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Suspected poisoning in children. Study of the incidence of true poisoning and poisoning scare in a defined population in North East Bristol.

The distinction between true and suspected poisoning in children has not been made clear in previous work on childhood poisoning. A study of suspected poisoning in children under 15 years of age in a defined population of North East Bristol from November 1970 to July 1973 carried out by the Health Education Council Medical Research Division included 53,000 child-years at risk. The number of suspected poisonings was 3-4/1000 population aged under 15 years per year, with a higher incidence in younger age groups. Detailed investigation of the circumstances of the accidents carried out by a multidisciplinary team showed that at least 65%, and possibly as many as 78% were poisoning scares and not true poisoning. The evidence used by the casualty doctor and by the parents to diagnose poisoning was explored, and in many cases was circumstantial. Children with fathers in nonmanual occupations were over-represented. This may reflect differences in patterns of utilization behaviour rather than true differences in incidence.

Accidents, Home

Poisoning and poison control centres in Canada.

Poisoning is a major and increasing health problem in the Western world. In 1972 the 310 poison control centres in Canada reported 53 531 enquiries about poisoning, 40% in adults. In 1964 the numbers of hospital admissions and deaths due to poisoning in this country were 2446 and 38, respectively, but in 1972 the figures were 6263 and 319, respectively. Most of the hospitalizations and deaths were among adults. Of 100 Canadian poison control centres two thirds were staffed by "any nurse in the emergency room", most of whom had received no training to answer the phone enquiries. However, two thirds agreed a training program is needed. Only 6.7% of 223 parents surveyed stated they would call a poison control centre if their child had accidentally swallowed a large amount of a poisonous substance. Regionalization of centres, a training program for personnel answering telephone enquiries, the need for crisis intervention as part of poison control programs, and public education about poisoning and poison control centres are the new challenges facing those providing health services.

Canada

Poisoning prevention knowledge and practices of parents after a childhood poisoning incident.

This study investigated the effectiveness of a poison center-initiated mailed intervention on improving the preventive practices of families whose preschool child had recently experienced a poisoning incident. A low-cost, mailed poisoning prevention packet consisting of telephone stickers, a +f41 coupon for syrup of ipecac, one slide-style cabinet lock, a nine-step checklist for "poison-proofing" the home, pamphlets, and a cover letter was tested prospectively on a population of parents calling a poison center for advice about possible poisoning exposures involving their preschool children. Parents without ipecac 1 week after the incident were randomized so that half received the mailed intervention. A "blind" follow-up telephone interview was conducted 3 months later. Of the 336 original families enrolled in the study, 301 (90% retention) completed the follow-up interview. Those who had received the intervention were more likely to have a telephone sticker than control families (78% vs 39%; P < .0001) and were more likely to be using at least one slide lock in the home (59% vs 40%; P < .001). However, intervention families were no more likely to have ipecac on hand than control families (57% vs 52%; P = not significant) and did not indicate a higher rate of compliance with suggested changes in other behaviors and practices to prevent poisonings. A poisoning recurrence rate of 3.7% was seen in the total sample during the 3-month period of surveillance; there was no difference between groups in recurrence rate. Even after a poisoning event, parents may not be sufficiently motivated to take poisoning prevention measures on their own.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Home

[Mortality from accidental poisoning in Budapest during 1961-1975. III. Alcohol poisoning].

In the examined 15 year period 174 persons--134 males and 40 females--died from alcohol poisoning. The number of cases of accidental alcohol poisonings has considerably increased. The number of cases of alcohol poisoning has increased at a rate thrice as high as the poisonings of all the other causes. The number of cases in the last third of the 15-year-period was five time higher than in the first third of it. The number of women deceased of alcohol poisoning increased at a greater rate than that of the males. Deaths from alcohol poisoning occurred first of all among the age groups between 40--59. In 67 cases of fatal alcohol poisoning the alcohol level in the serum was under 3 0/00. Regarding the latter, authors emphasize the importance of experts-opinions dealing with indirect cause relationships.

Accidents

One year's experience in a regional poison control center: The Intermountain Regional Poison Control Center.

The Intermountain Regional Poison Control Center in Salt Lake City, Utah, has served as a regional poison center since 1971. Between 1972 and 1976 the call load has more than tripled, with the highest frequency of calls per population coming from counties most proximate to the center. Two-thirds of the cases involve children age five or less, with 18 or over being the next large group. Adolescents and school-age children comprised the smallest group of cases. Two predominant types of poisonings were encountered: accidental ingestions of toxic substances in children and intentional self-poisonings in adults, but the poison center handled almost every conceivable type of poisoning or toxic situation. A detailed analysis of the center's overall experience as well as these two major categories is presented.

Adolescent

Case reports of lead poisoning in dogs from the National Animal Poison Control Center and the Centre National D'Informations Toxicologiques, Veterinaires: anecdotes or reality?

This paper presents case reports of lead toxicoses from 2 major animal poison control centers in Europe and North America, gathered from 1985 through 1989. All results examined here involved cases assessed as "toxicosis" or "suspected toxicosis" by the National Animal Poison Control Center (NAPCC) or the Centre National d'Informations Toxicologiques Veterinaries (CNITV). 537 cases were reported to the NAPCC, most of them concerning dogs (59%). In France, most of the 362 cases involved cattle (57.2%). There was an increased number of cases reported during late summer and early fall, and a decreased number of cases in November and December, in both centers. Dogs intoxicated were predominantly young animals (60% were less than 2 years old). No sex difference was noted. Pure bred dogs appeared more often involved than mixed-breed ones, but the breed distribution closely resembles dog breed distribution in the US. The source of lead was usually unknown and, when information was available, paint seemed to be the most common cause of poisoning. Clinical signs reported to the animal poison control centers involved the CNS and GI tract. Results from the French and the American database showed similar trends. They are compared to data from veterinary clinics and veterinary colleges in the US and Australia. In each case, data are very similar to what was reported to the CNITV and the NAPCC. It is concluded that animal poison control centers databases can provide a useful tool for better knowledge of animal poisoning. They can also help identify unexpected toxicologic problems related to drug administration or pesticide use.

Age Factors

The poison center as a reservoir for antidotes for veterinary poisoning emergencies.

Animal poisonings account for a significant number of the cases responded to by poison centers. The majority of consultations involve small animals and do not necessitate the use of large amounts of pharmacologic antagonists, such as atropine to treat anticholinesterase pesticide poisonings. However, large animals such as cattle present unique management problems, since phenomenal amounts of antidotes may be needed to treat a herd of cattle, creating a significant economic impact. The most challenging dilemma is providing 24-h availability and a means of acquisition of sufficient quantities of antidotes to reduce the economic impact of large-animal poisonings. In conjunction with a state veterinary medical association, a RPIC serves as a depot for the storage and distribution of emergency veterinary antidotes. Sufficient quantities of atropine, methylene blue, calcium EDTA, sodium nitrite and thiosulfate, and activated charcoal are available via the RPIC to treat a herd of 200 cattle. The antidotes are available only for emergency treatment and with a veterinary prescription. The 24-h nature of the poison center makes it an ideal location to serve the needs of veterinarians.

Animals

Comparison of pediatric poisoning hazards: an analysis of 3.8 million exposure incidents. A report from the American Association of Poison Control Centers.

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.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool

[Mortality from accidental poisoning in Budapest during 1961-1975. II. Carbon monoxide poisoning].

In the examined 15 year period accidental deaths from carbon monoxide poisoning amounted to 641 persons--341 males and 300 females. The number of poisonings increased evenly and at a progressive rate, although the frequency of carbon monoxide poisoning--among the accidental poisonings--decreased. The majority of the deceased from accidental carbon monoxide poisoning was older 60 years. 90.4 per cent of cases occurred at home. In 37.7 per cent of the cases the source of the gas appeared to be the gap-tap turned off wrongly and in 36.4 per cent the escape of gas. 4.4 per cent of the cases survived. 14.4 per cent of the deceased had alcohol in their blood.

Accidents

[Mortality from accidental poisoning in Budapest during 1961-1975. IV. Various types of poisoning].

In the 15-year-period analyzed 242 persons--170 males and 72 females--died from various kind of poisons (alcohol and carbon monoxide excluded). The fatal poisonings were as follows: 69 cases--due to mushroom, 33--organic solvents, 23--23 cases--caustic material (soda and acids), 21--methylalcohol, 18--weedkillers and insecticides. Some types of poisonings seems to be more frequent among males, others among females. The frequency of above mentioned poisonings decreases. The majority of deceased appeared to be of elderly age. The type of poisoning and the age of the deceased are not correlated.

Accidents

A regional poison center's experience with poisoning exposures occurring in schools.

The nature of and response to poisonings in the school setting has not been characterized. To define these problems a retrospective review of calls to a Regional Poison Information Center (RPIC) involving school exposures was done for the 1988-89 academic year. 362 cases were reported; 74% were reported by school nurses, 10% by other school employees, 10% by parents, 5% by health care facilities, and 1% by students themselves. Ingestions accounted for 45% of exposures, dermal 24%, ocular 19%, inhalation 7%, with the remainder being combinations of routes. Correct treatment prior to RPIC consultation occurred in only 40% of the cases. None developed major symptoms, 23% had minor and 10% had moderate symptoms. High school students accounted for the greatest number (20) of suicide gestures, while middle schools reported more cases of substance abuse. School nurses often were unaware of situations until several hours later. 61% of suicide gestures were referred to an HCF; 7 of these developed moderate symptoms. Exposures to chemicals in science or vo-tech classes accounted for 102 cases; 28% were referred to a HCF and 15% had moderate symptoms. There was often a delay in evaluation by the school nurse and initial decontamination was inadequate or absent. Parents were often instructed by school personnel to contact the RPIC for information and then relay it to the school. These delays could have resulted in greater toxicity. School nurses should be targeted for educational programs by poison centers, but teachers and other school employees must also be included since often they are the first at the scene. Students should be instructed to report exposures to a teacher immediately.

Accidents

Implication of dispensing cups in dosing errors and pediatric poisonings: a report from the American Association of Poison Control Centers.

OBJECTIVE: To characterize reports to poison centers involving liquid medication errors associated with the use of dispensing cups. DESIGN: Case series reported by 16 US poison centers over an eight-day period. SETTING: Calls to poison control centers, predominantly but not exclusively from homes. PATIENTS: Children and adults. RESULTS: Of 34 reported cases, most (79 percent) involved a two- to threefold dosing error, and most (94 percent) involved an error in a single dose of medication. Cough and cold preparations were implicated in 65 percent; acetaminophen elixirs in 18 percent. Three major causes of dosing errors were identified, including teaspoon/tablespoon confusion, assumption that the dispensing cup was the unit of measure, and assumption that the full dispensing cup was the actual dose. CONCLUSIONS: Dispensing cup markings should use a single unit of measure, and a uniform labeling system should be implemented. Teaspoon/tablespoon abbreviations should be avoided, and dispensing cup lettering should be more legible. Consumer education is essential to correct the misimpression that the full cup is always the recommended dose.

Child

Paraquat poisoning: Experience of Poison Control Centers in France.

Seventy acute intoxications with paraquat have been collected in 11 out of the 17 French Poison Control Centers from 1970 to 1977. The main route of intoxication is oral ingestion and accounts for all the lethal cases (24). Accidental ingestion may be severe : 7 deaths out of 25 cases but suicidal intoxications have a more important morality rate : 17 deaths out of 22 cases. The addition of an emetic to the formulation of this herbicide will lower the severity of this acute poisoning and will be demonstrated by the survey of the next cases of paraquat poisoning.

France

A "pennurth of arsenic for rat poison": the Arsenic Act, 1851 and the prevention of secret poisoning.

In this country any chemist or druggist can furnish the means of self-destruction or murder for a few pence, and in too many instances have done so with the utmost indifference. The sale of a poison is regarded as a mere act of commercial intercourse; tant pis for the unfortunate victim of error or passion; he has the benefit of a coroner's inquest; the vendor of the poison receives a reprimand, and things resume their natural course--that is, arsenic and oxalic acid are retailed without compunction, and men are hurried from time to time into eternity.

Animals

[Poisoning by anorexigenics. Information from the data bank of the Anti-Poison Center of Marseille (1973)].

Using the data bank developed by the Computer Service of the Lyon Hospitals, the Anti-Poisons Centre of Marseille presents an initial study of intoxications by appetite suppressants. The work was complemented by a simultaneous study using conventional manual techniques. An epidemiologic review of 1973 and an approximate assessment of toxic doses in the adult and child were possible. They should be of particular use in answering telephone enquiries at anti-poison centres.

Adolescent

Motor nerve conduction velocity after carbon monoxide or m-dinitrobenzene poisoning following elimination of the poisons.

24 hrs after acute carbon monoxide or m-dinitrobenzene poisoning (about 60% CO-Hb or Met-Hb) the sciatic motor conduction velocity of rats is significantly reduced by 33% and 16% respectively. Whereas 48 hrs after methemoglobinemia the nerve conduction is normal, a retardation is detectable even 4 weeks following carboxyhemoglobinemia. Also, 4 weeks after single carbon monoxide intoxication producing a mean CO-Hb content of 19%, the motor conduction velocity is significantly decreased. This effect may be useful for detection of carbon monoxide intoxication after elimination of the poison. The results show that there are carbon monoxide effects independent of blockade of hemoglobin.

Animals

[The number of admissions to Dutch hospitals for barbiturate poisoning from 1981-1989 and those for poisoning with sedatives and hypnotics,and benzodiazepines].

Over the period 1981 to 1989, the number of admissions to Dutch general hospitals for barbiturate poisoning has dropped sharply and steadily, due to a more restrictive policy in prescribing regarding these sedatives. This trend is also present concerning poisoning with sedatives and hypnotics in general (ICD-code 967), but not concerning those with benzodiazepines (ICD-code 969.4). The female-male ratio was nearly 2:1. This difference is possibly due to the fact that females take more medication than males.

Adolescent