Texas Poison Center Network Research Articles

Fasciotomy following North American pit viper envenomation in Texas 2004–2021

Introduction North American pit viper envenomation occurs over 4,000 times annually in the United States, with polyvalent Fab antivenom being the primary treatment. Fasciotomy is occasionally performed due to concerns about compartment syndrome. We utilized our direct access to Texas Poison Center Network data to create a new snakebite abstraction form and database on relevant available information between 2004 and 2021 and to identify, describe, and estimate the incidence of fasciotomy following pit viper envenomation in Texas. Methods We searched the Texas Poison Center Network database for cases during 2004–2021 using keywords such as fasciotomy, surgery, compartment pressure, and compartment syndrome. Descriptive statistics summarized the data. Results Of 16,911 reported envenomations, 0.69 percent involved fasciotomies (n = 117). Most common bite sites were digits/hands and lower extremities. Patients who underwent fasciotomy were typically male, aged 20–59, and 10 years younger than the total snakebite population. Only 6 percent of reported compartment syndrome cases had a compartment pressure measurement. Antivenom was administered in 101 (86.3 percent) cases, 92 (91.1 percent) of which received only Fab antivenom product. Patients with bites from rattlesnakes (47.9 percent) were associated with most fasciotomies Discussion Our findings suggest a potential increase in snakebite exposures, accompanied by a decrease in fasciotomies. Overall, copperheads constituted the majority of snakebites, but most fasciotomies were from rattlesnake envenomations (47.9 percent). In this cohort, compartment syndrome diagnosis and decisions regarding fasciotomy were primarily based on clinical evaluation/surgeon expertise without compartment pressure measurements. Despite the efficacy of antivenom, only 86.3 percent of patients in our study received antivenom. Conclusions Fasciotomy after North American pit viper envenomation in Texas is uncommon (0.69 percent) and has decreased over time, possibly due to increased antivenom use or surgeon comfort with nonsurgical management.

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.

Euphorbia tirucalli exposures reported to Texas poison centers

Introduction: Euphorbia tirucalli, commonly known as pencil cactus, is a member of the Euphorbiaceae family that produces a milky, white latex substance that can cause local irritation if ingested or comes in contact with the skin or eyes. This study characterized E. tirucalli exposures reported to a large, statewide poison center network.Methods: Cases were E. tirucalli exposures reported to the Texas Poison Center Network (TPCN) during 2000–2018. The distribution of cases was determined for various factors related to patient demographics, exposure circumstances, management, and outcome.Results: Of 678 total E. tirucalli exposures, the patient age distribution was 16.8% five years or less, 8.0% 6–12 years, 1.6% 13–19 years, and 72.1% 20 years or more; 55.6% were male. The most common exposure routes were ocular (60.9%), ingestion (31.9%), and dermal (17.3%). The exposure reason was unintentional in 97.5% of the exposures and occurred at the patient’s own residence in 94.4%. The patient was managed outside of a healthcare facility in 66.5% of the cases, and 17.1% had potentially serious outcomes. The most common reported clinical effects were ocular (60.0%), dermal (14.0%), and gastrointestinal (12.1%).Conclusion: The majority of patients involved in E. tirucalli exposures reported to the TPCN were adults and male. The most common routes of exposure and clinical effects were ocular, ingestion, and dermal contact. Such information may prove useful for targeting education and prevention activities relating to E. tirucalli exposures.

The Changing Face of Synthetic Cannabinoids in Texas

ABSTRACTThis article describes the characteristics of individuals who used synthetic cannabinoids and the changes in the user population over time. Data sources include treatment admissions with a primary problem with synthetic cannabinoids reported to the Texas treatment dataset, synthetic cannabinoid exposures reported to the Texas Poison Center Network, and items identified in the National Forensic Laboratory Information System in 2009–2016. Statistically significant trends were identified for race/ethnicity, gender, age, education level, employment status, homelessness, criminal justice problems, use of other substances, lag time between first use and time to treatment, exposure site, chronicity, reason for exposure, and the most common types of cannabinoids. Comparisons were made between the years and the variables in the datasets. Findings suggest that the characteristics of synthetic cannabinoid users and the varieties of these drugs in Texas have changed over time. Data to link individual cases with the changing results of toxicological analysis are needed, as well as targeted prevention and treatment efforts for an aging population who may be at risk of homelessness and also have co-morbid substance use and psychiatric problems.

Energy drink exposures reported to Texas poison centers: Analysis of adverse incidents in relation to total sales, 2010–2014

The ill-defined term “energy drink” includes a disparate group of products (beverages, shots, concentrates, and workout powders) having large differences in caffeine content and concentration and intended use. Hence, inaccurate conclusions may be drawn when describing adverse events associated with “energy drinks”. The FDA is considering new regulation of these products but product specificity is needed to evaluate safety. To help address this, we queried Texas Poison Center Network data for single substance exposures to "energy drinks" from 2010 to 2014, then analyzed adverse events by product type. We specifically compared energy beverage exposures with sales data for the same time period to evaluate the safety profile of this category of energy drinks.Among 855 documented "energy drink" exposures, poison center-determined outcome severity revealed 291 with no/minimal effects, 417 judged nontoxic or minor/not followed, 64 moderate and 4 major effects, and no deaths. Serious complications included 2 seizures and 1 episode of ventricular tachycardia. Outcome severity by category for beverages: 11 moderate/1 major effects (none in children <17 years); shots: 19 moderate/2 major; non-liquids: 16 moderate/1 major; concentrates: 7 moderate; unknown: 10 moderate. Call incidence to poison centers for beverage type exposures was 0.58 (for moderate effects) and 0.053 (for major) per hundred million units sold.Small volume and concentrated products were associated with a greater number of adverse effects than beverage versions of "energy drinks".

Intentional Misuse and Abuse of Loperamide: A New Look at a Drug with “Low Abuse Potential”

BackgroundDespite its opioid properties, loperamide has long been thought to have low abuse potential due to its poor absorption from the gastrointestinal tract and limited potential to cross the blood–brain barrier. A recent patient reportedly taking loperamide to avoid heroin withdrawal symptoms, at doses approximately 100 times those recommended, directed our attention to this issue. Objectives1) Investigate number of cases of intentional loperamide abuse and misuse reported to poison centers between 2009 and 2015; 2) Compile reports of clinical effects of loperamide abuse; and 3) Search for evidence of increasing Internet interest in the central opioid effects of loperamide. MethodsFor the years 2009 thru 2015, we reviewed exposure calls related to misuse/abuse of loperamide in the Texas Poison Center Network's database and the National Poison Data System. We used Google trend analysis to detect evidence of increased Internet interest in the illicit use of loperamide. ResultsBetween 2009 and 2015, the number of misuse/abuse calls related to loperamide alone nearly doubled, with about one-third of cases occurring in teens and young adults in their 20s. Of particular concern are reports of significant cardiotoxic effects (∼18% of cases), including conduction defects and various dysrhythmias, sometimes leading to death. Google Trends analysis demonstrates an increasing number of searches for “loperamide high” and “loperamide withdrawal” beginning in 2011. ConclusionsLoperamide misuse/abuse seems to be on the rise. Given its propensity to induce conduction disturbances and dysrhythmias at very high doses, emergency physicians should be vigilant for this form of drug abuse.

Comparison of Unintentional Exposures to Codeine and Hydrocodone Reported to Texas Poison Centers

BackgroundHydrocodone has recently been reclassified as a Schedule II drug by the United States Drug Enforcement Administration and Food and Drug Administration in order to curtail prescription drug abuse. There is concern that analgesic substitutes, such as codeine, will not be as safe or effective. ObjectiveThe purpose of this study is to compare the demographics, adverse events, and medical outcomes of patients who had unintentional hydrocodone or codeine exposures through the use of a state's poison center database. MethodsThe Texas Poison Center Network's database was utilized to find all reported unintentional ingestions or adverse reactions of products containing codeine or hydrocodone. Comparisons were made between the two medications by calculating the rate ratios (RR) and 95% confidence intervals (CI). ResultsChildren aged 5 years or younger were more exposed to codeine (51.6%). Hydrocodone exposures had more serious outcomes (11% vs. 9%; RR = 0.82; 95% CI 0.73–0.91) and had more nausea (7.1% vs. 2.8%; RR = 0.4; 95% CI 0.32–0.48) and vomiting (6.5% vs. 3.3%; RR = 0.51; 95% CI 0.43–0.62). Hydrocodone had a higher rate of intravenous fluids administration (2.4% vs. 1.7%; RR = 0.71; 95% CI 0.54–0.92) and antiemetics (0.4% vs. 0.1%; RR = 0.23; 95% CI 0.08–0.64). Codeine was more closely associated with dermal reactions and patients were given antihistamines (2.5% vs. 1.3%; RR = 1.88; 95% CI 1.46–2.41) more frequently. Cardiovascular side effects, ataxia, and headache occurred equally between the groups. ConclusionsBoth drugs had a wide array of reported side effects, but the overall incidence of serious outcomes was low.

Antiretroviral Drug Exposures Reported to Texas Poison Centers.

Background. A number of different antiretroviral drugs are used to manage patients with human immunodeficiency virus (HIV). Objective. This study describes antiretroviral drug exposures reported to a large statewide poison center system. Methods. Cases were all antiretroviral drug exposures reported to the Texas Poison Center Network during 2000 to 2014. The distribution of cases was determined for various demographic and clinical factors. Results. Of a total of 632 exposures, the most commonly reported drugs were emtricitabine-tenofovir combination (17.1%), efavirenz-emtricitabine-tenofovir combination (13.8%), ritonavir (10.9%), lamivudine-zidovudine combination (10.3%), and efavirenz (10.1%). The annual number of antiretroviral drug exposures increased from 34 in 2000 to 67 in 2014. Males comprised 67.9% of the patients; 72.2% were 20 years or older. The exposures were 58.5% unintentional and 37.5% intentional. Only antiretroviral drugs were reported in 440 of the exposures. Of these exposures, 62.5% were managed on site, 28.0% were already at or en route to a health care facility when the poison center was contacted, and 8.6% were referred to a health care facility. The exposures were not serious in 88.7% of these cases. The most frequently reported adverse clinical effects were vomiting (5.7%), nausea (4.8%), dizziness/vertigo (3.2%), and drowsiness/lethargy (3.2%). Conclusions. The most commonly reported antiretroviral drugs were emtricitabine-tenofovir combination and efavirenz-emtricitabine-tenofovir combination. The patients were most likely to be adults and males. The exposures tended to be unintentional. Of those exposures involving only antiretroviral drugs, the majority of the exposures were not serious and could be managed outside of a health care facility.

Toxicity of Nutmeg (Myristicin): A Review

In this paper a detailed review of myristicin is reported. Numerous literatures report that myristicin is responsible for hallucinogenic effects, which induced by the consumption of nutmeg due to its metabolism structure of 3-methoxy-4,5-methylendioxyamphetamine (MMDA). Minimum dosage of nutmeg that can cause psychogenic effect is 5 g (ground nutmeg) with 1 to 2 mg myristicin content and this dosage is considered as ‘toxic dose’. At higher dosage of myristicin death may occur. Additionally, Myristicin poisoning can lead to many health problems that related to brain problem. Those symptoms usually occur 3 to 6 hours after ingestion of myristicin or foodstuffs containing it, and effects may persist up to 72 hours. California Poison Control System (CPCS) electronic database 72.3% exposures between 1997 and 2008 that were intentional for recreational purposes (between ages 13 and 20 years old). The remaining considered as unintentionally exposed. Between 1998 to 2008, Texas Poison Center Network (TPCN) received seventeen nutmeg poisoning and 64.7% from that cases involved abuse, and the rest was unintentional exposure. Most of the nutmeg exposures were via the oral route and minor cases of nutmeg exposure occurred through insufflated nutmeg, unintentional dermal and ocular exposures. Nutmeg also has been misused by mixing it with other drugs in order to get “high”. For intoxication cases, treatments like decontamination (cathartic, charcoal, dilution, fresh air, IV fluids) and supportive care (benzodiazepines) will be provided to reduce the effects.

Effect of Cough and Cold Medication Withdrawal and Warning on Ingestions by Young Children Reported to Texas Poison Centers

This study examined whether the withdrawal of over-the-counter cough and cold medication labeled for use in children younger than 2 years in October 2007 and the warning against use of the products in children younger than 4 years in October 2008 affected cough and cold medication ingestions by young children reported to a statewide poison system. Cases were all cough and cold medication ingestions by children aged 0 to 5 years reported to the Texas Poison Center Network during October 1998 to September 2009. The annual number of ingestions was determined, and the percent change from the previous year calculated. During October 1998 to September 2007, the number of ingestions exhibited a mean annual increase of 2.5%. The number of ingestions declined by 16.0% during October 2007 to September 2008 and 9.3% during October 2008 to September 2009. During October 2007 to September 2008, the number decreased by 26.5% in children aged 0 to 1 years, 13.5% in those aged 2 to 3 years, 5.4% in those aged 4 to 5 years, 23.4% therapeutic errors or adverse drug reactions, and 11.5% in all other circumstances. The voluntary withdrawal and subsequent voluntary warning of over-the-counter cough and cold medications appear to have resulted in a decline in ingestions reported to Texas poison centers not only among children aged 0 to 1 and 2 to 3 years but also among children aged 4 to 5 years, although the degree of decline was greatest for the youngest age groups. The decrease was observed not only among therapeutic errors and adverse drug reactions, but also in other circumstances of ingestion, although the decrease was greater for the former circumstances.

Use of Interactive Voice Response Technology by Poison Centers during the H1N1 Outbreak

Interactive voice response (IVR) technology may facilitate poison centers to handle increased call volumes that may occur during public health emergencies. On 28 April 2009, the Texas Poison Center Network (TPCN) added a H1N1 message in English and Spanish to its IVR system. This study tested whether IVR technology could be used to assist Texas poison centers during the H1N1 outbreak. The distribution of callers who accessed the H1N1 message during 29 April-31 May 2009 was determined with respect to message language, subsequent caller action, and date of the call. The H1N1 message was accessed by 1,142 callers, of whom, 92.9% listened to the message in English, and 7.1% listened to the message in Spanish. After listening to the message, 33.3% hung up while 66.7% spoke to a poison center agent. The number of callers who accessed the message was highest on 29 April 2009 and then declined. Interactive voice response technology can be used to assist poison centers to provide information and handle calls from the public during a public health emergency.

Validation of the American Association of Poison Control Centers out of hospital guideline for pediatric diphenhydramine ingestions

Context. In 2006, the American Association of Poison Control Centers (AAPCC) published an out of hospital guideline for diphenhydramine overdoses in children. This guideline has not been validated. Objective. Our objective was to determine the incidence of serious clinical effects or use of medical treatments after unintentional diphenhydramine ingestions in children. We sought to determine if patients with less than 7.5 mg/kg ingestions developed medical complications of diphenhydramine toxicity. Materials and methods. In our observational case series, we searched 7 years of data (2000–2006) in the Texas Poison Center Network for diphenhydramine using the AAPCC generic codes. We included only acute, single ingestions of diphenhydramine in children under 6 years old. We included only patients with a recorded weight, known amount of ingestant, and known follow-up. We defined “serious clinical effects” as hallucinations, seizure, wide QRS on electrocardiogram, wide complex dysrhythmia, any conduction block, hypotension, hypertension, rhabdomyolysis, pyrexia, dystonia, coma, respiratory depression, or death. One trained abstractor reviewed the data and entered it into an electronic data collection form. Twenty percent of the charts were audited for abstractor agreement. Results. Our search resulted in 928 cases. Of these, 305 were included in our study. Of the patients who ingested doses less than 7.5 mg/kg, 99.7% (299/300) did not require critical treatments or were without serious clinical effects. One child was admitted. Five children ingested doses of more than 7.5 mg/kg. All five were observed in the emergency department and discharged home. Two patients had serious clinical effects of hallucinations, one of which ingested more than 7.5 mg/kg. No child required critical treatments. Our agreement on chart review for 20% of the cases was very good for “serious clinical effects” (kappa, 0.79; 95% CI, 0.39–1.0) and excellent for “critical treatments” (kappa, 1.0). Conclusion. Based on our observational case series, 99.6% of patients who reportedly ingested doses less than 7.5 mg/kg did not develop serious clinical effects or require admission. Pediatric ingestions over 7.5 mg/kg were uncommon in our study population. Serious clinical effects, critical treatments, and admission from diphenhydramine were rare in children under 6 years old.

Incidence of tricyclic antidepressant-like complications after cyclobenzaprine overdose

Background The cyclobenzaprine structure is similar to amitriptyline; however, tricyclic antidepressant (TCA)-like wide complex dysrhythmia has not been reported. Our objective was to determine the incidence of TCA-like effects in cyclobenzaprine overdoses as reported to 6 poison centers for 2 years. We compared the incidence of these effects to amitriptyline overdoses collected during the same period. Methods We performed a retrospective review of 2 years of cases as reported to the Texas Poison Center Network. We identified sole ingestions of cyclobenzaprine and of amitriptyline. Cases had a recorded clinical outcome and clinical effect. A trained reviewer used a standard data collection sheet within a secured electronic database. One investigator audited a random sample of charts. Results We identified 3974 cases of cyclobenzaprine calls. Of these, we collected 209 cases of acute overdoses without coingestions. There were no deaths. No cases of cyclobenzaprine ingestions were reported to have died or have a wide QRS or ventricular dysrhythmia. Seizures were reported in 2 cases; however, both were unrelated to cyclobenzaprine. Hypotension was reported in 1.4% (3/209) of cases, and a vasopressor was used in one case (0.5%). Patients with an amitriptyline overdose were more likely to have seizure, coma, tachycardia, a wide QRS or ventricular dysrhythmia, and have received sodium bicarbonate or be intubated. Conclusions Cyclobenzaprine overdoses were not reported to cause widened QRS, ventricular dysrhythmias, or seizures, and hypotension was rarely reported. Tricyclic antidepressant-related effects occurred more often in our comparison group of amitriptyline overdoses.

Six Years of Epinephrine Digital Injections: Absence of Significant Local or Systemic Effects

Epinephrine autoinjectors are known to result in accidental digital injections. Treatment recommendations and adverse outcomes are based on case reports. The objective of our study is to determine the frequency of digit ischemia after epinephrine autoinjector digital injections. In addition, we describe the frequency of epinephrine digital injections, treatments used, adverse local effects, and systemic effects. We performed a retrospective cohort study on cases reported to 6 poison centers during 6 years, using a search of the Texas Poison Center Network database. Patients who had an epinephrine injection of the hand were reviewed, and digital injections were included. Variables collected included demographics, local and systemic effects, symptom duration, treatments used, comorbidities, and whether admission, surgery, or hand surgery consultation was used. One trained abstractor used a standard electronic data collection form. There were 365 epinephrine injections to the hand identified for the 6-year period. Of these, 213 were digital injections, and 127 had follow-up. All patients had complete resolution of symptoms. None of the patients were hospitalized or received hand surgery consultation or surgical care. Significant systemic effects were not reported. Pharmacologic vasodilatory treatment was used in 23% (29/127) of patients. Ischemic effects were documented for 4 patients, and 2 of these had symptom resolution within 2 hours. All 4 patients received vasodilatory therapy and were discharged home, with complete resolution of symptoms. In our series of patients using poison center calls about digital epinephrine autoinjections, there were no cases in which clinically apparent systemic effects were recorded and few patients had ischemia. No patient was admitted or had surgery. Most clinicians did not use vasodilation medications or techniques.

Alcohol-Based Hand Sanitizers and Unintended Pediatric Exposures: A Retrospective Review

Alcohol-based hand sanitizers (ABHS) have proliferated throughout the United States in recent years and are now common products in households and hospitals. These products are effective and can reduce absenteeism caused by gastrointestinal illness in elementary school students. The most common ABHS generally use ethyl alcohol as their active ingredient, with concentrations of this compound in the 60% ethanol-by-weight range. Inactive or ingredients are water, isopropyl alcohol, some fragrances, and other emollients. Isopropanol compounds are also occasionally used. Although these agents would not be considered to have a good flavor by most consumers, purposeful abuse to achieve intoxication has been previously reported. In light of the high alcohol concentrations and extraordinary dissemination of these products, we sought to characterize what acute impact, if any, exposure to these products has on young children. To provide a preliminary description in a pediatric population, we studied exposures to ABHS in individuals less than 6 years of age within the Texas Poison Center Network (TPCN) during 2006 and 2007. In 2006 and 2007, there were a total of 826 and 1022 total exposures meeting the study criteria, respectively. Of these exposures, 685 and 792 were in children under 6 years of age, and 621 and 737 exposures were ingestions, 2 and 1 were inhalations, 32 and 20 were ocular, and 30 and 33 were dermal. The type of exposure could not be discerned in 1 case in the 2007 database. Of the entire study population, 55 and 62 sustained a minor effect, and 9 and 11 had effects. Our study demonstrates a paucity of significant effects for exposures related to these products. Since there were no moderate or major effects reported from 1477 children, the product appears relatively safe when misused by this age group. As with many pediatric exposures, the exposures in children under 6 almost invariably occurred as a brief taste or accidental ocular or dermal exposure, thus resulting in little or no toxicity. Of course, significant poisoning and even deaths do occur in children despite this tasting tendency, resulting from substances capable of causing toxicity in low concentrations. Examples of such substances include camphor, sulfonylureas, lead, clonidine, and methylsalicylates. 10 In the setting of young children and ABHS in current formulations, it seems that significant intoxication is extremely unlikely.

Transdermal Patch Medication Delivery Systems and Pediatric Poisonings, 2002-2006

Transdermal drug delivery systems are an increasingly popular method of medication delivery containing large quantities of medication and presenting new opportunities for toxicity. To provide a description of exposures to transdermal medications in a pediatric population, we studied exposures in individuals less than 12 years of age. This is a retrospective database study in which the Texas Poison Center Network database from 2002 to 2006 was reviewed. In all, 336 poison control center records of patch exposures over the 5-year period were identified. Of those, 110 cases involved children less than 12 years old. A majority of cases resulted in no significant clinical effects. One death resulted from opioid toxicity. Although a majority of patch exposures in children less than 12 years of age resulted in no significant clinical toxicity, practitioners and the public must be made aware of the available patch-based medications and their potential for toxicity in children.

Texas Coral Snake (Micrurus tener) Bites

The clinical features of bites from Texas coral snakes (Micrurus tener) have not been well studied. Our goal was to review the largest number of victims of Texas coral snakebites to determine their characteristics, effects, treatment, and outcome. Retrospective case series of Micrurus tener exposures reported to the Texas Poison Center Network from 2000 to 2004. Eighty-two patients were included in the analysis. Most (57.3%) were 18 to 49-year-old men. Almost 90% had local swelling, pain, erythema, or paresthesias. Only 7.3% had systemic effects, and none of these were severe. Over half received coral snake antivenin, and 15.9% were given opioids for pain. No patient died and no patient required mechanical ventilation due to hypoventilation from the snakebite. There were more local findings and less severe systemic effects than previously reported. Antivenin is not needed for most of these patients, and opioids may be administered safely.

Fabuloso: A Cleaning Product That Tastes and Smells Good Enough to Drink

To the Editor .— Fabuloso (see Fig 1) is one of a group of consumer products that have been reportedly misused as a result of packaging that is claimed by consumer groups to be misleading. In past months, Colgate-Palmolive, the makers of Fabuloso, has been contacted in reference to altering the packaging to avoid such confusion. We were concerned about this issue and looked at the call volume related to Fabuloso at the Texas Poison Center Network to better characterize the impact of this product packaging choice on call volume. …

Pattern of Sildenafil Calls to Texas Poison Control Centers, 1998–2004

Sildenafil, a popular medication approved for the treatment of erectile dysfunction, is often misused. This study sought to describe the patterns of sildenafil calls to poison control centers in Texas during 1998–2004. Data on all sildenafil calls reported to the Texas Poison Center Network were analyzed. There were 628 sildenafil calls, 36% of which were human exposures and 44% were drug identifications. The number of calls increased during 1998–2003 but leveled off in 2004. The sildenafil exposure was isolated in 70% of the human exposure calls and involved other substances in 30% of the calls. Nonisolated exposures were more likely than isolated exposures to be intentional, involve males, occur in adults, and involve more serious problems as reflected by higher rates of health care facility treatment usage and more severe medical outcomes. The most frequently reported clinical effects were dizziness, tachycardia, erythema, and drowsiness. Most sildenafil calls were for human exposures or drug identification. The characteristics of human exposures such as the exposure reason and medical outcome were dependent on the presence of other substances. Funding for this research was provided by a contract with the Commission on State Emergency Communications in Texas. We thank the staff of the six poison control centers (Central Texas Poison Center, North Texas Poison Center, Texas Panhandle Poison Center, South Texas Poison Center, Southeast Texas Poison Center, West Texas Regional Poison Center) of the TPCN who collected the data.

Association Between Sociodemographic Factors and Exposures and Utilization of Poison Centers In Texas, 1998–2002

This study evaluated whether selected sociodemographic factors and exposures may be associated with utilization of poison centers in Texas during 1998–2002. Data were obtained from the six poison centers that service the entire state. Cases were all human exposures where the caller county was known. The utilization rate (calls per 1000 population) was calculated for the entire state and for each county. Counties were then grouped into those with utilization rates lower than the utilization rate for the entire state and those with utilization rates higher than the rate for the entire state. The two groups were then compared with respect to sociodemographic factors derived from the 2000 Census and exposure categories derived from the poison centers. The group of counties with lower utilization rates had a lower population density, higher African-American and Hispanic populations, lower median household incomes, and higher percentage of the population who spoke a language other than English at home and spoke English less than "very well." Gender, age, and education factors were not related to utilization rates, and the most frequently reported exposure categories were similar between counties with lower and higher utilization rates. This information can be used to focus education and prevention efforts at those populations with lower utilization of the Texas Poison Center Network.