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PubMed1998

Evaluation of a poison prevention lesson for kindergarten and third grade students.

OBJECTIVES: The purpose of this study was to evaluate the MORE HEALTH poison prevention lesson that is given to kindergarten and third grade students in Hillsborough County, Florida. The lesson reaches approximately 6000 students per year. METHODS: The evaluation was based on a post-test only control group design. Three schools were chosen as evaluation sites and three served as control settings. Students were administered a previously tested, age appropriate questionnaire that addressed the goals of the poison lessons. In addition, a survey was developed for intervention school parents to determine their poison prevention practices. RESULTS: One hundred ninety four intervention schoolchildren and 184 control schoolchildren completed the study. Children in the intervention schools consistently answered more questions correctly than those in the control schools. The parent survey showed that the majority have homes that are safe from poisons, although fewer than 50% said they had syrup of ipecac in their homes. CONCLUSIONS: These results show that key concepts related to poison prevention can be communicated effectively to primary school students and parents report having homes safe from many poisons.

Case-Control Studies↗
PubMed1995

Kinetics of the pituitary-thyroid axis and the peripheral thyroid hormones in 2 children with thyroxine intoxication.

Thyroxine intoxication is a benign, nonfatal condition, relatively common in the pediatric age group. We present here a detailed laboratory follow-up of all thyroidal hormones in 2 healthy girls who inadvertently ingested 2,500 micrograms of L-thyroxine. The two girls were hospitalized and treated with ipecac, gastric lavage, propranolol, prednisone, cholestyramin and propyl-thiouracil. All physical signs were normal and no symptoms were reported. All thyroidal hormones were measured 12 times from 2 h to 20 days after the ingestion. For T4, T3, rT3 and thyroglobulin (Tg) a one-compartment kinetic model was formulated and fitted to the empirical data. The kinetic data constants of production and elimination were calculated, as well as the metabolic clearance rate. All laboratory values were similar in both girls. T4 serum levels were already high 2 h after the intoxication and returned to normal values only after 13 days. Fitting the T4 serum levels with a one-compartment model resulted in absorption and degradation constants similar to those in normal adult subjects. Thyroid-stimulating hormone (TSH) levels decreased reaching their lowest concentration 14 h after the intoxication. They remained low till the 4th day, after which they rose gradually. Twenty days after the intoxication, TSH levels were still below their initial values. T3 reached its peak levels 11 h after the ingestion and decreased to normal values after 3 days. Both T3 production constants and T3 degradation constants were significantly increased. rT3 reached its peak level on the 2nd day after the intoxication and decreased to normal values on the 4th day. Its production and degradation constants were somewhat below normal levels. The T3/rT3 ratio decreased from a normal level of around 3 to as low as 1 and rose again after 13 days to extremely high levels (as high as 8). Tg serum levels dropped continuously with a half-life of 1-5 days and started rising again after 2-13 days. In conclusion, T4 intoxication in the child is combated primarily by a significant increase in T3 production and degradation, while meticulously maintaining relatively low T3 levels.

Child, Preschool↗
PubMed1991

History of the treatment of chronic bronchitis.

Although chronic bronchitis was first named and described in 1808, the disease has been known since earliest time, and numerous drugs have been utilized in its therapy. The basic historic theories of human function have readily been applied to bronchitis; thus in Greek medicine, the disease was appreciated as one of excess phlegm. Early remedies included garlic, pepper, cinnamon, and turpentine, whereas later therapies of choice emphasized coffee, ipecac, and potassium nitrate. Most of the favored bronchodilator drugs of today are derived from the traditional folk remedies, ephedrine, atropine, and theophylline. The most interesting historical drugs, however, are those that have given rise to modern mucokinetic agents such as bromhexine and iodides.

Bronchitis↗
PubMed1979

IgE and IgG4 antibodies in specific human allergies.

In 90 sera from patients with specific allergies (i. e. to guinea pig dander, cat dander, horse dander, dog dander, human dander or ipecac) and with positive skin tests to the allergenic preparations, the presence of IgE and IgG4 antibodies was determined by radioallergosorbent test (RAST). A correlation between IgE RAST scores and IgG4 RAST scores to the individual allergens was established. In patients allergic to guinea pig dander, a high incidence of negative IgE RAST scores but positive IgG4 RAST scores was found. This was less often the case in the group with cat dander allergy. IgG RAST scores determined in 51 sera proved to have some predictive value with respect to IgG4 or other IgG subclasses involved in the allergic reactions. Because a high incidence of negative IgE RAST scores was found, IgE RAST inhibition does not seem to be the method of choice for the standardization of allergenic preparations in general.

Allergens↗
PubMed2002

Pemoline ingestion in children: a report of five cases and review of the literature.

The authors describe five pediatric cases of excessive pemoline ingestion. Based on their experience compared with previously reported cases in the literature, they describe the clinical presentation and rational treatment recommendations for acute pemoline ingestion. Overall, patients experienced a relatively benign clinical course following pemoline ingestion. Symptoms of pemoline ingestion appear to be primarily an accentuation of the drug's pharmacological effects on the central nervous and cardiovascular systems with sinus tachycardia, hypertension, hyperactivity, choreoathetoid movements, and hallucinations being most commonly observed. These findings are consistent with previously reported cases. Possible rhabdomyolysis manifested by evaluation of serum CPK was also observed in 3 of 4 patients in whom this laboratory parameter was measured and appears to be a common finding in acute pemoline poisoning. After acute ingestion, symptoms occurred within 6 hours, lasting up to 48 hours in all patients. Gastric lavage and/or activated charcoal would be effective decontamination measures, whereas ipecac-induced emesis should be avoided after massive ingestion due to the possibility of seizures. Aggressive use of a benzodiazepine appears a reasonable first choice to treat associated involuntary movements, tremor, hyperactivity, irritability, and agitation. Phenothiazines or butyrophenones may also be used especially for serious life-threatening symptoms, including hypertensive crisis and severe hyperthermia, although these serious complications of stimulant overdose have not been reported after pemoline ingestion. If a patient should experience pemoline-induced hypertensive crisis, individual dose titration of labetalol or sodium nitroprusside would appear reasonable pharmacologic approaches for rapid stabilization of blood pressure.

Adolescent↗
PubMed1986

Infectious croup: a critical review.

Infectious croup is a viral or bacterial syndrome characterized by a barking cough, hoarseness, and stridor. Three separate conditions will be discussed: laryngotracheobronchitis, spasmotic croup, and bacterial tracheitis. Each clinical entity will be defined and its treatment reviewed. Current treatment regimens for infectious croup involve various combinations of mist therapy, racemic epinephrine, corticosteroids, and syrup of ipecac. Tradition, rather than science, appears to be the basis of many of these treatments. Despite the frequent occurrence of infectious croup, no treatment has proved consistently successful. Prevention and better treatment methods are the keys for reducing the high cost of infectious croup to the medical care system.

Bronchitis↗
PubMed1992

Verapamil overdose: case report and review of the literature.

OBJECTIVE: To report the presentation and controversies regarding therapy of an 18-year-old man following a life-threatening ingestion of verapamil. CASE SUMMARY: An 18-year-old man ingested large quantities of dipyridamole, trimethoprim/sulfamethoxazole, amoxicillin, and verapamil. He presented to an outlying hospital and was initially conscious. Soon thereafter, the patient had a seizure; he required intubation, developed cardiac conduction abnormalities, and became hypotensive. The patient required pharmacologic pressors and a pacemaker for transfer to our institution. At our institution, vigorous fluid resuscitation, cardiac pacing, and careful attention to acid/base and electrolyte management provided the basis of therapy. The patient recovered without deficit and was discharged from the intensive care unit five days later. DISCUSSION: Current controversies regarding the management of verapamil overdose are reviewed. Removal of the drug by gastric lavage is a mainstay of therapy. Administration of syrup of ipecac is contraindicated. Although specific recommendations for calcium dosing in the overdose situation have not been rigorously studied, maintenance of a normal serum ionized calcium concentration is suggested. An exogenous catecholamine, rather than dopamine, may be the drug of choice for treating hypotension. Cardiopulmonary bypass provides a method for drug removal in cases of severe toxicity; however, this invasive method requires further study. Management of fluid/electrolyte, acid/base, and ventilation abnormalities is required to treat large ingestions of verapamil. Treatment guidelines for critical care clinicians are provided.

Adolescent↗
PubMed2004

Unintentional intravenous infusion of Golytely in a 4-year-old girl.

OBJECTIVE: To report an accidental intravenous infusion of Golytely (polyethylene glycol and electrolyte solution; PEG-ELS) in a pediatric patient that did not result in systemic toxicity. CASE SUMMARY: A 4-year-old Hispanic girl presented to the emergency department after ingestion of approximately 24 tablets of 6-mercaptopurine (6-MP) 2 hours earlier. She vomited twice after receiving syrup of ipecac at home. Upon arrival, her vital signs were temperature 36.2 degrees C, heart rate 102 beats/min, respiratory rate 42 breaths/min, and blood pressure 115/67 mm Hg. Her physical examination was normal. The patient received activated charcoal 1 g/kg. Golytely administered through a nasogastric tube was ordered. Upon reevaluation, it was noted that the patient had received 391 mL of Golytely intravenously. The infusion was immediately stopped. There was no evidence of acidosis, renal failure, or ethylene glycol toxicity. She was admitted for observation and was discharged 36 hours later. DISCUSSION: As of April 29, 2004, accidental intravenous infusion of PEG-ELS has not been previously reported. Potential toxicity from Golytely is mainly related to the molecular weight of PEG in the formulation. PEG can theoretically be degraded to ethylene glycol. It is thus important to monitor acid-base status, renal function, and pulmonary function in these patients. CONCLUSIONS: When administered correctly, an infusion of PEG-ELS by nasogastric tube is a safe gastrointestinal decontamination technique used in toxicology; PEG-ELS is not indicated for intravenous administration. Protocols need to be implemented in the workplace to minimize errors in the delivery of treatment to patients. Fortunately, this patient did not have any toxicity from the intravenous infusion of Golytely.

Child, Preschool↗
PubMed1991

Injury prevention awareness in an urban Native American population.

The injury-related mortality rate for Native American children between the ages of 1 and 4 years is nearly three times that of the same age group in the general population. To assess injury prevention awareness in urban Native American families, we administered 39 age-appropriate questions from the Framingham Safety Survey to 50 Native American families and 100 other families and developed an answer scoring system to analyze and compare survey responses. Survey responses revealed that Native American families are less likely to keep small objects, household products, and medicines out of the reach of their children and to possess and understand the use of ipecac. Although urban Native-American families appear to be less aware of ingestion prevention practices than other urban families, these and other deficiencies in injury prevention awareness are more likely the result of factors related to their low-income status than to culturally based practices.

Accident Prevention↗
PubMed1993

An injury prevention program in an urban African-American community.

OBJECTIVES: Injury is a major US public health problem, particularly in urban minority communities. This paper evaluates the impact of the Safe Block Project, a comprehensive injury prevention trial, on home hazards and injury prevention knowledge in a poor urban African-American community. METHODS: Nine census tracts in the community were allocated to either the intervention area or the control area. The intervention, carried out by trained community outreach workers, consisted of (1) home modification for simple prevention measures, (2) home inspection accompanied by information about home hazards, and (3) education about selected injury prevention practices. Approximately 12 months after the intervention, random samples of control and intervention homes were assessed for home hazards and injury prevention knowledge. RESULTS: A significantly larger proportion of intervention homes than control homes had functioning smoke detectors, syrup of ipecac, safely stored medications, and reduced electrical and tripping hazards. No consistent differences were observed between control and intervention homes on home hazards requiring major effort to correct. CONCLUSIONS: There was a distinct difference between control and intervention homes with respect to safety knowledge and home hazards requiring minimal to moderate effort to correct. The Safe Block Project could serve as a model for future urban injury prevention efforts.

Accidents, Home↗
PubMed2005

[Acute toxic exposure in children: an overview].

OBJECTIVE: To review the literature on acute toxic exposure in children, excluding envenomations. SOURCES OF DATA: MEDLINE review (emphasis on the past decade), including the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists position statements and position papers (peer-reviewed information based on scientific evidence and broad consensus) on gastrointestinal decontamination, multiple-dose activated charcoal and urine alkalinization. SUMMARY OF THE FINDINGS: Acute toxic exposure in children is a common event, mainly in children under six years of age. Death is rare. Although widely employed, there is no evidence that gastrointestinal decontamination and multiple-dose activated charcoal improve the outcome of poisoned patients. Very few efficient antidotes are used on a consistent basis, and some of them are very expensive and not available in Brazil. CONCLUSIONS: Ipecac syrup and cathartics should not be administered on a routine basis in acute toxic exposures in outpatient treatment. Excluding the contraindications, single-dose activated charcoal and gastric lavage may be considered within one hour of ingestion if a patient ingested a potentially toxic amount or a potentially lethal amount, respectively. Whole bowel irrigation, multiple-dose activated charcoal and urine alkalinization may be considered in a few situations. Fomepizole and octreotide are safe and efficient antidotes, which can be used in the treatment of alcohol (methanol and ethylene glycol) and sulfonylureas poisoning, respectively.

Acute Disease↗
PubMed1990

Toxicity of nightshade berries (Solanum dulcamara) in mice.

Ripened nightshade berries (Solanum dulcamara) are among the most commonly reported plant ingestions in Minnesota. Because of the lack of adequate information regarding the toxic qualities of S. dulcamara berries, the ingestion of even small quantities by children is usually treated conservatively with syrup of ipecac. The toxicity of S. dulcamara berries was studied by gavaging mice with a preparation of lyophilized berries, ripened and unripened, collected at various times of the year. Mice receiving unripened fruit from early in the season had gastrointestinal tissue changes consistent with solanine toxicity. Animals dosed with unripened fruit from the latter part of the year showed behavioral signs suggestive of solanine toxicity, however gastrointestinal lesions were not observed. In no case did the ripened fruit produce behavioral or histologic toxicity. Aggressive treatment of children ingesting limited amounts of ripened S. dulcamara berries appears to be unnecessary.

Administration, Oral↗
PubMed1997

Zolpidem (Ambien): a pediatric case series.

BACKGROUND: In 1993, the nonbenzodiazepine sedative-hypnotic zolpidem tartrate (Ambien) was approved for use in the US. Zolpidem has an imidazopyridine structure and possesses a rapid onset of action and a short half-life. The toxic threshold and profile have not been well established in the pediatric population. METHODS: All pediatric zolpidem exposures reported to a regional poison information center over 24 months were reviewed retrospectively from the American Association of Poison Control Centers Toxic Exposure Surveillance System data collection forms. RESULTS: Twelve pediatric zolpidem exposures were reported. Seven were unintentional (ages 20 mon-5 y) and five were intentional misuse/suicide (ages 12-16 y). The regional poison information center was contacted within 1 h in ten cases with onset of symptoms within 10 to 60 min (mean 31.6 min). One child had no effect with 2.5 mg. As little as 5 mg caused symptoms with minor outcome in six unintentional ingestions (5-30 mg). Minor to moderate symptoms were reported 1-4 h after intentional ingestions (12.5-150 mg). The duration of symptoms in the unintentional cases ranged from less than 60 min up to 4 h (mean 2.4 h) and 6-10 h (mean 7.5 h) in the intentional exposures. Treatment consisted of observation (4), syrup of ipecac (1), lavage and activated charcoal (1), activated charcoal alone (5), and unknown (1). CONCLUSION: Due to the very rapid onset of central nervous system symptoms in children, emesis is not a treatment option. Supportive care, activated charcoal in large ingestions, and observation until symptoms resolve may be sufficient in most pediatric cases.

Adolescent↗
PubMed1995

Clinical effects and management of eucalyptus oil ingestion in infants and young children.

OBJECTIVE: To determine the symptoms and signs of eucalyptus oil poisoning in infants and young children, to estimate the toxic dose and to recommend management strategies. DESIGN AND SETTING: Retrospective analysis of case histories of children admitted to the Royal Children's Hospital, Melbourne, between 1 January 1981 and 31 December 1992 with a diagnosis of eucalyptus oil poisoning. MAIN OUTCOME MEASURES: Demographic data, circumstances of ingestion, doses, clinical effects, management, complications and duration of hospital stay. RESULTS: 109 children (mean age, 23.5 months; range, 0.5-107) were admitted; clinical effects were observed in 59%. Thirty-one (28%) had depression of conscious state; 27 were drowsy, three were unconscious after ingesting known or estimated volumes of between 5 mL and 10 mL, and one was unconscious with hypoventilation after ingesting an estimated 75 mL. Vomiting occurred in 37%, ataxia in 15% and pulmonary disease in 11%. No treatment was given for 12%. Ipecac or oral activated charcoal was given for 21%, nasogastric charcoal for 57%, and gastric lavage without anaesthesia for 4% and under anaesthesia for 6%. All patients recovered. Hazardous treatment and overtreatment were common. For 105 children, mean hospital stay was 22 hours (range, 4-72 h) and for 13 patients mean intensive care unit stay was 18 hours (range, 4-29 h). In 27 patients who ingested known doses of eucalyptus oil, 10 had nil effects after a mean of 1.7 mL, 11 had minor poisoning after a mean of 2.0 mL, five had moderate poisoning after a mean of 2.5 mL and one had major poisoning after 7.5 mL (P = 0.0198). CONCLUSIONS: Ingestion of eucalyptus oil caused significant morbidity in infants and young children. Significant depression of conscious state should be anticipated after ingestion of 5 mL or more of 100% oil. Minor depression of consciousness may occur after 2-3 mL. Airway protection should precede gastric lavage.

Adult↗
PubMed1987

Medical complications and medical management of bulimia.

The syndrome of bulimia is a common disorder and can be associated with serious psychological and physical morbidity. Unfortunately, many patients are reluctant to discuss their symptoms with their physicians and few clues can be found on physical examination to aid in the diagnosis. Possible physical signs include ulceration or scarring of the dorsum of the hand, salivary gland hypertrophy, and dental enamel erosion. In laboratory testing it is fairly common for patients with active bulimia to have fluid and electrolyte abnormalities, particularly hypokalemic alkalosis, and some also have elevated serum amylase levels. Rare complications include myopathies from misuse of ipecac, ruptured esophagus and pneumomediastinum associated with vomiting, and subtle abnormalities in neuroendocrine regulatory systems. Medical management including monitoring of fluid and electrolyte balance is essential during treatment.

Bulimia↗
PubMed1996

Generalized Weakness.

A 16-year-old female presented with weakness that began about 2 weeks earlier and has become progressively worse. It was accompanied by occasional dizziness and two brief episodes of syncope. Her history was remarkable for self-induced vomiting in order to lose weight. Her obvious diagnosis was bulimia nervosa, but it was further complicated by abnormal unexplained weakness. Upon careful questioning, she admitted using ipecac to induce vomiting for the past several weeks. She was placed on a strict eating disorder protocol combined with careful cardiac monitoring and her weakness eventually resolved.

Journal Article↗
PubMed2001

Availability of antidotes at acute care hospitals in Ontario.

BACKGROUND: Acutely poisoned patients sometimes require immediate treatment with an antidote, and delays in treatment can be fatal. We sought to determine the availability of 10 antidotes at acute care hospitals in Ontario. METHODS: Mailed questionnaire with repeated reminders to pharmacy directors at all acute care hospitals in Ontario. RESULTS: Responses were obtained from 179 (97%) of 184 hospitals. Only 9% of the hospitals stocked an adequate supply of digoxin immune Fab antibody fragments, a life-saving antidote for patients with severe digoxin toxicity, whereas most of the hospitals stocked sufficient supplies of ipecac syrup (88%) and flumazenil (92%), arguably the least crucial antidotes in the survey. Only 1 hospital stocked adequate amounts of all 10 antidotes. Certain hospital characteristics were associated with adequate antidote stocking (increased annual emergency department volume, teaching hospital status and designation as a trauma centre). Conversely, antidote supplies were particularly deficient at small hospitals and, paradoxically, geographically isolated facilities (those most reliant on their own inventory). The cost of antidotes correlated only weakly with stocking rates, and many examples of excessive antidote stocking were identified. INTERPRETATION: Most acute care hospitals in Ontario do not stock even minimally adequate amounts of several emergency antidotes, possibly jeopardizing the survival of an acutely poisoned patient. Much of this problem could be rectified at no additional cost by reducing excessive stock of expensive antidotes and redistributing the resources to acquire deficient antidotes.

Antidotes↗
PubMed2002

Recognition and management of acute pesticide poisoning.

Most poisonings from pesticides do not have a specific antidote, making decontamination the most important intervention. For maximal benefit to the patient, skin, eye, and gastric decontamination should be undertaken while specifics of the poisoning are being determined. As in most illnesses and injuries, the history of the poisoning is of great importance and will determine specific needs for decontamination and therapy, if any exist. Protection of health care workers during the decontamination process is important and frequently overlooked. Skin decontamination is primarily accomplished with large volumes of water, soap, and shampoo. Gastric decontamination by lavage is indicated if ingestion of the poisoning has occurred within 60 minutes of patient presentation. Activated charcoal, combined with a cathartic, is also indicated in most poisonings presenting within 60 minutes of ingestion. With large volume ingestion poisonings, activated charcoal may be used after 60 minutes, but little data exist to support this practice. Syrup of ipecac is no longer recommended for routine use. The cholinergic syndrome "all faucets on" characterizes poisoning by organophosphates and carbamates. Organochlorine insecticides (lindane and other treatments for scabies and lice) can produce seizures with excessive use or use on large areas of nonintact skin. Non-dipyridyl herbicides, biocides (including pyrethrins, pyrethroids, and Bacillus thuringiensis) rarely produce anything other than mild skin, eye, and/or gastrointestinal irritation on topical exposure or ingestion.

Acute Disease↗