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

your friendly neighborhood toxicologist here to tell you about “pink cocaine” ☠️🧵 ☠️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:

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)

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:

https://twitter.com/armyemdoc/status/1740648024240472444

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

poisoning with eyedrops??? BUT HOW??

a thread on tetrahydrozoline tox 🧵 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 👁️ 👄 👁️

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

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!

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.

After taking tons of tests over the years, I have honed a study technique that works well for me.

And hopefully, it works for you too!

A thread on the study technique that got me through med school, residency, fellowship, and one of the hardest board exams I’ve ever taken:🧵📚 Step 1: Gather materials

This technique requires a white board (or a wall with paper on it), sticky notes, a pen, and your study material. Ideally, the white board would be in a place you are studying in each day such as your bedroom, office, or cubicle.

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?☠️☠️ 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.🐉🪰

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☠️.