Poison Center Research Articles

The Association Between QTc-Interval and Blood Glucose with Plasma Acetylcholinesterase in Organophosphate (OP)-Poisoned Patients

Background: Organophosphate (OP) poisoning ranks among the leading causes of poisoning, morbidity, and mortality in developing countries due to its relatively high prevalence and potentially grave outcomes. Consequently, it is crucial to identify an easily accessible and cost-effective marker that can be utilized across healthcare facilities. Objectives: This study aimed to explore the relationship between the QTc interval and blood glucose levels with serum cholinesterase levels in patients poisoned by organophosphates. Methods: The sample consisted of all patients admitted with OP poisoning to a Northwest Poisoning Center in Iran during 2016 and 2017. Diagnosis of OP poisoning was confirmed through patient history, physical examination, or the measurement of acetylcholinesterase levels. Data collected were analyzed using SPSS software version 25. Results: Out of 238 patients, 104 remained after applying exclusion criteria and were included in the study. The mean age of these patients was 30.81 ± 15.04 years. A statistically significant negative correlation was found between average blood glucose and serum cholinesterase levels (P = 0.046, Pearson Correlation = -0.196). Furthermore, patients with abnormal QTc intervals exhibited significantly lower serum cholinesterase levels (P < 0.001). Conclusions: The findings indicate a significant association between QTc intervals and blood glucose levels with serum cholinesterase levels. Serum cholinesterase levels decreased with an increase in QTc intervals and blood glucose levels. Specifically, patients with a QTc interval greater than 440 milliseconds or random blood glucose levels above 200 milligrams per deciliter showed significantly lower serum cholinesterase levels.

Clinical outcomes associated with orphenadrine deliberate self-poisoning: a retrospective poisons centre study

Introduction Orphenadrine overdoses can cause antimuscarinic toxicity, respiratory failure, refractory seizures and cardiotoxicity. The dose–toxicity relationship is poorly defined. Orphenadrine is marketed as immediate and sustained release formulations, and it is not known how the formulation impacts on toxicity. We determined the clinical toxicity of orphenadrine in patients referred to a regional poisons centre. Methods Retrospective case series of patients in New South Wales with orphenadrine deliberate self-poisoning from January 2016 to April 2022 referred to the New South Wales Poisons Information Centre. Demographics, history of exposure, treatment and outcomes were extracted from clinical databases. Receiver-operating characteristic curves were constructed to determine thresholds predicting toxicity. Results Forty-eight patients were identified, with information on clinical outcomes in 46 patients and doses in 41 patients. All patients were older than 12 years. The median orphenadrine dose was 770 mg (range 210–10,000 mg), 59 per cent as the immediate release formulation, and 67 per cent reported coingestants. Doses of sustained release formulations were significantly greater than immediate release formulations, median 2,750 mg versus 595 mg. Common clinical features were drowsiness (59 per cent), sinus tachycardia (37 per cent) and confusion (33 per cent). Three patients had mild hypotension, three were intubated for coma, and two had seizures; no patients suffered ventricular dysrhythmias. All patients survived, with 75 per cent being medically cleared within 24 hours of presentation. A dose–toxicity relationship was observed, but conclusions are limited by the small number of cases with moderate or severe toxicity. Discussion All patients survived, and severe cardiac and neurological toxicity were not observed. This contrasts to published case reports noting severe poisoning at similar or lower doses. Formulation may have an impact on outcomes, with lesser toxicity from sustained release products. Conclusions Orphenadrine doses up to 10 g were associated with antimuscarinic toxicity and sedation, but not severe cardiotoxicity. More research exploring the effect of dose and formulation on outcomes is required.

Self-medication cases reported to a poison information center in Brazil from 2014 to 2020

Introduction Self-medication is the use of drugs to treat self-diagnosed illnesses or symptoms, on one’s own initiative, without the guidance of a healthcare professional. Poison centers play an important role in understanding the relationship between self-medication and poisoning. The objective of this study is to evaluate the clinical and epidemiological profile of patients exposed to and/or poisoned by different drugs through self-medication. Methods This retrospective, cross-sectional, and descriptive study analyzed data from 2014 to 2020, provided by the Toxicological Information and Assistance Center of Santa Catarina, Brazil. Data were selected, tabulated, and analyzed by using descriptive statistics and group comparison with the chi-square test or Fisher’s exact test. A P value <0.05 was considered statistically significant. Results There were 683 cases of self-medication identified. Most patients were female (62.8 percent) and between 20 and 29 years old (26.1 percent). A toxic dose of a substance was administered in only 22.8 percent of the cases, and five deaths were recorded. The most commonly used medications were anxiolytics (18 percent), followed by analgesics and antipyretics (15.4 percent). Paracetamol was the drug used in three of the five cases that resulted in deaths. Discussion This study demonstrates the prevalence of self-medication among women aged between 20 and 29 years old. Statistical analysis failed to show a relationship between a toxic dose and clinical manifestations. Anxiolytics, analgesics, and antipyretics are the most reported medications probably because healthcare professionals are mostly the ones who contact the center. Analgesics and antipyretics account for more than fifty percent of the deaths caused by self-medication in the present report. Some limitations such as secondary sources are related. Conclusion We highlight the importance of health professionals in promoting the rational use of medicines, as well as poison centers in assisting the population and raising their awareness regarding the issue.

Impact of social media “challenges” on poison center case volume for intentional ingestions among school-aged children: an observational study

Introduction Mental health problems among youth have escalated over the past decade, with increased rates of self-harm, including suicide attempts by ingestion. Social media use has been linked to youth mental health, including “challenges” urging youth to ingest substances for recreational and other purposes. We hypothesized that social media challenges for particular substances would temporally correspond with increased ingestions of these substances. Methods We identified peak Google Trends search times for social media ingestion challenges involving diphenhydramine, laundry pods, nutmeg, and cinnamon, and used data from America’s Poison Centers National Poison Data System to plot reported ingestions 3 months before and after peak searches in school-aged children. Results There were 2,169 individuals in the analysis. Diphenhydramine was the most frequently reported ingestion for misuse/abuse and suicidal purposes (n = 266 and 1,609, respectively). For all ingestions together, 45 percent (n = 979) had a moderate health effect, and 6.35 percent (n = 137) had a major health effect. Time of peak searches corresponded with increased ingestions for each substance. Discussion We found a temporal relationship between peak Google Trends searches for ingestion challenges and ingestions of that substance reported to United States poison centers. Compared to misuse/abuse ingestions, most suicidal ingestions peaked 1–2 months later, suggesting a public health opportunity for intervention. Limitations This retrospective observational study does not establish causal effect. All data are a result of self-reporting of the exposures, which may lead to a reporting bias. Google Trends is not the only search engine and likely underestimates the true incidence of social media posts. Conclusions Additional research is needed on the relationship between social media and youth mental health, particularly around “challenges” that place youths’ health at risk. There may be opportunities for intervention to decrease medical and mental health sequelae of these challenges.

Glucagon-Like Peptide-1 Receptor Agonist Cases Reported to United States Poison Centers, 2017–2022

IntroductionGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are a class of medications for management of diabetes and obesity. The objective of this study is to characterize the epidemiology of GLP-1RA cases reported to US poison centers.MethodsWe analyzed cases involving a GLP-1RA reported to the National Poison Data System during 2017–2022.ResultsThere were 5,713 single-substance exposure cases reported to US poison centers involving a GLP-1RA. Most cases were among females (71.3%) and attributable to therapeutic errors (79.9%). More than one-fifth (22.4%) of cases were evaluated in a healthcare facility, including 0.9% admitted to a critical care unit and 4.1% admitted to a non-critical care unit. Serious medical outcomes were described in 6.2% of cases, including one fatality. The rate of cases per one million US population increased from 1.16 in 2017 to 3.49 in 2021, followed by a rapid increase of 80.9% to 6.32 in 2022. Trends for rates of serious medical outcomes and admissions to a healthcare facility showed similar patterns with 129.9% and 95.8% increases, respectively, from 2021 to 2022.ConclusionsMost GLP-1RA cases reported to US poison centers were associated with no or minimal effects and did not require referral for medical treatment; however, a notable minority of individuals experienced a serious medical outcome or healthcare facility admission. The rate of reported cases increased during the study period, including an 80.9% increase from 2021 to 2022. Opportunities exist to improve provider and patient awareness of the adverse effects of these medications.

Psilocybin Exposures Reported to U.S. Poison Centers: National Trends Over a Decade

PurposeWe describe trends in psilocybin exposures among adolescents and young adults as reported to US poison centers over the past decade. MethodsWe queried the National Poison Data System for cases involving psilocybin during January 1, 2013–December 31, 2022. Persons aged 13–25 years were included. We examined exposures to psilocybin by demographics, clinical effects, level of care, and medical outcome. ResultsDuring the 10-year study period, 4,055 psilocybin-involved exposures were reported among adolescents and young adults, 2,667 (65.8%) being single substance exposures. Most single substance cases received medical attention (adolescents: 75.3% [n = 1,176], young adults: 72.1% [n = 797]). We did not find significant change in the number of cases during 2013–2018. Cases started increasing in 2019. In 2022, cases more than tripled among adolescents and more than doubled among young adults, compared to 2018 (p < .0001). DiscussionContinued national surveillance is critical to determine the impact of psilocybin exposures on youth as it becomes increasingly available.

Epidemiology and Clinical Characteristics of Acute Plant Exposure in Patients Aged between 0 and 18 Years-A Six-Year Retrospective Study.

Exposure to plants accounts for approximately 5% of human poisoning cases reported by poison control centers in North America and Europe. The aim of this study was to investigate acute plant poisoning in patients aged 0-18 years admitted to a Romanian pediatric poison center, focusing on epidemiological and clinical aspects. A retrospective observational study was conducted between 2017 and 2022, analyzing medical records for demographic information, clinical features, biological findings, and outcomes. Statistical analysis was performed using Microsoft Excel. 71 patients (aged 7 months to 16 years) presented with acute plant poisoning. Most cases were unintentional (92.9%), peaking during the autumn season. Colocasia (18.3%), Dieffenbachia (9.8%), and Ricinus (5%) were the most frequently involved plants. Gastrointestinal symptoms, especially vomiting, predominated. The Poisoning Severity Score classified most cases as mild (52.1%), with no severe or fatal cases. The mean length of hospitalization was 1.8 days. Unintentional plant exposure, mainly in children under 5 years of age, accounted for more than 90% of cases. Gastrointestinal exposure and symptoms were prevalent, and treatment consisted mainly of symptomatic and supportive measures. Severe and fatal cases were rare, highlighting the generally favorable outcome and low incidence of severe poisoning in the pediatric population.

Assessing the frequency and types of errors involved in the use of a modified intravenous N-acetylcysteine protocol for acetaminophen overdose.

Acetaminophen overdose is a leading cause of acute liver failure in developing countries. N-acetylcysteine (NAC) is a highly effective antidote for acetaminophen hepatotoxicity, typically initiated in the emergency department. Due to a known high rate of errors with the standard three-bag IV NAC protocol, in 2019, the Ontario Poison Center changed to a modified 3% IV NAC one-bag protocol. This study was undertaken to determine the frequency and types of errors associated with the use of this protocol. Data were gathered via chart review of Ontario Poison Centre electronic medical record cases identified as receiving IV NAC for acetaminophen overdose between August 1 and September 30, 2022. 218 total charts were identified, and 188 were deemed eligible based on inclusion and exclusion criteria. Errors were identified in 25% of charts, consisting of dosing errors in 11.7%, stopping errors in 9.0%, initiation errors in 3.7%, and interruptions in therapy in 3.2%. Dosing errors were the most common type of error (44.4%), with overdoses occurring three times more than underdoses. Errors were identified at 39% of geographic locations in the charts reviewed, with similar frequency in Ontario, Manitoba, and Nunavut. Clinical outcomes were similar in charts with and without errors. The rate of errors identified with this 3% IV NAC one-bag protocol is lower than reported for the standard three-bag protocol, but remains high due to dosing errors. Previously reported issues with prolonged interruptions in therapy with the standard three-bag protocol were low with the current 3% one-bag protocol. Although severe outcomes are rare, IV NAC overdose can be fatal. Identifying local factors in emergency departments that can contribute to administration errors (i.e., dose calculation, pump programming issues) can enhance the safety of this important antidote.

An Analysis of Clinical Outcomes of Exploratory Pediatric Metformin Ingestions Reported to the Texas Poison Center Network From 2011 to 2021.

Background: Poison centers develop triage threshold guidelines for pediatric metformin ingestions. Our network uses 1700 mg, or 85 mg/kg. Objective: To describe the dose, clinical course, and outcomes for inadvertent metformin ingestions in children 5 years old and younger reported to our statewide poison center network. Methods: We searched the poison center database 2011 to 2021 for metformin ingestions in patients 5 years and younger. Variables included age, sex, weight, dose, symptoms, outcome, and more. We used descriptive statistics with medians and interquartile ranges (IQR) for continuous variables. Results: Of 669 cases, exposures by age were 208 (31.1%) 1 to 2 years, and 275 (41.1%) 2 years. Weight was recorded in 342 (51.1%) (median 13.5 kg; IQR: 3.7 kg), and dose in 149 (22.3%) (median 500 mg; IQR: 500 mg). Milligram/kilogram values were available for 103 (15.4%) with median 42.4 mg/kg, IQR: 39 mg/kg. Most (647, 98.5%) exposures were unintentional. Most (445/669, 66.5%) were managed at a non-healthcare facility, while 204 (30.7%) were already at or referred to a healthcare facility. Of these 204 patients, 169 (82.8%) were evaluated and treated at the emergency department and discharged. Four (2%) were admitted to critical care, and 7 (3.4%) to the ward. Medical outcomes by effect were 5 (0.7%) minor, 2 (0.3%) moderate, 253 (37.8%) none, 292 (43.6%) not followed (minimal effects possible), and no major effects or deaths. Of 20 clinical occurrences reported, vomiting was most common (8, 1.2%). Conclusion: Despite little recorded dosage information, pediatric metformin ingestions under 85 mg/kg had predominantly uneventful medical outcomes.

Dangerous exposures to chemicals managed by Poison Centers all around the world during the COVID-19 pandemic: a systematic review and proportional meta-analysis.

During COVID-19 pandemic, cleaning/disinfection activities were highly recommended. This study summarizes the state of art and estimates the prevalence of dangerous exposures to specific chemicals managed by Poison Centers (PCs) from all over the world during 2020 vs 2019, trying to overcome the critical aspects of the product categorization systems used by PCs. A systematic research was conducted in 3 major databases and 2 websites of PCs associations. Proportional meta-analyses were performed to estimate the prevalence of exposures to disinfectants, household products and hand sanitizers in 2020 vs 2019. The pooled prevalence of exposures to disinfectants, household products and hand sanitizers were respectively 5.9% (95% CI 4.9-7.0) (2019: 4.4% vs 2020: 7.8%; p=0.22), 25.9% (95% CI 24.0-27.7) (2019: 25.0% vs 2020: 28.6%; p=0.71) and 1.6% (95% CI 1.3-1.9) (2019: 0.6% vs 2020: 2.8%; p<0.001). This study detected overall increases of exposures to specific chemicals in 2020, suggesting that the awareness on topics related to the safe use of these products should be improved, especially during health emergencies, highlighting the need to develop standardized systems to better compare data coming from PCs all over the world.

Safety of Physostigmine for Pediatric Antimuscarinic Poisoning.

Physostigmine fell out of widespread use in the 1980s due to safety concerns; however, more recent research has demonstrated that its safety profile is better than previously thought. These studies have mainly included adults. We theorized that improved safety data may lead to more acceptance. Our objectives, therefore, were to characterize current frequency of use of physostigmine in pediatric patients as well as to study adverse effect rates in a national pediatric patient population. The National Poison Data System was queried for cases of patients aged 0-18years that involved single-substance exposures to antimuscarinic xenobiotics that were reported to a poison center between January 1, 2000, and December 31, 2020. Cases were stratified into groups by therapy received: benzodiazepines alone, benzodiazepines and physostigmine, physostigmine alone, or no physostigmine or benzodiazepines. Patient demographics, clinical effects, and medical outcomes were analyzed. A total of 694,132 cases were reviewed, and 150,075 were included for analysis. Nearly 5% (7562/150,075) of patients received specific pharmacological therapy with benzodiazepines, physostigmine, or both. A benzodiazepine as a single agent was the most frequently used pharmacologic therapy (92% of 7562). Among patients receiving any pharmacological therapy, only 8.3% (n = 627) of patients received physostigmine. Frequency of serious outcomes significantly increased across the study period among patients receiving benzodiazepines alone or with physostigmine. There was no increase in serious outcomes among patients receiving only physostigmine. Physostigmine frequency of use was low overall, but when used, was associated with less severe outcomes when compared to benzodiazepines.

Transient Hematotoxicity After Emerald Horned Pitviper (Ophryacus smaragdinus) Envenomation: A Case Report

BackgroundA minority of snake envenomations in the United States involve non-native snakes. In this report, we describe what we believe is the first documented human envenoming from an emerald horned pitviper, Ophryacus smaragdinus. Case ReportA previously healthy 36-year-old woman was bitten on her left index finger by a captive emerald horned pitviper she was medicating at work. Swelling to the entire hand was present on emergency department arrival. She had no systemic symptoms and her initial laboratory studies were unremarkable. The affected limb was elevated. We administered five vials of Antivipmyn TRIⓇ (Bioclon), which specifically lists Ophryacus among the envenomations for which it is indicated. She developed pruritus and was treated with IV diphenhydramine and famotidine. Her swelling improved, but her repeat laboratory studies were notable for a platelet count of 102 K/µL and a fibrinogen level of 116 mg/dL. She declined additional antivenom because of the previous allergic reaction. She was admitted for further monitoring and pain control. Subsequent laboratory tests were better, but a small hemorrhagic bleb developed at the bite site. She was discharged the next day and followed up as an outpatient. Her swelling had resolved, her bleb had healed, and her laboratory studies continued to improve. Why Should an Emergency Physician Be Aware of This?Emergency physicians may be required to treat bites from non-native snakes. Many of these bites will warrant treatment with non–U.S. Food and Drug Administration–approved antivenoms. Consultation with a regional poison center or medical toxicologist may be necessary to procure the proper antivenom.

Human poisoning with glyphosate-surfactant herbicides: Retrospective analysis of mortality outcomes of patients treated in a poison center.

The toxicity and carcinogenicity of glyphosate have long been debated. Nevertheless, the mortality rate in patients with acute glyphosate-surfactant poisoning varies across different groups. Between 2002 and 2020, 109 patients with glyphosate-surfactant poisoning received treatment at Chang Gung Memorial Hospital. Patients were stratified into two subgroups according to their prognosis: good (n = 74) or poor (n = 35). Baseline demographics, psychiatric comorbidities, medical complications, and laboratory data were collected, and mortality data were analyzed. The patients were 54.1 ± 17.5years of age and were mostly male (68.8%). Most patients (91.7%) ingested pesticides intentionally, and patients arrived at the hospital within 7.1 ± 12.7 h. Psychiatric comorbidities were prevalent, and the top three comorbidities were mental (71.6%), depressive (48.6%), and adjustment (14.7%) disorder. Patients with poor prognoses were older than those with good prognoses (p = .007). Moreover, patients with poor prognoses had lower Glasgow Coma Scale scores (p < .001) and diastolic blood pressure (p = .008), but higher incidences of upper gastrointestinal bleeding (p < .001), aspiration pneumonia (p < .001), hypotension (p < .001), hyperglycemia (p = .002), acute kidney injury (p < .001), and metabolic acidosis (p < .001) than patients with good prognoses. The mortality rate was 5.5%. A multivariate-logistic-regression model revealed that the Glasgow Coma Scale score was a significant risk factor for poor prognosis (odds ratio 0.653, confidence interval 0.427-0.998; p = .049). However, no risk factors for mortality were identified. A total of 32.1% of patients with glyphosate-surfactant poisoning had poor prognoses, and 5.5% of patients died despite treatment. The mortality outcome is comparable to that of published reports from other international poison centers.

Role of N-acetylcysteine and vitamin B complex in improving outcomes of corrosive ingestion.

Corrosive ingestion remains a worldwide public health problem. To date, there are no specific medications with approved efficacy in reducing gastrointestinal injury progression following corrosive ingestion. The current study assessed the efficacy of N-acetylcysteine (NAC) and vitamin B complex as adjuvant therapy in improving the outcome of patients with corrosive ingestion. The study included 92 patients with acute corrosive ingestion admitted to Alexandria Poison Center. Patients were distributed into four equal-sized groups and managed as such; Group I received the standard treatment protocol. The other three groups received IV antioxidants in addition to the standard treatment; Group II received NAC, Group III received vitamin B complex, and Group IV received both NAC and vitamin B complex. To assess occurrence of delayed complications, barium swallow and meal were done 21days after acute corrosive ingestion, and every patient was followed up for one year. Start of oral intake was earliest among patients in Group II, and as a result, the need for parenteral nutrition decreased significantly with a subsequent decrease in duration of hospitalization. The highest percentage of patients showing normal findings of barium swallow and meal was among the two groups that received NAC (72.7% in Group II and 77.8% in Group IV). Group IV patients who received NAC and vitamin B complex had no esophageal strictures with improved outcomes. NAC and vitamin B complex enhanced recovery in the acute stage, in addition to prevention of delayed complications, especially esophageal strictures. Acute corrosive ingestion is associated with high morbidity because of its catastrophic presentation and lifelong complications.This study was conducted on 92 patients admitted to Alexandria Poison Center (APC).IV NAC significantly decreased the time needed for starting oral intake after acute corrosive ingestion and consequently, the need for parenteral nutrition and duration of hospitalization.No patients suffered from esophageal strictures in the group which received both IV NAC and vitamin B complex.Both NAC and vitamin B complex improved the outcome of patients after ingestion of corrosives whether acids or alkalis.

Rural–urban disparity in patterns of poison center calls related to controlled substances between 2019 and 2022.

Rural–urban disparity in patterns of poison center calls related to controlled substances between 2019 and 2022.

Poisoning from Ingestion of Fungus-Infected Cicada Nymphs: Characteristics and Clinical Outcomes of Patients in Thailand.

The current data regarding poisoning associated with ingestion of fungus-infected cicada nymphs are limited. We performed a retrospective cohort study of patients who ingested fungus-infected cicada nymphs and were referred to the Ramathibodi Poison Center for consultation from June 2010 to June 2022. Thirty-nine patients were included for analysis. Most were men (53.8%). Mean age was 40.2 ± 15.0 years. All nymphs were ingested as a health/food supplement. Thirty-one patients (79.5%) reported gastrointestinal symptoms. Median time from ingestion to symptom onset was 5 h. Twenty-nine patients (74.4%) reported neurological symptoms, including tremor, myoclonus, muscle rigidity, nystagmus/ocular clonus, drowsiness, dysarthria, seizure, and confusion. Some complained of dizziness, urinary retention, and jaw stiffness. Most patients (94.9%) were admitted to the hospital. Median hospital stay was 3 days. Ibotenic acid was detected in the blood and urine samples of one patient. All received supportive care. Four patients developed infectious complications. No deaths occurred. Consuming fungus-infected cicada nymphs may cause poisoning in humans. Gastrointestinal and neurological symptoms were common. Ibotenic acid might be the underlying cause. The main treatment is supportive care and appropriate management of complications. Education of the general public is advocated to prevent the incidence of this type of poisoning.

Central ECMO cannulation for severe dihydropyridine calcium channel blocker overdose

Calcium channel blocker (CCB) toxicity carries a high mortality and is the sixth most fatal drug class reported to US poison centers. Amlodipine overdose is characterized by a life-threatening arterial vasodilation that compromises organ perfusion. The management of CCB intoxication is focused on maintaining adequate organ perfusion. In cases refractory to medical therapies, hemodynamic support with extracorporeal membrane oxygenation (ECMO) is warranted necessitating higher flows than usual to compensate for the vasodilation and requiring central cannulation. We present a case of a 12-year-old with severe dihydropyridine CCB ingestion, refractory to medical management and successfully treated with central ECMO cannulation. The patient was discharged home with no significant disability. Central ECMO cannulation may be helpful to facilitate adequate flows in vasodilatory shock such as CCB overdose.

Loperamide cases reported to United States poison centers, 2010–2022

BackgroundIntentional use of high doses of loperamide has been linked to serious cardiac toxicity. The objective of this study is to investigate the characteristics and trends of loperamide cases reported to United States (US) poison centers and to evaluate the changes in reported loperamide cases following US Food and Drug Administration (FDA) warnings, labeling requirements, and packaging restrictions for loperamide starting in 2016, with an emphasis on intentional exposures.MethodsData from the National Poison Data System were analyzed.ResultsThere were 12,987 cases reported to US poison centers from 2010 to 2022, for which, loperamide was the most likely substance responsible for observed clinical effects. Although 46.1% of these cases were associated with minor or no effect, 13.4% resulted in a serious medical outcome, including 59 deaths (0.5%). Eight percent (8.1%) of cases were admitted to a critical care unit and 5.0% were admitted to a non-critical care unit. Among cases with a serious medical outcome, most were associated with loperamide abuse (38.0%), intentional-misuse (15.7%), or suspected suicide (27.5%). The majority (60.0%; n = 33) of fatalities were related to abuse, followed by suspected suicide (20.0%; n = 11) and intentional-misuse (5.5%, n = 3). The rate of loperamide cases per 100,000 US population reported to US PCs decreased from 0.44 in 2010 to 0.36 in 2015 (p = 0.0290), followed by an increase to 0.46 in 2017 (p = 0.0013), and then a trend reversal with a decrease to 0.28 in 2022 (p < 0.0001). The rate of serious medical outcomes related to loperamide increased from 0.03 in 2010 to 0.05 in 2015 (p = 0.0109), which subsequently increased rapidly to 0.11 in 2017 (p < 0.0001), and then demonstrated a trend reversal and decreased to 0.04 in 2022 (p < 0.0001).ConclusionsFDA warnings, labeling requirements, and packaging restrictions may have contributed to the observed trend reversal and decrease in reports to US poison centers of loperamide cases related to intentional misuse, abuse, and suspected suicide. This demonstrates the potential positive effect that regulatory actions may have on public health. These findings contribute to the evidence supporting the application of similar prevention efforts to reduce poisoning from other medications associated with intentional misuse, abuse, and suicide.

Occupational Carbon Monoxide Poisoning in Wisconsin: Results From a Statewide Electronic Disease Surveillance System and From the Wisconsin Poison Center, 2018-2021.

Prevention methods for carbon monoxide (CO) poisoning in Wisconsin address occupational and nonoccupational exposures together, but differences between the settings could inform new approaches to preventing occupational CO poisonings. We described occupational CO poisonings in Wisconsin from July 1, 2018, through July 1, 2021, using surveillance data from the Wisconsin Electronic Disease Surveillance System and Wisconsin Poison Center. We identified cases of CO poisoning from the Wisconsin Electronic Disease Surveillance System and Wisconsin Poison Center. Occupational CO poisonings were records where "workplace" was recorded as the location of exposure. We excluded records classified as suspect/not a case, those missing laboratory results or information on exposure source/location, and intentional poisonings. We compared characteristics between occupational and nonoccupational settings using odds ratios (ORs), and we estimated crude incidence rates of occupational exposures by occupation. We identified 614 cases of CO poisoning, of which 168 (27.4%) were occupational exposures. When compared with patients with nonoccupational exposures, patients with occupational exposures were more likely to be male (OR = 3.8; 95% CI, 2.4-6.1), Hispanic (OR = 2.4; 95% CI, 1.4-4.2), and younger (mean difference [SD] = 6.6 [20.9]). Several CO sources were significantly associated with occupational poisonings: forklifts (OR = 58.4; 95% CI, 13.9-246.1; P < .001), pressure sprayers (OR = 2.4; 95% CI, 1.3-4.4; P = .003), and other gasoline-powered tools (OR = 3.8; 95% CI, 2.3-6.3; P < .001). The natural resources, construction, and maintenance occupation group had the highest crude incidence rate-45.0 poisonings per 100 000 full-time equivalent employees. Incorporating data from the Wisconsin Poison Center improved data quality, but surveillance is limited by underreporting. Creating strategies to increase reporting would allow for a more comprehensive understanding of occupational CO poisoning.

A ten-year retrospective California Poison Control System experience with possible amatoxin mushroom calls

Introduction Mushrooms containing amatoxin are found worldwide and represent a challenging poisoning for the clinician and consulting poison center. This study evaluates the experience of a large poison system with possible amatoxin-containing mushroom ingestion calls. Methods A 10-year retrospective review of the California Poison Control System database was performed for amatoxin mushroom ingestion calls resulting in hospitalization. Cases found were abstracted and data statistically analyzed for association with a composite endpoint of death, liver transplant, and/or the need for dialysis. Results Amatoxin-containing mushroom calls are infrequent with the vast majority (98.4 percent) coming from Northern California during the rainier first and fourth quarters (October through March) of the year. Elevated initial aminotransferase activities and international normalized ratios were predictive of the composite negative outcome. The mortality plus liver transplant and hemodialysis composite rate was 8.2 percent, consistent with current literature. Conclusion The California Poison Control System has relatively few amatoxin-containing mushroom ingestion calls that result in hospitalization but those that are reported mostly occur in Northern California. Treatment bias towards the sickest patients may explain the association of intravenous fluid use or treatment with acetylcysteine or silibinin with meeting the composite outcome. The initial presence of elevated hepatic aminotransferase activity and international normalized ratios are poor prognostic indicators and are likely reflective of late presentation, an advanced toxic phase of amatoxin poisoning, and/or delays in time to obtain poison center consultation.