported having a dedicated ethics module within their residency curriculum. The mean (±SD) knowledge score was 59.7% (±12.8%); assessing decisional capacity was the most difficult topic for respondents as only 1% both correctly addressed the general issue and identified the correct plan of action. Participants having a dedicated ethics module perceived themselves better prepared, although there was no association between having a dedicated ethics module and knowledge scores. CONCLUSIONS: Gaps in clinical ethics knowledge appear prevalent among emergency medicine trainees, and few programs have dedicated ethics modules. Greater study is needed to understand and remedy clinical ethics knowledge shortfalls.

  PublisherOA PDFDOI

Frequent coauthors

• Aasim I. Padela

  25 shared

• Shellie Asher

  25 shared

• Stephen E. Hall

  Alzheimer's Association

  25 shared

• Joshua Davis

  25 shared

• Timothy E. Albertson

  University of California Davis Medical Center

  6 shared

• John Kendall

  5 shared

• Molly E.W. Thiessen

  University of Colorado Hospital

  5 shared

• Pieter Scheerlinck

  4 shared

Labs

• University of Utah HealthPI

Education

• M.D.

  University of Colorado

• Other, Emergency Medicine

  University of California - Davis