National Poison Center Research Articles

Revolutionising pesticide detection: a high-sensitivity electrochemical sensor with CdS/g-C3N4/MWCNTs for paraquat monitoring

ABSTRACT Over a decade, the Malaysia National Poison Centre found that 40% of pesticide poisoning cases may be linked to excessive paraquat (PQ) in water, soil, or food, underscoring the widespread impact on public health and emphasising the importance of detecting even trace amounts of PQ residues in the environment. Thus, this study presents a novel electrochemical sensor based on multiwalled carbon nanotubes (MWCNTs) reinforced cadmium sulphide co-anchoring on graphitic carbon nitride (CdS/g-C3N4) nanocomposites for PQ detection. The CdS/g-C3N4 nanocomposite was successfully synthesised and characterised through FTIR, XRD, EDX, FESEM and TEM analysis. The modified electrode (CdS/g-C3N4/MWCNTs PE) exhibited improved electrocatalytic activity, as demonstrated by cyclic voltammetry (CV) and impedance spectroscopy. The CdS/g-C3N4/MWCNTs PE displayed a high CV peak and low Rct value which corresponded to a higher electron transfer rate, reduced charge transfer resistance and enhanced mass transport properties. The electrochemical sensor’s performance was evaluated for the detection of PQ, and it demonstrated a linear response in a range of 1.0 µM to 0.1 mM with a limit of detection of 0.14 μM. Furthermore, the sensor exhibited selectivity with a less than 16% potential interference from various organic chemicals and inorganic ions. The sensor’s applicability was tested by quantifying PQ in real water samples, showing excellent recovery percentages ranging from 98.9% to 102.0%. The developed electrochemical sensor provides a practical solution for the rapid and accurate monitoring of PQ levels in the environment. This work establishes the foundation for the development of a selective electrochemical sensor for pesticide analysis, addressing both public health and environmental concerns.

A PROFILE OF POISONING CASES IN MALAYSIA CAUSED BY HOUSEHOLD CHEMICAL PRODUCTS: 14 YEARS OF REPORTED CASES TO THE NATIONAL POISON CENTRE

The increase in chemical product manufacturing in Malaysia contributed to an expanding array of commercialised household chemical products (HCP). These products, after pesticides and pharmaceuticals, rank among the top three poison reagents listed by the Malaysia National Poison Centre. This study conducts a retrospective review of HCP poisoning admissions to the NPC over a 14-year period, aiming to evaluate the HCP poisoning rates in Malaysia. The database of HCP poisoning exposure calls received by the NPC from 2006 to 2020 was analysed and discussed. State profiles and populationbased incidence rates revealed 15,381 HCP poisoning cases. Household cleaning products emerged as the predominant poison reagent (53%) during the study period, followed by solvents and cosmetic/personal care items. The increase in poisoning cases by these products coincided with the spread of the COVID-19 disease. West Coast states (Selangor and Perak) reported higher poisoning exposures compared with East Coast states (Kelantan and Terengganu), with urbanisation appearing to play a role in the disparity of HCP poisoning cases among states. The study recommends intensified prevention efforts and enforcement of HCP poisoning regulations as a fundamental step towards developing national poisoning preventive strategies.

Trends in the Intentional and Non-intentional Poisoning-related Calls among Adolescents Reported to the Malaysia National Poison Centre (2010-2020)

Trends in the Intentional and Non-intentional Poisoning-related Calls among Adolescents Reported to the Malaysia National Poison Centre (2010-2020)

Phytochemical Compounds of Raw Versus Methanol-Extracted Kelulut, Tualang, and Manuka Honeys.

Honey has been widely used for medicinal purposes since ancient times. It is produced by stinging bees or stingless bees by processing the collected nectar or plant sap in their bodies into raw honey. Extraction of honey will result in the pooling of crude volatile bioactive materials that could enhance its benefits. This work aims to compare the phytochemical characteristics of raw and methanol-extracted honeys in the Kelulut, Tualang and Manuka honeys. All types of raw honey samples were extracted by using the methanol extraction method and both groups were analysed using gas chromatography/mass spectrometry (GC/MS) at the National Poison Centre, Universiti Sains Malaysia, Malaysia. The findings showed that 23 compounds were identified in raw Kelulut honey and 18 compounds in methanol-extracted Kelulut honey; 28 compounds were identified in raw Tualang honey and 29 compounds in methanol-extracted Tualang honey; 19 compounds in raw Manuka honey and 22 compounds in methanol-extracted Manuka honey. There were differences in the phytochemical substances detected in raw and methanol-extracted honeys. The major compounds in raw honeys were mostly from the ketone, alcohol, and ester groups, whereas the ketone group was dominant in methanol-extracted honeys. Most bioactive substances identified in the methanol-extracted variant of honeys were more concentrated than the raw variant. A majority of these substances have antimicrobial characteristics.

Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper.

Magnet ingestion is a special category of foreign body ingestion associated with high levels of morbidity and mortality worldwide, particularly if it is associated with staggered ingestion of multiple magnets or with simultaneous ingestion of other metallic foreign bodies, especially button batteries. A special category of magnet ingestion is the ingestion of earth magnets, which have higher levels of magnetism and therefore, potentially, carries a worse outcome. Legislative bodies, scientific Societies and community-led initiatives have been implemented worldwide with the aim of mitigating the effects of this growing, yet avoidable potential medical emergency. A scoping literature review summarized epidemiology, diagnosis, management, and prevention, including an algorithm for the diagnosis and management of magnet ingestion is presented and compared to previously published reviews and position papers (North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, National Poison Center, Royal College of Emergency Medicine). The main emphasis of the algorithm is on identification of staggered/multiple magnet ingestion, and early joint gastroenterology and surgical consultation and management.

A retrospective analysis of therapeutic drug exposures in New Zealand National Poisons Centre data 2018–2020

ObjectiveThe New Zealand National Poisons Centre advises the general public and health professionals on management of exposures to various substances. The epidemiology of medicine exposures was used to characterise inappropriate use of medicines across age groups. MethodsData from contacts in 2018–2020 were analysed: patient demographics (age, gender), number of therapeutic substances, and advice given. The most frequent individual therapeutic substance exposures across age groups and the reasons for these occurring were determined. ResultsA total of 76% of children’s (aged 0–12 or unknown child) exposures were exploratory in nature, involving a variety of medicines. Youth (aged 13–19) had frequently engaged in intentional self-poisoning (61% of their exposures), and most commonly by exposure to paracetamol, antidepressants, and quetiapine. Adults (aged 20–64) and older adults (aged 65 and over) were frequently affected by therapeutic errors (50% and 86% of their exposures, respectively). Adults were most frequently exposed to paracetamol, codeine, tramadol, antidepressants, and hypnotics, while older adults were exposed to paracetamol and various cardiac medications. ConclusionsTypes of inappropriate medicine exposures vary in different age groups. Implications for public healthPoisons centre data add to pharmacovigilance monitoring of potential harm from medicines and inform medication safety policies and interventions.

Specialist medical toxicologist consultations provided by the New Zealand National Poisons Centre, 2018-2020.

The National Poisons Centre (NPC) provides 24/7 specialist medical toxicologist consultations to healthcare professionals regarding the clinical management of poisoning cases. The use of toxicologist services was investigated to characterise the extent and content of consults to inform further development of this service. A retrospective analysis of 2018-2020 medical toxicologist consultations summarised contact numbers, professional backgrounds and district health boards (DHBs) of the people contacting the NPC, and the patient(s) and substance(s) involved. There were 3,451 medical toxicologist consultations with 2,400 (67%) provided directly to healthcare professionals. Crude rates of consults increased across all DHBs. Of all 2,603 therapeutic substances that were consulted about during the study period, 1,492 (57.3%) were drugs affecting the nervous system, and paracetamol was the most common individual drug (528; 20.3%). Of all 1,185 non-therapeutic substance exposures that were advised on, 66 (5.6%) were unidentified mushrooms, 51 (4.3%) unidentified substances, and 47 (4.0%) lead exposures. There was increasing utilisation of the NPC service by healthcare professionals from all 24 areas of the country, covering a wide range of substance exposures and scenarios. The growing utilisation suggests healthcare professionals derive value from this consultation service for the care of their patients.

Synthetic cannabinoid poisonings and access to the legal cannabis market: findings from US national poison centre data 2016–2019

Aim To investigate trends in synthetic cannabinoid exposures reported to United States (US) poison control centres, and their association with status of state cannabis legalisation. Methods A retrospective study of National Poison Data System (NPDS) data from 2016 to 2019 identified and associated synthetic poisoning reports with annual state cannabis law and market status. State status was categorised as restrictive (cannabis illegal or limited medical legalisation), medical (allowing THC-containing medical cannabis use) and permissive (allowing non-medical use of THC-containing cannabis by adults). We categorised a subset of states with permissive policies by their implementation of legal adult possession/use and opening retail markets, on a quarterly basis. Mixed-effects Poisson regression models assessed synthetic exposures associated with legal status, first among all states using annual counts, and then among states that implemented permissive law alone using quarterly counts. Results A total of 7600 exposures were reported during the study period. Overall, reported synthetic exposures declined over time. Most reported exposures (64.8%) required medical attention, and 61 deaths were documented. State implementation of medical cannabis law was associated with 13% fewer reported annual exposures. Adoption of permissive state cannabis policy was independently and significantly associated with 37% lower reported annual synthetic exposures, relative to restrictive policies (IRR: 0.63, 95% CI: 0.50–0.79). Among states with permissive law during the period, implementation of legal adult possession/use was associated with 22% fewer reported quarterly exposures. Opening of retail markets was associated with 36% fewer reported exposures, relative to states with medical cannabis only. Conclusions Adoption of permissive cannabis law was associated with significant reductions in reported synthetic cannabinoid exposures. More permissive cannabis law may have the unintended benefit of reducing both motivation and harms associated with use of synthetic cannabis products.

Opioid sales and opioid-related poisonings in Switzerland: A descriptive population-based time-series analysis.

SummaryBackgroundTo examine time trends and characteristics of calls related to opioid poisonings reported to the National Poison Centre and opioid sales in Switzerland.MethodsWe used population-level data from the Swiss National Poisons Information Centre on reported opioid-related poisonings and data provided by the Swiss Pharmacists’ Association (pharmaSuisse) based on IQVIA data to identify sold opioid packages. The rate of opioid-related poisoning calls and dispensed opioid packages per 100,000 Swiss inhabitants between 2000 and 2019 were plotted by year and annual trends were assessed. All analyses were stratified by individual opioid and potency (strong vs weak).FindingsThere was a significant 177% increase in the rate of calls for opioid-related poisonings (1·4 to 3·9 per 100,000 inhabitants, p<0·001) and a 91·3% increase in opioid sales (from 14,364·0 to 27,477·6 per 100,000 inhabitants, p<0.001). The increase associated with strong opioids was higher when compared to weak opioids, in both poison centre calls and sales. In 2019, tramadol was the most frequently reported opioid in the poison centre data (35·7%, n=133) and sales (37·5%, n=8,863,377), followed by oxycodone calls (24·4%, n=91) and sales 23·4%, n= 552,751). Poisoning calls and sales related to oxycodone increased substantially between 2009 and 2016, as did the rate of poison centre calls requiring medical care.InterpretationCalls to the Swiss National poison centre and sales for opioid have increased substantially in Switzerland in the last two-decades. Increases were primarily driven by oxycodone and tramadol; however, sales have attenuated since 2016. Our findings mirror other European countries and stress the importance of surveillance and monitoring.FundingThe research did not receive external funding. Translation of the abstract in German, French and Italian are available in the Supplementary section.

Trends Over 2 Decades in Adolescent Suicidal and Recreational Ingestions of Over-the-Counter Coricidin Preparations.

The aim of this study was to assess national trends in recreational and suicidal ingestions of over-the-counter cough preparations that contain Coricidin. Using the American Association of Poison Control Center's National Poison Data System, we obtained data from 2004 to 2017 on patients aged 13 to 19 years with an ingestion of "Coricidin." We examined trends over time overall and ingestion intent (recreational vs suicidal) using linear regression. We compared patient characteristics, substances ingested, clinical effects and therapies, and outcomes by suicidal versus misuse or recreational intention. An initial search with the inclusion criteria found 19,213 calls that matched study inclusion criteria. On average, there was a yearly linear increase of 180.0 (95% confidence interval [CI], 136.6-223.3; P < 0.01) ingestions per year. Within suicide ingestions, there was an average yearly increase of 97.9 (95% CI, 66.9-128.9; P < 0.01) ingestions, and within misuse/recreational ingestions, there was an average yearly increase of 82.1 (95% CI, 60.3-103.9; P < 0.01) ingestions. The most common clinical effect was tachycardia, which occurred in 42.4% of ingestions. Altered mental status, mydriasis, and ataxia were all more common in misuse/recreational ingestions. Suicidal ingestions resulted in more hospital admissions and need for medical treatment. Recreational-use coded calls peaked in 2013, whereas calls coded for suicide attempts have continued to rise dramatically, with a 50% increase in the 14-year study period. Combination Coricidin products are a major source of morbidity in adolescents. Targeted preventive measures in primary care offices or larger-scale policy/legislative efforts may be helpful to address this.

Poisoning among children in Malaysia: A 10-years retrospective study.

Poisoning commonly occurs among children due to their curiosity, where they tend to explore and investigate their surroundings. They frequently put what they find into their mouths as they do not understand the danger and probably cannot read the warning label. As this issue has not been extensively studied in Malaysia; hence, a retrospective analysis of records was carried out to determine the profile of phone call enquiries regarding poisoning among children at the National Poison Centre (NPC). The records of all cases of poisoning among children below the age of 18 years were retrospectively reviewed over a period of 10 years from 2006 to 2015. The data on the cases were analysed according to age group and gender, the circumstances and the toxic agent implicated in the poisoning. During the 10-year study period, 13,583 calls that met the criteria for this study were referred to the NPC. Of these calls, 62.2% involved children between the age of 0 to 5 years, 9% were children aged between 6 to 12 years, and 28.8% were children between 13 to 18 years. Unintentional poisoning accounted for 96.7% of the incidents involving children between the age of 0 to 5 years, although among the children who were between the age of 13 to 18 years, 76% of the cases were intentional. In all the cases involving children, pharmaceutical agents were the most frequent source of the poisoning. More than 95% of the cases were exposed to poisoning through the oral route. Poisoning in children between the age of 0 to 5 years was mainly unintentional, while poisoning in children between the age of 13 to 18 years was mainly intentional, where pharmaceutical and household agents were responsible for more than two-thirds of the poisoning cases. Most of these incidents could have been prevented if protective measures, such as child-resistant enclosures, had been implemented and if the parents and guardians had been educated about preventive measures, such as keeping poisoning agents out of the reach of children.

Observational cross-sectional case study of toxicities of antifungal drugs

In this study, we examined the toxicities, including poisoning and overdoses, with polyene, azole, flucytosine and echinocandin antifungals reported to the Swiss National Poison Centre. An observational cross-sectional study on antifungals was performed based on reports between 1995 and 2016 to Tox Info Suisse. Patient demographic and clinical characteristics were summarised among all reported calls, stratified by age group. In secondary analyses, we evaluated cases with clinical follow-up information. In total, 149 cases were reported to the National Poison Centre during the study period, of which 49 (32.9%) were male and 91 (61.1%) were female, and 95 (63.8%) were adults and 54 (36.2%) were children (age ≤16 years). The most frequently reported drug class was azoles (136; 91.3%). In 31 cases (20.8%) reported by treating physicians, further clinical follow-up information was available. Nearly one-half of these patients were asymptomatic (15/31; 48.4%). In 11 patients (35.5%) among those with symptoms, the symptoms of toxicity were categorised with a strong causality to the respective antifungal. Clinical findings caused by triazoles were effects in the gastrointestinal tract, hallucinations and predelirium state. Clinical findings caused by polyenes were mostly minor symptoms with infusion-related effects or hypokalaemia. The severity was categorised as minor in 6 (54.5%) of 11 cases and as moderate in 5 cases (45.5%). Despite high administered doses, no severe or fatal cases occurred within the study period. Although various toxicities can occur with antifungal administration and overdoses, they showed a favourable safety profile.

Exposures in pregnant patients reported to United States Poison Centers

Background Limited data describe poisoning exposures in pregnant women. Previous studies are limited to inpatient populations, those seen only by toxicologists, or single poison centers. This study aimed to describe poison exposures reported to U.S. poison control centers in pregnant patients compared to non-pregnant controls. Methods This was a retrospective observational study of exposures reported to the American Association of Poison Control Centers National Poison Data System from 2000 through 2019. Pregnant patients were included from 15–44 years along with a random sampling of 5:1 age and year matched control group of non-pregnant exposures. Demographics, primary substance, and known medical outcomes were described. Chi square analysis was performed for comparisons. Results From 2000 to 2019, a total of 131,619 pregnant cases and 658,095 non-pregnant controls were identified. The median age was 27 years (IQR: 22, 31) for the matched groups. For known trimester of pregnancy: 29.8, 37.0, and 28.2% were in the first, second, and third trimester, respectively. Most common exposures were analgesics and cleaning products. Intentional exposures were more common in non-pregnant compared to pregnant cases (41.2 vs 21.9%; OR 2.71, 95% CI 2.67–2.75), mostly self-harm attempts (31.5 vs. 15.8%). Notably, there was a large discrepancy in the proportion of environmental exposures, with fewer in non-pregnant controls compared with pregnant cases (3.8 vs. 12.1%; OR 0.29, 95% CI 0.28–0.29). More non-pregnant cases had multiple substance exposures compared with pregnant cases (22.2 vs. 10.9%; OR 2.34, 95% CI 2.29–2.38). There were more moderate effect outcomes in non-pregnant compared with pregnant cases (13.2 vs. 6.3%; OR 2.25, 95% CI 2.20–2.30). Conclusions Outcomes of poisoning exposures in pregnant patients reported to U.S. poison centers are less serious compared to non-pregnant controls, likely due to the lower rates of intentional abuse and self-harm exposures and greater number of minimally toxic environmental exposures.

Kratom exposures among older adults reported to U.S. poison centers, 2014-2019.

In recent years, use of the herbal supplement kratom has increased in the United States. The reasons for use include pain relief, particularly as a substitute for opioids. To describe epidemiologic trends in kratom-related exposures among older adults reported to U.S. poison centers. Retrospective analysis of American Association of Poison Control Center's National Poison Data System (NPDS). Data from all U.S. poison centers from 2014 to 2019 were examined. Kratom exposure cases involving adults aged 18 and older. Kratom cases were identified by product and NPDS generic codes. Non-human and information-only calls were excluded. Data were examined for all calls for exposures among adults, with a focus on older adults aged 60-69 years and above 70 years. Descriptive analyses were used to characterize individual demographic, exposure information, clinical effects, and medical outcomes associated with kratom exposures among older adults. Comparisons across age groups (18-59, 60-69, and 70+ years) were made using Fisher's exact tests. Among 3484 kratom-related exposures reported between 2014 and 2019, 4.6% (n=162) were among adults over 60 years. The number of kratom-related exposures increased over time. Most cases originated with calls from healthcare facilities (81.1%) and involved kratom as a single ingestant (63.0%). The reason for most ingestions was intentional (74.5%). One in five exposures among adults aged 70 and older involved an adverse reaction (e.g., drug interaction; 21.9%), compared with 12.3% among ages 60-69 and 9.6% among ages 18-59 years. Neurological and cardiovascular clinical effects were observed. Twenty-three deaths were observed among older adults. Healthcare providers and older adult patients should be aware of the potential risks of kratom use, including medication interactions and falls. When reviewing medication lists, providers should query this population for all medications and substances being used, especially in people being treated for pain.

Staying at home: the potential cost savings related to triage advice provided by the New Zealand National Poisons Centre

Introduction Evidence from multiple countries suggests poisons centres create value in several ways including the provision of expert clinical advice, decreased hospital length of stay and triage of exposures enabling safe management without further medical utilisation. Data specific to the New Zealand context are lacking. Therefore, this study aimed to estimate one aspect of poison centre value, namely the potential savings to the health system related to triage advice provided by the New Zealand National Poisons Centre (NZNPC). Methods A prospective survey was conducted over a 2-week period where eligible NZNPC callers – who were advised their exposure did not require further medical assessment – were asked what alternative action they would have taken in the hypothetical absence of the NZNPC. The potential cost savings associated with the alternative actions respondents would have taken were calculated using publicly available information and extrapolated to the population level using annual NZNPC call numbers for 2019. Results Among 554 eligible callers, 399 were recruited to participate and 396 provided responses. The single most common alternative action was “search the Internet” (54/396, 14%). In-person medical assessment would have been sought by 25% (100/396), and 39% (154/396) would have called an alternative provider within the healthcare system. The estimated cost associated with alternative actions for the study period was NZ$25,637. When extrapolated to the 2019 year, the potential savings from avoided healthcare utilisation was NZ$1,061,551. Conclusion In 2019, in the absence of NZNPC triage advice, a conservatively estimated NZ$1,061,551 would have been spent on healthcare related to poisoning exposures that were appropriate for management without further medical utilisation. It is important to note that this estimate is only one aspect of the total value created by the NZNPC and is consistent with findings of value from other poisons centres internationally.

Adolescent Ingestions: Various Reasons and Medications.

1. David C. Sheridan, MD, MCR* 2. Adrienne Hughes, MD*,† 3. B. Zane Horowitz, MD*,† 1. *Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 2. †Oregon Poison Center, Portland, OR 1. There have been increases in both suicidal and recreational adolescent ingestions over time. 2. Knowledge of these common ingestions is important to properly diagnose, treat, and refer to emergent care as needed. 3. Pediatricians and emergency physicians should be familiar with these ingestions to develop preventive efforts. After completing this article, readers should be able to: 1. Explain the national trends for adolescent suicidal ingestions and recreational abuse. 2. Become familiar with ingestions of prescription drugs, over-the-counter medications, and recreational drugs of abuse. 3. Describe the potential serious clinical complications and treatment options for these ingestions. Adolescents generally do not unintentionally ingest pharmaceutical agents, as seen in the younger pediatric population. The main reasons for adolescent ingestions generally fall into 2 categories: suicidal/self-harm and recreational abuse. These 2 categories are very important and carry different levels of morbidity and mortality. The agents ingested may be unique and require different clinical management and preventive strategies. Suicidal ingestions alone now account for more than 1 million annual emergency department visits, making this a very timely and important review article. (1) Adolescent suicidality and suicide attempts are growing in number, now accounting for more than 1.12 million emergency department visits per year. (1) The reasons for this are multifactorial, with ingestions a common part of a suicide plan or attempt. One recent study evaluated national trends in suicidal ingestions over the most recent decade using the National Poison Center System, a database that consists of all calls to poison centers in the United States. (2) This study found that there were approximately 400,000 calls for “intentional-suspected suicide.” More importantly, calls about adolescent ingestions accounted for more than 80% of all intentional ingestion calls during the study period. The top 5 agents ingested included over-the-counter (OTC) medications of acetaminophen, ibuprofen, and antihistamines, as well as the prescription psychiatric …

Clinical effects and factors associated with adverse clinical outcomes of hymenopteran stings treated in a Thai Poison Centre: a retrospective cross-sectional study

Objective To describe clinical effects and outcomes of hymenopteran stings and to explore the non-laboratory factors associated with adverse clinical outcomes, a composite outcome including death, respiratory failure requiring intubation, acute kidney injury (AKI) requiring dialysis and hypotension requiring vasopressor use. Methods A retrospective cross-sectional study was performed at the Ramathibodi Poison Center, a poison centre of a tertiary care hospital in Thailand. All cases of hymenopteran sting consultations from January 2015 to June 2019 were consecutively enrolled, and charts were reviewed. Demographics, initial clinical characteristics and outcomes were collected. Factors associated with adverse clinical outcome were explored. Results One hundred and fourteen hymenopteran stings cases (wasp 48%, bee 33%, hornet 14% and carpenter bee 8.8%) were included (median age, 36.5 years (interquartile range 9–55); male 63%). The prevalence of adverse clinical outcomes was 12.3% (95%CI 6.88–12.8). At initial presentation, 100% of cases had local skin reactions, 11.4% were clinical anaphylaxis, and 8% had red urine. Adverse clinical outcomes included death (n = 10), respiratory failure requiring intubation (n = 9), AKI requiring dialysis (n = 6) and hypotension requiring vasopressor use (n = 2). None of the patients with carpenter bee or hornet stings developed adverse clinical outcomes. In univariable analysis, urticaria, wheezing, red urine, wasp sting and sting number > 10 were significantly associated with adverse clinical outcomes. In multivariable analysis, red urine (adjusted OR 11.1 (95% CI 1.57–216)), wheezing (adjusted OR 16.7 (95% CI 1.43–402)) and a number of stings > 10 (adjusted OR 21.5 (95% CI2.13-2557)) were significant. Conclusions Adverse clinical outcomes in hymenopteran stings were not uncommon among cases inquiring to a national Thai poison centre. At initial presentation, red urine, wheezing and a number stings >10 were significantly associated with adverse clinical outcomes. Larger epidemiologic studies are required to confirm these associations.

Toxicological exposures among the pediatric patients at a tertiary care center in Lebanon: the case for establishing a national poison center

Background Despite its preventable nature, poisoning remains one of the leading causes of morbidity and mortality in the pediatric population. In Lebanon, this population is poorly studied and there is no poison center to which healthcare providers and the public can refer in case of toxicological exposure, leading to unnecessary Emergency Department (ED) visits. This study describes the pediatric toxicological exposures seen at the largest tertiary care center in Lebanon. It also evaluates the appropriateness of ED visits among confirmed or suspected toxicological exposures in children, in order to assess the role of a national poison center in reducing unnecessary ED visits. Methods This is a secondary analysis of a database for a telephonic medical toxicology service at the American University of Beirut Medical Center, the largest tertiary care center in Lebanon. Data relating to all pediatric patients aged 0–19 years of age were entered into the database by the medical toxicology team. The cases were independently reviewed by 2 medical toxicologists for the adequacy of referral to the ED and performance of invasive procedures. Results Two hundred and nine exposures were recorded between 15 April 2015 and 31 December 2019, of which 53.1% were females. Children aged less than 5 years were involved in 67.0% of cases while adolescents aged 13–19 years were involved in 21.1%. The most commonly involved substances were analgesics (14.8%) and cardiovascular drugs (10.0%). The majority had no (59.3%) or minor (26.3%) effects and were treated and discharged home (67.5%). More than a third of ED visits were deemed unnecessary by the toxicologists (Kappa = 0.705), and when including only unintentional cases, around 45% of the ED visits were deemed unnecessary (Kappa = 0.677). Conclusion Our data show that 37% of all pediatric poisoning ED visits and 45% of ED visits due to unintentional pediatric poisonings were unnecessary. Additionally, more often than not lavage suctions were done unnecessarily. Future research investigating the possibility of preventing unnecessary visits by establishing a national poison center is needed.

Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper.

Button batteries (BB) remain a health hazard to children as ingestion might lead to life-threatening complications, especially if the battery is impacted in the esophagus. Worldwide initiatives have been set up in order to prevent and also timely diagnose and manage BB ingestions. A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) task force for BB ingestions has been founded, which aimed to contribute to reducing the health risks related to this event. It is important to focus on the European setting, next to other worldwide initiatives, to develop and implement effective management strategies. As one of the first initiatives of the ESPGHAN task force, this ESPGHAN position paper has been written. The literature is summarized, and prevention strategies are discussed focusing on some controversial topics. An algorithm for the diagnosis and management of BB ingestions is presented and compared to previous guidelines (NASPGHAN, National Poison Center). In agreement with earlier guidelines, immediate localization of the BB is important and in case of esophageal impaction, the BB should be removed instantly (preferably <2 hours). Honey and sucralfate can be considered in ingestions ≤12 hours while waiting for endoscopic removal but should not delay it. In case of delayed diagnosis (first confirmation of the BB on X-ray >12 hours after ingestion or time point of removal >12 hours after ingestion) and esophageal impaction the guideline suggests to perform a CT scan in order to evaluate for vascular injury before removing the battery. In delayed diagnosis, even if the battery has passed the esophagus, endoscopy to screen for esophageal damage and a CT scan to rule out vascular injury should be considered even in asymptomatic children. In asymptomatic patients with early diagnosis (≤12 hours after ingestion) and position of the BB beyond the esophagus, one can monitor with repeat X-ray (if not already evacuated in stool) in 7 to 14 days, which is different from previous guidelines where repeat X-ray and removal is recommended after 2-4 days and is also based on age. Finally, prevention strategies are discussed in this paper.

Therapeutic errors captured by the New Zealand National Poisons Centre: a retrospective audit.

INTRODUCTION Medication errors are one important cause of harm to patients. Information about medication errors can be obtained from diverse sources, including databases administered by poisons centres as part of their routine operation. AIM The aim of this study was to describe the data regarding therapeutic errors captured by the New Zealand National Poisons Centre (NZNPC). METHODS A retrospective study of calls made to the NZNPC between 1 September 2016 and 31 August 2018 was conducted, which involved human patients and were classified as 'therapeutic error' in the NZNPC database. Variables extracted and analysed included the demographics of the individual, the substance(s) involved, and site of exposure. RESULTS During the study period, a total of 43,578 calls were received by the NZNPC, including 5708 (13%) that were classified as 'therapeutic error'. Just over half of the exposures occurred in females, 3197 (56%) and 4826 (85%) of the calls involved a single substance. All age groups were affected and 2074 (37%) of the calls were related to children aged <12 years. A residential environment (n=5568, 97%) was the site of exposure for almost all reported therapeutic errors, most commonly in the patient's own home (n=5207, 91%). DISCUSSION This study provides insights into therapeutic error-related calls to the NZNPC. Almost all errors occurred in the residential setting. Over one-third of the calls involved children. Enhanced data capture and classification methods are needed to determine the types of errors and their possible causes to better inform prevention efforts.