California Poison Control System Research Articles

Life after Lindane in California: Water Concentrations, Poison Control Calls Drop Following Ban

Vol. 116, No. 3 EnvironewsOpen AccessLife after Lindane in California: Water Concentrations, Poison Control Calls Drop Following Ban Valerie J. Brown Valerie J. Brown Search for more papers by this author Published:1 March 2008https://doi.org/10.1289/ehp.116-a128aCited by:3AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Lindane, a persistent, highly toxic, and bioaccumulative organochlorine insecticide, was used in agriculture and as a topical treatment for human head lice and scabies beginning in the 1940s. As its toxicity became better known, manufacture and use declined in the United States; in 2002, California banned the pharmaceutical use of lindane altogether. According to a new study, that ban appears to have resulted in steep drops in concentrations of lindane in Southern California’s wastewater and a dramatic reduction in calls to the California Poison Control System [EHP 116:297–302; Humphreys et al.].The most common adverse effects of lindane exposure in humans include seizures, dizziness, and headaches. High levels of exposure can be fatal. Although the U.S. Environmental Protection Agency has canceled all registrations for lindane-containing compounds in agriculture, the chemical is still available by prescription as a second-line treatment for head lice in states other than California. Its continued pharmaceutical use raises concerns about its potential presence in wastewater effluent and drinking water.The research team, part of the University of California, San Francisco, Pediatric Environmental Health Specialty Unit, examined historical lindane concentrations in several Southern California water pollution control plants and compared them before and after the ban. To assess the ban’s impact on human exposures, they analyzed lindane-related calls to California’s poison control hotline between 1998 and 2006. They searched the MediCal fee-for-service pharmacy-paid claims database and obtained national data from Verispan, a commercial health industry data tracker, to determine the number of lindane prescriptions issued. The team also conducted a random survey of pediatricians to ascertain both their awareness of the ban and their current treatment preferences for scabies and head lice.In Los Angeles County, the average wastewater concentration of lindane in 1999 was 36 ppt. By 2006, concentrations had dropped to almost undetectable levels throughout California. In 1998, 135 per 100,000 calls to the Poison Control System concerned lindane; by 2006 such calls had declined to 2 per 100,000. Similarly, lindane prescriptions fell from 114,000 in 1997 to 34 in 2002. Medical providers reported few problems using alternative treatments such as pyrethrins.The study authors are encouraged by their findings but note that lindane is still used in many countries, mostly in the developing world, and that every ton of lindane manufactured produces about 9 tons of toxic waste. Although the U.S. Food and Drug Administration has not banned pharmaceutical lindane in the United States, the pesticide is currently under review for inclusion in the Stockholm Convention on Persistent Organic Pollutants, which could eventually lead to a worldwide ban.FiguresReferencesRelatedDetailsCited by Nitoi I, Oncescu T and Oancea P (2013) Mechanism and kinetic study for the degradation of lindane by photo-Fenton process, Journal of Industrial and Engineering Chemistry, 10.1016/j.jiec.2012.08.016, 19:1, (305-309), Online publication date: 1-Jan-2013. Ngueleu S, Grathwohl P and Cirpka O (2013) Effect of natural particles on the transport of lindane in saturated porous media: Laboratory experiments and model-based analysis, Journal of Contaminant Hydrology, 10.1016/j.jconhyd.2013.02.009, 149, (13-26), Online publication date: 1-Jun-2013. Goldust M, Babae Nejad S, Rezaee E and Raghifar R (2013) Comparative trial of permethrin 5% versus lindane 1% for the treatment of scabies, Journal of Dermatological Treatment, 10.3109/09546634.2012.723122, (1-3) Vol. 116, No. 3 March 2008Metrics About Article Metrics Publication History Originally published1 March 2008Published in print1 March 2008 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Case files of the medical toxicology fellowship of the California poison control system—San Francisco: Calcium plus digoxin—More taboo than toxic?

A 68 year old woman with a history of diabetes mellitus presented to the emergency department after experiencing several days of nausea and vomiting. Recorded vital signs included: blood pressure 98/32 mm Hg, heart rate 69 bpm, "normal" respirations, and no fever. Her initial ECG revealed peaked T waves and regular rhythm with no visible P waves. Initial serum electrolytes were notable for a potassium level of 7.7 mmol/L, and a creatinine level of 9.6 mg/dL (849 micromol/L). She was unable to provide a list of her current medications or other medical history. There was no old chart immediately available for comparison.

Outcomes of the California ban on pharmaceutical lindane: clinical and ecologic impacts.

IntroductionThere are increasing concerns over the presence and implications of pharmaceutical agents in water. In 2002, California banned pharmaceutical use of lindane because of concerns about water quality, as lindane treatment for head lice and scabies was found to be a significant factor adversely affecting wastewater quality.ObjectivesIn this article we describe the effects the ban has had on wastewater quality, unintentional exposures, and clinical practice. This is the first time that a pharmaceutical has been outlawed to protect water quality. As such, this ban provides a rare opportunity to evaluate the possible or potential outcomes of future public health interventions aimed at reducing pharmaceutical water contamination.MethodsWe compiled data on lindane in wastewater treatment plant effluent for several large plants in California and one outside of California. Data on exposures to lindane were obtained from records of the California Poison Control System. We assessed the impact on clinical practice via a survey of 400 pediatriciansResultsWastewater treatment plant monitoring showed that lindane declined in California after the ban. Similarly, unintentional exposure calls declined. Most physicians were aware of the ban (81%) and had used lindane previously (61%), but they did not notice any difficulties with the ban (78%).ConclusionsThe California experience suggests that elimination of pharmaceutical lindane produced environmental benefits, was associated with a reduction in reported unintentional exposures, and did not adversely affect head lice and scabies treatment. This ban serves as a model for governing bodies considering limits on the use of lindane or other pharmaceuticals.

Methamphetamine Exposures in Young Children

Methamphetamine abuse is reaching epidemic proportions. As this occurs, the likelihood of accidental poisoning in children increases. We sought to evaluate the presentation, treatment, and outcome of pediatric methamphetamine exposures reported to the California Poison Control System. This is a retrospective review of California Poison Control System records for methamphetamine exposure from 2000 through 2004. All charts of patients identified as younger than 6 years were reviewed and abstracted. The charts of 47 children younger than 6 years were identified and reviewed. Three were coded as minor effects, 3 as major effects, and 16 as moderate effects. The remainder of the charts were not evaluated because of no effect (n = 6), unrelated or confirmed nonexposure (n = 3), or unable to follow (n = 16). The most common presenting symptom was agitation (82%), whereas seizures were documented in only 2 cases (9%). Tachycardia was common (mean heart rate, 171 beats/min; confidence interval [CI], 154-187), whereas blood pressure (BP) (mean systolic BP, 120 mm Hg; CI, 104-136; and mean diastolic BP, 70 mm Hg; CI, 51-88) and rectal temperature (mean, 37.4 degrees C; CI, 36.9-37.9) were slightly elevated compared with normal values. Creatinine was documented in 6 cases and noted as normal in all (0.3IU/L; CI, 0.2-0.4), whereas creatine kinase was documented in 3 charts and elevated in all (mean 1984 IU/L; range, 212-4942 IU/L). Most cases (55%) received benzodiazepines as treatment, although only 2 received activated charcoal. Symptoms persisted for an average of 22 hours (CI, 16.3-27.2). No deaths were reported. In this series of children, methamphetamine exposure was strongly associated with agitation that was successfully treated with benzodiazepines. Tachycardia was common, although hypertension and hyperthermia were not. Laboratory studies were not routinely recorded. The clinical significance of elevated creatine kinase concentrations recorded in 3 children is unclear.

Creatinine Elevation Associated with Nitromethane Exposure: A Marker of Potential Methanol Toxicity

Nitromethane, methanol, and oil are the common components of radio-controlled (R/C) vehicle fuels. Nitromethane can cause a false elevation of serum creatinine concentration as measured by the widely used Jaffe colorimetric method. We gathered data from our poison control system and from previously published case reports to see if a correlation exists between serum methanol concentrations and spuriously elevated serum creatinine concentrations after human exposures to R/C fuel. The California Poison Control System (CPCS) computerized database was queried for all cases of human exposure to R/C vehicle fuel reported between December 1, 2002 and December 1, 2004. Serum creatinine and methanol concentrations were recorded when available, as was the method used to determine serum creatinine. A MEDLINE search was used to obtain previously published cases of human nitromethane exposure associated with falsely elevated creatinine concentrations. During the 2-year period, serum creatinine concentrations were recorded in 7 of 26 R/C fuel exposures (all ingestions), and 6 of these were abnormal (range of 1.9–11.5 mg/dL). In this series, the higher the serum creatinine concentration measured by Jaffe method, the higher the serum methanol concentration. The MEDLINE search yielded data from six previously published case reports on this topic. The data from these case reports seem to follow the trend seen in our case series. These data suggest that a spuriously elevated serum creatinine (by Jaffe method) may have value as an early surrogate marker of methanol poisoning in those who ingest R/C fuel. Also, the degree to which the serum creatinine is elevated may indicate the severity of methanol poisoning.

Increase in Dextromethorphan Abuse Among Adolescents

Emergency Medicine| March 01 2007 Increase in Dextromethorphan Abuse Among Adolescents AAP Grand Rounds (2007) 17 (3): 26–27. https://doi.org/10.1542/gr.17-3-26 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Increase in Dextromethorphan Abuse Among Adolescents. AAP Grand Rounds March 2007; 17 (3): 26–27. https://doi.org/10.1542/gr.17-3-26 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: dextromethorphan, common cold Source: Bryner JK, Wang UK, Hui JW, et al. Dextromethorphan abuse in adolescence. An increasing trend: 1999–2004. Arch Pediatr Adolesc Med. 2006;160:1217–1222; doi:10.1001/arch-pedi.160.12.1217 Dextromethorphan (DXM) has been used as an anti-tussive for many years. It is available as an over-the-counter (OTC) component in many cold and cough medications including both liquid and tablet preparations. Because of its similar pharmacology to phencyclidine and ketamine, DXM in high doses may produce hallucinations and out-of-body experiences.1,2 Other side effects include tachycardia, hypertension, agitation, ataxia, and psychosis. Although DXM abuse has been recognized for several years, there has been a recent increase in abuse by adolescents.3 Researchers from the School of Pharmacy at the University of San Francisco reviewed all DXM cases reported to the California Poison Control System (CPCS) during a 6-year period (January 1, 1999, to December 31, 2004). Data were compared to... You do not currently have access to this content.

Evolving epidemiology of drug-induced seizures reported to a poison control center system

We sought to determine whether or not the causes and consequences of drug-induced seizures have changed in the last decade. We conducted a retrospective review of all calls to the California Poison Control System in 2003 in which seizures occurred in association with poisoning or drug intoxication. We reviewed the poison center chart of each case to determine the drug(s) involved, the type of seizures, and the medical outcome. We compared the cause of reported seizures to that found in previous investigations. 386 cases were evaluated and related to poisoning or drug intoxication. The leading causes of seizures were bupropion (89 cases, 23%), diphenhydramine (32 cases, 8.3%), tricyclic antidepressants (30 cases, 7.7%), tramadol (29 cases, 7.5%), amphetamines (27 cases, 6.9%), isoniazid (23 cases, 5.9%), and venlafaxine (23 cases, 5.9%). Since 1993, there was a statistically significant increase in antidepressant related seizures but a decrease in TCA and cocaine related seizures. In 265 patients (68.6%) only a single seizure was reported, while 3.6% (14 cases) reported status epilepticus. Two-thirds (65.5%) of the cases involved suicide attempts and 14.8% the direct result of drug abuse. There were 7 deaths. Of the 7 deaths, 4 people had significant hyperthermia. There was a statistically significant increased risk of death associated with stimulant exposure. While tricyclic antidepressants, antihistamines, stimulants, and isoniazid remain common causes of drug induced seizures, bupropion, tramadol, and venlafaxine have emerged as common causes of drug-induced seizures for which poison center consultation is requested.

Patterns of Ecstasy-Associated Hyponatremia in California

We describe the clinical characteristics of patients with ecstasy- (3,4-methylenedioxymethamphetamine [MDMA]) associated hyponatremia (serum sodium level <130 mmol/L) reported to the California Poison Control System during a 5-year period and determine whether a sex difference exists among patients with ecstasy-associated hyponatremia and hyponatremia-associated adverse outcomes. We performed a retrospective review of cases involving ecstasy intoxication reported to the California Poison Control System and recorded in its computerized database from January 1, 2000, through October 9, 2005. We excluded cases that did not involve MDMA exposure or in which there were no symptoms or were minimal effects only. Confirmation of exposure to MDMA was based on history of use and, when available, urine toxicology testing results positive for MDMA or amphetamine derivatives. Hyponatremia was defined as a measured serum sodium level less than 130 mmol/L. A total of 1,436 cases potentially involving ecstasy were reported to the California Poison Control System during the 5-year study period, of which 891 were excluded according to the criteria described above. Of the 545 cases that met inclusion criteria, 296 (54.3%) were women and 249 (45.7%) were men. There were 188 cases (34.5%) with a documented serum sodium level, of which 73 (38.8%) reported hyponatremia (Na <130 mmol/L). Of the 73 subjects with hyponatremia, 55 (75.3%) were women and 18 (24.7%) men; of the 115 nonhyponatremic subjects, 50 (43.5%) were women and 65 (56.5%) were men. Among patients with a documented serum sodium level, female sex was associated with increased odds of hyponatremia (odds ratio [OR] 4.0; 95% confidence interval [CI] 2.1 to 7.6). Among women, those with hyponatremia demonstrated increased odds of coma (OR 3.9; 95% CI 1.2 to 12.9), whereas among men, no increased odds of hyponatremia-associated coma were observed (OR 0.8; 95% CI 0.15 to 4.0). Female sex was associated with increased odds of hyponatremia and increased odds of hyponatremia-associated coma among persons with ecstasy intoxication and a documented serum sodium level reported to the California Poison Control System from 2000 to 2005. Multiple potential confounders, including spectrum bias, incomplete laboratory data, and individual differences in study subject characteristics, prevent determination of causality about sex differences in the incidence of ecstasy-associated hyponatremia and its complications.

Trends in γ-Hydroxybutyrate (GHB) and Related Drug Intoxication: 1999 to 2003

To analyze changes in gamma-hydroxybutyrate (GHB) case reporting, we review GHB or congener drug cases reported to the California Poison Control System, comparing these to other data sets. We identified cases from the California Poison Control System computerized database using standardized codes and key terms for GHB and congener drugs ("gamma butyrolactone," "1,4-butanediol," "gamma valerolactone"). We noted California Poison Control System date, caller and exposure site, patient age and sex, reported coingestions, and outcomes. We compared California Poison Control System data to case incidence from American Association of Poison Control Centers and Drug Abuse Warning Network data and drug use prevalence from National Institute for Drug Abuse survey data. A total of 1,331 patients were included over the 5-year period (1999-2003). California Poison Control System-reported GHB exposures decreased by 76% from baseline (n=426) to the final study year (n=101). The absolute decrease was present across all case types, although there was a significant proportional decrease in routine drug abuse cases and an increase in malicious events, including GHB-facilitated sexual assault (P=.002). American Association of Poison Control Centers data showed a similar decrease from 2001 to 2003. Drug Abuse Warning Network incidence flattened from 2001 to 2002 and decreased sharply in 2003. National Institute for Drug Abuse survey time trends were inconsistent across age groups. Based on the precipitous decrease in California Poison Control System case incidence for GHB during 5 years, the parallel trend in American Association of Poison Control Centers data, and a more recent decrease in Drug Abuse Warning Network cases, a true decrease in case incidence is likely. This could be due to decreased abuse rates or because fewer abusers seek emergency medical care. Case reporting may account for part of the decrease in the incidence of poison center contacts involving GHB.

Dietary supplement-related adverse events reported to the California Poison Control System

Dietary supplement (DS)-related adverse events (AEs) reported to the California Poison Control System (CPCS) were studied. The CPCS database was used to search for all telephone calls from consumers concerning DS-related AEs received during the six-month period between April and September 2002. The calls were characterized according to the substance involved, the caller's age (adult or pediatric), and the type of ingestion (accidental or intentional). Each exposure in which symptoms were reported was categorized as involving an AE. Each AE was assessed for severity and causality. Data on a total of 1183 telephone calls were retrieved, of which 828 calls (70%) met the study's inclusion criteria. DS exposure occurred in 389 adults (47%) and 438 children (53%). DS ingestion was accidental in 360 patients (43%) and intentional in 467 patients (56%). Exposure resulted in an AE in 480 patients (58%). AEs were reported in 353 patients (74%) who ingested products containing ephedra; other exposures frequently involved zinc, kava, creatine, and valerian. AEs were classified as moderate in 198 patients (41%) who ingested a DS and as severe in 40 patients (8%). One patient had a fatal reaction. Among the 480 AEs in DS-exposed consumers, the DS was classified as the definite cause of 1 AE (<1%) and a probable cause of 237 (49.4%). The most frequently reported AE symptoms were increased heart rate (45%), agitation (30%), vomiting (30%), and nausea (15%). A majority of DS-related AEs reported by consumers to CPCS involved ephedra-containing products.

Regional variations in the use and awareness of the California Poison Control System.

To investigate regional variations in public awareness and utilization of the services of Poison Control Centers (PCC) before and after an intervention. This study examines call rates of different California regions based on the final five regional PCCs prior to the consolidation of these services under a single statewide California Poison Control System (CPCS) and interventions to increase utilization. Awareness surveys were performed before and after a media campaign that was directed primarily to the Los Angeles basin and to a lesser extent other high Hispanic concentration areas. Focus groups were also utilized to better define specific areas of poison knowledge and awareness of CPCS services. Large differences in regional California call rates were seen, with the Los Angeles basin showing the lowest utilization of CPCS services compared with the rest of California. Significant seasonal variation in utilization was also found, with the highest average call rates observed in August and the lowest in February. Focus groups demonstrated that urban awareness of PCC was lower than suburban awareness, particularly in monolingual Hispanic households. An improvement was seen after the institution of a media education campaign that included use of Spanish language material and radio spots. Similar increases in call rates were also seen in Fresno county category, with a higher percentage of Hispanic population that was not as aggressively targeted by the awareness campaign. Significant regional variations in CPCS call rates were found and an increased awareness and utilization was seen in the Los Angeles basin after a directed media campaign compared with most areas of California. Further efforts to increase CPCS utilization in the Los Angeles region, primarily among urban monolingual Hispanics, are needed.

Characterizing Adverse Events Reported to the California Poison Control System on Herbal Remedies and Dietary Supplements

Characterizing Adverse Events Reported to the California Poison Control System on Herbal Remedies and Dietary Supplements

An evaluation of selected herbal reference texts and comparison to published reports of adverse herbal events.

There has been a recent proliferation of medical reference texts intended to guide practitioners whose patients use herbal therapies. We systematically assessed six herbal reference texts to evaluate the information they contain on herbal toxicity. We selected six major herbal references published from 1996 to 2000 to evaluate the adequacy of their toxicological information in light of published adverse events. To identify herbs most relevant to toxicology, we reviewed herbal-related calls to our regional California Poison Control System, San Francisco division (CPCS-SF) in 1998 and identified the 12 herbs (defined as botanical dietary supplements) most frequently involved in these CPCS-SF referrals. We searched Medline (1966 to 2000) to identify published reports of adverse effects potentially related to these same 12 herbs. We scored each herbal reference text on the basis of information inclusiveness for the target 12 herbs, with a maximal overall score of 3. The herbs, identified on the basis of CPCS-SF call frequency were: St John's wort, ma huang, echinacea, guarana, ginkgo, ginseng, valerian, tea tree oil, goldenseal, arnica, yohimbe and kava kava. The overall herbal reference scores ranged from 2.2 to 0.4 (median 1.1). The Natural Medicines Comprehensive Database received the highest overall score and was the most complete and useful reference source. All of the references, however, lacked sufficient information on management of herbal medicine overdose, and several had incorrect overdose management guidelines that could negatively impact patient care. Current herbal reference texts do not contain sufficient information for the assessment and management of adverse health effects of botanical therapies.

Delayed valproic acid toxicity: A retrospective case series

Study Objective: We estimate how often an initially undetectable or nontoxic valproic acid (VPA) concentration misrepresents the potential toxicity of an acute VPA overdose. Methods: All patients followed up by the San Diego and San Francisco Divisions of the California Poison Control System between January 1997 and June 1999 with a documented serum VPA concentration of 120 μg/mL or greater at any time were identified through a search of poison center databases. Cases involving patients who had serial VPA concentrations and an initial VPA concentration that was unmeasurable or less than 100 μg/mL were also identified. The methods of decontamination, clinical outcomes, highest measured concentration, and times after ingestion of the initial and highest measured concentration of VPA were determined by means of chart review for these cases. Results: Of the 173 patients identified with VPA concentrations of 120 μg/mL or greater, 21 (12.1%) had a detectable initial concentration not in the toxic range, and 5 (2.9%) had initial concentrations of less than the limit of detection. These 26 cases involved acute ingestion of VPA preparations. Four of these 26 patients were discharged to home or to a psychiatric facility after the initial results were obtained. Conclusion: Delayed toxicity might occur in patients after an acute overdose of enteric-coated VPA. Initial serum VPA concentrations might be misleading. Serial measurements documenting declining VPA concentrations or prolonged observation are recommended to determine whether a patient is medically safe for discharge or psychiatric placement. [Ingels M, Beauchamp J, Clark RF, Williams SR. Delayed valproic acid toxicity: a retrospective case series. Ann Emerg Med. June 2002;39:616-621.]

Characterizing Adverse Events Reported to the California Poison Control System on Herbal Remedies and Dietary Supplements

The purpose of this study was to (1) characterize the population who uses and reports adverse events to the California Poison Control System (CPCS) related to herbal remedies (HR) and dietary supplements (DS), (2) to assess whether adverse drug reactions (ADRs) occur within the usual recommended dosing, and (3) to describe the nature of adverse events. A retrospective search of HR and DS related calls was conducted between January 1997 and June 1998. Data collection included the demographics of callers, types of exposures, substances involved, amounts ingested and severity. Of the 918 HR and DS calls received, 259 (28.2%) were drug information queries, 599 (65.3%) were exposures, and 60 (6.5%) were excluded. Exposures occurred most often in pediatric patients 324 (54.1%), but exposures resulting in ADRs occurred most often in adults at recommended doses. There were 233 ADRs, of which 67 (28.8%) occurred in children. The most common products involved in ADRs were zinc (38.2%), echinacea (7.7%), chromium picolinate (6.4%) and witch hazel (6%). Severity of ADRs required no treatment or was minor in a majority of cases, but may have contributed to hospitalization in three. Children were involved in a majority of exposure calls to the CPCS involving HR and DS. Adults, however, were more likely to develop an ADR from these products due to intentional exposure. Overall, the ADRs caused by HR and DS were mild, could be managed at home and rarely resulted in a severe outcome or other sequelae. Products involved in ADRs were consistent with the most common HR and DS products used by adult U.S. consumers.

Abuse of Coricidin HBP cough & cold tablets: episodes recorded by a poison center.

Cases involving ingestion of a dextromethorphan-containing product recorded at a poison control center were studied. A retrospective review of all consultations involving the ingestion of Coricidin HBP Cough & Cold tablets recorded by the California Poison Control System was conducted for the period from January 1 to October 1, 2000. Computerized charts on the consultations were reviewed to obtain data on patient age and sex, number of tablets taken, reason for tablet ingestion, symptoms, treatment, disposition, and outcome. A total of 92 charts (for 92 patients) documenting Coricidin HBP Cough & Cold tablet ingestion were reviewed. The reason for tablet ingestion was classified as abuse in 65 patients (71%), a suicide attempt in 8 (9%), misuse in 1 (1%), malicious administration in 1 (1%), and normal use (but with an adverse drug reaction) in 1 (1%); 16 patients (17%) consumed the tablets for an unknown reason. The 92 patients comprised 42 males and 50 females. Among all patients, 78 (85%) were 13-17 years old, and among those classified as having abusive intent, 58 (89%) were in the same age range. The most commonly reported signs and symptoms associated with ingestion were tachycardia (50 patients), hypertension (29), lethargy (40), mydriasis (20), agitation (15), ataxia or dizziness (20), and vomiting (9). Sixty-one patients (66%) had some alteration in mental status. Fifty-six (61%) were treated in the emergency department; 11 (12%) were admitted. All patients recovered completely. Information on the ingestion of Coricidin HBP Cough & Cold tablets recorded at a poison control center indicated a high rate of abuse of the product among teenagers.