Josh Trebach, MD Profile picture
Jun 7, 2022 5 tweets 2 min read Read on X
A 20-year-old patient presents to your ER with vomiting. They tell you they drank pennyroyal tea to induce an abortion because they did not have access to any safe/legal options.

A brief thread on ☠️PENNYROYAL TOXICITY☠️ and its management 🧵:
Pennyroyal (Mentha pulegium) is a plant that has a pleasant mintlike🍬 odor. It has been used historically as an abortifacient for centuries. The plant can be concentrated into an oil called pennyroyal oil. The plant, and especially the oil, contain the toxin ☠️PULEGONE☠️.
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PULEGONE gets metabolized by the body to form toxins (e.g., menthofuran) that cause CENTRILOBULAR HEPATIC NECROSIS (tylenol toxicity also does this). Studies have shown that pulegone can also cause lung necrosis🫁and can interfere with potassium channels in the heart❤️‍🩹. Image
This case is made up BUT there are definitely cases of patients taking pennyroyal to induce abortion. Given the current political climate and abundance of medical misinformation out there (see pic below), we need to be prepared for anything so that we can best treat our patients. Image
Roe v Wade must not be overturned. I fear that if it is, we will see a rise in unsafe abortions that will lead to people getting hurt/dying.

Further reading: Goldfrank's Toxicologic Emergencies 11th edition, PMID 1686249, 7157374, 8909490, 2891472, 22004607, 8633832

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More from @jtrebach

Dec 30, 2025
An 18-year-old female presents to the emergency department with abdominal pain and shortness of breath after drinking a fancy cocktail. Her x-ray is below.

What do you think is going on? Image
This individual drank an alcoholic beverage that contained LIQUID NITROGEN and subsequently had a gastric perforation (xray shows large volume pneumoperitoneum)

(case report/image source: . Patient survived after surgery)pmc.ncbi.nlm.nih.gov/articles/PMC36…
Liquid nitrogen = nitrogen gas that’s been supercooled until it’s a liquid. It is very cold and has to be held in special containers because it actually boils at room temperature. It can cause frostbite when in contact with skin/tissues Image
Read 7 tweets
Sep 22, 2025
hi, medical toxicologist that knows a lot about Tylenol here👋 Claiming that tylenol use in pregnancy causes autism is fearmongering

here's what you need to know 🧵
Currently, the strongest study we have that examined this is by Ahlqvist et al (2024), a study of 2.5 MILLION children...its a prospectively controlled study and adjusted for confounders (environment, genetic). It showed no association between acetaminophen in pregnancy & autism
However a paper by Prada et al (2025) claims to show an association between acetaminophen in pregnancy and autism. However this was a systematic review with a bunch of observational studies and limited control for confounding. There's so much heterogeneity. This is weak.
Read 5 tweets
Apr 7, 2025
🧵hi, medical toxicologist and poisoning expert here

let's talk about pong-pong (“the suicide tree”) from The White Lotus #whitelotus #thewhitelotus 🪷

(yes it's real, yes it's deadly, and YES I HAVE OPINIONS)
Cerbera odollam, also known as “pong pong” or “the suicide tree” is a plant that grows primarily in South/Southeast Asia.

she looks 😇innocent😇 with her beautiful glossy leaves🍃 and bears a fruit that kind of looks like a small mango (starts out green, gets reddish over time) Image
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each pong pong fruit contains a fibrous shell/husk which contains an ovoid kernel (~2 cm × 1.5 cm) with two fleshy white halves (also i don't like the word fleshy)

it is this kernel that contains the deadly poison known as ☠️cerberin!☠️ Image
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Read 11 tweets
Nov 21, 2024
the dietary supplement industry continues to thrive despite being implicated in lies, deceit, and patient harm

a medical toxicologist's rant (and warning) about dietary supplements:
what is a dietary supplement?

it is defined as a "product intended to supplement the diet" and is super vague--it can be plant-derived, animal-derived, a vitamin...but it can also be a gas station boner pill, instagram influencer energy booster, "weight loss" pills, etc
dietary supplements are NOT regulated the same way that medications are

There is scant premarket testing to check for quality & safety, and regulations are poorly enforced. "medications" = term for drugs approved by the US FDA. medications are rigorously tested
Read 17 tweets
Oct 23, 2024
your friendly neighborhood toxicologist here to tell you about “pink cocaine” ☠️🧵 Image
☠️What is pink cocaine?

It’s literally just a bunch of different drugs rolled into one…ketamine, mdma, caffeine, meth…sometimes it doesn’t even contain cocaine. Obvi this isn't regulated so pink cocaine may differ in its contents from batch to batch. From PMID 37162319: Image
☠️What does “pink cocaine” do to someone?

Depends on what is actually in it...making it unpredictable. If one batch contains lots of meth, people can get sympathomimetic effects. If another batch contains a bunch of ketamine, people can get hallucinations/psychomotor change etc Image
Read 7 tweets
Jan 22, 2024
medical toxicologist here to give u 5 tips on how to stay safe when buying gas station sexual enhancement products 🧵🧵
1) dont buy gas station sex pills

supplements are not regulated like your typical pharmaceutical drugs are and these supplement products can contain literally nothing (best case scenario) or random shit that can cause toxicity (ie, liver failure)
2) consider buying one of these for ur grandmother instead
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Read 8 tweets

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