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PubMed1982

Accidental ingestion of NaF tablets by children--report of a poison control center and one case.

Accidental ingestion by children of NaF tablets for caries prophylaxis is a frequent event. However, our own experience from the Poison Information Centre in Vienna and reports from other centers show that these accidents usually do not present a serious risk. The mechanism of fluoride toxicity and symptoms of poisoning are briefly reviewed. The case of a boy who died after ingesting 16 mg fluoride/kg, but whose cause of death is not certain beyond doubt, is discussed.

Child, Preschool↗
PubMed1995

Home use of syrup of ipecac is associated with a reduction in pediatric emergency department visits.

STUDY OBJECTIVE: To determine whether home use of syrup of ipecac is safe and effective in reducing pediatric emergency department visits. DESIGN: Retrospective, multicenter comparison based on secondary use of a large database. PARTICIPANTS: Children younger than 6 years after acute, accidental ingestion of a pharmaceutical product. INTERVENTIONS: 1990 Data corresponding to the study patients from seven regional poison centers were obtained from the American Association of Poison Control Centers. Poison center management choices (particularly use of syrup of ipecac for home decontamination) and characteristics (distribution of pharmaceutical ingestions managed, work volume per staff, staff experience, and training of decision-making director) were analyzed for their impact on the decision to refer a patient to a health care facility or to manage the patient at home. Statistical techniques included weighted least-squares regression analysis using logistic transformation of dependent variables and the forward selection procedure. Adverse patient outcome was defined as moderate effect, major effect, or death (American Association of Poison Control Centers coding criteria). RESULTS: In all, 55,436 children were included in the analysis (range, 3,839 to 12,691 per poison center). The distribution of medications ingested was similar among centers. Increased home use of syrup of ipecac, decreased frequency of ingestion of "high-risk" drugs, and increased staff experience were associated with decreased referral to a health care facility (P < .0001 for each variable). The forward selection procedure determined that syrup of ipecac use explained 45% of the variation in the poison center referral rates. The percentage of drugs defined as high-risk accounted for an additional 31%, and staff experience accounted for another 10% of the variation. Outcome of patients was excellent. No child died. Two home-managed patients had a major effect, and 26 had a moderate effect. CONCLUSION: Centers that recommended home use of syrup of ipecac more frequently were able to manage childhood poisoning more cost-effectively, without a decrease in safety. Although increased home management was strongly associated with syrup of ipecac use, the reason for this relationship cannot be determined from the data. Management by experienced professionals also contributed to cost-effectiveness.

Child, Preschool↗
PubMed1992

Acute fluoxetine overdose: a report of 234 cases.

Limited toxicity information is available in the medical literature on the antidepressant fluoxetine (Prozac, Dista Products Co, Indianapolis, IN). The goal of this prospective multicenter study was to develop a toxicity profile of initial signs and symptoms observed in an acute fluoxetine overdose. A prospective study was made of patients reported to one of four American Association of Poison Control Centers' regional poison control centers after ingesting an acute overdose of fluoxetine. A standard data collection form was used on all patients ingesting fluoxetine. Information obtained included age, current medications, dose, coingested drugs, presenting symptoms, vital signs, electrocardiogram abnormalities, outcome, and fluoxetine levels. The authors collected 272 cases; 234 cases met the criteria of the study. Fluoxetine was ingested alone in 87 cases and with ethanol or other drugs in the remaining 147 cases. Of the 87 cases where fluoxetine was ingested alone, 67 patients were adults and 20 were children. Symptoms that were seen in the adult group included: tachycardia (15/67), drowsiness (14/67), tremor (five/67), vomiting (four/67), or nausea (four/67). Thirty patients did not develop symptoms. Twelve of the adult overdose patients had total fluoxetine levels ranging from 232 to 1390 ng/mL. The authors conclude that symptoms that develop after an acute overdose of fluoxetine appear minor and of short duration. Aggressive supportive care is the only intervention necessary.

Acute Disease↗
PubMed1986

Poison exposures and use of ipecac in children less than 1 year old.

Poison exposures in children less than 1 year old and the safety and efficacy of syrup of ipecac in children 9 to 12 months old were evaluated in a prospective eight-month study conducted at the Massachusetts Poison Control Center. Poison exposures in children less than 1 year old represented approximately 9% of the 38,080 calls received. Mobile children (in walkers, crawling, or walking) were at the greatest risk of poisoning. The majority of children (94%) were asymptomatic and none were hospitalized or died. The products involved were primarily plants (38%) and household products (30%). All 21 patients, ages 9 to 12 months, were given 10 mL syrup of ipecac under medical supervision and vomited within one hour. The mean time to vomit was 21.7 (SEM +/- 2.8) minutes. The patients vomited 3.3 (SEM +/- 0.3) times and all episodes of vomiting abated by 26.4 (SEM +/- 6.6) minutes. No significant side effects were noted. The use of the syrup of ipecac in the 9- to 12-month-old child appears to be safe and effective.

Female↗
PubMed2002

Comparison of poison exposure data: NHIS and TESS data.

OBJECTIVE: To identify age-adjusted poisoning episode rates, and poison control center contacts due to poisonings in children under 6 years old based on 1997-1999 National Health Interview Survey data; and compare findings with 1997-1999 Toxic Exposure Surveillance System data. METHODS: Secondary analysis of National Health Interview Survey poisoning episode data for children 5 years and younger. Respondents were asked about poison exposures during the previous 3 months. RESULTS: Based on National Health Interview Survey population weighted data there were 196/10,000 poisonings to young children < 6 years. These exposures resulted primarily from harmful solid or liquid substances. A poison control center was called in 86% of exposures to children < 4 years, but only in 70% of the 4-5 year old exposures. The odds of a poison control center not being called were 3.2 times greater for 4-5 year olds (compared to < or = 3 years) and 4.5 times greater for African-American (compared with White-Americans). Comparison of National Health Interview Survey data with data in the 1997-1999 Annual Reports of the Toxic Exposure Surveillance System revealed the number of estimated exposures in the National Health Interview Survey data were approximately half those reported in the Toxic Exposure Surveillance System data. In both datasets, children 1-2 years of age had the highest percent of poisoning exposures. CONCLUSIONS: Using multiple datasets to explore poisoning rates in young children provides a broader perspective. Differences in findings reflect divergent data collection methods and biases inherent in each database. Although the majority of National Health Interview Survey respondents reporting contacting a poison control center for a poisoning exposure, rates are lower in specific subgroups indicating a need for targeted educational efforts.

Age Factors↗
PubMed2005

Understanding poison control and protecting its future.

Poison centers save money and lives. Individual patients and their doctors benefit from local poison center availability, as do healthcare facilities and insurance companies. All have a stake in a stable poison control system. It is likely that the greatest contribution of poison control centers to society has yet to be realized. Poison control centers already possess an efficient, realtime surveillance mechanism (TESS). With increased funding, this can be expanded and made more available outside the poison control community. TESS can be used to detect chemical releases or attacks and environmental and infectious disease outbreaks as they occur - long before individual healthcare providers could connect the dots. In conclusion, while the value of a nationwide poison control system to society is well recognized, its future is not as clear. Establishing a stable system to monitor and treat poisonings in the US will take political will at the local, state, and federal levels to ensure full funding for years to come.

Comprehension↗
PubMed1984

Comparison of poison control statutes in the United States.

Statutory compilations of each of the 50 states and the District of Columbia were searched for laws pertaining to poison control activities, and existing statutes were compared. Poison control statutes exist in 13 states and vary among these states. Provisions of the statutes include statewide poison control center programs, enumerated functions, state funding, health department coordination, advisory committees, university affiliation, joint drug information centers, 24-hour service, toll-free telephone numbers, community education activities, and case-reporting systems. In 1957, a Connecticut law authorized establishment of a poison information center; this was the first state statute. Between 1971 and 1977, Massachusetts, Tennessee, Arkansas, and Indiana established statutes. In 1978, the American Association for Poison Control Centers (AAPCC) published criteria for regional poison control centers; after this, states including Michigan, Oregon, Washington, Arizona, Minnesota, and New Jersey adopted more comprehensive laws. Since publication of the AAPCC criteria, there has been a trend toward regional and more comprehensive poison control center services both in states with poison control statutes and in those without pertinent statutes.

Humans↗
PubMed2006

[Accidental poisoning among children and adolescents in a county in southern Brazil].

This study analyzes the characteristics of accidental poisoning among children and young adolescents (< 15 years) in Londrina, Paraná State, Brazil, in 2001. Data were obtained from patient records in general hospitals, the local Poison Control Center, and the municipal Mortality Information Center. There were 473 cases of poisoning, with an incidence rate of 339.8 per 100,000, 58.5% due to poisonous substances and 39% due to venomous animals and plants. Increased risk was observed in the 1-3-year age group, due to poisonous substances. Medications (47.5%), pesticides (14.1%), and cleaning products (11.3%) were the main substances involved (284 cases), and 17.2% of children were hospitalized. Among 189 cases of contact with venomous animals and plants, caterpillars (29.1%), bees (25.9%), and spiders (22.8%) were the main agents, with a 1.1% hospitalization rate. Incidence of poisoning is high, and there are important differences in the types of agents involved according to age group, which may help orient the prevention of such accidents.

Accidents, Home↗
PubMed1999

Toxicology training of paramedic students in the United States.

A 16-item survey was mailed to the directors of 618 paramedic training programs in the United States to determine (1) the number of lecture hours devoted to toxicology topics and (2) how often paramedic training includes a rotation in a poison control center. The response rate was 82%. Toxicology accounts for approximately 2% of paramedic students' total training. Cardiovascular drug toxicity and hazardous materials are discussed for over 60 minutes by more than 50% of paramedic training programs. Four paramedic programs have no lecture time on cyclic antidepressant overdoses and one program has no lecture time on carbon monoxide poisoning. Eighty-one percent (377 of 467) have access to a regional poison control center; 11% (42 of 377) use the poison control center as a paramedic training site. Some US paramedic training programs spend insufficient time covering topics that have significant out-of-hospital morbidity. Although poison control centers are often available, they are underutilized for paramedic training.

Allied Health Personnel↗