The Poison Lab

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• A Morel Dilemma: Episode 2 — Investigations and Falsehoods 03.06.2026 43分

  As reports of severe illness and death come in, the Bozeman outbreak moves from medical mystery to full public health investigation. Local and state investigators race to identify the source, shut down the risk, interview patients, collect food samples, and figure out whether anyone else could still be in danger.The early signal points toward one unlikely ingredient: morel mushrooms. But for toxicologists, that raises more questions than answers. Morels are supposed to be edible. Rapid vomiting and diarrhea usually suggest foodborne illness, not a deadly mushroom poisoning. So investigators have to ask the question that will drive the rest of the series: is the morel really the culprit, or is something else hiding in the meal?In Episode 2 of A Morel Dilemma, we meet the public health team on the front lines, hear how the outbreak was contained, and begin testing the first theories behind what made diners so sick.
• A Morel Dilemma: Episode 1 — Outbreak in Bozeman 03.06.2026 33分

  A deadly outbreak begins with a single meal at a sushi restaurant in Bozeman, Montana. Within hours, diners develop severe nausea, vomiting, and diarrhea. Some collapse. Two people die. At first, it looks like food poisoning, but investigators quickly notice one strange ingredient connecting many of the sick patients: morel mushrooms.In the first episode of A Morel Dilemma, we meet the people caught in the earliest moments of the outbreak and begin following the investigation as it unfolds in real time. What starts as a suspected restaurant-associated illness quickly becomes a much stranger question: how could a prized edible mushroom, eaten for centuries, suddenly be linked to death?This is not a retrospective summary. It is the beginning of a poisoning mystery, told the way investigators experienced it: with urgency, uncertainty, and more questions than answers.
• Introducing: A Morel Dilemma 01.06.2026 4分

  Available June 3rd- A deadly outbreak begins at a sushi restaurant in Bozeman, Montana. Diners develop rapid, severe gastrointestinal illness. Some collapse. Two people die. And the only clue pointing investigators toward a cause is also the hardest one to believe: morel mushrooms.A Morel Dilemma is a serialized outbreak investigation from The Poison Lab, following the story in real time as clinicians, toxicologists, public health officials, mycologists, and families try to answer one unsettling question:How could a prized edible mushroom suddenly be linked to death?This is a story about poisoning, public health, uncertainty, and the uncomfortable process of discovering that something we thought we understood may be far more complicated than it seemed.A Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow Website
• Gas Station Heroin? Kratom, Regulation, and Recovery — A Co-Broadcast with the Kratom Sobriety Podcast 24.05.2026 1時間 16分

  In this special co-broadcast episode, The Poison Lab joins forces with The Kratom Sobriety Podcast for a deeper conversation about kratom, regulation, addiction, recovery, and what poison center data can tell us about real-world harm.Kratom is a plant-derived substance that contains mitragynine and 7-hydroxymitragynine, compounds with opioid-like effects. It is sold in many forms, including powders, capsules, drinks, tonics, and concentrated extracts, often in gas stations, smoke shops, and online. For many people, kratom is encountered with little warning about its risks, including dependence, withdrawal, and toxicity.Study NewsThis episode grew out of our newly published study in Addiction, which examined kratom-related poison center calls across states with different legal approaches: states with bans, states with kratom consumer protection acts, and states with no specific regulation.The study began with a real policy question in Wisconsin: is the public better protected by prohibition, by regulated access, or by leaving kratom largely unregulated? As clinical toxicologists and poison center clinicians, our goal was not to write policy, but to add objective data to a debate that often moves faster than the evidence.Ryan discusses how that question led to a broader debate within medical toxicology and poison center circles: What are the harms of prohibition? What are the risks of unfettered access? Is regulation safer than a ban? And what can poison center data actually tell us about those questions?After the study was published, people reached out from several directions: journalists, policymakers, people concerned about the risks of prohibition, and people who had experienced harm from easy access to kratom. That included the team behind The Kratom Sobriety Podcast, who wanted to talk about the study and the lived experience of kratom dependence and recovery.The conversation highlights both the data and the human side of the issue: people who developed kratom dependence, struggled to stop, and found their way into recovery. The episode explores why policy decisions around kratom are so difficult, why easy access to opioid-like substances can be dangerous, and why lived experience matters alongside epidemiologic data.Topics covered include:What kratom is and why it is often called a “gas station drug”Mitragynine, 7-hydroxymitragynine, and opioid-like effectsKratom dependence, withdrawal, and recoveryHow poison centers track emerging substancesDifferences between state bans, consumer protection acts, and unregulated accessWhat poison center data can and cannot tell usWhy kratom policy is more complicated than “ban it” versus “leave it alone”The importance of listening to people with lived experienceThis episode is a longer-form conversation about science, policy, toxicology, and recovery. It is not medical advice, and it is not meant to tell any individual person what they should do. But it is meant to bring more evidence, nuance, and humanity into a debate that needs all three.If you or someone you know is struggling with kratom or any substance use, help is available. In the United States, you can contact the SAMHSA National Helpline at 1-800-662-HELP.ExtrasFree to read version of the study News articles about the studyUS Kratom Use Surges 65-Fold in 13 YearsCalls to poison centers over 'natural' supplement have skyrocketed by 6,500% since 2010Kratom Use Soars in US, Alters Lives Dramatically | Mirage NewsKratom use is surging in the US, with life-changing consequences, study revealsKratom use is surging in the US, with life-changing consequences | EurekAlert!
• Outbreak: 75 Fatalities After a Funeral Poisoning in Mozambique 07.05.2026 2分

  In this episode of The Poison Lab Outbreak, Ryan talks with Dr. Alaina Steck about a devastating mass poisoning in Mozambique that began at a funeral and ultimately sickened more than 200 people, with a fatality toll of over 70.Early reports blamed crocodile bile. Others suspected intentional poisoning. But as the investigation unfolded, the clinical picture, timeline, and exposure history did not fit neatly with the early theories.Dr. Steck, then a medical toxicology fellow at Emory, joined a CDC-supported outbreak investigation team sent to Mozambique. She walks through what it was like to investigate the outbreak on the ground, including the overwhelmed rural health center, limited medical records, scarce biological and environmental samples, early toxicologic hypotheses, and the eventual role of comparative food testing in identifying the cause.This episode explores the real-world uncertainty of outbreak investigation: incomplete data, competing theories, community fear, and the importance of epidemiology, toxicology, public health, and analytical chemistry working together.Topics CoveredMass poisoning investigation in rural MozambiqueEarly reports of crocodile bile and suspected intentional poisoningClinical presentations including GI symptoms, seizures, pulmonary edema, liver injury, kidney injury, and multisystem diseaseChallenges of interpreting sparse medical records during a mass casualty eventHow toxicologists approach possible intentional poisoningWhy exposure history and timing matter in outbreak investigationThe importance of control samples in analytical testingLessons for clinicians, poison centers, and public health teamsGuestDr. Alaina SteckMedical toxicologist, Emory UniversityFormer medical toxicology fellow involved in the CDC-supported investigation of the Mozambique outbreakResources (Spoilers)Outbreak paperU.S. CaseInstagram @tox_talk • Twitter @LabPoison • Email toxtalk1@gmail.comDisclaimer: 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.A Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow Website
• Rebroadcast: Phenibut. The emerging drug you don’t know about (yet) 04.05.2026 1時間 6分

  Phenibut is an emerging and unfamiliar drug taking hold in the US that is readily available online and legal to obtain. It acts as a GABA-B agonist and carries risks of dependency and withdrawal. In this episode Ryan interviews phenibut users as well as experts involved in phenibut treatment. They explore the history, current trends, toxicity, and management of phenibut, a novel GABA-B agonist. He is joined by guest Dr. Matthew Stanton PharmD and Dr. Benjamin Weston MD who listen in to an audio documentary that includes clips from Dr. Janessa Graves PhD and Dr. Erica Liebelt MD who wrote a recent report on increasing phenibut exposures, Dr. Dan McCabe MD who is the author of the largest published phenibut case series, and Elliot, a recovered phenibut user who we would like to sincerely thank for sharing his story of use and recovery.+Update- a systematic review of phenibut withdrawal treatment strategies authored by the poison lab host himeself, Ryan!+More on St Anthony's fire CDC MWR Study documenting increased poison center exposures (Dr. Graves & Dr. Liebelt) Phenibut case series from Dr. McCabe All published cases of phenibut withdrawal, reported baclofen regimens, clinical outcomes, multimodal therapiesTHEORETICAL UNTESTED Phenibut withdrawal treatment schema (Not tested, not intended as treatment, intended to stimulate discussion and highlight key considerations in managing withdrawal)A Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow Website
• If I had a Nickel (Mystery Case) & Toxicologist vs The internet (#13) with Dr. Damilola Idowu-Ellsworth 11.02.2026 1時間 40分

  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 crystalA Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow Website
• Poison Lab Update: Mushroom Poisoning Radio Roundup 04.02.2026 1分

  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
• Sick at Work? A Poisonous Cause of Coworker Illness? 18.12.2025 1分

  Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episodeA Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow Website
• Outbreak: Thebaine Poisoning from Poppy Seed Tea in Australia 03.12.2025 9分

  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 toxtalk1@gmail.comDisclaimer: 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.A Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow Website
• Poisonous Fungus Amongus is Here— The Rhyming Kid (or Adult) Book For Mushroom Safety 17.11.2025 3分

  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!A Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow Website
• LIVE from Chicago: 2025 NACCT Research Review – Insights from the North American Congress of Clinical Toxicology 06.10.2025 1時間 41分

  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.A Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow Website
• Toxicologist vs The internet (#12) with Dr. Joe Kennedy MD 10.09.2025 1時間 34分

  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” productsCase set #3: Refractory wide-complex rhythms in a teen overdoseCase set #4: Sudden collapse at a hog farm- (SPOLIER) Recent outbreak of deaths as related to case 4Want the cases summarized and sent to you so you can come up with your differential before the show? SIGN UP FOR THE NEWS LETTER! Listener Q&ATHAM 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. antivenomsCall outs from the showNACCT Abstracts!Clover coagulopathy!THAM VS BICARB ElectrolytesPotato quality video of dialysis from RyanArticle on snake antivenom costing >200,000 for one patientArticle on exotic antivenom procurementCase report Ryan published on treating blue Indonesian pit viperA Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow Website
• GOTTA PICCEM is Here! — The Poisonous Mushroom Card Game Launch 03.09.2025 3分

  GOTTA PICCEM: The Poisonous Mushroom Card Game👉 Order now right here OR go to www.gottapiccem.com and click "Buy GOTTA PICCEM"Why this is awesomeWhat 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.What’s inside the deck58 Poisonous Mushroom CardsFull-color pictures, toxin info, clinical syndromes, key anatomy, U.S. + global distribution, and spore print colors.88 Play Cards + 30 Bonus CardsCollect mushrooms, play antidotes and modifiers, stack combos, and score big.Toxin-Based ScoringPoint systems reflect real-world toxicity—every round plays differently based on your hand and bonus cards.Endless ReplayabilityRule variants at gottapiccem.com keep things fresh.Learn while you playDive into the companion blog at www.gottapiccem.com for:Deep-dive toxin explainers for each mushroomCase reports & real-world clinical notesControversies and mysteries in mushroom poisoning📖 Start here: gottapiccem.com (Companion Blog → “Learn the Mushrooms”)How to get it👉 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.Join the funIf you grab a copy:📸 Snap a photo of your first round✉️ Send it to toxtalk1@gmail.com or tag @LabPoison / @tox_talkNothing would make Ryan happier than seeing the community play!
• Ryan is LIVE on the Radio Thursday July 17th 11:45AM-12:30 PM CST WPR Larry Meiller Show! 16.07.2025

  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!
• Poisoning Outbreak: Aconite Poisoning at Markham, Ontario Restaurant 10.07.2025 7分

  A Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow WebsiteThe Poison Lab: Outbreak – Markham Aconite PoisoningOn August 29, 2022, twelve diners at a Markham, Ontario restaurant fell critically ill with vomiting, numbness, and life-threatening arrhythmias. The culprit? A deadly plant toxin: aconite.In this episode—the first of a new Poison Lab Outbreak series—we go inside the Markham mass poisoning case. Join host Ryan Feldman, clinical toxicologist and emergency medicine pharmacist, as he investigates how a rare and lethal toxin ended up in a restaurant spice jar and nearly cost lives.You’ll hear firsthand from the experts who responded to the outbreak:Dr. Jessica Kent, toxicology fellow at the time at the University of TorontoDr. Abinhay Sathya, intensivist at Markham Stouffville HospitalDr. Margaret Thompson, toxicologist and on-call consultant for the Ontario Poison CentreDr. Randy Purves, research scientist at the Canadian Food Inspection Agency (CFIA)Bryn Shurmer, MS- analytical chemist at the Canadian Food Inspection Agency (CFIA)Together, they walk us through the outbreak timeline—from the first patients in VT to the public health investigation that uncovered a mislabeled spice bag full of pure aconite root.Looking for timestamps?A fully timestamped version of the episode—so you can jump to any topic—is available to our supporting members.💡 Key topics:Clinical presentation and toxic effects of aconiteChallenges in mass poisoning recognition and coordinationThe crucial role of poison centers in outbreak responsePublic health trace-back to contaminated galangal powderLessons for emergency departments and toxicologists📍 Resources & Mentions:Case series about the incident written by Dr. Kent, Sathya, and ThompsonTwitter/X post by Dr. David Juurlink that helped disseminate early infoThe Poison Lab previous aconite episode: Open and shut (Mystery Case #31)Paper written by Ryan, Dan McCabe, and Crissy Lawson🎧 Listen now at: www.ThePoisonLab.com💬 Have thoughts or questions? Connect on Instagram @tox_talk, Twitter @LabPoison, or email toxtalk1@gmail.com.
• MURDER for Lunch: Toxicologist vs The internet (#11) with Dr. Amy Zosel MD 30.04.2025 1時間 29分

  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 2News story37:00 Case 3 New story48:00 Case 4 News storyUS outbreak "Robocough"Study about Naloxone in Clonidine overdose++Spoiler++: 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 dangerResources Mentioned:National Poison Control Hotline: 1-800-222-1222National Suicide Prevention Lifeline: 1-800-273-8255SAMHSA Free Helpline: 1-800-662-HELP (4357)Follow The Poison Lab:Twitter: @LabPoisonInstagram: @tox_talkWebsite: www.ThePoisonLab.comSubscribe and Review:Love what you're hearing? Help us reach more toxicology enthusiasts by leaving a review on Apple Podcasts, Spotify, or wherever you listen. Don’t forget to share this episode with your colleagues and friends!A Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow Website
• A Mnemonic For Poisonous Mushrooms and Their Effects- GOTAA PPICEM 30.04.2025 22分

  A Morel DilemmaSupport 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: Toxtalk1@gmail.comMore Show ResourcesRyan's Medical Games and ResourcesShow Website 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/ToxThe GOTAA PPICCEM MnemonicLate-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 (Clitocybe, Inocybe spp.) – Cholinergic crisis (SLUDGE symptoms), similar to nerve agents.Ryan's Modified Mnemonic GOTTAAA PICCEMThe GOTTA3  P2ICCEM Mnemonic (Ryan's Modification)Late-Onset (Severe) Toxic Mushrooms ("GOTTAA")These mushrooms have delayed symptoms (>6 hours) and are associated with significant toxicity:G – Gyromitrin (Gyromitra esculenta) – False morels; inhibits GABA, leading to seizures. While this is classically taught, newer data suggests its extremely rare, GI effects, with or without hepatoxicity or minor neurologic symptoms predominateO – Orellanine (Cortinarius spp.) – Causes renal failure; famously poisoned The Horse Whisperer author.T – Tricholoma equestre (Man on Horseback) – Leads to rhabdomyolysis.T- Tender nesting polypore (Hapalopilus rutilans) causes late GI effects,  altered mental status, acidosis, and purple urine!A – Amatoxin (Amanita phalloides, Galerina spp.) – Causes liver failure; the most lethal mushroom toxicity.A- Acromelic Acid is found in Clitocybe acromelalga in Japan and C amoenolens in France causes erythromelalgia. It can be treated with IV nicotinic acid!  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. Thee are actually many species that have been implciated here incuding Verpa bohemica (early morel) and Boletus luridus (luride bolete).C- Cholinergics (muscarine containing, Clitocybe, Inocybe spp.) Cholinergic crisis (SLUDGE symptoms), similar to nerve agents.E –  Emetic Mushrooms (LBMs: Little Brown Mushrooms) – Various species that cause self-limited vomiting and diarrhea.M – Morchella (morels) while an edible delicacy, they must be thoroughly cooked, recently multiple deaths have been links to eating morels, and the exact mechanism of toxicity is unclear but they result in incredibly fast GI effects. 
• Leafy Greens & Injured Beans: Natures Nephrotoxins – A Poison Lab & NephMadness Collaboration 01.03.2025 1時間 21分

  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:IntroListener Guesses With Josh and Ryan– 8:30Listener Winner – 25:42NephMadness and Guest Introductions – 28:07Toxin Reveal – 33:41NEJM Case reportTubular Toxins – 35:46Aristolochic Acid & the Belgian Weight-Loss Clinic Outbreak – 40:30Black Licorice & Its Surprising Toxic Effects – 47:16The Oxalate Offenders Team: How Dietary Oxalates Harm the Kidneys – 52:00Historical 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 – 1:00:00Resources for identifying nephrotoxic herbal productsTalk to your patients non judgmentally, open conversations, discuss efficacy (or lack there of, see resources below) and safetyHerbal medicines are not FDA approved and may not contain what they claim toHerbals may not all be safe: Josh King Discovering Contaminants– 1:01:11Wrap up– 1:08Key Takeaways:Aristolochic acid is a direct nephrotoxin, associated with progressive kidney damage and urothelial cancers.Black licorice toxicity results from 11β-hydroxysteroid dehydrogenase inhibition, leading to excess cortisol activity, hypertension, potassium wasting, and rhabdomyolysis.Regulatory gaps in herbal supplements can lead to unexpected toxicities, making consumer awareness essential.High dietary oxalate intake increases the risk of kidney stone formation and chronic kidney disease.NephMadness is open to everyone—vote for your favorite nephrotoxin team and join the conversation!Resources Mentioned:NephMadness: Follow along and fill out your bracket!AJKD BlogNational Kidney Foundation Herbal Medicine GuideNational Center for Complementary and Integrative Health (NCCIH)Poison Control Center (Available 24/7 for toxicology questions): 1-800-222-1222Follow The Poison Lab:Twitter: @LabPoisonInstagram: @tox_talkWebsite: www.ThePoisonLab.comDon’t forget to rate and review the podcast on Apple Podcasts, Spotify, or your preferred platform. Share this episode with your fellow nephrology and toxicology enthusiasts!Thanks for tuning in, and remember: If it sounds too good to be true, it might just be nephrotoxic. Stay safe and stay curious!
• A Mysterious Case of Weakness, Low Potassium, and Kidney Injury 12.02.2025 1分

  Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episode Support the show!Rep the show!Show website