In this episode of The Poison Lab, host Ryan Feldman is joined by Dr. Amy Zosel, a medical toxicologist, emergency physician, and educator. Together, they use real poisoning cases to practice identifying toxins and flexing their toxic differential The conversation dives into intriguing and challenging toxicology cases, with a focus on educating listeners about real-world poisoning scenarios, myth-busting internet misinformation, and providing practical clinical insights.

Mini episode with Dr. Robert Bassett on Remembering Poisonous Mushrooms

Dr. Zosel and Ryan discuss:

14:15 Case 1

33:04 Case 2

• News story

37:00 Case 3

• New story

48:00 Case 4

• News story
• US outbreak

"Robocough"

Study about Naloxone in Clonidine overdose

Below this will be key takeaways regarding managing the poisonings discussed, it may ruin your experience if you are guessing the poisons

Key Takeaways:

• Amatoxin Mushroom Poisoning: The classic delayed onset of severe GI symptoms, followed by a latent phase, can mask progressive liver damage. Early recognition and treatment with hydration, silibinin, and possible liver transplant are critical.
• Tetramine Toxicity: Known for causing refractory seizures, tetramine is a rare but serious poisoning often requiring aggressive supportive care and anticonvulsants.

A Lethal mushroom hiding in edible mushrooms

Mushroom foraging danger

Resources Mentioned:

• National Poison Control Hotline: 1-800-222-1222
• National Suicide Prevention Lifeline: 1-800-273-8255
• SAMHSA Free Helpline: 1-800-662-HELP (4357)

Follow The Poison Lab:

• Twitter: @LabPoison
• Instagram: @tox_talk
• Website: www.ThePoisonLab.com

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The GOTTA PICCEM Poisonous Mushroom Game Landing Page!

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If you are looking for links to Dr. Basset's initiatives check back later, they are not fully launched yet!

Check it out on Dr. Hamilton's website as well

Poison Mushrooms! Got’a Pic’em (GOTAAPPICEM) A mnemonic device to sort through mushroom ingestions – The Hot Stove League of EM/Tox

The GOTAA PPICCEM Mnemonic

Late-Onset (Severe) Toxic Mushrooms ("GOTA")

These mushrooms have delayed symptoms (>6 hours) and are associated with significant toxicity:

G – Gyromitrin (Gyromitra esculenta) – False morels; inhibits GABA, leading to seizures.

O – Orellanine (Cortinarius spp.) – Causes renal failure; famously poisoned The Horse Whisperer author.

T – Tricholoma equestre (Man on Horseback) – Leads to rhabdomyolysis.

A – Amatoxin (Amanita phalloides, Galerina spp.) – Causes liver failure; the most lethal mushroom toxicity.

Early Onset Nausea, Late Toxicity Mushrooms ("A²P²")

A² – Allenic norleucine (Amanita smithiana) – Found in the Pacific Northwest; early GI symptoms followed by renal failure.

These may present early but still cause significant toxicity.

P² – Paxillus spp. – Can cause hemolytic anemia and multi-organ injury.

Early-Onset Nausea Mushrooms ("PICCEM")

P– Psilocybin (Psilocybe spp.) – Hallucinogenic, similar to LSD, typically low toxicity but may cause hyperthermia or seizures.

Symptoms appear within 6 hours and are usually self-limited.

I – Ibotenic Acid & Muscimol (Amanita muscaria, Amanita pantherina) – Acts like a “mushroom speedball”, causing both stimulant and sedative effects.

C – Coprine (Coprinus spp., Inky Caps) – Induces disulfiram-like reaction with alcohol.

E – Emetic Mushrooms (LBMs: Little Brown Mushrooms) – Various species that cause self-limited vomiting and diarrhea.

M – Muscarine...

In this special collaboration with NephMadness, we're diving into the world of nephrotoxins with an expert panel from Virginia Commonwealth University. NephMadness is an educational competition modeled after March Madness, and this year, one of the featured regions focuses on plant-based nephrotoxins. Together, with our expert panel we break down the competing nephrotoxin teams: Tubular Toxins vs. Oxalate Offenders.

Joining us are Dr. Anna Vinnokova (Nephrologist), Dr. Rachel Khan PharmD (Neph pharmacist), Dr. Ethan Downes (Nephrology fellow), and the legendary nephrotoxicologist, Dr. Josh King (Board certified Nephrologist and Toxicologist). We ALMOST named this episode "Getting Downe with the Mad Neph King and the Bean Queens"... but we didn't, your welcome.

After the show, go to the blog and vote for your favorite!

Expect irreverent musings, deep dives into toxic plant exposures, and a mystery case reveal that will leave you questioning your diet.

Topics and Timeline of Episode:

Intro

Listener Guesses With Josh and Ryan– 8:30

Listener Winner – 25:42

NephMadness and Guest Introductions – 28:07

Toxin Reveal – 33:41

• NEJM Case report

Tubular Toxins – 35:46

• Aristolochic Acid & the Belgian Weight-Loss Clinic Outbreak – 40:30
• Black Licorice & Its Surprising Toxic Effects – 47:16

The Oxalate Offenders Team: How Dietary Oxalates Harm the Kidneys – 52:00

• Historical Context: First recognized through sheep die-offs when herds grazed on Halogeton glomeratus, a high-oxalate plant, leading to fatal poisoning.
• Oxalate in Plants: Functions to bind excess calcium in the soil.
• Impact on the Body: Plants high in oxalate but low in calcium can contribute to oxalate accumulation, this leads to binding calcium in the blood, creating calcium oxalate crystals and acute renal calculi. Chronic inflammation from excess oxalate deposition leads to CKD progression.
• High-Oxalate Foods: Spinach, Swiss chard, rhubarb, cashews. Everything in moderation!

Practical Advice for Clinicians & Patients on Herbal Medicine Use – 1:00:00

• Resources for identifying nephrotoxic herbal products
• Talk to your patients non judgmentally, open conversations, discuss efficacy (or lack there of, see resources below) and safety
• Herbal medicines are not FDA approved and may not contain what they claim to

Herbals may not all be safe: Josh King Discovering Contaminants– 1:01:11

Wrap up– 1:08

Key Takeaways:

• Aristolochic acid is a direct nephrotoxin, associated with progressive kidney damage and urothelial cancers.
• Black licorice toxicity results from...