21. Tales from the Tox Files

Human School

As a medical toxicologist, I take care of people of all ages who have any type of poisoning, overdose, envenomation or medication misadventure. One of our core tenets in toxicology is 'the dose makes the poison' and the cases I discuss in this episode demonstrate that very fact. Taking care of sick poisoned patients isn't just about the immediate care but also involves detective work, to figure out exactly what happened and sometimes place it in the context of the community at large. It's about digging deep until you get the answer and having the mental space to see when a story isn't adding up, indicating that more investigation is needed. Basically, it's about being a detective. I discuss two series of cases that taught me valuable lessons about being helpful to patients, their families and the community by not stopping until I figured out what happened- and working with great colleagues along the way.
If you would like to read about these cases in more detail, see below. Don't keep scrolling if you don't want spoilers!
References:
1. Armenian P et al. Multiple MDMA (Ecstasy) overdoses at a rave event: a case series. J Intensive Care Med. 2013 Jul-Aug;28(4):252-8. PMID: 22640978.
2. Armenian P et al. Notes from the Field: Unintentional Fentanyl Overdoses Among Persons Who Thought They Were Snorting Cocaine - Fresno, California, January 7, 2019. MMWR Morb Mortal Wkly Rep. 2019 Aug 9;68(31):687-688. PMID: 31393864.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687194/pdf/mm6831a2.pdf

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Music courtesy of Zach Effron, MD