Over-the-counter antacids linked to severe hypokalaemia in the context of threatened preterm labour

A healthy multiparous woman presented at 35 weeks and 4 days' gestation with threatened preterm labour on multiple occasions. An incidental finding of severe hypokalaemia (2.4 mmol/L) was detected on routine blood tests. The cause of this hypokalaemia was not initially obvious. It was eventually linked to overuse of over-the-counter antacids for pregnancy-associated heartburn. The patient was managed with parenteral and then oral electrolyte replacement which corrected a pH of 7.55, bicarbonate of 36.7 mEq/L and a base excess 13.1. In this case report we consider whether hypokalaemia could be linked to uterine irritability and threatened preterm labour, whether antacids were being abused in the context of an eating disorder and the importance of taking a full drug history.

Characteristics of Drugs Ingested for Suicide Attempts in the Elderly

BACKGROUND

Suicide is a significant public health problem worldwide. Suicide rates among elderly persons (≥ 65 years of age) are three times higher than those of younger people in Korea. The emergency department is an important entry of drug-related suicide attempt patients. In this study, we compared the frequency of drug types by age subgroup. Furthermore, we provide suggestions for preventing suicide attempts in the elderly.

METHODS

We investigated 433 patients who were admitted to the emergency department for drug-related suicide attempts between 1 May 2015 and 30 April 2017.

RESULTS

The proportion of patients who overdosed on antidepressants was 32.5% in the non-elderly age group and 8.0% in the elderly group (≥ 65 years of age) (P < 0.001). Among the elderly, the most commonly ingested agent was hypnotics (59.1%) (P < 0.001). Compared with the non-elderly, the results showed that the elderly used fewer antidepressants (P < 0.001) and analgesics (P < 0.001). Meanwhile, the elderly used more hypnotics (P < 0.001). Over-the-counter drugs and other medications showed similar usage trends in both age groups (P = 0.664, P = 0.193).

CONCLUSION

The categories of drugs ingested for suicide attempts vary widely between different age groups. Younger people used antidepressants more frequently in suicide attempts, while the elderly used hypnotics more frequently. And the elderly required longer hospital stays. Suicide ideation and depressive mood in older patients who are prescribed hypnotics for various reasons should not be neglected. Further prevention efforts are needed to prevent suicide among the elderly.

Pediatric Poisonings: The Risk of Over-the-Counter Pharmaceuticals

Every week in the United States, 56% of children younger than age 18 years and 82% of adults take at least one medication. Nonprescription medications, including acetaminophen and ibuprofen, are among the most commonly used pharmaceuticals across all age groups. Use of nonprescription medications, traditionally available over-the-counter, has become ubiquitous. Unfortunately, with such abundant use there is an associated risk for therapeutic misuse, intentional misuse, and even abuse. [Pediatr Ann. 2017;46(12):e454-e458.].

Acute Poisoning During Pregnancy: Observations from the Toxicology Investigators Consortium

Acute poisonings during pregnancy pose a particular challenge to health care providers because of the potential for an immediate life threat or possible life-long implications for both the mother and fetus, including teratogenicity of the poison or its antidote. We describe recent consequential exposures among pregnant women in the USA. We identified all poisoning cases involving pregnant women that were catalogued by the medical toxicology services across the 37 sites of the Toxicology Investigators Consortium (ToxIC) Registry of the American College of Medical Toxicology between January 2010 and December 2012. Of 17,529 exposure cases reported in the ToxIC Registry, 103 (0.6 %) involved pregnant women, 80 % of whom were symptomatic and about a quarter displayed a specific toxidrome. The majority of cases (n = 53; 51.5 %) involved intentional exposures, most commonly to pharmaceutical agents, followed by unintentional pharmaceutical exposures (10 %) and withdrawal syndromes (9 %). Non-opioid analgesics were the most common class of agents encountered (31 %), followed by sedative-hypnotics/muscle relaxants (18 %), opioids (17 %), anti-convulsants (10 %), and anti-depressants (10 %). Over a third of cases involved exposure to multiple substances, and 32 % involved exposure to more than one drug class. The most commonly administered antidotes were N-acetylcysteine (23 %), sodium bicarbonate (10 %), flumazenil (4 %), and physostigmine (4 %). About half of acute poisoning cases among pregnant women presenting for emergency care involved intentional exposures, mostly with over-the-counter analgesics and psychoactive medications. Clinicians should be cognizant of the unique circumstances, maternal and fetal risks, and management principles of the acutely poisoned pregnant woman.

Characteristics of hospital-treated intentional drug overdose in Ireland and Northern Ireland

OBJECTIVES

This study compared the profile of intentional drug overdoses (IDOs) presenting to emergency departments in Ireland and in the Western Trust Area of Northern Ireland between 2007 and 2012. Specifically the study aimed to compare characteristics of the patients involved, to explore the factors associated with repeated IDO and to report the prescription rates of common drug types in the population.

METHODS

We utilised data from two comparable registries which monitor the incidence of hospital-treated self-harm, recording data from deliberate self-harm presentations involving an IDO to all hospital emergency departments for the period 1 January 2007 to 31 December 2012.

RESULTS

Between 2007 and 2012 the registries recorded 56 494 self-harm presentations involving an IDO. The study showed that hospital-treated IDO was almost twice as common in Northern Ireland than in Ireland (278 vs 156/100 000, respectively).

CONCLUSIONS

Despite the overall difference in the rates of IDO, the profile of such presentations was remarkably similar in both countries. Minor tranquillisers were the drugs most commonly involved in IDOs. National campaigns are required to address the availability and misuse of minor tranquillisers, both prescribed and non-prescribed.

[Paracetamol overdose]

Acetaminophen is the most widely used analgesic-antipyretic and is available as an over-the-counter medication in many countries. Although generally safe at usual therapeutic doses, acetaminophen may cause hepatic toxicity in case of chronic or acute overuse and even at therapeutic doses in susceptible individuals. The aim of this article is to review the mechanisms of acetaminophen toxicity and to review the critical steps in the management of acute or chronic acetaminophen intoxication.

[Important toxic and undesirable effects of medicaments in animals from the pharmacists viewpoint]

Both veterinary and human drugs belong to the most common sources of poisoning in companion animals. The most problematic are "over the counter" drugs, mainly those from the group of analgesics, which are often given to animals by their owners who are not informed about their toxicity to animals, and those from the group of antiparasitics, which are often administered in an improper dose and to improper animal species. Pharmacists should play an important role in the education of their clients and animal owners in this field. To be able to give qualified advice and thus decrease the possibility of animal poisoning by drugs, they need to obtain sufficient and up-to-date information in this issue. The aim of this overview is to supply pharmacists with the most important knowledge from the area of drug toxicology in small animals.

[Dextromethorphan (DXM): new methods of intoxications among teenagers--a case description]

The study highlighted the problem of intoxication using substances and/or preparations, to which nowadays young people have unrestricted access. Based on the case developed in the Department of Forensic Medicine of the Medical University of Gdansk, our team members were able to gather information showing "ingenuity" of today's teenagers, which was reflected in the types of preparations used to induce a state of euphoria and intoxication. The study was based on the case of a 17-year-old woman, who took Acodin in combination with compressed air used to clean computer keyboards in order to induce psychoactive effects. The study used qualitative and quantitative methods: GC-FID and GC-MS. The results were compared with data from the literature.

Evaluation and referral for child maltreatment in pediatric poisoning victims

OBJECTIVE

Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine the percentage and characteristics of young poisoning victims who were evaluated for child maltreatment by the hospital team (social work and/or child protection team) and/or referred to CPS.

METHODS

Retrospective study of poisoning victims<6 years old seen at an urban children's hospital from 2006 to 2008. Logistic regression was performed to evaluate the associations between the outcomes (evaluation for maltreatment by hospital team and/or referral to CPS) and predictor variables (demographics and circumstances, type and severity of poisoning).

RESULTS

Among 928 poisonings, 41% were from household products, 20% from over-the-counter drugs, 7% from prescription narcotics/sedatives, 29% from other prescription drugs, and ≤ 1% each from ethanol, illicit drugs, or other substances. Most children were asymptomatic (69%) or stable (28%); 3% were critically ill. Only 13% were evaluated by the hospital team and 4% were referred to CPS. Demographic characteristics were not associated with referral to CPS. Higher clinical severity was associated with increased referral (p<0.001). Compared to poisonings with over-the-counter drugs, referrals were more likely for poisonings with ethanol and prescription narcotics/sedatives, but not other prescription drugs or household products (p<0.001). All illicit drug poisonings and 44% of ethanol poisonings were referred. The majority of referrals to CPS were for concerns for illicit drugs, poor supervision or multiple forms of maltreatment; 6% were secondary to concerns for intentional poisoning.

CONCLUSIONS

Evaluations and referrals to CPS for maltreatment are uncommon in young poisoning victims. Referrals occurred consistently for illicit drugs but not ethanol. Although referrals were more likely for higher severity poisonings, it is unclear if the severity of poisoning is associated with the level of supervisory neglect or a marker of ongoing risk to the child. These findings suggest the need to identify risk factors for ongoing harm and the development of clinical guidelines used to determine which poisoning victims should be referred to Child Protective Services.

Over-the-counter codeine analgesic misuse and harm: characteristics of cases in Australia and New Zealand

AIM

To describe the characteristics of clients addicted to over-the-counter (OTC) codeine analgesics presenting to an Auckland open-access clinic, and to compare them to clients admitted to a New Zealand detoxification unit, and in the Australian community.

METHOD

Cross-sectional study of clients presenting to a regional, open-access detoxification clinic covering the Greater Auckland area between 1 January and 31 March 2010.

RESULTS

Fifteen clients were analysed, and compared to 77 similar clients identified in Victoria and five other Australian States, and 7 clients admitted to a New Zealand detoxification unit. Cases in each cohort were consistent with those in the published literature, and appear to be similar to each other both demographically and in terms of the high average tablets consumption (49-65 tablets per day), the serious non-steroidal anti-inflammatory drug (NSAID) adverse drug reactions identified, and the long duration of misuse. Many had a history of alcohol or other drug use and mental health disorder.

CONCLUSIONS

This study has identified that controls on OTC codeine analgesics in both countries were not sufficient to limit non-medical use of these products. As a result, cases identified in these two countries escalated the number of self-administered tablets taken daily for misuse, resulting in codeine dependence and serious NSAID toxicity secondary to this dependence.

Is non-therapeutic aspirin use in children a problem in South Africa?

BACKGROUND

Aspirin should not be used in children except for specific therapeutic reasons. We report on a severely ill infant who had ingested aspirin contained in a traditional medicine and review 21 other patients with pre-admission non-therapeutic salicylate exposure.

OBJECTIVES AND METHODS

We reviewed laboratory, clinical and poisons unit records to determine how many children were admitted to our hospital over an 18-month period with evidence of salicylate ingestion not prescribed for therapeutic reasons. We determined the source of the salicylate, elapsed time between ingestion and laboratory assay, morbidity and mortality and final diagnosis.

RESULTS

Twenty-one children meeting our criteria, including 9 under 6 months of age, were admitted during this period. The most prevalent source of salicylate was over-the-counter (OTC) aspirin, but some had reportedly only been given traditional medicines. Nineteen were seriously ill, 4 died and 3 had severe brain injury. Two, initially diagnosed with Reye's syndrome, probably had inherited metabolic disorders. Only 2 patients had salicylate levels that at the time of measurement are normally considered toxic; however, the literature suggests that lower levels may exacerbate illness severity in young children.

CONCLUSIONS

We found inappropriate use of OTC aspirin in children that requires explanation. There may be policy implications for the content and presentation of patient information; the incorporation of pharmaceuticals in traditional medicines merits further study. Salicylate toxicity should be considered in children with unexplained metabolic acidosis out of keeping with the severity of their acute illness.

[Drug intoxications as an indicator of social tensions and social ill-being]

Taken together statistical data illustrating the frequency of acute iatrogenic intoxication and parameters of economic development of the country testify to the importance of the problem of drug abuse confirmed by calculation of Piearson's correlation coefficients. The analysis of the rating list of pharmaceutical products known to most frequently cause intoxication indicates that a group of potentially dangerous' preparations include not only prescription drugs, such as neuroleptics, antidepressants, and soporifics, but also over-the-counter medicines. The results of the present study give evidence of the appearance of a separate nosological form in this country referred to as iatrogenic diseases. Moreover, they give reason to regard iatrogenic intoxication as a risk factor of social tensions and ill-being.

Misuse of over-the-counter codeine-containing analgesics: dependence and other adverse effects

AIM

To review cases of codeine dependency from over-the-counter (OTC) combination analgesics admitted to a hospital detoxification unit.

METHOD

Case records of all admissions following an index case were reviewed over a 2-year period.

RESULTS

There were 7 cases reporting chronic excess of Nurofen Plus, of which 6 had prior or current histories of alcohol dependency. Complications which were likely contributed by excessive ibuprofen consumption included: gastric ulcer (4 patients), gastrointestinal bleeding (3), hepatotoxicity (1), and inflammatory bowel conditions (2).

CONCLUSIONS

This pattern of admissions is new to the detoxification unit, and may relate to higher codeine content in the combination product, and marketing strategies. These cases likely represent the severer end of the spectrum of codeine dependency acquired from OTC pharmacy sources. The paucity of evidence to support additional benefit from the inclusion of codeine in analgesic combination products is concerning. There is a need for increased pharmacovigilance around these and other OTC medications.

Profound hypokalaemia due to Nurofen Plus and Red Bull misuse

We report an unusual and emerging cause of profound hypokalaemia associated with a severe myopathy, attributable to misuse of Nurofen Plus, a readily available over-the-counter medication containing ibuprofen and codeine, and excessive ingestion of the caffeine-containing energy drink, Red Bull. The mechanism of the hypokalaemia may be ascribed to ibuprofen-mediated type 2 renal tubular acidosis, and caffeine-mediated antagonism of adenosine receptors or intercompartmental shift of potassium into the intracellular space. Practitioners should be aware that patients with codeine addiction who misuse Nurofen Plus may present with severe hypokalaemia complicated by myopathy.

[Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the material of Poison Information Centre]

There were 10 636 toxicological information given in 2004-2008 by the Poison Information Center Jagiellonian University Medical College. 538 of them concerned NonSteroidal Anti-Inflammatory Drugs (NSAIDs); 336 cases of NSAIDs ingested alone and 202 co-ingested with other drugs and/or with ethanol. 58,9% of them were intentional and 29,6% were accidental. Children (1-6 years) and adolescents (15-19 years) were mostly involved.

Revised product labels for pediatric over-the-counter cough and cold medicines

October 7, 2008, the Consumer Healthcare Products Association announced that the leading manufacturers of pediatric over-the-counter cough and cold medicines would voluntarily modify the labels on these products to state that they should not be used in children aged <4 years.

Paracetamol availability and recent changes in paracetamol poisoning: is the 1998 legislation limiting availability of paracetamol being followed?

OBJECTIVE

To determine the degree of adherence to legislation introduced in 1998 restricting the availability of over the counter paracetamol.

DESIGN

A prospective observational study.

SETTING

An emergency department in an inner city London teaching hospital. Pharmacy and non-pharmacy outlets in south London.

MAIN OUTCOME MEASURES

(1) The source of paracetamol ingested by 107 patients presenting with an acute paracetamol overdose (2001-2003) and (2) the ability to purchase paracetamol from pharmacy and non-pharmacy outlets in a manner contravening paracetamol pack size legislation (2004).

RESULTS

Potentially toxic amounts of paracetamol in excess of pack size restrictions were purchased in 70% (17 of 24) of outlets. Forty six per cent of patients who had ingested a potentially toxic dose of paracetamol obtained the tablets in a manner contravening the 1998 legislation.

CONCLUSION

Legislation limiting the availability of over the counter paracetamol is not being adhered to in south London. A significant number of patients ingesting a potentially toxic dose of paracetamol report purchasing the tablets in a manner contravening the legislation. Studies that attempt to assess the impact of the legislation need to be interpreted in the context of these results. Measures to enforce current legislation may help to reduce the severity of paracetamol poisoning in the UK.

“Over-The-Counter” Drug Toxicities in Companion Animals

A truly astonishing variety of "over-the-counter" drugs not taken under the auspices of a physician or veterinarian and not regulated by the Federal Drug Administration (FDA) are currently available to the American public. Many of these are widely advertised, readily available, remarkably inexpensive, and universally taken. Although most of the over-the-counter medications are fairly safe, the potential for toxic episodes exists due in large part simply on account of the amounts curious unsupervised animals may ingest. Another part of the problem is that since they are over the counter a large proportion of the public perceives them as totally harmless. In this article, we will investigate the most frequently seen non-prescription intoxications, their mechanism of action, clinical signs, diagnosis management, and prevention.

Efficacy, abuse, and toxicity of over-the-counter cough and cold medicines in the pediatric population

PURPOSE OF REVIEW

Over-the-counter cough and cold medicines are widely prescribed by general pediatricians in order to relieve cough and other symptoms in the setting of upper respiratory infections. This article will review the pharmacologic components found in over-the-counter cough medicines, the data concerning their use and efficacy in children, the increasing trend of abuse of these medications, and their potential toxicity.

RECENT FINDINGS

There is an overall paucity of data evaluating the use of over-the-counter cough medicines in children as well as a lack of evidence for their efficacy. The articles cited will review the efficacy of over-the-counter cough medicines, the emerging trend of abuse of certain preparations such as dextromethorphan, and specific cases of morbidity and even mortality.

SUMMARY

According to the limited data that exist, there is not any evidence that over-the-counter cough and cold medicines are effective in children. In otherwise healthy children without chronic complicating factors such as asthma, the symptoms of acute upper respiratory infections are generally mild and self-limited. Pediatricians must weigh the benefits against the potential risks of recommending over-the-counter cough medicines and should be prepared to educate parents about the expected natural course of their child's illness and the likelihood that these medications will be minimally effective in relieving symptoms, if at all.

Prescription and over-the-counter medication in deliberate self-poisoning and accidental overdosing--preliminary study

186 case records of patients who overdosed pharmaceuticals (confirmed by toxicological lab analysis) hospitalized at the Department of Clinical Toxicology during three months of 2000 were analyzed for age, sex, type of medication, reason for poisoning (intentional or accidental overdosing). Patients poisoned with prescription medication (Rx group) were compared with those who overdosed nonprescription (OTC-group) medications (alone or combined with Rx). Relative frequency of medication drug poisoning was highest in the 40-49 age group (28.5%) and was followed by the group of young adults (20-29 years; 24.2%). The lowest frequency (2.2%) was noted in the 60-69 age group. Of 186 cases analyzed, in 163 (87.6%) prescription medication (Rx) and in 23 (12.4%) OTC alone or co-ingested with Rx were involved (chi2 = 63.9; p < 0.001). The Rx and OTC groups were not significantly different as to reason for poisoning (chi2 = 0.7; p = 0.792) with significant overrepresentation of deliberate ingestion in both the group analysed (chi2 = 114.39; p < 0.001 for Rx, and chi2 = 13.49; p = 0.002 for OTC). Most adults attempting suicide used Rx with the highest incidence in the 40-49 age group (31.1%). Adolescents (14-19 years) with female over-representation ingested rather OTC pharmaceuticals (40.9%). Acetaminophen (alone or combined with benzodiazepines or/and ethanol) and nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common OTC medications used for deliberate self-poisoning.

UK legislation on analgesic packs: before and after study of long term effect on poisonings

OBJECTIVE

To evaluate the long term effect of legislation limiting the size of packs of analgesics sold over the counter.

DESIGN

Before and after study.

SETTING

Suicides in England and Wales, data from six liver units in England and Scotland and five general hospitals in England, and UK data on sales of analgesics, between September 1993 and September 2002.

DATA SOURCES

Office for National Statistics; six liver units in England and Scotland; monitoring systems in general hospitals in Oxford, Manchester, and Derby; and Intercontinental Medical Statistics Health UK.

MAIN OUTCOME MEASURES

Deaths by suicidal overdose with paracetamol, salicylates, or ibuprofen; numbers of patients admitted to liver units, listed for liver transplant, and undergoing transplantations for paracetamol induced hepatotoxicity; non-fatal self poisonings with analgesics and numbers of tablets taken; and sales figures for analgesics.

RESULTS

Suicidal deaths from paracetamol and salicylates were reduced by 22% (95% confidence interval 11% to 32%) in the year after the change in legislation on 16 September 1998, and this reduction persisted in the next two years. Liver unit admissions and liver transplants for paracetamol induced hepatotoxicity were reduced by around 30% in the four years after the legislation. Numbers of paracetamol and salicylate tablets in non-fatal overdoses were reduced in the three years after the legislation. Large overdoses were reduced by 20% (9% to 29%) for paracetamol and by 39% (14% to 57%) for salicylates in the second and third years after the legislation. Ibuprofen overdoses increased after the legislation, but with little or no effect on deaths.

CONCLUSION

Legislation restricting pack sizes of analgesics in the United Kingdom has been beneficial. A further reduction in pack sizes could prevent more deaths.

Management of intentional overdose in A&E departments

This guided reflection article discusses the biological, psychological and social causes of intentional overdose and how the A&E nurse can treat the suicidal patient. The author shows how nurses in A&E can provide interventions that address patients' physical and psychosocial needs. The correct acute response to the medications commonly taken in an intentional overdose case are described. These interventions promote patient survival, improve concordance with mental health follow-up and reduce recidivism.

[Over-the-counter drugs in the inquiries to the Poison Information Centre]

The aim of the study is to assess the occurrence of inquiries to the Poison Information Centre in the years 1998-2002, concerning medical preparations containing active agents included in Act No. 79/1997 on Drugs in the group of over-the-counter (OTC) drugs which can be sold in the Czech Republic in other shops than pharmacies. It deals especially with medical preparations containing paracetamol, ibuprofen, mephenhydramine teoclate, disinfectants with iodine or 10% solutions of quaternary ammonium compounds and 3% solutions of hydrogen peroxide. The attention is focused on the quantitative assessment of inquiries, sex, age of patients, ingested dose, way of intoxication, recommended treatment and prognosis of the intoxication of the patient. The computer programme employed was established for the registrations of the calls to the Poison Information Centre. The highest number of intoxications was seen in the case of pharmaceuticals containing paracetamol and ibuprofen. The inquiries on OTC drugs that can be sold in other shops than pharmacies represent 6.3% of all calls during this five year period. The intoxication in women, suicidal attempts, ingestion of a toxic dose, rather good prognosis and a combination of several drugs predominate in the calls.

Trends in child and teen nonprescription drug abuse reported to a regional poison control center

PURPOSE

Trends in child and teen nonprescription drug abuse reported to a regional poison control center over a 10-year period were examined.

METHODS

Human exposures to toxic substances reported to the Utah Poison Control Center between January 1990 and December 1999 were reviewed. Cases were selected for analysis if the exposure involved a nonprescription drug, the patient was 6-19 years old, and the reason for exposure was intentional abuse. Frequencies and cross-tabulations were calculated to identify trends in nonprescription drug abuse.

RESULTS

There were 2214 reports of intentional drug abuse among children and teenagers 6-19 years old. Of those, 844 (38.1%) involved nonprescription drugs. The percentage of exposures Involving nonprescription products varied every year and declined over time. Exposures were slightly more common In males (51.7%). The site of exposure was a residence in 65% of cases and a school in 10% of cases. The majority of patients with exposures (68.4%) were treated In a health care facility. The most common types of nonprescription medications abused were drugs with anticholinergic properties, caffeine, dextromethorphan, and nonprescription stimulants.

CONCLUSION

Reports of the Intentional abuse of nonprescription drugs by children and teenagers were common at a regional poison control center. There was significant variation in the type of nonprescription medication most commonly abused. The knowledge of these trends may assist public health policymakers, physicians, pharmacists, and child educators in their attempts to curb nonprescription drug abuse. drugs.

Salicylate poisoning in children: report of three cases

To raise clinicians' awareness of chronic (therapeutic) salicylate poisoning as a common cause of admission in paediatric patients presenting to hospital with respiratory distress (a clinical manifestation of metabolic acidosis) and a history of 'over the counter' treatment with salicylate (Aspirin). We present two complex cases and provide a review of the literature on pathogenesis, clinical presentation and management of salicylate poisoning. A complete history of the illness, including questions on drug use, is vital in assessing the cause of metabolic acidosis in children. Due to the limited options available in managing such patients in many developing countries, emphasis should be placed on prevention of poisoning by educating the community and health care providers.

Drugs detected in suspected pediatric ingestions: a three-year review

Comprehensive toxicology testing can be a valuable resource when pediatric patients are suspected of having ingested unknown chemicals. In a recent 36-month period (January 2000-December 2002), the Analytical Toxicology Laboratory at the University of Mississippi Medical Center, Jackson, MS, tested 190 urine samples referred from the hospital's Pediatric Emergency Department for STAT toxicology testing. All samples were tested in parallel using an immunoassay technique for drugs of abuse and a comprehensive technique using gas chromatography/mass spectroscopy (GC/MS). With immunoassay, sixteen percent of the samples were positive for a drug of abuse. In comparison, drugs were detected in 85% of the samples using comprehensive GC/MS analysis. A total of 86 different pharmaceuticals were identified by GC/MS. This review shows that comprehensive toxicology testing provides the clinician significantly more information regarding the exposure of the pediatric patient presenting with an unknown chemical ingestion.

Fatal Cold Medication Intoxication in an Infant

The case history and toxicological findings of an infant fatality involving pseudoephedrine, brompheniramine, and dextromethorphan are presented. Concentrations of brompheniramine and dextromethorphan were measured in both postmortem blood and liver specimens using a gas chromatograph equipped with a nitrogen-phosphorus detector. Brompheniramine and dextromethorphan were 0.40 mg/L and 0.50 mg/L, respectively, in the blood sample and 0.16 mg/kg and 0.57 mg/kg in the liver sample. The concentration of pseudoephedrine in blood and liver specimens was measured using gas chromatography-mass spectrometry and was determined to be 14.4 mg/L in the blood and 16 mg/kg in the liver. Additionally, a baby bottle allegedly administered to the infant was collected as evidence and sent to the Medical Examiner's Office for evaluation. The amounts of total brompheniramine, dextromethorphan, and pseudoephedrine remaining in the baby bottle were 1.4 mg, 9.4 mg, and 40 mg, respectively.