Over-the-Counter Loperamide Overdose Resulting in Cardiac Arrest

JACC Case Reports · 2026-03-01 · 1 citations

BACKGROUND: Over-the-counter loperamide at high doses can lead to QT prolongation and cardiac arrest. CASE SUMMARY: We present a case of a woman with cardiac arrest due to ventricular tachycardia storm. Overdrive pacing, antiarrhythmic medications, and deep sedation were used to manage the recurrent ventricular tachycardia. Untargeted urine testing helped determine the etiology of the arrest may be loperamide overdose, and this was later confirmed on patient interview and targeted testing. The patient was discharged without the need for an implanted defibrillator. DISCUSSION: Multiple over-the-counter medications, such as loperamide and diphenhydramine, can result in QT prolongation at high doses and therefore can be a cause of arrhythmia and cardiac arrest. TAKE-HOME MESSAGES: In cases of cardiac arrest in patients where overdose is suspected, untargeted urine testing through mass spectrometry may be helpful in determining the etiology to guide therapies and prevent unnecessary medical interventions.

Vasopressor Requirements in Antipsychotic Overdose

Journal of Clinical Psychopharmacology · 2025-02-07

PURPOSE/BACKGROUND: The antipsychotic class of medications has a varying degree of peripheral alpha antagonism resulting vasodilation and potentially hypotension. These hemodynamic changes may require treatment with crystalloids and vasopressors. The primary aim of this study was to evaluate the occurrence of hypotension after antipsychotic overdose and characterize vasopressor use. METHODS/PROCEDURES: A retrospective cohort study was conducted by chart review of electronic records from 2 regional poison centers from January 1, 2004, to December 31, 2020. Inclusion criteria were single acute antipsychotic exposures evaluated in a health care facility and age >15. Exclusion criteria included missing data, minor or no effect outcomes, and polypharmacy overdose. The primary outcome was hypotension, which was defined as systolic blood pressure <90 mm Hg and/or MAP <65. FINDINGS/RESULTS: There were 4488 single acute antipsychotic overdoses that presented to a healthcare facility after the initial search was conducted. After exclusions, there were 2070 cases with moderate or severe outcomes. The mean age was 42 (SD = 16), and 70% were female. There were 169 cases with hypotension. Of the hypotensive cases, 92% involved atypical antipsychotics, with quetiapine being the most common (n = 128, 76%). Vasopressor therapy was administered in 16/169 cases (9.9%). In the cases where vasopressor use was recorded, norepinephrine was used 12 times, dopamine 3 times, and phenylephrine once. No deaths were reported. IMPLICATIONS/CONCLUSIONS: In antipsychotic overdoses that presented to a healthcare facility, hypotension was present in n = 169 (3.8%). CONCLUSIONS: Among patient reports to 2 regional poison centers, we found that hypotension following acute antipsychotic overdose was infrequent and vasopressors are rarely administered.

Clinical effects, outcomes, and disposition of unintentional pediatric mushroom exposures reported to United States poison centers from 2009 through 2023

Clinical Toxicology · 2025-07-01

INTRODUCTION: Pediatric exposures to mushrooms can cause distress to parents and healthcare workers due to fear that ingestion could be toxic or fatal. This study aims to characterize the clinical effects, outcomes and disposition of unintentional pediatric mushroom exposures reported to poison centers in the United States over the past 15 years. METHODS: from 2009 to 2023, which analyzes unintentional single-substance mushroom exposures in patients aged 5 years or younger. The primary outcomes were the rate of clinical effects, medical outcomes, and disposition. The secondary outcome was medical outcomes amongst patients who received activated charcoal. RESULTS: There were 50,323 exposures, but no symptoms (89.4%) were reported in the majority of children, and most were managed at home (80.1%). Minor effects were reported in 5.0% of exposures, moderate effects in 0.6% of exposures, and major effects in 0.03% of exposures. Two patients received transplants. In the group of patients who received activated charcoal (7.2%), 7.0% had minor effects, 0.6% reported moderate effects, and 0.05% reported major effects. The type of mushroom was reported as unknown in 92.1% of cases. DISCUSSION: This study shows that clinically significant symptoms and outcomes are rare from unintentional exposures to mushrooms in children aged 5 years or younger, even without mushroom identification. Of 50,323 exposures, major outcomes were reported only in 17. Symptoms were not reported in the majority of children regardless of activated charcoal administration. CONCLUSION: In the absence of symptoms, it may be safe to manage children with unintentional mushroom exposures at home, even without mushroom identification, due to the low risk for adverse outcomes.

Guess Who: Toxicology and Pharmacology

Western Journal of Emergency Medicine · 2024-03-24

5 (SD 0.71) (Figure) for PGY1, PGY2, and PGY3s, respectively (P<0.001).The phi-coefficient was 0.31, providing evidence that differences in entrustment were due to residents, not faculty members.

<i>Notes from the Field</i>: Schedule I Substances Identified in Nootropic Gummies Containing <i>Amanita muscaria</i> or Other Mushrooms — Charlottesville, Virginia, 2023–2024

MMWR Morbidity and Mortality Weekly Report · 2024 · 9 citations

• Toxicology
• Chemistry
• Medicine

Since late 2023, according to conversations between investigators and smoke shop employees, gas stations and smoke shops in Virginia have been selling mushroom gummies, marketed as nootropics (substances taken to enhance cognitive function) or psychedelics.These gummies are labeled to contain either Amanita muscaria or proprietary mushroom nootropic blends.Unlike other hallucinogenic mushrooms that contain the Drug Enforcement Administration (DEA) schedule I substance psilocybin, A. muscaria is currently legal.* A. muscaria contains ibotenic acid and muscimol and is used less commonly as a hallucinogen than are psilocybin-containing mushrooms because A. muscaria can cause undesired symptoms, including gastrointestinal upset, agitation, and seizures (1-3).During September 2023-June 2024, five patients, including one child, were evaluated in Virginia after ingestion of gummies listing A. muscaria as an ingredient.Because the actual contents of these novel mushroom gummies are unknown, samples from five brands were obtained for testing using liquid chromatography-mass spectrometry.

Notorious poisoners and poisoning cases

Elsevier eBooks · 2023-02-20

The Toxicology Investigators Consortium 2022 Annual Report

Journal of Medical Toxicology · 2023 · 16 citations

• Medicine
• Emergency medicine
• Family medicine

The Sting of a White Flannel Moth Caterpillar (<i>Norape ovina</i>)

Wilderness and Environmental Medicine · 2022-05-14 · 3 citations

The purpose of this report is to describe a case of urticarial dermatitis, or erucism, caused by the white flannel moth caterpillar (Norape ovina) in central Virginia. Many caterpillars are known to cause erucism, with the puss caterpillar (Megalopyge opercularis) being the most reported culprit in the United States. White flannel moth caterpillars are expected to cause erucism as they belong to the same family as the puss caterpillar (Megalopygidae) and have similar venom-containing hairs, but no reports of the reaction or clinical course have been documented in the medical literature. A subject was stung by a white flannel moth caterpillar after it fell on his neck while clearing brush with a machete. The subject experienced immediate pain and developed a raised, erythematous rash where the caterpillar had fallen. The rash, referred to as erucism, was painful for 1 d and improved slowly over the course of 2 wk, but a small area of discoloration remained 2.5 mo after contact. Symptoms were managed by the subject at home and no medications were administered. The white flannel moth caterpillar inflicts erucism similar to that caused by the more commonly mentioned puss caterpillar. If only local symptoms are sustained from contact with a white flannel moth caterpillar, it can be safely and effectively managed with over-the-counter medications similar to the management for erucism induced by other caterpillar species. Irrigation and removal of urticating hairs with adhesive tape may help reduce the pain and is recommended, though not performed in this case.

Emerging Agents of Substance Use/Misuse

Emergency Medicine Clinics of North America · 2022 · 5 citations

• Medicine
• Pharmacology
• Intensive care medicine

An Intoxicating Case of Altered Mental Status

Clinical Pediatrics · 2022-04-24 · 1 citations