Poisoning in children 4: household products, plants, and mushrooms

Protecting the children -a virtual reality experiment on consumers' risk perceptions of household chemicals

Warnings on the labels of hazardous household chemicals (e.g. warning pictograms and use instructions) should create risk awareness and thus encourage safe storage, handling and disposal. However, scientific findings have called into question the effectiveness of warnings to prevent accidents, albeit mostly based on consumers' self-reports. This study aimed to contribute to existing data on household chemicals and consumer safety by applying a novel observational method using virtual reality (VR). The study participants (N = 119) were observed after receiving a task to childproof a virtual apartment from various interactable neutral and hazardous objects (i.e. knives, lighters and household chemicals with and without warnings) that were placed in the virtual apartment. For the analysis, the object placement (i.e. accessible or inaccessible to the children) and the level of interaction with the objects were coded, and the observational data were supplemented with data gathered through a questionnaire. The results showed that most hazardous household chemicals were moved to spots that were inaccessible to the children without any interactions of the participants with the warnings. Instead, they used their pre-existing knowledge and intuitive strategies to judge the objects' risks. These potentially misleading intuitive strategies should be increasingly considered in the regulation of hazardous household chemicals. This study also discussed the use and limitations of VR for the observation of human behaviour and decision making under uncertainty.

Beverage ethanol exposures among infants reported to United States poison control centers

BACKGROUND

Case studies and small series have demonstrated that beverage ethanol may pose a serious poisoning hazard to infants. Intoxicated infants may not present with the classic signs or symptoms of ethanol poisoning. The objective of this study was to describe the epidemiology of beverage ethanol exposures among infants reported to the United States poison control centers.

METHODS

Data from the National Poison Data System were retrospectively analyzed for infants <12 months of age who were exposed to beverage ethanol from 2009-2018.

RESULTS

Over the 10-year study period, 1,818 infant exposures to beverage ethanol were reported. Most exposures were single substance (95.2%), and the most common route of exposure was ingestion (n = 1,738). Infants 9-11 months were the most commonly exposed age group subset (45.3%). The annual number and rate of alcoholic beverage exposure increased by 37.5% and 42.9%, respectively, from 2009 to 2018. Of the 563 infants evaluated at a healthcare facility, 38% of exposures were hospitalized. Infants 0-5 months of age had higher odds of being admitted to a non-critical (OR: 2.35, 95% CI: 1.41-3.92) or critical care unit (OR: 2.39; 95% CI: 1.50-3.79) compared to infants 6-11 months of age. Infants 0-5 months of age were more likely to (OR: 4.65; 95% CI: 3.18-6.79) experience a serious outcome compared to infants ages 6-11 months. Five fatalities in infants <6 months old were documented. An in-depth case review identified improper storage and subsequent formula preparation with beverage ethanol as a common exposure mechanism.

CONCLUSIONS

Beverage ethanol exposures among infants are associated with hospitalization, serious clinical effects, and mortality. Infants may present with atypical signs and symptoms of intoxication, requiring a high index of suspicion. Opportunities exist to reduce exposures by addressing improper storage of beverage alcohols.

Retrospective assessment of acute poisoning incidents by nonpharmaceutical agents in Jordan: Data from Pharmacy One™ Poison Call Center, 2014 to 2018-Part I

The Pharmacy One™ Poising Call Center (P1 PCC), located in Amman, Jordan, was created to address deficiencies identified by the pharmacy service, including in the management of poisoning cases. The aims of this study were to analyze the patterns of poisoning cases reported to the P1 PCC and to describe the role of the P1 PCC pharmacist in ensuring preparedness and managing the response to poisoning cases. In addition, the information from these interventions was used to survey human poisoning in Jordan. This is a retrospective descriptive study of acute poisoning incidents in the Jordanian population, as recorded by the P1 PCC during the period 2014-2018. Inquiries received by the P1 PCC were recorded on a predesigned form. The year, patient demographics, toxic agent involved, and circumstances of the poisoning event were all fully documented utilizing Oracle and Excel spreadsheets. A total of 1992 poisoning incidents were reported to the P1PCC, predominately (68.59%) via 911 phone calls. Reports were predominantly from males (1.67:1). Children were the second most common age group after adolescents (22.62% and 42.49%, respectively). The most frequent causative nonpharmaceutical agents were household products (17%) in preschool children and animal bites (20%) in adolescents. Most of the poisoning incidents (74.63%) occurred at home. Unintentional poisoning (54.12%), with mild medical outcomes (61.45%), accounted for most of the poisoning incidents caused by exposure to household products. These data may represent the most recent picture of poisoning incidents in Jordan. Emergency medical services were provided by experienced pharmacy practitioners at the P1 PCC, to respond to emergency needs in the community in a professional manner. Therefore, the need for unnecessary hospitalization and the cost of ambulance dispatch were minimized, which are highly valuable outcomes.

Ethanol Intoxication of Young Children

Ethanol intoxication of infants and young children can be a challenging diagnosis in the pediatric emergency department, and features of the poisoning may differ in comparison with adolescents. The sources of ethanol exposures in this age are varied and include unintentional, malicious, and iatrogenic etiologies. Young children exposed to ethanol often present with mixed clinical signs and symptoms that may not fit the traditional ethanol or sedative-hypnotic toxidrome. Pediatric ethanol intoxications are often managed supportively, and recovery is usually rapid. The purpose of this review is to describe the sources of ethanol poisoning among children 6 years and younger, highlight presenting symptoms and pharmacokinetic considerations unique to this age group, and review management strategies. In addition, published cases of ethanol poisoning due to ingestion among young infants are compiled for presentation.

A retrospective study of mushroom poisoning in Iran

The objective of this study was to describe the pattern of mushroom poisoning in adults admitted to the Loghman Hakim Hospital Poison Center from 1992 to 2002. All patients ≥ 12 years of age were included in the study. The frequency of mushroom poisoning with respect to age, sex, season, reason, place of residence, latent phase, clinical and laboratory findings, treatment, and outcome of patients was investigated. Of the 72 421 poisoning cases admitted to Loghman-Hakim Hospital Poison Center from 1992 to 2002, only 37 were poisoned by consumption of toxic mushrooms. As some of the patients' files were incomplete, only 25 files were included in the study. Of this number, 68% were male. The patients' age ranged between 12 and 65 years, with a mean of 31 years of age. All cases were accidental and mostly from Tehran (36%) and the northern provinces (rainy woodlands) of Iran (32%). Autumn was the most common season for poisoning with a frequency of 80%. The latent phase of poisonings was between 0.5 and 12 hours. The most frequently reported symptoms were vomiting (84%), nausea (60%), abdominal pain (60%) and diarrhea (40%). Jaundice was observed in 44% of cases, with a 50% rate of hepatic encephalopathy. A total of 66% of patients were discharged and the duration range of hospitalization was 1-12 days.

In conclusion, people should be more informed of the dangers posed by wild mushrooms. Training of physicians and nurses in the accurate diagnosis and management of patients poisoned with poisonous mushrooms would improve the rate of survival.

Pediatric ingestions of house hold products containing ethanol: a review

BACKGROUND

Alcohol is present in a number of household items that are readily accessible to children. Ingestion of these household products containing alcohol can lead to significant health risks.

OBJECTIVE

To identify reported cases of ingestions of common household items that have led to ethanol intoxication, poisoning, or death in children up to the age of 18 years.

METHODS

The OVID MEDLINE database from 1948 to March 2011, Embase from 1980 to March 2011, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from 1982 to February 2011 were searched for articles with the following key terms: alcohols(ethanol or ethyl alcohol) and ingest*(ingestion) or intoxic*(intoxication) or poisoning* or death. The search was limited to children (0-18 years). All articles that reported ingestion of household products that contained ethanol were included in the analysis. Results. Many household products, particularly mouthwashes, hand sanitizers, and cosmetics contain quantities of ethanol that are significant enough to induce intoxication and hypoglycemia. There were 17 publications directly reporting on children with alcohol intoxication from household products. Serious adverse events included hypoglycemia, seizures, and death. Child-resistant closures appear to have reduced the incidence of ingestion of ethanol-based products, including mouthwashes, and may be applicable to other products such as hand sanitizers.

CONCLUSION

Ingestion of household substances containing alcohol continues to be a health care problem. Legislature to reduce alcohol content in household products and public education should be instituted to prevent poisonings in children.

Mushroom poisoning: a case report from Jordan

An eight years male child with his family ate fresh mushroom at lunch time from back garden at their home in a village in the North of Jordan. By the evening approximately six hours later all started feeling nausea, abdominal cramps and vomiting they rushed to nearest primary health care center. After getting general medical medication they were transfer to a referral hospital at city of Irbid. The boy got deteriorated with diarrhea in addition to the previous gastrointestinal complains and died on third day. The message from this case is to ascertain in the public opinion that unknown type of mushroom even eaten previously could be poisonous and fetal.

Acute intoxication with the adjuvant itself for Gramoxone INTEON

The adjuvant for Gramoxone INTEON is composed of 20% methanol, 20% sodium lingo sulphonate, 10% alkylaryl polyoxyethylene ether, and 50% water. Although the adjuvant is a potential source of intoxication due to the widespread use of Gramoxone INTEON, there has been no prior report characterizing the acute toxicity of this adjuvant. This study evaluated the acute toxicity of adjuvant ingestion. Seven patients presenting with acute adjuvant intoxication at Chonnam National University Hospital were enrolled in this retrospective study. The patients had intentionally or accidentally ingested 20-150 mL of adjuvant. Gastrointestinal symptoms such as nausea and vomiting were most common, and no ocular symptoms were reported. Cardiovascular symptoms were limited to electrocardiogram changes such as corrected QT interval (QTc) prolongation (71.4%) and sinus tachycardia (28.6%). All patients had an elevated serum osmolar gap and lactate levels. One patient had metabolic acidosis with a high anion gap that required administration of sodium bicarbonate. These clinical symptoms were resolved within 3 days with supportive treatment without any sequelae. There were no life-threatening symptoms and no deaths. However, the physician should keep in mind the possibility of methanol intoxication in patients poisoned with this adjuvant.

Acute poisoning among children admitted to a regional university hospital in Northern Greece

OBJECTIVES

The aim of our study was to elucidate the current pattern of acute poisoning among children admitted to a regional University Hospital in the prefecture of Evros in Northern Greece. We also compared the obtained findings with those of two previous studies performed in the same region.

METHODS

Demographic and clinical data, management, and outcome of children with acute poisoning were recorded in our region, during the past 5-years (2005-2009, period C) and compared to similar studies carried out in the periods 1985-1989 (period A) and 1995-1999 (period B).

RESULTS

Comparison between the three periods showed that in period Athe lower incidence of children's acute poisoning (CAP) was observed. Also this revealed a 20%-reduction in the frequency of poisoning over the past 5-years (period C) compared to period B (p = 0.219), a significant increase in tobacco intoxication over the years (in the order A-C; p < 0.001 for comparisons of periods A and B, and periods B and C), while poisoning from insecticides-pesticides decreased (p < 0.001). The incidence of poisoning via salicylates significantly reduced from 9.7% in period A to 6.2% in period B, and further to 4.7% in period C (p = 0.016), whereas during the same periods poisoning via paracetamol increased from 2.3% to 5.1% and then to 10.4%, respectively (p < 0.001). Atrend toward a higher incidence of suicide attempt via poisoning was found during the three periods (from 3.0% in period A to 4.7% and 6.6%, in periods B and C, respectively; p = 0.049).

CONCLUSIONS

The frequency of acute poisoning among children has decreased over the past 5 years. The incidences of poisoning via paracetamol and tobacco, and attempted suicide have increased in recent years. Targeted and continuous educational preventive programs are mandatory.

A profile of unintentional poisoning caused by household cleaning products, disinfectants and pesticides

Unintentional poisoning occurred mainly among children. The leading cause of such poisoning in Brazil, among consumer products was household cleaning products. For this study 2810 calls made to two poison control centers in the State of Rio de Janeiro between January 2000 and December 2002 were analyzed. Children under five were the most vulnerable group. More boys under 10 suffered accidental poisoning than girls, although above this age, the distribution was inverted. The calls received by poison control centers were mainly from health services within the first two hours following poisoning. The most frequent exposure routes were ingestion (90.4%), followed by inhalation (4.3%), skin and eye contact (2.4% and 2% respectively). The products involved were bleach, petroleum derivates, rodenticides and pesticides. The main causes were products within the children's reach, storage in soft drink bottles, food mixed with rodenticides, incorrect product use, and kitchen utensils used for measured cleaning products. The most common outcome was that the patient was cured, although a lot of cases were lost to follow-up. Education programs are necessary in order to avoid these poisonings.

Labelling of household products and prevention of unintentional poisoning

Unintentional poisoning occurs mainly in childhood due to ingestion of common household products. A decisive factor is the lack of knowledge concerning the potential toxicity of these products. A random study of 158 labels of cleaning products was conducted at the National Institute of Quality Control in Health - Brazil. Health hazard warnings, first aid in case of poisoning and storage instructions were evaluated to assess the quality of information provided to the consumer regarding the risks inherent in these products. Among these labels, 75% were considered inadequate since they did not provide all cautionary information necessary to avoid the health hazards associated with these products. First aid instructions in the case of inhalation were missing on more than 50% of labels studied and 47% did not recommend taking the label to a health professional in case of accident. Furthermore, the labels did not provide other important warnings such as "read before use" and "keep in original container". The results indicate that the labelling of cleaning products does not provide all safety information recommended for consumers.

Turpentine oil inhalation leading to lung necrosis and empyema in a toddler

Household poisons can cause serious damage to the health of children. Turpentine oil, used chiefly as a solvent in paints, varnishes, and waxes; is often placed within easy reach of children during polishing or painting work. It is capable of causing serious toxicity, whether ingested or inhaled. Pulmonary aspiration can lead to lung parenchymal damage and turpentine-associated pneumonia. We report a case of exploratory ingestion and inhalation of turpentine oil in an 18-month-old boy, leading to extensive lung parenchymal damage, formation of multiple abscess cavities, and necrosis treated with decortication and segmental resection.

Emergency visits for childhood poisoning: a 2-year prospective multicenter survey in Spain

OBJECTIVES

To describe the characteristics of childhood poisoning leading to consultation to 17 pediatric emergency departments in Spain.

METHODS

During a 2-year period (January 2001 to December 2002), accompanying people of 2157 children with acute intoxication who visited consecutively at the emergency room were prospectively surveyed.

RESULTS

Childhood poisoning accounted for 0.28% of all emergency visits during the study period. The median (interquartile range, 25th-75th percentile) age was 24 months (22-60 months); 67% of children were younger than 4 years. Drug ingestion was involved in 54.7% of cases (paracetamol was the most frequent drug), domestic products in 28.9%, alcohol in 5.9%, carbon monoxide in 4.5%, and illicit drugs in 1.5%. A total of 61.3% of patients were admitted within 1 hour after exposure to the toxic substance, and 10.3% had been already treated before arrival; 29.1% of patients were referred for clinical manifestations which were mostly neurological symptoms. Laboratory tests and other investigations were performed in 40.7% of cases. Gastrointestinal decontamination was used in 51.7% of patients, with activated charcoal in 32.3%. Treatment varied significantly according to the individual hospitals. A total of 83.3% of patients were treated as outpatients, 15.2% were hospitalized, and 1.5% were admitted to the intensive care unit. One 11-month-old boy with carbon monoxide intoxication died. Six patients had permanent sequelae (esophageal stenosis in 5 and partial blindness in 1).

CONCLUSIONS

Young children who accidentally ingested drugs and, less frequently, domestic products accounted for most cases of intoxication who presented at the pediatric emergency department.