Medical toxicology and infectious disease are not specialties traditionally associated with one another. Pandemics, however, have a way of disrupting convention, and in this era of modern medicine, our specialty has much to offer.When a major medical crisis occurs for which there is no known cure, several phenomena may ensue. The public, fearful and increasingly connected to and influenced by social media, the internet, and television, may experiment with self-medication. Institutional bodies, desperate to advance care, may abandon the conventional mechanisms that ensure medication safety in order to facilitate the rapid approval and dissemination of novel pharmacotherapy. When these developments are considered within the context of our specialty, our role becomes clear. As medical toxicologists we serve as a fund of knowledge for our healthcare colleagues and the public: we provide physicians with information regarding antidotal therapy, drug-drug interactions, and novel therapeutics. We advise the public on an individual and community level through poison control centers and public outreach. As a specialty, we have the knowledge base and the position with respect to our peers and our society to monitor, prevent, and manage the toxicities born of a pandemic.

Background: Exposure to environmental metals can cause nephrotoxicity. There is an international epidemic of chronic kidney disease of unknown cause (CKDu). Whether metal exposures contribute to kidney dysfunction in populations at-risk for CKDu remains unresolved. Objective: Urinary metals (arsenic, cadmium, nickel, and uranium) were examined in 222 sugarcane cutters in Guatemala at three time points over one year. Methods: We explored the relationships between metal concentrations and markers of kidney function using multivariable linear mixed-effect models. Results: Arsenic, cadmium, and nickel were detected in the majority of the 340 urine samples and were generally within limits previously considered to be non-nephrotoxic. Nevertheless, higher urine cadmium was inversely associated with estimated glomerular filtration rate (eGFR) (β: −4.23, 95% confidence interval [CI]: −6.92, −1.54) and positively associated with neutrophil gelatinase-associated lipocalin (NGAL) (β: 2.92, 95% CI: 1.20, 4.64). Higher urine arsenic was also inversely associated with eGFR (β: −4.36, 95% CI: −7.07, −1.64). Significance: Our findings suggest that exposures to metals, including cadmium and arsenic, might contribute to kidney toxicity seen in workers at risk for CKDu. These findings are consistent with the potential for metal nephrotoxicity at lower than expected levels in the setting of manual work in a very hot environment.