Show Notes
In this special holiday bonus episode, Ryan takes a look back at some of the most captivating episodes of The Poison Lab from 2022. Get ready for an ultimate test of your toxicology differential diagnosis skills as we compile all the "Stump the Toxicologist" segments into one streamlined, binge-worthy episode. Explore eight unique poisoning cases, be sure to check the show notes for a description of each case. time stamp of where it begins, and links to the original episodes, where you can dive deeper into the discussions and unravel the mysteries behind these intriguing cases! Case Teasers and Time Stamps Episode 13, March 2nd, 2022: Dr. Howard Greller 0:06:19 Case 1: A 19-year-old male collapses at home and presents to the ED unresponsive, tachycardic, and hypotensive, with a wide QRS complex on EKG and a serum lactate of 20. 0:22:58 Case 2: A 16-year-old female presents to the ED 9 hours after ingesting 100 tablets of an unknown medication in a suicide attempt. She presents with vomiting, lethargy, bloody diarrhea, and a metabolic acidosis. An abdominal x-ray shows numerous radiopaque tablets in her GI tract. She is treated with a redacted antidote and whole bowel irrigation, but her condition worsens and she develops liver failure. She is transferred to a tertiary care center for a liver transplant, but recovers. On day 12, she develops a lower GI bleed and bowel perforation and dies. 0:34:42 Case 3: A seven-month-old child presents with crying, cough, vomiting, and respiratory distress. 0:37:42 Case 4: A 32-year-old male with a history of alcohol use and depression presents to the ED seven hours after ingesting two handfuls of an unknown medication and alcohol in a suicide attempt. He is initially anxious and tremulous, but has normal vital signs and labs, aside from an elevated ethanol level. He has a seizure nine hours after ingestion. His EKG shows a widened QRS, and he becomes hypotensive. He is intubated, placed on vasopressors, and undergoes extracorporeal membrane oxygenation (ECMO) and targeted temperature management (TTM), but dies three days later.
Episode 15, July 6th, 2022: Dr. Josh Trebach 0:46:11 Case 1: Two British medical students present to the ED after developing nausea, vomiting, paresthesias, myalgias, pruritus, and cold allodynia 12 hours after sharing a meal. Their neurological symptoms persisted for 4 weeks and the cold allodynia for 10 weeks. 0:54:18 - 1:05:23 Case 2: A 16-year-old female presents to the ED unresponsive and cyanotic after intentionally ingesting a substance purchased online. Her oxygen saturation is in the 70s and a methemoglobin level is greater than 30%. 1:05:25 - 1:10:18 Case 3: A 48-year-old female, and co-author of the published case report, presents to the ED 10 minutes after eating a “peppery” tuna steak. She is tachycardic, hypotensive, flushed, and has conjunctival erythema. She also experiences abdominal pain, nausea, vomiting, diarrhea, headache, and chest pain. Her EKG shows tachycardia with ST depression. She requires phenylephrine to maintain her blood pressure. She is treated with famotidine and discharged from the hospital 43 hours later. 1:10:20 – 1:13:16 Case 4: A 63-year-old female presents to the ED 12 hours after ingesting five capsules of a weight loss product. She is bradycardic and has nausea, vomiting, and hyperkalemia.
Episode 17, November 9th, 2022: Dr. Emily Kieran 1:16:35 Case 1: A 34-year-old female presents to a clinic in West Bengal, India, with a three-year history of skin changes. She has hypo-pigmented macules on a background of hyperpigmentation, creating a “raindrop” like appearance on her chest, hands, and soles. 1:19:17 Case 2: An 85-year-old male with a history of Alzheimer’s dementia, COPD, and depression calls 911 for symptomatic hypoglycemia and goes into cardiac arrest after EMS mistakenly administers an unknown substance instead of dextrose 10% (D10). He is asystolic upon arrival to the ED, but achieves return of spontaneous circulatio
More from The Poison Lab
A quick Poison Lab update: new episodes are in the works, including a forthcoming NACCT research episode—though Ryan is briefly buried under mushroom-poisoning programming, NACCT, travel, and the start of a new academic year. In the meantime, revisit the back catalog, including outbreak episodes, Toxicologists Versus the Internet, and favorites such as “Should We Give Naloxone in Cardiac Arrest?” and “Leafy Greens and Injured Beans: Nature’s Nephrotoxins.” As a bonus, this episode includes Ryan’s interview with the podcast from the journal Addiction, discussing his recent study on kratom regulation and medical outcomes. For a more informal companion conversation, check out the “Co-Broadcast with the Kratom Sobriety Podcast” episode. A Morel Dilemma Support the show Review the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game
After weeks of investigation, the Bozeman outbreak is contained, but the questions it raised are much harder to close. In the final episode of A Morel Dilemma, we return to Montana to understand how investigators traced the mushrooms, looked for additional cases, communicated risk to the public, and worked to prevent another outbreak. But the ending is not as simple as naming a culprit. Morels have now been linked to severe illness and death, yet we still do not know the toxin, why some people are more vulnerable, or exactly how much cooking is enough. Episode 7 brings the story back to what matters most: what we know, what we still do not know, and what has to happen next so this does not happen again. A Morel Dilemma Support the show Review the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game
When someone eats a mushroom and starts to feel sick, the first instinct is often to figure out exactly what mushroom it was. But mushroom identification is harder, riskier, and more specialized than most people realize. In this bonus episode of A Morel Dilemma, we look at what actually happens after a possible mushroom exposure: who to call, why online apps and social media can be dangerous, and how poison centers work with trained mycologists and mushroom identification experts when the stakes are high. Because in a mushroom emergency, the answer is not to keep scrolling. It is to call the Poison Center at 1-800-222-1222.
The Bozeman outbreak was the first loud signal, but it was not the only one. After the CDC report, toxicologists in other countries started looking back through their own poison center data and found something unsettling: more patients with severe illness after eating morels, including cases of shock, gastrointestinal bleeding, and death. And it did not stop there. In Episode 6 of A Morel Dilemma, we follow that signal beyond Montana and ask whether this was truly an isolated outbreak, or whether morels have been causing severe poisonings for years without anyone recognizing the pattern. We also meet the researchers now trying to answer the harder question: if morels are responsible, what exactly is happening inside this mushroom? The mystery is no longer confined to one restaurant. It is starting to spread. Select referecnces: Dr. Vodovar's Study Swiss Poison Center Study Peter Dayton
Hey everyone, it’s Ryan. I know many of you are patiently waiting for Episode 6 of A Morel Dilemma, and it is coming next week. I genuinely cannot wait for you to hear this one. But it is actually available right now for supporter members. You can go to www.thepoisonlab.com/support and get every single episode right now for as little as $1 a month. And full disclosure, I only get about half of that. It does not go to profit. It just helps repay some of the very real costs of making this show: the interviews, editing, sound design, hosting, and the absurd amount of time that went into producing it. So if you have been enjoying the series, becoming a supporter is an incredible way to help make work like this possible. And if you are already supporting the show, thank you. Truly. It helps more than you know. And for everyone else listening, thank you for being here and for sharing the series. But for today, I wanted to give everyone a small glimpse into the supporter bonus episodes that have been available to members throughout the series. See the episode here https://the-poison-lab.captivate.fm/episode/a-morel-dilemma-preview-supporting-member-bonus-episodes A Morel Dilemma Support the show Review the show where ever your listening Get Messages from Toxo (Join the Newsletter!) Join as a supporting member Ad free episodes Bonus content and early access Discounts and give aways on GOTA PICCEM Mushroom card game