The Toxicology Conundrums are targeted case-based question-&-answer toxicology quiz posts designed to highlight important principles, pitfalls, and ‘tricks of the trade’ for the clinical assessment and management of poisoned and envenomed patients.
The problems are based on cases seen in hospitals in Australia, calls to the Poison Information Centre, as well as a variety of other sources including published books and papers, presentations and toxicology meetings. We hope they will be useful to non-specialists – who may have to see patients in EDs, ICUs and/or remote settings without the benefit of an “on site” toxicology service – as well as the “budding” clinical toxicologist.
The approach used is based on the “The Toxicology Handbook” (by Lindsay Murray, Frank Daly, Mark Little, and Mike Cadogan) – with links to other references where appropriate. Remember if you require urgent assistance with poisoning or envenoming – contact the Australia Poisons Information Service [PIC].
| Conundrum | LITFL Link | Keywords |
|---|---|---|
| 50 | Another TCA Overdose | TCA, amitriptyline, overdose, BCT, tricyclic antidepressant |
| 49 | Alprazoslammed | Alprazolam, OD, BZD, flumazenil |
| 48 | Lithium, Vomiting And Diarrhoea | Lithium, acute OD, |
| 47 | Brain Dead? | quetiapine, Baclofen, Gamma-Hydroxybutyrate (GHB) |
| 46 | A Fumbling, Mumbling Mess | benzodiazepine, toxidrome, anticholinergic, Physostigmine |
| 45 | Paracetamol-induced hepatotoxicity | paracetamol, overdose, hepatotoxicity, liver |
| 44 | Propanolol Overdose | beta blocker, B-blocker, OD, propanolol |
| 43 | Therapeutic Showering | Cannabinoid Hyperemesis Syndrome, showering |
| 42 | A Remorseless Poison | Colchicine, polypharmacy, overdose |
| 41 | A Toxic Slumber | Clonidine |
| 40 | Life in the TOO fast lane? | Bromo-DragonFLY, Mephedrone, Nexus, 2C-B, K2, Spice, Salvia, Naphyrone, NRG-1 |
| 39 | Paralysis and a head lump | Tick |
| 38 | Smoking is deadly | Smoke inhalation, CO, carbon monoxide |
| 37 | Hypoglycemia, but how? | Hypoglycemia |
| 36 | Seafood poisoning | Marine, Seafood poisoning, seafood |
| 35 | Ethylene glycol inebriation | Ethylene glycol, |
| 34 | The toddler with the Iron gut | Iron, pediatric, paediatric |
| 33 | Chloroquine poisoning? | Chloroquine |
| 32 | Corrosive ingestion | Corrosive, Corrosive ingestion |
| 31 | The Antidote Challenge | Antidote |
| 30 | Acute Dystonic Reaction | Dystonia, Acute Dystonic Reaction, OGC |
| 29 | Two pills can kill | paediatric, pediatric, toddler, toxicity, fatal |
| 28 | Verapamil overdose | Verapamil, CCB, calcium channel blocker |
| 27 | The sniff a poison challenge | poison, sniff, smell |
| 26 | Snakebite Envenoming Challenge | Snakebite, snake, Envenoming |
| 25 | Toxidrome Challenge | Toxidrome |
| 24 | Serotonin toxicity | Serotonin toxicity |
| 23 | Toxic Seizures | Seizures, toxicology seizures, Toxic Seizures |
| 22 | Tricyclic antidepressant toxicity | TCA, Tricyclic antidepressant, toxicity, poisoning |
| 21 | Supratherapeutic INR | INR, toxicity, warfarin |
| 20 | Chloral hydrate overdose | Chloral hydrate |
| 19 | Thyroxine overdose | Thyroxine |
| 18 | Necrotic arachnidism? | Necrotic arachnidism, spider, spiderbite |
| 17 | Citalopram overdose | Citalopram, poisoning, overdose |
| 16 | Warfarin deliberate self poisoning | warfarin, DSP, poisoning |
| 15 | Little Johnny and Grandads warfarin | warfarin, overdose, paediatric, pediatric |
| 14 | Theophylline overdose | Theophylline, poisoning, overdose |
| 13 | Lionfish envenoming | Lionfish, marine, envenoming |
| 12 | Stingray envenoming | Stingray, marine, envenoming |
| 11 | It was the little octopus! | BRO, blue ringed octopus, octopus, marine, envenoming |
| 10 | Chironex fleckeri envenoming | Chironex fleckeri, marine, envenoming, box jellyfish, jellyfish |
| 9 | Irukandji Territory-style | Irukandji, Irukandji Syndrome, marine, envenoming, jellyfish |
| 8 | Irukandji Puzzler | Irukandji, Irukandji Syndrome, marine, envenoming, jellyfish |
| 7 | Strychnine poisoning | Strychnine poisoning, Strychnine |
| 6 | Suboxone Poisoning | Suboxone poisoning, Suboxone |
| 5 | Snakebite? | Snakebite, envenoming, snake |
| 4 | Is this a RedBack I see before me? | RBS, Redback, Spider, Redback Spider, envenoming |
| 3 | Bitten by a Redback Spider | RBS, Redback, Spider, Redback Spider, envenoming |
| 2 | Poisoning by a mercury thermometer | mercury, thermometer, poisoning |
| 1 | ParacetamolÛ_ Too much, too often? | Paracetamol, |
"I need help... Someone's stolen my Tox Handbook!"
Toxicology Resources on the Web
Toxinology and Envenoming
| Blue Ringed Octopus | Box Jellyfish (Chironex fleckeri) | ||
| Irukandji |
| BlueBottle | |
| Scorpionfish, Stonefish, Lionfish | Brown Snake |
| |
| RedBack Spider | Snakes |
LITFL Clinical education resources
About Chris Nickson
