The Toxicology Investigators Consortium Case Registry-the 2016 Experience.

The Toxicology Investigators Consortium (ToxIC) Case Registry was established by the American College of Medical Toxicology in 2010. The Registry contains data from participating sites with the agreement that all bedside medical toxicology consultations will be entered. Currently, 83% of accredited medical toxicology fellowship programs in the USA participate. The Registry continues to grow each year, and as of 31 December 2016, a new milestone was reached, with more than 50,000 cases reported since its inception. The objective of this seventh annual report is to summarize the Registry\u27s 2016 data and activity with its additional 8529 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from 1 January to 31 December 2016. Detailed data was collected from these cases and aggregated to provide information which includes the following: demographics (age, gender, race, ethnicity, HIV status), reason for medical toxicology evaluation (intentional pharmaceutical exposure, envenomation, withdrawal from a substance), agent and agent class, clinical signs and symptoms (vital sign abnormalities, organ system dysfunction), treatments and antidotes administered, fatality and life support withdrawal data. Fifty percent of cases involved females, and adults aged 19-65 were the most commonly reported. There were 86 patients (1.0%) with HIV-positive status known. Non-opioid analgesics were the most commonly reported agent class, with acetaminophen the most common agent reported. There were 126 fatalities reported in 2016 (1.5% of cases). Major trends in demographics and exposure characteristics remained similar overall with past years\u27 reports. While treatment interventions were commonly required, fatalities were rare

Correction to: The Toxicology Investigators Consortium Case Registry-The 2017 Annual Report.

Please note the Collaborators for this article listed in the Acknowledgements

Prolonged infusion of flumazenil for the reversal of sedation from chlordiazepoxide: a case report

A continuous infusion of flumazenil may be needed to mitigate prolonged sedation from benzodiazepines. Some benzodiazepines have extended durations of action. We describe a cirrhotic patient who was on an infusion of flumazenil for 37 days due to prolonged sedation from chlordiazepoxide. An 80-year-old man with alcohol use disorder and cirrhosis presented to the emergency department for abdominal distention and was admitted for management of ascites. On hospital day (HD) 2, he developed alcohol withdrawal, for which he received 350 mg of chlordiazepoxide over 48 h. Without receiving further sedatives, the patient remained deeply sedated. A bolus dose of flumazenil on HD 18 improved his mental status, allowing him to follow commands. A flumazenil infusion was started on HD 18. Serum chlordiazepoxide and nordiazepam concentrations were 230 ng/mL and 265 ng/mL, respectively, on hospital day 21, despite no additional doses since HD 4. The infusion was stopped 37 days after initiation (HD 55) and the patient was discharged on HD 76 to subacute rehabilitation. Patients with cirrhosis may develop prolonged sedation from chlordiazepoxide. This patient had detectable metabolites of chlordiazepoxide weeks after his last dose, which was associated with prolonged sedation managed with flumazenil infusion

The Toxicology Investigators Consortium Case Registry-the 2019 Annual Report.

The Toxicology Investigators Consortium (ToxIC) Registry was established by the American College of Medical Toxicology (ACMT) in 2010. The Registry collects data from participating sites with the agreement that all bedside medical toxicology consultation will be entered. This tenth annual report summarizes the Registry\u27s 2019 data and activity with its additional 7177 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from 1 January to 31 December 2019. Detailed data was collected from these cases and aggregated to provide information which included demographics, reason for medical toxicology evaluation, agent and agent class, clinical signs and symptoms, treatments and antidotes administered, mortality, and whether life support was withdrawn. 50.7% of cases were female, 48.5% were male, and 0.8% were transgender. Non-opioid analgesics was the most commonly reported agent class, followed by opioid and antidepressant classes. Acetaminophen was once again the most common agent reported. There were 91 fatalities, comprising 1.3% of all Registry cases. Major trends in demographics and exposure characteristics remained similar to past years\u27 reports. Sub-analyses were conducted to describe exposures in cases of self-harm, gender differences in substance use disorder, and trends in addiction medicine and pain management consultations