The Poison Lab

In this episode of The Poison Lab, host Ryan Feldman is joined by medical toxicologist Damilola Idowu‑Ellsworth for a fast-moving, case-heavy conversation packed with clinical pearls, listener participation, and classic toxicology weirdness.The show opens with listener guesses for the previously released mystery case before diving headfirst into a rapid-fire series of Stump the Toxicologist cases—questions pulled straight from the internet and real-world toxicology problem-solving. Along the way, Ryan and Dami cover everything from rodenticides and drug-testing myths to how to clean a benzodiazepine bottle, plus one of the most toxic substances you’ve probably never heard of.One lucky listener also wins a copy of Poisonous Fungus Amongus, and a shout-out to the newly released second edition featuring photography from expert mycologists.Skip the listener guesses and jump straight to the mystery toxin: 38:15Mystery toxin caseThe rest of the episode is Dr. Idowu and Ryan discuss the topics below. Looking for timestamps? Join the supporting member feed!Looking for time stamps for the rest of the show? Join as a supporting memberStump the Toxicologist – Case Discussions(Looking for timestamps? Join the supporting member feed!)Case #1 A methemoglobinemia, renal failure inducing enemaCase #2Wide-complex dysrhythmia from an over-the-counter topicalBonus - Paper from Ryan on the topical toxicity (or lack there of) of this productCase #3Black stools, seizures, high sodium and low potassium after trying to beat a drug test.Case #4GCS 15 and normal vitals… until they’re not — delayed seizures, neurologic collapse, and a toxicologic time bomb.Paper from Ryan on this tricky toxic time bombInternet & Listener QuestionsDo GLP-1 agonists release toxins from fat and how might that impact drugged driving laws with THC?Why do sedatives make you twitch?Not all benzos are XanaxWhat shape is a ketamine crystalSupport the showReview the show where ever your listeningGet Messages from Toxo (Join the Newsletter!)Join as a supporting memberAd free episodesBonus content and early accessDiscounts and give aways on GOTA PICCEM Mushroom card gameThe GOTTA PICCEM Poisonous Mushroom Game!The Poisonus Fungus Amongus Children's Book!Full book reading (6 minutes!)Tox trinkets (Rep the show at home!)Reach the showEmail: [email protected] Show ResourcesRyan's Medical Games and ResourcesShow Website

Hey everybody, you’re listening to The Poison Lab—well, almost.We’ve got a new episode coming next week, but we’re running a little behind on our usual release schedule because… life happens. That said, if you’re looking for some toxicology content right now, I’ve got you covered.Recently, I had the chance to appear on two local and state radio shows talking about one of my favorite topics: mushroom poisoning 🍄—and both were an absolute blast.🌱 Garden Talk (Call-In Episode) (Ryan starts @ 1 hour and 14 min)The first appearance was on Garden Talk, a fun, live call-in show where we covered:Mushroom poisoning basicsListener questionsMy game GOTTA PICCEMThe book Poisonous Fungus Among UsIt was lively, unpredictable, and a great example of how curious people are about mushrooms once you open the door.📻 Local Health Update Radio SegmentAfter that, I joined a local radio health update to talk specifically about mushroom poisoning from a public-health perspective. It’s always interesting to hear how radio hosts approach such a niche topic—and how quickly it turns into something broadly relevant.🔬 Want a Quick Toxicology Fix?If you’re itching for some Poison Lab content while you wait for the next full episode, these two appearances are a great place to start.And don’t worry—we’ll be back next week with a full episode and answers to our mystery case.Thanks, as always, for listening.Hope to see you there.— Ryan

Do you think you know the cause of these symptoms? Send your guesses to [email protected] to take part in the next episodeSupport the showReview the show where ever your listeningGet Messages from Toxo (Join the Newsletter!)Join as a supporting memberAd free episodesBonus content and early accessDiscounts and give aways on GOTA PICCEM Mushroom card gameThe GOTTA PICCEM Poisonous Mushroom Game!The Poisonus Fungus Amongus Children's Book!Full book reading (6 minutes!)Tox trinkets (Rep the show at home!)Reach the showEmail: [email protected] Show ResourcesRyan's Medical Games and ResourcesShow Website

In November 2022, hospitals across Australia began seeing patients with sudden rigidity, spasms, seizures—and in some cases cardiac arrest—after drinking homemade poppy seed tea. The source? Food-shelf poppy seeds contaminated with extraordinarily high levels of thebaine, an opioid alkaloid that acts nothing like morphine. In this Outbreak episode, host Ryan Feldman, clinical toxicologist and emergency medicine pharmacist, investigates how pharmaceutical-grade, thebaine-rich poppy seeds were mistakenly repackaged into the food supply—and how poison centers, clinicians, labs, and public health teams traced and contained the threat within days.You’ll hear firsthand from the experts who responded:Dr. Katherine Isoardi, Emergency Physician, Clinical Toxicologist, Medical Director, Queensland Poisons Information CentreDr. Amanda Holford, Clinical Toxicology Fellow & Emergency Physician, Princess Alexandra HospitalDr. Darren Roberts, Medical Director, NSW Poisons Information Centre; Nephrologist; Clinical PharmacologistTogether, they walk us through the outbreak timeline—from the first ICU cases and puzzling “strych­nine-like” neuroexcitation to the multi-state investigation, product recall, and lessons for future foodborne poisonings.Looking for timestamps?A fully timestamped version—so you can jump to any topic—is available to our supporting members.💡 Key topics:Clinical presentation of thebaine toxicity (rigidity, spasms, seizures, metabolic acidosis) and how it differs from classic opioid effectsWhy thebaine behaves like a glycine receptor antagonist (strych­nine-like) rather than a sedating mu agonistHow early-warning networks (e.g., PRISE in NSW; EDNA in QLD), poison centers, and forensic labs coordinated a rapid responsePublic health trace-back: mislabeled/repacked pharmaceutical poppy seeds entering the food supply; national recallsPractical ED management pearls (benzodiazepines, airway/ICU support; recognizing recurrent symptoms) and communication pitfalls during mass poisonings📍 Resources & Mentions:Dr. Isoardi led case series on thebaine-contaminated poppy seeds (Queensland Health, NSW Health)Dr. Roberts led kinetics study on thebainePrior Poison Lab Outbreak episode: Markham Aconite Poisoning🎧 Listen now: www.ThePoisonLab.com💬 Have thoughts or questions?Instagram @tox_talk • Twitter @LabPoison • Email [email protected]: The Poison Lab is for educational purposes only and does not provide medical advice. If you suspect a poisoning, contact your local poison center. In the U.S., call 1-800-222-1222.Support the showReview the show where ever your listeningGet Messages from Toxo (Join the Newsletter!)Join as a supporting memberAd free episodesBonus content and early accessDiscounts and give aways on GOTA PICCEM Mushroom card gameThe GOTTA PICCEM Poisonous Mushroom Game!The Poisonus Fungus Amongus Children's Book!Full book reading (6 minutes!)Tox trinkets (Rep the show at home!)Reach the showEmail: [email protected] Show ResourcesRyan's Medical Games and ResourcesShow Website

Get your copy here! https://a.co/d/8QUBmQyWant to hear it with insights from the author?:  • Poisonous Fungus Among Us | Full Children’...  Don't have time for the full thing: check the highlights: • Poisonous Fungus Amongus Highlights Reel  Want a clearer picture: Full reading large scale here: • Poisonous Fungus Amongus- Children's Book ...  From the mind of a toxicologist who treats real mushroom poisonings alongside doctors and poison centers comes Poisonous Fungus Amongus—a playful, rhyming adventure into the fascinating world of poisonous mushrooms!Inside, readers will find a colorful introduction to mushroom anatomy and ecology—learning the parts of a mushroom and discovering helpful hints for safe foraging and identifying dangerous look-alikes. Every species featured in these pages is a real poisonous mushroom, brought to life through vivid illustrations and engaging verse.This beautifully illustrated book goes beyond the basics, exploring how mushrooms grow, reproduce, and take shape in nature—from tiny spores to sprawling mycelium to the fruiting bodies we find in forests and fields.Through rhymes and clear explanations, readers learn to recognize essential mushroom features—caps, gills, pores, rings, bulbs (volvas), veils, warts, scales, spore prints, and gill types like free, adnate, and decurrent. Each detail helps distinguish the edible from the toxic—and shows how some features can fool us!The story encourages safe and curious observation: note each feature, dig gently to look for bulbs, observe nearby trees and seasons, and check for bruising or color changes. Along the way, readers also discover fungi’s hidden ecological roles, from tree-nurturing mycorrhizae to the saprotrophs that recycle the forest floor.With rhythm, rhyme, and a spark of scientific wonder, Poisonous Fungus Amongus blends accuracy with imagination—inviting kids and adults alike to explore and respect the natural world, while learning that curiosity and caution must always grow together when it comes to mushrooms.Perfect for young readers, nature lovers, teachers, and families who want to explore the mysterious and magical world of fungi!Support the showReview the show where ever your listeningGet Messages from Toxo (Join the Newsletter!)Join as a supporting memberAd free episodesBonus content and early accessDiscounts and give aways on GOTA PICCEM Mushroom card gameThe GOTTA PICCEM Poisonous Mushroom Game!The Poisonus Fungus Amongus Children's Book!Full book reading (6 minutes!)Tox trinkets (Rep the show at home!)Reach the showEmail: [email protected] Show ResourcesRyan's Medical Games and ResourcesShow Website

Show NotesIn this special live episode from the 2025 North American Congress of Clinical Toxicology (NACCT), Ryan takes you inside the conference to hear directly from the researchers themselves. Covering 11 abstracts that span high-stakes management decisions, surprising case reports, and challenges to toxicology dogma, this year’s highlights feature everything from amlodipine overdoses to naturopathic misadventures, metformin-associated blindness, and more. The show kicks off with a foreword from Ryan and Dr. Jon Cole (abstract co-chair for AACT) discussing some of their favorite research from the conference. If you couldn’t make it to NACCT or just want to catch up on some of the most impactful new research in our field, this episode will give you a front-row seat. Check below for links to the published abstracts, the full list of studies discussed, and timestamps for where you can hear each one.Link to published abstract manuscriptForeword with Dr. Jon Cole 10:43 #7. Is beta blocker toxicity associated with hypoglycemia?Lead author: Dr. Megan Audette, MD18:17 #237. V-A ECMO as a treatment for vasoplegic shock in amlodipine poisoning: a comparisonLead author: Dr. Daniel Tirado, MD27:59 #247. Blocked but not beaten: ECMO’s role in severe amlodipine toxicity – a poison center case seriesLead author: Dr. Carlos Saldarriaga, MD28:18 #26. Amlodipine double-dose therapeutic errors reported to Poison CentersLead author: Johanne Freeman30:38 #27. Dosing on the edge: unpacking inadvertent amlodipine ingestions reported to a single poison centerLead author: Dr. Tiana Patriarca, PharmD34:03 #292. Intravenous administration of sodium zirconium cyclosilicate resulting in deathLead author: Dr. Stephen Thornton, MD Researcher interviews44:16 – #21. Quantitative analysis of amlodipine removal by plasmapheresisGuest: Dr. Keahi Horowitz, MD – Acute and Intensive Care Research Award winner48:33– #23. Relationship between reported ingestion dose and outcome in amlodipine poisoningGuest: Dr. Colleen Cowdery, MD51:37 – #24. Management of severe amlodipine toxicity with high-dose calcium aloneGuest: Dr. Vincent Ma, MDHigh dose norepinephrine in amlodipine overdose Case report of calcium death 56:56– #70. Iatrogenic exposure to long-acting buprenorphine injectable in an opioid-naïve patientGuest: Dr. Conor Young, MD01:00:11 – #182. Left in the dark: a case of blindness in the setting of metformin toxicityGuest: Dr. Madison Bombard, MD01:12:11 – #169. Just because it’s natural doesn’t mean it’s safe: a case of pediatric toxicity from topical and herbal remediesGuest: Dr. Aria Darling, MD01:04:31 – #203. Serotonin syndrome after vaping MoocahGuest: Dr. Connor Murphy, MD01:07:06 – #307. Intravenous ozone autohemotherapy: a retrospective observational case seriesGuest: Nicole McLarty 01:11:25 – #134. Do they really need n-acetylcysteine? Exploratory analysis of outcomes in patients with elevated liver function tests but no detectable acetaminophenGuest: Dr. Seth Carroll, PharmD01:15:33 – #130. Outcomes of acute acetaminophen-poisoned patients treated with and without fomepizole: a Toxic registry studyGuest: Dr. Jordan Woollum, PharmD01:21:23 – #295. Evaluation of onset and resolution of complications after chronic methotrexate poisoningGuest: Dr. Van Quach, PharmD01:24:51 – #325. Implications of potassium in salicylate toxicity treated with urinary alkalinizationGuest: Dr. Andrew Yetka, PharmDBonus ContentStick around to the very end of the episode for a teaser of Stump the Tox and the brand-new game Tox Wavelength, recorded on the train to NACCT. The full episode is available now for supporting members.Support the showReview the show where ever your listeningGet Messages from Toxo (Join the Newsletter!)Join as a supporting memberAd free episodesBonus content and early accessDiscounts and give aways on GOTA PICCEM Mushroom card gameThe GOTTA PICCEM Poisonous Mushroom Game!The Poisonus Fungus Amongus Children's Book!Full book reading (6 minutes!)Tox trinkets (Rep the show at home!)Reach the showEmail: [email protected] Show ResourcesRyan's Medical Games and ResourcesShow Website