This week on The Tox Lab, we’re closing out the year with a festive twist as we explore the link between marzipan, bitter almonds, and cyanide.
We take a closer look at the chemistry linking cyanide to almonds and discuss a case of intentional bitter almond ingestion. We then turn to National Poisons Information Service data to examine patterns of cyanide exposure, clinical outcomes, and the antidotes used in management.
To round off the episode, we dip into the archives with a historical case report describing thallium poisoning linked to contaminated marzipan, reminding us that even festive treats can carry hidden toxicological risks.
Join us for a seasonal deep dive into poisons, cases, and chemistry as we wrap up the year on a sweet but slightly sinister note.
Hope you enjoy!
We're taking a little break over the festive season but will be back with a brand new episode on the 5th January!
Links to the papers we discussed:
https://onlinelibrary.wiley.com/doi/10.1002/ccr3.8418
https://www.tandfonline.com/doi/full/10.1080/15563650.2022.2080074
https://www.tandfonline.com/doi/abs/10.3109/15563659409017979
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re taking a closer look at serotonin and its intriguing role in both depression and epilepsy.
We review recent data examining the seizure risk associated with different classes of antidepressants and what this means for clinical decision making. We then explore a case report in which sertraline, an SSRI, appeared to have an anti-seizure effect, challenging some long-held assumptions. Finally, we discuss emerging evidence on the potential use of serotonergic therapies in epilepsy management and even in reducing the risk of SUDEP.
Join us as we unravel the complex relationship between serotonin, antidepressants, and seizure disorders, and what this evolving evidence could mean for patient care.
Hope you enjoy!
Links to the papers we discussed:
https://www.sciencedirect.com/science/article/pii/S0165032725005853?via%3Dihub
https://www.seizure-journal.com/article/S1059-1311(20)30145-X/fulltext
https://pmc.ncbi.nlm.nih.gov/articles/PMC8478129/
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we are examining the growing evidence around cannabis and cardiovascular risk.
We start with a recent systematic review and meta-analysis that explores whether cannabis use is linked to higher rates of cardiovascular disease. We break down the strength of the data and discuss what the current evidence can and cannot tell us.
We then move onto research investigating how THC and its metabolites affect cardiac myocyte structure and function. These findings offer a possible mechanistic explanation for cardiac dysregulation and may help connect population-level associations with cellular effects.
Join us as we unpack the toxicology, the uncertainties, and what this emerging research means for clinicians, researchers, and anyone interested in the evolving science of cannabis and heart health.
Hope you enjoy!
Links to the papers we discussed:
https://heart.bmj.com/content/111/22/1047.long
https://www.ahajournals.org/doi/10.1161/JAHA.123.030178
https://pmc.ncbi.nlm.nih.gov/articles/PMC8835806/pdf/ijms-23-01401.pdf
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re diving into the emerging world of “space oil”, the anesthetic drug etomidate, which has begun appearing in the recreational drug supply across parts of Asia and beyond.
We explore several cases involving etomidate vaping, where repeated exposure led to adrenal insufficiency due to its potent inhibition of 11β-hydroxylase. We also discuss a fatal ingestion case, highlighting just how dangerous this drug can become when used outside controlled medical settings.
Etomidate’s presence isn’t limited to Asia: it has recently been detected alongside fentanyl in Philadelphia and identified in a handful of UK seizures, raising important questions about its evolving role in the illicit drug market. With emerging analogues starting to surface, the landscape may become even more complex.
Join us as we unpack the pharmacology, the clinical consequences, and why etomidate is now a substance toxicologists are watching closely.
Hope you enjoy!
Links to the papers we discussed:
https://www.hkmj.org/system/files/hkmj2412244.pdf
https://link.springer.com/article/10.1007/s12024-024-00813-8
https://hip.phila.gov/document/4686/PDPH-HAN-429U-Etomidate-08.12.2024-1.pdf/
https://www.gov.uk/government/publications/acmd-review-of-the-evidence-on-the-use-and-harms-of-etomidate
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re taking a closer look at organophosphates, a diverse group of compounds used everywhere from agriculture to chemical warfare.
We walk through two real-world poisoning cases: an accidental exposure from a head lice treatment and an intentional ingestion of phorate, illustrating just how wide the spectrum of organophosphate toxicity can be. Along the way, we break down their mechanism of action, why their effects can be so severe, and the key treatment approaches clinicians depend on.
We also revisit the Salisbury poisonings, exploring the devastating impact of organophosphate nerve agents and the wider implications for public health and emergency response.
Join us as we unpack the chemistry, the clinical realities, and the far-reaching consequences of these powerful compounds.
Hope you enjoy!
Links to the papers we discussed:
https://academic.oup.com/jat/advance-article-abstract/doi/10.1093/jat/bkaf096/8300174?redirectedFrom=fulltext
https://www.frontiersin.org/journals/toxicology/articles/10.3389/ftox.2025.1581362/full
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re exploring a series of fascinating and unusual poisoning cases, each with its own toxic twist.
From hair straightening treatments and bearded fireworms to midodrine, isotocyanozene, and sodium azide, we discuss the mechanisms, clinical presentations, and toxicological challenges behind each case.
Join us as we unpack what these cases reveal about the diverse and sometimes surprising ways that chemicals and compounds can cause harm.
Hope you enjoy!
Links to the papers we discussed:
https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2577706?src=
https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2541702
https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2546073
https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2528995
https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2528990
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re turning our attention inward to errors in toxicology.
From calibration and maintenance mistakes to reporting issues and even instances of fraud, we unpack how things can go wrong in the analytical process and what that means for the credibility of our field.
We explore the real-world consequences of these errors and most importantly, what we can learn from them to strengthen toxicology as a discipline.
Join us for a candid look at accuracy, accountability, and the human side of science.
Hope you enjoy!
Link to the paper we discussed:
https://www.sciencedirect.com/science/article/pii/S2589871X25000580
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re discussing brorphine — a novel synthetic opioid that briefly appeared on the drug market around 2020.
We explore its emergence and pharmacology, including data on its activity at the µ-opioid receptor. We also discuss one of the few documented case studies describing an individual presenting for detoxification following brorphine use. Finally, we review recent research examining its in vitro and in vivo metabolites, highlighting how these findings may offer new ways to detect this short-lived substance.
Although brorphine is now under international control, could other “orphine” analogues step into the spotlight, potentially replacing nitazenes as the next wave of synthetic opioids?
Join us as we unpack the chemistry, the risks, and what the story of brorphine reveals about the constantly shifting landscape of synthetic opioids.
Hope you enjoy!
Links to the papers we discussed:
https://academic.oup.com/jat/article-abstract/44/9/937/5879253?login=false
https://www.sciencedirect.com/science/article/abs/pii/S0379073821003091?via%3Dihub
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re celebrating our 50th episode — and one whole year of toxicology talk! 🎉
Join us as we look back on some of our most memorable moments from the past year, revisit a few topics with new updates, and share what’s next for The Tox Lab.
Whether you’ve been here since episode one or you’re just joining us, thank you for being part of our growing community of toxicologists, scientists, and curious listeners. Here’s to another year of exploring the science behind the substances!
Hope you enjoy!
Link to ketamine paper we mentioned:
https://journals.sagepub.com/doi/10.1177/02698811251373058
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re revisiting one of history’s most infamous poisons — arsenic.
Once dubbed the king of poisons, arsenic still poses real risks today. We discuss recent research on arsenic in the water supply and how prenatal exposure may influence birth outcomes in the United States. We also review two unusual cases of intentional elemental arsenic ingestion, exploring the unexpected clinical effects observed, along with a case of chronic arsenic toxicity.
Join us as we uncover how this Victorian-era poison continues to challenge toxicologists in the modern world.
Hope you enjoy!
Links to the papers we discussed:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2835321
https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2496223
https://link.springer.com/article/10.1007/s12328-024-02045-3
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re embracing autumn and diving into the fascinating, and sometimes dangerous, world of mushrooms.
We explore ten years of mushroom exposure data reported to the UK National Poisons Information Service, examining the species most often involved and the mechanisms behind their toxicity. We also take a look at commercial products containing mushrooms and discuss a paper showing that some may not always contain what they claim.
Join us as we unpack the science, the surprises, and the toxicology of mushrooms this autumn.
Hope you enjoy!
Links to papers we discussed:
https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2507357
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2838765
https://www.health.nsw.gov.au/sabs/Documents/2024-sn-015.pdf
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re taking a closer look at clozapine, a highly effective antipsychotic with a complex toxicological profile.
We review a study from Western Sydney examining cases of self-poisoning and adverse drug reactions, discuss a case of chronic clozapine toxicity, and explore new research into its effects on cardiac mitochondria.
From clinical outcomes to cellular mechanisms, we unpack the risks, challenges, and unanswered questions around this fascinating but unpredictable drug.
Hope you enjoy!
Links to the papers we discussed:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10522536/
https://pmc.ncbi.nlm.nih.gov/articles/PMC11954577/
https://www.sciencedirect.com/science/article/pii/S2214750025001088?via%3Dihub
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re discussing medetomidine and its unexpected association with hallucinations.
We review a recent paper highlighting its emergence in the drug supply and the apparent increase in hallucinatory effects reported with its use. Although medetomidine has been linked to reducing post-operative delirium, we also discuss a case report of dexmedetomidine-induced delirium in a patient with schizophrenia — adding to the complexity of this picture. And yes, we even wonder what dogs might be dreaming about when they come round from their vet visit.
We then explore a possible mechanism for these effects, including the hypothesis that activity at the kappa opioid receptor could play a role.
We'd love to hear your thoughts on this, so please get in touch!
Hope you enjoy!
Links to the papers we discussed:
https://onlinelibrary.wiley.com/doi/10.1111/dar.70024
https://pmc.ncbi.nlm.nih.gov/articles/PMC11312422/
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re taking a closer look at diphenidine and other diarylethylamines — a class of drugs that briefly emerged as alternatives to ketamine.
We explore their history, reported effects, and the fatalities linked to their use before they faded from the drug scene.
With current discussions around reclassifying ketamine, we ask: could diphenidine — or similar substances — make a comeback?
Join us as we unpack the toxicology, the risks, and the lessons from their short but impactful appearance.
Hope you enjoy!
Link to the paper we discussed:
https://journals.sagepub.com/doi/10.1177/02698811251349203?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re diving into the world of GLP-1 receptor agonists, including the well-known weight loss drug Ozempic.
We explore how these drugs work and their potential benefits beyond weight loss, including effects on heart health. We then discuss a case of intentional Ozempic overdose, examining the clinical presentation and outcomes.
Finally, we turn to the growing problem of counterfeit Ozempic — exploring what’s really in these fake products, why people are taking the risk, and the dangers this trend poses for public health.
Join us as we unpack both the promise and the pitfalls of this so-called “miracle” drug.
Hope you enjoy!
Links to the papers we discussed:
https://journals.lww.com/practicalpsychiatry/abstract/2024/11000/clinical_manifestations_of_semaglutide_overdose__a.10.aspx
https://jamanetwork.com/journals/jama/article-abstract/2821502
https://www.bmj.com/content/383/bmj.p2506.full
https://pmc.ncbi.nlm.nih.gov/articles/PMC10739421/
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re shaking things up with a case-based mystery episode.
We walk through four real-life poisoning cases, starting with how each patient presented and progressed, before revealing the substance behind the toxic effects.
Can you solve the puzzle before we uncover the cause?
If you like this style of episode, let us know in the comments below!
Hope you enjoy!
⚠️ Spoiler alert!
Links to the papers we discussed:
A case of glitter poisoning: https://www.thepoisonjournal.com/articles/severe-glitter-poisoning-case-report
Snake firework ingestion: https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2474563
Mass Aconite poisoning:https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2526115 - Don't forget to check out The Poison Lab podcast for a deep dive into this case!
A case of bromism ingestion after AI advice: https://www.acpjournals.org/doi/10.7326/aimcc.2024.1260
Editor’s note: Yes, we mixed up “chloride” with “chlorine” and “bromide” with “bromine.” If you do the same, don’t worry — we’ll cover your case in a future episode.
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re talking about 2C-B and “Tusi” — two drugs often confused, but very different in composition and effects.
We explore Dutch Poison Information Centre data on 2C-B, examining reported exposures and the spectrum of effects across low, moderate, and high doses. We then turn to casework from the Miami-Dade Medical Examiner Toxicology Laboratory to look at “Tusi” (also known as Tucibi or pink cocaine), discussing what’s actually found in these samples and what this means for interpretation.
Join us as we untangle the realities behind these two commonly misunderstood substances.
Hope you enjoy!
Links to the papers we discussed:
https://www.sciencedirect.com/science/article/abs/pii/S019606442030278X#:~:text=Conclusion,addition%20to%20mild%20somatic%20effects
https://onlinelibrary.wiley.com/doi/epdf/10.1111/1556-4029.70012
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re taking a closer look at ibogaine — a plant-derived alkaloid attracting interest as a potential treatment for addiction.
We discuss a study from New Zealand exploring its use in opioid dependence, while also highlighting the serious risks reported in case studies, including severe cardiotoxicity. We then turn to National Poisons Information Service data to examine recent trends in ibogaine use in the UK.
Can the therapeutic potential of ibogaine ever outweigh its dangers? Join us as we unpack the evidence, the risks, and the unanswered questions around this compound.
Hope you enjoy!
Link to the papers we discussed:
https://www.tandfonline.com/doi/10.1080/00952990.2017.1310218?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
https://www.tandfonline.com/doi/full/10.1080/15563650.2024.2447500#:~:text=Our%20cases%20are%20consistent%20with,of%20cardiac%20output%20and%20arrest
https://onlinelibrary.wiley.com/doi/full/10.1002/joa3.12061
https://erowid.org/experiences/exp.php?ID=63089
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re diving into the surprising sides of nicotine.
Beyond its well-known risks, we explore how nicotine might have therapeutic potential in conditions like schizophrenia and dementia—where deficits in nicotinic acetylcholine receptors could play a role. We also discuss the MIND study, which is testing whether nicotine can boost memory, attention, and learning in dementia patients.
Then, we turn to the other side of the story—nicotine as a poison—examining U.S. poison centre data on exposures in children, and what trends and outcomes tell us about the risks.
From possible medicine to dangerous toxin, join us as we explore the full spectrum of nicotine’s impact.
Hope you enjoy!
Links to papers we discussed:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9020415/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10854606/
https://clinicaltrials.gov/study/NCT02720445
https://publications.aap.org/pediatrics/article/156/2/e2024070522/202640/Nicotine-Ingestions-Among-Young-Children-2010-2023?autologincheck=redirected
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com
This week on The Tox Lab, we’re taking a closer look at BTMPS.
A compound used as a light stabiliser in plastics, BTMPS unexpectedly surfaced in the U.S. drug supply in the summer of 2024.
We unpack what’s known so far about its emergence, discuss possible reasons for its appearance, and revisit earlier research exploring its activity at nicotinic acetylcholine receptors and signs of cardiotoxicity in animal models.
Join us as we examine what makes this compound so unexpected—and why it’s raising eyebrows in toxicology.
Hope you enjoy!
Links to the papers we discussed:
https://jamanetwork.com/journals/jama/fullarticle/2829939
https://www.sciencedirect.com/science/article/abs/pii/S0376871625002169?via%3Dihub
https://www.cfsre.org/nps-discovery/public-alerts/an-update-on-the-presence-of-btmps-in-the-drug-supply-and-the-discovery-of-tetramethylfentanyl-related-substances#:~:text=in%20April%202025%20and%20since,acquisition%20of%20standard%20reference%20material
https://academic.oup.com/toxsci/article-abstract/77/2/368/1678969?redirectedFrom=fulltext
https://www.sciencedirect.com/science/article/abs/pii/S0028390809003141?casa_token=Fhh1rnqcuBcAAAAA:YpFG5go4VuiD9gW-cpdH1eipRNS6R104T68cuhwSF-wyp7piS8yp_UvpCi3wbreT_M82npMYVrE4
Disclaimer: All opinions are our own.
Find us on instagram: @the_tox_lab
Email us here: thetoxlab@gmail.com