Join host Ryan Feldman in an insightful episode of "The Poison Lab" as he sits down with Dr. John Downs, Director of the Virginia Poison Center, and one of the leading experts on per- and polyfluoroalkyl substances (PFAS), commonly known as "forever chemicals." Known for their persistence in the environment and human body, PFAS have raised significant public health concerns over the past few decades. Dr. Downs shares his journey through occupational medicine, toxicology, and public health, which uniquely positioned him to provide expertise on PFAS exposure, health risks, and ongoing regulatory efforts. Together, they delve into the origins, uses, and potential health effects of these ubiquitous compounds, while examining government policies, environmental impact, and strategies to reduce exposure. A must-listen for anyone interested in the intersection of environmental health and toxicology!

Episode Breakdown:

• 2:42 – What Are Forever Chemicals?
• 8:01 – History of PFAS and Associated Health Concerns
• 15:41 – Government Regulation of PFAS
• 20:42 – Shortcomings in PFAS Regulation
• 25:20 – How Individuals Can Mitigate Risk
• 31:15 – Testing for PFAS Levels and Exploring Treatment Options
• 41:14 – Future Directions and Research Needs for PFAS
• 45:29 – Conclusion and Outro

Key Topics Discussed

2:42 – What Are Forever Chemicals?

• PFAS are a large group of man-made chemicals that are persistent in the environment and human body.
• The podcast focuses primarily on PFOA (perfluorooctanoic acid) and PFOS (perfluorooctanoic sulfonic acid), as these were the first compounds identified as having very long elimination half-lives, measured in years, and not undergoing significant human metabolism
• The podcast mentions that there are potentially thousands of different PFAS compounds and that more research is needed to determine if they all induce the same health effects as PFOA and PFOS
• Commonly used for their water- and oil-resistant properties in nonstick cookware, fast food wrappers, firefighting foams, and more.

8:01 – History of PFAS and Associated Health Concerns

• First created by Dupont chemical, used widely in 1940's in Teflon
• Large contamination of water by PFAS identified in West Virginia town
• Led to landmark study in West Virginia (the C8 study) on epidemiological data of PFAS-related health risks.
• Effects noted: High cholesterol, thyroid dysfunction, ulcerative colitis, hypertension in pregnancy, decreased immune response to vaccine, and certain cancers (testicular and kidney cancer).

PFAS in the Environment

• PFAS are not easily degraded, leading to bioaccumulation in humans and animals.
• Non-stick cookware: Teflon, the trade name for non-stick cookware, was one of the earliest applications of PFAS, utilizing PFOA.
• Firefighting foam: PFAS was used in firefighting foams, particularly for aviation fuel fires. This has led to contamination of groundwater around military installations and airports.
• Fast food wrappers and other consumer products: PFAS are used to make products water and oil resistant, including fast food wrappers, clothing, upholstery, and popcorn bags.
• Biosolids: The nitrogenous waste produced after wastewater treatment, have been found to contain concentrated PFAS. These biosolids are sometimes sold to farms as fertilizer, potentially contaminating water and crops.
• Ski wax: Ski waxers have been found to have a high degree of PFAS...

Ryan on others shows

• Ryan on "22 at the Lips"
• Ryan on "Continuing Studies"

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In this exciting live episode from the 2024 North American Congress of Clinical Toxicology (NACCT) in Denver, Ryan dives into 12 of the most impactful research abstracts presented at the conference directly with the authors themselves. Covering a wide range of toxicology topics—from the NACSTOP2 trial on acetaminophen overdose, ECG intervals, cannabis toxicity in young children, and more—each guest breaks down their study’s findings and clinical relevance. If you missed the conference or want a deeper understanding of the year's most important toxicology research, this episode is for you. Check the show notes for links to the published abstracts, the full list of studies discussed, and time stamps for where you can find those studies.

Link to published abstract manuscript

Abstracts

07:48-Abstract #1. The NACSTOP2 trial: a multi-center randomized controlled trial investigating the early cessation of n-acetylcysteine in acetaminophen overdose

• Guest- Dr. Anslem Wong, MD, PhD

21:33- Abstract #36. ECG intervals: does one size really fit all?

• Guest- Dr. Caitlin Roake, MD, PhD

25:41- Abstract #85. Do abnormal electrocardiographic intervals predict death in poisoned patients older than 65 years?

• Guest- Dr. Michael Chary, MD

30:06- Abstract #61. Minimum tetrahydrocannabinol dose that produces severe symptoms in children <6 years old with cannabis edible ingestions

• Guest- Dr. Keahi Horowitz, MD

36:25- Abstract #114. Frequency and severity of cannabis toxicity before and after legislative change to increase cannabis edible package size

• Guest- Dr. Robert Hendrickson, MD

38:24- Abstract #101. Quantification of acetaminophen line-crossers in the setting o f overdose with delayed gastric absorption

• Guest- Dr. Jamie Sterr, PharmD

41:41- Abstract #175. Cause for pause: bradycardia induced by transdermal rivastigmine in anticholinergic delirium

• Guest- Dr. Santiago Batista Minaya, MD

46:21- Abstract #199. Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) Syndrome with poor neurological outcome in the setting of suspected opioid use

• Guest- Jack Yang and Dr. Avery Michienzi, DO

49:49- 191. Severity scores for caustic injury: Zargar they even used?

• Guest- Dr. Amar Chakrabortya, MD

53:!2- Abstract #9. Disparity in immune-mediated reactions to Crotalidae polyvalent immune fab (ovine) and Crotalidae immune F(ab’)2 [equine] in alpha-gal endemic regions and alpha-gal sensitized adults

• Guest- Dr. Ari Filip, MD

59:10- Abstract # 26. Acute propranolol overdose and dose thresholds of severe toxicity

• Guest- Dr. Katherine Isoardi, MBBS

1:06:05- 28. Risk of serotonin toxicity following acute lamotrigine overdose

• Guest- Dr. Angela Chiew, MBBS, PhD (Introduction at 1:00:00)

1:12:36- Interview with AACT President Elect

• Guest- Dr. Jillian Theobald, MD, PhD

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In this episode the poison lab hosts scientific discourse . Three listeners (Dr. Michael Mullins, Dr. Donna Seger, and Dr. Leon Gussow) write in their critiques surrounding specific recommendations and language used with the AHA 2023 Management of Poisoning Cardiac Arrest or Life-Threatening Toxicity guidelines. Lead author of the guidelines Dr. Eric Lavonas then responds to and addresses their points with counterpoints or appraisals. Tune in and draw your own conclusions!

• Link to guidelines
• Link to high yield review

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Have a burning question you have always wanted to ask a toxicologist? What are tips for managing an anticholinergic overdose? What is the deadliest poison? Why are they called lead pencils if there is no lead?! Send your questions in to toxtalk1@gmail.com to take part in a future episode! (If you would like to be anonymous simply state it in the email)

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In this episode Ryan is joined by two expert guests to help read listener guesses for the cause of this poisoning murder and shed light on the toxin involved in the case, which puzzled medicolegal investigators. Ryan is joined by Dr. Dan McCabe, MD (emergency medicine physician, medical toxicologist, medical director of Iowa poison center) and Dr. Crissy Lawson PharmD (emergency medicine pharmacist).

• SPOLIER ALERT
• Mystery case from the show
• Review Paper from Dr's Lawson, McCabe, and Feldman (PMID: 38613376)
• Toxo's show note references

1. TV special about Mary Yoder colchicine murder
2. Colchicine potential arrhythmic effects
3. Go fund me for Dr. Betty Bowman

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In this bonus episode Ryan highlights some of the great episodes done in 2023 and compiles ALL of the stump the toxicologist segments from 2023 into one easy to consume episode. Test your toxicology differential skills with more than six poisoning cases. Check out the actual episodes for more information in the show notes on each of the poisonings.

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Do you think you know the cause of these symptoms? Send your guesses to toxtalk1@gmail.com to take part in the next episode

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