{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T08:20:19Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 23.5, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094b2-cc47-7832-90c9-623c32d854db\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: Calcium channel blocker toxicity\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n", "usd": 0.0, "recall": true }, "codex": { "seconds": 79.3, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094b2-cc3c-7702-94d4-4f91019725e5\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: Calcium channel blocker toxicity\nRegistry id: vr.tr.calcium-channel-blocker-toxicity\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorde" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:46:39+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "visual_identification" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:26+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q17071650", "registryId": "vr.tr.calcium-channel-blocker-toxicity", "name": "Calcium channel blocker toxicity", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q17071650/", "model": { "registry_id": "vr.tr.calcium-channel-blocker-toxicity", "name": "Calcium channel blocker toxicity", "purpose": "Enable an AI agent to represent a suspected or confirmed calcium channel blocker toxicity episode, assess its evolving severity and uncertainty, and support clinician-directed decisions.", "definition": "Calcium channel blocker toxicity is a poisoning syndrome caused by excessive calcium channel antagonist effects, principally on vascular smooth muscle, cardiac conduction and contractility, and pancreatic insulin secretion, potentially producing life-threatening circulatory failure.", "scope_statement": "This model owns the pathological state registered as vr.tr.calcium-channel-blocker-toxicity in XCT / XCT.STA, including attribution to calcium channel blocker exposure, physiological manifestations, temporal progression, and treatment response.", "in_scope": [ "Suspected or confirmed toxicity attributable to one or more calcium channel blockers", "Exposure circumstances, formulation, timing, and uncertainty relevant to the episode", "Cardiovascular, metabolic, and organ-perfusion abnormalities assessed in context", "Mixed exposures and competing explanations that affect causal attribution", "Clinical escalation, intervention response, recurrence, and episode resolution" ], "out_of_scope": [ "Chemical identity, manufacture, and general pharmacology of individual calcium channel blockers", "Routine prescribing and monitoring without suspected toxicity", "Independent models of shock, arrhythmia, or organ injury beyond their role in this episode", "Full toxicology models for co-ingestants", "Longitudinal psychiatric assessment and intentional self-harm care", "Institution-specific treatment protocols and autonomous medication dosing" ], "distinguishing_features": [ "Requires a supported or explicitly uncertain causal connection between calcium channel blocker exposure and a harmful physiological state; exposure alone does not establish toxicity.", "Separates expected therapeutic effects and mild adverse effects from a toxicity episode using documented clinical interpretation rather than a universal dose cutoff.", "Tests attribution against beta-blocker toxicity and other causes of hypotension or bradycardia; no single heart-rate, glucose, or electrocardiographic finding is treated as diagnostic.", "Distinguishes predominantly vascular, myocardial, conduction-related, and mixed presentations rather than requiring one fixed toxidrome.", "Evaluates findings against exposure timing and formulation so an initially reassuring assessment is not automatically treated as resolution." ], "characteristics": [ { "name": "Causal attribution status", "kind": "state", "unit_or_values": "suspected | supported | clinician-confirmed | disputed | excluded", "why_it_matters": "Separates physiological observations from the confidence that calcium channel blockers explain them." }, { "name": "Implicated agent and formulation", "kind": "relation", "unit_or_values": "Links to drug identities, product records, and immediate-release, modified-release, or unknown formulation", "why_it_matters": "Supports interpretation of the likely manifestation pattern and time course." }, { "name": "Exposure estimate", "kind": "measurement", "unit_or_values": "mg, mg/kg when justified, or an explicit range; unknown permitted", "why_it_matters": "Preserves the exposure estimate without presenting uncertain quantities as established facts." }, { "name": "Exposure timing", "kind": "measurement", "unit_or_values": "Timestamp or interval with confidence; elapsed hours relative to a specified assessment", "why_it_matters": "Anchors onset, surveillance, deterioration, and recovery." }, { "name": "Exposure circumstance", "kind": "category", "unit_or_values": "acute excess | repeated excess | therapeutic-use accumulation or interaction | administration error | uncertain", "why_it_matters": "Distinguishes routes into toxicity that require different causal explanations." }, { "name": "Hemodynamic phenotype", "kind": "state", "unit_or_values": "predominantly vascular | predominantly myocardial | predominantly conduction-related | mixed | undetermined; assessment time and evidence required", "why_it_matters": "Describes the observed physiological problem without inferring it solely from the drug name." }, { "name": "Cardiovascular observations", "kind": "measurement", "unit_or_values": "Heart rate in beats/min, blood pressure in mmHg, ECG intervals in ms, and linked rhythm interpretation", "why_it_matters": "Makes cardiovascular change and intervention response assessable over time." }, { "name": "Metabolic and perfusion observations", "kind": "measurement", "unit_or_values": "Glucose in mmol/L or mg/dL, lactate in mmol/L, pH, and linked clinical perfusion observations", "why_it_matters": "Supports assessment of systemic effects while preserving alternative explanations and treatment confounding." }, { "name": "Clinical trajectory", "kind": "state", "unit_or_values": "not yet clinically manifest | worsening | stable with support | improving | recurrent | resolved | uncertain", "why_it_matters": "Distinguishes temporary physiological control from sustained recovery." }, { "name": "Intervention dependence", "kind": "relation", "unit_or_values": "Links to active interventions, their timing, monitoring, and clinician-assessed dependence", "why_it_matters": "Prevents supported measurements from being mistaken for unsupported stability." } ], "affordances": [ "Assemble a time-aligned account of exposure evidence, clinical findings, and interventions.", "Identify missing exposure details and unresolved alternative causes that limit attribution.", "Track deterioration, mixed physiological patterns, and possible recurrence for clinician review.", "Compare observed intervention responses while identifying simultaneous treatments and confounding.", "Prepare a structured toxicology consultation or care handoff with uncertainty preserved.", "Evaluate whether documented recovery and disposition criteria have been met under an applicable clinical protocol." ], "agent_conduct": { "may": [ "Explain what calcium channel blocker toxicity is and its warning signs from medical sources.", "Direct anyone with suspected poisoning to emergency care or a poison centre." ], "must_not": [ "Diagnose poisoning or advise on treatment for a person.", "Advise on dosing these medicines.", "Provide information that helps anyone harm themselves or others.", "Delay emergency help." ], "requires_human": [ "All treatment decisions, made by clinicians." ] }, "ethics": { "considerations": [ "These medicines are widely prescribed, and poisoning, including in children, can be fatal.", "Overdose information must focus on safety and treatment." ], "affected_parties": [ "Patients", "Children who swallow medicines", "Caregivers" ] }, "owners": { "steward": "Nobody owns the condition; the treating clinician answers for each patient.", "master_systems": [] }, "visual_identification": [ "Not visible directly; signs include low blood pressure, slow heart rate and collapse.", "Diagnosed by clinical assessment, heart rhythm tests and history of ingestion." ], "failure_modes_and_hazards": [ "Severe low blood pressure and shock.", "Delayed effects from extended-release tablets can be missed." ], "what_it_is_for": [ "Calcium channel blocker toxicity is encountered in emergency medicine, clinical toxicology and intensive care following excessive drug exposure.", "It is represented in clinical records to support assessment of circulatory compromise, changes over time and uncertainty about the exposure.", "Poison information services and treating clinicians use the diagnosis to coordinate specialist assessment and ongoing care." ], "standards_and_regulation": [ "ICD-10 category T46.1, Poisoning by calcium-channel blockers, issued by the World Health Organization, classifies poisoning episodes involving these medicines." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q17071650: Calcium channel blocker toxicity", "url": "https://www.wikidata.org/wiki/Q17071650", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Calcium channel blocker toxicity", "url": "https://en.wikipedia.org/wiki/Calcium_channel_blocker_toxicity", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "exposure-and-attribution", "name": "Exposure and attribution", "description": "Establishes what calcium channel blocker exposure may have occurred and how strongly it explains the episode.", "rationale": "A toxicity model must distinguish verified exposure, estimated exposure, and causal inference.", "layers": [ { "id": "agent-formulation-and-amount", "name": "Agent, formulation, and amount", "description": "Captures the implicated product and the evidence supporting its identity and quantity.", "findings": [ { "id": "exposure-reconstruction", "name": "Exposure reconstruction", "description": "A traceable exposure account with explicit uncertainty about product, formulation, amount, and timing.", "questions": [ { "text": "Which calcium channel blocker and formulation are implicated, and what packaging, medication record, witness account, or other evidence supports that identification?", "kind": "provenance", "id": "exposure-reconstruction-q01" }, { "text": "What amount and exposure interval can be supported, and which estimates depend on assumptions such as missing-tablet counts?", "kind": "measurement", "id": "exposure-reconstruction-q02" } ] } ] }, { "id": "causal-context", "name": "Causal context", "description": "Separates calcium channel blocker effects from mixed exposures and non-toxicological explanations.", "findings": [ { "id": "attribution-and-alternatives", "name": "Attribution and alternatives", "description": "Records the evidence for attribution and the competing explanations that remain viable.", "questions": [ { "text": "What evidence connects the observed harmful state to calcium channel blocker exposure rather than merely documenting that exposure occurred?", "kind": "boundary", "id": "attribution-and-alternatives-q01" }, { "text": "Which co-exposures, medication interactions, baseline conditions, or acute illnesses could explain or amplify the presentation?", "kind": "boundary", "id": "attribution-and-alternatives-q02" } ] } ] } ] }, { "id": "cardiovascular-expression", "name": "Cardiovascular expression", "description": "Represents the vascular, myocardial, and electrical components of the observed presentation.", "rationale": "Blood pressure and heart rate alone do not adequately describe the physiological problem being managed.", "layers": [ { "id": "circulation-and-pump-function", "name": "Circulation and pump function", "description": "Connects hemodynamic measurements with evidence about perfusion and cardiac function.", "findings": [ { "id": "hemodynamic-pattern", "name": "Hemodynamic pattern", "description": "A time-specific interpretation of the contributions of vascular dysfunction and impaired cardiac performance.", "questions": [ { "text": "What do blood-pressure trends, examination, echocardiography, and available hemodynamic measurements show about the current circulatory state?", "kind": "measurement", "id": "hemodynamic-pattern-q01" }, { "text": "What supports a predominantly vascular, myocardial, or mixed interpretation, and what remains unmeasured?", "kind": "boundary", "id": "hemodynamic-pattern-q02" } ] } ] }, { "id": "rate-rhythm-and-conduction", "name": "Rate, rhythm, and conduction", "description": "Tracks electrical findings and their relationship to circulatory compromise.", "findings": [ { "id": "electrical-manifestations", "name": "Electrical manifestations", "description": "Serial rhythm and conduction observations interpreted against baseline status and co-exposures.", "questions": [ { "text": "Which rate, rhythm, and conduction abnormalities are documented on serial ECGs or monitoring, and when did they appear?", "kind": "measurement", "id": "electrical-manifestations-q01" }, { "text": "Which abnormalities are new and plausibly attributable to this episode, and which may reflect baseline disease, co-ingestants, or treatment?", "kind": "boundary", "id": "electrical-manifestations-q02" } ] } ] } ] }, { "id": "metabolism-and-organ-perfusion", "name": "Metabolism and organ perfusion", "description": "Connects metabolic observations and organ dysfunction to the evolving toxicity episode.", "rationale": "Systemic consequences and treatment effects must be interpreted alongside cardiovascular observations.", "layers": [ { "id": "metabolic-observations", "name": "Metabolic observations", "description": "Records glucose, acid-base, lactate, and electrolyte findings with their clinical context.", "findings": [ { "id": "metabolic-pattern-and-confounding", "name": "Metabolic pattern and confounding", "description": "Separates observed metabolic abnormalities from assumptions about their cause.", "questions": [ { "text": "How do glucose, lactate, pH, and relevant electrolytes change across the episode, with units and sampling times preserved?", "kind": "measurement", "id": "metabolic-pattern-and-confounding-q01" }, { "text": "How do diabetes, hypoperfusion, co-exposures, and administered therapies affect interpretation of these measurements?", "kind": "boundary", "id": "metabolic-pattern-and-confounding-q02" } ] } ] }, { "id": "organ-consequences", "name": "Organ consequences", "description": "Represents neurological, renal, respiratory, and other consequences requiring assessment.", "findings": [ { "id": "perfusion-and-organ-dysfunction", "name": "Perfusion and organ dysfunction", "description": "Links organ-level observations to possible toxicity-related circulatory compromise while retaining alternatives.", "questions": [ { "text": "What changes in mental status, urine output, renal function, oxygenation, or other organ observations accompany the cardiovascular course?", "kind": "measurement", "id": "perfusion-and-organ-dysfunction-q01" }, { "text": "Which organ abnormalities are attributed to hypoperfusion, another exposure, pre-existing disease, or an intervention, and with what confidence?", "kind": "boundary", "id": "perfusion-and-organ-dysfunction-q02" } ] } ] } ] }, { "id": "time-course-and-severity", "name": "Time course and severity", "description": "Represents onset, progression, supported stability, and possible recurrence.", "rationale": "An assessment is meaningful only in relation to exposure timing, formulation, and the support currently being delivered.", "layers": [ { "id": "onset-and-observation", "name": "Onset and observation", "description": "Aligns exposure timing with symptom emergence and the rationale for continued assessment.", "findings": [ { "id": "temporal-risk-assessment", "name": "Temporal risk assessment", "description": "A documented interpretation of the episode's timing without assuming that an early normal examination excludes later toxicity.", "questions": [ { "text": "When were the last known well state, earliest symptoms, first abnormalities, and subsequent deterioration relative to the possible exposure interval?", "kind": "measurement", "id": "temporal-risk-assessment-q01" }, { "text": "Which applicable toxicology guidance supports the observation plan for this agent, formulation, exposure pattern, and current presentation?", "kind": "provenance", "id": "temporal-risk-assessment-q02" } ] } ] }, { "id": "severity-and-recurrence", "name": "Severity and recurrence", "description": "Tracks clinical severity using observations, organ effects, and required support.", "findings": [ { "id": "dynamic-severity-state", "name": "Dynamic severity state", "description": "A time-specific severity judgment that distinguishes deterioration, treatment-supported stability, and recovery.", "questions": [ { "text": "Which observed abnormalities, organ consequences, and support requirements justify the current severity assessment?", "kind": "definition", "id": "dynamic-severity-state-q01" }, { "text": "Has deterioration or recurrence followed apparent improvement or reduction of support, and what evidence supports its proposed cause?", "kind": "measurement", "id": "dynamic-severity-state-q02" } ] } ] } ] }, { "id": "clinical-actions-and-resolution", "name": "Clinical actions and resolution", "description": "Records clinician-directed actions, their rationale, monitored effects, and the basis for ending acute episode management.", "rationale": "The model must support reviewable decisions without substituting a generic treatment sequence for individualized toxicology care.", "layers": [ { "id": "interventions-and-response", "name": "Interventions and response", "description": "Connects exposure-directed and physiological treatments to indications, oversight, and observed effects.", "findings": [ { "id": "treatment-decision-and-effect", "name": "Treatment decision and effect", "description": "A record of selected or deferred interventions, including calcium, high-dose insulin therapy, vasoactive support, and advanced support when considered by the treating team.", "questions": [ { "text": "What clinical indication, toxicology recommendation, or protocol supports each intervention selected or deferred, and who owns the decision?", "kind": "action", "id": "treatment-decision-and-effect-q01" }, { "text": "What intended response and adverse effects were monitored, and how do simultaneous interventions limit attribution of improvement or harm?", "kind": "measurement", "id": "treatment-decision-and-effect-q02" } ] } ] }, { "id": "recovery-and-handoff", "name": "Recovery and handoff", "description": "Defines the evidence for sustained recovery and the information required at transfer or disposition.", "findings": [ { "id": "resolution-evidence", "name": "Resolution evidence", "description": "A documented basis for episode resolution or continued care that accounts for residual abnormalities and ongoing support.", "questions": [ { "text": "What sustained clinical findings and applicable observation criteria support resolution, including the period after relevant support is withdrawn?", "kind": "boundary", "id": "resolution-evidence-q01" }, { "text": "Which residual organ effects, exposure uncertainties, medication-review needs, and recurrence concerns must be communicated at handoff?", "kind": "action", "id": "resolution-evidence-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is recalled knowledge, without sources consulted.", "Agent-specific patterns overlap substantially in severe poisoning and should not be treated as diagnostic rules.", "There is no single reliable toxic dose or blood concentration applicable across this drug class; formulation, co-exposures and patient characteristics matter." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of Calcium channel blocker toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Dihydropyridine toxicity, such as amlodipine poisoning, often dominated by vasodilation", "Verapamil toxicity, often involving myocardial depression and impaired cardiac conduction", "Diltiazem toxicity, involving variable combinations of vasodilation, myocardial depression and impaired conduction" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of Calcium channel blocker toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "T46.1", "note": "Poisoning by calcium-channel blockers; national modifications may require additional characters and distinguish poisoning from adverse effects and underdosing." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of Calcium channel blocker toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Emergency department and poison centre classification of suspected medication poisoning", "Clinical assessment of otherwise unexplained hypotension, bradycardia or shock following medication exposure", "Toxicovigilance and medication safety surveillance" ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of Calcium channel blocker toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Severe vasodilation and hypotension can progress to shock and organ hypoperfusion.", "Myocardial depression, bradycardia and atrioventricular block can progress to cardiac arrest.", "Impaired insulin secretion and disturbed glucose utilization can produce hyperglycemia; severe shock can produce lactic acidosis.", "Modified-release formulations can delay deterioration, while long-acting agents can produce prolonged toxicity.", "Severe poisoning can erase usual differences between drug subclasses; co-exposure to other cardiovascular depressants can worsen toxicity." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of Calcium channel blocker toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Available agents, formulations and prescribing patterns differ between countries.", "Diagnostic coding details vary between national ICD modifications." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of Calcium channel blocker toxicity this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Calcium channel blocker", "difference": "The medication class is the causal exposure; toxicity is the harmful clinical state resulting from excessive effects." }, { "name": "Beta-blocker toxicity", "difference": "Both can cause bradycardia and shock, but involve different drug targets; exposure history is central to distinguishing them." }, { "name": "Hypercalcemia", "difference": "Hypercalcemia is an elevated blood calcium concentration; calcium channel blocker toxicity is impaired calcium channel function and does not require elevated blood calcium." }, { "name": "Calcium channel blocker adverse effect", "difference": "Adverse effects can occur during correctly administered therapy; poisoning classifications distinguish excessive exposure or administration errors from adverse effects at therapeutic use." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of Calcium channel blocker toxicity this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which authoritative definitions best distinguish calcium channel blocker toxicity from expected therapeutic effects and non-toxic adverse reactions?", "Which severity framework is sufficiently validated across different calcium channel blockers, age groups, and mixed exposures?", "Which agent- and formulation-specific evidence should determine observation and recovery criteria when exposure amount or timing is uncertain?", "How reliably can available bedside evidence separate vascular and myocardial contributions, and how should unresolved mixed physiology be represented?", "Which current consensus sources should govern treatment indications, escalation, and monitoring, and where do evidence limitations or disagreements remain?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 17, "questions": 27 } }