Toxicology

Rotation
Residents will have a unique opportunity to participate in a Medical Toxicology Consult Service. The rotation spans one 4 week block during the PGY-2 year. We see consults spanning the inpatient medical and critical care teams, in addition to the emergency department at Kennestone Hospital. The board-certified Medical Toxicologists staff approximately 200-300 consultations per year, in addition to rounding on patients in the hospital. Common exposures include cardiovascular toxins, acetaminophen, toxic alcohols, sedatives and crotalid snakebite envenomations. The resident, working closely with the attending, provides critical, timely input with bedside consultation while taking call from home. Other components of the rotation include: 

  • Joint conferences with the Georgia Poison Control Center in a weekly case conference to discuss Poison Center cases from across the state.  
  • Participation in the American College of Medical Toxicology (ACMT) National Case Conference and Journal Club.  
  • Working through a set of toxicology cases 1 on 1 with the attending. These cases span the breadth of the standard knowledge set for the emergency physician. 
  • Formulating an educational case report for a monthly Tox Newsletter for the EM group 

Faculty

Richard Kleiman, MD
Medical Toxicology Co-Director 

Hometown: Durham, NC 
Undergraduate: Davidson College 
Residency: Wake Forest University 
Fellowship: Medical Toxicology  (Emory University/CDC/Georgia Poison Control) 

Mohan Punja, MD, FACEP, FACMT 
Medical Toxicology Co-Director 

Hometown: Gainesville, FL 
Undergraduate: University of Florida 
Residency: Mt. Sinai Beth Israel 
Fellowship: Medical Toxicology  (Emory University/CDC/Georgia Poison Control) 

Tox Newsletter

May Tox: Valacyclovir

Brief HPI  71 yo M with HTN presented with decreased PO intake and confusion, was found down in his yard. Pt cannot give hx. Of note, he was recently seen in the ED and started on valcylovir for shingles in R eye, family noted despite TID dosing one day later he only has 11 pills…

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April Tox: Wellbutrin

Brief Clinical Course 67F PMH Bipolar disorder, suicide attempt, admitted overdosing on Risperdal 1 mg x 90, Risperdal 3 mg x 90, Atorvastatin 10 mg x 90, Wellbutrin XL 150 mg x 90, Wellbutrin XL 300 mg x 90.  4/15, Patient initially admitted to Piedmont Henry. 4/16 seizure x1, intubated at that time, transferred to…

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Publications 

Infanzon, JW; Punja, M; Kleiman, RJ. The Adjunctive Use of Plasmapheresis After Severe Amlodipine OverdosePresented at North American College of Clinical Toxicology Annual Scientific Symposium, San Francisco, September 2022 

Horton D and Punja M. Rummy Rum Rums-Ethanol Intoxication: What do I do Now? 1st Edition, edited by  Joseph Carpenter and Brian Murray. Oxford Press. In publication.  

Benatar, S. E., Punja, M., & Kleiman, R. J.  Ingestion of a Small Quantity of “Food Grade” Hydrogen Peroxide Purchased Onlin . Presented at American College of Medical Toxicology Annual Scientific Meeting, March 2020 

Inhalational Abuse of Keyboard Cleaner Presenting as Anteroseptal ST-Elevation Myocardial Infarction Mimic and Leading to Fatal Dysrhythmias. Nguyen N; Kleiman RJ; Punja M, and Demestihas M. Presented at American College of Medical Toxicology Annual Scientific Meeting, March 2020 

Patel, MD; Punja, M; Kleiman, RJ; Demestihas, M. Pneumomediastinum, Acute Kidney Injury, Rhabdomyolysis, and Cryogenic Dermal Injuries Secondary to Inhalation Abuse of Keyboard Cleaner. Presented at ACMT Spring Symposium, San Francisco 2019. 

Punja M, Hoffman RJ: Envenomation, Marine: Fleisher and Ludwig’s 5 Minute Pediatric Emergency Medicine Consult, 2nd edition, edited by Hoffman RJ, Wang VJ, Scarfon R. Philadelphia, Lippincott Williams & Wilkins. 2019. 

Punja M, Hoffman RJ: Evenomation, Insect Bites and Stings. Fleisher and Ludwig’s 5 Minute Pediatric Emergency Medicine Consult, 2nd edition, edited by Hoffman RJ, Wang VJ, Scarfon R. Philadelphia, Lippincott Williams & Wilkins. 2019.  

Carpenter JE, Murray BP, Saghafi R, Thomas B, Lee S, Kleiman R, Punja M, Silver E, Busse LW. J Emerg Med. Successful Treatment of Antihypertensive Overdose Using Intravenous Angiotensin II. 2019: pS0736-4679(19)30422-6.