[00:36.630 --> 00:38.330]  A couple quick announcements.
[00:38.630 --> 00:40.290]  First off, in the U-Room.
[00:41.510 --> 00:43.250]  All right, I'm full of feedback today.
[00:43.830 --> 00:46.750]  Nice to see how many packets I'm dropping as we speak.
[00:47.790 --> 00:57.450]  In the U-Room, at noon, we are having to talk about the Ukrainian situation that's been put... God, I am full of feedback and drop packets today.
[00:59.230 --> 01:01.210]  Saturday night is a great night to be at HOPE.
[01:02.290 --> 01:06.530]  Sunday morning is a little bit of recovery time from Saturday night.
[01:06.630 --> 01:06.890]  I hope.
[01:08.830 --> 01:11.650]  There's a collision in times that seems to be coming on.
[01:11.890 --> 01:14.430]  The U-Room at noon is going to be the Ukrainian situation.
[01:14.550 --> 01:18.110]  If you are the person that signed up for the 12 o'clock slot, please find me.
[01:18.250 --> 01:21.110]  Please find any other person wearing a badge like this one.
[01:21.830 --> 01:31.490]  And we'll talk, because the talk that was signed up for at noon, we will be having that one at 1 o'clock for Professor Tycoon, I believe the name is the person.
[01:32.530 --> 01:37.610]  The talk that's coming up next, it's amazing to see how sensitive biosystems are.
[01:39.390 --> 01:43.950]  Given some idea, I became a lot more sensitive to it after HOPE Number Nine.
[01:44.530 --> 01:51.310]  For those of you who don't know, right before HOPE Number Nine, I actually went through cancer surgery.
[01:51.310 --> 01:57.070]  Right after that, I became extremely sensitive to even small changes in food and drink.
[01:58.410 --> 02:02.670]  It was really amazing to see how those changes affected me personally.
[02:05.470 --> 02:10.630]  And it is truly amazing how different things happen.
[02:10.630 --> 02:16.510]  And what can I say, it's really cool to see a bottle like this one with random active stuff in it.
[02:17.050 --> 02:19.730]  I would love to touch what's inside here, just for fun.
[02:21.010 --> 02:25.870]  To see if it would be a smart idea for me to see what this cool bottle would be here.
[02:26.090 --> 02:27.610]  Our speaker, Jennifer Ortiz.
[02:35.110 --> 02:35.990]  Let's see here.
[02:37.930 --> 02:38.330]  Hello.
[02:42.980 --> 02:43.780]  All right.
[02:44.020 --> 02:46.940]  Welcome to my talk about poisoning.
[02:55.600 --> 03:01.720]  Well, like hacking, poisoning in your life is not like you see in movies.
[03:06.160 --> 03:09.080]  I mean, they ended up within 17 seconds.
[03:12.480 --> 03:13.880]  There's only a few drops.
[03:17.140 --> 03:17.980]  All right.
[03:19.440 --> 03:20.020]  Whew.
[03:22.260 --> 03:23.120]  That's better.
[03:23.440 --> 03:26.380]  It would have been insta-death if I hadn't taken that.
[03:28.980 --> 03:30.900]  It's actually kind of hard to see my notes.
[03:31.280 --> 03:34.660]  Well, I'm going to get into a little bit about how poisons really work.
[03:41.180 --> 03:43.260]  This is my...
[03:45.410 --> 03:45.990]  Sorry.
[03:46.710 --> 03:49.370]  My keyboard is...
[03:54.880 --> 03:57.580]  Sorry, a little bit of technical difficulty here.
[04:01.440 --> 04:01.940]  All right.
[04:02.080 --> 04:02.780]  I'll do it this way.
[04:03.820 --> 04:04.340]  All right.
[04:04.420 --> 04:06.940]  I'm a pharmacist and I like toxicology.
[04:07.640 --> 04:09.060]  I did a couple rotations.
[04:09.080 --> 04:13.280]  One at a poison center and one at a hospital.
[04:14.020 --> 04:14.960]  The thing I like...
[04:14.960 --> 04:19.280]  One thing I like about toxicology is talking to people.
[04:19.280 --> 04:28.420]  If I talk to a normal person and I say, well, you know, if someone were to have a bunch of rat poison, they'd be okay for a few days, really.
[04:28.600 --> 04:34.560]  But then they'd start to have internal bleeding and they'd get anemic and low blood pressure.
[04:34.560 --> 04:39.800]  And if they survived the hemorrhaging, they would need vitamin K for several months.
[04:40.180 --> 04:46.820]  And a reaction from a normal person might be, why do you know that?
[04:49.560 --> 04:52.340]  And it's just strange because it's like, why?
[04:52.540 --> 04:55.740]  Why do you know a certain piece of knowledge?
[04:57.600 --> 05:01.280]  But in toxicology, I don't get that question.
[05:02.400 --> 05:08.080]  A question I do like when people ask why, you know, why present at a hacker conference?
[05:08.080 --> 05:13.160]  One is because, you know, a body is a biochemical system.
[05:13.620 --> 05:23.400]  There is an analogy of hacking because chemicals can hijack these chemical processes or change them.
[05:23.700 --> 05:27.940]  So basically, you know, chemistry can hack the body.
[05:28.160 --> 05:32.000]  Although more importantly, I like talking at HOPE.
[05:32.000 --> 05:33.640]  I've done it a couple times now.
[05:34.300 --> 05:38.640]  Because you guys are really interested in knowing how stuff works.
[05:38.900 --> 05:43.980]  And it's really the knowledge that is important, I think.
[05:45.720 --> 05:46.520]  Oh, yeah.
[05:46.660 --> 05:48.360]  And I'll introduce...
[05:48.360 --> 05:50.500]  This is my favorite hacker.
[05:50.820 --> 05:57.820]  It's a cold virus because it attaches to receptors in your nose and throat, which makes not.
[05:58.420 --> 06:01.940]  And the snot is full of viruses and then it spreads around.
[06:01.940 --> 06:03.800]  So it hacks to survive.
[06:12.600 --> 06:19.270]  And so really, it's about understanding how a system works, the biochemical system of the body.
[06:19.620 --> 06:23.440]  And I'm going to go into some more examples.
[06:24.500 --> 06:29.080]  Just starting generally, there's, you know, perception versus reality, obviously.
[06:29.380 --> 06:32.280]  You don't have insta-death from poisons.
[06:32.920 --> 06:38.710]  A lot of times there's not an antidote or there will be an antidote, but we won't use it to treat.
[06:40.400 --> 06:46.320]  And you don't really get that instant painless death that some people might imagine.
[06:49.880 --> 06:59.340]  And a lot of how poisons actually bring down the system has to do with homeostasis, which is basically the balance of the body.
[06:59.920 --> 07:05.820]  And I'll mean some sort of metaphorical balance.
[07:05.820 --> 07:14.680]  There's very specific parameters that the body is always keeping itself within at any given time.
[07:14.920 --> 07:21.480]  In response, the environment changes, but the body needs to stay the same and yet be flexible to changes.
[07:21.480 --> 07:28.600]  And, you know, I've listed some things that keeps in balance, you know, including even water.
[07:28.600 --> 07:34.940]  If you have too much water, it can become toxic because too much of it gets into the cells and they can burst.
[07:36.740 --> 07:39.280]  So homeostasis is very important.
[07:42.580 --> 07:51.020]  So one way that poisons can disrupt that is by damaging certain organs, especially the liver and kidneys.
[07:51.020 --> 08:02.560]  The liver is involved in a whole lot of things, from glucose to clotting to the water balance, the digestion, you know, detox.
[08:06.620 --> 08:15.940]  So Tylenol, there's a perception that maybe, you know, if you take the whole bottle, you might, you know, go to sleep and just never wake up.
[08:15.940 --> 08:19.920]  And this is... couldn't be farther from the truth.
[08:22.440 --> 08:25.400]  There was actually a delayed toxicity with Tylenol.
[08:26.360 --> 08:29.400]  Paracetamol is another name for the drug, acetaminophen.
[08:29.520 --> 08:30.740]  It's in the top left there.
[08:30.960 --> 08:33.560]  And it's metabolized into different things.
[08:33.800 --> 08:38.060]  The one on the bottom left, napke, is a toxic metabolite.
[08:38.060 --> 08:40.300]  And that damages liver cells.
[08:40.680 --> 08:47.960]  Thankfully, our body has glutathione, or GSH, which cleans up the napke normally.
[08:48.380 --> 08:53.470]  But in a large overdose, there isn't enough GSH.
[08:53.780 --> 08:55.000]  It gets depleted.
[08:56.440 --> 09:02.340]  And so, sometimes, well, someone will, like, take a big overdose of Tylenol.
[09:02.580 --> 09:06.320]  And they'll go... they'll feel okay, you know, the first day.
[09:06.560 --> 09:08.020]  They'll be like, oh, that didn't work.
[09:08.160 --> 09:09.300]  I changed my mind.
[09:10.760 --> 09:13.940]  And then the second day, they might start to feel a little sick.
[09:14.580 --> 09:18.940]  And then by the third day, they're really sick, and they end up in the hospital.
[09:18.940 --> 09:25.180]  And by that time, the antidote, which I'll talk about in a minute, doesn't have much of a chance to work.
[09:25.660 --> 09:30.600]  And so, they're on the liver transplant list, in the ICU, on supportive care.
[09:31.180 --> 09:32.480]  It can get messy.
[09:35.480 --> 09:38.580]  The antidote is called an acetylcysteine.
[09:38.760 --> 09:42.580]  And basically, it promotes the production of GSH.
[09:44.180 --> 09:51.000]  And it's most effective before the damage is done.
[09:55.480 --> 09:59.000]  Did any of you go to the biohacking last night?
[10:01.000 --> 10:01.520]  Cool.
[10:02.320 --> 10:12.980]  When they talked about, you know, printing out organs and such, I think the liver would actually be a good one to start with, because it's got, it can regenerate very well.
[10:13.240 --> 10:26.740]  And if at the hospital, you can get the person through, like if you can keep them alive, and keep them from going into multiple organ failure, after this overdose, the liver will actually recover quite well.
[10:29.520 --> 10:32.020]  Another thing to deal with is the kidneys.
[10:32.020 --> 10:38.240]  So, if you ever wondered about antifreeze, it's got some toxic metabolites.
[10:38.900 --> 10:41.140]  Again, it's not itself that's toxic, it's the metabolites.
[10:41.760 --> 10:44.620]  And they crystallize in the kidneys, doing damage.
[10:45.460 --> 10:47.980]  And it's got an interesting antidote.
[10:49.980 --> 10:51.520]  Good old ethanol.
[10:54.040 --> 11:01.220]  Basically, what happens is the antifreeze gets metabolized by the same enzyme that metabolizes ethanol.
[11:01.220 --> 11:06.520]  And so, the idea is, there used to be, overwhelm that pathway.
[11:07.200 --> 11:15.660]  And you give them, you get them drunk enough, and they won't get toxicity from antifreeze, because it'll eventually get excreted.
[11:17.700 --> 11:25.400]  And, but there are a lot of side effects, because you have to keep them at a blood alcohol level of 0.1 to 0.15.
[11:27.480 --> 11:30.780]  Which is, you know, on average, maybe like slamming five shots.
[11:32.760 --> 11:38.280]  And you have to keep them at that level for a long time until all the antifreeze is gone.
[11:38.520 --> 11:40.600]  It could be, you know, it could be a few days.
[11:44.920 --> 11:48.920]  So, thankfully, we do have a drug now that works as an antidote as well.
[11:48.920 --> 11:54.280]  It inhibits the enzyme without actually dealing with all those side effects.
[11:57.120 --> 12:02.780]  So, another way to bring the system down, obviously, you need to breathe and to use oxygen.
[12:03.860 --> 12:14.140]  So, some examples are, you know, drugs that slow down breathing, like opiates, heroin, morphine, benzodiazepines, like Valium.
[12:15.020 --> 12:22.720]  There are things that stop your breathing, like curare, tetrodotoxin, which is the fugu fish toxin.
[12:23.180 --> 12:27.000]  They basically paralyze you, and that includes your diaphragm.
[12:27.140 --> 12:32.320]  So, if you just stop breathing, obviously stop getting oxygen.
[12:33.280 --> 12:38.060]  But artificial respiration will help keep you alive in that case.
[12:38.060 --> 12:43.500]  There are some that interfere with the availability of oxygen, carbon monoxide.
[12:44.780 --> 12:54.460]  Basically, in your blood, oxygen is carried by hemoglobin, but carbon monoxide will bind to that and displace the oxygen.
[12:54.640 --> 12:55.460]  It will kick it out.
[12:56.280 --> 13:02.580]  And then there's ones that interfere with respiration on a cellular level, and that's cyanide.
[13:04.300 --> 13:14.480]  On a cellular level, this graph looks kind of complicated, but you can think of it as a hydroelectric generator, except with electrons instead of water.
[13:14.720 --> 13:17.980]  There's a flow from left to right here of electrons.
[13:17.980 --> 13:27.180]  And on the right, that ATP synthase over there, it actually turns physically and generates the energy for your cell.
[13:29.580 --> 13:39.300]  And cyanide will inhibit the complex four, the purple one, and basically stop the flow.
[13:39.940 --> 13:43.000]  So, it stops the generation of energy.
[13:45.600 --> 13:56.420]  And carbon monoxide and cyanide are called the toxic twins of smoke inhalation, because whenever someone's in a fire, they're both a big concern.
[13:56.740 --> 14:06.460]  With carbon monoxide, you can give the person lots and lots of oxygen in an attempt to get them, get some oxygen on that hemoglobin.
[14:07.040 --> 14:10.340]  If you do that for cyanide, that's not going to work.
[14:10.600 --> 14:18.660]  But thankfully, we have vitamin B12 in its different forms, hydroxylcobalamin.
[14:19.980 --> 14:30.080]  You can give that and it'll bind up the cyanide and, you know, turn it like the cyanocobalamin is not toxic at all.
[14:33.830 --> 14:35.460]  So, moving on to the heart.
[14:36.330 --> 14:37.800]  This is River Phoenix.
[14:38.090 --> 14:39.260]  I'm just going to use his...
[14:40.370 --> 14:47.080]  He's an actor who overdosed when he was 23, back in 1993.
[14:49.340 --> 14:53.940]  And his...the cause of death was acute multiple drug intoxication.
[14:54.760 --> 15:03.350]  What happened was he went to a nightclub and he was speedballing, apparently, which is a mix of heroin and cocaine.
[15:04.700 --> 15:07.710]  And he was feeling sick and also took some Valium.
[15:08.480 --> 15:12.500]  And he collapsed outside the club and was having seizures.
[15:12.500 --> 15:17.880]  When the paramedics arrived around 1.30 a.m., they started giving CPR.
[15:18.090 --> 15:20.420]  He had already flatlined.
[15:20.730 --> 15:23.020]  And I'll make a note about CPR.
[15:25.260 --> 15:29.330]  It's actually...you only really give it when a person is in very bad shape.
[15:29.380 --> 15:32.230]  They're not breathing and they've got no pulse.
[15:32.980 --> 15:38.820]  And it's really the act of...again, it's not like TV where you just, like, gently press on their chest.
[15:38.820 --> 15:56.880]  You have to really press down because you're physically squeezing the heart in a desperate attempt to get blood to circulate and to keep that person's brain alive by getting some blood into the brain and the rest of their body when their heart can't do it.
[15:57.560 --> 16:03.700]  So the success rate...like, you need to do it, but the success rate is very low.
[16:03.700 --> 16:06.700]  And it wasn't successful in this case, obviously.
[16:07.350 --> 16:21.730]  To start the heart again, you need either some drugs and, you know, they're shocking, but you don't shock...you can't really get the person's heart started with a shock if it's stopped.
[16:23.090 --> 16:39.060]  So, like, unlike in TV, if their heart's not beating, you know, you can try to CPR and certain drugs, but it's not likely to be successful, unfortunately.
[16:40.710 --> 16:43.820]  You know, you arrived at the hospital at 1.34 a.m.
[16:43.820 --> 16:46.460]  and was pronounced dead about 20 minutes later.
[16:47.060 --> 17:04.820]  So the autopsy found morphine, which is a metabolite of heroin, cocaine, diazepam, that's a Valium, metabolite of marijuana, pseudoephedrine, and ephedrine, which could have been contaminants in the cocaine or cold medication.
[17:06.230 --> 17:08.280]  So there were a lot of drugs in this system.
[17:08.420 --> 17:12.560]  And the levels of cocaine and heroin, in particular, were both very high.
[17:12.560 --> 17:15.970]  So they ruled it acute, you know, they're like, we don't know what killed him.
[17:16.400 --> 17:31.140]  But looking at it as a toxicologist, as I talked about before with the breathing and respiration, heroin and Valium, if they would have been toxic, they would have killed him by slowing his breathing.
[17:31.470 --> 17:35.680]  On the other hand, his heart was stopped and he had seizures.
[17:35.680 --> 17:38.780]  That's very typical of cocaine and stimulants.
[17:39.900 --> 17:42.100]  So that's really what killed him.
[17:44.360 --> 17:56.660]  Interestingly, the Valium is one of the things he would have been, is one of the things he might have been, the type of drug he would have been treated with in the hospital if he'd been, if he'd survived longer.
[17:57.020 --> 18:01.360]  It was actually the right thing to take, but it was too little.
[18:02.060 --> 18:08.540]  The cocaine was way too much for whatever small amount of oral Valium he had.
[18:10.000 --> 18:18.440]  Another toxicity that he wouldn't have had to worry about back in 93, but is more of a problem now, is Levamisole.
[18:18.700 --> 18:21.460]  It's a drug that is used against worms.
[18:23.950 --> 18:27.440]  And it's in a lot of the cocaine in the U.S.
[18:28.100 --> 18:30.920]  As of 2011, it was in over 80%.
[18:31.450 --> 18:35.820]  I couldn't find a more recent number for that.
[18:37.250 --> 18:45.230]  But a lot of the cocaine, it's actually cut before it comes into the country, and it seems to have some enhancing effects on the cocaine.
[18:45.730 --> 18:52.010]  Unfortunately, it can cause some heavy-duty immune system failure and skin toxicity.
[18:53.250 --> 18:59.360]  I could have found some illustrations for the skin toxicity, but they were pretty gross.
[18:59.680 --> 19:03.710]  So, I'm with the XKCD guy.
[19:03.710 --> 19:05.770]  I'm just showing you a squirrel.
[19:10.930 --> 19:14.370]  So, nervous system toxicities.
[19:15.390 --> 19:25.910]  We've got, with the case of stimulants, you've got the sympathetic nervous system, which is the fight or flight, and that's activated by stimulants.
[19:26.070 --> 19:30.830]  And you've got the parasympathetic nervous system, which is the rest and digest.
[19:31.330 --> 19:41.810]  We don't hear about that as much, but it's very common to see these toxicities anti-cholinergic, because it involves the neurotransmitter acetylcholine.
[19:43.550 --> 19:48.730]  Tylenol PM, we already talked about the acetaminophen, the Tylenol part.
[19:49.510 --> 19:56.770]  So, here we're going to concentrate on the PM, which is diphenhydramine, also sold as Benadryl.
[19:59.030 --> 20:03.490]  And if you were to take the whole bottle, you would get...
[20:03.490 --> 20:06.710]  Again, there's a perception of like, oh, Tylenol PM.
[20:06.730 --> 20:10.530]  If I took the whole bottle, like, you know, you take a little bit, you fall asleep.
[20:10.910 --> 20:14.050]  If I took the whole bottle, maybe I'd fall asleep and never wake up.
[20:14.470 --> 20:15.750]  That's not what happens.
[20:17.190 --> 20:23.570]  You get anti-cholinergic toxicity, which is the same kind you find in deadly nightshade.
[20:26.210 --> 20:38.090]  There's basically a bunch of different symptoms that basically have a lot to do with having very dried up, you know, few bodily fluids.
[20:38.490 --> 20:43.410]  The skin is really hot and dry and itchy, and you're really heated up.
[20:44.330 --> 20:48.250]  There's delirium, as in talking to people who aren't there.
[20:48.250 --> 20:49.970]  That's a characteristic.
[20:53.490 --> 21:01.690]  And it can lead to, you know, so hyperthermia, being too hot, and seizures and coma, and an overdose.
[21:03.770 --> 21:06.810]  And the treatment is generally supportive care.
[21:06.910 --> 21:08.230]  That's a treatment for a lot of stuff.
[21:08.410 --> 21:16.470]  There actually is an antidote, but it's very short-lived, and is used more to diagnose the toxicity than it is to treat it.
[21:17.670 --> 21:23.870]  It cultivates a stigmine, reverses the effect, but again, it wears off really fast.
[21:25.150 --> 21:36.870]  So you usually treat whatever symptoms are needed in the hospital to keep the person alive, keep them cool until their body can clear out the drug.
[21:38.890 --> 21:47.530]  Another common one, often you see these two together because there are a lot of antidepressants and things that have both kinds of effects.
[21:48.490 --> 21:51.590]  Serotonin toxicity, or serotonin syndrome.
[21:52.770 --> 22:00.530]  It's basically a special type of the nervous system going haywire with too much serotonin activity.
[22:00.970 --> 22:15.430]  There's a lot of overactive reflexes, tremor, bowel sounds, and also altered mental status, not quite the same as the delirium you get with the anticholinergics.
[22:16.370 --> 22:32.730]  And the hyperthermia is a real problem because a person's moving like their muscles are shaking, and after several hours of that there's a real chance of muscle breakdown, which also can cause kidney failure.
[22:33.470 --> 22:38.150]  And that's in addition to the damage that can happen from hyperthermia.
[22:41.490 --> 22:49.970]  And, I mean, it can basically happen from any combination of two drugs that affect serotonin, although it's dose-dependent.
[22:50.090 --> 22:57.290]  So you see it a lot in overdoses, but not normally, not a lot in normal treatment.
[22:59.370 --> 23:03.470]  You know, in this case, again, there's an antidote, but it's oral.
[23:03.470 --> 23:11.570]  And if someone is shaking, a lot of times if they're really bad, you don't want to give it because there's a chance they might not be able to swallow it properly.
[23:12.370 --> 23:22.870]  And so usually IV benzodiazepines are used to calm the body down and keep people from moving.
[23:23.930 --> 23:31.510]  In some cases where it's extreme, you have to put them in a drug-induced coma for a while, and you maintain their breathing and everything.
[23:32.190 --> 23:38.630]  And, again, it's keep them alive until the toxicity, until their body clears out the poison.
[23:42.210 --> 23:48.410]  I also wanted to go over a little bit about acid and bases, and also a special case.
[23:48.410 --> 24:04.690]  Usually acids and bases, like Drano, they'll be corrosive, like on direct contact, because they're directly damaging to cells, and you won't get a systemic poisoning.
[24:05.770 --> 24:15.390]  But as shown in this still from a popular TV show, there's one called hydrofluoric acid.
[24:15.390 --> 24:32.950]  And this would be probably a toxicologist nightmare to see this in any chemistry lab, six jugs of the stuff, because it's a weak, like as far as acids are, it's weak.
[24:33.690 --> 24:40.890]  It's considered weak, but it's special because it can cause systemic toxicity.
[24:42.410 --> 24:47.850]  That fluorine is basically the problem.
[24:48.410 --> 24:54.170]  And, I mean, it can cause burns, delayed burns, like they don't necessarily show up right away.
[24:55.070 --> 24:57.850]  But, like a day later, they can show up.
[24:58.290 --> 25:01.010]  And I'm not going to show some more serious ones.
[25:01.950 --> 25:03.730]  You can look them up yourself.
[25:05.870 --> 25:10.970]  Well, the interesting thing, the fluorine part of hydrofluoric acid will absorb.
[25:11.510 --> 25:18.410]  It actually, it can eat through glass, because it's not the acid, it's the fluorine.
[25:18.630 --> 25:20.010]  It'll attack the silicon.
[25:21.110 --> 25:22.170]  And, huh?
[25:22.810 --> 25:25.580]  Etch glass, actually.
[25:25.580 --> 25:26.360]  Oh, yeah, yeah.
[25:26.520 --> 25:31.300]  It's used low concentrations to etch glass, because it's special.
[25:31.460 --> 25:34.000]  Other acids won't be able to do that.
[25:34.360 --> 25:36.540]  It also loves to bind to calcium.
[25:36.880 --> 25:38.420]  And so, it could eat through bone.
[25:39.380 --> 25:43.500]  And it can absorb in your system, and it can bind up the calcium.
[25:43.740 --> 25:46.860]  And that's what can cause systemic toxicity.
[25:48.840 --> 25:55.640]  I mean, it takes very little, like if you were to ingest it, it takes very little to do a whole lot of damage.
[25:55.640 --> 26:07.000]  Even just a 5% solution, just a few ounces could be fatal, and result in cardiac arrest six hours later.
[26:07.000 --> 26:12.300]  A garbage man, he walked a few years, about 10 years ago, that died rather horribly that way.
[26:12.680 --> 26:17.240]  He dug a bunch of garbage into the compactor and the truck, and it was a big jug of it in there.
[26:17.780 --> 26:19.180]  The jug squirted it.
[26:20.780 --> 26:22.120]  He did not live.
[26:23.140 --> 26:28.600]  Yeah, so there was a garbage man who, there was a jug in there, and it squirted him.
[26:28.760 --> 26:30.560]  Yeah, yeah, covered it with the truck, basically.
[26:30.740 --> 26:31.300]  And it's closed.
[26:31.680 --> 26:32.120]  Yeah.
[26:33.640 --> 26:34.080]  Yeah.
[26:39.120 --> 26:45.460]  Yeah, so I mean, the thing is, it can be very toxic and absorb through the skin, too.
[26:45.760 --> 26:48.680]  And especially if it's high concentration.
[26:48.680 --> 27:02.320]  If it's a 100% concentration, it can be fatal if it absorbs through 2.5% of your body's surface area, which is about the surface of the skin covering your hand.
[27:02.320 --> 27:10.560]  So if it covers your hand, 100% concentration, it can kill you, because of the calcium.
[27:10.840 --> 27:12.180]  It takes all the calcium in your body.
[27:13.100 --> 27:22.260]  And so, at lower concentrations, it's not going to be, like, as problematic, but it can still give you burns.
[27:22.260 --> 27:24.940]  The treatment is calcium.
[27:25.600 --> 27:37.540]  Whether it's topical or systemic, they'll give lots of calcium to try to bind up the fluorine and keep you from, you know, keep your heart from stopping.
[27:42.160 --> 27:50.640]  And the last example I wanted to talk about, this is actually one of my favorites, because it's a more complicated toxicity, aspirin.
[27:50.640 --> 27:53.900]  And it just seems like a lot of different things happen.
[27:58.260 --> 28:01.620]  So, first of all, it stimulates an overdose.
[28:02.000 --> 28:05.340]  It'll stimulate the respiratory centers in your brain stem.
[28:07.440 --> 28:12.580]  And that'll cause the patient to hyperventilate and breathe really fast.
[28:13.240 --> 28:20.580]  And the reason this is important, I'm going to go into a bit of background, is that, again, homeostasis.
[28:20.900 --> 28:29.060]  The pH of your blood is kept in a very tight range, and two organs actually do this, your lungs and your kidneys.
[28:30.080 --> 28:32.140]  And they can compensate for each other.
[28:32.360 --> 28:36.940]  Your lungs only take a couple minutes to compensate, and your kidneys take a few hours.
[28:37.300 --> 28:44.740]  But if you start hyperventilating your blood pH, it will become more basic, less acidic.
[28:45.080 --> 28:51.880]  Because you're blowing off a lot of carbon dioxide, which in your blood gets converted to carbonic acid.
[28:53.840 --> 29:05.380]  But if you were to hyperventilate for several hours, your kidneys would kick in and bring your blood pH back into normal range.
[29:06.600 --> 29:12.980]  But since the aspirin stimulates that, it'll cause a respiratory alkalosis.
[29:12.980 --> 29:16.360]  That's when your blood becomes more basic because of your lungs.
[29:17.520 --> 29:25.260]  And then you also get a metabolic acidosis, which is, first of all, your kidneys will compensate.
[29:26.360 --> 29:29.100]  Aspirin and its metabolites are also acidic.
[29:30.300 --> 29:35.240]  It also has the effect of decoupling, oxidative phosphorylation.
[29:35.480 --> 29:47.480]  Basically, going back to the cyanide in the hydroelectric generator there, if you imagine that process, instead of blocking it like cyanide does, it detaches it.
[29:47.600 --> 29:50.060]  It's like taking the generator offline.
[29:50.380 --> 29:56.850]  So there's electrons still, they can flow, but they're not making any cellular energy.
[29:58.840 --> 30:01.620]  And that results in more acid buildup.
[30:01.660 --> 30:07.920]  And it causes your body to have to use other methods to get energy and metabolize glucose.
[30:08.840 --> 30:16.320]  And the byproducts of that, lactic acid, pyruvic acid, they also make things more acidic.
[30:17.100 --> 30:27.800]  And also, if you're hyperventilating for several hours and you're sweating and your body, your cells are metabolizing faster, you lose a lot of water.
[30:29.040 --> 30:33.120]  And then, your blood pressure goes down, there's less volume there.
[30:33.360 --> 30:35.860]  So that concentrates the acids in your blood.
[30:37.140 --> 30:40.980]  And so, an aspirin overdose patient, they'll be...
[30:41.840 --> 30:47.860]  Like that alone, they'll also stimulate them to hyperventilate to compensate for the acidosis.
[30:47.860 --> 30:52.160]  And so, their blood pH actually might be in normal range.
[30:52.420 --> 30:55.580]  But from lab values, you can tell that there's a mixed...
[30:55.580 --> 31:02.160]  There's both an acidosis process and an alkalosis process going on at the same time.
[31:04.120 --> 31:07.860]  And so, it's a more complicated overdose.
[31:07.860 --> 31:21.480]  And the problem is too, like when you're treating it, if you were to give oxygen, if you were to intubate, give someone a breathing tube, you set the respiratory rate.
[31:21.720 --> 31:34.020]  And if they're breathing 36 times a minute to compensate and keep their blood pH normal, if you've set the respiratory rate at 20, they're gonna go downhill very quickly.
[31:34.300 --> 31:39.280]  Because their blood's gonna go into acidosis and they're gonna die.
[31:40.880 --> 31:46.820]  And another thing is, after several hours of this, they'll wear out.
[31:46.960 --> 31:48.480]  They'll wear out themselves.
[31:49.100 --> 31:49.900]  And they can...
[31:49.900 --> 31:58.500]  Again, one of the things with aspirin overdose is they can just quickly go downhill after being kind of stable for a while.
[32:01.380 --> 32:06.560]  So, if the acidosis isn't the thing, there's also the other things that can kill you.
[32:08.540 --> 32:12.720]  There's hypoglycemia, because your cells are using up a whole lot of glucose.
[32:13.220 --> 32:16.220]  There's dehydration from all the fluid loss I talked about.
[32:16.600 --> 32:20.840]  There's electrolyte imbalances from all the stuff that's going on.
[32:21.020 --> 32:23.480]  And also, hyperthermia can be a danger.
[32:23.480 --> 32:30.780]  So, aspirin has a lot of stuff going on at the same time.
[32:31.560 --> 32:33.580]  So, it has to be approached carefully.
[32:34.420 --> 32:35.700]  There are treatments.
[32:36.220 --> 32:43.760]  Sodium bicarbonate, which is the same as baking soda, except they'll give it as an IV and a fluid.
[32:44.020 --> 32:50.660]  Give lots of fluids that'll make the urine more alkaline, more basic.
[32:50.660 --> 32:57.740]  And so, that helps the acid, the aspirin and its metabolites get excreted.
[33:02.780 --> 33:04.640]  And also, dialysis.
[33:04.880 --> 33:13.440]  In toxicology, a poison center will recommend, in an aspirin overdose, to have the team ready, like with the dialysis.
[33:13.440 --> 33:16.460]  Because, again, someone can go downhill really fast.
[33:17.240 --> 33:23.480]  And if you need to do dialysis, you'll want to do it and have everything ready to do it.
[33:24.520 --> 33:28.120]  Sometimes, aspirin is still deadly, even with all the treatment.
[33:29.560 --> 33:34.460]  And that's... have you ever wondered what happens if you drink, you know, eat the whole bottle of aspirin?
[33:36.080 --> 33:37.000]  It's this stuff.
[33:41.170 --> 33:42.430]  So, that's the end.
[33:43.590 --> 33:50.570]  I wanted to give you some examples of how, you know, again, these things can bring the system down, the biological system.
[33:51.350 --> 34:00.450]  Hopefully, I've encouraged you to think of your body, which you have with you all the time, as a system, as a machine, just like, you know, computers, except more complicated.
[34:01.350 --> 34:05.650]  And, again, we know how some of these processes work.
[34:06.770 --> 34:10.590]  And I think understanding that can only be a good thing.
[34:10.830 --> 34:14.930]  And, in fact, can mean the difference between life and death, sometimes.
[34:15.890 --> 34:25.290]  Also, poison center is a really good resource, in the U.S., at least, if you have any questions about any poisons or toxicities.
[34:25.630 --> 34:26.270]  Thank you.
[34:32.800 --> 34:34.220]  So, if you have any questions...
[34:35.200 --> 34:35.700]  May I ask you a question?
[34:36.100 --> 34:36.340]  Uh-huh.
[34:36.520 --> 34:41.760]  You mentioned a protective measure that Valium could have on, was it the cocaine?
[34:42.040 --> 34:42.520]  Cocaine.
[34:42.940 --> 34:43.520]  The example.
[34:43.720 --> 34:43.880]  Yes.
[34:43.960 --> 34:45.100]  Can you talk about that further, please?
[34:46.220 --> 34:55.900]  Well, basically, in a stimulant overdose, the system's really amped up, and you can have seizures.
[34:55.900 --> 35:03.260]  And the benzos, well, they help you not seize.
[35:03.700 --> 35:07.320]  They slow breathing and heart rate and calm you down.
[35:07.420 --> 35:08.720]  They calm your whole body down.
[35:10.360 --> 35:15.380]  And, you know, there's less oxygen usage from your muscles.
[35:16.220 --> 35:17.620]  A lot of different things.
[35:17.920 --> 35:18.760]  I mean, they're really good.
[35:18.960 --> 35:27.960]  And in the hospital, they'll be given, I mean, you can go really high doses if a person needs it.
[35:28.040 --> 35:33.280]  You just have to watch their breathing and you have to intubate them if it's too slow.
[35:34.780 --> 35:39.440]  But they're extremely useful for treating a lot of different overdoses because of that.
[35:40.380 --> 35:41.020]  Thank you.
[35:42.180 --> 35:42.780]  Hi there.
[35:42.920 --> 35:43.280]  Great talk.
[35:44.340 --> 35:54.100]  I'm sure you must get asked this all the time, but I heard, maybe it's a myth, maybe it's not, that there's enough potassium in five, six bananas to kill somebody.
[35:54.520 --> 35:55.480]  What's going on there?
[35:55.580 --> 35:57.280]  Do you have any background on that?
[35:58.680 --> 36:00.180]  Could you repeat that?
[36:00.380 --> 36:00.840]  Potassium?
[36:00.840 --> 36:01.540]  Yeah.
[36:01.700 --> 36:06.760]  I heard that if you eat five or six bananas, there's enough potassium to kill you.
[36:08.460 --> 36:09.300]  Is that right?
[36:15.500 --> 36:22.100]  There could be enough potassium to kill you if you looked at, you know, the amount of potassium.
[36:22.120 --> 36:29.840]  But if you're eating bananas, the thing is your body, again, has mechanisms for homeostasis.
[36:29.840 --> 36:34.940]  You can't, like, just get a potassium overdose out of bananas.
[36:35.100 --> 36:35.440]  Right.
[36:35.940 --> 36:41.760]  Because there are mechanisms, you know, with absorption and things that will even it out.
[36:41.760 --> 36:42.180]  Okay.
[36:42.300 --> 36:43.180]  So it's definitely a myth then.
[36:43.540 --> 36:43.600]  Right.
[36:43.960 --> 36:44.040]  Okay.
[36:44.200 --> 36:45.920]  And just one other thing, real quick.
[36:46.720 --> 36:53.520]  To do with the hydrofluoric acid, there's probably a lot of guys here that, like myself, that do a lot of work with lithium-ion batteries as hackers.
[36:53.820 --> 36:59.000]  And I think if you end up getting a battery fire and you put water on it, you can generate hydrofluoric acid.
[36:59.000 --> 37:00.540]  So be careful with that.
[37:00.720 --> 37:00.880]  Yeah.
[37:01.320 --> 37:01.680]  Indeed.
[37:03.260 --> 37:03.700]  Okay.
[37:03.880 --> 37:05.240]  I walked in a little late.
[37:05.500 --> 37:08.380]  When I came in, you were towards the end of the Tylenol PM thing.
[37:08.480 --> 37:10.140]  You covered the antichlorogenic.
[37:10.880 --> 37:16.300]  But you also covered the acetaminophen itself because that's actually more of a problem than the other part of it is.
[37:16.660 --> 37:22.600]  Considering that with acetaminophen, you take enough of it, you're going to give your liver a rather hard time.
[37:22.600 --> 37:28.280]  If they don't get you in time with anacetylcysteine to basically block the action, you're going to risk it up with a dead liver.
[37:29.220 --> 37:29.940]  I don't know if you covered that.
[37:30.680 --> 37:31.080]  Yeah.
[37:31.080 --> 37:34.220]  I mean, basically, you know, talked about the liver damage.
[37:34.540 --> 37:34.720]  Oh, you did.
[37:34.900 --> 37:35.460]  The antidote.
[37:36.340 --> 37:42.480]  We usually give the antidote anyway, even if they come to the hospital late, because it seems to help a little bit.
[37:43.080 --> 37:49.060]  But mainly it's supportive care and put them on the transplant list.
[37:49.500 --> 37:55.380]  A lot of times, if you can get them through with supportive care, the liver recovers.
[37:55.560 --> 37:56.880]  Depends how bad it's damaged, exactly.
[37:57.200 --> 38:07.700]  Incidentally, going back to the hydrofluoric acid angle, believe it or not, they sell a protocol wink in some supermarkets as a cleaner and it actually has hydrofluoric acid in it, believe it or not.
[38:07.840 --> 38:12.400]  So it's not as hard to find as you think, plus the glass etching stuff that they sell to anybody.
[38:13.200 --> 38:14.240]  Yeah, the glass etching.
[38:14.340 --> 38:15.260]  It's low concentration.
[38:15.780 --> 38:16.940]  It's kind of scary stuff to handle.
[38:16.940 --> 38:22.240]  Like at that moment, the garbage man was trying to figure out all the papers because he sticks the thing in the compactor on the truck.
[38:22.420 --> 38:23.180]  The bottle pops.
[38:23.780 --> 38:25.240]  He didn't even make it to the hospital.
[38:25.360 --> 38:26.340]  That's how fast he died.
[38:26.480 --> 38:27.880]  It was high strength stuff.
[38:28.220 --> 38:28.640]  Nasty.
[38:31.200 --> 38:38.740]  In a large number of cities in the U.S., we're seeing a huge increase in heroin overdose.
[38:39.120 --> 38:46.320]  And as a result, I've read that medical law enforcement first responders are now starting to carry an injectable.
[38:46.320 --> 38:49.440]  I believe it is that's administered on scene.
[38:49.900 --> 38:52.400]  That's something new I've really never heard of.
[38:52.520 --> 38:54.540]  I wonder if you could tell us the background, how it works.
[38:54.840 --> 38:57.420]  Does it need to be administered in some period of time?
[38:57.640 --> 38:58.820]  How effective just...
[38:58.820 --> 39:05.360]  There's an antidote for opiates called naloxone, which can be...
[39:05.360 --> 39:07.920]  I mean, it basically reverses the effect.
[39:08.100 --> 39:08.940]  So it's very good.
[39:08.960 --> 39:17.080]  If you have an overdose, you can give it and wake the person up if they're going unconscious.
[39:17.700 --> 39:20.420]  There are some pitfalls.
[39:21.140 --> 39:27.220]  If they're an addict and you give a lot of this stuff, it'll send them into withdrawal, which has its own issues.
[39:27.220 --> 39:29.400]  Mostly, you know, being unpleasant.
[39:30.840 --> 39:33.860]  But it's not really a desirable thing.
[39:34.520 --> 39:40.180]  And the other thing is the usefulness of naloxone, you know, in an emergency.
[39:41.480 --> 39:49.240]  It's good when they're going unconscious and it'll keep you from needing to intubate.
[39:50.100 --> 39:58.240]  If you're going to intubate them anyway, give them a breathing tube and, you know, use the machines to help them breathe for a while.
[39:58.240 --> 40:06.600]  And then you don't need the naloxone because it's basically to reverse the effect and keep them breathing enough.
[40:07.180 --> 40:15.660]  Do you think that first responders get trained enough in how to make those decisions in an emergency type situation?
[40:16.220 --> 40:17.180]  I don't know.
[40:17.340 --> 40:18.180]  I mean, it varies.
[40:18.180 --> 40:24.840]  I've certainly heard stories of where naloxone is given, where it probably doesn't need to be.
[40:26.240 --> 40:35.340]  You know, so I think training, I mean, usually it doesn't do harm, but the person is not encouraged.
[40:35.520 --> 40:46.180]  If they go into withdrawal, they're not encouraged to, you know, call paramedics as quickly if they, you know, have a possible overdose situation the next time.
[40:46.180 --> 40:48.220]  I think there are harms that come from it.
[40:48.920 --> 41:04.220]  And, I mean, that's one of the usefulness of poison centers is you get a lot of calls from health professionals of all types, you know, pharmacists, doctors, hospitals, EMTs, asking, you know, what the recommendation is.
[41:04.940 --> 41:11.240]  And so that's, I mean, I think it's a great resource and it helps these decisions get made.
[41:11.460 --> 41:11.840]  Thank you.
[41:14.600 --> 41:15.080]  Hello.
[41:15.500 --> 41:23.860]  I was curious if you're familiar with monolaurin, which is lauric acid and glycerol, in terms of, it's found in coconut oil and breast milk.
[41:23.860 --> 41:28.800]  And I've, I mean, I've heard that the mechanism of actions through like, you know, it stays as a lipid.
[41:28.980 --> 41:41.220]  If you're the virus, anything with a lipid outer layer like viruses and even some things with like anthrax and things like that, it can actually potentially, because of the way it works with, it acts like a skin cell in your body.
[41:41.380 --> 41:46.560]  And so the viruses are, they'll put it in their outer layer and then it dissolves within 12 to 24 hours.
[41:46.560 --> 41:48.420]  I was wondering, have you ever heard of that, that stuff?
[41:48.780 --> 41:50.560]  I have not heard of that.
[41:50.920 --> 41:51.200]  Okay.
[41:51.460 --> 41:57.040]  If you'd be interested, email me and I can look up what I can find about it.
[41:57.260 --> 41:57.460]  Okay.
[41:57.500 --> 42:01.040]  There's a patented version by a guy who discovered it named lauricidin.
[42:01.280 --> 42:03.440]  And there's a guy, capybara, I think is his name.
[42:04.440 --> 42:04.840]  Okay.
[42:07.220 --> 42:09.220]  I had a question about the hydrofluoric acid.
[42:09.320 --> 42:11.960]  You mentioned there was a delayed reaction on your skin if it was to spill.
[42:12.240 --> 42:12.580]  Mm-hmm.
[42:12.580 --> 42:19.380]  And I was wondering if there was a way that you could, if you had some splash on you, if you could protect yourself from the absorption.
[42:19.960 --> 42:24.660]  Or to wash it off, or if some kind of chemical reaction to keep you from getting sick.
[42:25.380 --> 42:32.620]  Yeah, I mean, usually, you know, standard treatment is to, you know, wash and wash.
[42:33.020 --> 42:43.280]  With hydrofluoric acid, there's also calcium, topical calcium preparations that are used to minimize the absorption and toxicity.
[42:44.380 --> 42:48.080]  The higher the concentration, though, the faster a reaction happens.
[42:48.520 --> 42:52.080]  You know, if it's low concentration, it might not happen for a while.
[42:52.080 --> 42:55.140]  But also, you're not going to get systemic stuff from that.
[42:55.280 --> 42:56.640]  But you might get a bad burn.
[42:57.740 --> 43:03.580]  It's best to seek medical treatment for it with the calcium.
[43:04.600 --> 43:05.100]  Thank you.
[43:07.440 --> 43:08.380]  Hi, great talk.
[43:08.540 --> 43:10.640]  I guess the big topic is hydrofluoric acid.
[43:11.300 --> 43:11.660]  Mm-hmm.
[43:11.780 --> 43:15.820]  You said that the mechanism was the fluorine attaches to the calcium.
[43:16.180 --> 43:16.660]  Mm-hmm.
[43:16.660 --> 43:20.260]  So why do we put fluoride in toothpaste in water?
[43:20.400 --> 43:23.300]  Is that the same pathway and stuff like that?
[43:23.820 --> 43:24.820]  Well, it's different.
[43:25.020 --> 43:27.240]  In toothpaste, you have sodium fluoride.
[43:29.500 --> 43:33.440]  And that's a different situation than when you have the acid in the fluoride.
[43:33.440 --> 43:40.200]  I mean, it's the fluoride ion that is troublesome, but it's in the context of the acid.
[43:40.900 --> 43:46.000]  The acid is really what allows it to absorb and to attack.
[43:47.440 --> 43:53.860]  You know, and it's just a sodium salt that's not a concern.
[43:53.860 --> 44:02.240]  But if you were to take a bunch of sodium fluoride and then mix it with a strong acid, you could get some of the same effect.
[44:03.360 --> 44:04.040]  Thank you.
[44:06.400 --> 44:06.900]  Hi.
[44:07.240 --> 44:09.720]  You mentioned that poisoning is not painless.
[44:09.720 --> 44:14.200]  What about when they sentence somebody to lethal injection, and what are they using?
[44:15.760 --> 44:18.640]  Well, typically, they use a couple different drugs.
[44:20.220 --> 44:23.380]  They use... and, you know, they try to make it painless.
[44:23.560 --> 44:29.180]  In this case, there is someone, you know, like administering it, first of all.
[44:29.180 --> 44:34.120]  So it's not like a suicide situation where you're trying to do it yourself.
[44:34.380 --> 44:40.720]  They give a paralytic, which does not... it just paralyzes you.
[44:40.840 --> 44:43.340]  It doesn't knock you unconscious or anything.
[44:44.240 --> 44:48.390]  And they give... I believe... I know in the past they've given a barbiturate.
[44:50.550 --> 44:52.870]  I'm not... I think they still do.
[44:53.810 --> 44:57.590]  And that knocks you... that's what puts you to sleep mentally.
[44:57.970 --> 45:01.370]  And then they give potassium chloride to stop your heart.
[45:03.530 --> 45:06.450]  And... and so it's the combination there.
[45:06.730 --> 45:09.390]  If they just gave the potassium chloride...
[45:10.110 --> 45:17.690]  Well, it's a little bit controversial because if they don't give enough of, you know, the barbiturate or whatever they give to...
[45:17.690 --> 45:22.490]  to knock you out mentally, it's not painless, but you're not going to show any pain.
[45:22.790 --> 45:24.170]  You know...
[45:24.690 --> 45:31.250]  The potassium chloride can actually kill pretty quickly, but it's not painless unless you're knocked out.
[45:32.190 --> 45:32.770]  So...
[45:32.770 --> 45:33.330]  Thank you.
[45:36.070 --> 45:40.770]  I was wondering if you might be able to outline the basics of how rat poison works...
[45:40.770 --> 45:45.330]  and if the mechanism is the same in humans and rats and dogs or cats.
[45:46.590 --> 45:49.890]  I believe it's a... I believe it's the same mechanism.
[45:50.890 --> 45:57.510]  The rat poison, the kind I was thinking of, is... works a lot like warfarin, actually.
[45:57.770 --> 46:05.210]  It is referred to as superwarfarin, in fact, because it's longer lasting and absorbs more.
[46:05.310 --> 46:06.190]  It's more tenacious.
[46:06.190 --> 46:11.030]  It basically inhibits the vitamin K cycle.
[46:11.450 --> 46:16.750]  And vitamin K is essential for making your body... making clotting factors.
[46:17.850 --> 46:21.290]  Clotting is actually a kind of complicated process.
[46:21.290 --> 46:22.370]  But...
[46:23.290 --> 46:36.810]  But when you inhibit the vitamin K, basically you're going to bleed, because your body doesn't have the proper clotting enzymes and things to be able to do it.
[46:37.610 --> 46:41.690]  So that's why... that's why it causes the bleeding.
[46:42.890 --> 46:46.530]  And I... I think that... I believe that's... it's the same in rats.
[46:46.750 --> 46:53.190]  And the idea is that... they don't want a poison that kills them right away, because they want...
[46:53.190 --> 46:58.650]  because rats will, like, try a little bit of food and then leave it alone, see how they feel...
[46:59.130 --> 47:02.310]  before eating a lot of it to prevent being poisoned.
[47:03.410 --> 47:06.350]  So they're actually going for that delayed reaction there.
[47:09.750 --> 47:13.810]  A lot of the poisons you mentioned, you talked about what happens if you take the whole bottle.
[47:14.290 --> 47:18.650]  What about poisons that act in very, very small concentrations, like ricin or something like that?
[47:19.630 --> 47:24.570]  I have a little kid now, and one time I came in and I found him sucking on one of these Airwick air fresheners.
[47:24.970 --> 47:32.070]  And I knew that he'd only been doing it for a few seconds, but it kind of freaked me out, because I didn't know what's in it, and so I called the Poison Control Center.
[47:32.190 --> 47:41.310]  And I'm a biochemist by trade, but I was still, you know, kind of afraid of what could happen, because I didn't know the mechanisms of some of these small molecules or small concentrations of molecules.
[47:42.250 --> 47:49.010]  Yeah, well, generally around the household, I mean, I didn't concentrate a lot on poisons.
[47:49.210 --> 47:52.970]  There are poisons out there that can be extremely small concentrations.
[47:54.150 --> 47:58.810]  You don't usually find that around the house for those reasons.
[47:59.290 --> 48:08.690]  And generally speaking, when you have things like air fresheners, the formulations are usually non-toxic, although there are things that are of concern.
[48:10.070 --> 48:14.990]  I mean, we had a kid who, a poison center, there was a case.
[48:15.230 --> 48:22.490]  We got called in where the kid had had some, a kerosene lamp, something like that, a hydrocarbon.
[48:23.670 --> 48:31.790]  And the big concern with that was not the toxicity so much as aspirating it into the lungs, where it could do damage.
[48:32.750 --> 48:34.310]  So there are cases like that.
[48:34.470 --> 48:54.030]  It's always good to cause, call the poison center in those cases to see, because they can look up, there's a database with, you know, I mean, I don't know what exactly, what is in any given air freshener, but I could look it up and then decide, you know,
[48:54.030 --> 49:00.210]  see what problems there may or may not be for that exposure.
[49:05.000 --> 49:07.620]  One time I did something a little foolish.
[49:08.820 --> 49:12.560]  I thought I would learn to breathe fire, you know, to spit fire.
[49:13.080 --> 49:20.560]  And the person who was teaching me was very good, but she didn't tell me what happened sometimes when the wind blew back in your face.
[49:21.790 --> 49:23.660]  And I did have the beard at the time.
[49:24.770 --> 49:25.980]  It was ugly.
[49:26.540 --> 49:28.960]  So, but fortunately I was able to put it out really quick.
[49:29.440 --> 49:34.340]  But in the process I swallowed about a good mouthful of lamp oil.
[49:37.940 --> 49:39.960]  And I know what I did do.
[49:40.250 --> 49:47.600]  I rode my bike home like nine miles and I threw up and had diarrhea for like, you know, 12 hours or something like that.
[49:48.120 --> 49:50.620]  What should I have done in that circumstance?
[49:55.020 --> 50:00.770]  Well, probably if you had called the poison center, I would have, you know, discussed.
[50:01.040 --> 50:07.960]  I mean, a lot of times when we get calls like this, it'll be based on what symptoms the patient has.
[50:08.180 --> 50:19.380]  And so if you were, you know, vomiting and things that you would make, they would say, you know, watch it and, you know, have fluids and they would probably follow up calls with you.
[50:20.770 --> 50:33.560]  I will say too, I learned that in the past, a lot of times the recommendation would be to induce vomiting for exposures just in case.
[50:34.290 --> 50:36.820]  And I mean, if you vomit, you vomit.
[50:36.820 --> 50:44.840]  But we don't recommend inducing vomiting anymore because it doesn't usually help very much.
[50:45.480 --> 50:53.200]  And if there are some serious symptoms, you know, they can help you get in touch with the hospital and things like that.
[50:53.360 --> 51:00.000]  A lot of times it's watching, you know, wait and see if anything serious develops.
[51:00.900 --> 51:02.940]  What made that change?
[51:03.290 --> 51:06.840]  Like the difference between, you know, thinking it was a good thing to induce vomiting and not...
[51:06.840 --> 51:12.120]  Was that like long studies and hundreds and thousands of cases or...?
[51:12.120 --> 51:13.880]  Yeah, it was research.
[51:14.920 --> 51:26.620]  I mean, sometimes in toxicology it's tough because you don't, you know, go out and do a trial and, you know, a randomized control trial, give some people poison, give some, you know.
[51:28.160 --> 51:31.700]  So, you kind of have to do it on case studies and things.
[51:32.440 --> 51:44.250]  But they actually measured things like, well, how much of the drug is in the stomach, you know, before and after, things like that.
[51:44.250 --> 51:53.080]  It was basically better research that informed us that, you know, that it's, it just doesn't...
[51:53.080 --> 51:58.660]  And, you know, outcomes that basically has made the change.
[52:01.840 --> 52:08.960]  Well, the thing obviously, if you're going to do this vomiting, you don't really want to do that with a patrolling product.
[52:09.120 --> 52:09.960]  Well, yeah, exactly.
[52:10.280 --> 52:10.600]  If you...
[52:10.600 --> 52:14.900]  Alkalized burn coming back up as well as going down, so they don't recommend it for that anymore either.
[52:14.900 --> 52:24.900]  Yeah, yeah, I mean, if you have a petroleum product, I mean, main danger is aspiration getting into the lungs.
[52:24.900 --> 52:27.720]  And if you vomit, you just repeat that danger.
[52:28.700 --> 52:34.680]  You know, and probably if you get lung symptoms, then they recommend you go into the hospital or...
[52:34.680 --> 52:37.440]  But, you know, you would call them and see.
[52:39.240 --> 52:40.960]  I had a question about aspirin.
[52:40.960 --> 52:49.280]  And so on TV, they say for somebody having a heart attack, they can survive the heart attack if they take an aspirin like within a certain amount of time afterwards.
[52:50.500 --> 52:51.900]  Yeah, it's recommended.
[52:53.140 --> 52:59.640]  I mean, if you have a heart attack, obviously call a hospital, but call 911.
[53:00.520 --> 53:05.240]  But it's recommended to also chew an aspirin, a full-strength one, right away.
[53:05.700 --> 53:07.540]  It has helped outcomes.
[53:07.540 --> 53:12.300]  I mean, that amount of aspirin is only life-saving.
[53:12.860 --> 53:15.060]  I mean, maybe you get a stomach ache.
[53:15.620 --> 53:20.240]  The kind of toxicity I was talking about is with way more.
[53:20.620 --> 53:28.060]  Because most of our medicines, most of them, not all of them, have a pretty big range before they become toxic.
[53:29.320 --> 53:31.740]  So, yeah, aspirin is true.
[53:32.380 --> 53:35.280]  Aspirin can be life-saving in that case.
[53:35.540 --> 53:36.080]  Okay.
[53:36.080 --> 53:46.560]  So, you agree with the recommendation that, I guess, I don't know, people in a certain shape or over a certain age should take a daily aspirin?
[53:47.320 --> 53:53.600]  Yeah, usually, I mean, the doctor will... I haven't reviewed the recommendations.
[53:54.120 --> 53:58.020]  In some cases, it's just 81 milligrams per day.
[53:58.420 --> 54:00.780]  In some cases, it's a 325.
[54:01.800 --> 54:03.380]  There are actually guidelines.
[54:03.880 --> 54:05.540]  They're research-based for those.
[54:05.740 --> 54:07.360]  I don't know them off the top of my head.
[54:07.520 --> 54:12.580]  But, yes, I think they're based on solid research and are good.
[54:12.800 --> 54:13.140]  Okay.
[54:13.240 --> 54:13.540]  Thank you.
[54:20.900 --> 54:23.540]  Going back to the whole rat poison angle that came up.
[54:23.760 --> 54:28.680]  The basic deal is, you're right, an anticoagulant, it's similar to warfarin or cruminin.
[54:28.780 --> 54:31.500]  But, basically, they mix it with some roughage, basically.
[54:31.780 --> 54:33.560]  So, sort of, abrades their insides.
[54:33.760 --> 54:35.420]  So, this way, you get minor bleeding.
[54:35.580 --> 54:37.760]  And because they take it, they keep bleeding.
[54:37.940 --> 54:42.400]  And then what's nice is, is they usually, they think that they need to drink.
[54:42.520 --> 54:44.560]  Or they think they need water, because they're bleeding out.
[54:44.680 --> 54:47.200]  So, they usually run out of your house before they croak, hopefully.
[54:48.280 --> 54:53.800]  Incidentally, the heavier-duty rat poison that they use for the super rats is usually, believe it or not, a form of fluoride.
[54:54.800 --> 54:56.700]  And it kills them very, very well.
[54:56.820 --> 54:57.640]  Induces heart failure.
[54:57.780 --> 54:58.860]  It's sort of predictable.
[54:59.660 --> 55:00.140]  Yeah, yeah.
[55:00.760 --> 55:03.960]  I don't know a lot about the different rat poisons.
[55:03.960 --> 55:05.900]  Just the super warfarin one.
[55:05.900 --> 55:07.260]  Those are the two most common.
[55:07.400 --> 55:07.940]  I'm sure there's others.
[55:08.240 --> 55:09.160]  Those are the people that we hear about.
[55:09.920 --> 55:10.320]  Yeah.
[55:10.800 --> 55:12.340]  So, are there any more questions?
[55:15.240 --> 55:15.800]  All right.
[55:15.900 --> 55:17.040]  Thank you very much.
[55:17.040 --> 55:18.060]  Thank you.
[55:18.180 --> 55:18.420]  Thank you very much.
[55:18.420 --> 55:18.560]  Thank you very much.
[55:18.560 --> 55:19.060]  Thank you.