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☠️.
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❤️🩹.
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.
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.
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
Hi, medical toxicologist here. Administering large doses of naloxone to all patients with opioid toxicity to "totally reverse" them is not a good take. My thoughts below:
If your patient is coding/on the verge of dying then a large dose of naloxone is not unreasonable...however, for most patients a smaller dose is safe/effective. The goal of reversal with naloxone is to restore adequate spontaneous ventilation--NOT to precipitate acute withdrawal
Precipitating acute withdrawal can be dangerous for multiple reasons: risks include cardiovascular complications or pulmonary complications (from increase in catecholamines/hyperadrenergic state) and patient agitation from reversal posing a risk to self/staff.
Eye drops such as Visine can be purchased without a prescription from your local pharmacy
they contain tetrahydrozoline which is an alpha-1 receptor agonist which works to (temporarily) decrease eye redness by constricting blood vessels in your eyeballs 👁️ 👄 👁️
if you ingest a bunch of tetrahydrozoline, however, the drug gets rapidly absorbed from your GI tract and gets distributed to your entire body (not just your eyeballs)
what if I told you this sheep’s collar contained a deadly poison? BUT WHY??? 🧵 ☠️
In order to protect against coyote attacks, some sheep are outfitted with special collars around their necks
when the coyotes try to chomp the sheep’s neck, they will rip open the pouch on the collar and the coyote will ingest a deadly poison and die
that poison is called SMFA
Sodium monofluoroacetate (SMFA) is a VERY cool poison. If SMFA was a person at my high school they would be the super popular guy who had not only a wallet chain but also a tattoo (hi chris I’ll never forget u)
SMFA works by messing with our evil nemesis the Krebs cycle
A 23yo male presents to the hospital after an overdose of unknown medications. He is watched for 24 hours, has no symptoms, and is sent home.
7 days later, he develops palpitations, tremor, sweating, and diarrhea. He denies taking any other meds.
What is going on?🤔☠️
7 days ago, this patient overdosed on LEVOTHYROXINE (aka synthroid). But why the delay in symptoms?
Levothyroxine contains T4 hormone which is inactive and requires conversion to the active form T3. This conversion can be delayed, and symptoms may take up to 10 days to appear!
Once T4 gets converted to the active T3 form, it can cause symptoms that resemble hyperthyroidism/thyroid storm. People have had hyperthermia, agitation, seizures, heart attacks, and multiorgan failure.
Some patients will have no symptoms or barely any symptoms at all.
A family of five arrives to the emergency department with "the flu." They all have headache, nausea, vomiting, and generally feel unwell. You are about to discharge them when they let you know that even their dog is sick with "the flu"!
What do you think is going on? 🤔☠️
This time of year can be tricky...because CARBON MONOXIDE toxicity can mimic things like the flu or a viral illness.
Carbon monoxide is an odorless, tasteless, invisible gas that comes from things like automobile exhaust, fires, fuel-burning heaters, gas stoves, generators, etc.
More than 1/3rd of deaths from carbon monoxide in the United Sates occur during winter months. Clusters of carbon monoxide cases are associated with ice storms/blizzards/hurricanes probably because people are crowded inside and using fuel-burning items.