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Andrew Stolbach, MD, MPH

@toxicologist12.bsky.social
522 followers 267 following 2.1K posts

Toxicologist. Emergency doctor. Living in Baltimore City. Teaching and learning about poisoning and overdose.

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Reposted by Andrew Stolbach, MD, MPH
Manini AF @maninialex.bsky.social · 11/06/2025
1/ Exciting news: Our team has been awarded a NIDA R01 grant to fund "Fentalog II", a continuation of our groundbreaking collaboration to detect novel fentanyl analogue overdoses in EDs across ten major hospitals over five years. #syntheticopioids #Medsky 🧵 www.mountsinai.org/about/newsro...
mountsinai.org
Mount Sinai Receives $3.8 Million Grant to Study New Synthetic Drugs and Opioid Overdoses in Emergency Departments to Prevent Deaths
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 06/08/2025
Hospital pro tip: Put a Chux pad on your seat and no one will steal it.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 10/07/2025
Mitochondrial DNA is just Mom Genes
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 17/06/2025
Consultant: Nothing is wrong with this patient. Me: Should I discharge them? Consultant: No, you should order all these tests. Me: Why? Consultant: To see if anything is wrong.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 11/06/2025
FYI, here is the a link to purchase and read reviews of this Pulitzer winner bookshop.org/p/books/a-mi...
bookshop.org
A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812 (Pulitzer Prize Winner)
The Life of Martha Ballard, Based on Her Diary, 1785-1812 (Pulitzer Prize Winner)
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 11/06/2025
I'm reading "A Midwife's Tale," a memoir of a 27-year career of a midwife from 1785 on. In case you're wondering, here is her hierarchy of medical condition: Comfortable Easier Much as she was yesterday Revived Dangerous Poorly Very Ill Very ill indeed Seemingly dangerously ill Seemingly expiring
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Reposted by Andrew Stolbach, MD, MPH
American College of Medical Toxicology @acmtmedtox.bsky.social · 03/06/2025
#MedToxTuesday #ToxVisualPearl "Not Very A-peel-ing" Which chemical, commonly used in chemical peels, can cause severe, gray colored skin burns upon direct contact? Answer in the comments! Acetone | Hydrogen peroxide | Phenol | Salicylic acid @ziadkazzi.bsky.social @toxicologist12.bsky.social
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Reposted by Andrew Stolbach, MD, MPH
Toxicology Investigators Consortium (ToxIC) @toxicacmt.bsky.social · 27/05/2025
#MedToxTuesday Our latest #Fentalog study report reveals that although numerous NPS detected, including #xylazine #bromazolam, and #nitazene analogues, #Fentanyl remains most prevalent nationally. Report>> bit.ly/4jjJ8jm ‪@maninialex.bsky.social @toxicologist12.bsky.social @ziadkazzi.bsky.social
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 09/05/2025
The wellness industry wants to make money by selling products that make you feel better. The pharmaceutical industry wants to make money by selling products that make you feel better. Only one of these is required by law to prove that their products work.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 03/04/2025
Toxicologist Dr. Johns Downs summarizes our current understanding of PFOS risks #ACMT2025
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 25/03/2025
We also see Takotsubo after stimulant (eg cocaine or amphetamine) poisoning
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Reposted by Andrew Stolbach, MD, MPH
American College of Medical Toxicology @acmtmedtox.bsky.social · 13/03/2025
We're pleased to announce the release of the Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits, developed through a partnership of 10 medical & prof. societies, including ACMT. bit.ly/4iQ3UqT @toxicologist12.bsky.social @ryanmarino.bsky.social
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Reposted by Andrew Stolbach, MD, MPH
The Guardian @theguardian.com · 12/03/2025
Under-eights should not drink slushies containing glycerol, say doctors
theguardian.com
Under-eights should not drink slushies containing glycerol, say doctors
Study of 21 hospitalisations shows the iced drinks can cause decreased consciousness and low blood sugar Children under eight should not drink slushies containing glycerol, paediatricians have warned. Public health advice on their safety may need…
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Reposted by Andrew Stolbach, MD, MPH
American College of Medical Toxicology @acmtmedtox.bsky.social · 28/02/2025
🚨Findings from ACMT pivotal study published in JAMA Network Open underscores the vital role of medical toxicology physicians in improving outcomes for pediatric patients admitted to the PICU due to poisoning. Read it now >>> bit.ly/ACMTJAMA @toxicologist12.bsky.social @toxicacmt.bsky.social
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 26/02/2025
Give naloxone (narcan) for *hypoventilation* -not- Give naloxone (narcan) for *opioids* *********************+ Hypoventilation—> Give naloxone (If it works, the cause was probably an opioid)
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Reposted by Andrew Stolbach, MD, MPH
American College of Medical Toxicology @acmtmedtox.bsky.social · 14/02/2025
🚨The early bird gets the savings! 🪱🐦Register for #ACMT2025 activities by NEXT Friday 2/21 to save - and book your stay at the conference hotel while rooms are still available! ➡️http://bit.ly/acmtmeeting⬅️ @ziadkazzi.bsky.social @toxicologist12.bsky.social @nephrotox.bsky.social
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 12/02/2025
Abe Lincoln and Charles Darwin were both born on *this day* in 1809. Is there a single birth date that produced humans with a greater historical impact than February 12, 1809?
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 06/02/2025
I don’t know if this was intentional, but I love the juxtaposition of a big formulaic protocol with an anti-protocol editorial directly across the center spread of ACEP Now.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 28/01/2025
SIGN OUT There is a new patient in Room 2 who has delusions of invisibility. I haven’t seen him yet.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 16/01/2025
Me: I wonder what is the biggest organ in the human body? Dermatologist: The skin! Me: Ok, sure, but what’s the biggest *real* organ?
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Reposted by Andrew Stolbach, MD, MPH
Skeptical Raptor @skepticalraptor.bsky.social · 11/01/2025
A new study on #fluoride in water and lower #IQ in children is unconvincing. Lots of bias, and there isn't a difference at levels of 0.7 mg/L which is found in the USA. RFK Jr will use this study to push his Make America Have Cavities Again.
buff.ly
Fluoride in water and lower IQ in children — unconvincing research
A recent study suggests a potential link between fluoride in drinking water and lower IQ in children. However, the research has significant flaws, and no connection is found at the standard fluoride…
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Reposted by Andrew Stolbach, MD, MPH
American College of Medical Toxicology @acmtmedtox.bsky.social · 10/01/2025
NEW: ACMT Position Statement on Sterile Solution Shortage. Auths: Maryann Amirshahi, Erin Fox, @toxicologist12.bsky.social >> READ: bit.ly/3DMVG3L <<
ACMT Position Statement on Sterile Solution Shortage
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 07/01/2025
I saw a note with “dialyzed” misspelled as “diazzled” and I imagined “what if Snoop Dogg had been a nephrologist?”
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Reposted by Andrew Stolbach, MD, MPH
Denis Wirtz @deniswirtz.bsky.social · 06/01/2025
An ever rarer sight: Snow at Hopkins. Cool, no?
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 03/01/2025
I can't emphasize the last point enough. In cholinergic toxicity, patients have a lot of reasons to be tachycardia (hypoxia, hypovolemia, distress...) Keep giving atropine until secretions dry up, and then start an atropine drip. 4/4
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 03/01/2025
"Atropinisation" Titrate atropine dose to cessation of SLUDGE –Patients with mild symptoms may need 1 to 2 mg (IM autoinjector or IV) –Double doses every 5 minutes –Some adults have received over 1000 mg (!!) of atropine in 24 hours –Tachycardia is NOT a contraindication to atropine 3/4
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 03/01/2025
Atropine will treat these findings, although it won't affect nicotinic symptoms such as skeletal muscle weakness. 2/4
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 03/01/2025
Cholinergic Toxicity Recognition and Treatment with Atropine If you see some combination of "SLUDGE" and "KILLER B" symptoms, strongly consider the cholinergic toxidrome. The main treatment is atropine. 1/4
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 03/01/2025
👆jokes aren’t medical advice 🙂. People can overdose on methylxanthines, including caffeine. (But coffee is delicious)
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 03/01/2025
Me: Do you drink an excessive amount of caffeine? Patient: No. Me: Well, you should, because it’s awesome.
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Reposted by Andrew Stolbach, MD, MPH
David Juurlink @davidjuurlink.bsky.social · 25/12/2024
Worth reading Roald Dahl’s account of the death of his daughter Olivia, age 7
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 13/12/2024
It's a good day to post this one:
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 09/12/2024
Thank you for the invitation to your “Ugly Sweater” party. I’m afraid I must decline, because, as a gentleman, I only own classic, sophisticated sweaters.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 02/12/2024
Ugh.Weird. We either work a 5-day block surrounding the holiday or we have that time off.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 23/11/2024
Great win today #coys
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 22/11/2024
Think methanol if you see any combination of: 1)Anion-gap metabolic acidosis without big ketone or lactate elevation 2) History of alcohol use with negative EtOH 3) Vision changes
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 22/11/2024
Fatal methanol poisoning in a group of travelers staying at lodging known for serving free spirits/liquor.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 21/11/2024
Sports commentator: You can’t measure heart Echocardiographer: Left ventricular ejection fraction is 60%
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 18/11/2024
For now, I’m keeping my Twitter account open, but I will be posting more over at the other place under the same name.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 15/11/2024
These are the Nixon brothers, growing up in Yorba Linda, CA in the 1920s. One of them grew up and became US President. Two of them died from bovine tuberculosis from drinking *raw milk* from the family cow.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 19/10/2024
This product is neither liquid nor given by IV route 🤷🏻‍♂️
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 10/10/2024
Traces of metals like lead can be detected in tampons. They are probably naturally incorporated into the materials- like cotton- used to make them. There is *no evidence* that people absorb an amount that would hurt their health. x.com/acmtmedtox/sta…
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 01/10/2024
Patient: I keep having urges to set up a stall and sell crafts. Me: That is bazaar.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 26/09/2024
pubmed.ncbi.nlm.nih.gov/15784664/
pubmed.ncbi.nlm.nih.gov
NCBI - WWW Error Blocked Diagnostic
Your access to the NCBI website at www.ncbi.nlm.nih.gov has been temporarily blocked due to a possible misuse/abuse situation involving your site. This is not an indication of a security issue such as a virus or attack. It could be something as simple as a run away script or learning how to better use E-utilities, http://www.ncbi.nlm.nih.gov/books/NBK25497/, for more efficient work such that your work does not impact the ability of other researchers to also use our site. To restore access and understand how to better interact with our site to avoid this in the future, please have your system administrator contact info@ncbi.nlm.nih.gov.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 12/09/2024
Reference: doi: 10.1093/annhyg/mel028 Van Nimmen NF, Poels KL, Veulemans HA. Identification of exposure pathways for opioid narcotic analgesics in pharmaceutical production workers. Ann Occup Hyg. 2006 Oct;50(7):665-77.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 12/09/2024
Air samples taken from filters of workers in the fentanyl manufacture industry. The single highest level (12.965 ng/L) requires 200-400 minutes to produce a "therapeutic" 100 mcg fentanyl dose in the unprotected. Even in the fentanyl factory, you won't breathe it and pass out.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 01/09/2024
Everyone who has ever worked in a hospital knows what the presence of this at the nursing station means.
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 29/08/2024
Worth pointing out that the only overdose patients in data used for nalmefene FDA approval came from the 1990s, before synthetic opioids were on the streets. x.com/DrugAlcReports…
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 29/08/2024
jamanetwork.com/journals/jama/…
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Andrew Stolbach, MD, MPH @toxicologist12.bsky.social · 29/08/2024
Treatment of delirium tremens in 1939 (below) vs today 1. No 2. Yes, but not paraldehyde 3. Yes! 4. Food is good 5. Yes, let's not argue about LR vs NS 6. See 4 7. "force" seems strong, see 5 8. Out of nowhere, but Yes 9. Yes! 10. Yes!
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