Vitamin and mineral supplement exposures: cases reported to Australia’s largest Poisons Information Centre, 2014-15 to 2018-19

ABSTRACT Vitamin and mineral supplements (VMS) are widely available and commonly used. Little is known about patterns of poisoning exposures to VMS in the Australian population. We performed a retrospective study of calls to the New South Wales Poisons Information Centre (NSWPIC), July 2014-June 2019. NSWPIC is Australia’s largest PIC, taking approximately 100,000 calls/year (50% of Australian poisoning calls) from healthcare professionals and members of the public. We conducted additional analyses on iron exposures due to their high risk of acute toxicity. There were 10 944 VMS exposures reported to NSWPIC during the study period, increasing 9.6% per annum over a five year period (95%CI, 7.2 – 12.1%). Toddlers (1-4 years) accounted for 41.5% (4546) of cases. Agents most commonly involved were multivitamins (n=3610), Vitamin D (n=2080), iron (n=1533), and magnesium (n=804). In 17.7% (1934) of cases the call originated from hospital or the patient was referred to hospital by NSWPIC. Iron exposures increased by 14.0% per year (95%CI, 9.5 – 18.5%), and most were associated with high strength products (>45 mg elemental iron per unit dose, n=1036). Iron exposures were hospitalised in 38% of cases (n=583). We conclude that vitamin and mineral supplement exposures are increasing in Australia. Although most exposures can be managed at home, many required hospitalisation. Iron exposures are increasing and had higher rates of hospitalisation than other agents. Vitamin and mineral supplements are often considered safe and without the potential for adverse effects, highlighting the importance of public education into the potential risks of misuse of these products.

Paediatric poisoning exposures in schools: reports to Australia’s largest poisons centre

ObjectiveTo describe poisoning exposures occurring at school in a large sample of Australian children.DesignA population-based retrospective cohort study.SettingCases reported to the New South Wales Poisons Information Centre (NSWPIC), Australia’s largest poisons information centre, taking 50% of the nation’s poisoning calls.PatientsPoisoning exposures occurring in children and adolescents while at school were included, over a 4.5-year period (January 2014 to June 2018).Main outcome measuresTime trends in poisonings, demographics, exposure characteristics, substances involved, disposition.ResultsThere were 1751 calls relating to exposures at school made to NSWPIC. Most calls concerned accidental exposures (60.8%, n=1064), followed by deliberate self-poisonings (self-harm, 12.3%, n=216). Over a quarter of cases were hospitalised (n=468), where the call originated from hospital or patients referred to hospital by NSWPIC. Disposition varied by exposure type, and hospitalisation was highest with deliberate self-poisonings (92.6%, n=200), recreational exposures (57.1%, n=12) and other intentional exposures (32.6%, n=45). The median age was 12 (IQR 8–15 years), and 54.7% were male (n=958). The most common pharmaceutical exposures were to paracetamol (n=100), methylphenidate (n=78) and ibuprofen (n=53), with the majority being deliberate self-poisonings. Copper sulfate was responsible for 55 science class cases, 45% of which were hospitalised. Cases may be increasing, with 81.3 (±8.2) calls per quarter, 2014–2016, and 129.3 (±24.3) calls per quarter, 2017–2018.ConclusionsPoisoning exposures occurring at school are common, with disposition and substances involved varying considerably by exposure reason. The relatively high number of referrals to hospital highlights the need for investigation into preventative measures.

Plants and mushrooms associated with animal poisoning incidents in South Africa

BackgroundThere is extensive literature on animal poisoning from plants and mushrooms worldwide; however, there is limited account of poisoning from South Africa.MethodsThis study sought to describe and provide an overview of animal poison exposures in South Africa. Poisoning episodes reported to the Poisons Information Helpline of the Western Cape, jointly run by the Poisons Information Centres at the Red Cross War Memorial Children’s Hospital and Tygerberg Hospital over a period of approximately 2.5 years, from June 2015 to November 2017, were analysed to identify exposure patterns, severity and clinical outcomes.ResultsAlien plant species accounted for most cases (n=10) of reported poison exposures. Among the 26 recorded animal poisoning episodes, the dog was the most commonly implicated species (n=24), whereas just two enquiries were related to other animals (one rabbit and one cow) . There were 20 plant cases and 6 mushroom cases (all dogs). There was only one fatal case involving cycad in a dog.ConclusionFeatures of animal poisoning in South Africa were similar to those in other countries. The reported cases of animals exposed to poisonous plants and mushrooms could represent only a fraction of the actual exposures. Since most reported cases involved taxa that could not be identified to species level, more attention should be paid in case reporting and in animal poisoning prevention, engaging the public to enable people to recognise potentially hazardous plants and reduce the risk of poisoning in animals.

Fifty years ago: ‘A poisons information service’

This series provides a selection of articles from the past. In Fifty years ago: ‘A poisons information service’ the author briefly explores a service set up in the 1960s to offer advice on medicinal, veterinary, agricultural, horticultural, and household poisoning, and after some debate, industrial poisoning.