2013 Annual Meeting of the North American Congress of Clinical Toxicology (NACCT)

Figures & data

Table. Results for abstract number 8.

	Odds Ratio (95%CI)
Male	1.72 (0.2–13.3)
Female	0.58 (0.08–4.54)
Age
< 19 years old	0.62(0.13–2.91)
19–39 years old	2.1 (0.65–6.86)
> 40 years old	0.63 (0.17–2.42)
Decreased Level of Consciousness	42.3 (16.1–111.23)
Edema	10.1(1.82–55.6)
Redness	0.23 (0.03–1.64)
Location of Bite
Upper Extremity	1.33 (0.16–10.86)
Head	14.5 (2.38–88.45)
Snake Pulled Off	1.65 (0.28–9.88)
Ptosis	63 (26.94–147.74)
Diplopia	83.1 (22.67–304.67)
Blurred Vision	4.06 (0.55–29.96)
Emesis	1.76 (0.38–8.27)
Dysphagia	162 (72.1–365.4)
Dysphonia	106.5 (40.5–280.1)
Paresthesias	2.1 (0.66–6.99)
Fasciculations	12.4 (1.96–78.37)
Weakness	14.0 (5.19–38.05)
Paralysis	61.7 (25.3–150.1)
Nausea	1.55 (0.33–7.31)
Respiratory Depression	247.3 (111.1–550.6)
Anaphylaxis	23.3 (8.56–63.42)
No sign/symptoms for 24 hours	3.65 (1.17–11.38)

Table. Results for Abstract number 12.

	[APAP] (mg/L)	[NAC] (mg/L)	N	Mean (s)	95% CI
APAP Alone	0	0	34	13.0	12.8–13.2
	100	0	34	12.9	12.7–13.1
	50	0	34	12.9	12.7–13.2
	25	0	34	13.0	12.7–13.2
NAC +/− APAP	0	1000	10	15.2	14.3–16.0
	100	1000	10	15.2	14.4–16.0

Table. Comparison of Respondents With and Without Detectable UUC.

	No Detectable UUC	Detectable UUC
Number	187 (7.3%)	2,374 (92.7%)
Age	38.0 [34.7, 41.2]	36.0 [35.1, 36.9]	p = 0.248
Gender	47% M/53% F	50% M/50% F
sCr (μmol/L)	73.4 [70.7, 76.0]	76.0 [74.3, 77.8]	p = 0.10
ACR (mg/g)	10.0 [8.3, 11.7]	23.4 [18.5, 28.3]	p < 0.001
History of renal disease	0.76%	2.1%	p = 0.512
Average UUC normalized to urine creatinine (μg/g)		0.017 [0.010, 0.024]

95% confidence intervals given in brackets.

Table

Variable	Value	Non-Reporters n = 28	All Others n = 72	p value
Gender	Female	17 (60.7%)	40 (55.6%)	0.6399
	Male	11 (39.3%)	32 (44.4%)
Age (years)	Mean (SD)	38.8 (14.02)	36.0 (11.67)	0.3058
Ethnicity	Hispanic	12 (42.9%)	29 (40.3%)	0.8138
	Non-Hispanic	16 (57.1%)	43 (59.7%)

Table. Results for abstract number 30.

	Diameter (mm)
Time (h)	Milk R/Y/G	Water R/Y/G	Gastric Fluid R/Y/G	GoLytely R/Y/G	Vodka R/Y/G
0	2.3/2.3/2.3	2.0/2.3/1.8	2.4/2.1/2.3	2.1/2.3/2.3	2.3/2.0/2.1
1	4.5/4.9/4.2	6.7/6.6/7.1	3.5/3.5/3.5	4.7/4.7/5.1	3.5/3.5/3.5
2	5.7/5.7/--	8.1/8.1/8.1	3.7/3.5/3.5	5.2/5.4/5.8	3.9/3.9/3.9
4	6.8/6.9/7.1	9.4/9.3/9.6	3.2/3.5/3.5	6.3/6.0/6.1	6.9/6.5/7.2
6	7.3/7.3/7.1	9.4/9.4/9.5	3.2/3.5/3.3	6.3/6.1/6.1	8.9/8.7/8.7
12	6.7/6.7/6.6	7.5/7.0/7.5	2.9/3.1/3.0	6.4/6.4/6.2	1.02/1.0/1.03
24	6.5/6.5/6.5	5.8/5.5/5.9	3.0/2.8/3.0	6.4/6.5/6.3	1.11/1.13/1.15

Table

CR over time
Hours post-ingestion	3	4	10	20	36	60
Serum creatinine (mg/dL)	4.9	4.7	4.4	4	2.9	1

Table. Results for abstract number 50.

Medical Outcome	Number of patients	% of total reported exposures	Mean and median age	% of patients < 6 yrs with outcome
Death	2	0.02%	33 yrs,	0%
Major effect	25	0.2%	41 yrs, 42 yrs	8%
Moderate effects	219	2%	40 yrs, 38 yrs	18%
Minor effect	906	8%	24 yrs, 10 yrs	46%
No effect	4499	40%	8 yrs, 2 yrs	85%

Table 1. Pediatric laundry detergent packs by brand.

	Tide^TM %	All^TM %	Purex^TM %
Age 1 year or less	40	43	37
Male	52	52	52
Route - ingestion	89	94	89
Route - ocular	12	10	11
Route - dermal	9	12	6
Referred to healthcare facility (excludes already at healthcare facility)	22	26	35
Medical outcome - no effect	20	7	11
Medical outcome - serious (moderate effect, major effect, unable to follow-potentially toxic	10	17	16
Clinical effect - vomiting	45	69	50
Clinical effect - cough	7	21	16
Clinical effect - ocular irritation	9	9	15
Clinical effect - red eye	8	7	13
Clinical effect - nausea	6	7	2

Table. Serious adverse effects of laundry packet ingestion (n = 89).

Effect	Total
CNS Effect (lethargy, sedation, seizure)	49
Respiratory distress, pneumonitis, hypoxia	24
Metabolic Disturbance (acidosis, hyperglycemia, elevated anion gap)	14
Corneal abrasion or ulceration	8
Endoscopic findings of esophageal or gastric injury	3
Laryngeal edema on bronchoscopy	2

Table. Summary of results for abstract number 71.

Measure	Italy PC	US PC	Combined
Description of Cases
Number of Exposures	1,275	353	1,628
Date of first Exposure	29-Jul-10	28-Feb-12
Maximum Exposures @ month	64 @22 mo	36 @ 28 mo	86 @ 24 mo
Max Exposures/month/million (PS)	1.49	3.41	4.28
Age-years: mean ± SD	3.55 ± 8.49	3.88 ± 9.03	3.62 ± 8.61
Age-years: median [25,75%] tiles	2 [1.42, 3.17]	2 [1.42, 3]	2 [1.42,3]
Gender: % females/% males	48.4/51.6%	40.5/59.2%	48.7/53.2%
Outcome: number (%)
No effect	271 (21%)	90 (25%)	361 (22%)
Minor effect	840 (66%)	225 (64%)	1,065 (65%)
Moderate effect	80 (6.3%)	18 (5.1%)	98 (6%)
Major effect	16 (1.3%)	2 (0.6%)	18 (1.1%)
Intubation	3 (0.24%)	1 (0.28%)	4 (0.25%)
Clinical Effect Categories: number (%)
Gastrointestinal	802 (50%)	187 (47%)	989 (50%)
Respiratory	224 (14%)	48 (12%)	272 (14%)
Ocular	164 (10%)	31 (8%)	195 (10%)
Dermal	98 (6.2%)	57 (14.4%)	155 (7.8%)

Table. Results for abstract number 81.

Outcome/clinical effects/treatments	AAC (n = 13,812)	APAP (n = 120,231)	ASA (n = 38,356)
Death	2 (0.014)	316 (0.26)	142 (0.4)
Major effect	63 (0.46)	3705 (3.1)	1096 (2.9)
Acidosis	188 (1.4)		2586 (6.7)
ALT, AST > 100	30 (0.22)	5098 (4.2)
ALT, AST > 1000	19 (0.14)	5028 (4.2)
Hyperventilation	235 (1.7)		3843 (10)
Tinnitus	285 (2.1)		9721 (25.3)
Vomiting	3455 (25)	20922 (17.4)	9093 (23.7)
NAC R/P	1441 (10.4)	49050 (40.8)
ALK R/P	1045 (7.6)		18117 (47.2)
HD R/P	17 (0.12)		1385 (3.6)

Table. Hemodialysis for Toxin Removal.

Toxin	2010–2012 ToxIC data (%)	2001–2005 AAPCC data (%)
Ethylene Glycol	23.2	26
Lithium	18.9	32.4
Other	60.6	3.4
Salicylates	13.1	18.7
Methanol	3.9	5.8
Valproic Acid	1.2	6.5
Ethanol	0.4	3.7
Benzodiazepine	0.0	3.5

Table. Data for abstract number 93.

Case Number (Age/Gender)	Patches on Body	Antemortem Fentanyl Concentration (ng/mL)	Postmortem Fentanyl Concentration (ng/mL)^a	Delta Time (AM^bBlood Draw to Death) (hrs:min)	Delta Time (Death to PM^b Blood Draw) (hrs:min)
1 (45/F)	3 × 100 mcg/hr	2.4	13 (HB) 17 (FB) 9.0 (VH)	10:43	29:48
2 (30/F)	2 × 100 mcg/hr	9.0	21 (FB) 13 (VH)	00:52	˜14:00
3 (46/F)	100 mcg/hr (by Rx history– no patches on body)	12	22 (HB)	15:02	25:20

^aHB = Heart Blood; FB = Femoral Blood; VH = Vitreous Humor. ^bAM = Antemortem; PM = Postmortem

Table. Data for abstract number 97.

Date/Time	INR	PTT (s)	Fibrinogen	Platelets	Hemoglobin
19/3 02:44	> 9	111		228	83
06:22	FFP
11:00	> 9	> 140	< 0.2	104	77
11:57	FFP, 20 units cryoprecipitate; more cryoprecipitate @ 13:50
14:25	> 9	75	CroFab @ 14:25 to 15:25
17:30	> 9	> 140	< 0.6	73
20:20	10 vials Antivipmyn TRI @ 20:20 to 21:30, then 1 vial q1h ×3
21:38	2.9	70	< 0.6	86	70
20/3 00:42	1.3	37	< 0.6	80
02:40	Cryoprecipitate
08:00	1.1	29	2.6	85

Table. Most Common Controlled Substances in Blood of Drivers in Fatal Accidents.

Blood Drug Test Results	Number of Drivers (% of Drivers with Controlled Substances in Blood)
Most Common Controlled Substances
Marijuana	1515 (36.1%)
Alprazolam	434 (10.3%)
Methamphetamine	367 (8.7%)
Hydrocodone	365 (8.7%)
Cocaine	348 (8.3%)
Most Common Two-Drug Combinations
Alprazolam/marijuana	67 (1.6%)
Alprazolam/oxycodone	67 (1.6%)
Marijuana/methamphetamine	56 (1.3%)
Alprazolam/hydrocodone	50 (1.2%)
Cocaine/marijuana	50 (1.2%)
Most Common Three-Drug Combinations
Alprazolam/marijuana/oxycodone	8 (0.2%)
Diazepam/hydrocodone/oxycodone	6 (0.1%)
Alprazolam/diazepam/hydrocodone	4 (0.1%)
Alprazolam/hydrocodone/oxycodone	4 (0.1%)
Alprazolam/diazepam/dihydrocodeine	3 (0.1%)
Alprazolam/diazepam/meprobamate	3 (0.1%)
Alprazolam/diazepam/oxycodone	3 (0.1%)
Alprazolam/meprobamate/midazolam	3 (0.1%)

Table. Summary of Results for abstract number 115 for the last 3 years (N = 156 weeks).

NPDS Medication Exposure Group	Mean Exposures/wk	Rank	Correlation		CDC ILI correlated with
			Mean	Max
Cough-Cold	1,322	1	0.779	0.909	ILI Age 0–4 y
Promethazine-Combination	30.6	2	0.756	0.840	ILI Total
Codeine	37.9	3	0.710	0.793	ILI Age 0–4 y
APAP-Pediatric	595	4	0.706	0.814	ILI Age 0–4 y
APAP-Unknown	664	5	0.383	0.453	ILI Age 5–24 y
APAP-Adult	134	6	0.321	0.392	Total patients
Promethazine-Only	74.3	7	0.238	0.334	Total patients

Table. Patients’ characteristics, reason for exposure, ingested dose and outcome.

	Age range/mean(y)	Sex f/m/u	Exposure unintentional/ suicidal/therapeutic error/unknown	Dose range/mean (mg)	Symptoms/ signs no/minor/moderate	Dose for no/mild/ moderate effect range (mg)
Children(n = 13)	0.5–10 (3.5)	5/7/1	8/0/4/1	5–150/37	4/7/2	5–150/5–100/10–25
Adults(n = 31)	14–78 (38.7)	24/7/0	1/29/1/0	30–2000/ 382	4/26/1	30–300/50–2000/ 800

Table. Results for abstract number 121.

Year	Human Exposures	Total Intentional	Percent Intentional	Percent HCF	Percent age less than 6 years
2000	2,168,248	244,927	11.3	23.9	54.3
2001	2,267,979	262,703	11.6	24.0	53.6
2002	2,380,028	278,597	11.7	24.3	53.9
2003	2,395,582	283,845	11.8	23.9	54.7
2004	2,438,644	301,254	12.4	24.4	54.1
2005	2,424,180	304,957	12.6	24.7	53.8
2006	2,403,539	308,483	12.8	25.4	53.7
2007	2,482,041	323,367	13.0	25.5	54.1
2008	2,491,049	337,274	13.5	25.8	54.5
2009	2,479,355	344,423	13.9	25.9	54.6
2010	2,383,815	349,734	14.7	27.0	53.1
2011	2,334,004	368,207	15.8	28.1	51.4

Table. Results for abstract number 122.

Parameter	EU-PC	US-PC	p-value	Combined
Number of cases	10	12		22
Age-years, mean ± SD	55.6 ± 14.6	37.0 ± 12.7	0.0104	47.4 ± 16.9
Gender-%, females, males	40%, 60%	75%, 25%	ns	59.1%, 40.9%
Day of study, mean (Date)	674 (5-Nov-12)	378 (14-Jan-12)	0.0018	413 (18-Feb-12)
Date of study SD	4.56	259	< 0.0001	241
Clinical Effect Category
Neuro-Peripheral NS	9 (90%)	8 (67%)	ns	17 (77%)
Gastrointestinal	7 (70%)	7 (58%)	ns	14 (64%)
Malaise	5 (50%)	7 (58%)	ns	12 (55%)
Neuro-Central NS	3 (30%)	4 (33%)	ns	7 (32%)

Table. Results for abstract number 131.

Substance	Death	Seizure	AMS	Metabolic Acidosis	Metabolic Alkalosis	Serum Na > 165
Baking soda	5	5	5	0	5	6
Salt	2	3	4	4	0	3

Table. Measured ibogaine levels in serum and urine.

Sample	Time	Ibogaine Level (ng/mL)
Serum 1	0741H	377
Serum 2	0955H	95
Serum 3	1620H	19
Urine	1124H	757

Table. Results for abstract number 133.

Caffeinated Substance	Coffee	Energy Drinks	Energy Drinks & Caffeine Pills	Caffeine Pills
Number of cases	31	77	22	103
% HCF calls	13	29	41	64
Avg. Age (yrs)	32	25	22	23
Avg. Caffeine Concentration	8 to 20 mg/oz	10 to 100 mg/oz	-	100 to 200 mg/pill

Table. Results for abstract number 152.

Year	Number of Cases	Tracheotomy	Exposure		Mortality
			Suicidal	Accidental
1995	45	13	30	15	12
1996	77	40	52	25	15
1997	85	30	55	30	9
1998	95	51	74	21	11
1999	278	82	185	93	23

Table 1. Carbon Monoxide-Related Recreational Boating Accidents, Injuries and Deaths Per Year.

	Mean	95% Confidence Interval
Accidents (Percent of all recreational boating accidents)	14.5 (0.29%)	12.1–16.9 (0.24–0.34%)
Injuries (Percent of all recreational boating injuries)	30.9 (0.90%)	22.4–39.4 (0.66–1.14%)
Deaths (Percent of all recreational boating deaths)	6.7 0.95%	4.5–9.0 (0.63–1.27%)

Table 2. Carbon Monoxide-Related Accidents, Injuries, and Deaths by Vessel Type.

Vessel Type	Accidents*	Injuries*	Deaths*
Cabin Motorboats	49	123	29
Open Motorboats	46	45	12
Houseboats	27	73	9
All Other Vessel Types	6	3	4

*Accident and death totals are for the full nine-year study period (2002–2011), while injury data was reported for only the eight most recent years (2003–2011).

Table. Approximate 10 hour bupropion levels.

Serum drug level	5 yo	5 yo	3 yo
bupropion (ref: 50–100 ng/mL)	220	138	< 10
hydroxybupropion (ref: 600–2000 ng/mL)	4808	4151	714

Table. Suspected suicide accounted for 50% of the reported geriatric deaths (abstract number 164).

Pt	Substance Class					Intent		Outcome
Age	Sedative Hypnotics	CV drugs	Anti-depressants	Analgesics	Opioids	Suicidal	Unintentional	Severe Illness	Death
18–64	10.35%	3.59%	7.26%	13.58%	2.57%	25.66%	17%	3.15%	0.21%
≥ 65	3.89%	14.38%	2.82%	8.43%	1.91%	3.47%	51%	2.21%	0.23%

Table. Clinical Scenario # of centers recommending HBO.

Adult unconscious, COHb 9.5	33
Adult initially unconscious, arrives awake, assymptomatic, normal examination, COHb 9.5	24
Adult, COHb 9.5, Assymptomatic, no loss of consciousness	0
Adult, no loss of consciousness, COHb 9.5, headache and dizziness	1
Adult, no loss of consciousness, COHb 9.5, EKG suggestive of acute ischemia	23
Adult, no loss of consciousness, COHb 9.5, ataxia	25
Adult, no loss of consciousness, COHb 25, normal neurological examination, Assymptomatic	16
5 year old, CO level 10, assymptomatic	3

Table. Results for abstract number 167.

Level of Familiarity	Cap	Stem	Gills	Ring	Cup/volva	ID at least one toxic species	ID both toxic species
Little or none (N = 61)	53 (87%)	58 (95%)	49 (79%)	35 (57%)	32 (52%)	3 (5%)	0 (0%)
Low (N = 27)	25 (93%)	26 (96%)	25 (93%)	19 (70%)	18 (67%)	3 (11%)	0 (0%)
Moderate (N = 20)	20 (100%)	19 (95%)	20 (100%)	18 (90%)	16 (80%)	3 (15%)	0 (0%)
High (N = 8)	8 (100%)	8 (100%)	8 (100%)	6 (75%)	6 (75%)	0 (0%)	0 (0%)

Table. Data for abstract number 171.

Day	Trigs (mg/dL)	Amylase (U/L)	Lipase (U/L)
1		38	33
2	> 5000
3	> 5000	48	77
4	2877	89	291
5	368	125	471
6	203	47	142
7	160	48	120

Table 1. Case Demographics in maxQTc Groups I-IV (n = 378) and TdP cases (n = 14) (abstract number 179).

		378 cases with QTcMax Groups I-IV
Demographics	Findings in 2223 patient sample	I (n = 189)	II (n = 121)	III (n = 37)	IV (n = 31)	Tdp cases n = 14
maxQTc Mean (msec) ±standard deviation	511 ± 52 median: 500 (n = 378)	474 ± 17	519 ± 14	571 ± 15	635 ± 39	569 (3 cases)
Male:Female ratio	1 : 1.5	1 : 1.9	1 : 3.2	1 : 3.6	1 : 3.4	1 : 1
% of cases Magnesium used	not determined	17%	35%	41%	48%	93%
Cases with cardiac arrest and/or Vtach/Vfib (% of group)	401 (18)	8 (4.2)	5 (4.1)	3 (8.1)	2 (6.5)	14 (100)

Table 2. Substances found in Groups I-IV and in TdP cases (abstract number 179).

Substance categories	Total citations in category	Groups I-IV (n = 378) # of citations (% in category)				# Citations in TdP cases
		I	II	III	IV
SSRI	280	49 (18)	34 (12)	5 (1.8)	13 (4.6)	3
Atypical Antipsychotics	288	42 (15)	37 (13)	13 (4.5)	6 (2.1)	2
Tricyclic antidepressants	450	43 (9.6)	22 (4.9)	4 (0.9)	5 (1.1)	4
Antihistamines-only	216	17 (7.9)	16 (7.4)	5 (2.3)	9 (4.2)	1
Bupropion	88	18 (21)	9 (10)	4 (4.6)	4 (4.6)	2
Venlafaxine	53	9 (17)	4 (7.6)	1 (1.9)	1 (1.9)	1
Trazodone	167	26 (16)	28 (17)	5 (3)	3 (1.8)	0
Methadone	44	2 (4.6)	3 (6.8)	1 (2.3)	2 (4.6)	0
Tramadol	34	1 (2.9)	3 (8.8)	2 (5.9)	3 (8.8)	0
Valproic acid	41	5 (12)	4 (10)	2 (4.9)	1 (2.4)	1
Cesium	2	0	0	0	0	2
Haloperidol	12	1 (8.3)	2 (17)	2 (17)	0	1
Quinine	9	0	0	0	1 (11)	1
Methamphetamine	29	1 (3.5)	2 (6.9)	1 (3.5)	0	1

Table. Data for abstract number 181.

	V6 QTc > 500ms	K < 3.3 mEq/L	V6 TpTe > 120 ms
Odds Ratio	13.5	30.0	87.5
95% CI	1.4–130	2.03–441	6.65–1151

Table. Data for abstract number 192.

Hospital day	Adjusted PHT level (ug/mL)
8	193
9	201
10	173
11	151
12	130
14	98 (before HD)
14	58 (after HD)
16	48 (before HD)
16	26 (after

Table

Time post-ingestion (hrs)	4	25	39	63	87
Serum ibuprofen concentration (mcg/mL)	1,233	682	197	70	26

Table. Sources of misused Baclofen, Gabapentin and Pregabalin (n = number reporting misuse).

	Baclofen (n = 19)	Gabapentin (n = 17)	Pregabalin (n = 8)
Prescribed medication	3	8	1
High street pharmacy/shop	5	5	2
Friends or family	3	7	3
Street-level drug dealer	3	5	2
On-line pharmacy	6	3	2
Non-pharmacy Internet supplier	5	0	1
Purchased outisde of UK	1	2	0
Other	0	1	0

Table

	ETOH level (mg/dl)
Time since ingestion (hours)	Patient 1	Patient 2
4.0	723	–
4.5	–	485
9.6	501	269
15.6	253	90
21.6	87	< 10
36.0	< 10	–

Table. Frequency (number of urinals out of 12) of drug detection.

Group	Drug	Jul	Aug	Sept	Oct	Nov	Dec
NPS	Cathine	12	12	7	7	7	5
	Mephedrone	5	8	8	5	4	2
	Methylhexaneamine	3	7	8	12	4	3
	Methcathinone*	5	0	0	0	0	0
	Ethylmethcathinone	3	0	0	0	0	0
	Methiopropamine	1	2	1	1	0	2
	Pipradrol	1	4	1	2	0	0
	Cathinone	3	2	2	3	0	0
	5-(2-aminopropyl) benzofuran	1	0	0	0	1	1
	1,4-trifluoromethylphenylpiperazine	0	0	0	1	2	0
	4-methylbuphedrone	0	1	4	0	0	0
	4-methylethcathinone	0	1	1	0	1	0
	1,4-methoxyphenylpiperazine	0	0	0	0	1	0
	4-fluoroephedrine	0	0	1	0	0	0
	Methoxetamine	0	0	0	0	0	0
Classical	Cocaine*	12	12	12	12	8	12
	Morphine	12	12	12	12	12	12
	MDMA*	9	11	12	9	11	12
	Methadone*	5	11	11	7	7	7
	Amphetamine*	7	9	9	5	2	9
	Ketamine*	5	7	5	8	4	5
	3,4-methylenedioxyamphetamine	3	2	5	6	5	2
	Cannabis*	8	12	12	12	2	1
	Methamphetamine*	4	2	1	1	3	6

(*metabolite detected)

Table. Results for abstract number 212.

Toxin	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	Total
Carbon monoxide	14	6	4	7	10	8	6	15	9	8	6	7	3	103
Helium		2	4	2	4	2	3	4	4	8	12	6	13	64
Ethylene glycol	1				2	2	1	1	2	1	1	2	1	14
Cyanide		2		1			1	1	1	1			1	9
Caustic/corrosive	1	1										1	2	5
AChE inhibitor	1					1	1		1					4
Hydrogen sulfide											2		1	3
Strychnine	1		1											2
Herbicide/fungicide													1	1
Furniture stripper													1	1
Zinc phosphide						1								1
Gasoline	1													1
Water												1		1
Total	19	11	9	10	16	14	12	21	17	18	21	17	23	209

Table. Lab results, abstract number 213.

Hrs	Metformin mcg/ml	Lactate mmol/l	Glucose mg/dl
9			13
9.1			156
11	98	11.2	40
13	84	15	57
14	50	15	207
20	19	11.4	89
25	19	7.4	45
29	22	6.8	76
33	13	1.8	78
42	11		122

Table. Data for abstract number 218.

	HD 1	HD 2	HD 3	HD 4
CVP (Central Venous Pressure)	18	12	14	24
CI (Cardiac Index)	2.2	4.3	4.0	4.4
SVV (Stroke Volume Variation)	23		17	6
SVR (Systemic Vascular Resistance)	568	408	426	1081
Infusions	Levophed, Epi, Vaso, Glucagon, Insulin, Isoproterenol	Levophed, Epi, Vaso, Glucagon, Insulin, Isoproterenol, Phenylephrine, transvenous pacer	Glucagon, Insulin	None

Table. Data for abstract number 223.

	HD 6 (Extubated)	HD 7	HD 8 (Canopy Initiated)	HD 9	HD 10 (Canopy Discontinued)	HD 11	HD 12 (Discharge)
Diazepam (mg)	160	180	150	0	0	0	0
Haloperidol (mg)	5	5	5	0	0	0	0

Table

Time, hr	4	8	13	17	24	27	37	48	69	82
ASA, mg/dL	< 2	< 2	37.9	66.9	55	57	39	20	4	< 1
K			3.8		2.6	2.5	2.1	2.7	3.5	4.0
Anion Gap			7		16	15	15	11	11	9

Table. Data for abstract number 231.

	ng/mL
Drug	Serum 1 1220	Serum 2 1523	Serum 3 1715	Urine 1 0910	Urine 2 1221	Urine 3 1753
MDMA	148	130	132	4051	3726	3341
MDA	12	10	10	634	263	84
HMA	221	170	144	1949	905	151
3,4-DMA	150	125	121	2532	2245	1825

Statewide bath salt cases stratified by population density.

Geographic Area	# of cases	Population	Population/100,000
Large Metropolitan	46	5,194,675	0.89
Medium Metropolitan	50	3,936,816	1.27
Small Metropolitan	51	1,922,605	2.65
Micropolitan/Rural	75	866,051	8.66
Large + Medium	96	9,131,491	1.05
Small + Micro + Rural	126	2,788,656	4.52

Table. Results for abstract number 234.

CLASS	DRUG	Cutoff (ng/ml)	N tested	N positive	% positive
Opiates	Morphine	50	422	25	5.9
	Norhydrocodone	50	422	36	8.5
	Noroxycodone	50	422	19	8.5
	Norfentanyl	8	422	7	1.7
	Methadone	100	422	12	2.8
	Tramadol	100	422	18	4.3
Benzodiazepines	Lorazepam	40	422	80	19.0
	Oxazepam	40	422	55	13.0
Barbiturates	Phenobarbital	200	284	5	1.8
Tricyclics	General	500	281	10	3.6
SRIs	Norfluoxetine	25	284	21	7.4
Stimulants	Amphetamine	100	422	52	12.3
Others	Meprobamate	100	422	12	2.8
	Carboxy-zolpidem	10	284	18	6.3
Cannabinoids	Carboxy-THC	15	422	92	21.8
	JWH compounds	15	365	4	1.1

Table. Results for abstract number 240.

Sample	Description	Declared Concentration (mg/mL)	Measured Concentration (mg/mL)	Total Amount in bottle (mg)	pH
PG Base (Ecig Express)	Odorless, clear, viscous liquid	100	87.2 ± 2.7	2617 ± 81	8.5
Titan Fluid (Coffee)	Viscous orange liquid with coffee odor	36	18.1 ± 0.3	181 ± 3	8.0
Titan Tornado Fluid (Red Bull)	Viscous orange with candy-like odor	36	50.4 ± 0.5	504 ± 5	8.5
Provape Premium e-juice (Lot 3010D)	Viscous orange liquid with nutty & mild tobacco odor	24	18.6 ± 0.2	93 ± 1	7.25
Provape Premium e-juice (Lot 3027D)	Viscous orange liquid with nutty & mild tobacco odor	24	17.1 ± 0.2	85.5 ± 1	7.0
Hangsen Desert Ship	Viscous yellow liquid with nutty & mild tobacco odor	18	14.8 ± 0.2	148 ± 2	7.5

Table. Results for abstract number 252.

Group	N	Mean (SD) Overall Score	Mean (SD) PE Score	Mean (SD) TOP Score	Mean (SD) PK score
All students	332	10.0 (2.4)	3.1 (1.2)	3.5 (1.0)	3.4 (1.1)
Yr 1: 2010	108	10.2 (2.2)	2.9 (1.1)	3.6 (1.0)	3.7 (1.0)
Yr 2: 2011	116	9.9 (2.3)	3.1 (1.2)	3.4 (0.9)	3.3 (1.2)
Yr 3: 2012	108	9.8 (2.7)	3.1 (1.2)	3.3 (1.1)	3.3 (1.1)
Pharmacology intense	216	10.3 (2.2)	3.2 (1.1)	3.5 (0.9)	3.5 (1.1)
Less Pharmacology Intense	95	9.4 (2.7)	2.8 (1.3)	3.3 (1.0)	3.3 (1.2)
Both	10	11.2 (1.8)	3.3 (1.3)	4.1 (0.7)	3.8 (1.0)
Toxicology	35	11.6 (2.0)	3.7 (1.2)	4.0 (0.9)	3.9 (0.9)
Clinical Pharmacology	86	10.1 (1.9)	3.0 (1.2)	3.5 (0.9)	3.5 (0.9)
Neither	201	9.6 (2.5)	3.0 (1.1)	3.3 (1.0)	3.3 (1.2)

Table. Results for abstract number 254.

		Attending			Resident
					EM
		IM n = 19	EM n = 26	Intern n = 11	2^nd Year n = 7	3^rd Year n = 11	4^th Year n = 8
Rotated on a toxicology service		0	69	9	0	73	100
Administered physostigmine		16	54	0	0	18	50
Comfortable administering physostigmine without toxicology input		11	42	9	0	27	75
Indication
Glaucoma	Yes	35	19	18	11	15	17
Contraindications
Asthma	Yes	44	52	41	56	8	38
Intestinal Obstruction	Yes	56	44	35	56	39	29
Urogenital Obstruction	Yes	56	48	29	33	31	14
Tricyclic Antidepressants	Yes	28	40	12	0	31	38

Table. Results for abstract number 274.

Case	Sex	Age (Yr)	Amount Ingested	Time to Symptom Onset	Symptoms
1	F	3	0.6 mg	10 Hr	Diaphoresis, Abdominal Pain
2	F	38	400 μg/day over weeks	Chronic	Tachycardia
3	F	36	2.7 gm	Immediately	Diarrhea
4	M	5	0.75–3 gm	24 Hr	Tachycardia
5	M	19	10 mg (Liothyronine)	58 Hr	Tachycardia
6	F	15	Unknown	24–48 Hr	Tachycardia

Table. Results for abstract number 277.

PC Number source	Internet	Health Care Facility	Promotional Materials	Phone Book
	43.0% (252/586)	22.2% (130/586)	10% (60/586)	7.2% (42/586)
95% Confidence Intervals	39.1–47%	19–25.7%	8–13%	5.3%–9.5%

Table. Data for abstract number 279.

	10/1/12	10/2/12	10/3/12	10/4/12	10/5/12
ESI CALLS	133	160	139	158	126
TOTAL PC CALLS	394	454	441	461	401

Table

Component	Pre-Training Score (SE)	Post-Training Score (SE)	p-value
Demographics	96.58 (0.25)	97.04 (0.25)	0.2040
Exposure Characteristics	95.31 (0.26)	95.58 (0.26)	0.4616
Outcome	97.27 (0.25)	97.05 (0.25)	0.5202
Substance	88.94 (0.38)	92.98 (0.38)	< 0.0001
Product Name/Code	68.26 (1.27)	74.04 (1.27)	0.0013
Generic Code	94.07 (0.57)	96.95 (0.57)	0.0003
Quantity	87.87 (0.85)	91.68 (0.85)	0.0015
Quantity Unit	91.42 (0.68)	95.87 (0.67)	< 0.0001
Certainty	85.60 (0.87)	93.07 (0.87)	< 0.0001
Formulation	97.25 (0.33)	99.44 (0.33)	< 0.0001
Route	98.60 (0.21)	99.79 (0.21)	< 0.0001

Table. Results for abstract number 284; Standard Treatment Protocol.

INSECT BITE		OCULAR		HYDROCARBON
Obs for Allergy	41/53 (77%)	Irrigate	48/56 (86%)	No Emesis	9/55 (16%)
When Seek HCF	41/53 (77%)	Obs for Residual Sx	50/56 (89%)	Limit PO, Obs	41/55 (75%)
When Use Tape	N/A in 52/53	When Seek HCF	48/56 (86%)	When Seek HCF	43/55 (78%)
GI IRRITANT		ANTIHISTAMINE
Initial Dilute	53/57 (93%)	When Seek HCF	23/29 (79%)
Obs for Irritation	38/57 (67%)	Allow Pt to Sleep, Check Hourly	10/29 (34%)
N/V/D/ Dysphagia	48/57 (84%)	Pt Should Be Arousable	7/29 (24%)

Table 1. Patient demographics (Abstract number 289).

	Intentional (%) n = 15	Unintentional (%) n = 17	Total (%) n = 32
Patient gender
Male	13 (59.0)	9 (40.9)	22
Female	2 (20.0)	8 (80.0)	10
Patient age (years)
< 13	0	10 (100)	10
13–19	10 (76.9)	2 (16.7)	12
> 19	2 (40.0)	3 (60.0)	5
Unknown (above age 20)	3 (60.0)	2 (40.0)	5
Management site
Own Residence	7 (35.0)	13 (65.0)	20
Hospital	7 (70.0)	3 (30.0)	10
Acute Care Facility	1 (50.0)	1 (50.0)	2
Outcome
No effect	0	5 (100)	5
Minor	5 (35.7)	9 (64.3)	14
Moderate	4 (100)	0	4
Major	0	0	0
Death	0	0	0
Follow up unknown	6 (66.7)	3 (33.3)	9

Table 2. Secondary drugs taken (Abstract number 289).

Age	Sex	Drugs taken
17	Male	Cannibis
17	Female	Amphetamines, dexamfetamine (Vyvanse)
15	Male	Benzodiazepines, Dihydramines
16	Female	Cymbalta, Klonopin, Benzodiazepines, Acetaminophen, K2
20	Male	Cough Syrup, Acetaminophen, Antihistamine

Table. Results for abstract number 303.

	2004	2005	2006	2007	2008	2009	2010
NPDS	39,539	42,037	44,735	51,086	55,830	59,086	60,739
DAWN+NPDS	184,189	210,416	246,015	288,325	361,721	402,069	420,660
Ratio	0.215	0.200	0.182	0.177	0.154	0.147	0.144

Table

Drug	Number of IHCW exposures	Percent of IHCW exposures	IHCW exposures per 1,000 adult exposures
Hydrocodone	56	53.85%	0.83
Tramadol	12	11.54%	0.47
Oxycodone	12	11.54%	0.31
Morphine	10	9.62%	1.33
Hydromorphone	5	4.81%	1.71
Fentanyl	4	3.85%	0.95
Buprenorphine	4	3.85%	0.79
Methadone	1	0.96%	0.09

Table

% Rural	Pop rate (95% CI)	URDD per pop rate (95% CI)	URDD rate (95% CI)
10	3.53 (3.34, 3.73)	13.54 (13.01, 14.10)	0.28 (0.27, 0.30)
50	3.97 (3.77, 4.18)	15.43 (14.90, 15.99)	0.28 (0.27, 0.30)
100	4.59 (4.08, 5.16)	18.17 (16.73, 19.73)	0.29 (0.25, 0.32)

Table. Results for abstract number 313.

Exposures/100,000 Population (rounded to 2 decimal places)
	2007	2012	% Change 2007–2012
Oxycodone – Intentional Exposures
Australia	1.14	3.09	172
Germany	0.15	0.35	130
Italy	< 0.01	0.05	1371
Switzerland	0.11	0.45	329
United States	3.24	4.24	31
Oxycodone – Unintentional Exposures
Australia	0.67	2.52	278
Germany	0.03	0.10	225
Italy	< 0.01	0.01	153
Switzerland	0.04	0.16	313
United States	1.51	1.81	20
Buprenorphine – Intentional Exposures
Australia	0.19	0.14	−27
Germany	0.10	0.19	92
Italy	0.03	0.02	−45
Switzerland	0.11	0.16	55
United States	0.29	0.63	118
Buprenorphine – Unintentional Exposures
Australia	0.09	0.15	57
Germany	0.06	0.05	−13
Italy	< 0.01	< 0.01	−5
Switzerland	0.12	0.09	−26
United States	0.23	0.47	110
Methadone – Intentional Exposures
Australia	0.40	0.35	−13
Germany	0.30	0.48	64
Italy	0.08	0.08	1
Switzerland	0.74	0.67	−10
United States	1.28	1.12	−12
Methadone – Unintentional Exposures
Australia	0.17	0.17	3
Germany	0.08	0.16	110
Italy	0.02	0.01	−37
Switzerland	0.30	0.28	−9
United States	0.35	0.33	−8