Evaluation of Centrally Acting Cholinesterase Inhibitor Exposures in Adults

2007 ◽  
Vol 41 (10) ◽  
pp. 1632-1637 ◽  
Author(s):  
Keith R McCain ◽  
Tama S Sawyer ◽  
Henry A Spiller
Keyword(s):  
Healthcare Facility ◽  
Poison Control ◽  
Clinical Effects ◽  
Toxic Exposure ◽  
Lack Of Information ◽  
Number Of Patients ◽  
The Us ◽  
Poison Centers ◽  
Life Threatening ◽  
Toxic Exposure Surveillance System

Background: There are 4 centrally acting cholinesterase inhibitors (CA-ChEI) available in the US: tacrine, galantamina, rivastigmine, and donepezil. Documented clinical experience involving exposure to these agents is limited. The lack of information makes decisions involving excessive or unintended CA-ChEI exposure difficult. Objective: TO assess the effects, demographics, and outcomes of CA-ChEI exposures reported to US poison centers. Methods: A retrospective review of the Toxic Exposure Surveillance System of the American Association of Poison Control Centers data of acute and acute-on-chrontc exposures involving only a CA-ChEI in patients 19 years of age or older with documented medical outcomes from 2000–2005 was performed. Results: There were 1026 records that met criteria for this study. Patients aged 70–89 years made up 73% of reports; 69% of the patients were female. Moderate (197) and major outcomes (20) accounted for 21% of exposures. There were no deaths. Clinical effects that occurred in 5% or more of patients included vomiting (34%), nausea (28%), diarrhea (12%), dizziness/vertigo (9.9%), drowsiness/lethargy (7.7%), diaphoresis (7.4%), tremor (5.2%), and bradycardia (5%). Patients were admitted to the hospital in 19% of all exposures. Of those patients, 42% were admitted to a critical care unit. The majority (65%) of exposures were attributed to unintentional therapeutic error. Patients received at least one form of therapy In 47% of exposures, including intravenous fluid (111), antiemetic (46), atropine (17), benzodiazepine (15), oxygen (14), antihypertensive (4), pralidoxime (4), intubation (3), antihistamine (2), antiarrhythmic (1), anticonvulsant (1), and pacemaker (1). Conclusions: The majority of patients evaluated in this retrospective study experienced no or mild effect; however, significant or life-threatening effects were observed in a small group of patients and an appreciable number of patients were admitted to a healthcare facility.

Evaluation of toxicity of topiramate exposures reported to poison centers

2005 ◽  
Vol 24 (11) ◽  
pp. 591-595 ◽  
Author(s):  
A L Lofton ◽  
Wendy Klein-Schwartz
Keyword(s):  
Case Reports ◽  
Healthcare Facility ◽  
Poison Control ◽  
Poison Center ◽  
Clinical Effects ◽  
Toxic Exposure ◽  
Asymptomatic Patients ◽  
Poison Centers ◽  
Toxic Exposure Surveillance System ◽  
Gastrointestinal Decontamination

Published literature on the toxicity of a topiramate overdose is limited to case reports. This retrospective study of poison center data was performed to examine the severity of topiramate overdoses. Data on single substance exposures to topiramate reported to the American Association of Poison Control Centers (AAPCC) Toxic Exposure Surveillance System (TESS) in 2000 and 2001 were retrospectively analysed. A total of 567 cases met the inclusion criteria, of which 39% occurred in adults over 19 years of age and 30.2% in children 5 / 4 years old. The majority of patients (62.1%) experienced no toxicity. The most common clinical effects reported were drowsiness/lethargy (15.5%), dizziness/vertigo (4.9%), agitation (4.9%), confusion (3.9%), nausea (2.6%) and vomiting (2.5%). Symptomatic patients were older than asymptomatic patients and adults were more likely to be managed in a healthcare facility (P B / 0.0001). Patients who received gastrointestinal decontamination experienced less serious outcomes than those without decontamination (P B / 0.02). It is concluded that clinicians should expect relatively mild mental status changes in adults or children with toxicity from topiramate overdose. Serious toxic effects, such as CNS depression with respiratory depression or persistent non-anion gap metabolic acidosis, are infrequent.

Epidemiology and Toxicity of Pediatric Guanfacine Exposures

2002 ◽  
Vol 36 (11) ◽  
pp. 1698-1703 ◽  
Author(s):  
Jean C McGrath ◽  
Wendy Klein-Schwartz
Keyword(s):  
Children And Adolescents ◽  
Surveillance System ◽  
American Association ◽  
Healthcare Facility ◽  
Poison Control ◽  
Toxic Exposure ◽  
Inclusion Criteria ◽  
Poison Control Centers ◽  
Toxic Exposure Surveillance System

OBJECTIVE: To examine the epidemiology and toxicity of guanfacine exposures in children and adolescents reported to poison control centers. METHODS: Guanfacine exposures reported to the American Association of Poison Control Centers Toxic Exposure Surveillance System from 1993 to 1999 in children and adolescents <19 years of age were analyzed. RESULTS: There were 870 cases that met the inclusion criteria: 478 (54.9%) were children <6 years old, 304 (34.9%) were 6–12 years old, and 88 (10.1%) were adolescents 13–18 years old. The number of cases increased eight-fold over the 7-year period, with the largest increase in children <13 years of age. Analysis showed 29.7% of exposures were managed on site (non-healthcare facility) and 68.3% were managed in a healthcare facility. There were no symptoms in 546 (62.8%) children. In 324 symptomatic children, the most common symptoms were drowsiness/lethargy (76.8%), bradycardia (30.0%), and hypotension (25.8%). The majority of cases were acute (77.5%), 182 (20.9%) were acute-on-chronic, and 14 (1.6%) were chronic. Children aged 6–12 years represented the majority of the acute-on-chronic and chronic exposures with (n = 118). Overall, there were 195 (22.4%) exposures coded as minor, 121 (13.9%) as moderate, and 8 (0.9%) as major effects. CONCLUSIONS: These data demonstrated a trend of increasing numbers of guanfacine exposures annually. Although the majority of children experienced minimal or no toxicity, serious toxicity can occur.

Camphor Revisited: Focus on Toxicity

PEDIATRICS ◽  
1994 ◽  
Vol 94 (1) ◽  
pp. 127-128 ◽  
Author(s):  
Keyword(s):  
Adverse Reactions ◽  
Rapid Onset ◽  
The Body ◽  
Poison Control ◽  
Toxic Substances ◽  
Toxic Exposure ◽  
Poison Centers ◽  
Rate Of Absorption ◽  
Life Threatening ◽  
Level Of Concern

This commentary updates a previous AAP statement developed by the Committee on Drugs concerning camphor.1 The original commentary reflected the level of concern among pediatric practitioners and poison centers about the toxicity of camphor. Since the original statement, the Food and Drug Administration (FDA) has recognized camphor as a safe and effective topical antitussive, analgesic, anesthetic, and antipruritic agent.2 Following the approval process in 1983, the FDA required that the concentration of camphor in products not exceed 11%.2 Higher concentrations were not more effective and could cause more serious adverse reactions if accidentally ingested. Most reported camphor-related fatalities involved agents containing a concentration greater than 11%. Ingestion of potentially toxic substances by children is related to the availability of a product in their environment. Camphor remains widely available (Table). The toxicity of camphor when inappropriately used is well documented.3-6 Ingestion is the most common route of potentially toxic exposure, with rapid onset of toxic effects. The risk of toxicity relates to both the concentration of camphor in the ingested product and the rate of absorption of camphor into the body. From 1985 through 1989, 32 362 human exposures to camphor were reported to the American Association of Poison Control Centers.7-11 From 1985 through 1989, life-threatening toxicity occurred in 33 children as the result of camphor ingestion. During this period, there were no Childhood deaths as the result of camphor ingestion. In 5 cases, the products ingested contained more than 11% camphor even though they had been discontinued in 1983. In 14 cases, the products contained between 10% and 11% camphor.

Pattern of ziprasidone exposures reported to Texas poison centers, 2001–2005

2008 ◽  
Vol 27 (4) ◽  
pp. 355-361 ◽  
Author(s):  
MB Forrester
Keyword(s):  
Health Care ◽  
Age Distribution ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Clinical Effects ◽  
Poison Control Centers ◽  
Poison Centers ◽  
The Mean

Information on potentially adverse exposures to the atypical antipsychotic drug ziprasidone is limited. This study described the pattern of exposures involving only ziprasidone (isolated exposures) reported to Texas poison control centers during 2001–2005. The mean dose was 666 mg. The patient age distribution was ≤5 years (11%), 6–19 years (30%), and ≥20 years (60%). The exposures were intentional in 53% of the cases. Seventy-five percent of the exposures were managed at health care facilities. The final medical outcome was classified as no effect for 39% of the cases and minor effects for 40% of the cases. Adverse clinical effects were listed for 53% of the patients; the most frequently reported being neurological (42%), cardiovascular (13%), and gastrointestinal (5%). The most frequently listed treatment was decontamination by charcoal (34%) or cathartic (28%). Potentially adverse ziprasidone exposures reported to poison control centers are likely to involve management at a health care facility and involve some sort of adverse clinical effect. With proper treatment, the outcomes of such exposures are generally favorable.

2000 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

2001 ◽  
Vol 19 (5) ◽  
pp. 337-395 ◽  
Author(s):  
Toby L. Litovitz ◽  
Wendy Klein-Schwartz ◽  
Suzanne White ◽  
Daniel J. Cobaugh ◽  
Jessica Youniss ◽  
...  
Keyword(s):  
Surveillance System ◽  
Annual Report ◽  
American Association ◽  
Poison Control ◽  
Toxic Exposure ◽  
Poison Control Centers ◽  
Toxic Exposure Surveillance System

2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

2005 ◽  
Vol 23 (5) ◽  
pp. 589-666 ◽  
Author(s):  
William A. Watson ◽  
Toby L. Litovitz ◽  
George C. Rodgers ◽  
Wendy Klein-Schwartz ◽  
Nicole Reid ◽  
...  
Keyword(s):  
Surveillance System ◽  
Annual Report ◽  
American Association ◽  
Poison Control ◽  
Toxic Exposure ◽  
Poison Control Centers ◽  
Toxic Exposure Surveillance System
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