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PubMed2000

Cellular and molecular responses to topoisomerase I poisons. Exploiting synergy for improved radiotherapy.

The efficacy of topoisomerase (Topo) I-active drugs may be improved by better understanding the molecular and cellular responses of tumor compared to normal cells after genotoxic insults. Ionizing radiation (IR) + Topo I-active drugs (e.g., Topotecan) caused synergistic cell killing in various human cancer cells, even in cells from highly radioresistant tumors. Topo I poisons had to be added either during or immediately after IR. Synergy was caused by DNA lesion modification mechanisms as well as by concomitant stimulation of two pathways of cell death: necrosis (IR) + apoptosis (Topo I poisons). Cumulative data favor a mechanism of synergistic cell killing caused by altered DNA lesion modification and enhanced apoptosis. However, alterations in cell cycle regulation may also play a role in the synergy between these two agents in certain human cancers. We recently showed that NF-kappa B, a known anti-apoptotic factor, was activated in various cancer cells after poisoning Topo I using clinically active drugs. NF-kappa B activation was dependent on initial nuclear DNA damage followed by cytoplasmic signaling events. Cytoplasmic signaling leading to NF-kappa B activation after Topo I poisons was diminished in cytoplasts (lacking nuclei) and in CEM/C2 cells that expressed a mutant Topo I protein that did not interact with Topo I-active drugs. NF-kappa B activation was intensified in S-phase and blocked by aphidicolin, suggesting that activation was a result of double-strand break formation due to Topo I poisoning and DNA replication. Dominant-negative I kappa B expression augmented Topo I poison-mediated apoptosis. Elucidation of molecular signal transduction pathways after Topo I drug-IR combinations may lead to improved radiotherapy by blocking anti-apoptotic NF-kappa B responses. Recent data also indicate that synergy caused by IR + Topo I poisons is different from radiosensitization by beta-lapachone (beta-lap), a "reported" Topo I and II-alpha poison in vitro. In fact, beta-lap does not kill cells by poisoning either Topo I or II-alpha in vivo. Instead, the compound is "activated" by an IR (damage)-inducible enzyme, NAD(P)H:quinone oxidoreductase (NQO1), a gene cloned as x-ray-inducible transcript #3, xip3. Unlike the lesion modification pathway induced by IR + Topo I drugs, beta-lap kills cells via NQO1 futile cycle metabolism. Downstream apoptosis caused by beta-lap appears to be noncaspase-mediated, involving calpain or a calpain-like protease. Thus, although Topo I poisons or beta-lap in combination with IR both synergistically kill cancer cells, the mechanisms are very different.

Animals↗
PubMed2005

[Risk factors for the development of pneumonia in acute psychotropic drugs poisoning].

BACKGROUND/AIM: Pneumonia is the most frequent complication in acute psychotropic drugs poisoning, which results in substantial morbidity and mortality, but which also increases the costs of treatment. Risk factors for pneumonia are numerous: age, sex, place of the appearance of pneumonia, severity of underlying disease, airway instrumentation (intubation, reintubation, etc). The incidence of pneumonia varies in poisoning caused by the various groups of drugs. The aim of this study was to determine the incidence and risk factors for pneumonia in the patients with acute psychotropic drugs poisoning. METHODS: A group of 782 patients, out of which 614 (78.5%) with psychotropic and 168 (21.5%) nonpsychotropic drug poisoning were analyzed prospectively during a two-year period. The diagnosis of pneumonia was made according to: clinical presentation, new and persistent pulmonary infiltrates on chest radiography, positive nonspecific parameters of inflammation, and the microbiological confirmation of causative microorganisms. To analyze predisposing risk factors for pneumonia, the following variables were recorded: sex, age, underlying diseases, endotracheal intubation, coma, severity of poisoning with different drugs, histamine H2 blockers, corticosteroids, mechanical ventilation, central venous catheter. The univariate analysis for pneumonia risk factors in all patients, and for each group separately was done. The multivariate analysis was performed using the logistic regression technique. RESULTS: Pneumonia was found in 94 (12.02%) of the patients, 86 of which (91.5%) in psychotropic and 8 (8.5%) in nonpsychotropic drug poisoning. In the psychotropic drug group, pneumonia was the most frequent in antidepressant (47%), and the rarest in benzodiazepine poisoning (3.8%). A statistically significant incidence of pneumonia was found in the patients with acute antidpressant poisoning (p < 0.001). Univariate analysis showed statistical significance for the following parameters: sex (p < 0.05), chronic alcohol intake (p < 0.05), underlying diseases (p < 0.01), central venous catheter (p < 0.05) vasopressors (p < 0.05), coma (p < 0.001), H2 blockers (p < 0.001) and corticosteroids (p < 0.001). The multivariate analysis retained endotracheal intubation and antidepressant drug poisoning as an independent risk factor for pneumonia. CONCLUSION: Using univariate and multivariate analysis, risk factors for developing pneumonia were disclosed. Some of these factors may be modified by simple medical procedures, thus the incidence and mortality rate of pneumonia in drug poisoning might be substantially reduced.

Adult↗
PubMed2002

Paracetamol recall: a natural experiment influencing analgesic poisoning.

OBJECTIVES: To determine whether the occurrence of paracetamol and non-paracetamol analgesic deliberate self-poisoning (DSP) and accidental paediatric poisoning was affected by two periods of recall of paracetamol products. DESIGN: Retrospective, observational audit of proportions of poisonings with tablet and capsule formulations of paracetamol, ibuprofen and aspirin products during two recall periods compared with the number of poisonings during the same periods of the previous three years. SETTING: A national poisons information centre and a regional toxicology service. MAIN OUTCOME MEASURES: Rates of DSP and accidental paediatric poisoning with paracetamol, ibuprofen and aspirin. RESULTS: During the two recall periods, there was a significant increase in ibuprofen DSP calls to the poisons information centre (RR, 1.86; 95% Cl, 1.41-2.44; P = 0.001). There was no significant change in paracetamol or aspirin DSP calls over the two recall periods. However, there was a non-significant reduction in DSP calls with paracetamol in the first recall period alone (P = 0.057). There was a significant increase in the proportion of aspirin DSP presentations for the toxicology service (RR, 3.33; 95% CI, 0.97-11.4; P = 0.043), but no significant changes in paracetamol and ibuprofen DSP presentations. For accidental paediatric ingestions there was a significant increase in the proportion of ibuprofen calls (RR, 2.35; 95% CI, 1.85-2.98; P = 0.001), but no significant change in paracetamol or aspirin calls. CONCLUSIONS: Reduced paracetamol availability increased poisoning with alternative analgesics, but had little effect on the incidence of paracetamol poisoning. Restriction of paracetamol-containing products may inadvertently increase poisoning with potentially more toxic agents.

Acetaminophen↗
PubMed1998

Pesticide poisoning and its related factors among Korean farmers.

This study has been carried out to assess the health damages due to pesticide use and its related risk factors among Korean farmers. Data regarding pesticide handling and poisoning symptoms were collected by means of a questionnaire filled in by 1,032 farmers from two provinces. The results showed that during summer farming 21.9% of the subjects experienced suspected pesticide poisoning. 18.8% mild poisoning, and 2% more serious poisoning. Univariate and logistic regression analyses between "no poisoning", including the "suspected poisoning" and "poisoning" groups, were performed to select significant variables related to pesticide poisoning. Four variables were significantly associated: sex, days of consecutive pesticide use, hours of pesticide use per day, having received safety education (weakly associated), and compliance with safety guidelines for application. Safety education was weakly associated with poisoning, while age, education, wearing protective gear, and compliance with safety guidelines for personal hygiene after pesticide use were not significant risk factors to determine pesticide poisoning.

Adult↗
PubMed1983

[Comparative study of cases of poisoning by organophosphorous insecticides in various regions of Costa Rica].

336 cases of organophosphorous poisoning from case records of hospitals in Costa Rica between 1972 and 1978 were classified in four categories according to signs and symptoms: 8% latent; 25.9% mild; 43.8% moderate and 22.3% severe. Eighteen of the total patients died during hospitalization. Suicidal ingestion was the principal cause of severe and latent poisoning, especially in urban areas, followed by occupational poisoning in agricultural workers in mild and moderate cases. Occupational poisoning was common in men; in women it was attempted suicide and in children accidental poisoning. Under 40 years of age, the main cause was suicidal ingestion among both men and women, and occupational poisoning after 40 years of age. After discharge from the hospital, 19.6% of the total poisoned patients were referred to psychiatric treatment; 22.7% and 18.2% had had mental and alcoholic problems, respectively, prior to poisoning. Attempted suicide was the principal cause of poisoning in 86.4% of these patients, indicating emotional instability. In this study, the incidence in psychiatric consultation after discharge from the hospital is not indicative of a relationship between mental disorders and acute insecticide poisoning. In 42.6% and in 22% of the deceased patients pralidoxime (PAM) and atropine respectively, were not administered as antidotes in the emergency room. Aminophylline and skeletal muscle relaxants among other contraindicated drugs were administered as part of the treatment in these deceased patients. The consequences of this misguided treatment are questioned.

Adolescent↗
PubMed1996

An estimate of the incidence of pesticide poisoning in Hong Kong.

The exact incidence of vegetable-borne and other types of acute pesticide poisoning among the 6.2 million population of Hong Kong is difficult to determine. Vegetable-borne pesticide poisoning is notifiable and, in 1992, 47 outbreaks of such poisoning (all caused by methamidophos) affected about 329 persons. No similar figures are available for non-vegetable-borne pesticide poisoning, but we calculated it based on our experience at the Prince of Wales Hospital (PWH) and on reports to our territory-wide Drug and Poisons Information Bureau (DPIB). The PWH serves the 1.2 million population in the New Territories East, where much of the remaining farmland in Hong Kong is situated. Extrapolating from our regional data to the whole of Hong Kong, we estimate that, in subjects aged > or = 15 y between 1988 and 1991, the annual incidence of non-vegetable-borne acute pesticide poisoning from parasuicides, non-farming accidents and work-related accidents was 59, 4 and 1, respectively. Between 1988 and 1992, 5 pediatric cases of non-vegetable-borne pesticide poisoning were reported to the DPIB annually. In the New Territories East, 80% of the acute pesticide poisoning deaths were due to 24% paraquat solution. In Hong Kong, acute pesticide poisoning is relatively uncommon. By maintaining a close surveillance of imported vegetables for excessive methamidophos residues, replacing high concentration paraquat with less toxic formulations, and placing pesticides out of reach of children, much of this morbidity and mortality associated with acute pesticide poisoning can be prevented.

Adolescent↗
PubMedDate not supplied

Children poisoning in Taiwan.

Poisoning is a well known cause of morbidity and mortality in children. In Taiwan, little information has been published regarding the status of pediatric poisoning exposures. To provide more information on pediatric poisoning exposures for the purpose of poison prevention, a retrospective study was designed and conducted to analyse the data of National Poison Centre (NPC), Taiwan. All telephone inquiries concerning poisoning exposures in those under 19 years of age, received by NPC-Taiwan from July 1985 through December 1993, were included in this study. The age, sex, reason for exposure, route of exposure, substances involved and clinical outcome of those telephone calls were then analyzed. A total of 5,812 inquiries concerning poisoning exposures in children were recorded. Male exposures were more prevalent than females (59%) Vs. 41%) Accidental exposures accounted for 77.7% of the cases and most were exposed by the oral route. Substances most frequently ingested were household products, benzodiazepines and pesticides. The data revealed a mortality rate of 1.4%. Accidental poisoning exposures from household products and drugs remain a significant problem for those younger than 6 years of age. Further education of parents and care takers and the employment of child-resistant containers are needed to prevent cases of pediatric poisoning. Reduction of amphetamine abuse in adolescents is also of major concern and deserves more attention.

Adolescent↗
PubMed2002

The National Poisons Information Centre in Sri Lanka: the first ten years.

INTRODUCTION: Poisoning is a major health concern in Sri Lanka, which has a very high morbidity and mortality from pesticide poisoning. Poisoning, which continues to be in the first five leading causes of death, accounts for about 80,000 hospitalizations and over 3,000 deaths per year. The National Poisons Information Centre in Sri Lanka, thefirst such centre to be established in South Asia, completed 10 years service in 1997. The 4,070 calls received in thefirst 10 years are analyzed and compared with the national hospitalization pattern. METHODS: The recorded data sheets of all enquiries received from 1988 to 1997 were analyzed retrospectively to study (1) purpose of enquiry, (2) category of enquirer, (3) circumstances of poisoning, (4) gender of victim, (5) age of victim, (6) type of poison, and (7) outcome. Items (6) and (7) were compared with the national hospital statistics for 1998. RESULTS: Of the 4,070 enquiries, 92% concerned specific patients and 6% were for information on poisons. Almost 90% of the enquiries were from medical or paramedical personnel, 5% from relatives or friends, and 3% from the victims. Nearly 38% of enquiries concerned pesticides compared to 27% of poisoning hospitalizations. Medicinal agents were the subject of 20% of enquiries compared to 13% of hospitalizations. The major discrepancy was for snake bites, accounting for only 6% of enquiries but 42% of hospitalizations. Sex distribution of enquiries showed more males than females. Thirty-seven percent of the victims were young adults-15-29years age group. Nearly 49% of the enquiries were for suicidal attempts. Seventy-one percent of the victims recovered. CONCLUSIONS: Although enquiries to the NPIC averaged only 0.5% of poisoning hospitalizations, they were sufficiently representative of the national pattern to predict that increasing utilization of the NPIC would offer a much needed service, both for

Adolescent↗
PubMed1975

What is clinical smoke poisoning?

In this 13-year study, 51 patients were admitted with the primary diagnosis of "smoke poisoning" "carbon monoxide (CO) poisoning" or "respiratory burns." Forty patients (78%) had diagnosis of smoke poisoning with minor or no skin burns. The study indicated that clinical diagnosis of CO poisoning cannot be made reliably without carboxyhemoglobin (COHg) determination and that smoke poisoning patients often had CO poisoning. Seventeen of 19 smoke poisoning patients (89%) had CO poisoning above COHb levels of 15% saturation. Carbon monoxide was successfully removed from the blood by improving alveolar ventilation and oxygen concentration. However, there were 2 smoke poisoning deaths as the result of gaseous chemical injury. There was a correlation coefficient of 0.87 between initial COHg levels and patients' hospital days primarily determined by patients' pulmonary complications. Since CO is non-irritating, COHb levels may be used as an additional indicator of suspected pulmonary injury by noxious combustion gases.

Animals↗
PubMed1996

Plant poisonings in children.

1. Plant poisonings comprise 5% of all hospitalizations due to poisonings in children and plant inquiries to Poison Information Centre consist about 28% of calls concerning children. 2. A search of 71 cases of hospitalization due to plants in a 5 year period obtained from two children's hospitals in Helsinki were reviewed and 105 plant inquiries concerning poisonings among children to the Poison Information Centre in a 6 month period were studied. 3. The most frequent plant poisonings involved lily-of-the-valley, dumb cane and cotoneaster plant. Only 11% of the cases treated in hospital were evaluated to be unequivocal poisonings. 4. Mezereon, snowberry, cotoneaster plant, honeysuckle, and woody nightshade caused the most serious symptoms. Symptoms in mezereon poisoning were increased saliva excretion, haematuria and diarrhoea in a 1.2-year-old girl. Snowberries caused a semicomatose state and difficulty in urination, cotoneaster caused severe stomach ache, honeysuckle abudant gastrointestinal symptoms and muscle cramps, and nightshade led to prolonged high fever and sweating. 5. It appears that almost all plant poisonings could be treated with medical charcoal. Gastric evacuation is seldom required.

Child↗
PubMed2001

Epidemiology and medical aid at acute poisoning in Russia.

The present study is based on the selected data obtained from medical reports by some Russian poisoning treatment centers, recent publications, statistical materials, and the review of the existing system of medical aid at acute poisoning. The number of acute poisoning cases in Moscow and large Russian cities has increased almost twofold in the last fifteen years. The main groups of toxic agents causing poisoning are pharmaceuticals (up to 63.1%), alcohol and surrogates (up to 49.3%), corrosives (up to 21.8%), although the figures vary in various Russian regions. Acute poisoning mortality in Russia tends to increase with about 56,000 in the recent years. The main causes of poisoning were alcohol (62.2%), carbon monoxide (15.4%), acetic acid (6.3%), pharmaceuticals (4%) (data by the Moscow Forensic Bureau). Specialized medical aid is represented by poisoning treatment centers organized in 37 cities, 1 toxicology information and advisory center of federal level. Physicians can advance their skills at post-diploma courses organized at 4 chairs of clinical toxicology. Scientific research in the field is carried out by Moscow city poisoning treatment center, the abovementioned chairs and other interested institutions. To obtain the maximum complete data on the number, pattern and causes of acute poisoning a unified system for toxicological monitoring was introduced in Russia in 2000.

Adolescent↗
PubMed2003

The need for drug and poison information--the Singapore physicians' perspective.

INTRODUCTION: There appears to be a significant prevalence of poisoning and adverse drug reactions in Singapore. However, the resources needed by physicians to assist them in the management of such cases are limited. This study examines the information resources currently utilised by medical professionals in assisting them in the management of poisonings and adverse drug reactions. The preferred features of an ideal Drug and Poison Information Centre in the local setting were also explored. METHOD: A questionnaire survey involving all practicing physicians in Singapore to find out the current information resources utilised for Drug and Poison Information and the need for enhanced resources and its preferred form was looked at. RESULTS: A total of 1,071 practicing physicians responded forming 24% of all physicians in Singapore as of December 1997. Of these, 636 (61.3%) were general practitioners and the rest specialists. The main sources of poison information were Drug Index of Malaysia and Singapore or DIMS (73.7%), standard textbooks (70.1%), fellow colleagues (44.6%) and pharmacists (41.0%). In the opinion of most (82.4%), one well run and efficient Drug and Poison Information Centre was adequate for the whole island. The majority (58.9%) preferred that experienced individuals who could be consulted upon in times of need man such a service. CONCLUSION: The study shows the need for enhanced drug and poison information resources. The local physician community also expects guidance and expert advice from a specialist. With this in mind, it is worthwhile examining in depth the issues surrounding poison and adverse drug reaction management and the need for readily accessible Drug and Poison Information resources in Singapore.

Adverse Drug Reaction Reporting Systems↗
PubMed1988

Adolescent poisoning: a comparison of accidental and intentional exposures.

The fact that intentional drug and toxic substance use/abuse by adolescents has dramatically increased during the past 2 decades often overshadows the knowledge that adolescents also suffer accidental poisonings as well. A 1-year retrospective analysis of 1,879 poison exposures involving children 13 to 17 years of age revealed 894 (47.6%) were due to accidental circumstances and 945 (50.2%) were intentional in nature. Nonpharmaceuticals were involved in 63.5% of all accidental adolescent poisonings versus 36.5% involving various drugs. Intentional nonpharmaceutical exposures were 17.5% compared to total intentional adolescent poisonings, while 82.5% involved drugs. Site of exposure was the child's own home in 1,252 (66.7%) cases, school in 201 (10.8%), the workplace in 35 (1.9%), and other/unknown sites accounted for 387 (20.6%) poisonings. Poisoning by ingestion accounted for 1,408 (74.9%) of the adolescent exposures, inhalations 147 (7.8%), ocular 219 (11.5%), and dermal 110 (5.8%). Management at the nearest health care facility (HCF) was necessary in 1,252 (66.6%) of the poisonings versus 627 (33.4%) who were treated in non-HCF environments. Regional poison centers must be cognizant that accidental as well as intentional poisoning can occur with adolescents. Distinct viable prevention strategies should be developed to address these problems.

Accidents↗
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↗
PubMed1995

Health care cost effects of public use of a regional poison control center.

Poison control centers in the United States are threatened with closure, and attempts at a cost-benefit analysis of these services have been indeterminate. The purpose of this study was to compare the operating costs of a regional poison control center resulting from public use of its telephone hotline services with those of hypothetical alternative sources of advice and care. We conducted a follow-up telephone survey among 589 public callers to the San Francisco Bay Area Regional Poison Control Center who had been managed at home without medical referral after an unintentional poisoning. All survey respondents were asked what alternative action they would have taken had the poison control center not been available to assist them by telephone consultation. We then surveyed emergency departments and physicians' offices cited as alternatives by the callers to determine their response and charges for evaluating a suspected poisoning case. A total of 464 (79%) of the callers surveyed would have sought assistance from their local emergency health care system had the poison control center not been available. We conservatively estimated that the total charges for such evaluations would be +71,900. Comparatively, the total actual operating cost of services provided by the poison control center for all 589 poisoning cases was +13,547. Most of the study subjects (429 [73%]) had private insurance coverage. Direct public access to these services probably reduces the use of emergency health care resources, thus lowering health care costs.

Emergency Service, Hospital↗
PubMed1986

[Poisoning in swine].

For clinical interests it is advisable to subdivide cases of swine poisoning in such as caused by food, drugs and environmental poisonings. This division gives pointers to aetiologic connections and special measures necessary for the clearing of the processes. With food poisoning mycotoxicoses play an evermore important role, whereas poisonings by trace elements are on the decrease. Sodium chloride poisoning often results primarily from insufficient water supply. With environmental poisonings carbon monoxide and cyanamide intoxication are presented. Poisonings caused by drugs are mainly the result of an overdose, of segregation in food or of non-licensed drugs. A relatively unknown swine poisoning by a drug against coccidiosis--licensed for poultry--is described.

Animal Feed↗
PubMedDate not supplied

Poisoning in Zimbabwe: a survey of eight major referral hospitals.

A retrospective study of the pattern of poisoning cases admitted to eight major urban referral hospitals in Zimbabwe over a 2-year period (1998-1999 inclusive) was conducted to describe the pattern of poisoning at these centres. There were a total of 2764 hospital admissions due to poisoning, involving a total of 2846 toxic agents. Accidental poisoning (AP) and deliberate self-poisoning (DSP) accounted for 48.9% (1352 cases) and 41.3% (1142 cases), respectively. With AP, the highest number of cases (45.9%) occurred in children below the age of 5 years, with half of these due to chemicals, mainly paraffin. In the DSP group, however, more than 60% of all cases occurred in the 16-25-year age group. In addition, twice as many females as males were admitted for DSP compared with an overall male/female ratio of 1 : 1.2. Pesticides (31.4%) and pharmaceuticals (30.4%) were the most common groups of toxic agents responsible for the hospital admissions. Unknown toxins, natural toxins and pesticides showed the highest mortality rates (15.4%, 8.3% and 6.7%, respectively). Compared with the last major survey of poisoning in Zimbabwe, the pattern of poisoning at referral hospitals has changed over the last decade, with an increase in pesticide and pharmaceutical cases and a marked fall in cases of traditional medicine poisoning. Educational and legislative interventions may be required to address these changes. There is the need also to investigate further the high mortality rates associated with traditional medicine poisoning.

Adolescent↗
PubMed2001

Substances used in deliberate self-poisoning 1985-1997: trends and associations with age, gender, repetition and suicide intent.

BACKGROUND: Rates of deliberate self-poisoning have increased in recent years. While over-the-counter availability and prescribing patterns may influence trends in substances used in overdose, these may also be related to clinical characteristics of patients. We investigate trends in substances used for self-poisoning and the influence of age, gender, suicidal intent and repetition status on the substances used. METHOD: Data collected by the Oxford Monitoring System for Attempted Suicide were used to review trends and patterns of self-poisoning between 1985 and 1997. RESULTS: There were substantial increases in self-poisoning with paracetamol and antidepressants. While the increase in antidepressant self-poisoning closely paralleled local prescribing figures during 1995-97, SSRI antidepressant overdoses occurred somewhat more often than expected compared with tricyclic overdoses. Paracetamol overdoses were more common in first-timers and young people, whereas overdoses of antidepressants and tranquillizers were more common in repeaters and older people. Self-poisoning with gas and non-ingestible poisons was associated with high suicidal intent. CONCLUSIONS: There have been marked changes in the substances used for self-poisoning, which seem primarily to reflect availability, as do the influences of age and repeater status on choice of substances used. Degree of suicidal intent may also influence choice of method of self-poisoning.

Acetaminophen↗