In this episode of The Poison Lab, host Ryan Feldman is joined by Dr. Joe Kennedy, medical toxicologist at the University of Vermont and consultant for the Northern New England Poison Center. Together they work through real poisoning cases to sharpen toxic differentials, sum up practical resuscitation priorities, and connect first-principles pharmacology to bedside decisions. They also answer listener questions on THAM vs bicarbonate, when to dialyze even with “normal” kidneys, and why rattlesnake antivenom costs so much—plus the real-world logistics of sourcing exotic antivenoms in the U.S.

Dr. Kennedy and Ryan discuss the topics below. Looking for timestamps? Join the subscribed feed!

• Case set #1: Shock with hyperglycemia, big pupils, and probably NOT what you think it is.
• Case set #2: Massive bleeding after gas-station “herbal” products
• Case set #3: Refractory wide-complex rhythms in a teen overdose
• Case set #4: Sudden collapse at a hog farm- (SPOLIER) Recent outbreak of deaths as related to case 4

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Listener Q&A

• THAM vs bicarbonate (closed vs open buffering; “breathe for bicarb, tinkle for THAM”)
• Why dialyze if the kidneys work? (EXTRIP-style thinking, gradients, and properties)
• Snake antivenom pricing & how zoos help hospitals obtain non-U.S. antivenoms

Call outs from the show

• NACCT Abstracts!
• Clover coagulopathy!
• THAM VS BICARB Electrolytes
• Potato quality video of dialysis from Ryan
• Article on snake antivenom costing >200,000 for one patient
• Article on exotic antivenom procurement
• Case report Ryan published on treating blue Indonesian pit viper

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More Show Resources

• Ryan's Medical Games and Resources

GOTTA PICCEM: The Poisonous Mushroom Card Game

👉 Order now right here OR go to www.gottapiccem.com and click "Buy GOTTA PICCEM"

What started as a nerdy teaching tool made to teach mushroom poisoning by folks who treat mushroom poisoning is now a full-fledged card game—equally great for Friday game night and the classroom.

• 58 Poisonous Mushroom Cards
• Full-color pictures, toxin info, clinical syndromes, key anatomy, U.S. + global distribution, and spore print colors.
• 88 Play Cards + 30 Bonus Cards
• Collect mushrooms, play antidotes and modifiers, stack combos, and score big.
• Toxin-Based Scoring
• Point systems reflect real-world toxicity—every round plays differently based on your hand and bonus cards.
• Endless Replayability
• Rule variants at gottapiccem.com keep things fresh.

Dive into the companion blog at www.gottapiccem.com for:

• Deep-dive toxin explainers for each mushroom
• Case reports & real-world clinical notes
• Controversies and mysteries in mushroom poisoning

📖 Start here: gottapiccem.com (Companion Blog → “Learn the Mushrooms”)

👉 Order now right here OR go to www.gottapiccem.com and click "Buy GOTTA PICCEM"

• Multiple box options (pick your fancy)
• Ships direct from our manufacturer in South Korea
• 🌍 Global availability (shipping costs + tariffs may apply)

P.S. We’re exploring U.S. manufacturing to lower costs and expand distribution—timeline TBD—so we made the game available now.

If you grab a copy:

📸 Snap a photo of your first round

✉️ Send it to toxtalk1@gmail.com or tag @LabPoison / @tox_talk

Nothing would make Ryan happier than seeing the community play!

Listen here (https://www.wpr.org/shows/larry-meiller-show) to hear Ryan Live on AIR for the Larry Meiller show, Thursday July 17th 11:45AM-12:30 PM CST.

Check this "Listen Live" link if your having trouble!