Circumstances of Accidental Poisoning in Childhood

Of 377 children with accidental poisoning, the commonest ages were 1, 2, and 3. The most important contributory factor was that the poison was kept in an inappropriate place. Most containers were closed, but the children found them easy to open. In some cases the container itself was unsuitable for the contents.The frequency of poisoning in childhood might be reduced in six main ways: (1) a reduction in the quantity of drugs kept in the home; (2) the provision of drug cupboards; (3) the provision of containers that are difficult for children to open, or individually foil-wrapping tablets; (4) making tablets less attractive to children; (5) clear identification of potential poisons; and (6) increasing parental awareness of the circumstances under which poisoning occurs.A plea is made for further sociomedical research into the prevention of poisoning.     

儿童意外吸入磷化铝中毒55例临床分析及文献

目的:分析儿童意外吸入磷化铝中毒的临床特点、治疗方法及死亡原因。方法:对本院儿科2014年5月～2018年8月收治的55例意外吸入磷化铝中毒患者进行回顾性分析,根据病情严重程度将其分为轻度(31例)和重度(14例),统计患儿的年龄、性别、发病季节、中毒吸入时间、中毒就诊时间、临床症状、实验室及心电图检查。结果:55例吸入磷化铝中毒患儿中,死亡10例,存活45例,死亡患者均为重度中毒者,死亡原因为循环衰竭。轻度中毒毒素吸入时间平均为25.1 h,中毒后平均就诊时间14.6 h;重度中毒毒素吸入时间平均为185.4 h,中毒后平均就诊时间38.5 h;临床表现为恶心呕吐55例(100%),头晕、面色苍白14例(25%),心悸16例(29%),呼吸衰竭14例(25%),严重的心律失常8例(14.5%),低血压、心源性休克10例(18%);心电图检查:室上性心动过速1例,室性心动过速4例,II度II型房室传导阻滞1例,窦性心律不齐5例,窦性心动过速26例;实验室检查中心肌酶升高19例(34.5%);肝功能异常12例(21.8%);肾功能异常6例(10.9%);代谢性酸中毒14例(25%)。治疗上主要为对症支持治疗。结论:儿童意外吸入磷化铝中毒以重度中毒病例死亡率高,多为循环衰竭所致,目前无特效解毒药物,早期诊断和早期综合性治疗尤为重要。     

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.     

Effects of a major earthquake on calls to regional poison control centers.

We retrospectively evaluated the effect of the Loma Prieta earthquake on calls to 2 designated regional poison control centers (San Francisco and Santa Clara) in the area. In the immediate 12 hours after the earthquake, there was an initial drop (31%) in call volume, related to telephone system overload and other technical problems. Calls from Bay Area counties outside of San Francisco and Santa Clara decreased more dramatically than those from within the host counties where the poison control centers are located. In the next 2 days, each poison control center then handled a 27% increase in call volume. Requests for information regarding safety of water supplies and other environmental concerns were significantly increased. The number of cases of actual poisoning exposure decreased, particularly poison and drug ingestions in children. Most calls directly related to the earthquake included spills and leaks of hazardous materials and questions about water and food safety. Regional poison control centers play an essential role in the emergency medical response to major disasters and are critically dependent on an operational telephone system.     

Boric Acid Poisoning: Report of 11 Cases

Boric acid poisoning in 11 infants, occurring in the newborn nursery as a result of the accidental and inadvertent use of 2.5% boric acid in the preparation of the formulae, is reported. Five of the infants died. All except two exhibited the classical symptomatology of acute boric acid poisoning, namely, diarrhea, vomiting, erythema, exfoliation, desquamation of the skin, and marked central nervous system irritation. Early manifestations of poisoning were nonspecific, and one patient died before skin manifestations were noted. Peritoneal dialysis, instituted in nine cases, was found to be the most effective method of treatment. It is recommended that boric acid, which is of doubtful therapeutic value, should be completely removed from hospitals, dispensaries and pharmacopoeias.     

Phenothiazine Poisoning A Review of 48 Cases

Of 48 cases of phenothiazine poisoning that were analyzed, 34 were attributed to suicide attempts, nine to accidental ingestion, and five to drug reactions.As outpatient treatment of schizophrenia increases, cases of over-dose with phenothiazine drugs may be expected to increase also.The prescribing of multiple phenothiazines and antidepressants is probably contributory to the occurrence of mixed drug ingestions.The symptoms and signs of phenothiazine poisoning are largely predictable if the atropine-like, alpha-blocking, quinidine-like, and extrapyramidal actions of phenothiazines are appreciated. Unexplainable tachypnea and paradoxical miosis were noted in severe cases.In one case in the study phenothiazine intoxication was present in the newborn infant of a schizophrenic mother.     

Baseline Knowledge of Potential Pet Toxins among the US General Public

In 2014, the American Society for the Prevention of Cruelty toAnimals Animal Poison Control Center fielded more than 167,000cases of potential nonhuman animal toxicosis. Concomitantly, thereremain limited free and reputable veterinary toxicology resourcesavailable for companion-animal (pet) caregivers (owners) seekingassistance and advice about potentially harmful exposures inanimals. The objective of this study was to assess pet toxicantknowledge among a representative sample of Americans andgauge the need for additional toxicology resources. The studyinvolved a survey designed to capture participants’ ability to identifypotential animal toxicants and what resource they would use ifan accidental toxic ingestion occurred. Participants were ableto correctly identify 52% of potential pet toxins. Women, olderparticipants and participants from the South expressed moreconcern about each potential pet poison. Approximately halfof participants indicated they would consult a veterinarian andwhereas most others indicated they would search the Internet formore information about pet toxicology. The findings suggest moreveterinary poisoning education is needed for pet owners to be ableto accurately distinguish potential pet toxicants from nontoxicants.     

Accidental poisoning deaths in British children 1958-77.

In the 20 years 1958-77 598 deaths were registered as due to accidental poisoning in British children under the age of 10-343 boys and 255 girls. Drugs caused 484 deaths, non-medicinal products 111, and plants three. The annual number of deaths reached a peak in 1964 but fell steadily thereafter; 16 deaths occurred in 1977. After 1970 tricyclic antidepressants replaced salicylates as the most commonly fatal poison. The next ten drugs most often recorded in 1970-7 were, in order, opiates (including diphenoxylate/atropine (Lomotil)), barbiturates, digoxin, orphenadrine (Disipal), quinine, potassium, iron, fenfluramine (Ponderax), antihistamines, and phenothiazines. In 20 years paracetamol caused one death, and before 1976 deaths caused by aspirin had fallen to fewer than two a year. Thus the introduction in 1976 and 1977 of safety packaging of these drugs can be expected to have little impact on the mortality from them in childhood.     

Survival of brown kiwi (

Brown kiwi (Apteryx mantelli) in central Northland have been monitored for up to 32 months of sustained exposure to brodifacoum poison. The cereal baits were placed in bait stations to target brushtail possums (Trichosurus vulpecula). Annual survival of 55 radio-tagged adult kiwi in two poisoned forest patches has been high (95.9%), and similar to that in two nearby unpoisoned forest patches and in the patches before poison was used (95.3%). The two adult birds tested of the four that died in the poisoned areas had no traces of brodifacoum at the detection limit of 0.05 mg kg(-1). With an improved detection limit of 0.02 mg kg(-1), no traces of brodifacoum were found in nine eggs collected over 18 months after adults were first exposed to the poison. Of four chicks tested (detection limit: 0.005 to 0.02 mg kg(-1)), that had apparently died of natural causes or were killed by predators, three contained traces of brodifacoum (0.01—0.18 mg kg(-1)). The median survival of 39 radio-tagged chicks in the poisoned areas (36 days) was significantly better than that of 18 chicks in untreated areas nearby (15 days). Kiwi chicks may be more vulnerable than adult kiwi to accidental poisoning because of physiological or behavioural differences; however, the effects of sustained exposure to low levels of brodifacoum poison may not be visible in the adult population for several years. At this stage of the ongoing study, the benefits to kiwi of this method of pest control outweigh the costs, because chick survival is greatly improved.     

Pitfalls in cardiology: myocardial ischaemia in carbon monoxide poisoning

Carbon monoxide poisoning is a major cause of morbidity and mortality worldwide. Immediate and proper treatment is crucial for prognosis and is merely dependent on accurate diagnosis. However, correct diagnosis can be difficult due to the aspecific symptomatology in CO poisoning. In this report a case is discussed in which a patient with accidental CO poisoning presented primarily with syncope, extensive ECG changes and elevated troponin levels. In addition, a limited review of the current literature is provided.     

Poisoning and poison control centres in Canada.

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

洗胃术在抢救急性口服毒物中毒中的应用研究进展

洗胃在我国仍是抢救急性口服毒物中毒的重要措施,口服毒物中毒是生活中误服或有意自服而发生的中毒,是医院急诊科最常见的急症之一,它的发病时间与药物浸入的途经、毒性、剂量等有关。口服毒物中毒,情况紧急严重,若抢救不及时、治疗不当和观察护理不到位,可危及生命,而彻底清除胃肠毒物是抢救口服毒物中毒成功的关键。洗胃用物的合理选择,洗胃液的正确使用以及洗胃方法的不断改进是抢救成功的重要保证。     

Patterns and Trends in Accidental Poisoning Deaths: Pennsylvania’s Experience 1979-2014

IntroductionThe purpose of this study was to examine county and state-level accidental poisoning mortality trends in Pennsylvania from 1979 to 2014.MethodsCrude and age-adjusted death rates were formed for age group, race, sex, and county for accidental poisonings (ICD 10 codes X40-X49) from 1979 to 2014 for ages 15+ using the Mortality and Population Data System housed at the University of Pittsburgh. Rate ratios were calculated comparing rates from 1979 to 2014, overall and by sex, age group, and race. Joinpoint regression was used to detect statistically significant changes in trends of age-adjusted mortality rates.ResultsRate ratios for accidental poisoning mortality in Pennsylvania increased more than 14-fold from 1979 to 2014. The largest rate ratios were among 35–44 year olds, females, and White adults. The highest accidental poisoning mortality rates were found in the counties of Southwestern Pennsylvania, those surrounding Philadelphia, and those in Northeast Pennsylvania near Scranton.ConclusionsThe patterns and locations of accidental poisoning mortality by race, sex, and age group provide direction for interventions and policy makers. In particular, this study found the highest rate ratios in PA among females, whites, and the age group 35–44.     

Methadone poisoning due to accidental contamination of prescribed medication.

Two infants presented with fever and signs of brainstem dysfunction, including impaired consciousness, miosis, absence of oculocephalic responses, respiratory depression and a very peculiar tremor of the tongue and floor of the mouth. They were found to have methadone poisoning caused by accidental contamination of prescribed antibiotics in the same pharmacy, which was a dispensing centre for a methadone maintenance program. They recovered with supportive treatment only.     

Child-resistant containers: are we kidding ourselves?

A 20-month-old child was accidentally poisoned after biting through the bottom of a medicine container and ingesting the tablets inside. Consequently a study was carried out to determine the force required to fracture 20 randomly selected 25 and 32 ml polystyrene containers to see whether this exceeded the bite force of a child''s jaw. Tests were performed at displacement rates of 0.5 and 10 cm/min. All the containers failed at well below the bite force recorded for children, which is 392 N. All containers must conform to a British Standards test that requires that they withstand a force of only 35 N. Clearly this is not enough to safeguard small children. The use of polystyrene containers should be scrutinised closely, as the case of accidental poisoning reported may not be unique.     

A note on wildlife poisoning cases from Kerala,South India

Wildlife poisoning is an important conservation threat for endangered species in India. There are no publications in the scientific literature that identify the specific poisons or chemicals involved in wildlife poisoning cases from the state of Kerala. In this report, all cases of wildlife mortality recorded between 2011 and 2013 at the office of the Assistant Forest Veterinary Officer, Periyar Tiger Reserve in Kerala were reviewed and cases where poisoning was considered as a differential diagnosis were identified. Specific poisons or chemicals were identified in three cases, while in a fourth, poisoning was determined to have occurred based on physical traces of the poison in gut contents. The poisons identified include carbofuran (a carbamate pesticide) in a bonnet macaque (Macaca radiata), warfarin (a rodenticide) in a mortality event involving four wild boars (Sus scrofa), endosulfan (an organochlorine pesticide) toxicity in a gaur (Bos gaurus) and imidacloprid (a neonicotinoid pesticide) toxicity in a wild adult Asian elephant (Elephas maximus). This communication thus reports for the first time on the specific chemical compounds identified in wildlife poisoning cases from Kerala state and argues for greater regulation of the sale and use of such toxic compounds in India.     

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.