Comparison of Pediatric Poisoning Hazards: An Analysis of 3.8 Million Exposure Incidents A Report from the American Association of Poison Control Centers

PEDIATRICS ◽  
1992 ◽  
Vol 89 (6) ◽  
pp. 999-1006
Author(s):  
Toby Litovitz ◽  
Anthony Manoguerra
Keyword(s):  
Poison Control ◽  
Over The Counter ◽  
Research Areas ◽  
Poison Centers ◽  
Life Threatening ◽  
Cardiovascular Medications ◽  
Poison Prevention ◽  
Frequent Exposure ◽  
Clinical Advances ◽  
Hazard Factor

This analysis of life-threatening and fatal pediatric poisonings was conducted to aid poison prevention educational efforts, guide product reformulations and aversive agent use, reassess over-the-counter status for selected pharmaceuticals, and identify research areas for clinical advances in the treatment of pediatric poisonings. A hazard factor was devised to assess more objectively the pediatric poisoning hazard posed by pharmaceutical and nonpharmaceutical products. By considering the frequency and extent of injury following actual exposures, the hazard factor reflects more than the acute toxicity of individual ingredients and is also influenced by such variables as packaging, accessibility, availability (as a reflection of marketing), formulations, and closure types. Of the 3 810 405 exposures involving children younger than 6 years of age reported to poison centers in 1985 through 1989, 2117 patients experienced a major outcome (life-threatening effect or residual disability) and an additional 111 fatalities occurred. The three most commonly implicated substance categories, accounting for 30.4% of reported exposures, include cosmetics and personal care products, cleaning substances, and plants. All had low hazard factors, with significant hazards being limited to a small number of products identified herein. Thus this analysis of hazard factors demonstrates that frequent exposure does not imply toxicity. Iron supplements were the single most frequent cause of pediatric unintentional ingestion fatalities, accounting for 30.2% of reported pediatric pharmaceutical unintentional ingestion fatalities reported over an 8-year period. Antidepressants, cardiovascular medications, and methyl salicylate follow in frequency of pediatric pharmaceutical deaths. Hydrocarbons (including five lamp oil deaths) and pesticides were each implicated in 12 pediatric ingestion fatalities during the 8-year period. Selenious acid-containing gun bluing was involved in four deaths. These data allow a more informed approach to poison prevention efforts in the 1990s.

Poison Centers, Poison Prevention, and the Pediatrician

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 220-224 ◽  
Author(s):  
Frederick H. Lovejoy ◽  
William O. Robertson ◽  
Alan D. Woolf
Keyword(s):  
The United States ◽  
Poison Control ◽  
Poison Center ◽  
Department Of Health ◽  
Household Products ◽  
Prevention Model ◽  
Poison Centers ◽  
History Of ◽  
Poison Prevention ◽  
Remarkable Progress

The first poison centers were established in the United States in the early 1950s, stimulated by an American Academy of Pediatrics' survey of office-based pediatric practices which ascertained that its members had no place to turn for ingredient information on medications and household products.1 With the help of the Academy, pediatrician Dr. Edward Press, the Illinois Department of Health, and several community hospitals, the first poison center emerged. Over the subsequent 40 years, remarkable progress has occurred in the fields of clinical toxicology, poison control, and poison prevention. Yet despite these accomplishments, challenging clouds are appearing on the horizon which threaten these gains. This commentary, by the authors who have viewed and participated in a large part of the history of this progress, will focus on these major accomplishments with an emphasis on (a) poison prevention utilizing the pre-event (primary prevention), (b) the event (secondary prevention), and (c) the postevent (tertiary prevention) model.2

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.

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.

scholarly journals A case of nimesulide induced toxic epidermal necrolysis

2020 ◽  
Vol 9 (5) ◽  
pp. 810
Author(s):  
Suja Xaviar ◽  
Mirunalini Ravichandran
Keyword(s):  
Mortality Rate ◽  
Toxic Epidermal Necrolysis ◽  
Skin Disease ◽  
The Body ◽  
Drug Induced ◽  
Over The Counter ◽  
Life Threatening ◽  
Cox 2 ◽  
Adequate Management ◽  
Possible Cause

Toxic epidermal necrolysis (TEN) is a rare life-threatening drug-induced mucocutaneous skin disease with a mortality rate of approximately 30%. Nimesulide is a preferential cyclo-oxygenase (COX-2) inhibitor which is frequently used for its antipyretic, anti-inflammatory and analgesic activity. Here, we report a case of nimesulide induced toxic epidermal necrolysis in a 57 years old male patient. This patient was admitted in the hospital with symptoms of epidermal sloughing and fluid filled blisters all over the body following over the counter intake of nimesulide for fever. The drug was promptly stopped, and patient was managed with steroids, antibiotics and other adequate supportive measures. The patient showed significant recovery following stoppage of drug and adequate management. This case highlights the importance of nimesulide and other NSAIDs as possible cause of TEN.

Apparent Life-Threatening Events and Over-the-Counter Cough and Cold Medications

PEDIATRICS ◽  
2009 ◽  
Vol 123 (1) ◽  
pp. e170-e170 ◽  
Author(s):  
E. J. Lavonas ◽  
S. Yin
Keyword(s):  
Over The Counter ◽  
Life Threatening

Poison Prevention Education

PEDIATRICS ◽  
1984 ◽  
Vol 74 (5) ◽  
pp. 964-969
Author(s):  
Anthony R. Temple
Keyword(s):  
Life Support ◽  
First Aid ◽  
Poison Control ◽  
Poison Center ◽  
Prevention Education ◽  
Control Center ◽  
Support Measures ◽  
Poison Prevention ◽  
Household Chemicals ◽  
Epidemiologic Characteristics

Physicians can significantly decrease the frequency and severity of poisoning by educating parents and families in poison prevention. Appropriate strategies for poison prevention education require an examination of epidemiologic characteristics of exposures and potential intervention techniques. Parents should be taught immediate first-aid steps, such as initiating basic life-support measures and irrigation and dilution, that can be taken before seeking medical assistance. Other consumer actions, such as inducing emesis, require medical supervision. The poison control center is the best source for information and advice on treating poisoning. To decrease the frequency of poisoning, parents should be taught to purchase, store, and handle potentially toxic products appropriately. The purchase of household chemicals and drugs in child-resistant safety packaging should be encouraged. To decrease the severity of poisoning, parents should post the phone number of the local poison center, be able to initiate first-aid measures, and keep ipecac syrup on hand. Ideally, a physician should establish a preventive education schedule and discuss poison prevention with parents at regular well-child visits, beginning when the child is very young.

Effect of Safety Packaging on Aspirin Ingestion by Children

PEDIATRICS ◽  
1979 ◽  
Vol 63 (5) ◽  
pp. 687-693
Author(s):  
Alisone Clarke ◽  
William W. Walton
Keyword(s):  
Poison Control ◽  
Health Statistics ◽  
Accidental Ingestion ◽  
Poison Control Centers ◽  
Poison Prevention ◽  
Ingestion Level ◽  
Aspirin Ingestion

The effectiveness of child-resistant closures, required under the Poison Prevention Packaging Act of 1970, in reducing the incidence of accidental ingestion of aspirin and aspirin-containing products among children less than 5 years of age has been investigated. Data from Poison Control Centers and the National Center for Health Statistics were analyzed to determine the ingestion level before and two to three years after safety closures were required. Baby aspirin and nonbaby aspirin products were analyzed separately. For baby aspirin, it is estimated that safety packaging has reduced the incidence of ingestions 45% to 55%. For nonbaby aspirin products, the reduction has been 40% to 45%.

Nosedrops and S.I.D.S

PEDIATRICS ◽  
1991 ◽  
Vol 88 (2) ◽  
pp. 419-419
Author(s):  
GERALD B. HICKSON
Keyword(s):  
Side Effect ◽  
Case Reports ◽  
Common Side Effect ◽  
Wide Spread ◽  
Over The Counter ◽  
Ability To Act ◽  
Life Threatening ◽  
Therapeutic Doses

In Reply.— The purpose of our paper was to examine the question of safety concerning over-the-counter (OTC) release of promethazine.1 Our stated opinion, that the drug is not appropriate for OTC release, was based on more than a suggested relationship with SIDS, but also on the drug's common side effect of sedation, ability to act as a cerebral stimulant even in therapeutic doses inducing hallucinations, convulsions and encephalopathy in some children, case reports concerning promethazine use and apparent life-threatening events, the potential for families to misuse this drug due to its sedative and antiemetic properties, and most importantly, FDA standards of safety for OTC medications which require "a low potential for harm which may result from abuse under conditions of wide spread availability."2

Methaemoglobinaemia from Vagisil creme in a 50-year-old woman

2021 ◽  
Vol 14 (3) ◽  
pp. e239697
Author(s):  
Sarah Cheyney ◽  
Zachary Field ◽  
Jacqueline Kropf ◽  
Steve Carlan
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Topical Anaesthetic ◽  
Over The Counter ◽  
Perimenopausal Woman ◽  
Threatening Condition ◽  
Life Threatening

Methaemoglobinaemia is a life-threatening condition that results from increased methaemoglobin production. As methaemoglobin is unable to reversibly bind to oxygen potentially lethal hypoxia and functional anaemia can occur. Benzocaine can be used as a topical anaesthetic and can be found in many nonprescription preparations marketed for self-application. It is known to cause methaemoglobinaemia in rare cases but most reports describe the complication occurring during endoscopy procedures. Methaemoglobinaemia occurring after topical benzocaine use on the perineum of a perimenopausal woman is exceedingly rare. A 50-year-old woman with methaemoglobinaemia secondary to the perineal application of over-the counter Vagisil (benzocaine 20% and resorcinol 3%- an antiseptic and disinfectant, respectively) presented to the emergency department. She had been using Vagisil for severe, chronic vaginal itching. While methaemoglobinaemia secondary to excessive use of over-the-counter medications such as Vagisil creme is exceedingly rare, it should be included in the differential diagnosis.

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