The Poison Lab

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 [email protected]: 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.Support 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: [email protected] Show ResourcesRyan's Medical Games and ResourcesShow Website

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)Support 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: [email protected] Show ResourcesRyan's Medical Games and ResourcesShow Website

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 crystalSupport 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: [email protected] Show ResourcesRyan's Medical Games and ResourcesShow Website

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

Do you think you know the cause of these symptoms? Send your guesses to [email protected] to take part in the next episodeSupport 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: [email protected] Show ResourcesRyan's Medical Games and ResourcesShow Website