Josh Trebach, MD Profile picture
Nov 28, 2022 6 tweets 3 min read Read on X
A 18-year-old male presents to the emergency department with confusion and hallucinations for over 24 hours. He keeps muttering that he was "bitten by the dragonfly."

What do you think is going on?☠️☠️ blue insect (damselfly I th...
Turns out it wasn't an actual dragonfly, but rather, the compound known as 1-(8-Bromobenzo[1,2-b;4,5-b]difuran-4-yl)-2-aminopropane!!!!!!

Because the structure of this compound kind of looks like a dragonfly and it has a bromine on it, it is also called Bromo-DragonFLY.🐉🪰 organic chemistry structure...
Bromo-DragonFLY was first synthesized in the lab in 1998. It was briefly looked into as a potential antidepressant. It works by being agonist at serotonin receptors (and this is likely what mediates the hallucinogenic effects). It can be a powder, liquid, or on blotter paper. plastic package containing ...
Unfortunately, despite having a fun/cute name, the effects from Bromo-DragonFLY are NOT fun/cute. The adverse effects include:
-hallucinations for up to DAYS at a time
-vasoconstriction/limb ischemia
-seizures
-death

Treatment is supportive care. car on exit 12 meme shows c...
Those who have taken this drug say:

"It was like being dragged to hell and back again...It is the most evil [thing] I've ever tried. It lasted an eternity."

“bromo dragonfly makes my dick shrink like I am running from the police”

“this is what I would assume toxic tastes like” squidward looking very conc...
There's always new drugs coming out, and part of being a toxicologist is making sure we know about these drugs so we can best help our patients.

Thanks for tuning in. And don't get bitten by the dragonfly! #ToxTweets

Ref=Goldfranks Tox 11th ed, PMIDs: 19091499, 21592070, Erowid

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More from @jtrebach

Apr 7
🧵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
Image
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
Dec 29, 2023
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.
Read 5 tweets
Nov 16, 2023
poisoning with eyedrops??? BUT HOW??

a thread on tetrahydrozoline tox 🧵 Image
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)

so what happens? 🤔
Read 8 tweets

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