Unintentional Ingestion Research Articles

Toxicity of acute exploratory amphetamine-salt medication in amphetamine-naïve pediatrics: a retrospective cohort study

Background and Objectives: Pediatric ingestions of amphetamines used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) are on the rise. Little data provide an amphetamine dose at which to refer pediatric unintentional ingestions to a healthcare facility for monitoring. We studied the dose at which unintentional ingestions of amphetamines develop symptoms and receive benzodiazepines.Methods: We performed a retrospective study from a single poison center from 1/1/2005 through 11/30/2018. We included single substance ingestion of amphetamine salts to treat ADHD in amphetamine-naïve children age 0–12 years followed to a known outcome. Poison center documentation was reviewed for signs and symptoms related to amphetamine toxicity and use of benzodiazepines.Results: We screened 1,394 cases and 160 met inclusion criteria. The mean age of patients was 1.8 years and 55% were male. The median dose of symptomatic patients (1.38 mg/kg) was greater than those without symptoms (0.83 mg/kg). The median amphetamine dose of patients receiving benzodiazepines (1.58 mg/kg) was also greater than for patients not receiving benzodiazepines (1.0 mg/kg). A dose threshold of greater than 0.75 mg/kg was 100% sensitive and 36.8% specific for benzodiazepine administration and 93.9% sensitive and 47.4% specific for presence of any symptoms.Conclusions: The median dose of amphetamines ingested by patients receiving benzodiazepines was greater than those not receiving benzodiazepines. No child with a dose of ≤0.75 mg/kg received benzodiazepines. Prospective studies should be performed to assess triage guidelines and referral doses.

Organic Agriculture: Consumers Attitudes and Behavioral Change in the context of Environmental Challenges in Cameroon

Unintentional ingestion of pesticides is common in societies. Yet the consequences are multiplying in a disastrous way. Organic agriculture [OA] roles at preserving the environment and the health of the consumer. The objective of this study is to analyze the attitudes and purchase intentions of the consumer through the theory of Ajzen's planned behaviour. A total of 318 consumers were interviewed in the localities of Loum, Njombe-Penja and Mbanga using a mix questionnaire. The Likert model, 5-point scale was used to measure attitudes. The results obtained reveal that positive attitudes lead to purchasing intentions among consumers in relation to organic products (Mean = 40.5283; Standard Deviation. = 5.89638) to the detriment of conventional products (Mean = 22.7484; Standard Deviation. = 5.57707). This significant difference is in favour of organic products (F (1 318) = 1.812; p ˂ 0.05). In fact, intention is the intermediate variable between attitudes and observed behaviours.

Investigation of twenty metal, metal oxide, and metal sulfide nanoparticles' impact on differentiated Caco-2 monolayer integrity

The use of engineered nanomaterials (ENMs) in foods and consumer products is rising, increasing the potential for unintentional ingestion. While the cytotoxicity of many ENMs has been investigated, less attention has been given to adverse impact on the intestinal barrier integrity. Chronical disruption of gastrointestinal integrity can have far reaching health implications.Using fully differentiated Caco-2 cells, the perturbation of intestinal barrier function and cytotoxicity were investigated for 20 metal, metal oxide, and metal sulfide ENMs. Caco-2 cells were exposed to 50 μg/mL ENMs for 24 h. ENM formulations were characterized at 0 and 24 h, and In Vitro Sedimentation, Diffusion and Dosimetry Modeling was applied to calculate the effective dose of exposure during 24 h. The apparent permeability coefficient (Papp) was determined for fluorescent labeled dextran (3000 Da) and tight junction integrity was evaluated by immunofluorescence microscopy. Cytotoxicity was investigated by determining lactate dehydrogenase release (LDH) and cell metabolic activity (tetrazolium based MTS) assays.Four ENMs led to significantly increased Papp, (15.8% w/w% Ag-SiO2 nanoparticle (NP), 60 nm CdS NP, 100 nm V2O5 flakes, and 50 nm ZnO NP), while one ENM (20 nm MgO NP) decreased Papp. With the exception of CdS NP, significantly increased Papp was not connected with cell cytotoxicity. The calculated effective dose concentration was not correlated with increased Papp.Our results illustrate that while many metal, metal oxide, and metal sulfide ENMs do not adversely affect monolayer integrity or induce cytotoxicity in differentiated Caco-2 cells, a subset of ENMs may compromise the intestinal integrity. This study demonstrated the use of differentiated Caco-2 monolayer and Papp as an endpoint to identify and prioritize ENMs that should be investigated further. The interaction between ENMs and the intestinal epithelium needs to be evaluated to understand potential intestinal barrier dysfunction and resulting health implications.

Acute Cannabis Toxicity.

The change in legal status of cannabis (the botanical species Cannabis sativa, commonly known as marijuana) in the United States has had significant impact on pediatric drug exposures. In states with decriminalization of recreational and medicinal use of cannabis, emergency department visits and poison control center calls for unintentional pediatric cannabis intoxication are on the rise in the last few decades. Exploratory or unintentional ingestions of cannabis-containing products (as opposed to those derived from synthetic cannabinoids, which may mimic the structure and/or function of cannabis, but are not the focus of this article) can lead to significant pediatric toxicity, including encephalopathy, coma, and respiratory depression. With the increasing magnitude of the public health implications of widespread cannabis use, clinicians who care for pediatric patients routinely must be adept in the recognition, evaluation, management, and counseling of unintentional cannabis exposure.

1947 Unintentional Bread Bag Clip Ingestion Leading to High Risk Duodenal Ulcer

INTRODUCTION: Ingestion of bread bag clips has been described as a surprisingly common cause of GI bleeding or bowel perforation. CASE DESCRIPTION/METHODS: A 21-year-old man with no previous medical history or known foreign body ingestion presented after several episodes of acute onset coffee-ground and bright red hematemesis and hematochezia. Vital signs were notable for hypotension (90/65 mmHg) and tachycardia (120 bpm). Hemoglobin decreased from 15.5 to 12.2 mg/dL over four hours, and he received two units of pRBCs without an appropriate response in his hemoglobin concentration. During his EGD, we identified a 14 mm cratered ulcer with a visible vessel and an adjacent foreign body in the duodenal sweep. The object was grasped by rat-tooth forceps, but each attempt to remove it was complicated by hypotension and tachycardia. He then underwent urgent duodenotomy, where a bread-bag clip was identified and removed. Post-operative recovery was uneventful. DISCUSSION: Ingestion of foreign bodies poses a significant risk of GI bleeding or perforation. Guidelines generally recommend timely endoscopic removal of disk batteries in the esophagus, sharp objects, objects >6 cm in length, or in patients with severe esophageal obstructive symptoms. Various retrieval devices are available, and an overtube may be used to protect the esophagus. Surprisingly, there are already several described cases of bread bag clip ingestion that describe esophageal, small bowel, or large bowel bleeding or perforation. The unique shape of these clips leads to snaring of mucosal tissue which may ultimately lead to progressive ulceration. Interestingly, described cases of bread bag clip ingestion occur after unknown or accidental ingestion and occurs most commonly in cognitively impaired patients. Identification of these objects is difficult due to radiolucency, and often goes unnoticed until symptoms begin. Some are amenable to endoscopic removal, while others require surgical resection.

Renal replacement therapy in the management of intoxications in children: recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) workgroup

Intentional or unintentional ingestions among children and adolescents are common. There are a number of ingestions amenable to renal replacement therapy (RRT). We systematically searched PubMed/Medline, Embase, and Cochrane databases for literature regarding drugs/intoxicants and treatment with RRT in pediatric populations. Two experts from the PCRRT (Pediatric Continuous Renal Replacement Therapy) workgroup assessed titles, abstracts, and full-text articles for extraction of data. The data from the literature search was shared with the PCRRT workgroup and two expert toxicologists, and expert panel recommendations were developed. We have presented the recommendations concerning the use of RRTs for treatment of intoxications with toxic alcohols, lithium, vancomycin, theophylline, barbiturates, metformin, carbamazepine, methotrexate, phenytoin, acetaminophen, salicylates, valproic acid, and aminoglycosides.

A complicated case of bowel obstruction with sepsis and methamphetamine toxicity in a child with pica

In this report, a pediatric case of bowel obstruction with sepsis complicated by methamphetamine toxicity is described. The decedent, an eleven-year-old female with a clinical history of pica, was found unresponsive in her home and pronounced dead following unsuccessful resuscitative efforts. Radiologic imaging showed multiple radio-opaque foreign objects in the stomach and bowel. Autopsy revealed a green leafy substance, coins and other metallic items, folded paper, and plastic in her stomach and bowels. Postmortem iliac blood and urine tested positive for amphetamine and methamphetamine. While the decedent's medical history and autopsy findings provided evidence consistent with bowel obstruction with sepsis due to the ingestion of foreign materials, the high methamphetamine concentration was suggestive of concurrent methamphetamine toxicity. Unique complications associated with this case include the phenomenon that methamphetamine toxicity and bowel obstruction can present similarly in children and the reported opinion that accidental drug ingestion is uncommon in children over the age of five. This case emphasizes that the age range for suspected accidental drug ingestion should be expanded for those with pica, as these patients, despite being older, may not be able to differentiate between what they should and should not ingest. Furthermore, when treating a pediatric patient with pica that appears to present with bowel obstruction, unintentional drug ingestion should also be considered, particularly if there is a suspicion that the child lives in a household where drugs are abused, given the prospect that drug toxicity can present similarly.

Childhood home based unintentional injuries Surveillance in Punjab India

Objective1. To determine the prevalence and pattern of unintentional injuries among children2. To study the physical environment of house for various risk factors leading to unintentional injuries.IntroductionInjury and violence are public health problems now-a-days all over the world. Over 950000 children less than 18 years of age die as a result of injuries, 95% of which occur in low and middle income countries (LMIC) including India. Unintentional injuries account for 90% of these cases. The death rate due to unintentional injuries is almost double in LMIC as compared to developed countries. It is seen that most of childhood unintentional injuries occur in and around the home of children.India, with a population of app 1.25 billion, had about 40% children. India is passing through a major socio-economic, epidemiological and technological transition. Migration and rapid urbanization is contributing towards the development and growth. Mechanization is changing the traditional lifestyle and thereby resulting an increase in injuries in India. Despite efforts to understand the burden of injuries, the magnitude in terms of morbidity and mortality is still not clear as injury information did not receive much importance in the health sector.Few small studies have reported the prevalence and causes of childhood unintentional injuries. However, there is lack of proper surveillance data on burden of unintentional injuries among childrenMethodsWe conducted a surveillance study in 30 villages of Ludhiana district of Punjab, India. A total of 900 houses having at least one child below the age of 19 years formed the sample of study. The data pertaining to socio demographic profile, physical environment of house and injury details (in last 5 years) were recorded on the pre designed performa. The data were statistically analyzed using SPSS version 20.0.ResultsIn the 900 houses, there were 1910 children below the age of 19 years. Of these houses, unintentional injuries to their children was observed in 386(42.9%) houses during the last 5 years. The prevalence of unintentional injuries among children was 20.6%. There were 60.1% children below the age of 5 years who suffered injuries. 67% of injuries occurred among male children. Majority of injuries (63.5%) occurred during evening time, of which 87.2% occurred while the child was playing in and around the home. Fall was the most common (64.5%) mode of injury followed by 12.3% cut injuries due to chopper/fodder cutter or old instruments/machinery lying the courtyard. There were 16 injuries due electric current, 6 cases of dog bite, 4 cases of drowning and 4 cases of unintentional ingestion of poisonous substance. 48.3% of injuries were severe, 35.9% minor, 9.4% trivial and 5.9% very severe. There were 2 fatal death also.ConclusionsThe burden of unintentional childhood injuries in India is substantial but it a neglected health problem. There is a strong need for continuous surveillance of childhood injuries in India using systematic techniques so as to plan for timely intervention.

Prevalence and Clinical Characteristics of Unintentional Ingestion of Marijuana in Children Younger Than 6 Years in States With and Without Legalized Marijuana Laws.

The aim of this study was to examine the relationship between state marijuana legalization and the rates of unintentional ingestions of marijuana in children younger than 6 years. This was a retrospective review of all marijuana ingestions in the National Poison Data System in children younger than 6 years between January 1, 2000, and July 31, 2017. Data analysis from NPDS included, age, sex, state and year of occurrence, clinical effects, therapies, health care facility utilization, and medical outcome. Population of children younger than 6 years was obtained from the US Census Bureau. Public records search provided state legal status of marijuana and year of state marijuana legalization. From 2000 through 2008, there was no significant change in the annual number or rate of ingestions of marijuana in children younger than 6 years across the United States. Following 2009, there was mean annual increase of 27% per year, rising to 742 ingestions per year or 2.98 ingestions per 100,000 population, respectively, in 2017. More than 70% of all cases occurred in states with legalized marijuana. Of all pediatric patients, 54.6% received some form of hospital-based care, of which 7.5% required critical care. Pediatric patients experienced a wide range of symptoms from drowsiness and confusion, to seizures and coma. Medical treatments ranged from hydration therapy to sedation and intubation. Poison centers safely managed 23.4% of these pediatric cases by phone, without the need for hospital evaluation. There was a strong association between the legalization of marijuana and ingestions of marijuana by children younger than 6 years.

Unintentional cannabis intoxication in young children: Toward a standardized procedure for biological monitoring and follow-up?

Marijuana is the most commonly used illicit drug in France among diverse social circles. According to the ANSM report published in 2018, hospitalization of young children following cannabis exposure keeps increasing while concentration of Δ-9-tetrahydrocannabinol (THC) is higher and child poisoning with cannabis is more severe than ever. The effects of long-term THC exposure or recurrent intoxication during childhood may not be immediately perceptible and are poorly described in the literature. We reviewed poisoning conditions, diagnosis and monitoring of unintentional cannabis intoxication in children in order to suggest a standardized procedure for biological monitoring and follow-up. We conducted a retrospective observational study of admissions from 2010 to 2018 in the paediatric department at the University Hospital of Rouen. All children < 10 years old who were admitted to pediatric emergency with proven cannabis intoxication according to a rapid urine-screening test were considered. Thirty-three children were included and more than 70% were younger than 2 years old. Most cases were caused by accidental resin oral ingestion (85%) and intoxications were more frequently found in a family context (75%). Less than half of parents reported unintentional cannabis ingestion on arrival to emergency. Thirty children presented at least one acute neurologic symptom, 34% ophthalmological symptoms and less suffering from respiratory and cardiovascular impairment. All of them were hospitalized at least 24 h. Six of them underwent a lumbar puncture and one received intravenous antibiotics and antivirals. Only 12 quantitative blood tests using liquid chromatography-tandem mass spectrometry were performed. Only 30% of children were subject to a follow-up few months later. Three monitoring were performed by HPLC-MS/MS in hair samples, 7 in urines and one child had twice quantitative blood test. These data demonstrate a great variability in the biological management and follow-up according to prescribers who are not always well informed about the methodologies available. Clinicians should be careful about cannabis intoxication, especially concerning young children admitted in emergency units with unexplained neurological symptoms. We suggest a helping chart for biological diagnosis and monitoring, relying on the parent's good faith about their children cannabis ingestion. It includes hair, urine and blood analysis. The parents’ drug history (either therapeutic or recreational) should be investigated to avoid unnecessary and invasive tests and treatments. After initial diagnosis, the tests should usually include a quantitative blood test for the determination of THC and its metabolites to evaluate the severity of the intoxication and a plasma or blood bank should be stored for any further analysis. Furthermore, voluntary poisoning must be considered, especially if recurrent intoxication occurs. Depending on results, repeated hair analysis, toxicological screenings in blood and/or urines may be required several months later and may be reportable to a subsequent child protective services report. Nevertheless, recent data highlight some limits of hair sampling to discriminate acute from chronic exposure in children under 3 years old [1] . Cannabis intoxication in young children is becoming a more common problem and this report highlights the need to standardize procedures for biological monitoring and follow-up.

Rapid identification of herbal toxins using electrospray laser desorption ionization mass spectrometry for emergency care

The unintentional ingestion of toxic compounds in herbs is not uncommon in many parts of the world. To provide timely and life-saving care in the emergency department, it is essential to develop a point-of-care analytical method that can rapidly identify these toxins in herbs. Since electrospray laser desorption ionization mass spectrometry (ELDI/MS) has been successfully used to characterize non-volatile chemical compounds without sample preparation, it was used to identify toxic herbal compounds in this study. The herbal toxins were collected either by sweeping a metallic probe across the surface of a freshly cut herb section or by directly sampling extracts of ground herbal powder. The analytes on the probe were then desorbed, ionized and detected using ELDI/MS, wherein analysis of the herbal toxins was completed within 30 s. This approach allows for the rapid morphological recognition of herbs and early point-of-care identification of herbal toxins for emergency management and is promising in providing important toxicological information to ensure appropriate medical treatment.

Risk of Unintentional Ingestion of Harmful Chemicals among Under-five Children in Calabar South Local Government Area of Cross River State

Risk of Unintentional Ingestion of Harmful Chemicals among Under-five Children in Calabar South Local Government Area of Cross River State

Cetaceans and microplastics: First report of microplastic ingestion by a coastal delphinid, Sousa chinensis

In the Anthropocene, marine microplastic debris has been rapidly increasing and interacting with wildlife. As apex predators, cetaceans have been proven to be ideal sentinel species to indicate ecosystem changes and umbrella and flagship species to help develop environmental management strategies. Here, we report the presence of microplastics in the intestines of Sousa chinensis for the first time, which highlights the potential impacts of microplastic pollution in coastal environments. Microplastics were detected in the intestinal contents of both adult and calf individuals, indicating that consumption of prey and unintentional ingestion are the potential pathways for microplastic accumulation in Sousa chinensis. The properties of the microplastics indicated that fibers, white and blue items, 1–5 mm items, and polyester were the predominant shapes, colors, sizes and plastic materials, respectively. More microplastics were detected in the foreguts and midguts than in the hindguts, which may be correlated with the specific intestinal structure of Sousa. This study indicates that coastal delphinids might suffer from microplastic pollution, even young calves. The sample size in this study is limited, whereas it's a starting point for assessing microplastics in the endangered coastal delphinid, Sousa. We suggest that assessments of the risks of microplastic consumption by cetaceans and the presence of microplastics in their habitats should be conducted at a global scale. Moreover, further works should be done to look for evidence of adverse effects of microplastics pollution on cetaceans.

Unintentional Opioid Ingestions Presenting to a Pediatric Emergency Department.

The purpose of this study was to describe unintentional opioid exposures in young children, including demographics, medical interventions, and clinical outcomes. This was a retrospective, cross-sectional study of children 0 to 6 years of age with possible opioid exposure over a 3-year period (July 2010 to June 2013). Data collected included sex, age, specific drug, whether they were referred to the emergency department (ED) by the Regional Poison Control Center, presence of symptoms, therapeutic interventions, ED disposition, and clinical outcomes for admitted patients. Median age of patients included in the study was 2 years, and 64% of these children were male. The most common drug of exposure was buprenorphine/naloxone. Of the 429 charts screened, 140 patients were reported to be symptomatic and referred to the ED, of which 113 patients actually presented to the ED. An additional 122 patients presented to the ED without Regional Poison Control Center referral. Of the total 235 patients presenting to ED, 76 (32%) received a therapeutic intervention. Of 231 total opioid exposures, 31 exposures were administered naloxone. Three children underwent endotracheal intubation. Sixty-five patients were hospitalized, with a median length of stay of 1 day. Although there were no fatalities, 1 child suffered severe morbidity (anoxic brain injury). While opioid exposures in young children are a common and potentially life-threatening problem, most children remain asymptomatic. The majority of patients are able to be discharged from the ED after observation, and of those who are admitted, most have favorable outcomes and brief hospital stays. A small number of these patients require considerable medical interventions.

Ingestion of Over-the-Counter Liquid Medications: Emergency Department Visits by Children Aged Less Than 6 Years, 2012–2015

Unintentional medication ingestions by young children lead to nearly 60,000 emergency department visits annually; 15% involve oral liquid medications. Safety packaging improvements have been shown to limit liquid medication ingestions. Estimated rates of emergency department visits for pediatric ingestions by product were calculated to help target interventions. Frequencies and rates of emergency department visits for unintentional pediatric ingestions were estimated using adverse event data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project and retail sales/pharmacy dispensing data from Information Resources, Inc. and QuintilesIMS (collected 2012-2015; analyzed 2017). Rates of emergency department visits for ingestions of over-the-counter liquid medications were compared with those for prescription solid medications. From the results of 568 cases, an estimated 6,427 emergency department visits (95% CI=4,907, 7,948) were made annually after a child aged <6 years accessed one of the four most commonly implicated over-the-counter liquid medications without caregiver oversight. Nearly two thirds (63.8%) of these visits were made by children aged ≤2 years and 9.0% resulted in hospitalization. Acetaminophen was the most commonly implicated over-the-counter liquid medication (2,515 estimated emergency department visits annually). Rates of emergency department visits for liquid diphenhydramine and acetaminophen ingestions (8.1 and 7.4 emergency department visits per 100,000 bottles sold) were higher than rates for other common over-the-counter liquids and comparable to high-rate prescription solid medications (clonidine and buprenorphine/naloxone: 11.1 and 10.5 emergency department visits per 100,000 dispensed prescriptions, respectively). Product-specific rates of emergency department visits for unintentional ingestions can help prioritize preventive interventions, such as enhancing safety packaging with flow restrictors.

Hypotension, bradycardia and reversible conduction defect induced by prescription of Bhutanese traditional medicines

Aconite is widely used in both Chinese and Ayurvedic medications and therefore often used within the Himalayan Kingdom of Bhutan. Despite its use in traditional medicine, because of its narrow therapeutic index, significant cardiotoxic and neurotoxic events are documented due to both intentional and unintentional ingestion. In this case series we present 2 cases of bradycardia, hypotension and reversible conduction defects caused by prescribed aconite-based Bhutanese traditional medicines, for different therapeutic goals, who suffered cardiac dysrhythmias.

Bioaccessibility of Drug Residues on Common Police Station Work Surfaces.

The fraction of any surface-adsorbed contaminant available for absorption is considered the bioaccessible fraction. Applied previously to contaminants such as pesticides and heavy metals on surfaces such as soil, food and cosmetics, the term may also be used to describe the fraction of drug residue bound to work surfaces which may be mobilized via contact transfer with human skin. Police station work surfaces have been shown to commonly contain low levels of drug residues as thin films; however, no information is available on how readily these residues may be transferred to human skin during direct or glancing contact. A bioaccessibility study was undertaken in which jojoba oil and artificial sebum were used to mimic human sebum to identify how readily a mix of six licit and illicit drugs were transferred from three commonly used police station work surfaces. Transfer from surfaces was slightly greater for jojoba oil than sebum when using a direct pressure contact or a wiping motion. Generally, less than 5% of applied residues were recovered via direct contact, and up to 10% when a wiping motion was used to simulate a glancing contact. While swabbing of work surfaces with methanol provides a suitable environmental audit of drug residues present, it does not represent the bioaccessible fraction of residues available for contact transfer, and hence, absorption via skin or unintentional ingestion. The current study indicates that the ability of sebum to mobilize drug residues from thin films on work surfaces via casual contact is limited, and sebum may potentially assist in the preservation of residues on pitted work surfaces and on skin.

Endoscopic Removal of Gastric Perforating Fish Bone

Introduction: A foreign body ingestion in adults is usually diagnosed by medical history. In most cases, the foreign body passes through the gastrointestinal tract uneventfully. Complications such as perforation are rare and usually occur in areas of angulation or narrowing such as the gastric antrum. We present a case of an unintentional perforating fish bone ingestion that was found incidentally on cross-sectional imaging and was managed endoscopically. Case description: A 51-year-old woman presented to the hospital for subacute upper abdominal pain. The patient described the pain as crampy, accompanied by waxing-waning nausea and dry heaves. She had melena 2 weeks prior, for which she underwent a colonoscopy and an EGD which revealed polyps that were removed endoscopically. Her prior surgical history included open nephrectomy for a right kidney swelling. On examination, the patient was afebrile, hemodynamically stable and in no apparent distress. Her abdomen was soft, non-distended with mild epigastric tenderness, and no guarding or rebound tenderness. Lab tests revealed a white cell count of 12,600/mm3 and hemoglobin of 13.1 g/dl. A CT scan of the abdomen revealed a 3.2 cm intramural curvilinear foreign body within the gastric antrum, with an associated thickened antrum and pylorus and no evidence of extra-luminal air or bowel obstruction. After further questioning, the patient reported having eaten fish 3 weeks ago and had a fish bone stuck in her throat, which she was able to cough out. An urgent upper endoscopy was performed - revealing a large fish bone perforating through the gastric incisura. An overtube was placed and the fish bone was removed using a rat tooth forceps. The defect was closed with an over-the-scope clip. The patient post-endoscopy course was uneventful and she was discharged home. Discussion: Since foreign body ingestion is usually uneventful, conservative treatment is warranted in the majority of cases. Complications are more likely with foreign bodies that are sharp such as fish bones. CT is the most sensitive in locating the causal fish bone, most often appearing as a high-density linear structure within inflamed tissue. In our case, the foreign body finding on abdominal CT and the history of ingested fish bone, raised a high index of suspicion for a perforating fish bone, indicating urgent endoscopic intervention. Fish bone migrating into solid organs or intraperitoneal areas would require surgical intervention.1865_A Figure 1. Abdominal CT1865_B Figure 2. No Caption available.1865_C Figure 3. Endoscopic clip

SHOE SHINING: HAZARDOUS TO THE HEALTH

SESSION TITLE: Occupational and Environmental Lung Diseases SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Hydrocarbons are ubiquitous in society and are found in many common household products, including gasoline, cleaning agents, mineral oil, and industrial solvents. In 2016, the American Association of Poison Control Centers reported 29,796 cases of hydrocarbon exposure, with approximately 20 deaths attributed to this exposure. There are three main types of hydrocarbon exposure: children with unintentional ingestion of household hydrocarbons, workers with dermal or inhalational occupational exposures, and adolescents and young adults with intentional inhalational abuse. CASE PRESENTATION: Our patient is a 40-year-old male sailor who presented to the emergency department with productive cough and dyspnea. Approximately two hours prior to arrival, the patient was waterproofing his boots in an enclosed space. On initial evaluation, his heart rate was in the 100s, respiratory rate in the 30s, and oxygen saturation in the 70s%. His exam was notable for diffusely diminished breath sounds. He was placed on 10 liters via nonrebreather. The Poison Control Center was contacted, and the inhaled toxin was identified as a petroleum-based hydrocarbon. A chest x-ray showed diffuse bilateral hazy opacities. He was admitted to the intensive care unit and placed on high-flow nasal cannula with flow and FiO2 titrated to maintain oxygen saturation greater than 92%. A high resolution CT scan of the chest showed diffuse bilateral upper and central lobe predominant groundglass opacities with subpleural sparing consistent with diffuse alveolar damage. Treatment with high dose steroids and bronchodilators was initiated, and over the next 48 hours the patient had significant improvement. He was discharged on a tapering dose of prednisone and supplemental oxygen at 4 liters per minute for exertion. After discharge, his spirometry showed a mild restrictive pattern with a mild reduction in DLCO; he no longer required supplemental oxygen. Follow up chest imaging is currently pending. DISCUSSION: The mechanisms by which hydrocarbons cause pulmonary toxicity are dose-dependent, and include alveolar and interstitial edema, desquamation of pneumocytes, and disruption of surfactant. Hypoxia results from a combination of ventilation-perfusion mismatch, shunt formation, and bronchospasm. Initial imaging may be normal, with delay of radiographic changes for several hours after the development of pneumonitis. Radiographic findings typically demonstrate bilateral interstitial infiltrates, though may also reveal pneumatocele, pneumothorax, pleural effusions, and lung necrosis; additionally, intra-alveolar oils can coalesce into nodules surrounded by fibrosis called parafinomas. While symptoms usually resolve within a few days, radiographic abnormalities may last months. Most cases of hydrocarbon lung toxicity resolve with supportive care of oxygen and ventilatory support, but there have been case reports of benefit from corticosteroids, whole or segmental lung lavage, and intratracheal surfactant in severe cases, though there is no firm evidence for these treatments. CONCLUSIONS: Hydrocarbons are found in several household products, making exposure to these items not uncommon. While the acute effects of hydrocarbon toxicity are well recognized, the long-term effects of acute and chronic exposure require further research. Reference #1: Connellan SJ. Lung diseases associated with hydrocarbon exposure. Resp Med 2017; 126:46-51. Reference #2: Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report, Clin Toxicol 2017;55:(10)1072-1254. Reference #3: Tormoehlen LM, Tekulve KJ, Nanagas KA. Hydrocarbon toxicity: A review. Clin Toxicol 2014; 52:479-489. DISCLOSURES: No relevant relationships by Jeannette Collins, source=Web Response No relevant relationships by Angeline Lazarus, source=Web Response

\u201cWhere does the high road lead?\u201d Potential implications of cannabis legalization for pediatric injuries in Canada

The purpose of this commentary is to discuss how legalization of non-medical marijuana (LNMM) in Canada can potentially influence child and adolescent unintentional injuries based on evidence from states (American) and jurisdictions that have already legalized cannabis for recreational purposes. Although the evidence is still not conclusive, LNMM can bring about higher exposure, lower perceived harms, and higher prevalence of cannabis use by minors through role modeling and normalization of behaviour within the household and the community, and higher rates of driving under the influence of cannabis, which can contribute to a higher burden of road traffic injuries. Experience of American states with LNMM shows higher rates of emergency visits for pediatric poisoning due to unintentional ingestion of cannabis-containing foods and severe burns due to explosions during the course of home-based cannabis extraction. While the justification for legalization has created a strict legal framework for improved control of cannabis in Canada, the implications for health and safety of children and adolescents necessitate further study, communication with policy-makers and public health practitioners, and evidence-based education of parents, caregivers, and youth.