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!<ul><li>Case set #1: Shock with hyperglycemia, big pupils, and probably NOT what you think it is. </li><li>Case set #2: Massive bleeding after gas-station “herbal” products</li><li>Case set #3: Refractory wide-complex rhythms in a teen overdose</li><li>Case set #4: Sudden collapse at a hog farm- (SPOLIER) <a href="https://www.vox.com/future-perfect/459417/dairy-farm-deaths-cow-manure-osha-colorado" rel="noopener noreferrer" target="_blank">Recent outbreak of deaths as related to case 4</a></li></ul> Want 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&A<ul><li>THAM vs bicarbonate (closed vs open buffering; “breathe for bicarb, tinkle for THAM”)</li><li>Why dialyze if the kidneys work? (EXTRIP-style thinking, gradients, and properties)</li><li>Snake antivenom pricing & how zoos help hospitals obtain non-U.S. antivenoms</li></ul> Call outs from the show<ul><li><a href="https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2532975" rel="noopener noreferrer" target="_blank">NACCT Abstracts!</a></li><li><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6549048/" rel="noopener noreferrer" target="_blank">Clover coagulopathy!</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/16013019/" rel="noopener noreferrer" target="_blank">THAM VS BICARB Electrolytes</a></li><li>Potato quality video of dialysis from <a href="https://youtu.be/z1PHJQ_SSl0?si=OCtzEWt678_FpIdf" rel="noopener noreferrer" target="_blank">Ryan</a></li><li><a href="https://www.vice.com/en/article/toddler-rattlesnake-antivenom-cost-almost-300000/" rel="noopener noreferrer" target="_blank">Article on snake antivenom costing >200,000 for one patient</a></li><li><a href="https://www.medscape.com/viewarticle/hey-pharmacy-do-you-have-thai-green-pit-viper-antivenom-2024a10008bg" rel="noopener noreferrer" target="_blank">Article on exotic antivenom procurement</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/38525877/" rel="noopener noreferrer" target="_blank">Case report Ryan published on treating blue Indonesian pit viper</a></li></ul> <h2>Support the show</h2>Review the show where ever your listening<a href="https://thepoisonlab.aweb.page/p/cf635c33-5117-4652-abd6-6bedce51444a" rel="noopener noreferrer" target="_blank">Get Messages from Toxo (Join the Newsletter!)</a><a href="https://thepoisonlab.com/support" rel="noopener noreferrer" target="_blank">Join as a supporting member</a><ul><li>Ad free episodes</li><li>Bonus content and early access</li><li>Discounts and give aways on GOTA PICCEM Mushroom card game</li></ul> <a href="WWW.GOTTAPICCEM.COM" rel="noopener noreferrer" target="_blank">The GOTTA PICCEM Poisonous Mushroom Game! </a><a href="https://www.etsy.com/shop/ThePoisonLab" rel="noopener noreferrer" target="_blank">Tox trinkets (Rep the show at home!)</a><h2>Reach the show</h2><ul><li>Email: Toxtalk1@gmail.com</li></ul> More Show Resources<ul><li><a href="https://the-poison-lab.yolasite.com/" rel="noopener noreferrer" target="_blank">Ryan's Medical Games and Resources</a></li><li><a href="https://www.thepoisonlab.com" rel="noopener noreferrer" target="_blank">Show Website</a></li></ul>

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