@article{ref1,
title="Toad poisoning: clinical characteristics and outcomes",
journal="Therapeutics and clinical risk management",
year="2020",
author="Trakulsrichai, Satariya and Chumvanichaya, Kritsada and Sriapha, Charuwan and Tongpoo, Achara and Wananukul, Winai",
volume="16",
number="",
pages="1235-1241",
abstract="OBJECTIVE: This study was performed to describe the clinical characteristics and  outcomes of patients with toad poisoning in Thailand. <br><br>METHODS: We carried out a  retrospective study of patients with toad poisoning from the Ramathibodi Poison  Center Toxic Exposure Surveillance System during a 5-year period (2012-2016). <br><br>RESULTS: We studied 36 patients poisoned by toad toxin. The median age was 31 years. Most patients were male (66.7%) and had ingested toad meat (50%). The most common  presentation was gastrointestinal (GI) symptoms with a median onset of 2 h after  ingestion. Twelve patients presented with bradycardia; seven presented with shock  and one with cardiac arrest. In the initial EKGs of all patients, the most common  abnormality was sinus bradycardia.Two patients developed cardiac arrest early during  management in the emergency room (within 15 minutes after ER arrival or within 4.5 h  after ingestion). During admission, one patient developed sinus bradycardia, and two  developed bradyarrhythmia; however, all three were stable. No tachyarrhythmias such  as ventricular tachycardia were detected in any patient. Some patients (11.1%)  presented with hyperkalemia. Serum digoxin was detected in five of seven patients  tested, ranging from 0.43 to >8 ng/mL. Most patients (75%) were admitted to the  hospital; the median duration of hospitalization was 2 d (range 0.5-5 d). The  overall mortality rate was 8.3%, and all three patients that died ate toad meat  and/or eggs and developed cardiac arrest. All patients received supportive  with/without symptomatic care including GI decontamination, inotropic drugs, cardiac  pacing, and management of hyperkalemia. One patient received intravenous calcium for  hyperkalemia but did not develop dysrhythmia after calcium administration. One  patient received digoxin-specific antibody fragments (DsFab), after which he  clinically improved and was discharged. <br><br>CONCLUSION: Toad poisoning commonly caused  GI symptoms and bradycardia. However, in severe cases, death occurred. Tachyarrhythmia was not observed. Supportive, symptomatic care might be the main  therapies for this poisoning, especially if DsFab is not available.<p /> <p>Language: en</p>",
language="en",
issn="1176-6336",
doi="10.2147/TCRM.S272863",
url="http://dx.doi.org/10.2147/TCRM.S272863"
}