Unintentional Exposure Research Articles

A Gas Chromatographic System for the Detection of Ethylene Gas Using Ambient Air as a Carrier Gas

Ethylene gas is a naturally occurring gas that has an influence on the shelf life of fruit during their transportation in cargo ships. An unintentional exposure of ethylene gas during transportation results in a loss of fruit. A gas chromatographic system is presented here for the detection of ethylene gas. The gas chromatographic system was assembled using a preconcentrator, a printed 3D printed gas chromatographic column, a humidity sensor, solenoid valves, and an electrochemical ethylene gas sensor. Ambient air was used as a carrier gas in the gas chromatographic system. The flow rate was fixed to 10 sccm. It was generated through a mini-pump connected in series with a mass flow controller. The metal oxide gas sensor is discussed with its limitation in ambient air. The results show the chromatogram obtained from metal oxide gas sensor has low stability, drifts, and has uncertain peaks, while the chromatogram from the electrochemical sensor is stable and precise. Furthermore, ethylene gas measurements at higher ppb concentration and at lower ppb concentration were demonstrated with the electrochemical ethylene gas sensor. The system separates ethylene gas and humidity. The chromatograms obtained from the system are stable, and the results are 1.2% repeatable in five similar measurements. The statistical calculation of the gas chromatographic system shows that a concentration of 2.3 ppb of ethylene gas can be detected through this system.

In vitro assessment of neurotoxicity and neuroinflammation of homemade MWCNTs

Multi walled carbon nanotubes (MWCNTs) activate pathways involved in cytotoxicity, genotoxicity and inflammation. Inhaled MWCNTs are translocated to extra pulmonary organs and their hydrophobicity allows them to cross the blood–brain barrier (BBB). Further exposure of central nervous system (CNS) occurs via olfactory neurons.Using differentiated SH-SY5Y, we studied the neurotoxicity and neuroinflammation of pristine and functionalised MWCNTs. ROS overproduction was dose- and time-dependent (P<0.01) and was related to mitochondrial impairment, DNA damage and decreased viability (P<0.05). Transcript levels of TNFα, IL-1β and IL-6 increased, as confirmed by an ELISA test. Raman spectra were acquired to assess MWCNT-cells interactions.The almost superimposable pro-oxidant activity of both CNTs could be imputable to excessive lengths with regard to the pristine MWCNTs and to the eroded surface, causing increased reactivity, with regard to functionalised MWCNTs. Considering the ease with which lightweight MWCNTs aerosolize and the increased production, the results underlined the potential onset of neurodegenerative diseases, due to unintentional MWCNT exposure.

Hong Kong Poison Information Centre: Annual report 2016

Objective: To report and analyse the poisoning data of Hong Kong Poison Information Centre in 2016. Methods: In 2016, all poisoning cases received by Hong Kong Poison Information Centre were retrieved from its database (Poison Information and Clinical Management System) for analysis. Results: A total of 4096 poisoned cases were analysed. There were 1871 male patients (45.7%), 2203 female patients (53.8%) and 22 sex unspecified patients (0.5%). The majority of the cases (63.1%) were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (36.3%), unintentional exposure (18.4%) and abusive use (13.1%). Excluding the common co-ingestant ethanol, the five commonest types of poisons were benzodiazepines, paracetamol, household products, zopiclone and Chinese herbal medicine. Most patients were managed with supportive measures, while 14.3% and 12.9% of them were treated by decontamination and antidotes, respectively. Majority of the cases had uneventful recovery; 1% resulted in death and 3.9% had major outcomes. Six interesting cases and three poisoning outbreaks were discussed. Conclusion: This 11th annual report provided the updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports.

Numerical analysis for infant's unintentional exposure to 3.5 GHz plane wave radiofrequency electromagnetic fields by field test of fifth generation wireless technologies

AbstractIn this study, the plane wave exposure of an infant to radiofrequency electromagnetic fields of 3.5 GHz was numerically analyzed to investigate the unintentional electromagnetic field (EMF) exposure of fifth generation (5G) signals during field test. The dosimetric influence of age‐dependent dielectric properties and the influence of an adult body were evaluated using an infant model of 12 month old and an adult female model. The results demonstrated that the whole body‐averaged specific absorption rate (WBASAR) was not significantly affected by age‐dependent dielectric properties and the influence of the adult body did not enhance WBASAR. Taking the magnitude of the in situ E field strength into consideration, realistic WBASAR was far below the basic restriction. Age‐dependent dielectric properties could significantly change the tissue specified specific absorption rate (TSSAR) of internal organs. However, the variation was not significant because the absolute values were marginal. Among the factors that influenced TSSAR variation, change in dielectric properties demonstrated a close correlation. In general, at 3.5 GHz, the infant did not absorb more power than the case of EMF exposure to third generation (3G) and fourth generation (4G) signals. The work was helpful for network operators and device manufactures to estimate the potential exposure risk during the field test, especially for the infant.

Characteristics and outcomes of e-cigarette exposure incidents reported to 10 European Poison Centers: a retrospective data analysis

BackgroundThe use of e-cigarettes has increased during the past few years. Exposure to e-cigarette liquids, whether intentional or accidental, may lead to adverse events our aim was to assess factors associated with e-cigarette exposures across European Union Member States (EU MS).MethodsA retrospective analysis of exposures associated with e-cigarettes reported to national poison centers was performed covering incidents from 2012 to March 2015 from 10 EU MS. De-identified and anonymous raw data was acquired.ResultsIn total, 277 incidents were reported. Unintentional exposure was the most frequently cited type of exposure (71.3%), while e-cigarette refill vials were responsible for the majority of the reported incidents (87.3%). Two-thirds of all exposures (67.5%) occurred as ingestion of e-liquids, which was more frequent among children (≤ 5 years, 6–18 years) compared to adults (87.0% vs. 59.3% vs. 57.6%, p < 0.001 respectively), exposure via the respiratory (5.4% vs. 22.2% vs. 22.2%, p < 0.001) were more frequent among paediatric patients while ocular routes (2.2% vs. 3.7% vs. 11.4%, p = 0.021) were more frequent among adults. Logistic regression analyses indicated that paediatric incidents (≤ 5 years) were more likely to be through ingestion (adjusted Odds Ratio [aOR] = 4.36, 95% Confidence Interval [C.I.]: 1.87–10.18), but less likely to have a reported clinical effect (aOR = 0.41, 95% C.I.: 0.21–0.82).ConclusionsOur study highlighted parameters related to e-cigarette exposure incidents in 10 EU MS, the results of which indicate that consideration should be given to the design features which may mitigate risks, thereby protecting users, non-users and especially children.

Use of a 23-hour emergency department observation unit for the management of patients with toxic exposures

BackgroundA significant proportion of patients with toxic exposures presenting to the ED require admission. However, most will improve within 24 hours, and so could potentially be managed in a short-stay...

Adolescent Ingestions: Recent National Trends

Adolescent ingestions are common reasons for calls to poison centers in United States. As opposed to younger children who mostly have unintentional exposures, adolescent ingestions often result from intentional use. This manuscript reviews recent reports on adolescent ingestions related to intentional abuse, self-harm, and use of opioid medications.

A case report of methadone-associated hypoglycemia in an 11-month-old male

Background: Methadone is a synthetic μ-opioid receptor agonist that is used in the management of pain, neonatal abstinence withdrawal syndrome, and opioid dependence. Overdose can cause miosis, respiratory depression, and central nervous system depression. Rarely, hypoglycemia has been reported. We present the case of an 11-month-old male who developed hypoketotic, hyperinsulinemic, hypoglycemia after an acute, unintentional methadone exposure.Case details: The patient was a previously healthy 11-month-old male who presented in respiratory failure. He was intubated and transferred to a large tertiary care center where his physical exam was notable for miosis. His labs were notable for a blood glucose of 17 mg/dL, an elevated insulin level, and suppressed serum beta-hydroxybutyrate. The patient was given a dextrose bolus with improvement in blood glucose. Administration of IV naloxone improved his miosis and mental status. A quantitative methadone level was sent upon arrival and was 123 ng/mL. Testing for ethanol, salicylates, sulfonylureas, and metabolic causes of hypoglycemia was negative. A fasting study showed euglycemia with suppression of insulin and appropriate ketosis.Case discussion: We present the case of an 11-month-old male who developed hypoketotic, hyperinsulinemic, hypoglycemia after an acute, unintentional methadone exposure. Alternative explanations for hypoketotic hypoglycemia were rule out. Methadone-induced hypoglycemia has been reported in cancer patients receiving methadone for pain, but a mechanism has not been identified. Based on this case, we believe that the patient’s hypoglycemia was the result of methadone-induced insulin secretion.Conclusions: This case proposes that hyperinsulinism is the mechanism responsible for methadone-associated hypoglycemia. Methadone exposure should be included in the differential diagnosis of new onset hypoglycemia.

Video Tracking Protocol to Screen Deterrent Chemistries for Honey Bees.

The European honey bee, Apis mellifera L., is an economically and agriculturally important pollinator that generates billions of dollars annually. Honey bee colony numbers have been declining in the United States and many European countries since 1947. A number of factors play a role in this decline, including the unintentional exposure of honey bees to pesticides. The development of new methods and regulations are warranted to reduce pesticide exposures to these pollinators. One approach is the use of repellent chemistries that deter honey bees from a recently pesticide-treated crop. Here, we describe a protocol to discern the deterrence of honey bees exposed to select repellent chemistries. Honey bee foragers are collected and starved overnight in an incubator 15 h prior to testing. Individual honey bees are placed into Petri dishes that have either a sugar-agarose cube (control treatment) or sugar-agarose-compound cube (repellent treatment) placed into the middle of the dish. The Petri dish serves as the arena that is placed under a camera in a light box to record the honey bee locomotor activities using video tracking software. A total of 8 control and 8 repellent treatments were analyzed for a 10 min period with each treatment was duplicated with new honey bees. Here, we demonstrate that honey bees are deterred from the sugar-agarose cubes with a compound treatment whereas honey bees are attracted to the sugar-agarose cubes without an added compound.

Mediastinal seminoma presenting with superior vena cava syndrome

We present a rare cause of superior vena cava syndrome (SVC) in a previously healthy male aged 31 years. Malignancy was suspected due to unintentional weight loss and childhood exposure...

Warning Statements and Safety Practices Among Manufacturers and Distributors of Electronic Cigarette Liquids in the United States.

Prior to the US Food and Drug Administration's (FDA) regulation of electronic cigarettes and warning statements related to nicotine addiction, there was no critical examination of manufacturer/distributor voluntary practices that could potentially inform FDA actions aimed to protect consumers. This study examined the content of warning statements and safety characteristics of electronic cigarette liquid bottles using a national sample. Research staff randomly selected four electronic cigarette liquid manufacturers/distributors from four US geographic regions. Staff documented the characteristics of product packaging and content of warning statements on 147 electronic cigarette liquids (0-30 mg/ml of nicotine) purchased online from 16 manufacturers/distributors in April of 2016. Data showed that 97.9% of the electronic cigarette liquid bottles included a warning statement, most of which focused on nicotine exposure rather than health. Only 22.4% of bottles used a warning statement that indicated the product "contained nicotine." Of bottles that advertised a nicotine-based concentration of 12 mg/ml, 26% had a warning statements stated that the product "contains nicotine." None of the statements that indicated that the product "contained nicotine" stated that nicotine was "addictive." All bottles had a safety cap and 12% were in plastic shrink-wrap. Fifty-six percent of the websites had a minimum age requirement barrier that prevented under-aged persons from entering. Most manufacturers/distributors printed a warning statement on electronic cigarette liquid bottles, but avoided warning consumers about the presence and the addictiveness of nicotine. Studies are needed to examine manufacturer/distributor modifications to product packaging and how packaging affects consumer behaviors. These data can inform future FDA requirements related to the packaging and advertising of e-cigarette liquids; regulation related to the content of warning statements, including exposure warning statements, which are not currently mandated; and requirements on websites or language on packaging to help manufacturers adhere to the minimum age of purchase regulation. The data can also be used to help FDA develop additional guidance on the framing of statements on packaging that helps consumers make informed decisions about purchasing the product or protecting young people from use or unintentional exposure to the product.

Medication organizers (pill minders) increase the risk for unintentional pediatric ingestions

Objective: Medication organizers may help improve medication compliance; however, they may increase the risk of having an unintentional pediatric exposure. The objective of this study was to measure the association between a pediatric emergency department (ED) visit for an unintentional pharmaceutical ingestion and the use of a medication organizer in the household.Methods: This was a cross-sectional case control study at a tertiary care children’s hospital ED. Cases included subjects <6 years of age who were evaluated in the ED for an unintentional pharmaceutical ingestion. The control group presented to the ED for a non-injury complaint and was matched using age and sex.Results: The unadjusted odds ratio (OR) of risk for unintentional pharmaceutical ingestion with use of a medication organizer was 2.0 (95% CI, 1.3, 2.9). After adjusting for the presence of prescription medications in the home, the OR of risk for ingestion remained statistically significant at 1.8 (95% CI, 1.1, 2.7). The child obtained the exposure medication from the medication organizer in 63% of cases where a medication organizer was present in the home. Cases were more likely to have knowledge of, and previous contact with poison control centers (PCC) than non-injury controls. Overall, a large number of caregivers (36%) did not have any knowledge of PCC. There were also differences in smoking and use of seat belts between cases and controls.Conclusions: The use of medication organizers may be a risk factor for unintentional pediatric pharmaceutical ingestions, even when controlling for the use of prescription medications in the home. Further research is needed to evaluate the specific role of medication organizers, and subsequently, improve prevention strategies.

Poison control reports show increase in adverse exposures to drugs for depression

Serious outcomes after overdose or unintentional exposure to medications used to treat depression rose steadily in the period from 2000 to 2014, with both older and newer drugs contributing to the problem, according to a new study. The study's lead author suggests that many clinicians remain largely unaware of the relative dangers of these medications, including a selective serotonin reuptake inhibitor (SSRI) class that once was believed to result in virtually no morbidity or mortality. Study results were published online Jan. 31 in the American Journal of Psychiatry.

Unintentional Pediatric Cocaine Exposures Result in Worse Outcomes than Other Unintentional Pediatric Poisonings

BackgroundUnintentional pediatric cocaine exposures are rare but concerning due to potentially serious complications such as seizures, dysrhythmias, and death. ObjectivesThe objectives were to assess the demographic and clinical characteristics of pediatric cocaine exposures reported to the California Poison Control System. MethodsThis is a retrospective study of all confirmed pediatric (< 6 years of age) cocaine exposures reported to the California Poison Control System from January 1, 1997–September 30, 2010. Case narratives were reviewed for patient demographics, exposure details, clinical effects, therapy, hospitalization, and final outcome. ResultsOf the 86 reported pediatric cocaine exposures, 36 had positive urine drug testing and were included in the study cohort. The median age at presentation was 18 months (range: 0–48 months), and 56% were male (n = 20). The most common clinical manifestations were tachycardia and seizures. The most common disposition was admission to an intensive care unit (n = 14; 39%). Eleven cases (31%) were classified as having a major effect as per American Association of Poison Control Centers case coding guidelines. One child presented in asystole with return of spontaneous circulation after cardiopulmonary resuscitation and multiple vasoactive medications. The proportion of cocaine exposures with serious (moderate or major) outcomes (66.7%; 95% confidence interval 50.3–79.8%) was higher than other pediatric poisonings reported to the American Association of Poison Control Centers during the study period (0.88%; 95% confidence interval 0.87–0.88). ConclusionsAlthough pediatric cocaine exposures are rare, they result in more severe outcomes than most unintentional pediatric poisonings. Practitioners need to be aware of the risk of recurrent seizures and cardiovascular collapse associated with cocaine poisoning.

Reported Adverse Health Effects in Children from Ingestion of Alcohol-Based Hand Sanitizers - United States, 2011-2014.

Hand sanitizers are effective and inexpensive products that can reduce microorganisms on the skin, but ingestion or improper use can be associated with health risks. Many hand sanitizers contain up to 60%-95% ethanol or isopropyl alcohol by volume, and are often combined with scents that might be appealing to young children. Recent reports have identified serious consequences, including apnea, acidosis, and coma in young children who swallowed alcohol-based (alcohol) hand sanitizer (1-3). Poison control centers collect data on intentional and unintentional exposures to hand sanitizer solutions resulting from various routes of exposure, including ingestion, inhalation, and dermal and ocular exposures. To characterize exposures of children aged ≤12 years to alcohol hand sanitizers, CDC analyzed data reported to the National Poison Data System (NPDS).* The major route of exposure to both alcohol and nonalcohol-based (nonalcohol) hand sanitizers was ingestion. The majority of intentional exposures to alcohol hand sanitizers occurred in children aged 6-12 years. Alcohol hand sanitizer exposures were associated with worse outcomes than were nonalcohol hand sanitizer exposures. Caregivers and health care providers should be aware of the potential dangers associated with hand sanitizer ingestion. Children using alcohol hand sanitizers should be supervised and these products should be kept out of reach from children when not in use.

Unintentional Pediatric Exposures to Marijuana in Colorado, 2009-1015: Wang GS, Le Lait MC, Deakyne SJ, et al. JAMA Pediatrics. 2016; 170:1-6

Unintentional Pediatric Exposures to Marijuana in Colorado, 2009-1015: Wang GS, Le Lait MC, Deakyne SJ, et al. JAMA Pediatrics. 2016; 170:1-6

Self-poisoning with baclofen in alcohol-dependent patients: national reports to French Poison Control Centers, 2008–2013

Background: Alcohol use disorders are frequently associated with self-intoxication in attempted suicide. In France since 2008, the off-label use of baclofen for treatment of alcohol dependence has greatly increased, leading to temporary regulation of use of the drug. At the request of the national authorities, the French Poison Control Centers carried out a retrospective survey to give an overview of baclofen exposure in this population.Methods: A retrospective study was carried out from January 2008 to December 2013, focusing on baclofen exposures in alcohol-dependent patients managed by the nine national French Poison Control Centers.Results: 294 observations of baclofen exposures in alcohol-dependent patients were identified in our database. Of these, 220 were suicide attempts by self-poisoning and 74 were unintentional. The mean age of patients was 41.7 years, with a sex-ratio of 1.6. Patients attempting suicide with baclofen were younger than those with unintentional exposures, and 43.6% of them were women (vs 22.9%, p < 0.01). The mean supposed ingested dose was higher (480.7 mg) in patients who attempted suicide (vs 192.5 mg, p < 0.0001). 21.8% of intentional exposures involved baclofen alone. Psychiatric comorbidity (50.4%) was more frequent in the group of self-poisoning (p < 0.001). 132 patients were coded as severely exposed (60.0%). Nine victims died, but the causal link between self-poisoning with baclofen and fatal outcome should be interpreted with particular caution.Conclusions: Baclofen self-poisoning by alcohol-dependent patients is a serious concern for the French health authorities. Our results are similar to those previously published, suggesting that most patients with baclofen overdose should be admitted to an intermediate or intensive care unit as the clinical course requires close monitoring. Because suicidal ideation and suicide attempts are more prevalent in people with substance use disorders than in the general population, and because of the lack of recommendations governing baclofen prescription in such a situation, its use needs to be better controlled.

Development and Pilot Implementation of a Ladderized Biosafety Training Program in a Specialty Infectious Disease Hospital and Research Institute

Biosafety is the application of laboratory practices, use of safety equipment and implementation of procedures in laboratory facilities when working with potentially infectious microorganisms to protect not only the laboratory worker, but also the general public and the environment. Biosafety training specifically structured based on risk is vital to establish a safe working environment to reduce the risks of unintentional exposure and/or intentional release of infectious microorganisms. In 2016, a ladderized 3-step biosafety training program was established by the Research Institute for Tropical Medicine, a specialty infectious disease hospital and National Reference Laboratory in the Philippines. The training program includes 1) Biosafety 101, offered to all new RITM employees; 2) Applied Biosafety training, especially designed for laboratory personnel; and 3) Advanced Biosafety training, focused on developing Biosafety Officers and infectious disease outbreak responders. A 30% increase in awareness on biosafety has been achieved among participants of the first two steps of the program, with the third module to be implemented in 2017.

The Association between Involuntary Smoking Exposure with Urine Cotinine Level and Blood Cadmium Level in General Non-Smoking Populations.

Unintentional environmental exposure to toxicants is associated with an aggravated health status of the general population. Involuntary smoking (IS) exposure is one of the main routes to involuntary toxicants exposure. However, few studies have attempted to understand the environmental cadmium exposure by IS exposure in the general, non-smoking population. The purpose of the current study was to examine the relationship between blood cadmium level and IS level according to gender and age. We used the Korea National Health and Nutrition Examination Survey (KNHANES) IV–VI data that included heavy metal and urine cotinine sampling with IS exposure history. The final analysis comprised 3,493 adults (1,231 males and 2,262 females) and 395 adolescents (210 males and 185 females). Linear regression was performed to estimate the association between self-reported IS exposure with urine cotinine level and blood cadmium level in non-smokers with gender and age group stratification. In final regression model, the effect values (B) (standard errors [SE]) between blood cadmium and urine cotinine level in men was 0.0004 (0.0001) and 0.0006 (0.0002) in adults and adolescents, the B (SE) in women was 0.0006 (0.0002) and 0.0016 (0.0006) in adults and adolescents. Our study revealed, for the first time, a significant association between blood cadmium and IS exposure in non-smokers. Greater efforts are needed to improve environmental justices of the general population from IS, considering the severe harmful effects of involuntary exposure to even a low level of cadmium.

A 15-year retrospective review of brake fluid exposures in children from a single poison center

ABSTRACTBrake fluid frequently contains diethylene glycol, a poison known to cause kidney failure, metabolic acidosis, coma and death. No consensus exists regarding management of accidental pediatric brake fluid exposures. We sought to better characterize small-volume brake fluid exposures in children less than 6 years old. We retrospectively reviewed a single poison center's database from 2000 to 2014 for all small-volume, oral, unintentional exposures to brake fluid in children less than 6 years of age. We included cases followed to a known outcome. In all cases, we attempted to confirm the clinical outcome via telephone call between October and December of 2014. Data collected included gender, age, month and year of exposure, caller site, exposure site, management site, National Poison Data System (NPDS) medical outcome, estimated quantity of brake fluid ingested, clinical effects, therapies, and laboratory data. Initial database query yielded 121 cases. We excluded 69 cases, leaving 52 for analysis. Forty cases resulted in no effect; 12 resulted in a minor effect. No cases resulted in a moderate effect, major effect, or death. These retrospective observational data suggest acute exposures to small or unknown amounts of brake fluid in children result in minor effects. These children likely can be managed expectantly.