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Background: Copperhead snakes (Agkistrodon contortrix) are considered as the least toxic of the North American pit vipers. The reported incidence of coagulopathy from copperhead envenomation is variable, possibly secondary to regional variation in subspecies and venom potency. Coagulation studies are often obtained when evaluating for the coagulopathic effects of copperhead venom, but the clinical utility of these indices is unclear. The aim of this study was to determine the prevalence of hematologic toxicity due to copperhead envenomation in hospitalized patients. Methods: This was a multi-center retrospective chart review study using electronic hospital data between January 1, 2006 and December 31, 2016 evaluating prevalence of coagulopathy following copperhead envenomation. Patients presenting to one of three major academic tertiary care centers in Virginia with suspected copperhead envenomation were identified using medical billing codes. The primary outcome was to summarize the prevalence of hematologic toxicity including thrombocytopenia, elevated prothrombin or partial thromboplastin times, or hypofibrinogenemia. Results: There were 244 cases used for final analysis. Hematologic toxicity occurred in 14% (95% CI 10–18%) of patients. Specific indices included thrombocytopenia in 1.2% (95% CI 0.4–3.6%), hypofibrinogenemia in 0.7% (95% CI 0.0–3.8%), elevated PT in 10.0% (95% CI 6.8–14.5%), and aPTT in 3.9% (95% CI 2.1–7.2%) of patients. There was no clinically significant bleeding reported in any case. Conclusions: Subtle hematologic abnormalities due to copperhead envenomation in patients treated in the Commonwealth of Virginia were relatively common, but do not appear to be clinically significant in this study population. [ABSTRACT FROM AUTHOR]

In August 2019, the Virginia Poison Center (VPC) and the Blue Ridge Poison Center (BRPC) were contacted concerning patients experiencing repeated episodes of marked hypoglycemia following ingestion of a male enhancement supplement tablet marketed as "V8" in convenience stores in central Virginia. Over the following 3 months, the Virginia Department of Agriculture and Consumer Services (VDACS) and the Virginia Department of Health (VDH) conducted an investigation and identified 17 patients meeting the case definition (severe hypoglycemia within 48 hours of consuming an over-the-counter male enhancement supplement in a man with no history of use of insulin or other medication used to control blood glucose). Analysis of the V8 tablets revealed that most contained glyburide, a sulfonylurea oral hypoglycemic used in the treatment of diabetes and associated with prolonged hypoglycemia following overdose (1). To stem this outbreak, V8 was removed from stores when found, and public service announcements were released. The public health implications of V8 use include the potential for substantial morbidity from hypoglycemic episodes and the potential for mortality if health care services are not accessed in a timely manner when hypoglycemia occurs. The presence of V8 in the market poses a serious threat to public health because of its potentially life-threatening adverse effects., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Introduction: Single-use laundry detergent pods (LDPs) were introduced to the United States in 2010 but had been available in Europe as early as 2001. Case reports of unintentional exposures noted vomiting, ocular injuries, respiratory depression, and central nervous system depression. We summarize clinical effects from unintentional LDP exposures reported to a single poison center over 15 months., Methods: Electronic poison center records were searched using verbatim field and both product and generic codes to identify laundry pod exposures from January 1, 2012, through April 9, 2013. Clinical effects were abstracted to a database and summarized using descriptive statistics., Results: We identified 131 cases between March 2012 and April 2013. Median (interquartile range) age was 2.0 (1.5) years with 4 adult cases; all were coded as unintentional. The most common route was ingestion (120) followed by ocular (14) and dermal (6). Some patients had multiple routes of exposure. Of ingestion exposures, 79 (66%) were managed at home; and 41 (34%) were evaluated in a hospital, of which 9 patients were admitted. The median (interquartile range) age of admitted patients was 1.4 (1.1) years. Relevant findings in these admitted children included emesis (78%), central nervous system depression (22%), upper airway effects (56%), lower respiratory symptoms (33%), seizure (n = 1), and intubation (67%). One child with emesis initially managed at home was subsequently intubated for respiratory distress., Discussion: Exposure to LDP can cause significant toxicity, particularly in infants and toddlers. Compared to traditional detergents, clinicians should be aware of the potential for airway compromise following exposure to LDP., (Copyright © 2014 Elsevier Inc. All rights reserved.)