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PubMed2002

Discrepant advice from poison centres and their medical directors.

OBJECTIVE: To characterize the recommendations of the medical directors of North American poison information centres for gastrointestinal decontamination of a hypothetical poisoned patient, and to examine the extent to which those recommendations agree with the advice previously issued by their poison information centres for the same scenario. METHODS: The medical directors of 72 poison centres in the United States and Canada were contacted and invited to participate in a survey. Each participant was asked to provide specific advice for gastrointestinal decontamination of a hypothetical patient presenting 1 h after a potentially life-threatening ingestion (32.5 g) of enteric-coated acetylsalicylic acid. The directors were then presented with the recommendation their poison centres had previously issued for the same overdose scenario. The main outcome measures were perceived agreement with their own centre's recommendation and director-centre concordance for each method of gastrointestinal decontamination. RESULTS: Sixty-seven of 72 (93%) medical directors participated in the survey. They issued 30 different management suggestions for our hypothetical patient, and were in full agreement with their own centres 27% of the time. Concordance was moderate for recommendations on syrup of ipecac (k=0.468, P<0.001), and fair for whole bowel irrigation (k=0.348, P=0.005) and the use of sorbitol with activated charcoal (k=0.305, P=0.005). Concordance was poorest for advice on gastric lavage (k=0.093, P=0.445) and multidose charcoal (k=0.039, P=0.745). CONCLUSIONS: The medical directors of North American poison centres offer widely varying advice on gastrointestinal decontamination for a hypothetical patient who is acutely poisoned with enteric-coated acetylsalicylic acid. Their advice was often different from that previously issued by their respective centres.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2002

Contrary to the literature, vomiting is not a common manifestation associated with plant exposures.

A review of clinical toxicology references and the contemporay literature illustrates that vomiting is reported as a nearly universal symptom associatedwith exposure to cultivated and wild plants. However, the literature fails to put thesymptom of vomiting into a clinical perspectivewith regard to its frequency of occurrence. To clarify this issue a retrospective review of plant exposures was conducted. AAPCC TESS 1997-1999 was queried electronicaly to identify and extract all plant ingestion exposures where vomiting was documented as being related to the exposure. All exposures with documented ipecac syrup use were excluded. Data were stratified through the use through the use of a relational database. Plant ingestion exposures accounted for 229,538 reports and vomiting was reported in 5,917 (2.6%) of exposures. Vomiting was attributed as a related symptom in 753 different plants. It was reported once in 323 plants, 1-3 times in 495 plants (65.7%), and < or = 10 times in 657 (87.4%) of all plants in the database. Ten plants accounted for 32.3% of the reports of vomiting Philodendron, Spathiphyllum, Narcissus, Dieffenbachia, Phytolacca, Epipremnum, Euphorbia, Eucalyptus, Ficus, Hedera) and represented 1.3% of the plants associated with vomiting. Even with the most common plant exposures, vomiting is not a frequent adverse event.

Humans↗
PubMed2003

Bulimia nervosa and binge-eating disorder in adolescents.

Bulimia nervosa (BN) and binge-eating disorder (BED) are separate entities with the common denominator of binge eating. In this chapter, Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for BN are reviewed, including both recurrent episodes of binge eating and inappropriate compensatory behaviors to prevent weight gain in one whose self-evaluation is unduly influenced by body weight and shape. Two percent of adolescent females and 0.3% of adolescent males fulfill criteria for BN. Risk factors, medical complications of binge eating (vomiting, use of ipecac, diet pills, diuretics, and laxatives), physical and laboratory findings, and treatment options and outcome are discussed. BED is seen in 1-2% of adolescents. The DSM-IV lists BED under Eating Disorder Not Otherwise Specified. DSM-IV research criteria for BED is reviewed, including binge eating, distress over binge eating, and absence of regular extreme compensatory behaviors. The mean age of onset is 17.2 years. Up to 30% of obese patients have BED. Risk factors are discussed. Because most patients with BED are obese, medical evaluation is similar to that for obesity. Treatment goals must be geared not only toward decreased binge eating but toward weight loss. Outcome is discussed.

Adolescent↗
PubMed1992

Factors influencing non-compliance with poison center recommendations.

Non-compliance with prescribed therapies has long been recognized by medical practitioners in all fields as an important factor influencing the probability of a favorable outcome. Few references in the literature address this factor with regard to poisoning. Principles of assessing and improving compliance may also be applied to the advice given by poison information providers. Cases involving lay callers, who failed to comply with poison center recommendations, were studied. The type of advice, reason given for failing to comply, and outcome were assessed. 205 poisoning cases from the 12-mo period were analyzed involving 129 children and 76 adults. In 34 pediatric exposures of children where syrup of ipecac was recommended but not given, 29.4% of parents cited the influence of a family member in deciding not to comply; 47% indicated the potential risk of the exposure was not perceived accurately. In 90 cases of non-compliant referrals of children to emergency departments, 60% of parents minimized the threat of a serious outcome despite explanation of the expected risk. In 76 adult cases, 70 patients refused referral to an emergency department; 26% admitted to sociopsycological reasons, including public status, undisclosed drug abuse, or fear of reprisal. Sequelae developed in 31% of the children and 46% of the adults which may not have occurred if poison center recommendations had been followed. Willingness to comply with a recommended behavior is influenced by factors such as motivation, concern, perceived threat posed by the exposure, and perceived barriers. A compliance model relative to poisoning is needed to reduce risk and promote a favorable outcome.

Accidents↗
PubMed1992

The contemporary management of poisoning emergencies.

Most patients who ingest toxic substances can be properly managed with basic supportive care, and only infrequently is more extensive intervention necessary. Basic supportive care includes the use of clinical toxicology's primary tools-syrup of ipecac, activated charcoal, and cathartics. Appropriate use of these agents decreases the morbidity and mortality associated with poisoning emergencies.

Emergency Nursing↗
PubMedDate not supplied

Self-reported safety practices in child care facilities.

To determine the prevalence of safety hazards and current injury prevention practices in child care settings, we administered a structured telephone interview to a geographically stratified, randomly selected sample of licensed child care facilities. Representatives of 130 child care facilities responded to questions about current injury prevention practices. Specific hazards assessed were related to burns, falls, poisoning, playgrounds, and emergency telephone numbers. Results indicated that 26.8% of providers who knew the temperature of their tap water stated that it was over 130 degrees F.; 14.1% had space heaters accessible to children; 30.3% of those with stairs accessible to children lacked safety gates; 61.4% of those with playgrounds did not have an impact-absorbing surface under playground equipment; 16.9% of respondents had an unexpired bottle of syrup of ipecac; 55.8% demonstrated that a poison control center telephone number was available to them; and 80% of providers could demonstrate the availability of the telephone number of the local ambulance. We conclude that potential and remedial injury hazards exist in some licensed child care centers and that providers of child care within licensed facilities are a promising target for childhood injury prevention interventions.

Accidental Falls↗
PubMed1991

Safety practices and living conditions of low-income urban families.

Injuries remain the leading cause of mortality in children and disproportionately affect poor children. Prior injury prevention efforts have neglected the injury prevention needs of these children. One hundred thirty-three care givers of medically indigent urban children younger than 6 years old were interviewed regarding living conditions, previous injuries, and safety practices and knowledge. Functional smoke detectors and fire extinguishers were present in 75% and 27% of homes, respectively. Few respondents, regardless of previous poisoning experience, were cognizant of ipecac, had it in their homes, or had a good response to a possible poisoning. Few homes had locked storage space, and most hazards were stored suboptimally. While the frequency of the use of automobiles was low, rides in a variety of vehicles were common with 63% of children who usually were restrained inadequately. Additionally, 89% of children aged 35 to 59 months and 6% of those younger than 3 years old sometimes bathed without adult supervision. These findings indicate the dramatic need for injury prevention programs focused on low-income urban families. Specific concerns include exposure to fires and burns, falls, hazardous travel conditions, dangerous chemical, choking, and drowning. Lack of information and isolated care givers may result in poor supervision and responses to injury of these children.

Adolescent↗
PubMed1988

Multiple vitamins and vitamins with iron: accidental poisoning in children.

To insure adequate nutrition, parents and pediatricians often advocate vitamin and mineral supplementation in young children. A retrospective review of 275 pediatric cases (6 mo-6 yr) involving multiple vitamins and vitamins with iron was conducted. Six cases with co-ingestants were excluded. The product ingested was the child's own dietary supplement in 93% of the cases. Fifty-six percent were children's multiple vitamins and 44% were children's multiple vitamins with iron. Adult vitamin preparations accounted for 7% of the ingestions. The average amount of vitamin A ingested by history was 43,300 IU (1,500-225,000) while the mean ingestion of iron was 16.8 mg/kg (0.9-77.5 mg/kg). Fifty ingestions (18.2%) involved more than one child. The mean time since ingestion was 15.8 min (0-150 min). Management data showed 246 (89.5%) being treated in the home setting with dilution (83%) or syrup of ipecac induced-emesis (10%). Medical intervention including emesis, serum iron/TIBC, and oral complexation was needed in 10.5% of the cases. The mean serum iron levels were 204.6 mcg/dl (81-414 mcg/dl). No patient needed admission. This review revealed 100% of patients showed no significant toxic effects. We conclude that early recognition and prompt treatment of pediatric overdoses involving multiple vitamins with and without iron significantly reduces morbidity.

Child↗
PubMed1978

Acute digoxin poisonings: review of therapy.

Acute digoxin poisoning, its recognition and management, are reviewed. The uses of syrup of ipecac, gastric lavage, activated charcoal, cholestyramine, colestipol, edetate sodium and cathartics as measures to terminate the drug exposure are discussed. Measures to hasten digoxin elimination, such as the use of furosemide, hemodialysis and digoxin-specific antibodies are reviewed. Supportive management may include treatment with atropine, phenytoin, lidocaine, propranolol, glucose, insulin and sodium polystyrene sulfonate. Proper management of digoxin poisoning involves the use of standard decontamination procedures (emesis or gastric lavage). Activated charcoal is strongly recommended, followed by rapidly acting cathartics. Antiarrhythmic therapy usually involves atropine sulfate and phenytoin sodium.

Acute Disease↗
PubMed1985

Battery ingestions: product accessibility and clinical course.

Results of 125 battery ingestions in 114 separate episodes over an 11-month period are analyzed. The 125 batteries included 119 button batteries and six cylindrical cells. The location of batteries just prior to ingestion (loose or discarded [48.7%], in product [34.4%], in manufacturer's battery packaging [3.4%]) determined the need for consumer education of this potential hazard. The observation that hearing aid batteries were the most common type swallowed (33.9%), and that 14 batteries were ingested by hearing-impaired children after they removed the batteries from their own aids, further directs appropriate prevention efforts. All the larger cylindrical batteries and 89.9% of the button cells passed through the gastrointestinal tract spontaneously. Endoscopic retrieval was unsuccessful in 66.7% of cases attempted. Ipecac syrup, administered to 11 patients, uniformly failed to expel the battery. Transit time was within 48 hours for 68.8% of button cells, and 85.4% of the batteries were passed by 72 hours, with a range of 12 hours to 14 days. Once beyond the esophagus, arrested battery progression failed to correlate with adverse outcome. Symptoms developed in 11 patients but were only severe in the single case of esophageal lodgment. The vast majority of battery ingestions are benign and can be managed without endoscopic or surgical intervention.

Adolescent↗
PubMed1984

Poison prevention education.

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.

Adolescent↗
PubMed1984

TIPP usage.

In recent years, physicians have become more concerned about the prevention of childhood accidents. Developed to help physicians teach parents how to avoid unintentional injury, The Injury Prevention Program (TIPP) is significant because anticipatory guidance has now been recognized as being as much a part of routine health supervision as the history and physical examination. The American Academy of Pediatrics' policy statement enclosed with each TIPP package states five goals that deal with major causes of childhood mortality; three can be achieved with a single purchase or action--buying a smoke alarm, buying a bottle of ipecac, and turning down hot water temperature. TIPP comprises three elements: A parent questionnaire (the Framingham safety survey) is used to identify at-risk behavior. Safety sheets to be handed out at the next visit reinforce the information provided by the physician in his or her discussion of the questionnaire results. A model counseling schedule suggests how to incorporate the questionnaire and safety sheets into an effective office program. By gradually phasing TIPP into an office practice, physicians can become familiar with TIPP materials and integrate it in a controlled manner. The AAP Committee on Accident and Poison Prevention is studying measures to increase the usefulness of TIPP.

Accident Prevention↗
PubMed1993

[Role of medicinal coal in primary management of poisoning].

Primary detoxication by ipecac-induced emesis or gastric lavage is incomplete. In mild to moderate childhood poisoning administration of activated charcoal alone without gastric emptying is often more effective, because it binds toxins promptly. In-vitro and in-vivo studies of many substances have shown good adsorption to activated charcoal (e.g. digitalis, beta-blocking agents, phenobarbitone, carbamazepine, theophylline). If in-vitro adsorption is moderate to poor, administration of activated charcoal might nevertheless prove clinically valuable by altering the severity of symptoms such as has been shown with acetaminophen, salicylates or organophosphate insecticide intoxications. Possible risks are shown and dosage regimens of activated charcoal are given alongside an evaluation of additional cathartics in the initial treatment of childhood poisonings. The role of repeated doses of activated charcoal as a method of secondary detoxication in comparison with hemoperfusion techniques and its significance in clinical routine is pointed out. General conclusion: In mild to moderate childhood poisoning early administration of activated charcoal alone after consultation of pediatrician and/or poison center specialists is an adequate therapy.

Adsorption↗
PubMed1996

Advances in poison management.

This article advances the most current concepts in the management of poisoned patients including the use of ipecac, lavage, activated charcoal, whole-bowel irrigation, and specific antidotes. The benefits vs the risks of each of these procedures are reviewed.

Antidotes↗
PubMed1997

Effectiveness of a poison center: impact on medical facility visits.

To estimate the effectiveness of a poison center by determining the number of potential medical facility visits for childhood poisonings which are prevented, and to determine how callers learned about the poison center in order to help guide future public educational efforts, a cross-sectional telephone survey was done. A systematic sample of caretakers of children < 6-y-of-age living in Harris County, TX, and who called the poison center about a poisoning incident between February 1993 and January 1994, was taken. One hundred sixty-six/197 eligible caretakers (84%) completed the survey. Of the 166 caretakers, only 5 (3%) were referred by the poison center to a medical facility for treatment, although 6 (3.6%) actually sought medical attention. The remaining 160 (96.4%) were successfully managed at home. The majority of these (74%) required no intervention and the remaining 26% required only minimal treatment, including ipecac, dilution, irrigation or observation. Of the 160 caretakers managed at home, 69 (43%) would have sought medical attention for the child at a health care facility if the poison center did not exist, and of those 81% would have gone to an emergency center or hospital for evaluation. Callers learned about the poison center most often from family/ friends, doctors, Mr Yuk stickers, television, previous use, or pharmacists. Poison centers decrease health care costs by preventing unnecessary medical facility visits for minor childhood poisonings which can be successfully managed at home. Methods effective in educating the public about poison centers should be continued and other methods explored to increase poison centers' use.

Adolescent↗
PubMedDate not supplied

Innovative approaches to the administration of activated charcoal in pediatric toxic ingestions.

Toxic ingestions (accidental or intentional) continue to occur within the pediatric population. Activated charcoal has replaced syrup of ipecac as the gastrointestinal decontamination method of choice. Activated charcoal has poor palatability and poses acceptability and administration problems with children. This article proposes innovative approaches to the administration of activated charcoal as an antidote for pediatric toxic ingestions.

Administration, Oral↗
PubMed1963

SALICYLISM.

Explore the source record for details and available documents.

Absorption↗