- Professor, Emergency Medicine - (Clinical Scholar Track)
- Associate Professor, Pharmacology
- Clinical Investigator, Viper Institute
- Associate Clinical Professor, Pharmacy Practice-Science
- Medical Director, Arizona Poison and Drug Information Center
Farshad "Mazda" Shirazi, MS, MD, PhD, associate professor of Medical Toxicology, Emergency Medicine, Pharmacology and Pharmacy Practice. Dr. Shirazi trained in both basic science of pharmacology/toxicology and its application in medicine. He has served as PI for clinical trials for new therapeutics and continues to do research in effects of chemical in humans. Additionally, Dr. Shirazi is one of a hand-full of experts in effects of chemicals, therapeutics, natural toxins in humans with extensive training in basic science (i.e. engineering, bio materials, pharmacology, toxicology) and clinical practice of Medical Toxicology and Clinical Pharmacology (i.e. occupational/environmental exposures, hazardous materials, therapeutic effects, medication's interaction, adverse effect of medicines, drugs of abuse and performance enhancing agents in man).
Dr. Shirazi serves as the Medical Director of The Arizona Poison and Drug Information Center, one of the 55 designated centers by the CDC in the US. He is co-director of Center for Pharmacology, Toxicology, Research and Education at University of Arizona College of Medicine Phoenix. He also serves as a scientific liaison to the Pediatric Environmental Health Specialty Unit (PEHSU) of EPA Region 9 in the State of Arizona.
Dr. Shirazi is the Program Director of the Medical Toxicology Fellowship at University of Arizona's College of Medicine and Co-director of Clinical Toxicology fellowship at College of Pharmacy. He has trained multiple physicians and pharmacist in areas of toxicology most of which have passed their sub-specialities boards in toxicology.
Dr. Shirazi is an instructor for the Advanced Hazardous Material Life Support (AHLS) and served on the AHLS’s scientific advisory committee. He has taught AHLS and has lectured on variety subjects related to human toxicology nationally and internationally and is accessed to be one of the best effective teachers for this course by the participants.
- M.D. Medicine
- University of Arizona College of Medicine, Tucson, Arizona, United States
- Ph.D. Pharmacology and Toxicology
- University of Arizona College of Medicine, Tucson, Arizona, United States
- Metabolic Aspects of Cardiomyocyte's Hypertrophy
- M.S. Biomedical Engineering and Physiology
- Arizona State University, Tempe, Arizona, United States
- Master's Thesis: Investigation in Cancer Tumor Bio-potentials
- B.S. Chemical Engineering and Chemistry
- Arizona State University, Tempe, Arizona, United States
- The University of Arizona, College of Pharmacy (2021 - Ongoing)
- University of Arizona Health Sciences Center, Arizona Poison & Drug and Information Center, The University of Arizona College of Medicine (2021 - Ongoing)
- University of Arizona Health Sciences Center, Arizona Poison & Drug Information Center, The University of Arizona, College of Pharmacy (2021 - Ongoing)
- The University of Arizona Medical Center Tucson & South Campus (2021 - Ongoing)
- The University of Arizona, College of Medicine University of Arizona Medical Center University & South Campus (2021 - Ongoing)
- Banner University Medical Center - South Campus (2012 - Ongoing)
- The University of Arizona, College of Medicine University of Arizona Medical Center University & South Campus (2012 - 2021)
- The University of Arizona, College of Pharmacy (2012 - 2021)
- The University of Arizona Medical Center Tucson & South Campus (2012 - 2021)
- University of Arizona Health Sciences Center, Arizona Poison & Drug and Information Center, The University of Arizona College of Medicine (2012 - 2021)
- Arizona Poison & Drug Information Center, The University of Arizona, College of Pharmacy (2010 - Ongoing)
- The University of Arizona, College of Medicine, UAMC-South Campus (2010 - Ongoing)
- University of Arizona Health Sciences Center, Arizona Poison & Drug Information Center, The University of Arizona, College of Pharmacy (2010 - 2021)
- University of Arizona Health Sciences Center, Arizona Poison & Drug and Information Center, The University of Arizona College of Medicine (2007 - 2012)
- The University of Arizona, College of Medicine University of Arizona Medical Center and UPH Hospital at Kino (2006 - 2012)
- University of Arizona Health Sciences Center, Arizona Poison & Drug and Information Center, The University of Arizona College of Pharmacy (2006 - 2010)
- Carondelet St. Joseph’s and St. Mary’s Hospitals (2005 - 2006)
- The University of Arizona, University Medical Center (2004 - 2006)
- Tucson Medical Center (2004 - 2005)
- University Medical Center (2003 - 2004)
- Christus-Schumpert Highland Hospital (2002 - 2003)
- Christus-Schumpert St. Mary’s Hospital and Health System (2000 - 2003)
- Excellence in Clinical Toxicology Award
- Fall 1997
- Research Grant
- Arizona College of Cardiology, Fall 1992
- Yuma Friends of Arizona Health Sciences, Fall 1991
- Best Presentation Award
- Eleventh Annual Medical Student Research Forum, Spring 1991
- Student Award in Cardiology Subsection - Best Research Award
- Western Student Medical Research Committee, Spring 1991
- Most Providers Trained
- AHLS INTERNATIONAL OFFICE, University of Arizona, College of Medicine, Fall 2021
- GME Section for GME Teaching Incentive
- University of Arizona COM Dept. of Emergency Medicine, Summer 2020
- GME Section for Toxicology - Medical Toxicology Incentive
- University of Arizona COM Dept. of Emergency Medicine, Spring 2020
- Chair’s Award for Division/Section Leadership Excellence
- University of Arizona, College of Medicine, Department of Emergency Medicine, Winter 2019
- University of Arizona, College of Medicine, Department of Emergency Medicine., Winter 2018
- GME Teaching Award
- University of Arizona COM Dept. of Emergency Medicine, Fall 2019
- COM Convocation Award
- University of Arizona COM Dept. of Emergency Medicine, Summer 2019
- Certificate of Appreciation
- Sierra Vista Arizona Emergency Medical Services Community, Summer 2019
- US Army, Spring 2015
- Achievement and Contribution for Most Courses Taught, Radiological Incidents & Terrorism
- Advanced Hazmat Life Support, AHLS International Office, Fall 2018
- Achievement and Contribution for Most Participants Trained, Radiological Incidents & Terrorism Runner Up
- Advanced Hazmat Life Support, AHLS International Office, Fall 2018
- EM Medical Student Teaching Award
- University of Arizona, College of Medicine, Department of Emergency Medicine., Summer 2018
- Graduate Medical Education Teaching Award
- University of Arizona, College of Medicine, Department of Emergency Medicine., Summer 2018
- Academic Enrichment Award
- University of Arizona COM Dept. of Emergency Medicine, Fall 2017
- Chair’s Award for Fellowship Director Excellence
- University of Arizona COM Dept. of Emergency Medicine, Fall 2017
Licensure & Certification
- DEA Controlled Substance Registration Certificate, Drug Enforcement Administration (2003)
- State of Arizona Medical License, Arizona Medical Board (2003)
- Diplomate, Board Certified in Medical Toxicology, American Board of Emergency Medicine (2006)
- Diplomate, Board Certified in Emergency Medicine, American Board of Emergency Medicine (2004)
Medical toxicology and clinical pharmacology, geriatric pharmacology, public health and preparedness, occupational/environmental exposures, hazardous materials, therapeutic effects, medication's interactions, adverse effect of medicines, drugs of abuse and performance enhancing agents in man. Toxicology and clinical effects of bites and stings.
Medication's interactions, adverse effect of medicines, drugs of abuse and performance enhancing agents in man. New antivenom and antidotes. Public health impact of occupational and environmental exposures.
No activities entered.
- Shirazi, F., Young, R., & Kim-Ley, M. (2014). Top Pediatric Problem, Toxicologic Emergencies. EMRA.
- Hurst, N., Sloan, C. T., French, R., Karpen, S. R., & Shirazi, F. (2016). Critical Care Pharmacotherapy. In American College of Clinical Pharmacology(pp 781-792). Chapter 38, Medication Withdrawal in the Intensive Care Unit: American College of Clinical Pharmacy.
- Huffman, R., Boesen, K. J., Green Boesen, K. A., & Shirazi, F. (2015). SP 8 - Exotic Nonnative Snake Envenomation. In Goldfrank's Toxicologic Emergencies, 10th Edition. New York: PP McGraw Hill Education.
- Wilson, B. Z., Bahadir, A., Andrews, M., Karpen, J., Winkler, G., Smelski, G., Dudley, S., Walter, F. G., & Shirazi, F. (2022). Initial Experience with F(ab’)2 Antivenom Compared with Fab Antivenom for Rattlesnake Envenomations Reported to a single poison center during 2019. Toxicon: An Interdisciplinary Journal on the Toxins Derived from Animals, Plants and Microorganisms. doi:https://doi.org/10.1016/j.toxicon.2022.01.007More infoThis review treats the general biology, taxonomy, distribution and venom apparatus of the venomous snakes of Central America. Consideration has been given to the chemistry, pharmacology and immunology of the venom, and particular attention is dispensed to the clinical problem, including the treatment, of envenomations by these reptiles.
- Farkhondeh, T., Roshanravan, B., Shirazi, F. M., & Mehrpour, O. (2021). Can dantrolene be used in the treatment of cardioglycosides poisonings?. Expert opinion on drug metabolism & toxicology, 17(1), 1-2.
- Holzman, S. D., Larsen, J., Kaur, R., Smelski, G., Dudley, S., & Shirazi, F. M. (2021). Death by hand sanitizer: syndemic methanol poisoning in the age of COVID-19. Clinical toxicology (Philadelphia, Pa.), 59(11), 1009-1014.More infoThe advent of COVID-19 increased attention to hand hygiene in prevention of disease transmission. To meet the increased demand for hand sanitizer during the pandemic, the US FDA issued an Emergency Use Authorization allowing new manufacturers and importers to enter the market. Some of the newly introduced hand sanitizer products contained methanol in lieu of ethanol or isopropanol. We describe five patients with fatal methanol poisoning resulting from hand sanitizers improperly containing methanol.
- Klotz, S. A., Miller, M. L., Pogreba-Brown, K. M., Komatsu, K. K., Morehouse, L. M., Dudley, S. W., & Shirazi, F. M. (2021). e-Health for COVID-19 Epidemic: The Arizona Poison and Drug Information Center Experience. Telemedicine journal and e-health : the official journal of the American Telemedicine Association.More infoA significant challenge of the COVID-19 epidemic was the dissemination of accurate and timely information to the public, health care providers, and first responders. We describe the expansion of the Arizona Poison and Drug Information Center (APDIC) to fill such a need for residents of Arizona. The original mission of the APDIC was recognition and management of chemical exposure, poisoning, envenomation, and drug-related medical problems. In response to COVID-19, APDIC expanded its personnel and facilities to accommodate telephone calls and teleconsults regarding COVID-19. Thirteen different topics dealing with COVID-19 were addressed and tracked and included: testing information, isolation, prevention, personal protective equipment, travel, vaccines, therapies, antibody testing, contact tracing, exposure to the virus and what to do in businesses, at work or at school regarding isolation and quarantine. Responding to the public health needs, APDIC accepted >320,000 telephone calls and completed 48,346 teleconsults from March 3, 2020 to March 3, 2021. This represented a 15-fold increase in calls and twice the number of consults over 2019. Upon release of the vaccine, calls increased sharply with >7,000 calls in 1 day (February 7, 2021). In conclusion, the APDIC, rapidly expanded to address urgent public health information needs surrounding COVID-19 while still accomplishing its founding mission.
- Klotz, S. A., Yates, S., Smith, S. L., Dudley, S., Schmidt, J. O., & Shirazi, F. M. (2021). Scorpion Stings and Antivenom Use in Arizona. The American journal of medicine, 134(8), 1034-1038.More infoArizona's rugged desert landscape harbors many venomous animals, including a small nocturnal scorpion, Centruroides sculpturatus, whose venom can cause severe neuromotor disturbance. An effective antivenom is available at selected health care facilities in the state.
- Mehrpour, O., Modi, M., Mansouri, B., Azadi, N. A., Nakhaee, S., Amirabadi, A., Anaei-Sarab, G., Shirazi, F. M., & Weiss, S. T. (2021). Comparison of Vitamin B12, Vitamin D, and Folic Acid Blood Levels in Plumbism Patients and Controls in Eastern Iran. Biological trace element research, 199(1), 9-17.More infoThe aim of this study was to evaluate the blood levels of folic acid, vitamin B12, and 25-hydroxyvitamin D (25-OHD) in patients with lead poisoning compared with control subjects in Eastern Iran. This analytical case-control study was conducted on 40 lead-poisoned patients who were referred to Imam Reza Hospital in Birjand from 2018 to 2019. Blood samples were collected from an additional 40 individuals without lead poisoning as a control group. The results indicated that the mean vitamin B12, vitamin D, and folic acid levels for the case group were 356.5 ± 200.1 pg/ml, 24.38 ± 9.5 ng/ml, and 7.4 ± 3.7 ng/ml, respectively. Mean folic acid level in the case group was significantly lower than control group (7.4 ng/ml vs. 12.70 pg/ml, P = 0.001), whereas the mean of the vitamin D levels at the case group was significantly higher than that of the control group (24.3 ng/ml vs. 20.1 ng/ml, P = 0.03). Moreover, mean vitamin B12 levels were significantly lower in the case group in comparison with the control group (356.5 pg/ml vs. 500.8 pg/ml) (P
- Pasha, A. K., Clements, C. Y., Reynolds, C. A., Lopez, M. K., Lugo, C. A., Gonzalez, Y., Shirazi, F. M., & Abidov, A. (2021). Cardiovascular Effects of Medical Marijuana: A Systematic Review. The American journal of medicine, 134(2), 182-193.More infoUtilization of marijuana as a medicinal agent is becoming increasingly popular, and so far, 25 states have legalized it for medical purposes. However, there is emerging evidence that marijuana use can result in cardiovascular side effects, such as rhythm abnormalities, syncope/dizziness, and myocardial infarction, among others. Further, there are currently no stringent national standards or approval processes, like Food and Drug Administration (FDA) evaluation, in place to assess medical marijuana products. This review includes the largest up-to-date pooled population of patients with exposure to marijuana and reported cardiovascular effects. Although purported as benign by many seeking to advance the use of marijuana as an adjunctive medical therapy across the country, marijuana is associated with its own set of cardiovascular risks and deserves further definitive study and the same level of scrutiny we apply in research of all other types of medications. When used as a medicinal agent, marijuana should be regarded accordingly, and both clinical providers and patients must be aware of potential adverse effects associated with its use for early recognition and management.
- Rinner, G. R., Watkins, S. A., Shirazi, F., Fernandez, M. C., Hess, G., Mihalic, J., Runcorn, S., Waddell, V., Ritter, J., Reagan-Steiner, S., Thomas, J., Yip, L., & Walter, F. G. (2021). Fatal abrin poisoning by injection. Clinical Toxicology, 59(2), 169-171. doi:10.1080/15563650.2020.1771360
- Samarghandian, S., Shirazi, F. M., Saeedi, F., Roshanravan, B., Pourbagher-Shahri, A. M., Khorasani, E. Y., Farkhondeh, T., Aaseth, J. O., Abdollahi, M., & Mehrpour, O. (2021). A systematic review of clinical and laboratory findings of lead poisoning: lessons from case reports. Toxicology and applied pharmacology, 429, 115681.More infoLead is one of the most toxic heavy metals in the environment. The present review aimed to highlight hazardous pollution sources, management, and review symptoms of lead poisonings in various parts of the world. The present study summarized the information available from case reports and case series studies from 2009 to March 2020 on the lead pollution sources and clinical symptoms. All are along with detoxification methods in infants, children, and adults. Our literature compilation includes results from 126 studies on lead poisoning. We found that traditional medication, occupational exposure, and substance abuse are as common as previously reported sources of lead exposure for children and adults. Ayurvedic medications and gunshot wounds have been identified as the most common source of exposure in the United States. However, opium and occupational exposure to the batteries were primarily seen in Iran and India. Furthermore, neurological, gastrointestinal, and hematological disorders were the most frequently occurring symptoms in lead-poisoned patients. As for therapeutic strategies, our findings confirm the safety and efficacy of chelating agents, even for infants. Our results suggest that treatment with chelating agents combined with the prevention of environmental exposure may be an excellent strategy to reduce the rate of lead poisoning. Besides, more clinical studies and long-term follow-ups are necessary to address all questions about lead poisoning management.
- Wilson, B. Z., Larsen, J., Smelski, G., Dudley, S., & Shirazi, F. M. (2021). Use of Crotalidae equine immune F(ab') antivenom for treatment of an envenomation. Clinical toxicology (Philadelphia, Pa.), 59(11), 1023-1026.More infoAnavip (F(ab')AV) is a lyophilized F(ab') immunoglobulin fragment derived from horses immunized with venom from and . It was approved by the FDA in 2015 for treatment of North American rattlesnake envenomation but not for envenomation. Published data regarding the efficacy and safety of Anavip in treating envenomations is limited. We present a case of a patient treated with Anavip after confirmed envenomation.
- Ataei, M., Shirazi, F. M., Lamarine, R. J., Nakhaee, S., & Mehrpour, O. (2020). A double-edged sword of using opioids and COVID-19: a toxicological view. Substance abuse treatment, prevention, and policy, 15(1), 91.More infoToday, COVID-19 is spreading around the world. Information about its mechanism, prognostic factors, and management is minimal. COVID-19, as a human disease, has several identifying phases. Physicians of patients with COVID-19 may be interested in knowing whether opioid use disorder may affect their patients' course or prognosis. This information may be crucial when considering the opioid epidemic in the US and other parts of the world. Opioid use at high doses and over several months duration can mitigate the immune system's function, which may complicate the course of COVID-19 disease. Potential suppression of parts of the immune response may be important in prevention, clinical support, and therapeutic use of medications in various phases of the COVID-19. Specifically, opioid use disorders via an inhalation route may enhance the "late hyper-inflammatory phase" or result in end-organ damage. It is well established that opioids decrease ventilation as their effect on the medullary respiratory centers increases the risk of pneumonia. This increased risk has been associated with immune-suppressive opioids. The ultimate role of opioids in COVID-19 is not clear. This paper endorses the need for clinical studies to decipher the role and impact of chronic opioid use on viral diseases such as COVID-19.
- Chan, Y., Shirazi, F., Miller, D., & Campion, J. M. (2020). July 2020: Critical Care Case of the Month: Not the Pearl You Were Looking For.... Southwest Journal of Pulmonary/Critical Care Medicine, 2.
- Mehrpour, O., Modi, M., Mansouri, B., Azadi, N. A., Nakhaee, S., Amirabadi, A., Anaei-Sarab, G., Shirazi, F. M., & Weiss, S. T. (2020). Correction to: Comparison of Vitamin B12, Vitamin D, and Folic Acid Blood Levels in Plumbism Patients and Controls in Eastern Iran. Biological trace element research.More infoThe original version of this article unfortunately contained mistakes.
- Nakhaee, S., Brent, J., Hoyte, C., Farrokhfall, K., Shirazi, F. M., Askari, M., & Mehrpour, O. (2020). The effect of tramadol on blood glucose concentrations: a systematic review. Expert review of clinical pharmacology, 13(5), 531-543.More info: Studies comprehensively summarizing the impact of tramadol use on glucose homeostasis are very sparse. Thus, the present study was performed to collect and summarize the latest information about this issue in a systematic way.: An exhaustive literature search was carried out using relevant keywords. Web of Sciences, PubMed, Scopus, and Google scholar were interrogated until 30 June 2019. Case-control, cohort, cross-sectional, clinical trial, case report, and animal studies that focused on the objective of the study were retrieved. This review summarizes the results of 761 papers on glycemic changes due to tramadol exposure. Thirty-six publications reported hypoglycemia and 17 hyperglycemia during tramadol use. Twenty-two studies either reported normal blood glucose concentrations, or did not observe any difference in the blood glucose levels following tramadol use. Finally, hypoglycemia was reported in diabetic individuals exposed to tramadol in 12 studies.: The data suggest that primarily hypoglycemia but some degree of hyperglycemia has been reported with tramadol use. Importantly, all studies on tramadol use in diabetes reported hypoglycemia. Tramadol-induced hypoglycemia may be severe in some cases. The risk of alterations in glucose homeostasis accompanying tramadol exposure indicates time importance of careful blood glucose monitoring during tramadol use.Received 27 Nov 2019, Accepted 14 Apr 2020, Accepted author version posted online: 15 Apr 2020, Published online: 12 May 2020
- Rahimian, R., Mazda Shirazi, F., Schmidt, J. O., & Klotz, S. A. (2020). The Reply. The American journal of medicine, 133(6), e322.
- Rinner, G. R., Watkins, S. A., Shirazi, F. M., Fernández, M. C., Hess, G., Mihalic, J., Runcorn, S., Waddell, V., Ritter, J., Reagan-Steiner, S., Thomas, J., Yip, L., & Walter, F. G. (2020). Fatal abrin poisoning by injection. Clinical Toxicology (Phila). doi:10.1080/15563650.2020.1771360More infoAbrin is a toxin of public health concern due to its lethality, lack of antidote, and potential for use as a bioterrorism agent. Possible routes of exposure include ingestion, inhalation, and injection. Onset of symptoms is often delayed, even in severe cases. In fatal cases, death occurs from multi-organ failure. We describe the clinical course, laboratory, and pathologic findings in a case of fatal human poisoning associated with abrin injection. The seeds in this case were obtained the internet. The Centers for Disease Control and Prevention's Laboratory Response Network detected abrine in the urine confirming abrin exposure in this fatal poisoning.
- Shirazi, F. M., Banerji, S., Nakhaee, S., & Mehrpour, O. (2020). Effect of angiotensin II blockers on the prognosis of COVID-19: a toxicological view. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 39(10), 2001-2002.
- Yip, L., Bixler, D., Brooks, D. E., Clarke, K. R., Datta, S. D., Dudley, S., Komatsu, K. K., Lind, J. N., Mayette, A., Melgar, M., Pindyck, T., Schmit, K. M., Seifert, S. A., Shirazi, F. M., Smolinske, S. C., Warrick, B. J., & Chang, A. (2020). Serious Adverse Health Events, Including Death, Associated with Ingesting Alcohol-Based Hand Sanitizers Containing Methanol - Arizona and New Mexico, May-June 2020. MMWR. Morbidity and mortality weekly report, 69(32), 1070-1073.More infoAlcohol-based hand sanitizer is a liquid, gel, or foam that contains ethanol or isopropanol used to disinfect hands. Hand hygiene is an important component of the U.S. response to the emergence of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). If soap and water are not readily available, CDC recommends the use of alcohol-based hand sanitizer products that contain at least 60% ethyl alcohol (ethanol) or 70% isopropyl alcohol (isopropanol) in community settings (1); in health care settings, CDC recommendations specify that alcohol-based hand sanitizer products should contain 60%-95% alcohol (≥60% ethanol or ≥70% isopropanol) (2). According to the Food and Drug Administration (FDA), which regulates alcohol-based hand sanitizers as an over-the-counter drug, methanol (methyl alcohol) is not an acceptable ingredient. Cases of ethanol toxicity following ingestion of alcohol-based hand sanitizer products have been reported in persons with alcohol use disorder (3,4). On June 30, 2020, CDC received notification from public health partners in Arizona and New Mexico of cases of methanol poisoning associated with ingestion of alcohol-based hand sanitizers. The case reports followed an FDA consumer alert issued on June 19, 2020, warning about specific hand sanitizers that contain methanol. Whereas early clinical effects of methanol and ethanol poisoning are similar (e.g., headache, blurred vision, nausea, vomiting, abdominal pain, loss of coordination, and decreased level of consciousness), persons with methanol poisoning might develop severe anion-gap metabolic acidosis, seizures, and blindness. If left untreated methanol poisoning can be fatal (5). Survivors of methanol poisoning might have permanent visual impairment, including complete vision loss; data suggest that vision loss results from the direct toxic effect of formate, a toxic anion metabolite of methanol, on the optic nerve (6). CDC and state partners established a case definition of alcohol-based hand sanitizer-associated methanol poisoning and reviewed 62 poison center call records from May 1 through June 30, 2020, to characterize reported cases. Medical records were reviewed to abstract details missing from poison center call records. During this period, 15 adult patients met the case definition, including persons who were American Indian/Alaska Native (AI/AN). All had ingested an alcohol-based hand sanitizer and were subsequently admitted to a hospital. Four patients died and three were discharged with vision impairment. Persons should never ingest alcohol-based hand sanitizer, avoid use of specific imported products found to contain methanol, and continue to monitor FDA guidance (7). Clinicians should maintain a high index of suspicion for methanol poisoning when evaluating adult or pediatric patients with reported swallowing of an alcohol-based hand sanitizer product or with symptoms, signs, and laboratory findings (e.g., elevated anion-gap metabolic acidosis) compatible with methanol poisoning. Treatment of methanol poisoning includes supportive care, correction of acidosis, administration of an alcohol dehydrogenase inhibitor (e.g., fomepizole), and frequently, hemodialysis.
- Rahimian, R., Shirazi, F. M., Schmidt, J. O., & Klotz, S. A. (2019). Honeybee Stings in the Era of Killer Bees: Anaphylaxis and Toxic Envenomation. The American Journal of Medicine, 133(5), 621-626.More infoTwenty-six years after the arrival of "killer bees" in Arizona, the entire state with the exception of high elevations in the north is populated with this bee variety and 11 people have died at the scene of massive bee attacks.
- Rinner, G., Shirazi, F., & Walter, F. G. (2019). Rare Side Effects of Initiating Antihypertensive Therapy. Clinical Toxicology, 57(10), 917-918. doi:10.1080/15563650.2019.1636569
- August, J. A., Boesen, K. J., Hurst, N. B., Shirazi, F. M., & Klotz, S. A. (2018). Prophylactic Antibiotics Are Not Needed Following Rattlesnake Bites. The American journal of medicine, 131(11), 1367-1371.More infoAntibiotics are sometimes administered to victims of rattlesnake bites in the hope of preventing infections. Experts in the field recommend that prophylactic antibiotics not be used because secondary infections are rare. Current recommendations are based on a small number of studies conducted in the United States. We decided to reexamine the issue by taking advantage of a large database on snakebites in Arizona. This allowed us to determine how often prophylactic antibiotics were used and whether or not they were effective.
- Barbuto, A. F., Roman, D. M., Ori, M., & Shirazi, F. M. (2018). Shock and lactic acidosis due to inadvertent intravenous albuterol. CLINICAL TOXICOLOGY, 56(10), 929-929.
- Holzman, S. D., Massey, D. J., Clements, A., Boesen, K. J., & Shirazi, F. M. (2018). Arizona Ridge-nosed rattlesnake envenomation: Case report of a personal encounter with the official state reptile of Arizona, Crotalus willardi willardi. Toxicon : official journal of the International Society on Toxinology, 151, 84-88.More infoThis case report describes the effects of an envenomation from one of the most infrequently encountered species of rattlesnake in the United States, Crotalus willardi willardi (C. w. willardi), the Arizona Ridge-nosed Rattlesnake. A previously healthy 57-year-old male sustained a bite to his non-dominant hand from a C. w. willardi. The most pronounced effect from the envenomation was edema and progression of edema that extended from his hand to the mid bicep. He also experienced erythema and tenderness to palpation in the affected limb, and some diminished range of motion in the hand. He expressed only minimal pain. Other than a mildly positive D-Dimer and leukocytosis, he had no significant hematologic effects and no systemic effects. He was treated with standard doses of Crotalidae Polyvalent Immune Fab (Ovine). He reported complete recovery from the envenomation within three days of the bite. Although envenomation from rattlesnakes is somewhat common in Arizona, knowing the exact species of snake is not. Confirmed documentation is exceedingly rare as most people do not recognize the different rattlesnake species. In addition, some species of rattlesnake (such as C. w. willardi) are especially reclusive and found only in isolated mountainous regions. Being able to confirm an envenomation by C. w. willardi would require not only someone knowledgeable in herpetology, but also, preferably, photographic evidence. This case has both.
- Hurst, N. B., Lipe, D. N., Karpen, S. R., Patanwala, A. E., Taylor, A. M., Boesen, K. J., & Shirazi, F. M. (2018). Centruroides sculpturatus envenomation in three adult patients requiring treatment with antivenom. CLINICAL TOXICOLOGY, 56(4), 294-296.
- Khobrani, M. A., Dudley, S. W., Huckleberry, Y. C., Kopp, B. J., Biggs, A. D., French, R., Shirazi, F. M., & Erstad, B. L. (2018). Intentional use of carbapenem antibiotics for valproic acid toxicity: A case report. JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS, 43(5), 723-725.
- Ori, M. R., Larsen, J. B., & Shirazi, F. M. (2018). Mercury Poisoning in a Toddler from Home Contamination due to Skin- Lightening Cream. JOURNAL OF PEDIATRICS, 196, 314-317.el..More infoNov 2018
- Panich, J., Gooden, A., Shirazi, F. M., & Malone, D. C. (2018). Warnings for drug-drug interactions in consumer medication information provided by community pharmacies. Journal of the American Pharmacists Association : JAPhA, 59(1), 35-42.More infoIn 2006, the U.S. Food and Drug Administration (FDA) issued a draft guidance for pharmacies to provide consumer medication information (CMI) to patients receiving prescription medications. The objective of this study was to evaluate CMI leaflets provided by community pharmacies for accuracy and completeness regarding drug-drug interactions (DDIs).
- Rinner, G., Watkins, S. A., Curtis, K., Fernandez, M., & Shirazi, F. M. (2018). Massive fatal abrin poisoning by injection. CLINICAL TOXICOLOGY, 56(10), 998-998.
- Roman, D. M., Garrison, D. J., Larsen, J. B., French, R., & Shirazi, F. M. (2018). Successful ECMO for massive venlafaxine overdose. CLINICAL TOXICOLOGY, 56(10), 999-999.
- Shirazi, F. M., Roland, M., Schmid, K., Dudley, S., Kuhn, B., Rigler, J., Welch, S., Boesen, K. J., & Brooks, D. E. (2018). Poison centers respond to a state’s opioid crisis. Clinical Toxicology. doi:10.1080/15563650.2018.1506610More infoNAACT Abstracts 09/18
- Watkins, S. A., Boesen, K. J., & Shirazi, F. M. (2018). CRRT for metformin toxicity: is it enough?. CLINICAL TOXICOLOGY, 56(10), 1002-1003.
- Alharthi, M., Hurst, N., Boesen, K. J., & Shirazi, M. (2017). Venous thrombosis as a complication of rattlesnake envenomation. CLINICAL TOXICOLOGY, 55(7), 709-709.
- Malekzadeh, P., Hu, J., Sandweiss, A. J., Ameli, N., Bierny, P., Largent-Milnes, T. M., Vanderah, T. W., & Shirazi, F. (2017). Effect of Centruroides antivenom on reversal of methamphetamine-induced hyperkinesis and hyperthermia in rats. Journal of pharmaceutics & pharmacology, 5(1).More infoMethamphetamine (MA) toxicity is a major health concern causing agitation, hyperkinesia, hyperthermia, and even death, affecting 24.7 million people worldwide. It has been observed that MA generates movement disorders in children similar to that of scorpion envenomation. Four cases have been reported where MA intoxication in children were both subjectively and objectively improved as indicated by the reversal of nystagmus and movement disorders following administration of Centruroides antivenom (AV) therapy.
- Shirazi, F. (2017). Case 26 - Rattlesnake Envenomation. American College of Emergency Physicians (ACEP) Toxicology Section.
- Klotz, S. A., Shirazi, F. M., Boesen, K., Beatty, N. L., Dorn, P. L., Smith, S., & Schmidt, J. O. (2016). Kissing Bug (Triatoma spp.) Intrusion into Homes: Troublesome Bites and Domiciliation. Environmental health insights, 10, 45-9.More infoKissing bugs (Triatoma spp.) frequently enter homes and bite human and pet occupants. Bites may lead to severe allergic reactions and, in some cases, death. Kissing bugs are also vectors of Trypanosoma cruzi, the cause of Chagas disease. In general, modern houses in the United States are not conducive to domiciliation of kissing bugs (bugs living out their entire life within the home with the presence of eggs, nymphs, adults, and exuviae). Construction features such as concrete foundations, solid walls and ceilings, window screens, tight thresholds for doors and windows, and other measures impede bug entry into homes, and air conditioning reduces the need for open doors and windows. Where Chagas disease is endemic in Mexico and Central and South America, homes often have thatch roofs, adobe walls, and open doors and windows. We investigated numerous instances of kissing bug intrusions into homes in Southern Arizona, California, and Louisiana and documented the reactions to kissing bug bites. Our work confirms the importance of modern home construction in limiting kissing bug intrusions. Older homes, especially those lacking modern screening, caulking, and weather stripping to reduce air leakage, may be subject to kissing bug intrusions and domiciliation. We describe a community in Southern Arizona where domiciliation of homes by Triatoma recurva is common. We also provide recent data regarding kissing bug bites and allergic reactions to the bites.
- Ori, M., Boesen, K. J., & Shirazi, F. M. (2016). Venom Dose Response in Genetically Related Multicasualty Massive Bee Envenomation. CLINICAL TOXICOLOGY, 54(8), 670-670.
- Rhodes, S. M., Patanwala, A. E., Cremer, J. K., Marshburn, E. S., Herman, M., Shirazi, F. M., Harrison-Monroe, P., Wendel, C., Fain, M., Mohler, J., & Sanders, A. B. (2016). Predictors of Prolonged Length of Stay and Adverse Events among Older Adults with Behavioral Health-Related Emergency Department Visits: A Systematic Medical Record Review. The Journal of Emergency Medicine, 50(1), 143-52.More infoBehavioral health (BH)-related visits to the emergency department (ED) by older adults are increasing. This population has unique challenges to providing quality, timely care.
- Bush, S. P., Ruha, A., Seifert, S. A., Morgan, D. L., Lewis, B. J., Arnold, T. C., Clark, R. F., Meggs, W. J., Toschlog, E. A., Borron, S. W., Figge, G. R., Sollee, D. R., Shirazi, F. M., Wolk, R., de Chazal, I., Quan, D., García-Ubbelohde, W., Alagón, A., Gerkin, R. D., & Boyer, L. V. (2015). Comparison of F(ab')2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clinical toxicology (Philadelphia, Pa.), 53(1), 37-45.More infoCrotalidae Polyvalent Immune Fab (Ovine) has been the only antivenom commercially available in the US since 2007 for treatment of Crotalinae envenomation. Late coagulopathy can occur or recur after clearance of Fab antivenom, often after hospital discharge, lasting in some cases more than 2 weeks. There have been serious, even fatal, bleeding complications associated with recurrence phenomena. Frequent follow-up is required, and additional intervention or hospitalization is often necessary. F(ab')2 immunoglobulin derivatives have longer plasma half life than do Fab. We hypothesized that F(ab')2 antivenom would be superior to Fab in the prevention of late coagulopathy following treatment of patients with Crotalinae envenomation.
- Enakpene, E. O., Riaz, I. B., Shirazi, F. M., Raz, Y., & Indik, J. H. (2015). The long QT teaser: loperamide abuse. The American journal of medicine, 128(10), 1083-6.
- French, R., Brooks, D., Ruha, A., Shirazi, F., Chase, P., Boesen, K., & Walter, F. (2015). Gila monster (Heloderma suspectum) envenomation: Descriptive analysis of calls to United States Poison Centers with focus on Arizona cases. CLINICAL TOXICOLOGY, 53(1), 60-70.
- French, R., Brooks, D., Ruha, A., Shirazi, F., Chase, P., Boesen, K., & Walter, F. (2015). Gila monster (Heloderma suspectum) envenomation: Descriptive analysis of calls to United States Poison Centers with focus on Arizona cases. Clinical toxicology (Philadelphia, Pa.), 53(1), 60-70.More infoThe Gila monster (Heloderma suspectum) is a venomous lizard native to the deserts of southwestern United States (US) and northern Mexico. The purpose of this study was to describe human exposures to Gila monsters reported to US poison control centers (PCCs) with a focus on Arizona cases.
- Hurst, N., Karpen, S. R., Brillhart, D. B., French, R., Boesen, K. J., & Shirazi, F. (2015). Venous Thrombosis Following Rattlesnake Envenomation. Toxicon.
- Hypes, C. D., Hoverstadt, P., Lowry, J. S., Hurst, N., & Shirazi, F. (2015). Medical Image of the Week: Fluorescent Urine. Southwest Journal of Pulmonary and Critical Care, 11, 103-104.
- Strommen, J., & Shirazi, F. (2015). Methamphetamine Ingestion Misdiagnosed as Centruroides sculpturatus Envenomation. Case reports in emergency medicine, 2015, 320574.More infoThe authors present a case report of a 17-month-old female child who ingested a large amount of methamphetamine that looked very similar clinically to a scorpion envenomation specific to the southwestern United States by the species Centruroides sculpturatus. The child was initially treated with 3 vials of antivenom specific for that scorpion species and showed a transient, though clinically relevant neurologic improvement. Her clinical course of sympathomimetic toxicity resumed and she was treated with intravenous fluids and benzodiazepines after blood analysis showed significant levels of d-methamphetamine. This case report is to specifically underline the clinical confusion in discerning between these two conditions and the realization of limited and/or expensive resources that may be used in the process.
- Walter, F. G., Stolz, U., French, R., Chase, P. B., McNally, J., & Shirazi, F. (2014). Epidemiology of the Reported Severity of Cottonmouth ( Agkistrodon piscivorus) Snakebite. SOUTHERN MEDICAL JOURNAL, 107(3), 150-156.
- Alavala, A., Ulliman, E., Shirazi, M., & Szerlip, H. M. (2013). Quiz page October 2013: When things are not as they seem: a woman with anion gap metabolic acidosis after ingesting antifreeze. American journal of kidney diseases : the official journal of the National Kidney Foundation, 62(4), A25-8.
- Svirsky, I., Stoneking, L. R., Grall, K., Berkman, M., Stolz, U., & Shirazi, F. (2013). RESIDENT-INITIATED ADVANCED TRIAGE EFFECT ON EMERGENCY DEPARTMENT PATIENT FLOW. JOURNAL OF EMERGENCY MEDICINE, 45(5), 746-751.
- Kernan, L., Ito, S., Shirazi, F., & Boesen, K. (2012). Fatal gastrointestinal hemorrhage after a single dose of dabigatran. Clinical toxicology (Philadelphia, Pa.), 50(7), 571-3.More infoDabigatran (Pradaxa) is a new oral anticoagulant approved by the Food and Drug Administration (FDA), available internationally and indicated as an alternative to warfarin for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Dabigatran does not require laboratory monitoring and its kinetics allow for a more rapid onset of action with a time to peak concentration of 1.25-1.5 h. We are reporting a fatality resulting from gastrointestinal bleeding after the ingestion of a single dose of dabigatran 150 mg.
- Walter, F. G., Stolz, U., Shirazi, F., Walter, C. M., & McNally, J. (2012). Epidemiology of the Reported Severity of Copperhead (Agkistrodon contortrix) Snakebite. SOUTHERN MEDICAL JOURNAL, 105(6), 313-320.
- Daniel, G. W., Ewen, E., Willey, V. J., Reese, C. L., Shirazi, F., & Malone, D. C. (2010). Efficiency and Economic Benefits of a Payer-based Electronic Health Record in an Emergency Department. ACADEMIC EMERGENCY MEDICINE, 17(8), 824-833.
- Walter, F. G., Stolz, U., Shirazi, F., & Mcnally, J. (2010). Temporal analyses of coral snakebite severity published in the American Association of Poison Control Centers' Annual Reports from 1983 through 2007. CLINICAL TOXICOLOGY, 48(1), 72-78.
- Walter, F. G., Stolz, U., Shirazi, F., & McNally, J. (2009). Epidemiology of severe and fatal rattlesnake bites published in the American Association of Poison Control Centers' Annual Reports. CLINICAL TOXICOLOGY, 47(7), 663-669.
- Madadi, P., Shirazi, F., Walter, F. G., & Koren, G. (2008). Establishing causality of CNS depression in breastfed infants following maternal codeine use. Paediatric drugs, 10(6), 399-404.More infoWe recently reported on a breastfed infant who succumbed to opioid toxicity following exposure to morphine, the active metabolite of codeine, which was prescribed to his mother who was a cytochrome P450 2D6 (CYP2D6) ultrarapid metabolizer. This report is believed to be the first case of neonatal fatality as a direct result of maternal drug excretion into breast milk and, therefore, it is critical to corroborate the causative relationship between maternal codeine use during breastfeeding and neonatal opioid toxicity with other existing evidence.
- Walter, F. G., Chan, J. T., Winegard, B., Chase, P. B., Shirazi, F., Chow, Y., de Boer, M., & Denninghoff, K. (2008). Hazmat disaster preparedness in Hong Kong: what are the hazardous materials on Lantau, Lamma, and Hong Kong Islands?. American journal of disaster medicine, 3(4), 213-33.More infoHazmat disaster preparedness is critical, especially as Hong Kong prepares for major international events, such as the 2008 Olympic Equestrian Games. No published medical study describes the identities and quantities of hazardous materials (HMs) in Hong Kong and lists what antidotes are needed for these dangerous goods (DGs). This study describes what HMs are most common in Hong Kong to prioritize disaster preparedness and training.
- Walter, F. G., Chan, J., Winegard, B., Shirazi, F. M., Chase, P. B., Chow, Y. Y., de, B. M., & Denninghoff, K. (2008). Hazmat emergency preparedness in Hong Kong: what are the dangerous goods in Kowloon?. HONG KONG JOURNAL OF EMERGENCY MEDICINE, 15(3), 156-176.
- Coon, T., Miller, M., Shirazi, F., & Sullivan, J. (2006). Lead toxicity in a 14-year-old female with retained bullet fragments. PEDIATRICS, 117(1), 227-230.
- Skrepnek, G. H., Abarca, J., Malone, D. C., Armstrong, E. P., Shirazi, F. M., & Woosley, R. L. (2005). Incremental effects of concurrent pharmacotherapeutic regimens for heart failure on hospitalizations and costs. The Annals of pharmacotherapy, 39(11), 1785-91.More infoInappropriate medication use in patients with heart failure (HF) presents challenges in providing optimal, evidence-based care.
- Velez, L., Shirazi, F., Goto, C., Shepherd, G., & Roth, B. A. (2003). Opisthotonic posturing with neuromuscular irritability attributable to 4-aminopyridine ingestion by a healthy pediatric patient. PEDIATRICS, 111(1).
- LLOYD, T. R., & SHIRAZI, F. (1990). CAMP-MEDIATED CARDIOMYOCYTE HYPERTROPHY REQUIRES EXCITATION-CONTRACTION COUPLING. AMERICAN JOURNAL OF CARDIOLOGY, 66(4), 527-527.
- LLOYD, T. R., & SHIRAZI, F. (1990). NONGEOMETRIC DOPPLER STROKE VOLUME DETERMINATION IS LIMITED BY AORTIC SIZE. AMERICAN JOURNAL OF CARDIOLOGY, 66(10), 883-884.
- LLOYD, T. R., DONNERSTEIN, R. L., & SHIRAZI, F. (1990). OBSTRUCTION OF SYSTEMIC PULMONARY ARTERIAL SHUNTS BY DIAGNOSTIC CARDIAC CATHETERS. AMERICAN JOURNAL OF CARDIOLOGY, 66(10), 878-880.
- Bosen, K., Shirazi, F., & Larsen, J. (2017, January). Characterization of poison center calls from critical access hospitals in rural Arizona. In North American Congress of Clinical Toxicology (NACCT) Clinical Toxicology, 55, 823-824.
- Shirazi, F. (2017, January). Rattlesnake envenomation in a patient with Erhlers-Danlos Syndrome. In North American Congress of Clinical Toxicology (NACCT) Clinical Toxicology, 55, 733.
- Walter, F. G., Rice, A., Shirazi, F., Gaither, J. B., Smith, J., French, R. N., Beskind, D. L., Beskind, D. L., French, R. N., Smith, J., Gaither, J. B., Shirazi, F., Rice, A., & Walter, F. G. (2020, January). EMS Medical Directors Advanced Hazmat Life Support for Tox-Medics. National Association of EMS Physicians (NAEMSP) 2020 Annual Meeting. San Diego, CA: NAEMSP.More infoFull day pre-conference workshop presentation
- Ainapurapu, B. B., Ainapurapu, B. B., Shirazi, F., Shirazi, F., Swazo, R., Swazo, R., Ainapurapu, B. B., Shirazi, F., & Swazo, R. (2019, May). Confused and Belligerent Professor. Medicine Grand Rounds/CPC. UACOM.
- Rinner, G., Shirazi, F. M., Grossart, E., & Smelski, G. (2021, October/Fall). Reactive hypoglycemia during treatment of sulfonylurea overdose. North American Congress of Clinical Toxicology (NACCT) 2021, October 13-17, 2021. Montreal, Quebec, Canada: American Academy of Clinical Toxicology (AACT).
- Shirazi, F. M., Grossart, E., Troutman, A., Alsultan, R., Hurst, N., Shirazi, F. M., Grossart, E., Hurst, N., & Bowman, N. (2021, October/Fall). Outpatient management of a high-risk rattlesnake envenomation during the COVID-19 pandemic. North American Congress of Clinical Toxicology (NACCT) 2021, October 13-17, 2021. Montreal, Quebec, Canada: American Academy of Clinical Toxicology (AACT).
- Shirazi, F. M., Grossart, E., Wyman, M., Wheat, S., & Myers, B. (2021, October/Fall). Do poison centers contribute to risk identification for opioid overdose deaths?. North American Congress of Clinical Toxicology (NACCT) 2021, October 13-17, 2021. Montreal, Quebec, Canada: American Academy of Clinical Toxicology (AACT).
- Shirazi, F., Situ-LaCasse, E., Acuna, J., & Adhikari, S. R. (2020, October/Fall). Point-of-care Ultrasound in the Evaluation of Rattlesnake Envenomation. ACEP Research forum.
- Rinner, G., Shirazi, F., & Walter, F. G. (2019, September/Fall). Rare side effects of initiating antihypertensive therapy. North American Congress of Clinical Toxicology, September 23-27, 2019, Nashville, Tennessee. Nashville, Tennessee: American Academy of Clinical Toxicology (AACT).
- Walter, F. G., Shirazi, F., & Rinner, G. (2019, September). Rare Side Effects of Initiating Antihypertensive Therapy. North American Congress of Clinical Toxicology, September 23-27, 2019, Nashville, Tennessee. Nashville, Tennessee: American Academy of Clinical Toxicology (AACT).
- Hurst, N., Reilly, J. N., Boesen, K. J., & Shirazi, F. (2017, May). Epidemiology of rattlesnake envenoming reported to an Arizona Poison Center. 37th International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT). Basel, Switzerland: European Association of Poisons Centres and Clinical Toxicologists (EAPCCT).
- Svirsky, I., Stoneking, L. R., Stolz, U., Berkman, M. R., Grall, K., Shirazi, F., & DeBeche, J. (2013, June). Resident-initiated advanced triage effect on emergency department efficiency. Western Regional Society for Academic Emergency Medicine Annual Conference.More infoLong Beach, CA
- Hurst, N. B., Boesen, K. J., & Shirazi, F. M. (2015, September). Venous Thrombosis Following Rattlesnake Envenomation. The 18th World Congress of the International Society of Toxicology.
- Hurst, N. B., Karpen, S. R., French, R. N., Boesen, K. J., & Shirazi, F. M. (2015, AUG). ST elevation myocardial infarction following envenomation by North American Crotalus species. CLINICAL TOXICOLOGY.
- Hurst, N. B., Karpen, S. R., Myrtle, C., French, R. N., Boesen, K. J., & Shirazi, F. M. (2015, AUG). Prolonged recurrent coagulopathy after North American crotalus envenomation. CLINICAL TOXICOLOGY.
- Karpen, S. R., Hurst, N. B., Plitt, J., Chase, P., & Shirazi, F. M. (2015, AUG). Congenital lead poisoning in three siblings from a mother with retained bullet fragments. CLINICAL TOXICOLOGY.
- Karpen, S., Hurst, N. B., Lipe, D. N., Patanwala, A., Boesen, K. J., & Shirazi, F. M. (2015, AUG). Centuroides sculpturatus envenomation in three adult patients requiring treatment with antivenom. CLINICAL TOXICOLOGY.