The UAB Office of Medical Toxicology in the Department of Emergency Medicine encompasses the only board-certified medical toxicologists in the state of Alabama. This program elevates clinical care by providing direct patient consults, adolescent addiction and snake bite follow-up clinics, and provides medical direction to the Alabama Poison Information Center. Educational opportunities are offered to the community including development of a medical toxicology course for medical residents and pharmacists, ongoing statewide lectures to lay and medical providers, and scientific presentations at national conferences including North American Congress of Clinical Toxicology, American College of Medical Toxicology, and EMPoweRx Conference. Medical Toxicology is currently studying and advancing the fields of snakebite care, addiction medicine, critically ill poisoned patients, and screening for pediatric poisoning.

Advancing Snakebite Care

UAB Medical Toxicology founded and operates the Comprehensive Snakebite Program at UAB and Children’s of Alabama. Medical Toxicology’s published research on snake envenomations has focused on employing ultrasound as a management tool and utilization of thromboelastograms (TEGs) to diagnose and treat rattlesnake envenomations. Key findings illustrate how early abnormalities on TEGs can predict snakebite-induced coagulopathy and provide guidance on dosing of antivenom. Our toxicology program has also presented eight abstracts at national and international conferences including management of snake envenomation complicated by underlying hemophilia A, delayed antivenom usage, and further standardization of care.

Recent Publications

1. Ryan E, Atti S, Marshall S, Rivera J, Rushton W. Repeat antivenom administration following crotalidae immune F(ab’)2 antivenom in Agkistrodon species: a case series. Toxicology Communications 2023. 7:1, DOI: 10.1080/24734306.2023.2280893
2. Rushton W, Shapshak D. Snake Envenomation. N Engl J Med. 2022 Mar 17;386(11):1099. doi: 10.1056/NEJMc2201552. PMID: 35294827.
3. Rushton WF, Rivera JV, Brown J, Kurz MC, Arnold J. Utilization of thromboelastograms in management of Crotalus adamanteus envenomation [published online ahead of print, 2020 Jul 4]. Clin Toxicol (Phila). 2020;1-4. doi:10.1080/15563650.2020.1788053
4. Shapshak D; Kelly M; Greene C; Atti S; von Schwinitz B; Shapshak A; Rushton W. Novel approach for standardizing and enhancing crotalinae (North American pit vipers) envenomated patients’ follow-up care by linking state poison control program to an outpatient wound clinic. 2021. Symposium for the Advancement of Wound Care.
5. Rushton W; Arnold J: Rivera J; Implementation of a protocol driven Crotalinae Envenomation Unit. Presented at International Congress of the European Association of Poisons Centres and Clinical Toxicologists. 2019, Naples Italy. CLINICAL TOXICOLOGY 57 (6), 505-505.
6. Rushton WF, Vakkalanka JP, Moak JH, Charlton NP. Negative predictive value of excluding an embedded snake foreign body by ultrasonography. Wilderness Environ Med. 2015 Jun 30;26(2):227-31.
   
   

Drugs of Abuse

Surveillance and treatment of novel and emerging substances are a core aspect of our medical toxicology program with a recent focus on advancing the field of addiction medicine. UAB toxicology has contributed literature discussing synthetic drug use, experience with tianeptine, and withdrawal patterns, as well as presented nationally on associated topics.

Recent Publications

1. Marshall S, Ryan E, Rivera J, Reynolds L, Atti S. GLP-1 Receptor Agonist Exposures Are Increasingly Common and Generally Associated with Mild Symptoms: A Single Poison Center Experience. J Med Toxicol. 2024 Jun 11. doi: 10.1007/s13181-024-01008-x. PMID: 38861153. 
2. Bradford W, Figgatt M, Scott KS, Marshall S, Eaton EF, Dye DW. Xylazine co-occurrence with illicit fentanyl is a growing threat in the Deep South: a retrospective study of decedent data. Harm Reduct J. 2024 Feb 20;21(1):46. doi: 10.1186/s12954-024-00959-2. PMID: 38378660; PMCID: PMC10880285.
3. Palungwachira P, Yeh M, Whitworth B, Rushton W, Kazzi Z. Clinical Characteristics of Kratom Exposures Reported to the Georgia and Alabama Poison Control Centers from 2016-2020: A Retrospective Review. Journal of Drug and Alcohol Research. 2022 Feb 28;11(2).
4. Rushton W, Whitworth B, Brown J, Kurz M, Rivera J. Characteristics of tianeptine effects reported to a poison control center: a growing threat to public health [published online ahead of print, 2020 Jun 18]. Clin Toxicol (Phila). 2020;1-6. doi:10.1080/15563650.2020.1781151
5. Rushton W, Rivera J. Tianeptine: a new frontier in surveillance and understanding through social media. Am J Drug Alcohol Abuse. 2021 Jun 16:1-3. doi: 10.1080/00952990.2021.1938101. PMID: 34134575.
6. Carpenter J, Murray BP, Atti S, Moran TP, Yancey A, Morgan B. Naloxone Dosing After Opioid Overdose in the Era of Illicitly Manufactured Fentanyl. J Med Toxicol. 2020 Jan;16(1):41-48. doi: 10.1007/s13181-019-00735-w. Epub 2019 Aug 30. PMID: 31471760; PMCID: PMC6942078.
7. Rivera JV, Vance EG, Rushton WF, Arnold JK. Novel Psychoactive Substances and Trends of Abuse. Critical care nursing quarterly. 2017 Oct 1;40(4):374-82.
   
   
   

Critically Ill Poisoned Patients

UAB Office of Medical Toxicology has further pushed the advancement of advanced therapies in critically ill poisoned patients through strategic multidisciplinary collaboration. Work on these topics include advancement and understanding of chelator therapy in heavy metal poisoning, direct drug cellular toxicity, and extracorporeal membrane oxygenation in antihypertensive drug toxicity.

Recent Publications

1. Chenoweth J, Marshall S, Lewis J, Albertson T. Toxicity following tranexamic acid overdose. J Med Toxicol. 2024 Apr;20(2):215-217. doi: 10.1007/s13181-024-00989-z. Epub 2024 Feb 9. PMID: 38334906; PMCID: PMC10959844.
2. Cardenas JM, Borasino S, Timpa J, Hawkins J, McBride M, Rushton W, Newman J, Mendoza E, Sorabella R, Byrnes J. Central ECMO cannulation for severe dihydropyridine calcium channel blocker overdose. J Extra Corpor Technol. 2023 Dec;55(4):206-208. doi: 10.1051/ject/2023037. Epub 2023 Dec 15. PMID: 38099637; PMCID: PMC10723573.
3. Idowu D, Gray Z, Stanton M, Rushton W, Gummin D. A Case of Severe Lead Encephalopathy with Cardiac Arrest Managed During a Chelation Shortage. J Med Toxicol. 2024 Jan;20(1):49-53. doi: 10.1007/s13181-023-00970-2. Epub 2023 Oct 16. PMID: 37843802; PMCID: PMC10774239.
4. Das S, Hataway F, Boudreau HS, Alam Y, George JA, Rushton W, Atti S, Kaur M and Holland MT (2022) Management of cerebral herniation secondary to lead encephalopathy: A case report. Front. Neurol. 13:893767. doi: 10.3389/fneur.2022.893767.
5. Atti SK, Silver EM, Chokshi Y, Casteel S, Kiernan E, Dela Cruz R, Kazzi Z, Geller RJ. All that glitters is not gold: Mercury poisoning in a family mimicking an infectious illness. Curr Probl Pediatr Adolesc Health Care. 2020 Feb;50(2):100758. doi: 10.1016/j.cppeds.2020.100758. Epub 2020 Mar 7. PMID: 32151591.
6. Fuller BM, Roberts BW, Mohr NM, Knight WA 4th, Adeoye O, Pappal RD, Marshall S, et. al. The ED-SED Study: A Multicenter, Prospective Cohort Study of Practice Patterns and Clinical Outcomes Associated With Emergency Department SEDation for Mechanically Ventilated Patients. Crit Care Med. 2019 Nov;47(11):1539-1548. doi: 10.1097/CCM.0000000000003928.
7. Marshall S, Ryan E, Rivera J, Reynolds L, Atti S. GLP-1 Receptor Agonist Exposures Are Increasingly Common and Generally Associated with Mild Symptoms: A Single Poison Center Experience. J Med Toxicol. 2024 Jun 11. doi: 10.1007/s13181-024-01008-x. PMID: 38861153.

UAB Office of Medical Toxicology has been highlighted in media outlets frequently on drug surveillance and snakebite care. Our program has been highlighted by ABC, NBC, and PBS news, ACEP Now, multiple local and statewide public health agencies, and SAEM PULSE.

UAB Medical Toxicology in the News on Advancing Snakebite Care:

New snakebite program at UAB, one of the nation’s first, offers cutting-edge care

Snake bites in Alabama up to 47 this year; UAB opens unique clinic for patients

Two bites, one snake, 12 vials of antivenom and a fall wedding

UAB’s new snakebite program, one of the nation’s first, offers cutting-edge care

Alabama doctors launch nation’s first follow up clinic for snakebites

Venomous Snake Bites Alabama Woman Twice; UAB Experts Step In

Think You Know What To Do After A Snake Bite? This ER Doctor May Disagree 

A New Snakebite Center Provides Care Patients Desperately Need

SAEM Pulse September-October 2023

UAB Medical Toxicology in the News on Novel Drug Surveillance and Treatment:

CDC warns that Neptune's Fix — 'gas station heroin' — may contain synthetic pot

Deaths from 'gas station heroin' users bring renewed fears for parents, medical experts

Florida lawmakers move to prohibit ‘gas station heroin’

Toxicologist unravels the dangerous medical mystery of ZaZa, Alabama’s 'gas-station dope'

E-cigarette, or Vaping, Product Use–Associated Lung Injury Among Clusters of Patients Reporting Shared Product Use — Wisconsin, 2019

“Gas station dope:” The legal and personal battles over Tianeptine

FDA warns about Neptune's Fix supplements after reports of hospitalizations

“The danger is real and present”: Law enforcement, doctors warn about teen Delta-8 use

Our Team

Rushton, William, M.D.

Medical Director
Alabama Poison Information Center
Associate Professor
UAB Department of Emergency Medicine, Office of Medical Toxicology

Atti, Sukhshant (Sukhi), M.D., MPH

Associate Medical Director
Alabama Poison Information Center
Assistant Professor
UAB Department of Emergency Medicine, Office of Medical Toxicology

Marshall, Stacy, M.D.

Associate Medical Director
Alabama Poison Information Center
Assistant Professor
UAB Department of Emergency Medicine, Office of Medical Toxicology

Rivera, Jessica, PharmD, DABAT

Clinical Director & Fellowship Director
Alabama Poison Information Center
Assistant Professor
UAB Department of Emergency Medicine