Nat Ketone

Not very permanent

4) although this situation is safer than the others, the presence of lead deposits anywhere can cause raised lead levels, particularly if the granuloma around the fragment is later disturbed (e.g. by trauma) or migrates to a higher risk area; therefore
5) any lead in the body is potentially an issue

1) lots of fluid moving over the fragment promoting dissolution
2) lots of bone turnover; as a large 2+ ion, lead looks similar to calcium to a lot of body processes
3) many small fragments have a higher surface area than one larger piece

I’m at the #AWTTC / #YellowCardWales Best Practice Day. Come and say hello if you’re here too!
@mhragovuk.bsky.social @toxbase.bsky.social @cavuhb.bsky.social

Which, to be clear, I am happy to do and I know it can be quite intimidating when you have a lot of them - but it’s quite funny

It’s only slightly tongue-in-cheek when I say my job is doing maths for people. When I’m not talking to the ICU consultant about a patient who is melting from the inside out, I’m doing sums for the triage clinicians at 111

Argyria! The silver deposits under the skin (gets oxidised or somehow fixed by sunlight? Or do all tissues get pigmented?) turning it this silver-blue colour

I ask about GLP-1RA exposure when considering whether to give late charcoal, but I’m going to try to start asking about them for all patients where it might matter

Most species of inkcap mushrooms appear only fleetingly before self-digesting themselves into a black liquid. They do this to spread their spores. Inkcaps break themselves down by producing the enzyme chitinase in their cells. Chitinase breaks down chitin, the sugar in fungi cell walls that holds them in shape, causing the mushroom to disintegrate into a black goo. This process is called deliquescence. The black liquid produced by inkcaps’ self-digestion can be used as an ink due to melanin pigment. Coprinopsis atramentaria, the common inkcap, is not considered edible due to the presence of coprine, which can cause unpleasant symptoms if it is consumed with alcohol. Our bodies metabolise coprine into aminocyclopropanol and glutamic acid. Aminocyclopropanol interferes with alcohol metabolism. It inhibits the aldehyde dehydrogenase enzyme, inhibiting breakdown acetaldehyde formed from ethanol. Acetaldehyde causes a flushed face, racing heart rate, nausea and vomiting.

Infographic on fly agaric mushrooms, with an image of the mushrooms in the middle (red with white spots). The chemical structures of the mushroom's pigments are shown, including muscarufin, the primary pigment responsible for their red colour. The compounds behind the mushrooms' psychoactive properties, ibotenic acid and muscimol, are also shown. These compounds imitate neurotransmitters in the brain to exert their effects.

Today is the #DayOfTheMushroom 🍄

Here are graphics on why common inkcaps and alcohol don't mix, and colourful and poisonous compounds found in fly agaric.

Inkcaps: www.compoundchem.com/2024/09/19/i...

Fly agaric: www.compoundchem.com/2024/11/11/f...

#ChemSky #FungiFriends 🧪

And lead is an even bigger problem when combined with iron deficiency, which is COMMON (tinyurl.com/JAMAFe)

Iron deficiency increases lead absorption
Lead decreases iron absorption and iron utilization.

And the same kids are often at risk for both.

A vicious cycle.

**Not Montelukast, but ranitidine, valsartan, and others

Your breathy bois are safe! My memory is not

bsky.app/profile/natk...

To be clear, apart from a specific few old batches of tetracycline, there have been no cases of toxicity from out-of-date medications and the highest risk remains that the medication has degraded and no longer works.

Addressing the saga of nitrosamine contamination in drugs Scientific and regulatory progress is helping minimise the impact of mutagenic impurities

As it turns out, I should have checked my sources. I was thinking of this story www.chemistryworld.com/news/address... and somehow has linked Montelukast in with the affected drugs in my mind. Montelukast remains low risk

I would guess it comes down to cost again. A few pence per lorry/shipping container vs a few pence per box or blister pack are very different calculations. Would be useful though, particularly for heat where the blister packs are not necessarily good barriers

Fully with you there

HOWEVER, storage outside of a pharmacy environment hasn’t really been studied and carries greater risks of degradation. Fortunately, there aren’t many cases of toxicity from expired medications (tetracycline famously, but also e.g. Montelukast more recently)

Pharmaceutical companies are required to do stability testing on their products, which is expensive - so they set the expiration dates for the minimum time. If stored in cool, dark, dry conditions, there’s no reason they can’t last for a long while - there was a big US Army study about this

Before reading the paper, I was under the impression that one of the requirements was low did intake before drinking large volumes of slushie, but that doesn’t seem to be the case! Maybe glycerol does just block glucose utilisation?

Some weird confluence of legislation and product design has revealed glycerol’s toxicity. There are cases from outside the UK/IE region. Please call your local poison centre if you suspect it in your patient - we could really do with collecting additional cases