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PubMed1997

Agricultural and horticultural chemical poisonings: mortality and morbidity in the United States.

STUDY OBJECTIVE: To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States. METHODS: Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990. RESULTS: There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%). CONCLUSION: Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature.

Accidents, Home↗
PubMed2003

Information sources accessed by parents following childhood poisoning.

OBJECTIVE: To ascertain the sources of information accessed by parents/caregivers following an incident of child poison ingestion, prior to their presentation to an ED. METHODS: A questionnaire based survey of the parents/caregivers of children presenting to the Mater Children's Hospital Emergency Department with poisoning from March to October 2001. RESULTS: A total of 121 parents/caregivers were surveyed. In 117 cases (97%), information was sought prior to presentation. The Poisons Information Centre (PIC) was the initial source of information in 39 cases (32%), the ED in 25 cases (21%) and the family doctor (by telephone or consultation) in 21 cases (17%). Poisons Information Centres, emergency departments and family doctors were the sole sources of information for 18%, 15% and 12% of cases, respectively. For 46% of cases multiple sources of information were accessed, and overall, in 57 cases (47%) the Poisons Information Centre was accessed, the ED in 38 cases (31%) and the family doctor in 34 cases (28%). CONCLUSIONS: Poisons Information Centres are under-utilized as the first point of contact after childhood poisoning but in nearly all cases of poison ingestion that presented to the ED, information was sought prior to presentation and in most cases this was from direct contact with a health professional.

Child↗
PubMed2001

Do poison center triage guidelines affect healthcare facility referrals?

BACKGROUND: The purpose of this study was to determine the extent to which poison center triage guidelines influence healthcare facility referral rates for acute, unintentional acetaminophen-only poisoning and acute, unintentional adult formulation iron poisoning. METHODS: Managers of US poison centers were interviewed by telephone to determine their center's triage threshold value (mg/kg) for acute iron and acute acetaminophen poisoning in 1997. Triage threshold values and healthcare facility referral rates were fit to a univariate logistic regression model for acetaminophen and iron using maximum likelihood estimation. RESULTS: Triage threshold values ranged from 120-201 mg/kg (acetaminophen) and 16-61 mg/kg (iron). Referral rates ranged from 3.1% to 24% (acetaminophen) and 3.7% to 46.7% (iron). There was a statistically significant inverse relationship between the triage value and the referral rate for acetaminophen (p < 0.001) and iron (p = 0.0013). The model explained 31.7% of the referral variation for acetaminophen but only 4.1% of the variation for iron. CONCLUSION: There is great variability in poison center triage values and referral rates for iron and acetaminophen poisoning. Guidelines can account for a meaningful proportion of referral variation. Their influence appears to be substance dependent. These data suggest that efforts to determine and utilize the highest, safe, triage threshold value could substantially decrease healthcare costs for poisonings as long as patient medical outcomes are not compromised.

Acetaminophen↗
PubMed1993

The effect of providing ipecac to families seeking poison-related services.

Although home availability of ipecac is recommended for families with young children in case of unintentional toxic ingestion, fewer than half actually have it. We designed a study to evaluate the efficacy of providing ipecac to families requiring poison-related services. Families (n = 100) contacting the Children's Memorial Hospital (CMH) emergency department (ED)/poison center were enrolled. Baseline general poison knowledge and self-report of ipecac availability were obtained. Ipecac was discussed, and families were mailed general safety and poison information, the ED telephone number, and a coded package of ipecac, with instructions. Approximately three months later a follow-up call was made to determine change in knowledge, access to our ED (or any poison center) phone number, and availability of ipecac. Initially 71% had heard of ipecac, 51% knew what it did, and 47% said they had it. Ninety families were contacted in follow-up, 82 by phone and eight by mail. Eighty-three of 90 (92%) knew what ipecac did (vs 51/100 initially; P < 0.0001). Sixty-eight of 90 (76%) knew the ED or a poison control phone number (vs 39/100 initially; P < 0.0001). Seventy-seven of 82 (94%) reached by phone read the ipecac code number (vs 47/100 initial self-reports of possession; P < 0.0001). The data indicate that providing ipecac to poison service users increases availability in the home for at least three months. Poison service users may be particularly amenable to anticipatory guidance and interventions related to poisoning prevention and preparedness.

Adult↗
PubMed1985

Seasonal variation and recurring peaks of reported poisonings during a 3-year period.

Seasonality of poisonings was studied among 28 692 cases reported during the years 1980-1982 in Finland with special reference to recurring peak months over years. Poisonings predominated in the summer. For all age-groups peaks of envenomations, plant poisonings and pesticide poisonings recurred between June and September. Among children aged 0-6 years, there were in addition recurrent peaks in poisonings by tobacco between June and August, by corrosive agents in September and by vitamins, trace elements and external medicines in October. Among children aged 7-15 years, fertilizer poisonings peaked recurrently in August. Among adults, poisonings by petroleum products peaked recurrently in July and December, psychopharmacologic drugs in July and October, paints, glues and plastics in November, alcohols in December and antimicrobial drugs in August and October. Of all poisonings, 33% occurred in July, August or September in contrast to the expected 25%. Preventive efforts should thus be intensified during the summer.

Adolescent↗
PubMed1978

Establishment of a regional poison center.

Since its inception in 1972, the San Diego Poison Center has made considerable progress towards achieving its goal of developing a poison care system which will decrease incidence, morbidity, and cost of poisonings. A systems approach has been developed to care for patients at all levels of severity. Subregional centers have been identified and linked to the poison center. Education of the region's emergency medical personnel and the public have been actively pursued. Calls to the center have increased from 6829 in 1972 to 25,949 in 1976. Eighty-five percent of poisoning calls in 1976 were managed at home over the telephone. A follow-up call at 24 hours for each case revealed that less than 1% sought additional medical care. The percent of all emergency department visits resulting from poisoning in a tracer group (children under age 12 leaving emergency department asymptomatic) dropped from 6.1% in 1971 to 1.9% in 1976. The percent of hospital admissions due to poisoning in children under 10 years also dropped by 40% between 1971 and 1974. Estimated cost savings to the community by preventing emergency department visits alone each year covers the cost of operation of the poison center itself.

Adolescent↗
PubMed2000

Examining the contribution of infant walkers to childhood poisoning.

Parents frequently utilize baby walkers in their infants of approximately 5-15 mo of age and create opportunities for traumatic accidents. Healthcare professionals have tried to increase awareness of their dangers; despite this, between 1986 and 1991 reported walker-related accidents rose 45%. We determined if walkers were a significant contributor to childhood poisonings and what toxins were encountered most commonly. A 14-mo prospective study in a regional poison information center determined the prevalence of accidental pediatric poisonings in children aged 5-15 mo old who suffered their exposure while in a baby walker. The regional poison information center managed 7.058 poisoning exposures, 2.8% of which occurred while the child was in an infant walker. The mean age was 8.25 mo (range 5-14 mo), with 96% less than 12 mo. Substances involved were: plants 56.7%, cleaning products 9.9%, cosmetics 5.5%, construction supplies 5.0%, cigarettes 4.5%, topicals 4.5%, oral medications 2.0%, chalk 2.0% and miscellaneous 9.9%. The majority (95%) of children were asymptomatic. Infant walkers contributed substantially less to infant poisonings than was anticipated. Despite the innocuous nature of exposures, a vulnerable population was exposed to potential poisons within reach of their grasp. Baby walker injuries are not limited to trauma, and accidental poisonings should be included in the admonitions that accompany their use.

Female↗
PubMed2002

An epidemiological study of poisoning in northern Islamic Republic of Iran.

We examined the causes and mortality of poisoning in the province of Mazandaran. In all, 1751 poisoning cases referred to four main hospitals over a three-year period (1997-2000) were included. More poisoning cases were females (55.5%) than males (45.5%) but the proportional mortality for males was greater than for females (65% versus 35%). The greatest proportion of poisonings occurred between the ages of 16 and 25 years. Most frequent was intentional poisoning, followed by accidental and occupational poisoning. Medicines were the most common cause, followed by chemicals such as pesticides. Poisoning by opiates, aluminium or zinc phosphide, rodenticides, petroleum and ethanol intoxication was also observed. Pesticide poisoning was most frequently fatal.

Accidents↗
PubMed2004

Chemical poisonings among Kraków inhabitants in 1972 and 2002.

The patterns (frequency, poisoning type, toxic agent involved) of adolescent and adult poisonings in Kraków in 1972 and 2002 are presented. The analysis includes data for poisoned patients treated at the Kraków Department of Clinical Toxicology in 2002 and 1972, and all on the spot fatal cases subjected to post-mortem autopsy and toxicological examinations at the Department of Forensic Medicine in both the years. As much as 4116 poisoned cases (males 2722; females 1394) were treated in 2002 compared to 1485 (males 649; females 836) in 1972. There was no substantial difference between a number of poison related fatalities on the spot in years analysed: 126 (males 105; females 21) in 2002 and 122 (males 84; females 38) in 1972. An elevation in poisoning incidence rate per 10,000 of Kraków inhabitants was also noted in 2002 compared to 1972 (54.3 vs. 30.0). A pharmaceuticals (32.9%) followed by CO (18.2%) and mixed pharmaceuticals (16.2%) were mostly involved in poisoning cases in 1972, whereas ethanol (46%), pharmaceuticals (13.2%), pharmaceuticals co-ingested with ethanol (7.8%), narcotics (7.8%), mixed pharmaceuticals (6.7%), and CO (5.2%) were mostly involved in poisoning cases treated in 2002. A mortality rate both concerning only a people who died in hospital or/and those who died on the spot (prior to any treatment) was significantly higher in 1972 compared to 2002.

Adolescent↗
PubMed1984

Comparison of poison control statutes in the United States.

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

Humans↗
PubMed2000

Hyperbaric oxygen for carbon monoxide poisoning.

BACKGROUND: Poisoning with carbon monoxide (CO) remains an important cause of accidental and intentional injury worldwide. Several unblinded nonrandomized trials have suggested that the use of hyperbaric oxygen (HBO) prevents the development of neurological sequelae. This has led to the widespread use of HBO in the management of patients with carbon monoxide poisoning. OBJECTIVES: To assess the effectiveness of hyperbaric oxygen (HBO) compared to normobaric oxygen (NBO) for the prevention of neurologic symptoms in patients with acute carbon monoxide poisoning. SEARCH STRATEGY: We searched MEDLINE (1966-present), EMBASE (1980-present), and the Controlled Trials Register of the Cochrane Collaboration, supplemented by a manual review of bibliographies of identified articles and discussion with recognized content experts. SELECTION CRITERIA: All randomized controlled trials involving non pregnant adults acutely poisoned with carbon monoxide, regardless of severity, with adequate or unclear allocation concealment were examined. Trials with a score of 3 out of 5 or higher on the validity instrument of Jadad were included in the primary analysis. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted from each trial information on the number of randomized patients, types of participants, the dose and duration of the intervention, and the prevalence of neurologic symptoms at follow-up. A pooled odds ratio (OR) for the presence of neurologic symptoms at one month follow-up was calculated using a random effects model. MAIN RESULTS: Six randomized controlled trials were identified. The trials were of varying quality. Three trials employing different doses of NBO and HBO were included in the primary analysis. The severity of CO poisoning was inconsistent between trials. At one month follow-up after treatment, symptoms possibly related to carbon monoxide poisoning were present in 81 of 237 patients (34.2%) treated with HBO, compared with 81 of 218 patients (37.2%) treated with NBO (O.R. for benefit with HBO 0.82; 95% CI 0.41-1.66). REVIEWER'S CONCLUSIONS: There is no evidence that unselected use of HBO in the treatment of acute CO poisoning reduces the frequency of neurological symptoms at one month. However, evidence from the available randomized controlled trials is insufficient to provide clear guidelines for practice. Further research is needed to better define the role of HBO, if any, in the treatment of carbon monoxide poisoning. This research question is ideally suited to a multicentre, randomized, double-blind controlled trial.

Carbon Monoxide Poisoning↗
PubMedDate not supplied

Chloroquine poisoning in Zimbabwe: a toxicoepidemiological study.

Chloroquine is commonly implicated in pharmaceutical poisonings in Zimbabwe. A retrospective hospital record review was performed to describe the epidemiology of chloroquine poisoning compared with that of other medicines. All records of admissions to eight referral hospitals in Zimbabwe due to poisoning with single pharmaceutical agents were collated and separated into those involving either chloroquine or other medicines. Case characteristics were compared and a retrospective cohort study performed to investigate the association of pregnancy with chloroquine overdose. Of 544 cases, antimalarials accounted for the largest proportion of admissions (53.1%), with chloroquine accounting for 96.2% (279 cases) of these. The latter were compared with the remaining 265 cases. The median length of hospital stay for the chloroquine group was significantly lower (1 vs 2 days; P = 0.001) and a greater proportion of patients took chloroquine deliberately (80.3% vs 68.7%; P < 0.05). The mortality rate due to chloroquine poisoning was significantly higher than that of poisoning due to other drugs (5.7% vs 0.7%; P < 0.0001). There was no significant gender bias in mortality. Women of childbearing age admitted with chloroquine poisoning (188 cases) were twice as likely to be found pregnant (relative risk = 2.3, 95% CI = 1.2-4.5) than similar women admitted due to other medicines (157 cases). In conclusion, chloroquine is the most common cause of pharmaceutical poisoning admission at referral hospitals in Zimbabwe. It is normally taken deliberately with significant mortality. In women of childbearing age admitted with chloroquine poisoning, pregnancy should be suspected.

Adolescent↗
PubMedDate not supplied

Analysis of acute adult poisoning in a 6-year period and factors affecting the hospital stay.

Case management of adult patients with acute poisoning in a university-based emergency department to determine the factors that affect duration of hospital stay was assessed. In this survey, data were obtained for the period between January 1, 1997 and December 31, 2002 at the emergency department (ED). Case analyses of 2229 patients older than 14 years of age were reviewed. Of all patients, 725 (32.5%) were male, 801 (35.9%) were younger than 20, and 540 (24.2%) were older than 30 years. Mean ages of patients were 29.3+/-13.2 for the males and 23.8+/-9.6 for the females (P<.001). During the study, the greatest number of patients were admitted in May (11.0%). Suicidal poisoning was the observed etiology in the majority of cases (76.4%). Moreover, the mortality rate due to poisoning was 3.9%. Drug ingestion was the most frequent means of poisoning (59.0%), followed by pesticides (19.0%). The rate of poisoning with multiple drugs has declined over time, whereas the rate owing to psychoactive drugs has increased markedly. The mean length of hospital stay was 2.9+/-1.8 days and the proportion of patients who stayed for longer than 2 days was 44.3%. The mean length of hospital stay was longer for males, those older than 30 years, those who had been poisoned unintentionally, and for confused and unconscious patients and those who had arrived to ED more than 2 hours after the event. This study suggests that morbidity for adult patients with poisoning varied by sex, age, and season. Length of hospital stay was affected by sex, age, arrival time to ED, mode of transport, severity of poisoning, and type of agent.

Adolescent↗
PubMed1977

Failure to elicit conditioned taste aversion by severe poisoning.

In an attempt to assess the universal validity of the conditioned taste aversion (CTA) paradigm, various types of poisoning (UC) were associated with the gustatory CS. Water deprived rats were habituated for two days to the drinking box, where water was available for 15 min. On Day 3, access to the CS (0.1% saccharin 15 min) was followed after 30 min by a sublethal dose of the poison (0.15 M LiCl, 4% body weight; 0.1 M sodium malonate, 1% body weight; pyrrolopyrimidine drug BW 58-271, 15 mg/kg; sodium cyanide 4 mg/kg; sodium iodoacetate 40 mg/kg; sodium fluoride 30 mg/kg; gallamine triethiodide 40 mg/kg). Rats injected with the last drug were maintained under artificial respiration until muscular paralysis disappeared. After 4 days of recovery, water deprivation schedule was resumed on Days 8 and 9. During the retention test on Day 10 saccharin consumption dropped by 60% in the LiCl poisoned rats, but not CTA developed in animals poisoned by pyrrolopyrimidine, gallamine, malonate and cyanide. CTA of intermediate intensity was evoked by iodoacetate and fluoride. The absence of CTA was not due to the amnesic effect of poisoning, since LiCl administration to NaCN poisoned rats produced CTA of usual intensity. It is concluded that CTA is not related to the overall severity of poisoning but rather to the effect of the poison on specific interoceptors.

Animals↗
PubMed2006

Agricultural and horticultural pesticides fatal poisoning; the Jordanian experience 1999-2002.

A prospective autopsy study addressing fatal poisoning with agricultural and horticultural pesticides was undertaken in Jordan over a 4 year period. A total number of 140 deaths occurred during 1999-2002. The mean fatality rate was 0.68 case per 100,000 population and the age range was 2-55 years; mean 28.3 years with male to female ratio 1.03. The largest number of cases occurred in those 20-29 years (n=69, 49.3%) followed by the age group 30-39 years (n=34, 24.3%) and 40-49 years (n=17, 12.1%). Less than 3.0% of the total fatal poisoning was noticed in both children younger than 9 years of age and those in the age group 50-59 years, with no fatal poisoning in adults at the age 60 years and above. At least 64.3% of all pesticide fatalities were due to suicide with male: female ratio (1.37:1). Accidental and homicide poisoning resulted in 24.3% and 7.9% of the total fatalities, respectively; however, only five cases 3.6% of fatal poisoning were due to unknown pesticides. The main pesticide used was carbamates with 110 cases 78.6% followed by organophosphorus 23 cases 16.4%. The study showed that the present legislation on pesticides availability in Jordan failed to reduce the number of fatal pesticides poisoning since the number of fatal pesticides poisoning was increased from 25.3 to 35 cases per year over a 20 years period. Enforcement of a new legislation addressing the availability of agricultural and horticultural pesticides for self-harm, especially carbamates and organophosphorus, is the most important strategy in the long term to prevent fatal pesticides poisoning in Jordan.

Adolescent↗
PubMedDate not supplied

Differences between organophosphorus insecticides in human self-poisoning: a prospective cohort study.

BACKGROUND: Although more than 100 organophosphorus insecticides exist, organophosphorus poisoning is usually regarded as a single entity, distinguished only by the compound's lethal dose in animals. We aimed to determine whether the three most common organophosphorus insecticides used for self-poisoning in Sri Lanka differ in the clinical features and severity of poisoning they cause. METHODS: We prospectively studied 802 patients with chlorpyrifos, dimethoate, or fenthion self-poisoning admitted to three hospitals. Blood cholinesterase activity and insecticide concentration were measured to determine the compound and the patients' response to insecticide and therapy. We recorded clinical outcomes for each patient. FINDINGS: Compared with chlorpyrifos (35 of 439, 8.0%), the proportion dying was significantly higher with dimethoate (61 of 264, 23.1%, odds ratio [OR] 3.5, 95% CI 2.2-5.4) or fenthion (16 of 99, 16.2%, OR 2.2, 1.2-4.2), as was the proportion requiring endotracheal intubation (66 of 439 for chlorpyrifos, 15.0%; 93 of 264 for dimethoate, 35.2%, OR 3.1, 2.1-4.4; 31 of 99 for fenthion, 31.3%, 2.6, 1.6-4.2). Dimethoate-poisoned patients died sooner than those ingesting other pesticides and often from hypotensive shock. Fenthion poisoning initially caused few symptoms but many patients subsequently required intubation. Acetylcholinesterase inhibited by fenthion or dimethoate responded poorly to pralidoxime treatment compared with chlorpyrifos-inhibited acetylcholinesterase. INTERPRETATION: Organophosphorus insecticide poisoning is not a single entity, with substantial variability in clinical course, response to oximes, and outcome. Animal toxicity does not predict human toxicity since, although chlorpyrifos is generally the most toxic in rats, it is least toxic in people. Each organophosphorus insecticide should be considered as an individual poison and, consequently, patients might benefit from management protocols developed for particular organophosphorus insecticides.

Acetylcholinesterase↗
PubMed1992

Treating poisonings: focus on syrup of ipecac.

The awareness of poison prevention is increasing despite an alarming incidence of accidental and intentional poisonings in the United States. During 1990, 72 poison centers throughout the United States, serving a population of 191.7 million, submitted to the American Association of Poison Control Centers data collection system 1,713,462 cases of poisonings, which included 612 deaths. Emetic agents, when used properly, can reduce the extent and severity of improperly ingested medications, selected household products, and other toxic chemicals. The pharmacist can play a valuable role in distributing information about poison control centers, poison prevention, and appropriate treatment of poisonings.

Accidents, Home↗
PubMed2002

Recording acute poisoning deaths.

Recording deaths from acute poisoning/substance abuse is not straightforward. The International Classification of Diseases (ICD), used to code mortality statistics, is aimed towards recording the underlying cause of death such as suicide or drug dependence rather than gathering data on poisoning per se. Despite the inherent difficulties clear trends can be observed from the data available for England and Wales. There have been marked changes in the compounds featuring in suicidal poisoning in the last 35 years reflecting changes in the availability of poisons, notably carbon monoxide and prescription barbiturates. However, although the number of poisoning suicides has decreased in the recent years, suicides from other means have increased in males (suicides in 1999, 75% male), hence there has been little change in the annual total of suicides. There are also striking differences in drug abuse- and volatile substance abuse (VSA)-related deaths between males and females. Drug abuse-related fatal poisoning (83% male, 1979-1999, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) definition which does not include suicide), largely attributable to heroin and methadone, increased markedly during the 1990s, with a sharp rise in deaths attributed to accidental poisoning, although deaths involving methadone are now declining. VSA-related deaths (90% male, 1971-1999, almost entirely accidental deaths), nowadays predominantly from abuse of fuel gases (liquefied petroleum gas, LPG) from, for example, cigarette lighter refills, have declined from a peak in the early 1990s and are now becoming manifest in an older age group. These two latter instances especially provide examples where ICD-derived fatal poisoning data are inadequate and a 'poisons oriented' approach to data collection and analysis is necessary.

Adolescent↗