Poisons Information Service Research Articles

Paediatric opioid poisoning in the UK: a retrospective analysis of clinical enquiries to the National Poisons Information Service

ObjectiveTo evaluate a decade of reported paediatric opioid poisoning cases in the UK.MethodsThe National Poisons Information Service (NPIS) telephone enquiries database (UK Poisons Information Database) was searched for calls regarding...

The role of the United Kingdom national poisons information service (NPIS) in the diagnosis of death according to neurological criteria in poisoned and non-poisoned patients.

The diagnosis of death by neurological criteria (DNC) requires the exclusion of any clinical effect attributable to xenobiotics. We undertook a retrospective analysis of enquiries to the National Poisons Information Service (NPIS) relating to DNC over a 10-year period. Enquiries were categorised as toxicological, where exposure to a non-therapeutically administered xenobiotic was implicated in the clinical presentation and non-toxicological where exposure to the xenobiotic was not the primary cause of the clinical state. The frequency of enquiry to the NPIS regarding xenobiotics and DNC demonstrates that it remains a valuable source of expert advice.

2214 Using poisons Centre data to identify potential safety risks associated with the use of monitored dosage systems.

Abstract Introduction Monitored dosage systems (MDS) encompass a wide range of devices to help management of medication. This research uses poison centre data to explore risks associated with their use. Method A search of accidental overdose enquiries to the UK National Poisons Information Service (NPIS) between 1/01/2017–31/12/22, classified as ‘therapeutic error/medical error’ involving patients aged 65 or over was performed. Enquiries involving an MDS were identified. Data were analysed using descriptive statistics and chi-square test. Results There were 394 enquiries concerning 393 patients and mean patient age was 81 years. There were significantly more females (n = 266) than males (n = 127), p = <0.0001. Exposures occurred at home (n = 372), in care homes (n = 18), in prisons (n = 2) and in hospital (n = 1). Cognitive impairment was reported in 32.5% patients (n = 127). The 10 most common medications involved were bisoprolol (n = 74), lansoprazole (n = 59), atorvastatin (n = 58), aspirin (n = 47), omeprazole (n = 43), amlodipine (n = 44), paracetamol (n = 42), clopidogrel (n = 42), ramipril (n = 42) and metformin (n = 35). Most patients were asymptomatic (n = 312). Common symptoms recorded were somnolence (n = 16), dizziness (n = 13), confusion (n = 11), fatigue (n = 7) and hypotension (n = 5). Common reasons for incidents were a mistake by patient or family member (n = 189), medications taken unwitnessed (n = 88), MDS incongruent with current prescription (n = 22), patient took another person’s medications (n = 19), patient took medication in MDS in addition to that in normal packaging (n = 15) and extra doses administered by different people (n = 15). Almost 51% of patients were recommended to attend Emergency Department (ED) by the NPIS (n = 200) and 18% were advised to contact their GP (n = 71). Conclusion MDS are perceived to improve adherence, these results reveal their potential harm. For example, most of patients in these enquiries were advised to seek medical help. MDS harm is likely underreported as this was a retrospective study and some information was not routinely collected. Further work including a prospective study is needed alongside support of safer medicine use through improved communication, education, and alternative tailored support.

A case of severe benzalkonium chloride intoxication in a cat

BackgroundBenzalkonium chloride (BAC) is a quaternary ammonium compound (QAC), that can be found in a wide variety of household products–from disinfectants to medicaments and home fragrances–but also professional products. In pets, cats have long been reported as more sensitive than dogs to QACs; in fact, signs of irritation such as oral ulcerations, stomatitis and pharyngitis can be observed after contact with concentrations of 2% or lower. In a review of 245 cases of BAC exposure in cats, reported by the Veterinary Poisons Information Service (United Kingdom) only 1.2% of the cases died or were euthanized. Nevertheless, BAC toxidromes in cats can result in transitory CNS and respiratory distress, as well as severe mucosal and cutaneous lesions. Currently, only a few reports are available concerning BAC poisoning in this species.Case presentationA 4 month-old kitten presented with severe glossitis, lameness in the hindlimbs and episodes of vomiting and diarrhoea. The cause was unknown until the owners reported use of a BAC-containing mould remover (5%) 4 days later. The patient developed severe oral burns requiring a pharyngeal tube for feeding and severe cutaneous chemical burns. The kitten was managed with supportive therapy and required hospitalization for 10 days. The symptoms disappeared completely 3 weeks after exposure.ConclusionsBAC is a very common compound contained in several household and professional products but, to the best of our knowledge, no previous case had been reported in Italy. We hope that this report will help raise awareness on the hazards of BAC products for cats in both domestic and work contexts.

Neurological adverse effects of isoxazoline exposure in cats and dogs.

Isoxazolines are rarely reported to be associated with neurological adverse events in cats and dogs, but information about the onset and duration of neurological signs is lacking in the summary of product characteristics of these medicines. The Veterinary Poisons Information Service and the Dutch Poisons Information Center databases were searched using the Veterinary Dictionary for Drug-Related Affairs terms for ataxia, muscle tremor, convulsions or hyperesthesia in cats and dogs exposed to isoxazolines. There were 22 cases with and 57 cases without outcome information, mostly involving fluralaner or sarolaner. In both groups, muscle tremors and convulsions were the most common signs. In dogs, neurological signs occurred with oral therapeutic dose and overdosage. In cats, most fluralaner cases involved therapeutic topical exposure, and all sarolaner cases involved oral exposure. In all cases with outcome information, the animals recovered. Cases discussed with poison centres tend to involve more severe signs. The true incidence of neurological adverse effects from isoxazolines remains unclear.The delay between the administration and onset of signs can be long, and the association may be missed. A lack of timing information in the summary of product characteristics could also contribute to missed attribution of adverse effects.

Medication errors involving intravenous paracetamol in children: experience from enquiries to the National Poisons Information Service

IntroductionChildren are at higher risk of medication errors due to the complexity of drug prescribing and administration in this patient group. Intravenous (IV) paracetamol overdose differs from overdose by ingestion...

2022 Annual Report of the Seoul Poison Control Center

Purpose: The Korea University Anam Hospital Seoul Poison Control Center (SeoulPCC) was established in accordance with Seoul Metropolitan Government Ordinance No. 7524 “Seoul Metropolitan Government Ordinance on the Prevention of Toxic Substances Poisoning and Accident Safety.” Herein, the center’s annual performance in terms of project results and consultation information for 2022 are reported.Methods: SeoulPCC operates a helpline (Help Call, 1855-2221) that the general public can use from 9:00 AM to 5:00 PM on weekdays, as well as chatting and chatbot counseling through KakaoTalk’s “Seoul Poison Control Center,” and one-on-one online counseling through the website. Additionally, it has constructed a system for communicating with the general public through social media. Poisoning disease information collected from SeoulPCC from January to December 2022 was analyzed according to the number of requests, age of exposure, gender, location, and reason. Requests from the general public were summarized, and a brief image presenting information on poisoning disease-related consultations was produced.Results: SeoulPCC has a database containing information on 188,065 toxic substances collected by public institutions and provides this information to the general public and medical staff through its website. In 2022, consultations were performed through phone calls and SNS (social networking service) for 577 cases of poison information and first aid treatment due to exposure to toxic substances. There were 1,431 instances of providing poison information services. The annual requests included 512 exposure cases and 65 non-exposure cases. Furthermore, 366 cases were in Seoul, 145 cases were outside of Seoul, and 66 had an unknown location. The exposure cases included 161 requests from the general public and 351 requests from medical staff.Conclusion: This is the first annual report in Korea to analyze the occurrence of poisoning based on consultations. It is of major significance that this report serves as a starting point for identifying and tracking the aspects and characteristics of poisoning cases in the pre-hospital stage. In the future, poisoning-related disease information provided through consultations and at the emergency room should be linked, and through real-time collection and analysis, this information should be used as basic data for poisoning disease management policies.

Metformin-associated lactic acidosis reported to the United Kingdom National Poisons Information Service (NPIS) between 2010 and 2019: a ten-year retrospective analysis

Introduction Metformin toxicity following therapeutic use or overdose may result in metabolic acidosis with hyperlactatemia. This study aims to assess the relationship between serum lactate concentration, arterial pH, and ingested dose with severity of poisoning, and to identify if serum lactate concentration is a useful marker of severity in metformin toxicity. Methods A retrospective study of telephone enquiries relating to metformin exposures to the National Poisons Information Service between 2010 and 2019 from hospitals in the United Kingdom. Results Six-hundred and thirty-seven cases were identified; 117 involved metformin only and 520 involved metformin with other drugs. The majority of cases involved acute (87%) and intentional (69%) exposures. There was a statistically significant difference in doses between the Poisoning Severity Scores, as well as between intentional and unintentional or therapeutic error doses (P < 0.0001). The distribution of cases for each Poisoning Severity Score differed between the metformin only and metformin with other drugs cases (P < 0.0001). Lactic acidosis was reported in 232 cases. Serum lactate concentration and arterial pH differed across Poisoning Severity Scores. Arterial pH inversely correlated with ingested dose (r=-0.3, P = 0.003), and serum lactate concentration positively correlated with ingested dose (r = 0.37, P < 0.0001). Serum lactate concentration and arterial pH did not correlate with each other. Twenty-five deaths were recorded, all following intentional overdoses. Discussion The dataset focuses mostly on acute, intentional overdoses. Increasing ingested metformin dose, a higher serum lactate concentration and worsening arterial pH were all associated with an unfavourable Poisoning Severity Score in patients in both metformin only and metformin with other drugs groups. As serum lactate concentration did not correlate with arterial pH, it represents an independent marker of poisoning severity. Conclusions Data from the present study suggest that serum lactate concentration can be used to assess severity of poisoning in patients who have reportedly ingested metformin.

Treatment of insulin poisoning: A 100-year review.

Insulin poisoning, as opposed to hypoglycaemia induced by therapeutic doses of insulin, is rare, and guidelines on management differ. We have reviewed the evidence on treatment of insulin poisoning. We searched PubMed, EMBASE and J-Stage with no restrictions of date or language for controlled studies on treatment of insulin poisoning, collected published cases of insulin poisoning from 1923, and used data from the UK National Poisons Information Service. We identified no controlled trials of treatment in insulin poisoning and few relevant experimental studies. Case reports described 315 admissions (301 patients) with insulin poisoning between 1923 and 2022. The insulin with the longest duration of action was long-acting in 83 cases, medium-acting in 116, short-acting in 36 and a rapid-acting analogue in 16. Decontamination by surgical excision of the injection site was reported in six cases. To restore and maintain euglycaemia, almost all cases were treated with glucose, infused for a median 51 hours, interquartile range 16-96 h in 179 cases; 14 patients received glucagon and nine octreotide; adrenaline was tried occasionally. Both corticosteroids and mannitol were occasionally given to mitigate hypoglycaemic brain damage. There were 29 deaths reported, 22/156 (86% survival) up to 1999 and 7/159 (96% survival) between 2000 and 2022 (p= 0.003). There is no randomized controlled trial to guide treatment of insulin poisoning. Treatment with glucose infusion, sometimes supplemented with glucagon, is almost always effective in restoring euglycaemia, but optimum treatments to maintain euglycaemia and restore cerebral function remain uncertain.

Autumn poisoning hazards for pets

In the autumn, plants commonly produce their fruits, nuts and seeds, and fungi their fruit bodies (mushrooms). Some of these are poisonous and hazardous to pets. In addition to mushrooms, warm wet weather may promote the growth of mould producing tremorgenic mycotoxins, including on food waste, compost and windfall fruits and nuts. There is also a risk of exposure to luminous novelties and fireworks associated with autumnal events such as Halloween and in the UK, Bonfire Night. For pets that ingest mushrooms, expert identification of the suspect mushroom is highly recommended to identify animals as risk of severe poisoning. Many mushrooms only cause gastrointestinal upset, but others cause neurological effects, renal and/or liver damage. Tremorgenic mycotoxins cause rapid-onset whole-body tremors and seizures. Ingestion of luminous novelties usually only produces a taste reaction which rapidly resolves. Fireworks generally only cause gastrointestinal signs but there is a potential risk of metal poisoning, although this is uncommon. Conkers and acorns are commonly eaten by dogs in the autumn and typically cause only gastrointestinal signs, but there is the risk of obstruction and occasionally more significant signs. Management of autumnal hazards is supportive but advice from a poisons information service should be sought if necessary.

Bone meal ingestion in dogs: 255 Cases reported to the Veterinary Poisons Information Service

AbstractBone meal is a widely used fertiliser, and its ingestion in dogs is common, presumably because they are attracted by the odour. In a case series of 255 cases reported to the Veterinary Poisons Information Service, 47.1% of dogs remained well. Clinical signs were reported in 52.9% and were predominantly gastrointestinal, particularly vomiting and diarrhoea. Some dogs also displayed lethargy (14.9%) and abdominal pain (5.9%). Signs were typically mild, but in a small number of cases, gastrointestinal impaction and/or perforation (1.2%) occurred. Of the 135 symptomatic dogs that ingested bone meal, 132 recovered (51.8%), two were euthanased (0.8%) and one died (0.4%). Two dogs with gastrointestinal complications following bone meal ingestion are described in detail. Both had prolonged gastrointestinal signs, and exploratory coeliotomy confirmed gastrointestinal impaction with perforation in one case and necrosis of the gastric wall in the other. Both dogs were euthanased perioperatively due to poor prognosis.

Bites by exotic snakes reported to the UK National Poisons Information Service 2009–2020

Introduction: Snakebite is recognised as a neglected tropical disease and a cause of substantial morbidity and mortality. Whilst the most medically important snakes are typically native of Asia, Africa, Latin America and Oceania, the possibility of encountering these snakes is no longer limited by geography due to an increasing number of exotic (non-native) snakes being held in captivity. Methods: A retrospective review of snakebite enquiries to the UK National Poisons Information Service (NPIS) between 2009 and 2020. Enquiries about the European adder (Vipera berus) or where the identity of the snake was unknown were excluded. Results: There were 321 exotic snakebites in 300 patients involving 68 different species during this period. Ten patients were bitten on more than one occasion. The majority of patients (64.5%) were male. Most bites were inflicted by snakes of the family Colubridae (184/321, 57.3%); seventeen bites resulted in moderate symptoms (predominantly swelling of the bitten limb). There were 30 (9.3%) bites by Viperidae and 14 (4.3%) bites by Elapidae. All severe cases (n = 15) resulted from bites by either Viperidae (n = 10) or Elapidae (n = 5). Antivenom was given in 17 cases. One fatality was recorded. Conclusions: Despite their low incidence, exotic snakebites present a substantial challenge for UK healthcare professionals. Although rare, these bites typically occur in individuals (usually male) who keep snakes as part of their occupation or hobby and are therefore at risk of multiple bites. Bites can result in venom hypersensitisation and the risk of venom-induced anaphylaxis. Rapid access to expert clinical advice is available in the UK on a 24-hour basis through the National Poisons Information Service and is strongly recommended in all cases of exotic snakebite.

Potential cyanide poisoning reported to the UK national poisons information service: 2008–2019

Introduction Cyanide is a prevalent, lethal chemical. Possible sources of exposure include products of combustion, plant material, industry, chemical warfare and terrorism. Methods Retrospective review of UK Poisons Information Database of telephone enquiries to the National Poisons Information Service between 1st January 2008 and 31st December 2019 where cyanide poisoning was considered a possibility. Data extracted included demographics, exposure source, clinical features, Poisoning Severity Score, lactate concentration and antidotes given. Results A total of 1,252 cases of suspected cyanide poisoning were identified, 239 (19%) involved children under 10 years. The commonest sources of exposure were ingestion of plant material (437 cases; 35%) and smoke inhalation (399; 32%). Smoke inhalation caused the majority of severe and fatal cases (139; 71%). Clinical features associated with fatal outcomes were cardiac arrest (OR 36.4; 95% CI 14.4–92.2), hypotension (15.8; 7.0–35.9), coma (10.8; 5.6–21.0) and lactic acidosis (7.8; 4.1–14.8). 110 patients (9%) were given an antidote and 40 patients (3%) died. Lactate concentrations correlate with Poisoning Severity Score category (r = 0.6, p < 0.0001). Serum lactate <2.0 mmol/L was associated with Poisoning Severity Score None or Minor (sensitivity 76%; specificity 86%) and >11.0 mmol/L was associated with fatal outcome (sensitivity 74%; specificity 80%). 61 cases (5%) had severe carboxyhaemoglobin toxicity (COHb >30%). This was associated with a fatal outcome (OR 7.0; 95% CI 1.5-33.7) and there was positive correlation between carboxyhaemoglobin and Poisoning Severity Score, r = 0.57, p < 0.0001. Conclusions Most cases of ingestion of plant material involved children under five years and resulted in no or mild symptoms. In adults smoke inhalation was associated with the most severe poisoning. The lactate cut-off values associated with each severity score calculated in this study are lower than the values used by NPIS on TOXBASE. Analytical conformation of cyanide exposure was unavailable in the majority of case, limiting the strength of these conclusions.

Retrospective evaluation of acute salbutamol (albuterol) exposure in dogs: 501 cases.

To determine the common clinical signs, with onset and duration, treatments given, and outcome in dogs with acute, accidental exposure to salbutamol. Retrospective study. Five hundred and one canine cases reported to the UK's Veterinary Poisons Information Service (VPIS). A review of all records in the VPIS database for dogs exposed to salbutamol was carried out. After applying inclusion and exclusion criteria, the records of 501 dogs were further analyzed. The most common clinical signs were tachycardia (80.6%), tachypnea (32.9%), depression (21.0%), and vomiting (19.2%). The dose was unknown in most cases as the dogs typically pierced a salbutamol inhaler. The blood potassium concentration was measured in at least 142 dogs and hypokalemia was reported in 21.2% (106/501), 18 (17%) of which had associated weakness, twitching, or collapse. Three dogs had paralysis probably as a result of hypokalemia, although no potassium concentration was reported in these cases. Arrhythmias occurred in 17 dogs (3.4%), and 7 required pharmacological intervention. There were no reports of persistent cardiac injury or thermal injury from the compressed gas present in some salbutamol products. Signs were rapid in onset, generally within 1-3h, and, where time to outcome was recorded (n=172), 78% of dogs recovered within 24h. Of the 501 dogs, no treatment was required in 27.9%. Beta-blockers were used in 39.5%, intravenous fluids in 28.7%, and potassium supplementation in 15.8%. Overall, 30 dogs remained asymptomatic (6.0%), 469 recovered (93.6%), and 2 dogs (0.4%) died. Most dogs exposed to salbutamol rapidly develop clinical signs; these were commonly increased heart and respiration rates. Hypokalemia and arrhythmias (particularly ventricular arrhythmias) are potential complications. Any dog that chews a salbutamol inhaler should be assessed promptly for signs of toxicosis. Prognosis in dogs with acute salbutamol exposure is good, but more guarded in those with severe tachycardia and at risk of cardiac injury.

How to…

Abstract Nicola Bates, of the Veterinary Poisons Information Service, discusses how to handle this serious toxicity.

Event-Based Surveillance of Poisonings and Potentially Hazardous Exposures over 12 Months of the COVID-19 Pandemic.

The COVID-19 pandemic has seen people and governments utilise an array of chemical and pharmaceutical substances in an attempt to prevent and treat COVID-19 infections. The Centre for Radiation, Chemicals and Environmental Hazards (CRCE) at Public Health England (PHE) routinely undertakes Event-Based Surveillance (EBS) to monitor public health threats and incidents related to chemicals and poisons. From April 2020, EBS functions were expanded to screen international media for potentially hazardous exposures associated with the COVID-19 pandemic. Media sources reported that poisons centres were experiencing increased enquiries associated with the use and misuse of household cleaners and alcohol-based hand sanitiser (HS). There were also media reports of people self-medicating with over-the-counter supplements and traditional or herbal remedies. Public figures who directly or indirectly facilitated misinformation were sometimes reported to be associated with changes in poisoning trends. Border closures were also believed to have been associated with increasingly toxic illicit drug supplies in Canada, and record numbers of opioid-related deaths were reported. In other countries, where the sale of alcohol was banned or limited, home-brewing and methanol-based supplies resulted in a number of fatalities. At least two chemical incidents also occurred at industrial sites in India, after sites were left unattended or were closed and reopened due to lockdown measures. Reports of poisoning identified in the international media were provided to the UK National Poisons Information Service (NPIS) and contributed to the UK COVID-19 public health response.

A Study and Report on Impact of Clinical Pharmacy Services Over Indian Health Care System in the Management of Chronic Disorders/Diseases in Hospital

The study aims to ensure safe, effective, economic, and patient friendly with the knowledge inputs of each professional practice. With the primary and secondary objectives being: to study the role of the clinical pharmacist/doctor of pharmacy professional in the management of chronic diseases/illness, minimise medication/prescription errors, minimise/prevent adverse drug reactions, all types of drug interactions, and unnecessary healthcare costs, reducing drug-related problems and to monitor drug therapy efficiently, attain desired pharmacological effect of the drug, improve quality of life of the patients suffering from chronic conditions, provide patient counselling in a way that it helps to provide effective drug treatment in thereby improving the patient's condition, improve medication adherence, patient compliance and patient safety and therefore to provide drug or poison information services as needed. In India, chronic diseases such as cardiovascular diseases, diabetes, cancer, HIV and mental health disorders and injuries are the leading causes of death and disability. Most chronic diseases are equally prevalent in poor and rural populations and often occur together. Although a wide range of cost-effective primary and secondary prevention strategies are available, their coverage is generally low, especially in poor and rural populations. Much of the care for chronic diseases and injuries is provided in the private sector and can be very expensive. Sufficient evidence exists to warrant immediate action to scale up interventions for chronic diseases and injuries through private and public sectors; improved public health and primary health care systems are essential for the implementation of cost-effective interventions. This study enrolled 200 patients totally, out of which, 120 (sample size) patients’ prescriptions were analysed for potential drug interactions and were also selected for comparison of results of other related clinical pharmacy services. The majority of the population being males (65) and the rest being females (55) and among the study population, around 60 (132.5%) patients were geriatric, about 17 (38%) were renal impairment patients and about 13 (29.5%) were hepatic impaired patients. Out of the 45 interventions proposed, the most frequent suggestion was on substitution for 26.67% of the population and monitoring 26.67%. Out of this, 20.69% of the interventions/suggestions made were accepted and therapy was changed. Hence the prospective study was performed based on other categories which are discussed further using various software and spreadsheets to calculate the desired results and hence with the overall objective being to improve and make better the patients’ health and quality of life.

National audit of antidote stocking in UK emergency departments

BackgroundPrevious audits of antidote stocking in UK hospitals have demonstrated variable but improving compliance with joint Royal College of Emergency Medicine and National Poisons Information Service guidance on antidote availability...

Unintentional paediatric iron poisoning: A retrospective case series.

Iron poisoning is a historically important cause of paediatric morbidity and mortality. In recent decades, public health measures have considerably reduced paediatric iron exposures. We investigated unintentional paediatric iron poisoning in children with the aim of developing an assessment approach specific for this group. This was a retrospective observational study of unintentional iron poisoning in children (<7 years old) referred to either a state-wide poisons information service or a tertiary clinical toxicology unit from 1 January 2015 to 16 February 2020. Patients were identified from prospective databases maintained by both services, and data were extracted from these in addition to the medical record. There were 54 children included in the study (29 [54%] male; median age 2 years (range 8months to 4 years). The median suspected dose of elemental iron ingested was 72 mg/kg (IQR 41-140 mg/kg). Seventeen (31%) children were symptomatic. There were no cases of severe toxicity. Children symptomatic with gastrointestinal toxicity had a median suspected dose ingested of 60 mg/kg (IQR 38-150 mg/kg) that was similar to asymptomatic children (81 mg/kg [IQR 41-143 mg/kg], P= 0.809). The median peak iron concentration was 49 μmol/L (IQR 13.5-67.5μmol/L, range 4-75 μmol/L). Symptomatic children had a significantly higher median peak serum iron concentration of 66 μmol/L (IQR 54-68 μmol/L) compared to 12 μmol/L (IQR 9-15 μmol/L) in asymptomatic children (P< 0.001). Unintentional paediatric iron poisoning is uncommon and largely benign. Suspected dose ingested is a poor predictor of toxicity. Targeting investigations and interventions to symptomatic children should reduce unnecessary assessment and management while still safely managing the exposure.

Carbon monoxide exposures reported to the UK National Poisons Information Service: a 4-year study.

Unintentional carbon monoxide (CO) poisoning poses a public health challenge. The UK National Poisons Information Service (NPIS) provides advice to healthcare professionals via the online database, TOXBASE®, and a 24-hour telephone line. Our aim was to analyse all CO-related enquiries to the NPIS. We analysed enquiries regarding unintentional CO exposure (1st July 2015-30th June 2019). Information on patient demographics, CO source and location, clinical features and poisoning severity was collected from telephone enquiries and TOXBASE accesses. 2970 unintentional non-fire-related CO exposures were reported. Exposures occurred commonly in the home (60%) with faulty boilers frequently implicated (27.4%). Although five fatalities were reported, 68.7% of patients experienced no or minor symptoms only (headache most frequently reported). Despite being the gold standard measurement, blood carboxyhaemoglobin concentration was only recorded in 25.6% patients, with no statistically significant correlation with severity. Unintentional CO exposures in the UK commonly occur in domestic settings and although are generally of low severity, fatalities continue to occur. Carboxyhaemoglobin measurement is important to confirm exposure but further work is required to assess its validity as a prognostic indicator in CO exposure. Public health policy should continue to focus on raising awareness of the dangers of CO.