Electronic Cigarette Exposure: Calls to Wisconsin Poison Control Centers, 2010–2015.

PubMed

Weiss, Debora; Tomasallo, Carrie D; Meiman, Jon G; Creswell, Paul D; Melstrom, Paul C; Gummin, David D; Patel, Disa J; Michaud, Nancy T; Sebero, Heather A; Anderson, Henry A

2016-12-01

E-cigarettes are battery-powered devices that deliver nicotine and flavorings by aerosol and have been marketed in the United States since 2007. Because e-cigarettes have increased in popularity, toxicity potential from device misuse and malfunction also has increased. National data indicate that during 2010–2014, exposure calls to US poison control centers increased only 0.3% for conventional cigarette exposures, whereas calls increased 41.7% for e-cigarette exposures. We characterized cigarette and e-cigarette exposure calls to the Wisconsin Poison Center January 1, 2010 through October 10, 2015. We compared cigarette and e-cigarette exposure calls by exposure year, demographic characteristics, caller site, exposure site, exposure route, exposure reason, medical outcome, management site, and level of care at a health care facility. During January 2010 to October 2015, a total of 98 e-cigarette exposure calls were reported, and annual exposure calls increased approximately 17-fold, from 2 to 35. During the same period, 671 single-exposure cigarette calls with stable annual call volumes were reported. E-cigarette exposure calls were associated with children aged ≤5 years (57/98, 58.2%) and adults aged ≥20 years (30/98, 30.6%). Cigarette exposure calls predominated among children aged ≤5 years (643/671, 95.8%). The frequency of e-cigarette exposure calls to the Wisconsin Poison Center has increased and is highest among children aged ≤5 years and adults. Strategies are warranted to prevent future poisonings from these devices, including nicotine warning labels and public advisories to keep e-cigarettes away from children.

Unintentional Epinephrine Auto-injector Injuries: A National Poison Center Observational Study.

PubMed

Anshien, Marco; Rose, S Rutherfoord; Wills, Brandon K

2016-11-24

Epinephrine is the only first-line therapeutic agent used to treat life-threatening anaphylaxis. Epinephrine auto-injectors are commonly carried by patients at risk for anaphylaxis, and reported cases of unintentional auto-injector injury have increased over the last decade. Modifications of existing designs and release of a new style of auto-injector are intended to reduce epinephrine auto-injector misuse. The aim of the study was to characterize reported cases of unintentional epinephrine auto-injector exposures from 2013 to 2014 and compare demographics, auto-injector model, and anatomical site of such exposures. The American Association of Poison Control Center's National Poison Data System was searched from January 1, 2013, to December 31, 2014, for cases of unintentional epinephrine auto-injector exposures. Anatomical site data were obtained from all cases reported to the Virginia Poison Center and participating regional poison center for Auvi-Q cases. A total of 6806 cases of unintentional epinephrine auto-injector exposures were reported to US Poison Centers in 2013 and 2014. Of these cases, 3933 occurred with EpiPen, 2829 with EpiPen Jr, 44 with Auvi-Q, and no case reported of Adrenaclick. The most common site of unintentional injection for traditional epinephrine auto-injectors was the digit or thumb, with 58% of cases for EpiPen and 39% of cases with EpiPen Jr. With Auvi-Q, the most common site was the leg (78% of cases). The number of unintentional epinephrine auto-injector cases reported to American Poison Centers in 2013-2014 has increased compared with previous data. Most EpiPen exposures were in the digits, whereas Auvi-Q was most frequently in the leg. Because of the limitations of Poison Center data, more research is needed to identify incidence of unintentional exposures and the effectiveness of epinephrine auto-injector redesign.

21 CFR 347.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... called “lip balm.” Poison ivy, oak, sumac dermatitis. An allergic contact dermatitis due to exposure to plants of the genus Rhus (poison ivy, poison oak, poison sumac), which contain urushiol, a potent skin...

21 CFR 347.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... called “lip balm.” Poison ivy, oak, sumac dermatitis. An allergic contact dermatitis due to exposure to plants of the genus Rhus (poison ivy, poison oak, poison sumac), which contain urushiol, a potent skin...

21 CFR 347.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... called “lip balm.” Poison ivy, oak, sumac dermatitis. An allergic contact dermatitis due to exposure to plants of the genus Rhus (poison ivy, poison oak, poison sumac), which contain urushiol, a potent skin...

[Household gas poisonings].

PubMed

Maloca, Ivana; Macan, Jelena; Varnai, Veda Marija; Turk, Rajka

2006-12-01

Exposure to toxic gases which can induce serious health effects, can occur in the working as well as in general environment, including home. The severity of gas poisoning is determined by its physical and chemical characteristics, intensity and duration of exposure, and concomitant diseases and injuries in the poisoned person. Manifestations of gas toxic action involve simple asphyxia, local irritation of respiratory mucosa, systemic toxicity, and a combination of these mechanisms. This article describes the characteristics, modes of exposure and health effects of most common gases causing poisoning at home. These include gas fuels, carbon monoxide, ammonia, chlorine, and fire gases such as nitrogen and sulphur oxides, hydrogen cyanide and phosgene. First aid as well as preventive measures to avoid exposure to toxic gases and prevent fire at home are also given. The Croatian Poison Control Centre gathered data on toxic gas exposures in households between November 2005 and July 2006. During this period 30 persons (3 % of the total number of cases) were exposed to toxic gases at home, including carbon monoxide, irritating vapours from cleaning agents and disinfectants, gas fuels, septic tank gases, tear-gas, and chlorofluorocarbons from refrigerators.

Neurological Complications Resulting from Non-Oral Occupational Methanol Poisoning.

PubMed

Choi, Ji Hyun; Lee, Seung Keun; Gil, Young Eun; Ryu, Jia; Jung-Choi, Kyunghee; Kim, Hyunjoo; Choi, Jun Young; Park, Sun Ah; Lee, Hyang Woon; Yun, Ji Young

2017-02-01

Methanol poisoning results in neurological complications including visual disturbances, bilateral putaminal hemorrhagic necrosis, parkinsonism, cerebral edema, coma, or seizures. Almost all reported cases of methanol poisoning are caused by oral ingestion of methanol. However, recently there was an outbreak of methanol poisoning via non-oral exposure that resulted in severe neurological complications to a few workers at industrial sites in Korea. We present 3 patients who had severe neurological complications resulting from non-oral occupational methanol poisoning. Even though initial metabolic acidosis and mental changes were improved with hemodialysis, all of the 3 patients presented optic atrophy and ataxia or parkinsonism as neurological complications resulting from methanol poisoning. In order to manage it adequately, as well as to prevent it, physicians should recognize that methanol poisoning by non-oral exposure can cause neurologic complications.

Pediatric Minoxidil Exposures Reported to Texas Poison Centers.

PubMed

Forrester, Mathias B

2018-06-01

It has been suggested that ingestion of even small amounts of minoxidil by young children may result in serious adverse effects. The intent of this study was to describe pediatric minoxidil exposures reported to a statewide poison center system. Cases were minoxidil exposures among patients 5 years or younger reported to Texas poison centers during 2000 to 2014. The distribution by various demographic and clinical factors was determined. Of 125 total cases, 58% were male and 78% aged 1 to 2 years. Ingestion alone was reported in 92% of the exposures. Ninety-eight percent of the exposures were unintentional, and 94% occurred at the patient's own residence. Sixty-two percent of the patients were managed on site. The outcome was not serious (no effect, minor effect, not followed [nontoxic], not followed [minimal effects]) in 88% of the exposures. The most common adverse effect was vomiting, reported in 8% of the exposures. The most common treatments were dilution/irrigation/wash (53%), activated charcoal (18%), food/snack (17%), and intravenous fluids (8%). Few pediatric minoxidil exposures were reported to Texas poison centers. Of these exposures, most involved ingestion, were unintentional, and involved patients who were male and aged 1 to 2 years. Although it has been suggested that pediatric minoxidil ingestions might result in serious adverse effects, this study suggests that most pediatric minoxidil exposures reported to poison centers are not likely to have serious outcomes and may be managed at home.

Relating calls to US poison centers for potential exposures to medications to Centers for Disease Control and Prevention reporting of influenza-like illness.

PubMed

Beauchamp, Gillian A; McKeown, Nathanael J; Rodriguez, Sergio; Spyker, Daniel A

2016-03-01

The Centers for Disease Control (CDC) monitors influenza like illness (ILI) and the National Poison Data System (NPDS) warehouses call data uploaded by US poison centers regarding reported exposures to medication. We examined the relationship between calls to poison centers regarding reported exposures to medications commonly used to treat ILI and weekly reports of ILI. The CDC reports ILI, by age group, for each of 10 Health and Human Services (HHS) regions. We examined NPDS summary data from calls reported to poison centers regarding reported exposures to acetaminophen, cough/cold medications, and promethazine, for the same weeks, age groups, and HHS regions for influenza seasons 2000-2013. ILI and NPDS exposures were examined using graphical plots, descriptive statistics, stepwise regression analysis, and Geographic Information Systems (GIS). About 5,101,841 influenza-like illness cases were reported to the CDC, and 2,122,940 calls regarding reported exposures to medications commonly used to treat ILI, were reported by poison centers to the NPDS over the 13 flu seasons. Analysis of stepwise models of the linear untransformed data involving 24 NPDS data groups and for 60 ILI measures, over the 13 influenza seasons, demonstrated that reported exposures to medications used to treat ILI correlated with reported cases of ILI with a median R(2 )=( )0.489 (min R(2 )=( )0.248, max R(2 )=( )0.717), with mean ± SD of R(2 )=( )0.494 ± 0.121. Median number of parameters used (degrees of freedom - 1) was 7. NPDS data regarding poison center calls for selected ILI medication exposures were highly correlated with CDC ILI data. Since NPDS data are available in real time, it provides complimentary ILI monitoring. This approach may provide public health value in predicting other illnesses which are not currently as thoroughly monitored.

The status of childhood lead poisoning and prevention in Nevada, USA.

PubMed

Rothweiler, Anne M; Cabb, Elena E; Gerstenberger, Shawn L

2007-03-30

One of the first steps in addressing the problem of childhood lead poisoning is to identify the possible sources of exposure in specific communities and target high-risk populations with appropriate interventions. Due to several factors, such as lack of funding and lack of blood lead reporting, little information exists regarding the occurrence of childhood lead poisoning and the prevalence of potential exposure sources in the state of Nevada. Following the recent establishment of a Nevada-based Lead Poisoning Program, we compiled the most current information available on Nevadans, and use this knowledge to suggest future research objectives and outreach activities for the state. Accordingly, we identify the characteristics of the vulnerable Nevada populations, explore possible sources of lead exposure unique to Nevada, and summarize the existing data on childhood lead poisoning. Emerging data indicates that Nevada is an area of rapid population growth, characterized by increasing immigration from Latin America, increasing numbers of children from low-income families with no health insurance. Also, childhood lead poisoning may arise from exposure to non-paint sources of lead. After presenting the Nevada statistics, we propose and recommend a set of research and outreach strategies that best suit the needs of Nevada residents.

Poisoning following exposure to chemicals stored in mislabelled or unlabelled containers: a recipe for potential disaster.

PubMed

Millard, Yvette C; Slaughter, Robin J; Shieffelbien, Lucy M; Schep, Leo J

2014-09-26

To investigate poisoning exposures to chemicals that were unlabelled, mislabelled or not in their original containers in New Zealand over the last 10 years, based on calls to the New Zealand National Poisons Centre (NZNPC). Call data from the NZNPC between 2003 and 2012 were analysed retrospectively. Parameters reviewed included patient age, route and site of exposure, product classification and recommended intervention. Of the 324,411 calls received between 2003 and 2012, 100,465 calls were associated with acute human exposure to chemicals. There were 757 inquiries related to human exposure to mislabelled or unlabelled chemicals consisting of 0.75% of chemical exposures. Adults were involved in 51% of incidents, children, <5 years 32%, 5-10 years 10%, and adolescents 5%. Child exploratory behaviour was responsible for 38% of calls and adult unintentional exposures 61%. Medical attention was advised in 26% of calls. Inadvertent exposure to toxic products stored in unlabelled or mislabelled containers is a problem for all age groups. Although it represents a small proportion of total calls to the NZNPC it remains a potential risk for serious poisoning. It is important that chemicals are stored securely, in their original containers, and never stored in drinking vessels.

Characterizing Golden Eagle risk to lead and anticoagulant rodenticide exposure: A review

USGS Publications Warehouse

Herring, Garth; Eagles-Smith, Collin A.; Buck, Jeremy A.

2017-01-01

Contaminant exposure is among the many threats to Golden Eagle (Aquila chrysaetos) populations throughout North America, particularly lead poisoning and anticoagulant rodenticides (AR). These threats may act in concert with others (e.g., lead poisoning and trauma associated with striking objects) to exacerbate risk. Golden Eagles are skilled hunters but also exploit scavenging opportunities, making them particularly susceptible to contaminant exposure from ingesting tissues of poisoned or shot animals. Lead poisoning has long been recognized as an important source of mortality for Golden Eagles throughout North America. More recently, ARs have been associated with both sublethal and lethal effects in raptor species worldwide. In this review, we examine the current state of knowledge for lead and AR exposure in Golden Eagles, drawing from the broader raptor contaminant ecology literature. We examine lead and AR sources within Golden Eagle habitats, exposure routes and toxicity, effects on individuals and populations, synergistic effects, and data and information needs. Continued research addressing data needs and information gaps will help with Golden Eagle conservation planning.

Epidemiology of organophosphate pesticide poisoning in Taiwan.

PubMed

Lin, Tzeng Jih; Walter, Frank Gardner; Hung, Dong Zong; Tsai, Jin Lian; Hu, Sheng Chuan; Chang, Jung San; Deng, Jou-Fang; Chase, Jung San; Denninghoff, Kurt; Chan, Hon Man

2008-11-01

The nationwide epidemiology of organophosphate pesticide (OP) poisoning has never been reported in detail for Taiwan. This study retrospectively reviewed all human OP exposures reported to Taiwan's Poison Control Centers (PCCs) from July 1985 through December 2006. There were 4799 OP exposures. Most OP exposures were acute (98.37%) ingestions (74.50%) of a single OP (80.37%) to attempt suicide (64.72%) in adults (93.25%). Males were the most common gender (64.95%). Most patients (61.97%) received atropine and/or pralidoxime. The mortality rate for all 4799 OP exposures was 12.71%. Exposures to single OPs without co-intoxicants caused 524 deaths; of these, 63.36% were due to dimethyl OPs. Dimethyl OPs cause the majority of deaths in Taiwan.

Kratom abuse in Ramathibodi Poison Center, Thailand: a five-year experience.

PubMed

Trakulsrichai, Satariya; Tongpo, Achara; Sriapha, Charuwan; Wongvisawakorn, Sunun; Rittilert, Panee; Kaojarern, Sming; Wananukul, Winai

2013-01-01

Kratom (Mitragyna speciosa Korth), a native tree in Southeast Asia, is misused as an abuse drug and becomes legally widespread to several countries. Currently, it is available through the online market or by some shops. The clinical manifestations of Kratom's effects are not well-defined and the clinical studies are limited. This study was designed to identify the characteristics of Kratom poisoning and withdrawal cases from Kratom exposure cases in Ramathibodi Poison Center (RPC), Thailand, during a five-year period. We used a retrospective review of Kratom exposure cases from the RPC toxic surveillance system. A total of 52 Kratom exposure cases were identified. The trend of case consultations has been increasing. There were Kratom poisoning cases (76.9%) and withdrawal cases (23.1%). Common presenting symptoms in the poisoning group were palpitation (22.5%), followed by seizure (17.5%). For the withdrawal group, the common presenting symptoms were myalgia (33.3%), insomnia (16.67%), fatigue (16.67%), and chest discomfort (16.67%). There was a baby with withdrawal symptoms who was delivered from a chronic Kratom-abusing mother, suggesting possible exposure via the transplacental route. There were no deaths in either group. Kratom abuse can cause either poisoning or withdrawal. Most cases in both groups had good prognostic outcome.

Exploring the mango-poison ivy connection: the riddle of discriminative plant dermatitis.

PubMed

Hershko, Klilah; Weinberg, Ido; Ingber, Arieh

2005-01-01

A relationship between sensitivity to poison oak or poison ivy and mango dermatitis has been suggested by previous publications. The observation that acute allergic contact dermatitis can arise on first exposure to mango in patients who have been sensitized beforehand by contact with other urushiol-containing plants has been documented previously. We report 17 American patients employed in mango picking at a summer camp in Israel, who developed a rash of varying severity. All patients were either in contact with poison ivy/oak in the past or lived in areas where these plants are endemic. None recalled previous contact with mango. In contrast, none of their Israeli companions who had never been exposed to poison ivy/oak developed mango dermatitis. These observations suggest that individuals with known history of poison ivy/oak allergy, or those residing in area where these plants are common, may develop allergic contact dermatitis from mango on first exposure. We hypothesize that previous oral exposure to urushiol in the local Israeli population might establish immune tolerance to these plants.

Carbon monoxide exposures in New York City following Hurricane Sandy in 2012.

PubMed

Chen, B C; Shawn, L K; Connors, N J; Wheeler, K; Williams, N; Hoffman, R S; Matte, T D; Smith, S W

2013-11-01

On October 29, 2012, Hurricane Sandy made landfall and devastated New York's metropolitan area, causing widespread damage to homes and the utility infrastructure. Eight days later, snow and freezing temperatures from a nor'easter storm delayed utility restoration. To examine carbon monoxide (CO) exposures in the 2 weeks following Hurricane Sandy. Methods. This was a retrospective review of prospectively collected, standardized, and de-identified data sets. CO exposures and poisonings identified from two electronic surveillance systems, the New York City Poison Control Center (NYCPCC) and New York City's Syndromic Surveillance Unit, were compared with CO exposures from identical dates in 2008-2011. Data collected from the poison center included exposure type, CO source, poisoning type, treatment, and outcomes. Data collected from the Syndromic Surveillance Unit cases, which were identified by CO-related chief complaints presenting to NYC hospitals, included visit date and time, and patient demographics. Four hundred thirty-seven CO exposures were reported to the NYCPCC, 355 from NYC callers, and the remainder from surrounding counties, which represented a significant increase when compared with CO exposures from identical dates in the preceding 4 years (p < 0.001). The total cases that were reported to the NYCPCC in 2008, 2009, 2010, and 2011 were 18, 13, 24, and 61, respectively. Excluding a single apartment fire that occurred (n = 311), the more common sources of CO were grilling indoors (26.2%) and generators (17.5%). Syndromic surveillance captured 70 cases; 6 cases were captured by both data sets. CO exposures following weather-related disasters are a significant public health concern, and the use of fuel-burning equipment is a clear source of storm-related morbidity and mortality. Multiple real-time epidemiologic surveillance tools are useful in estimating the prevalence of CO exposure and poisoning and are necessary to assist public health efforts to prevent CO poisoning during and after disasters.

76 FR 16521 - National Poison Prevention Week, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-23

..., and learn how to respond if a poison emergency should occur. Children are particularly susceptible to unintentional poisoning. More than half of all reported poison exposures involve children under the age of six, and many occur when unsupervised children find and consume medicines or harmful chemicals...

Suspected poisoning of domestic animals by pesticides.

PubMed

Caloni, Francesca; Cortinovis, Cristina; Rivolta, Marina; Davanzo, Franca

2016-01-01

A retrospective study was carried out by reviewing all suspected cases of domestic animal poisoning attributed to pesticides, reported to the Milan Poison Control Centre (MPCC) between January 2011 and December 2013. During this period, pesticides were found to be responsible for 37.3% of all suspected poisoning enquiries received (815). The most commonly species involved was the dog (71.1% of calls) followed by the cat (15.8%), while a limited number of cases involved horses, goats and sheep. Most cases of exposure (47.1%) resulted in mild to moderate clinical signs. The outcome was reported in 59.9% of these cases, with death occurring in 10.4% of them. Insecticides (40.8%) proved to be the most common group of pesticides involved and exposure to pyrethrins-pyrethroids accounted for the majority of calls. According to the MPCC data, there has been a decrease in the number of suspected poisonings cases attributed to pesticides that have been banned by the EU, including aldicarb, carbofuran, endosulfan and paraquat. In contrast, there has been an increase of suspected poisoning cases attributed to the neonicotinoids, imidacloprid and acetamiprid, probably due to their widespread use in recent years. Cases of suspected poisoning that involved exposure to rodenticides accounted for 27.6% of calls received by the MPCC and anticoagulant rodenticides were the primary cause of calls, with many cases involving brodifacoum and bromadiolone. Herbicides were involved in 14.2% of calls related to pesticides and glyphosate was the main culprit in cases involving dogs, cats, horses, goats and sheep. As far as exposure to molluscicides (11.5%) and fungicides (5.9%), most of the cases involved dogs and the suspected poisoning agents were metaldehyde and copper compounds respectively. The data collected are useful in determining trends in poisoning episodes and identifying newly emerging toxicants, thus demonstrating the prevalence of pesticides as causative agents in animal poisonings. Copyright © 2015 Elsevier B.V. All rights reserved.

Hyperbaric oxygen therapy for carbon monoxide poisoning.

PubMed

Weaver, Lindell K

2014-01-01

Despite established exposure limits and safety standards, and the availability of carbon monoxide (CO) alarms, each year 50,000 people in the United States visit emergency departments for CO poisoning. Carbon monoxide poisoning can occur from brief exposures to high levels of CO, or from longer exposures to lower levels. Common symptoms include headaches, nausea and vomiting, dizziness, general malaise, and altered mental status. Some patients may have chest pain, shortness of breath and myocardial ischemia, and may require mechanical ventilation and treatment of shock. Individuals poisoned by CO often go on to develop neurological problems, including cognitive sequelae, anxiety and depression, persistent headaches, dizziness, sleep problems, motor weakness, vestibular and balance problems, gaze abnormalities, peripheral neuropathies, hearing loss, tinnitus and Parkinsonian-like syndrome. While breathing oxygen hastens the removal of carboxyhemoglobin (COHb), hyperbaric oxygen (HBO2) hastens COHb elimination and favorably modulates inflammatory processes instigated by CO poisoning, an effect not observed with breathing normobaric oxygen. Hyperbaric oxygen improves mitochondrial function, inhibits lipid peroxidation transiently, impairs leukocyte adhesion to injured microvasculature, and reduces brain inflammation caused by the CO-induced adduct formation of myelin basic protein. Based upon three supportive randomized clinical trials in humans and considerable evidence from animal studies, HBO2 should be considered for all cases of acute symptomatic CO poisoning. Hyperbaric oxygen is indicated for CO poisoning complicated by cyanide poisoning, often concomitantly with smoke inhalation.

Harmful Algal Blooms and Public Health.

PubMed

Grattan, Lynn M; Holobaugh, Sailor; Morris, J Glenn

2016-07-01

The five most commonly recognized Harmful Algal Bloom related illnesses include Ciguatera poisoning, Paralytic Shellfish poisoning, Neurotoxin Shellfish poisoning, Diarrheic Shellfish Poisoning and Amnesic Shellfish poisoning. Although they are each the product of different toxins, toxin assemblages or HAB precursors these clinical syndromes have much in common. Exposure occurs through the consumption of fish or shellfish; routine clinical tests are not available for diagnosis; there is no known antidote for exposure; and the risk of these illnesses can negatively impact local fishing and tourism industries. Thus, illness prevention is of paramount importance to minimize human and public health risks. To accomplish this, close communication and collaboration is needed among HAB scientists, public health researchers and local, state and tribal health departments at academic, community outreach, and policy levels.

3 CFR 8484 - Proclamation 8484 of March 15, 2010. National Poison Prevention Week, 2010

Code of Federal Regulations, 2011 CFR

2011-01-01

..., childhood death rates from unintentional poisonings have fallen considerably. However, adult death rates... senseless injuries and deaths. With nearly two million poison exposures reported each year, we must take...

Pick your poison: what's new in poison control for the preschooler.

PubMed

Glenn, Lauren

2015-01-01

Accidental childhood poisonings are a major public health concern despite many efforts to alleviate this problem. While the rate of pediatric fatalities due to poisonings have decreased over the last two decades, poison control centers around the US have collectively fielded over one million calls with regard to toxic exposures in the preschool age group. According to the American Association of Poison Control Centers nearly half of all human exposures reported last year involved children under six. By focusing poison prevention efforts on the preschooler, we can attempt to decrease morbidity and mortality in the most vulnerable age group affected. Although the subject is still prevalent, current discussion on this topic is limited. Newer literature discusses past initiatives such as child resistant packaging and sticker deterrent programs and addresses their efficacy. This article revisits older mechanisms of prevention as well as the science behind the human motivation to change one's own practice and behavior. Copyright © 2015 Elsevier Inc. All rights reserved.

Case definitions for human poisonings postulated to palytoxins exposure.

PubMed

Tubaro, A; Durando, P; Del Favero, G; Ansaldi, F; Icardi, G; Deeds, J R; Sosa, S

2011-03-01

A series of case reports and anecdotal references describe the adverse effects on human health ascribed to the marine toxin palytoxin (PLTX) after different exposure routes. They include poisonings after oral intake of contaminated seafood, but also inhalation and cutaneous/systemic exposures after direct contact with aerosolized seawater during Ostreopsis blooms and/or through maintaining aquaria containing cnidarian zoanthids. The symptoms commonly recorded during PLTX intoxication are general malaise and weakness, associated with myalgia, respiratory effects, impairment of the neuromuscular apparatus and abnormalities in cardiac function. Systemic symptoms are often recorded together with local damages whose intensity varies according to the route and length of exposure. Gastrointestinal malaise or respiratory distress is common for oral and inhalational exposure, respectively. In addition, irritant properties of PLTX probably account for the inflammatory reactions typical of cutaneous and inhalational contact. Unfortunately, the toxin identification and/or quantification are often incomplete or missing and cases of poisoning are indirectly ascribed to PLTXs, according only to symptoms, anamnesis and environmental/epidemiological investigations (i.e. zoanthid handling or ingestion of particular seafood). Based on the available literature, we suggest a "case definition of PLTX poisonings" according to the main exposure routes, and, we propose the main symptoms to be checked, as well as, hemato-clinical analysis to be carried out. We also suggest the performance of specific analyses both on biological specimens of patients, as well as, on the contaminated materials responsible for the poisoning. A standardized protocol for data collection could provide a more rapid and reliable diagnosis of palytoxin-poisoning, but also the collection of necessary data for the risk assessment for this family of toxins. Copyright © 2011 Elsevier Ltd. All rights reserved.

Get the Lead Out: Facts about Childhood Lead Poisoning [and] Housekeeping Tips To Reduce Lead Exposure [and] Nutrition and Lead Poisoning [and] The Medical Consequences of Lead Poisoning [and] Lead Poisoning for Health Care Providers.

ERIC Educational Resources Information Center

Illinois State Dept. of Public Health, Springfield.

This document is comprised of five fact sheets from the Illinois Department of Public Health regarding childhood lead poisoning. Recent studies claim that childhood lead poisoning can contribute to problems later in life, such as academic failure, juvenile delinquency, and high blood pressure. Directed to parents, caregivers, and health care…

3 CFR 8352 - Proclamation 8352 of March 13, 2009. National Poison Prevention Week, 2009

Code of Federal Regulations, 2010 CFR

2010-01-01

... children and adults alike, as both remain susceptible to poison exposure. According to the American... children aged five and under. The AAPCC also reports that more than one thousand deaths due to poisoning take place in the United States every year. Poisoning most frequently involves medicines and typical...

Pesticide poisoning in Zhejiang, China: a retrospective analysis of adult cases registration by occupational disease surveillance and reporting systems from 2006 to 2010.

PubMed

Zhang, Meibian; Fang, Xinglin; Zhou, Lifang; Su, Liling; Zheng, Jiajia; Jin, Minjuan; Zou, Hua; Chen, Guangdi

2013-11-21

Despite the rapid industrialisation and urbanisation over the past 30 years, agriculture is one of the largest economic sectors in China and the unregulated use of pesticides result in extensive pesticide poisoning. The objective of this study was to analyse pesticide poisoning cases registration received by Zhejiang Provincial Center for Disease Control and Prevention, China. Register-based study. Cases registered regarding pesticide poisoning. Data were obtained from the Occupational Disease Surveillance and Reporting Systems in Zhejiang province from 2006 to 2010, which contains anonymous records representing general population of Zhejiang province, China. All cases registered as pesticide poisoning were identified. Monthly and age-group pesticide poisoning death rates were calculated. A total of 20 097 pesticide poisoning cases with 1413 deaths were recorded during the study period. There were 10 513 male pesticide poisoning cases with 782 deaths, and 9584 females with 631 deaths. Pesticide poisoning occurred mostly in non-occupational exposure (79.86%), in which the majority (85.77%) of the cases was of intentional pesticide poisoning. The occupational exposure was most common in men during the farming season. The death rate increased stepwise with age, and the pesticide suicide rate was higher in the older age group. Pesticide poisoning remains a major health problem in China, and further recommendations to reduce the pesticide poisoning are required.

Childhood lead poisoning from commercially manufactured French ceramic dinnerware--New York City, 2003.

PubMed

2004-07-09

Lead poisoning adversely affects children worldwide. During 1999-2000, an estimated 434,000 children aged 1-5 years in the United States had elevated blood lead levels (BLLs) >/=10 microg/dL. Glazes found on ceramics, earthenware, bone china, and porcelain often contain lead and are a potential source of lead exposure. Children are especially vulnerable to the neurotoxic effects of lead. Exposures to lead in early childhood can have adverse effects on the developing nervous system, resulting in decreased intelligence and changes in behavior. In addition, certain behaviors (e.g., thumb sucking) place children at greater risk for exposure to lead. In 2003, the New York City Department of Health and Mental Hygiene's Lead Poisoning Prevention Program (LPPP), and the Mount Sinai Pediatric Environmental Health Specialty Unit (PEHSU) investigated a case of lead poisoning in a boy aged 20 months. This report summarizes that case investigation, which identified ceramic dinnerware imported from France as the source of lead exposure. This case underscores the susceptibility of children to a toxic exposure associated with 1) the high proportion of time spent in the home and 2) dietary habits that promote exposure to lead leached from ceramic ware.

Agricultural and horticultural chemical poisonings: mortality and morbidity in the United States.

PubMed

Klein-Schwartz, W; Smith, G S

1997-02-01

To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States. Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990. There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%). Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature.

Exposure to organophosphate (OP) pesticides and health conditions in agricultural and non-agricultural workers from Maule, Chile

PubMed Central

Muñoz-Quezada, María Teresa; Lucero, Boris; Iglesias, Verónica; Levy, Karen; Muñoz, María Pía; Achú, Eduardo; Cornejo, Claudia; Concha, Carlos; Brito, Ana María; Villalobos, Marcos

2017-01-01

The objective was to evaluate the characteristics of exposure to OP pesticides and health status in Chilean farm workers from the Maule Region. An occupational health questionnaire was administered in 207 agricultural and non-agricultural workers. For the group of agricultural workers we asked about specific occupational exposure history and symptoms of OP pesticide poisoning. The main health problem of the exposed group was previous OP pesticide poisoning (p <0.001). Fifty-six percent of agricultural workers reported symptoms consistent with acute OP pesticide poisoning. The use of respiratory personal protective equipment and younger age were protective against these symptoms, and number of years of OP pesticide exposure was positively associated with reporting symptoms of poisoning. Of the pesticide applicators 47% reported using chlorpyrifos. The regulations regarding use and application of pesticides should be strengthened, as should training and intervention with workers to improve the use of personal protective equipment. PMID:28002976

Exposure to organophosphate (OP) pesticides and health conditions in agricultural and non-agricultural workers from Maule, Chile.

PubMed

Muñoz-Quezada, María Teresa; Lucero, Boris; Iglesias, Verónica; Levy, Karen; Muñoz, María Pía; Achú, Eduardo; Cornejo, Claudia; Concha, Carlos; Brito, Ana María; Villalobos, Marcos

2017-02-01

The objective was to evaluate the characteristics of exposure to OP pesticides and health status in Chilean farm workers from the Maule Region. An occupational health questionnaire was administered in 207 agricultural and non-agricultural workers. For the group of agricultural workers, we asked about specific occupational exposure history and symptoms of OP pesticide poisoning. The main health problem of the exposed group was previous OP pesticide poisoning (p < 0.001). Fifty-six percent of agricultural workers reported symptoms consistent with acute OP pesticide poisoning. The use of respiratory personal protective equipment and younger age were protective against these symptoms, and number of years of OP pesticide exposure was positively associated with reporting symptoms of poisoning. Of the pesticide applicators 47 % reported using chlorpyrifos. The regulations regarding use and application of pesticides should be strengthened, as should training and intervention with workers to improve the use of personal protective equipment.

Silent latency periods in methylmercury poisoning and in neurodegenerative disease.

PubMed

Weiss, Bernard; Clarkson, Thomas W; Simon, William

2002-10-01

This article discusses three examples of delay (latency) in the appearance of signs and symptoms of poisoning after exposure to methylmercury. First, a case is presented of a 150-day delay period before the clinical manifestations of brain damage after a single brief (<1 day) exposure to dimethylmercury. The second example is taken from the Iraq outbreak of methylmercury poisoning in which the victims consumed contaminated bread for several weeks without any ill effects. Indeed, signs of poisoning did not appear until weeks or months after exposure stopped. The last example is drawn from observations on nonhuman primates and from the sequelae of the Minamata, Japan, outbreak in which low chronic doses of methylmercury may not have produced observable behavioral effects for periods of time measured in years. The mechanisms of these latency periods are discussed for both acute and chronic exposures. Parallels are drawn with other diseases that affect the central nervous system, such as Parkinson disease and post-polio syndrome, that also reflect the delayed appearance of central nervous system damage.

Lead toxicity in battery workers.

PubMed

Qasim, Saeeda Fouzia; Baloch, Malka

2014-11-01

Lead poisoning is a medical condition caused by increased levels of lead in the body. Routes of exposure include contaminated air, water, soil, food and consumer products. Occupational exposure is the main cause of lead poisoning in the adults. Two cases of occupational lead poisoning in adult battery workers are hereby presented. Both male patients had initial non-specific symptoms of intermittent abdominal pain, fatigue and headache for 6 - 8 years. Later on, they developed psychosis, slurred speech, tremors of hands and initially underwent treatment for Parkinsonism and Wilson's disease because of clinical misdiagnosis. They were diagnosed with lead poisoning later and were treated successfully with lead chelator (CaNa2 EDTA).

Parenteral organophosphorus poisoning in a rural emergency department: a case report

PubMed Central

2013-01-01

Background Poisoning is a common presentation in the emergency department. Oral exposures to organophosphorus compounds are especially frequent in rural and agricultural regions of South Asia and throughout the developing world. Case presentation Here we report a case of deliberate self-harm with an organophosphorus pesticide via the relatively uncommon parenteral route. A young woman injected herself with chlorpyriphos. Although the cholinergic effects were mild, cellulitis and abscess development were noted as a result. Conclusion Resource limited agricultural countries like Nepal present health care workers with numerous challenges in poisoning management. This case represents a rare but potentially morbid method of agrochemical poison exposure. PMID:24321121

Childhood lead poisoning and the new Centers for Disease Control and Prevention guidelines for lead exposure.

PubMed

Schnur, Julie; John, Rita Marie

2014-05-01

This article will give a brief history, review the latest guidelines, discuss risk factors and sources, and discuss screening, diagnosis, and management of lead poisoning in children. Additionally, the role of the nurse practitioner (NP) caring for children will be reviewed. Review of published literature on lead poisoning and the 2012 lead prevention guidelines of the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) of the Centers for Disease Control and Prevention (CDC). While lead poisoning levels have decreased over the past several decades, newer research has shown that even low levels of lead in the blood can have negative effects on children's intelligence and neurodevelopment. As a result, ACCLPP of the CDC issued new, stricter lead prevention guidelines in 2012. Lead exposure and lead poisoning are pediatric public health risks. Studies have shown that no level of lead is considered safe, and the emphasis has shifted to primary prevention of lead exposure. Despite the focus on primary prevention, the NP must remain vigilant in history taking, exploring risk factors, and screening children in order to assure the best possible outcome. ©2014 The Author(s) ©2014 American Association of Nurse Practitioners.

Harmful Algal Blooms and Public Health

PubMed Central

Grattan, Lynn M.; Holobaugh, Sailor; Morris, J. Glenn

2015-01-01

The five most commonly recognized Harmful Algal Bloom related illnesses include Ciguatera poisoning, Paralytic Shellfish poisoning, Neurotoxin Shellfish poisoning, Diarrheic Shellfish Poisoning and Amnesic Shellfish poisoning. Although they are each the product of different toxins, toxin assemblages or HAB precursors these clinical syndromes have much in common. Exposure occurs through the consumption of fish or shellfish; routine clinical tests are not available for diagnosis; there is no known antidote for exposure; and the risk of these illnesses can negatively impact local fishing and tourism industries. Thus, illness prevention is of paramount importance to minimize human and public health risks. To accomplish this, close communication and collaboration is needed among HAB scientists, public health researchers and local, state and tribal health departments at academic, community outreach, and policy levels. PMID:27616971

Selectivity and resistance to poisons of commercial hydrogen sensors

DOE PAGES

Palmisano, V.; Weidner, E.; Boon-Brett, L.; ...

2015-03-20

The resistance of several models of catalytic, workfunction-based metal-oxide-semiconductor and electrochemical hydrogen sensors to chemical contaminants such as SO 2, H 2S, NO 2 and hexamethyldisiloxane (HMDS) has been investigated. These sensor platforms are among the most commonly used for the detection of hydrogen. The evaluation protocols were based on the methods recommended in the ISO 26142:2010 standard. Permanent alteration of the sensor response to the target analyte (H 2) following exposure to potential poisons at the concentrations specified in ISO 26142 was rarely observed. Although a shift in the baseline response was often observed during exposure to the potentialmore » poisons, only in a few cases did this shift persist after removal of the contaminants. Overall, the resistance of the sensors to poisoning was good. However, a change in sensitivity to hydrogen was observed in the electrochemical platform after exposure to NO 2 and for a catalytic sensor during exposure to SO 2. The siloxane resistance test prescribed in ISO 26142, based on exposure to 10 ppm HMDS, may possibly not properly reflect sensor robustness to siloxanes. In conclusion, further evaluation of the resistance of sensors to other Si-based contaminants and other exposure profiles (e.g., concentration, exposure times) is needed.« less

Pregnancy outcome after risk assessment of occupational exposure to organic solvents: a prospective cohort study.

PubMed

Testud, François; D'Amico, Andrea; Lambert-Chhum, Rachel; Garayt, Christelle; Descotes, Jacques

2010-11-01

A rational medical, occupational and toxicological approach is instrumental to select objectively among pregnant women exposed to chemicals at the workplace those who should be withdrawn or benefit from improvements of working conditions. Risk assessment is based on a comprehensive review of compounds' hazards and a thorough evaluation of the actual exposure including biomonitoring whenever as possible. Since 1996, the Lyon Poison Center has been conducting a prospective follow-up of pregnant women exposed to chemicals at the workplace. Of these, 206 exposed to organic solvents since conception were selected and matched with 206 exposed to a non-embryotoxic agent. Total withdrawal from the workplace was recommended in 22% of cases, but exposure was not considered to be hazardous to pregnancy in 51%. Overall, no increase in adverse outcomes was found. Maintaining pregnant women at their workplace, particularly most of the laboratory technicians, is reasonably possible after careful toxicological risk assessment. Copyright © 2010 Elsevier Inc. All rights reserved.

Seeding materials: Health and safety considerations

NASA Technical Reports Server (NTRS)

Brown, R. D.

1985-01-01

The choice of a proper seeding material for laser velocimeters must include health and safety considerations. Failure to do so can lead to catastrophic results. All materials are toxic, and laser velocimeter seeding materials are no exception. Toxicity may be considered an inherent property of a given material. The manifestation of that property or the physiological response to the material is dependent on dose and exposure conditions. An approximate physiological classification of toxicity is given in tablular form. Toxicity in some situations is not necessarily the most restrictive factor in selection of materials. It is also very important to consider how the material is used so that actual exposure to the material in a damaging form can result. For example, nickel and cadmium are both extremely toxic as systemic poisons and in the case of nickel as a carcinogen. Seeding materials are dispersed in air under conditions that favor personnel exposure. Dispersal equipment is frequently if not normally manned, and personnel are often required to make frequent adjustments to assure proper operations.

Common causes of poisoning: etiology, diagnosis and treatment.

PubMed

Müller, Dieter; Desel, Herbert

2013-10-01

In 2011, German hospitals treated approximately 205 000 patients suffering from acute poisoning. Change is seen over time both in the types of poisoning that occur and in the indications for specific treatment. This article is based on a selective review of the literature, with special attention to the health reports of the German federal government, the annual reports of the GIZ-Nord Poisons Center (the poison information center for the four northwestern states of Germany, i.e. Bremen, Hamburg, Lower Saxony and Schleswig-Holstein), and the recommendations of international medical associations. From 1996 to 2011, the GIZ-Nord Poisons Center answered more than 450 000 inquiries, most of which involved exposures to medical drugs, chemicals, plants, foods, or cosmetics. Poisoning was clinically manifest in only a fraction of these cases. Ethanol intoxication is the commonest type of acute poisoning and suicide by medical drug overdose is the commonest type of suicide by poisoning. Death from acute poisoning is most commonly the result of either smoke inhalation or illegal drug use. Severe poisoning is only rarely due to the ingestion of chemicals (particularly detergents and cleaning products), cosmetics, or plant matter. Medical procedures that are intended to reduce the absorption of a poison or enhance its elimination are now only rarely indicated. Antidotes (e.g., atropine, 4-dimethylaminophenol, naloxone, toluidine blue) are available for only a few kinds of poisoning. Randomized clinical trials of treatment have been carried out for only a few substances. Most exposures to poisons can be treated with general emergency care and, if necessary, with symptomatic intensive-care measures. Poison information centers help ensure that cases of poisoning are dealt with efficiently. The data they collect are a useful aid to toxicological assessment and can serve as a point of departure for research projects.

Characterization of Animal Exposure Calls Captured by the National Poison Data System, 2000–2010

PubMed Central

Buttke, Danielle E.; Schier, Joshua G.; Bronstein, Alvin C.; Chang, Arthur

2015-01-01

Objective Our objective was to characterize the data captured in all animal exposure calls reported to the National Poison Data System (NPDS), a national poison center reporting database, from 1 January 2000 through 31 December 2010 and identify Poison Center usage and needs in animal exposure calls. Design We calculated descriptive statistics characterizing animal type, exposure substance, medical outcome, year and month of call, caller location, and specific state for all animal exposure call data in NPDS from 1 January 2000 to 31 December 2010. SAS version 9.2 was used for the analysis. Results There were 1,371,095 animal exposure calls out of 28,925,496 (4.7%) total human and animal exposure calls in NPDS during the study period. The majority involved companion animal exposures with 88.0% canine exposures and 10.4% feline exposures. Pesticides were the most common exposure substance (n=360,375; 26.3%), followed by prescription drugs (n=261,543; 18.6%). The most common outcome reported was ‘Not followed, judged as nontoxic exposure or minimal clinical effects possible’ (n=803,491; 58.6%), followed by ‘Not followed, judged potentially toxic exposure’ (n=263,153; 19.2%). There were 5,388 deaths reported. Pesticide exposures were responsible for the greatest number of deaths (n=1,643; 30.4%). Conclusions and clinical relevance Approximately 1 in 20 calls to PCs are regarding potentially toxic exposures to animals, suggesting a need for veterinary expertise and resources at PCs. Pesticides are one of the greatest toxic exposure threats to animals, both in numbers of exposures and severity of clinical outcomes, and is an important area for education, prevention, and treatment. PMID:26346434

Malicious Use of Nonpharmaceuticals in Children

ERIC Educational Resources Information Center

Yin, Shan

2011-01-01

Objective: The objective of this study was to describe malicious nonpharmaceutical exposures in children reported to US poison centers. Methods: We performed a retrospective study of all nonpharmaceutical exposures involving children 7 years old reported to the US National Poison Data System (NPDS) from 2000 to 2008 for which the reason for…

The Toxic Exposure Surveillance System (TESS): Risk assessment and real-time toxicovigilance across United States poison centers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Watson, William A.; Litovitz, Toby L.; Belson, Martin G.

2005-09-01

The Toxic Exposure Surveillance System (TESS) is a uniform data set of US poison centers cases. Categories of information include the patient, the caller, the exposure, the substance(s), clinical toxicity, treatment, and medical outcome. The TESS database was initiated in 1985, and provides a baseline of more than 36.2 million cases through 2003. The database has been utilized for a number of safety evaluations. Consideration of the strengths and limitations of TESS data must be incorporated into data interpretation. Real-time toxicovigilance was initiated in 2003 with continuous uploading of new cases from all poison centers to a central database. Real-timemore » toxicovigilance utilizing general and specific approaches is systematically run against TESS, further increasing the potential utility of poison center experiences as a means of early identification of potential public health threats.« less

Poisoning: fact or fiction?

PubMed

Flanagan, Robert J

2012-01-01

Analytical toxicology is a complex discipline. Simply detecting a poison in a biological sample does not necessarily mean that the individual from whom the sample was obtained had been poisoned. An analysis can prove exposure and perhaps give an indication of the magnitude of exposure, but the results have to be placed in proper context. Even if sampling was ante-mortem an analysis does not necessarily prove the effects that the drug or poison had on the victim immediately before or at the time of sampling. Tolerance is one big issue, the mechanism of exposure (how the drug got into the body) is another, and of course with post-mortem work there are always additional considerations such as site of sample collection and the possibility of post-mortem change in analyte concentration. There are also questions of quality and reliability, and whether a particular analysis and the interpretation placed upon the result are appropriate in a particular case.

Pesticide poisoning in Zhejiang, China: a retrospective analysis of adult cases registration by occupational disease surveillance and reporting systems from 2006 to 2010

PubMed Central

Zhang, Meibian; Fang, Xinglin; Zhou, Lifang; Su, Liling; Zheng, Jiajia; Jin, Minjuan; Zou, Hua; Chen, Guangdi

2013-01-01

Objective Despite the rapid industrialisation and urbanisation over the past 30 years, agriculture is one of the largest economic sectors in China and the unregulated use of pesticides result in extensive pesticide poisoning. The objective of this study was to analyse pesticide poisoning cases registration received by Zhejiang Provincial Center for Disease Control and Prevention, China. Design Register-based study. Setting Cases registered regarding pesticide poisoning. Data were obtained from the Occupational Disease Surveillance and Reporting Systems in Zhejiang province from 2006 to 2010, which contains anonymous records representing general population of Zhejiang province, China. Participants All cases registered as pesticide poisoning were identified. Primary outcome Monthly and age-group pesticide poisoning death rates were calculated. Results A total of 20 097 pesticide poisoning cases with 1413 deaths were recorded during the study period. There were 10 513 male pesticide poisoning cases with 782 deaths, and 9584 females with 631 deaths. Pesticide poisoning occurred mostly in non-occupational exposure (79.86%), in which the majority (85.77%) of the cases was of intentional pesticide poisoning. The occupational exposure was most common in men during the farming season. The death rate increased stepwise with age, and the pesticide suicide rate was higher in the older age group. Conclusions Pesticide poisoning remains a major health problem in China, and further recommendations to reduce the pesticide poisoning are required. PMID:24270833

Lead poisoning in automobile radiator mechanics.

PubMed

Goldman, R H; Baker, E L; Hannan, M; Kamerow, D B

1987-07-23

Exposure to lead occurs during automobile radiator repair when soldered joints are heated, but this relatively common hazard has received little public recognition. We therefore studied lead exposure among automobile radiator mechanics in the Boston area. Twenty-seven shops were surveyed, and most were found to be small and poorly ventilated. Seventy-five workers were interviewed and tested for blood lead and free erythrocyte protoporphyrin levels. Fifty-six of the 75 actually repaired radiators, and they had a mean blood lead level of 37.1 micrograms per deciliter (range, 16 to 73). Thirty-nine percent of these mechanics had levels higher than 40 micrograms per deciliter; hematologic, neurologic, and renal effects are known to develop at or above this blood lead level. Multiple regression analysis showed that the number of radiator repair work stations (an index of exposure) was the variable most significantly associated with increased blood lead levels. We conclude that excessive exposure to lead occurs frequently among radiator repair workers and should be prevented by improved ventilation, engineering controls, and the use of respirators (if indicated) while working.

Biomarkers, lactate, and clinical scores as outcome predictors in systemic poisons exposures.

PubMed

Lionte, C; Sorodoc, V; Tuchilus, C; Cimpoiesu, D; Jaba, E

2017-07-01

Acute exposure to systemic poisons represents an important challenge in clinical toxicology. We aimed to analyze the potential role of cardiac biomarkers, routine laboratory tests, and clinical scores as morbidity and in-hospital mortality predictors in patients intoxicated with various systemic poisons. We conducted a prospective study on adults acutely exposed to systemic poisons. We determined the PSS, Glasgow Coma Scale (GCS), and we performed electrocardiogram, laboratory tests, lactate and cardiac biomarkers (which were reassessed 4 h, respectively 6 h later). Of 120 patients included, 45% developed complications, 19.2% had a poor outcome, and 5% died. Multivariate logistic regression sustained lactate (odds ratio (OR) 1.58; confidence interval (CI) 95%: 0.97-2.59; p 0.066), MB isoenzyme of creatine kinase (6h-CKMB; OR 1.08; CI 95%: 1.02-1.16; p 0.018) as predictors for a poor outcome. A GCS < 10 (OR 0.113; CI 95%: 0.019-0.658; p 0.015) and 4h-lactate (OR 4.87; CI 95%: 0.79-29.82; p 0.087) predicted mortality after systemic poisons exposure. Receiver operating characteristic analysis showed that brain natriuretic peptide (area under the curve (AUC), 0.96; CI 95%: 0.92-0.99; p < 0.001), lactate (AUC, 0.91; CI 95%: 0.85-0.97; p < 0.001), and 6h-CKMB have good discriminatory capacity for predicting a poor outcome. In conclusion, these biomarkers, lactate, and GCS can be used to predict morbidity and mortality after systemic poisons exposure.

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

PubMed

Pelissier, Fanny; de Haro, Luc; Cardona, Florence; Picot, Cyndie; Puskarczyk, Emmanuel; Sapori, Jean-Marc; Tournoud, Christine; Franchitto, Nicolas

2017-04-01

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. 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. 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. 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.

Linking geological and health sciences to assess childhood lead poisoning from artisanal gold mining in Nigeria.

PubMed

Plumlee, Geoffrey S; Durant, James T; Morman, Suzette A; Neri, Antonio; Wolf, Ruth E; Dooyema, Carrie A; Hageman, Philip L; Lowers, Heather A; Fernette, Gregory L; Meeker, Gregory P; Benzel, William M; Driscoll, Rhonda L; Berry, Cyrus J; Crock, James G; Goldstein, Harland L; Adams, Monique; Bartrem, Casey L; Tirima, Simba; Behbod, Behrooz; von Lindern, Ian; Brown, Mary Jean

2013-06-01

In 2010, Médecins Sans Frontières discovered a lead poisoning outbreak linked to artisanal gold processing in northwestern Nigeria. The outbreak has killed approximately 400 young children and affected thousands more. Our aim was to undertake an interdisciplinary geological- and health-science assessment to clarify lead sources and exposure pathways, identify additional toxicants of concern and populations at risk, and examine potential for similar lead poisoning globally. We applied diverse analytical methods to ore samples, soil and sweep samples from villages and family compounds, and plant foodstuff samples. Natural weathering of lead-rich gold ores before mining formed abundant, highly gastric-bioaccessible lead carbonates. The same fingerprint of lead minerals found in all sample types confirms that ore processing caused extreme contamination, with up to 185,000 ppm lead in soils/sweep samples and up to 145 ppm lead in plant foodstuffs. Incidental ingestion of soils via hand-to-mouth transmission and of dusts cleared from the respiratory tract is the dominant exposure pathway. Consumption of water and foodstuffs contaminated by the processing is likely lesser, but these are still significant exposure pathways. Although young children suffered the most immediate and severe consequences, results indicate that older children, adult workers, pregnant women, and breastfed infants are also at risk for lead poisoning. Mercury, arsenic, manganese, antimony, and crystalline silica exposures pose additional health threats. Results inform ongoing efforts in Nigeria to assess lead contamination and poisoning, treat victims, mitigate exposures, and remediate contamination. Ore deposit geology, pre-mining weathering, and burgeoning artisanal mining may combine to cause similar lead poisoning disasters elsewhere globally.

Linking Geological and Health Sciences to Assess Childhood Lead Poisoning from Artisanal Gold Mining in Nigeria

PubMed Central

Durant, James T.; Morman, Suzette A.; Neri, Antonio; Wolf, Ruth E.; Dooyema, Carrie A.; Hageman, Philip L.; Lowers, Heather A.; Fernette, Gregory L.; Meeker, Gregory P.; Benzel, William M.; Driscoll, Rhonda L.; Berry, Cyrus J.; Crock, James G.; Goldstein, Harland L.; Adams, Monique; Bartrem, Casey L.; Tirima, Simba; Behbod, Behrooz; von Lindern, Ian; Brown, Mary Jean

2013-01-01

Background: In 2010, Médecins Sans Frontières discovered a lead poisoning outbreak linked to artisanal gold processing in northwestern Nigeria. The outbreak has killed approximately 400 young children and affected thousands more. Objectives: Our aim was to undertake an interdisciplinary geological- and health-science assessment to clarify lead sources and exposure pathways, identify additional toxicants of concern and populations at risk, and examine potential for similar lead poisoning globally. Methods: We applied diverse analytical methods to ore samples, soil and sweep samples from villages and family compounds, and plant foodstuff samples. Results: Natural weathering of lead-rich gold ores before mining formed abundant, highly gastric-bioaccessible lead carbonates. The same fingerprint of lead minerals found in all sample types confirms that ore processing caused extreme contamination, with up to 185,000 ppm lead in soils/sweep samples and up to 145 ppm lead in plant foodstuffs. Incidental ingestion of soils via hand-to-mouth transmission and of dusts cleared from the respiratory tract is the dominant exposure pathway. Consumption of water and foodstuffs contaminated by the processing is likely lesser, but these are still significant exposure pathways. Although young children suffered the most immediate and severe consequences, results indicate that older children, adult workers, pregnant women, and breastfed infants are also at risk for lead poisoning. Mercury, arsenic, manganese, antimony, and crystalline silica exposures pose additional health threats. Conclusions: Results inform ongoing efforts in Nigeria to assess lead contamination and poisoning, treat victims, mitigate exposures, and remediate contamination. Ore deposit geology, pre-mining weathering, and burgeoning artisanal mining may combine to cause similar lead poisoning disasters elsewhere globally. PMID:23524139

Linking geology and health sciences to assess childhood lead poisoning from artisanal gold mining in Nigeria

USGS Publications Warehouse

Plumlee, Geoffrey S.; Durant, James T.; Morman, Suzette A.; Neri, Antonio; Wolf, Ruth E.; Dooyema, Carrie A.; Hageman, Philip L.; Lowers, Heather; Fernette, Gregory L.; Meeker, Gregory P.; Benzel, William M.; Driscoll, Rhonda L.; Berry, Cyrus J.; Crock, James G.; Goldstein, Harland L.; Adams, Monique; Bartrem, Casey L.; Tirima, Simba; Behrooz, Behbod; von Lindern, Ian; Brown, Mary Jean

2013-01-01

Background: In 2010, Médecins Sans Frontières discovered a lead poisoning outbreak linked to artisanal gold processing in northwestern Nigeria. The outbreak has killed approximately 400 young children and affected thousands more. Objectives: Our aim was to undertake an interdisciplinary geological- and health-science assessment to clarify lead sources and exposure pathways, identify additional toxicants of concern and populations at risk, and examine potential for similar lead poisoning globally. Methods: We applied diverse analytical methods to ore samples, soil and sweep samples from villages and family compounds, and plant foodstuff samples. Results: Natural weathering of lead-rich gold ores before mining formed abundant, highly gastric-bioaccessible lead carbonates. The same fingerprint of lead minerals found in all sample types confirms that ore processing caused extreme contamination, with up to 185,000 ppm lead in soils/sweep samples and up to 145 ppm lead in plant foodstuffs. Incidental ingestion of soils via hand-to-mouth transmission and of dusts cleared from the respiratory tract is the dominant exposure pathway. Consumption of water and foodstuffs contaminated by the processing is likely lesser, but these are still significant exposure pathways. Although young children suffered the most immediate and severe consequences, results indicate that older children, adult workers, pregnant women, and breastfed infants are also at risk for lead poisoning. Mercury, arsenic, manganese, antimony, and crystalline silica exposures pose additional health threats. Conclusions: Results inform ongoing efforts in Nigeria to assess lead contamination and poisoning, treat victims, mitigate exposures, and remediate contamination. Ore deposit geology, pre-mining weathering, and burgeoning artisanal mining may combine to cause similar lead poisoning disasters elsewhere globally.

Long-term lead elimination from plasma and whole blood after poisoning.

PubMed

Rentschler, Gerda; Broberg, K; Lundh, T; Skerfving, S

2012-04-01

Blood lead (B-Pb), one of the most used toxicological biomarker all kind, has serious limitations. Thus, the objective is to evaluate whether plasma lead (P-Pb) is more adequate. A long-term follow-up study of five cases of lead poisoning. P-Pb was analysed by inductively coupled plasma mass spectrometry. Kinetics after end of exposure was modelled. P-Pb at severe poisoning was about 20 μg/L; haematological effects at about 5 μg/L. Biological half-time of P-Pb was about 1 month; B-Pb decay was much slower. P-Pb is a valuable biomarker of exposure to and risk, particularly at high exposure.

Reducing the incidence of acute pesticide poisoning by educating farmers on integrated pest management in South India.

PubMed

Mancini, Francesca; Jiggins, Janice L S; O'Malley, Michael

2009-01-01

Sixty-five farmers reported on pesticide use and the signs and symptoms of acute pesticide poisoning when using two different plant protection strategies: in 2003 using chemical controls and in 2004 using an approach to Integrated Pest Management (IPM) based on an ecological analysis of the field conditions. Exposure to organophosphates was confirmed as a serious risk factor for occupational poisoning. The adoption of IPM reduced the use of pesticides and halved the incidence of acute pesticide poisoning. Overall, the pesticide use spectrum shifted towards lower WHO Hazard Classes. A reduction of adverse health effects was attained through a reduction in exposure to toxic pesticides and behavioural changes. Given that other strategies to reduce the rate of acute poisoning have proven ineffective, interventions aiming to minimize pesticide poisoning in India and in other developing countries with similar rural conditions should focus on restricting the use of highly toxic compounds and educating farmers on IPM.

Pediatric ADHD Medication Exposures Reported to US Poison Control Centers.

PubMed

King, Samantha A; Casavant, Marcel J; Spiller, Henry A; Hodges, Nichole L; Chounthirath, Thitphalak; Smith, Gary A

2018-06-01

: media-1vid110.1542/5754332180001PEDS-VA_2017-3872 Video Abstract OBJECTIVES: To describe the characteristics and trends of exposures to attention-deficit/hyperactivity disorder (ADHD) medications among individuals 0 to 19 years old reported to US poison control centers. National Poison Data System data from 2000 through 2014 were retrospectively analyzed to examine pediatric ADHD medication exposures. From 2000 through 2014, there were 156 365 exposures reported to US poison control centers related to ADHD medications. The overall rate of reported exposures increased 71.2% from 2000 to 2011, followed by a 6.2% decrease from 2011 to 2014. Three-fourths (76.0%) of exposures involved children ≤12 years old. Methylphenidate and amphetamine medications accounted for 46.2% and 44.5% of exposures, respectively. The most common reason for exposure was therapeutic error (41.6%). Intentional medication exposures (including suspected suicide and medication abuse and/or misuse) were reported most often among adolescents (13-19 years old), accounting for 50.2% of exposures in this age group. Overall, the majority of exposed individuals (60.4%) did not receive health care facility treatment; however, 6.2% were admitted to a hospital for medical treatment, and there were 3 deaths. The increasing number and rate of reported ADHD medication exposures during the study period is consistent with increasing trends in ADHD diagnosis and medication prescribing. Exposures associated with suspected suicide or medication abuse and/or misuse among adolescents are of particular concern. Unintentional and intentional pediatric exposures to ADHD medications are an increasing problem in the United States, affecting children of all ages. Copyright © 2018 by the American Academy of Pediatrics.

Ayahuasca Exposure: Descriptive Analysis of Calls to US Poison Control Centers from 2005 to 2015.

PubMed

Heise, C William; Brooks, Daniel E

2017-09-01

Ayahuasca is a hallucinogenic plant preparation which usually contains the vine Banisteriopsis caapi and the shrub Psychotria viridis. This tea originates from the Amazon Basin where it is used in religious ceremonies. Because interest in these religious groups spreading as well as awareness of use of ayahuasca for therapeutic and recreational purposes, its use is increasing. Banisteriopsis caapi is rich in β-carbolines, especially harmine, tetrahydroharmine and harmaline, which have monoamine oxidase inhibiting (MAOI) activity. Psychotria viridis contains the 5HT2A/2C/1A receptor agonist hallucinogen N,N-dimethyltryptamine (DMT). Usual desired effects include hallucination, dissociation, mood alteration and perception change. Undesired findings previously reported are nausea, vomiting, hypertension, and tachycardia. All human exposure calls reported to the American Association of Poison Controls Centers' (AAPCC) National Poison Data System (NPDS) between September 1, 2005 and September 1, 2015 were reviewed. Cases were filtered for specific plant derived ayahuasca-related product codes. Abstracted data included the following: case age and gender, exposure reason, exposure route, clinical manifestations, treatments given, medical outcomes and fatality. Five hundred and thirty-eight exposures to ayahuasca botanical products were reported. The majority of the calls to poison control centers came from healthcare facilities (83%). The most common route of exposure was ingestion. Most cases were men (437, 81%, 95% CI 77.7% - 84.3%). The median age was 21 (IQR 18-29). Most exposures were acute. Three hundred thirty-seven (63%) were reported to have a major or moderate clinical effect. The most common clinical manifestations reported were hallucinations (35%), tachycardia (34%), agitation (34%), hypertension (16%), mydriasis (13%) and vomiting (6%). Benzodiazepines were commonly given (30%). There were 28 cases in the series who required endotracheal intubation (5%). Four cases were reported to have had a cardiac arrest and 7 a respiratory arrest. Twelve cases had a seizure. Reports of exposures called to poison centers appeared to increase during this period based on annual estimates. Three fatalities were reported. Ayahuasca use appears to be rising in the United States based on calls to poison control centers. While most use is reported to be safe and well tolerated, with possible beneficial effects, serious and life threatening adverse manifestations are possible. Most of the exposures reported to poison control centers were young people, more likely to be men and already in a healthcare facility. Further research, which includes comprehensive drug testing, will be needed to better identify the risks and effects of ayahuasca use.

Silent latency periods in methylmercury poisoning and in neurodegenerative disease.

PubMed Central

Weiss, Bernard; Clarkson, Thomas W; Simon, William

2002-01-01

This article discusses three examples of delay (latency) in the appearance of signs and symptoms of poisoning after exposure to methylmercury. First, a case is presented of a 150-day delay period before the clinical manifestations of brain damage after a single brief (<1 day) exposure to dimethylmercury. The second example is taken from the Iraq outbreak of methylmercury poisoning in which the victims consumed contaminated bread for several weeks without any ill effects. Indeed, signs of poisoning did not appear until weeks or months after exposure stopped. The last example is drawn from observations on nonhuman primates and from the sequelae of the Minamata, Japan, outbreak in which low chronic doses of methylmercury may not have produced observable behavioral effects for periods of time measured in years. The mechanisms of these latency periods are discussed for both acute and chronic exposures. Parallels are drawn with other diseases that affect the central nervous system, such as Parkinson disease and post-polio syndrome, that also reflect the delayed appearance of central nervous system damage. PMID:12426145

Global approach to reducing lead exposure and poisoning.

PubMed

Meyer, Pamela A; Brown, Mary Jean; Falk, Henry

2008-01-01

Lead poisoning is an important environmental disease that can have life-long adverse health effects. Most susceptible are children, and most commonly exposed are those who are poor and live in developing countries. Studies of children's blood-lead levels (BLLs) are showing cognitive impairment at increasingly lower BLLs. Lead is dangerous at all levels in children. The sources of lead exposure vary among and within countries depending on past and current uses. Sources of lead may be from historic contamination, recycling old lead products, or from manufacturing new products. In all countries that have banned leaded gasoline, average population BLLs have declined rapidly. In many developing countries where leaded gasoline is no longer used, many children and workers are exposed to fugitive emissions and mining wastes. Unexpected lead threats, such as improper disposal of electronics and children's toys contaminated with lead, continue to emerge. The only medical treatment available is chelation, which can save lives of persons with very high BLLs. However, chelating drugs are not always available in developing countries and have limited value in reducing the sequelae of chronic low dose lead exposure. Therefore, the best approach is to prevent exposure to lead. Because a key strategy for preventing lead poisoning is to identify and control or eliminate lead sources, this article highlights several major sources of lead poisoning worldwide. In addition, we recommend three primary prevention strategies for lead poisoning: identify sources, eliminate or control sources, and monitor environmental exposures and hazards.

2016 Annual Report of the University of Kansas Health System Poison Control Center.

PubMed

Thornton, Stephen L; Oller, Lisa; Coons, Doyle M

2018-05-01

This is the 2016 Annual Report of the University of Kansas Health System Poison Control Center (PCC). The PCC is one of 55 certified poison control centers in the United States and serves the state of Kansas 24-hours a day, 365 days a year, with certified specialists in poison information and medical toxicologists. The PCC receives calls from the public, law enforcement, health care professionals, and public health agencies. All calls to the PCC are recorded electronically in the Toxicall® data management system and uploaded in near real-time to the National Poison Data System (NPDS), which is the data repository for all poison control centers in the United States. All encounters reported to the PCC from January 1, 2016 to December 31, 2016 were analyzed. Data recorded for each exposure includes caller location, age, weight, gender, substance exposed to, nature of exposure, route of exposure, interventions, medical outcome, disposition and location of care. Encounters were classified further as human exposure, animal exposure, confirmed non-exposure, or information call (no exposure reported). The PCC logged 21,965 total encounters in 2016, including 20,713 human exposure cases. The PCC received calls from every county in Kansas. The majority of human exposure cases (50.4%, n = 10,174) were female. Approximately 67% (n = 13,903) of human exposures involved a child (defined as age 19 years or less). Most encounters occurred at a residence (94.0%, n = 19,476) and most calls (72.3%, n = 14,964) originated from a residence. The majority of human exposures (n = 18,233) were acute cases (exposures occurring over eight hours or less). Ingestion was the most common route of exposure documented (86.3%, n = 17,882). The most common reported substance in pediatric encounters was cosmetics/personal care products (n = 1,362), followed by household cleaning product (n = 1,301). For adult encounters, sedatives/hypnotics/antipsychotics (n = 1,130) and analgesics (n = 1,103) were the most frequently involved substances. Unintentional exposures were the most common reason for exposures (81.3%, n = 16,836). Most encounters (71.1%, n = 14,732) were managed in a non-healthcare facility (i.e., a residence). Among human exposures, 14,679 involved exposures to pharmaceutical agents while 10,176 involved exposure to non-pharmaceuticals. Medical outcomes were 32% (n = 6,582) no effect, 19% (n = 3,911) minor effect, 8% (n = 1,623) moderate effect, and 2% (n = 348) major effects. There were 15 deaths in 2016 reported to the PCC. Number of exposures, calls from healthcare facilities, cases with moderate or major medical outcomes, and deaths all increased in 2016 compared to 2015. The results of the 2016 University of Kansas Health System Poison Control annual report demonstrates that the center receives calls from the entire state of Kansas totaling over 20,000 human exposures per year. While pediatric exposures remain the most common, there is an increasing number of calls from healthcare facilities and for cases with serious outcomes. The experience of the PCC is similar to national data. This report supports the continued value of the PCC to both public and acute health care in the state of Kansas.

2016 Annual Report of the University of Kansas Health System Poison Control Center

PubMed Central

Thornton, Stephen L.; Oller, Lisa; Coons, Doyle M.

2018-01-01

Introduction This is the 2016 Annual Report of the University of Kansas Health System Poison Control Center (PCC). The PCC is one of 55 certified poison control centers in the United States and serves the state of Kansas 24-hours a day, 365 days a year, with certified specialists in poison information and medical toxicologists. The PCC receives calls from the public, law enforcement, health care professionals, and public health agencies. All calls to the PCC are recorded electronically in the Toxicall® data management system and uploaded in near real-time to the National Poison Data System (NPDS), which is the data repository for all poison control centers in the United States. Methods All encounters reported to the PCC from January 1, 2016 to December 31, 2016 were analyzed. Data recorded for each exposure includes caller location, age, weight, gender, substance exposed to, nature of exposure, route of exposure, interventions, medical outcome, disposition and location of care. Encounters were classified further as human exposure, animal exposure, confirmed non-exposure, or information call (no exposure reported). Results The PCC logged 21,965 total encounters in 2016, including 20,713 human exposure cases. The PCC received calls from every county in Kansas. The majority of human exposure cases (50.4%, n = 10,174) were female. Approximately 67% (n = 13,903) of human exposures involved a child (defined as age 19 years or less). Most encounters occurred at a residence (94.0%, n = 19,476) and most calls (72.3%, n = 14,964) originated from a residence. The majority of human exposures (n = 18,233) were acute cases (exposures occurring over eight hours or less). Ingestion was the most common route of exposure documented (86.3%, n = 17,882). The most common reported substance in pediatric encounters was cosmetics/personal care products (n = 1,362), followed by household cleaning product (n = 1,301). For adult encounters, sedatives/hypnotics/antipsychotics (n = 1,130) and analgesics (n = 1,103) were the most frequently involved substances. Unintentional exposures were the most common reason for exposures (81.3%, n = 16,836). Most encounters (71.1%, n = 14,732) were managed in a non-healthcare facility (i.e., a residence). Among human exposures, 14,679 involved exposures to pharmaceutical agents while 10,176 involved exposure to non-pharmaceuticals. Medical outcomes were 32% (n = 6,582) no effect, 19% (n = 3,911) minor effect, 8% (n = 1,623) moderate effect, and 2% (n = 348) major effects. There were 15 deaths in 2016 reported to the PCC. Number of exposures, calls from healthcare facilities, cases with moderate or major medical outcomes, and deaths all increased in 2016 compared to 2015. Conclusion The results of the 2016 University of Kansas Health System Poison Control annual report demonstrates that the center receives calls from the entire state of Kansas totaling over 20,000 human exposures per year. While pediatric exposures remain the most common, there is an increasing number of calls from healthcare facilities and for cases with serious outcomes. The experience of the PCC is similar to national data. This report supports the continued value of the PCC to both public and acute health care in the state of Kansas. PMID:29796151

Site-specific lead exposure from lead pellet ingestion in sentinel mallards

USGS Publications Warehouse

Rocke, T.E.; Brand, C.J.; Mensik, John G.

1997-01-01

We monitored lead poisoning from the ingestion of spent lead pellets in sentinel mallards (Anas platyhrynchos) at the Sacramento National Wildlife Refuge (SNWR), Willows, California for 4 years (1986-89) after the conversion to steel shot for waterfowl hunting on refuges in 1986. Sentinel mallards were held in 1.6-ha enclosures in 1 hunted (P8) and 2 non-hunted (T19 and TF) wetlands. We compared site-specific rates of lead exposure, as determined by periodic measurement of blood lead concentrations, and lead poisoning mortality between wetlands with different lead pellet densities, between seasons, and between male and female sentinels. In 1986, the estimated 2-week rate of lead exposure was significantly higher (P < 0.005) in P8 (43.8%), the wetland with the highest density of spent lead pellets (>2,000,000 pellets/ha), than in those with lower densities of lead pellets, T19 (18.1%; 173,200 pellets/ha) and TF (0.9%; 15,750 pellets/ha). The probability of mortality from lead poisoning was also significantly higher (P < 0.01) in sentinel mallards enclosed in P8 (0.25) than T19 (0) and TF (0) in 1986 and remained significantly higher (P < 0.001) during the 4-year study. Both lead exposure and the probability of lead poisoning mortality in P8 were significantly higher (P < 0.001) in the fall of 1986 (43.8%; 0.25), before hunting season, than in the spring of 1987 (21.6%; 0.04), after hunting season. We found no significant differences in the rates of lead exposure or lead poisoning mortality between male and female sentinel mallards. The results of this study demonstrate that in some locations, lead exposure and lead poisoning in waterfowl will continue to occur despite the conversion to steel shot for waterfowl hunting.

[Chronic CO poisoning. Use of generator gas during the second world war and recent research].

PubMed

Tvedt, B; Kjuus, H

1997-06-30

The consequences of long-lasting and low-grade exposure to carbon monoxide are a matter of debate. During the second world war, lack of petrol led to widespread use of wood as fuel (generator gas vehicles), especially in the Nordic countries. This caused many cases of "acute" or "chronic" carbon monoxide poisoning. Typical symptoms of "chronic poisoning" were headache, dizziness and tiredness. Usually the symptoms disappeared after some weeks or month, but in some patients probably became permanent. The experiences from the generator gas era are now almost forgotten, and chronic carbon monoxide poisoning is easily overlooked. The authors describe two cases of such poisoning. A crane driver at a smelting works developed permanent symptoms after twenty years of exposure. A faulty oil-fired central heating system caused long-lasting symptoms in four members of a family.

Pesticide poisoning and neurobehavioral function among farm workers in Jiangsu, People's Republic of China.

PubMed

Zhang, Xujun; Wu, Ming; Yao, Hongyan; Yang, Yaming; Cui, Mengjing; Tu, Zhibin; Stallones, Lorann; Xiang, Huiyun

2016-01-01

Pesticides remain an integral part of agricultural activities worldwide. Although there have been a number of studies over the last two decades concerning the adverse effects of pesticide poisoning and chronic long term exposures on neurobehavioral function, the impact of recent pesticide poisoning and long term pesticide exposure on neurobehavioral function in Chinese farm workers has not been reported. China is the largest user of pesticides worldwide and figures suggest 53,300-123,000 Chinese people are poisoned every year. A case control study was conducted to examine the impact of recent pesticide poisoning on neurobehavioral function and the relationship between years worked in agriculture and lower performance on neurobehavioral tests. A total of 121 farm workers who self-reported recent pesticide poisonings within the previous 12 months (case group) and 80 farm workers who reported no pesticide poisoning in the previous 12 months (control group) were recruited from three areas of Jiangsu Province, China. The World Health Organization (WHO) recommended neurobehavioral core test battery (NCTB) was used to assess neurobehavioral functioning among cases and controls. Student's t tests and two-way covariance analysis (ANCOVA) were used to test for significant differences in the neurobehavioral test results between the groups. Scores on the Profile of Mood States (POMS) in the recently poisoned group were significantly higher for anger-hostility, depression-dejection, tension-anxiety and lower for vigor-activity compared to controls (p < .05). Digit span, digit symbol, Benton visual retention and pursuit aiming scores were all significantly lower among the recently poisoned group compared to the controls (p < .05). Two-way ANCOVA indicated significantly lower performance in correct pursuit aiming and higher error pursuit aiming amongst the recently poisoned group and those who had worked for more than 30 years in agriculture (p < .05). These findings provide important preliminary epidemiological evidence regarding the association between occupational pesticide exposure and neurobehavioral functioning in Chinese farm workers. Copyright © 2015 Elsevier Ltd. All rights reserved.

Work-related pesticide poisoning among farmers in two villages of Southern China: a cross-sectional survey.

PubMed

Zhang, Xujun; Zhao, Weiyan; Jing, Ruiwei; Wheeler, Krista; Smith, Gary A; Stallones, Lorann; Xiang, Huiyun

2011-06-03

Pesticide poisoning is an important health problem among Chinese farm workers, but there is a paucity of pesticide poisoning data from China. Using the WHO standard case definition of a possible acute pesticide poisoning, we investigated the prevalence and risk factors of acute work-related pesticide poisoning among farmers in Southern China. A stratified sample of 910 pesticide applicators from two villages in southern China participated in face-to-face interviews. Respondents who self-reported having two or more of a list of sixty-six symptoms within 24 hours after pesticide application were categorized as having suffered acute pesticide poisoning. The association between the composite behavioral risk score and pesticide poisoning were assessed in a multivariate logistic model. A total of 80 (8.8%) pesticide applicators reported an acute work-related pesticide poisoning. The most frequent symptoms among applicators were dermal (11.6%) and nervous system (10.7%) symptoms. Poisoning was more common among women, farmers in poor areas, and applicators without safety training (all p < 0.001). After controlling for gender, age, education, geographic area and the behavioral risk score, farmers without safety training had an adjusted odds ratio of 3.22 (95% CI: 1.86-5.60). The likelihood of acute pesticide poisoning was also significantly associated with number of exposure risk behaviors. A significant "dose-response" relationship between composite behavioral risk scores calculated from 9 pesticides exposure risk behaviors and the log odds of pesticide poisoning prevalence was seen among these Chinese farmers (R2 = 0.9246). This study found that 8.8% of Chinese pesticide applicators suffered acute pesticide poisoning and suggests that pesticide safety training, safe application methods, and precautionary behavioral measures could be effective in reducing the risk of pesticide poisoning.

Work-related pesticide poisoning among farmers in two villages of Southern China: a cross-sectional survey

PubMed Central

2011-01-01

Background Pesticide poisoning is an important health problem among Chinese farm workers, but there is a paucity of pesticide poisoning data from China. Using the WHO standard case definition of a possible acute pesticide poisoning, we investigated the prevalence and risk factors of acute work-related pesticide poisoning among farmers in Southern China. Methods A stratified sample of 910 pesticide applicators from two villages in southern China participated in face-to-face interviews. Respondents who self-reported having two or more of a list of sixty-six symptoms within 24 hours after pesticide application were categorized as having suffered acute pesticide poisoning. The association between the composite behavioral risk score and pesticide poisoning were assessed in a multivariate logistic model. Results A total of 80 (8.8%) pesticide applicators reported an acute work-related pesticide poisoning. The most frequent symptoms among applicators were dermal (11.6%) and nervous system (10.7%) symptoms. Poisoning was more common among women, farmers in poor areas, and applicators without safety training (all p < 0.001). After controlling for gender, age, education, geographic area and the behavioral risk score, farmers without safety training had an adjusted odds ratio of 3.22 (95% CI: 1.86-5.60). The likelihood of acute pesticide poisoning was also significantly associated with number of exposure risk behaviors. A significant "dose-response" relationship between composite behavioral risk scores calculated from 9 pesticides exposure risk behaviors and the log odds of pesticide poisoning prevalence was seen among these Chinese farmers (R2 = 0.9246). Conclusions This study found that 8.8% of Chinese pesticide applicators suffered acute pesticide poisoning and suggests that pesticide safety training, safe application methods, and precautionary behavioral measures could be effective in reducing the risk of pesticide poisoning. PMID:21639910

Adverse effects of e-cigarette exposures.

PubMed

Cantrell, F Lee

2014-06-01

In 2007, a new source of nicotine exposure was introduced to the United States market, the electronic cigarette (ECIG) or "e-cigarette". Since then, the USA ECIG market has been doubling annually. Despite their widespread popularity, there is a paucity of existing data regarding ECIG toxicity. We report the experience of a statewide poison system. The database of a statewide poison system was queried for human ECIG exposures from 2010 (when Poisindex code first generated) through 2012. Year, age, manner and route of exposure, estimate exposure amount, product concentration, if evaluated at healthcare facility and symptoms were recorded. A total of 35 cases were identified--4 in 2010, 12 in 2011, 19 in 2012. Age range 8 months-60 years. Reported symptoms were mild and transient. Five patients were evaluated in an emergency department and none were admitted. Product concentrations ranged from 4 to 30 mg of nicotine per ml. Poison centers are likely to see an increase in exposures to ECIG given their growing popularity. Our modest results suggest that adverse effects and accidental exposures to ECIG cartridges are unlikely to result in serious toxicity.

Wild mushroom exposures in Florida, 2003-2007.

PubMed

Kintziger, Kristina W; Mulay, Prakash; Watkins, Sharon; Schauben, Jay; Weisman, Richard; Lewis-Younger, Cynthia; Blackmore, Carina

2011-01-01

Exposure to wild mushrooms can lead to serious illness and death. However, there is little information on the epidemiology of mushroom exposures nationwide, as there is no specific surveillance for this outcome. We described mushroom exposures in Florida using available data sources. We performed a population-based study of mushroom exposure calls to the Florida Poison Information Center Network (FPICN) and cases of mushroom poisoning reported in hospital inpatient and emergency department (ED) data from 2003 through 2007. There were 1,538 unduplicated mushroom exposures reported during this period, including 1,355 exposure calls and 428 poisoning cases. Most exposures reported to FPICN occurred in children ≤6 years of age (45%) and males (64%), and most were unintentional ingestions (60%). Many exposures resulted in no effect (35%), although 21% reported mild symptoms that resolved rapidly, 23% reported prolonged/systemic (moderate) symptoms, and 1% reported life-threatening effects. Most calls occurred when in or en route to a health-care facility (43%). More than 71% of poisonings identified in hospital records were managed in an ED, and most occurred in young adults 16-25 years of age (49%), children ≤6 years of age (21%), adults >25 years of age (21%), and males (70%). No deaths were reported. Combined, these data were useful for describing mushroom exposures. Most exposures occurred in males and in young children (≤6 years of age) and young adults (16-25 years of age), with 78% resulting in contact with a health-care facility. Education should target parents of young children-especially during summer, when mushrooms are more abundant-and young adults who are likely experimenting with mushrooms for their potential hallucinogenic properties.

Depression and Pesticide Exposures among Private Pesticide Applicators Enrolled in the Agricultural Health Study

PubMed Central

Beseler, Cheryl L.; Stallones, Lorann; Hoppin, Jane A.; Alavanja, Michael C.R.; Blair, Aaron; Keefe, Thomas; Kamel, Freya

2008-01-01

Background We evaluated the relationship between diagnosed depression and pesticide exposure using information from private pesticide applicators enrolled in the Agricultural Health Study between 1993 and 1997 in Iowa and North Carolina. Methods There were 534 cases who self-reported a physician-diagnosed depression and 17,051 controls who reported never having been diagnosed with depression and did not feel depressed more than once a week in the past year. Lifetime pesticide exposure was categorized in three mutually exclusive groups: low (< 226 days, the reference group), intermediate (226–752 days), and high (> 752 days). Two additional measures represented acute high-intensity pesticide exposures: an unusually high pesticide exposure event (HPEE) and physician-diagnosed pesticide poisoning. Logistic regression analyses were performed relating pesticide exposure to depression. Results After adjusting for state, age, education, marital status, doctor visits, alcohol use, smoking, solvent exposure, not currently having crops or animals, and ever working a job off the farm, pesticide poisoning was more strongly associated with depression [odds ratio (OR) = 2.57; 95% confidence interval (CI), 1.74–3.79] than intermediate (OR = 1.07; 95% CI, 0.87–1.31) or high (OR = 1.11; 95% CI, 0.87–1.42) cumulative exposure or an HPEE (OR = 1.65; 95% CI, 1.33–2.05). In analysis of a subgroup without a history of acute poisoning, high cumulative exposure was significantly associated with depression (OR = 1.54; 95% CI, 1.16–2.04). Conclusion These findings suggest that both acute high-intensity and cumulative pesticide exposure may contribute to depression in pesticide applicators. Our study is unique in reporting that depression is also associated with chronic pesticide exposure in the absence of a physician-diagnosed poisoning. PMID:19079725

Texas Bull Nettle (Cnidoscolus texanus) Exposures Reported to Texas Poison Centers.

PubMed

Forrester, Mathias B

2017-06-01

Texas bull nettle (Cnidoscolus texanus) is covered in bristly hairs similar to stinging nettle. Contact with the plant may result in intense dermal pain, burning, itching, cellulitis, and allergic reaction. This study characterizes C texanus exposures reported to a large state-wide poison center system. Cases were C texanus exposures reported to Texas poison centers during 2000-2015. The distribution of cases was determined for patient demographics, exposure circumstances, and patient outcome. A total of 140 C texanus exposures were identified. Twenty percent of the patients were aged ≤5 years, 21% were 6 to 12 years, 5% were 13 to 19 years, and 51% were ≥20years; and 51% of the patients were male. Eighty-one percent of the exposures occurred at the patient's own residence, 11% in a public area, 2% at another residence, and 1% at school. Seventy-eight percent of the patients were managed on site, 13% were already at or en route to a health care facility, and 6% were referred to a health care facility. Eighty-eight percent of the exposures resulted in dermal effects: irritation or pain (56%), erythema or flushing (31%), edema (27%), pruritus (24%), rash (19%), puncture or wound (19%), and hives or welts (11%). C texanus exposures reported to Texas poison centers were most likely to be unintentional and occur at the patient's own residence. The outcomes of the exposures tended not to be serious and could be managed successfully outside of health care facilities. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Modeling the effect of succimer (DMSA; dimercaptosuccinic acid) chelation therapy in patients poisoned by lead.

PubMed

van Eijkeren, Jan C H; Olie, J Daniël N; Bradberry, Sally M; Vale, J Allister; de Vries, Irma; Clewell, Harvey J; Meulenbelt, Jan; Hunault, Claudine C

2017-02-01

Kinetic models could assist clinicians potentially in managing cases of lead poisoning. Several models exist that can simulate lead kinetics but none of them can predict the effect of chelation in lead poisoning. Our aim was to devise a model to predict the effect of succimer (dimercaptosuccinic acid; DMSA) chelation therapy on blood lead concentrations. We integrated a two-compartment kinetic succimer model into an existing PBPK lead model and produced a Chelation Lead Therapy (CLT) model. The accuracy of the model's predictions was assessed by simulating clinical observations in patients poisoned by lead and treated with succimer. The CLT model calculates blood lead concentrations as the sum of the background exposure and the acute or chronic lead poisoning. The latter was due either to ingestion of traditional remedies or occupational exposure to lead-polluted ambient air. The exposure duration was known. The blood lead concentrations predicted by the CLT model were compared to the measured blood lead concentrations. Pre-chelation blood lead concentrations ranged between 99 and 150 μg/dL. The model was able to simulate accurately the blood lead concentrations during and after succimer treatment. The pattern of urine lead excretion was successfully predicted in some patients, while poorly predicted in others. Our model is able to predict blood lead concentrations after succimer therapy, at least, in situations where the duration of lead exposure is known.

Carbon Monoxide Poisoning After an Ice Storm in Kentucky, 2009

PubMed Central

Lutterloh, Emily C.; Iqbal, Shahed; Clower, Jacquelyn H.; Spillerr, Henry A.; Riggs, Margaret A.; Sugg, Tennis J.; Humbaugh, Kraig E.; Cadwell, Betsy L.; Thoroughman, Douglas A.

2011-01-01

Objectives. Carbon monoxide (CO) poisoning is a leading cause of morbidity and mortality during natural disasters. On January 26–27, 2009, a severe ice storm occurred in Kentucky, causing widespread, extended power outages and disrupting transportation and communications. After the storm, CO poisonings were reported throughout the state. The objectives of this investigation were to determine the extent of the problem, identify sources of CO poisoning, characterize cases, make recommendations to reduce morbidity and mortality, and develop prevention strategies. Methods. We obtained data from the Kentucky Regional Poison Center (KRPC), hyperbaric oxygen treatment (HBOT) facilities, and coroners. Additionally, the Kentucky Department for Public Health provided statewide emergency department (ED) and hospitalization data. Results. During the two weeks after the storm, KRPC identified 144 cases of CO poisoning; exposure sources included kerosene heaters, generators, and propane heaters. Hospitals reported 202 ED visits and 26 admissions. Twenty-eight people received HBOT. Ten deaths were attributed to CO poisoning, eight of which were related to inappropriate generator location. Higher rates of CO poisoning were reported in areas with the most ice accumulation. Conclusions. Although CO poisonings are preventable, they continue to occur in postdisaster situations. Recommendations include encouraging use of CO alarms, exploring use of engineering controls on generators to decrease CO exposure, providing specific information regarding safe use and placement of CO-producing devices, and using multiple communication methods to reach people without electricity. PMID:21563718

The neurotoxicology of carbon monoxide - Historical perspective and review.

PubMed

Sykes, Oliver T; Walker, Edward

2016-01-01

Carbon monoxide (CO) has been recognized as a poison for centuries, and remains one of the most common causes of both accidental and deliberate poisoning worldwide. Despite this, there are widespread misconceptions with regards to the mechanisms, diagnosis and outcomes of CO induced poisoning such as the idea that CO poisoning is rare; that carboxyhaemoglobin levels above 20% and loss of consciousness are required before nervous system damage ensues; and that the binding of CO to haemoglobin is the only mechanism of toxicity. Prevention and diagnosis of CO poisoning is hampered by the lack of awareness of CO as a cause of illness, among both the general public and healthcare professionals. To complicate matters further there is no standardized definition of CO poisoning. Carboxyhaemoglobin levels are often used as a marker of CO poisoning, yet plasma levels rapidly reduce upon removal of the source and are therefore an unreliable biomarker of exposure and tissue damage. Adverse neuropsychiatric outcomes after CO poisoning are difficult to define, especially as they fluctuate, mimic other non-specific complaints, and are not present in all survivors. This paper challenges a number of misconceptions about CO poisoning which can result in misdiagnosis, and consequently in mismanagement. We illustrate how recent developments in the understanding of CO toxicology explain the particular susceptibility of the central nervous system to the effects of CO exposure. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Dehydropyrrolizidine Alkaloid Toxicity, Cytotoxicity, and Carcinogenicity

PubMed Central

Stegelmeier, Bryan L.; Colegate, Steven M.; Brown, Ammon W.

2016-01-01

Dehydropyrrolizidine alkaloid (DHPA)-producing plants have a worldwide distribution amongst flowering plants and commonly cause poisoning of livestock, wildlife, and humans. Previous work has produced considerable understanding of DHPA metabolism, toxicity, species susceptibility, conditions, and routes of exposure, and pathogenesis of acute poisoning. Intoxication is generally caused by contaminated grains, feed, flour, and breads that result in acute, high-dose, short-duration poisoning. Acute poisoning produces hepatic necrosis that is usually confirmed histologically, epidemiologically, and chemically. Less is known about chronic poisoning that may result when plant populations are sporadic, used as tisanes or herbal preparations, or when DHPAs contaminate milk, honey, pollen, or other animal-derived products. Such subclinical exposures may contribute to the development of chronic disease in humans or may be cumulative and probably slowly progress until liver failure. Recent work using rodent models suggest increased neoplastic incidence even with very low DHPA doses of short durations. These concerns have moved some governments to prohibit or limit human exposure to DHPAs. The purpose of this review is to summarize some recent DHPA research, including in vitro and in vivo DHPA toxicity and carcinogenicity reports, and the implications of these findings with respect to diagnosis and prognosis for human and animal health. PMID:27916846

Dog and cat exposures to hazardous substances reported to the Kansas State Veterinary Diagnostic Laboratory: 2009-2012.

PubMed

Mahdi, Ali; Van der Merwe, Deon

2013-06-01

Pet dogs and cats in the USA are commonly exposed to potentially hazardous substances found in domestic environments. Requests for assistance and advice received by the Kansas State Veterinary Diagnostic Laboratory regarding exposures in dogs and cats to substances perceived by their caretakers to be potentially harmful included 1,616 phone calls, over a 3-year period covering 2009-2012. Enquiries occurred more often during summer. Dogs were involved in 84.7 % of calls and cats in 15.3 %. Oral exposures were reported in 95.5 % of calls, dermal exposures in 3.7 % of calls, inhalation exposures in 0.6 % of calls, and parenteral exposures in 0.2 % of calls. Therapeutic drugs were the most frequently reported substances, accounting for 35.4 % of calls, followed by household chemicals (15.5 %); foods (14.8 %); pesticides (13.9 %); plants (12 %), industrial chemicals and fertilizers (3.6 %); cosmetics and personal care products (2.8 %); and animal, insect, and microorganism toxins (2.1 %). Although requests for information or assistance are not a measure of poisoning incidence, it can provide insight regarding relative exposure rates, help to identify changing exposure trends and emerging exposures, and reflect the public concern regarding actual or apparent harmful exposures in pets.

Kratom exposures reported to Texas poison centers.

PubMed

Forrester, Mathias B

2013-01-01

Kratom use is a growing problem in the United States. Kratom exposures reported to Texas poison centers between January 1998 and September 2013 were identified. No kratom exposures were reported from 1998 to 2008 and 14 exposures were reported from 2009 to September 2013. Eleven patients were male, and 11 patients were in their 20s. The kratom was ingested in 12 patients, inhaled in 1, and both ingested and inhaled in 1. Twelve patients were managed at a healthcare facility and the remaining 2 were managed at home.

Occupational chemical exposures: a collaboration between the Georgia Poison Center and the Occupational Safety and Health Administration.

PubMed

Tustin, Aaron W; Jones, Alison; Lopez, Gaylord P; Ketcham, Glenn R; Hodgson, Michael J

2018-01-01

In the United States, regional poison centers frequently receive calls about toxic workplace exposures. Most poison centers do not share call details routinely with governmental regulatory agencies. Worker health and safety could be enhanced if regulators such as the Occupational Safety and Health Administration (OSHA) had the ability to investigate these events and prevent similar incidents. With this goal in mind, the Georgia Poison Center (GPC) began referring occupational exposures to OSHA in July 2014. GPC began collecting additional employer details when handling occupational exposure calls. When workers granted permission, GPC forwarded call details to the OSHA Regional Office in Atlanta. These referrals enabled OSHA to initiate several investigations. We also analyzed all occupational exposures reported to GPC during the study period to characterize the events, detect violations of OSHA reporting requirements, and identify hazardous scenarios that could form the basis for future OSHA rulemaking or guidance. GPC was informed about 953 occupational exposures between 1 July, 2014 and 7 January, 2016. Workers were exposed to 217 unique substances, and 70.3% of victims received treatment in a healthcare facility. Hydrogen sulfide was responsible for the largest number of severe clinical effects. GPC obtained permission to refer 89 (9.3%) calls to OSHA. As a result of these referrals, OSHA conducted 39 investigations and cited 15 employers for "serious" violations. OSHA forwarded several other referrals to other regulatory agencies when OSHA did not have jurisdiction. At least one employer failed to comply with OSHA's new rule that mandates reporting of all work-related hospitalizations. This collaboration increased OSHA's awareness of dangerous job tasks including hydrofluoric acid exposure among auto detailers and carbon monoxide poisoning with indoor use of gasoline-powered tools. Collaboration with the GPC generated a useful source of referrals to OSHA. OSHA investigations led to abatement of existing hazards, and OSHA acquired new knowledge of occupational exposure scenarios.

Poisoning of wild birds from exposure to anticholinesterase compounds and lead: diagnostic methods and selected cases

USGS Publications Warehouse

Franson, J. Christian; Smith, Milton R.

1999-01-01

Organophosphorus and carbamate compounds have largely replaced chlorinated hydrocarbons for pesticidal use in the United States, and many cases of poisoning resulting from exposure to these anticholinesterase agents have occurred in free-living birds. Although lead shot has been prohibited for waterfowl hunting throughout the United States since 1991, lead poisoning from the ingestion of spent lead shot is still occasionally seen in wild birds, and lead poisoning from the ingestion of fishing sinkers is an emerging issue of concern. A thorough history, a complete necropsy evaluation, and appropriate laboratory analysis of tissues are required to diagnose toxicoses in wild birds, including those caused by anticholinesterase compounds and lead. The interpretation of brain cholinesterase (ChE) activity results depends on the methods of analysis and comparison with expected normal enzyme activities in brain tissue from the same species. Although lead residues in tissues vary among species, many lead poisoned birds have tissue residues that are much higher than the lower threshold commonly accepted for a diagnosis of lead poisoning. We review histories, necropsy findings, and analytical methodologies and results for selected anticholinesterase and lead poisoning cases diagnosed in wild raptors, waterfowl, and loons.

Ciguatera and scombroid fish poisoning in the United States.

PubMed

Pennotti, Radha; Scallan, Elaine; Backer, Lorraine; Thomas, Jerry; Angulo, Frederick J

2013-12-01

Ciguatera and scombroid fish poisonings are common causes of fish-related foodborne illness in the United States; however, existing surveillance systems underestimate the overall human health impact. This study aimed to describe existing data on ciguatera and scombroid fish poisonings from outbreak and poison control center reports and to estimate the overall number of ciguatera and scombroid fish-poisoning illnesses, hospitalizations, and deaths in the United States. We analyzed outbreak data from the Foodborne Disease Outbreak Surveillance Systems (FDOSS) from 2000 to 2007 and poison control center call data from the National Poison Data System (NPDS) from 2005 to 2009 for reports of ciguatera and scombroid fish poisonings. Using a statistical model with many inputs, we adjusted the outbreak data for undercounting due to underreporting and underdiagnosis to generate estimates. Underreporting and underdiagnosis multipliers were derived from the poison control call data and the published literature. Annually, an average of 15 ciguatera and 28 scombroid fish-poisoning outbreaks, involving a total of 60 and 108 ill persons, respectively, were reported to FDOSS (2000-2007). NPDS reported an average of 173 exposure calls for ciguatoxin and 200 exposure calls for scombroid fish poisoning annually (2005-2009). After adjusting for undercounting, we estimated 15,910 (90% credible interval [CrI] 4140-37,408) ciguatera fish-poisoning illnesses annually, resulting in 343 (90% CrI 69-851) hospitalizations and three deaths (90% CrI 1-7). We estimated 35,142 (90% CrI: 10,496-78,128) scombroid fish-poisoning illnesses, resulting in 162 (90% CrI 0-558) hospitalizations and 0 deaths. Ciguatera and scombroid fish poisonings affect more Americans than reported in surveillance systems. Although additional data can improve these assessments, the estimated number of illnesses caused by seafood intoxication illuminates this public health problem. Efforts, including education, can reduce ciguatera and scombroid fish poisonings.

American Association of Poison Control Centers

Science.gov Websites

centers in their efforts to prevent and treat poison exposures. Poison centers offer free, confidential ۼ Over-the-Counter Medicine Safety Over-the-Counter Medicine Safety is a 100% free, evidence-based after the close of the data year in the journal Clinical Toxicology and is available for download free

Recognition and Management of Pesticide Poisonings

EPA Pesticide Factsheets

The Recognition and Management of Pesticide Poisonings: 6th Edition manual gives healthcare providers a quick reference resource for the best toxicology and treatment information for patients with pesticide exposures.

77 FR 16645 - National Poison Prevention Week, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-21

... the incidence of poisoning among children, accidental exposure to drugs and medicines, typical... and medication in locked or childproof cabinets beyond their children's reach, and by safely disposing...

Lead isotope profiling in dairy calves.

PubMed

Buchweitz, John; McClure-Brinton, Kimberly; Zyskowski, Justin; Stensen, Lauren; Lehner, Andreas

2015-03-01

Lead (Pb) is a common cause of heavy metal poisonings in cattle. Sources of Pb on farms include crankcase oil, machinery grease, batteries, plumbing, and paint chips. Consequently, consumption of Pb from these sources may negatively impact animal health and Pb may be inadvertently introduced into the food supply. Therefore, the scope of poisoning incidents must be clearly assessed and sources of intoxication identified and strategies to mitigate exposure evaluated and implemented to prevent future exposures. Stable isotope analysis by inductively-coupled plasma mass spectrometry (ICP-MS) has proven itself of value in forensic investigations. We report on the extension of Pb stable isotope analysis to bovine tissues and profile comparisons with paint chips and soils collected from an affected dairy farm to elucidate the primary source. Pb occurs naturally as four stable isotopes: (204)Pb, (206)Pb, (207)Pb, and (208)Pb. Herein a case is reported to illustrate the use of (207)Pb/(206)Pb and (208)Pb/(206)Pb ratios to link environmental sources of exposure with tissues from a poisoned animal. Chemical Pb profiling provides a valuable tool for field investigative approaches to Pb poisoning in production agriculture and is applicable to subclinical exposures. Copyright © 2014 Elsevier Inc. All rights reserved.

Arsenic exposures in Mississippi: A review of cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Park, M.J.; Currier, M.

Arsenic poisonings occur in Mississippi despite public education campaigns to prevent poisonings in the home. We reviewed 44 Mississippi cases of arsenic exposures occurring from January 1986 to May 1990. We compared the epidemiologic differences between unintentional and intentional poisonings. Cases were found and characterized through the two toxicology laboratories and hospital records. Arsenic-based rodenticides were the arsenic source in 23 of the 44 exposures. Other sources were monosodium methylarsenate (4 cases), dodecyl ammonium methane arsonate (5 cases), and other compounds (12 cases). Of the 44 exposures, 27 were unintentional, 7 were suicide attempts, 6 were homicide attempts, and 4more » were of unknown intent. Of the 27 unintentionally exposed patients, 19 were black and 14 were male; their median age was 3 years. Of the 13 intentionally poisoned persons, 9 were male and 10 were black, with a median age of 28 years. Six of the seven patients who attempted suicide were white; four of the six victims of attempted homicide were black. We recommend removal of remaining bottles of arsenic-based rodenticides from store shelves, and we urge practicing physicians to warn patients of the dangers of using such rodenticides.« less

A review of pitfalls and progress in chelation treatment of metal poisonings.

PubMed

Andersen, Ole; Aaseth, Jan

2016-12-01

Most acute and chronic human metal poisonings are due to oral or inhalation exposure. Almost 80% of published animal experiments on chelation in metal poisoning used single or repeated intraperitoneal, intramuscular or intravenous administration of metal and chelator, impeding extrapolation to clinical settings. Intramuscular administration of dimercaptopropanol (BAL) has until now been used in acute arsenic, lead, and mercury poisonings, but repeated BAL administration increased the brain uptake of As, Pb and Hg in experimental animals. Also, diethyl dithiocarbamate (DDC) has been used as antidote in acute experimental animal parenteral Cd poisoning, and both DDC and tetraethylthiuram disulfide (TTD, disulfiram, Antabuse) have been used in nickel allergic patients. However, even one dose of DDC given immediately after oral Cd or Ni increased their brain uptake considerably. The calcium salt of ethylenediamminetetraacetic acid (CaEDTA) but not dimercaptosuccinic acid (DMSA) increased the brain uptake of Pb. In oral Cd or Hg poisoning, early oral administration of DMSA or dimercaptopropane sulfonate (DMPS) increased survival and reduced intestinal metal uptake. Oral administration of Prussian Blue or resins with fixed chelating groups that are not absorbed offer chelation approaches for decorporation after oral exposure to various metals. Diethylenetriaminepentaacetic acid (DTPA) nebulizers for pulmonary chelation after inhalation exposure need further development. Also, combined chelation with more than one compound may offer extensive advances. Solid knowledge on the chemistry of metal chelates together with relevant animal experiments should guide development of chelation procedures to alleviate and not aggravate the clinical status of poisoned patients. Copyright © 2016 Elsevier GmbH. All rights reserved.

Carbon monoxide poisoning-induced cardiomyopathy from charcoal at a barbecue restaurant: a case report.

PubMed

Kim, Hyun-Jun; Chung, Yun Kyung; Kwak, Kyeong Min; Ahn, Se-Jin; Kim, Yong-Hyun; Ju, Young-Su; Kwon, Young-Jun; Kim, Eun-A

2015-01-01

Acute carbon monoxide poisoning has important clinical value because it can cause severe adverse cardiovascular effects and sudden death. Acute carbon monoxide poisoning due to charcoal is well reported worldwide, and increased use of charcoal in the restaurant industry raises concern for an increase in occupational health problems. We present a case of carbon monoxide poisoning induced cardiomyopathy in a 47-year-old restaurant worker. A male patient was brought to the emergency department to syncope and complained of left chest pain. Cardiac angiography and electrocardiography were performed to rule out acute ischemic heart disease, and cardiac markers were checked. After relief of the symptoms and stabilization of the cardiac markers, the patient was discharged without any complications. Electrocardiography was normal, but cardiac angiography showed up to a 40% midsegmental stenosis of the right coronary artery with thrombotic plaque. The level of cardiac markers was elevated at least 5 to 10 times higher than the normal value, and the carboxyhemoglobin concentration was 35% measured at one hour after syncope. Following the diagnosis of acute carbon monoxide poisoning induced cardiomyopathy, the patient's medical history and work exposure history were examined. He was found to have been exposed to burning charcoal constantly during his work hours. Severe exposure to carbon monoxide was evident in the patient because of high carboxyhemoglobin concentration and highly elevated cardiac enzymes. We concluded that this exposure led to subsequent cardiac injury. He was diagnosed with acute carbon monoxide poisoning-induced cardiomyopathy due to an unsafe working environment. According to the results, the risk of exposure to noxious chemicals such as carbon monoxide by workers in the food service industry is potentially high, and workers in this sector should be educated and monitored by the occupational health service to prevent adverse effects.

Toxicity of soluble film automatic dishwashing products as reported to the United Kingdom National Poisons Information Service 2008-2015.

PubMed

Day, Rachael; Eddleston, Michael; Thomas, Simon H L; Thompson, John P; Vale, J Allister

2016-11-01

Soluble film automatic dishwashing tablets, unlike their traditional counterparts, require no removal from an outer protective wrapper prior to use. Instead, the tablets are enclosed by a water-soluble polyvinyl alcohol film and are loaded straight into the dishwashing machine. They most commonly contain a source of hydrogen peroxide (often as sodium percarbonate) and non-ionic surfactants. Other constituents in some formulations include sodium carbonate, sodium tripolyphosphate and sodium silicate, which reduce water hardness. The pH once dissolved in water is alkaline. To determine the toxicity from exposure to soluble film automatic dishwashing tablets. Telephone enquiries to the United Kingdom National Poisons Information Service regarding soluble film automatic dishwashing products were analysed retrospectively for the period January 2008 to December 2015. There were 498 enquiries relating to 488 patients. Almost all exposures occurred in the home (98.4%) and involved children aged ≤5 years (92.8%). Exposure occurred mainly as a result of ingestion alone (n = 470, 96.3%); eye contact alone (n = 9, 1.8%) and exposures involving multiple routes (ingestion with skin or eye contact; n = 9, 1.8%) made up the remaining cases. The majority of patients were asymptomatic following exposure (n = 325, 67.4%). The most common feature following ingestion was vomiting which occurred in 121 of 474 cases (25.5%) where clinical data were available. Nausea (n = 8, 1.7%) and coughing (n = 6, 1.3%) were also reported; three patients developed stomatitis and another five developed a rash where ingestion alone was considered to be the sole route of exposure. Ocular exposure to the tablet contents resulted in blurred vision, eye pain or conjunctivitis in seven of ten patients. Ingestion of a soluble film automatic dishwashing tablet rarely resulted in clinically significant symptoms, which is surprising given the potential hazard of the ingredients. Hence, it seems probable that the amount of material actually ingested was very small or that most was spat out.

Toxicoepidemiology in Zimbabwe: admissions resulting from exposure to paraffin (kerosene).

PubMed

Tagwireyi, D; Ball, D E; Nhachi, C F B

2006-01-01

Paraffin (kerosene) ingestion is the most common form of childhood poisoning in most developing countries. Despite this, there is a paucity of toxicoepidemiological data which could potentially be used in measures to reduce preventable exposures. This article reports on the patterns of hospital admissions resulting from paraffin exposure in Zimbabwe. All cases of paraffin ingestion admitted to eight major referral hospitals in Zimbabwe from January 1998 to December 1999 (inclusive), were identified using ICD-9 codes and ward registers and relevant information recorded on a standard data collection sheet. There were a total of 327 admissions due to oral exposure to paraffin. This represented 11.8% of all the poisoning admissions to the eight study hospitals. Most exposures (300; 91.7%) occurred accidentally, with only 6.7% resulting from deliberate ingestion of the chemical. The median age on admission was 2 years (interquartile range [IQR] 1-2 yrs) with over 85% of cases in the 0-5 year age range and less than 10% above the age of 12 years. The median age on admission was much higher for deliberate self poisoning (23 yrs; IQR 19-26 yrs) compared to that for accidental poisoning (1.5 yrs; IQR 1-2 yrs). Accidental poisoning from paraffin occurred throughout the year. Over three-quarters of patients received an antibiotic either alone, or in combination with another antibiotic or drug. Paracetamol (24.3%) was the next most commonly encountered treatment. The case fatality rate (CFR) was therefore 0.3 deaths per 100 admissions (95% Confidence Interval 0.0-1.7). Paraffin ingestion remains an important cause of poisoning morbidity in Zimbabwe throughout the year, particularly in children. Clinical management appears adequate with a low mortality, although there may be overuse of prophylactic antibiotics. Further study specific to this area is warranted to prevent unnecessary antibiotic use and wastage of resources.

A Case of Mushroom Poisoning with Russula subnigricans: Development of Rhabdomyolysis, Acute Kidney Injury, Cardiogenic Shock, and Death.

PubMed

Cho, Jong Tae; Han, Jin Hyung

2016-07-01

Mushroom exposures are increasing worldwide. The incidence and fatality of mushroom poisoning are reported to be increasing. Several new syndromes in mushroom poisoning have been described. Rhabdomyolytic mushroom poisoning is one of new syndromes. Russula subnigricans mushroom can cause delayed-onset rhabdomyolysis with acute kidney injury in the severely poisoned patient. There are few reports on the toxicity of R. subnigricans. This report represents the first record of R. subnigricans poisoning with rhabdomyolysis in Korea, describing a 51-year-old man who suffered from rhabdomyolysis, acute kidney injury, severe hypocalcemia, respiratory failure, ventricular tachycardia, cardiogenic shock, and death. Mushroom poisoning should be considered in the evaluation of rhabdomyolysis of unknown cause. Furthermore, R. subnigricans should be considered in the mushroom poisoning with rhabdomyolysis.

Organophosphate acetylcholine esterase inhibitor poisoning from a home-made shampoo.

PubMed

Sadaka, Yair; Broides, Arnon; Tzion, Raffi Lev; Lifshitz, Matitiahu

2011-07-01

Organophosphate acetylcholine esterase inhibitor poisoning is a major health problem in children. We report an unusual cause of organophosphate acetylcholine esterase inhibitor poisoning. Two children were admitted to the pediatric intensive care unit due to organophosphate acetylcholine esterase inhibitor poisoning after exposure from a home-made shampoo that was used for the treatment of head lice. Owing to no obvious source of poisoning, the diagnosis of organophosphate acetylcholine esterase inhibitor poisoning in one of these patients was delayed. Both patients had an uneventful recovery. Organophosphate acetylcholine esterase inhibitor poisoning from home-made shampoo is possible. In cases where the mode of poisoning is unclear, direct questioning about the use of home-made shampoo is warranted, in these cases the skin and particularly the scalp should be rinsed thoroughly as soon as possible.

Poisoning by Herbs and Plants: Rapid Toxidromic Classification and Diagnosis.

PubMed

Diaz, James H

2016-03-01

The American Association of Poison Control Centers has continued to report approximately 50,000 telephone calls or 8% of incoming calls annually related to plant exposures, mostly in children. Although the frequency of plant ingestions in children is related to the presence of popular species in households, adolescents may experiment with hallucinogenic plants; and trekkers and foragers may misidentify poisonous plants as edible. Since plant exposures have continued at a constant rate, the objectives of this review were (1) to review the epidemiology of plant poisonings; and (2) to propose a rapid toxidromic classification system for highly toxic plant ingestions for field use by first responders in comparison to current classification systems. Internet search engines were queried to identify and select peer-reviewed articles on plant poisonings using the key words in order to classify plant poisonings into four specific toxidromes: cardiotoxic, neurotoxic, cytotoxic, and gastrointestinal-hepatotoxic. A simple toxidromic classification system of plant poisonings may permit rapid diagnoses of highly toxic versus less toxic and nontoxic plant ingestions both in households and outdoors; direct earlier management of potentially serious poisonings; and reduce costly inpatient evaluations for inconsequential plant ingestions. The current textbook classification schemes for plant poisonings were complex in comparison to the rapid classification system; and were based on chemical nomenclatures and pharmacological effects, and not on clearly presenting toxidromes. Validation of the rapid toxidromic classification system as compared to existing chemical classification systems for plant poisonings will require future adoption and implementation of the toxidromic system by its intended users. Copyright © 2016 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Pesticide poisoning in Palestine: a retrospective analysis of calls received by Poison Control and Drug Information Center from 2006-2010.

PubMed

Sawalha, Ansam F; O'Malley, Gerald F; Sweileh, Waleed M

2012-01-01

The agricultural industry is the largest economic sector in Palestine and is characterized by extensive and unregulated use of pesticides. The objective of this study was to analyze phone calls received by the Poison Control and Drug Information Center (PCDIC) in Palestine regarding pesticide poisoning. All phone calls regarding pesticide poisoning received by the PCDIC from 2006 to 2010 were descriptively analyzed. Statistical Package for Social Sciences (SPSS version 16) was used in statistical analysis and to create figures. A total of 290 calls regarding pesticide poisoning were received during the study period. Most calls (83.8%) were made by physicians. The average age of reported cases was 19.6 ± 15 years. Pesticide poisoning occurred mostly in males (56.9%). Pesticide poisoning was most common (75, 25.9%) in the age category of 20-29.9 years. The majority (51.7%) of the cases were deliberate self-harm while the remaining was accidental exposure. The majority of phone calls (250, 86.2%) described oral exposure to pesticides. Approximately one third (32.9%) of the cases had symptoms consistent with organophosphate poisoning. Gastric lavage (31.7%) was the major decontamination method used, while charcoal was only utilized in 1.4% of the cases. Follow up was performed in 45.5% of the cases, two patients died after hospital admission while the remaining had positive outcome. Pesticide poisoning is a major health problem in Palestine, and the PCDIC has a clear mission to help in recommending therapy and gathering information.

Effectiveness of isosorbide dinitrate in cyanide poisoning as a function of the administration timing.

PubMed

Lavon, Ophir; Avrahami, Amit; Eisenkraft, Arik

2017-03-14

Better and safer antidotes against cyanide poisoning are needed. Prior study has shown a favorable effect of isosorbide dinitrate (ISDN) on the survival of cyanide-poisoned rabbits when administered as early as 1 min after poisoning. The aim of the current study was to further evaluate the efficacy of intravenous ISDN administered in clinically relevant timing for first responders. A comparative animal study using 24 rabbits in 4 randomized study groups was performed. Animals were poisoned with intravenous potassium cyanide (1 mg/kg). Animals in Group 1 served as controls and received no treatment. Groups 2-4 animals were treated intravenously with ISDN (50 μg/kg) after poisoning; one group after 3 min, another group after 5 min and the last after 7 min. Animals were observed for 30 min after poisoning. The study endpoints included survival rate, clinical status, blood pressure, pulse per minute, blood lactate and pH. Five of 6 animals (83.3%) from every treatment group survived the whole observation period while all control untreated animals died. All the rabbits collapsed immediately after exposure, showing rapidly deteriorated vital signs with lactic metabolic acidosis (peak blood lactate levels of 18.1 to 19.0 mmol/L on average at 10 min post exposure). Vital signs, clinical scores, and blood gases of treated rabbits gradually improved. Poisoned rabbits showed improved short-term survival following the administration of ISDN up to 7 min after lethal cyanide poisoning of. We see a potential for ISDN as an antidote against cyanide poisoning.

Carbon monoxide poisoning from portable electric generators.

PubMed

Hampson, Neil B; Zmaeff, Jennette L

2005-01-01

While the overall death rate from unintentional carbon monoxide (CO) poisoning has decreased in the United States due to improved automobile emissions controls and a decline in CO poisonings from motor vehicles, exposures have not changed from some sources of CO. One of these is the operation of portable electrical generators in poorly ventilated spaces. This study sought to describe the population poisoned from CO produced by portable electric generators, and to determine the reasons that generators are operated in a hazardous fashion. Cases of CO poisoning referred for treatment with hyperbaric oxygen at Virginia Mason Medical Center in Seattle from November 1978 to March 2004 were reviewed. Those cases that resulted from portable generator use were selected for analysis. Sixty-three patients aged 2 to 85 years were treated for CO poisoning from portable electric generators. They included 34 males and 29 females who were poisoned in 37 separate incidents. Thirty-four lost consciousness with the exposure. Of the 63 total patients, 60 spoke English. Generators were typically used when normal electrical service was disrupted by a storm or in remote locations. In 29 of 37 incidents, the generator was operated in the home environment, most commonly in the garage. Lack of awareness of the dangers of CO poisoning or lack of knowledge of ventilation requirements were the most commonly identified reasons. CO poisoning from portable electric generators occurs in a characteristic population, in a few typical locations and for a limited number of reasons. This information may help target prevention efforts for this form of poisoning, such as warning labels or educational programs.

[A case of favourable outcome of the treatment of extremely severe acute poisoning with methanol].

PubMed

Batotsyrenov, B V; Livanov, G A; Vasil'ev, S A; Fedorov, A V; Antrianov, A Iu

2013-01-01

A case of favourable outcome of the treatment of extremely severe acute poisoning after prolonged exposure to lethal doses of methanol is reported. The complex treatment included urgent and effective elimination of the poison (multiple gastric lavage, hemodialysis), antidote therapy (administration of ethanol), correction of decompensated metabolic acidosis (alkali therapy and infusion therapy with reamberin). These measures had beneficial effect on the clinical course of poisoning and ensured its favourable outcome.

Physiological and serum biochemical changes associated with rayless goldenrod (Isocoma pluriflora) poisoning in goats.

PubMed

Davis, T Zane; Green, Benedict T; Stegelmeier, Bryan L; Lee, Stephen T; Welch, Kevin D; Pfister, James A

2013-12-15

Rayless goldenrod (Isocoma pluriflora) has been known to be toxic to livestock in the southwestern United States for many years; however, chemical composition of the plant as well as the dosage and duration required to cause toxicosis have not been completely described. Tremetol, the historical toxin, is actually a mixture of alcohols and ketones. Though not completely confirmed experimentally, the toxic compounds are believed to be benzofuran ketones that include tremetone, dehydrotremetone, 3-hydroxytremetone, and 3-oxyangeloyl-tremetone. The objectives of this study were to determine the dosage of benzofuran ketones and the duration of exposure to these compounds required to produce clinical signs of poisoning in Spanish goats and to document the pathophysiological changes associated with rayless goldenrod poisoning in goats. Goats dosed with rayless goldenrod containing 40 and 60 mg/kg BW of benzofuran ketones for 4 or 5 days, showed clinical signs of toxicosis that included trembles, and exercise intolerance seen as reluctance to perform on the treadmill, significantly increased resting and working heart rates and prolonged heart rate recovery following exercise. The affected goats also had significant serum biochemical changes that included increased concentrations of cardiac troponin I and increased activities of aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and creatine kinase. Exercise intolerant animals also had extensive degeneration and necrosis within nearly all skeletal muscles. Some goats dosed with 10 and 20 mg/kg BW of benzofuran ketones began to show some signs of poisoning on the last day of the study. In conclusion, benzofuran ketones at doses at or above 40 mg/kg BW for longer than 4 or 5 days are toxic and produce disease similar to that described in clinical rayless goldenrod poisoning. Additionally, smaller benzofuran ketone doses (10 and 20 mg/kg BW) for longer durations also cause the disease. The physiologic findings indicated that though there may be some myocardial changes, the majority of the clinical disease in goats is due to skeletal muscle degeneration and necrosis. More work is needed to determine the toxicity and physiologic effects of individual benzofuran ketones and to develop a model that better predicts the risk of poisoning and methods to avoid poisoning by plants containing benzofuran ketones. Published by Elsevier Ltd.

Intentional ethylene glycol poisoning increase after media coverage of antifreeze murders.

PubMed

Morgan, Brent W; Geller, Robert J; Kazzi, Ziad N

2011-07-01

The media can have a profound impact on human behavior. A sensational murder by ethylene glycol (EG) poisoning occurred in our state. The regional media provided extensive coverage of the murder. We undertook this investigation to evaluate our incidence of EG poisoning during the timeframe of before the first report linking a death to ethylene glycol to shortly after the first murder trial. Descriptive statistics and linear regression were used to describe and analyze the number of EG cases over time. A search of the leading regional newspaper's archives established the media coverage timeline. Between 2000 and 2004, our poison center (PC) handled a steady volume of unintentional exposures to EG [range: 105-123 per year, standard deviation (SD)=7.22]. EG exposures thought to be suicidal in intent increased from 12 cases in 2000 to 121 cases in 2004. In the 19 months prior to the first media report of this story, our PC handled a mean of 1 EG case with suicidal intent per month [range: 0-2, SD=.69]. In the month after the first media report, our PC handled 5 EG cases with suicidal intent. When media coverage was most intense (2004), our PC received a mean of 10 EG suicidal-intent calls per month [range: 5-17, SD=3.55]. Although uncommon, reports of malicious EG poisonings also increased during this same period from 2 in 2000 to 14 in 2004. Media coverage of stories involving poisonings may result in copycat events, applicable to both self-poisonings and concern for malicious poisonings. Poison centers should be aware of this phenomenon, pay attention to local media and plan accordingly if a poisoning event receives significant media coverage. The media should be more sensitive to the content of their coverage and avoid providing "how to" poisoning information.

Risk and Prognostic Factors of Inpatient Mortality Associated with Unintentional Insecticide and Herbicide Poisonings: A Retrospective Cohort Study

PubMed Central

Chien, Wu-Chien; Chung, Chi-Hsiang; Jaakkola, Jouni J. K.; Chu, Chi-Ming; Kao, Senyeong; Su, Sui-Lung; Lai, Ching-Huang

2012-01-01

Introduction Pesticide poisoning is an important public health problem worldwide. The study aimed to determine the risk of all-cause and cause-specific inpatient mortality and to identify prognostic factors for inpatient mortality associated with unintentional insecticide and herbicide pesticide poisonings. Methods We performed a retrospective cohort study of 3,986 inpatients recruited at hospitalization between 1999 and 2008 in Taiwan. We used the International Classification of Disease, 9th ed., Clinical Modification external causes of injury codes to classify poisoning agents into accidental poisoning by insecticides and herbicides. Comparisons in mortality rates were made between insecticide poisoning patients and herbicide poisoning patients by using the Cox proportional hazards models to estimate multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs). Results There were 168 deaths during 21,583 person-days of follow-up evaluation (7.8 per 1,000 person-days). The major causes of mortality for insecticide poisonings were the toxic effect of organophosphate and coma, and the major causes of mortality for herbicide poisonings were the toxic effect of other pesticides and the toxic effect of organophosphate. The mortality for herbicide exposure was fourfold higher than that for insecticide exposure. The factors associated with inpatient mortality were herbicide poisonings (HR = 4.58, 95% CI 3.29 to 6.37) and receiving mechanical ventilation treatment (HR = 3.85, 95% CI 2.73 to 5.42). Conclusions We demonstrated that herbicides stand out as the dominant agent for poisoning-related fatalities. The control of and limiting access to herbicide agents and developing appropriate therapeutic regimens, including emergency care, should be priorities. PMID:23029146

Feather lead concentrations and (207)Pb/(206)Pb ratios reveal lead exposure history of California Condors (Gymnogyps californianus).

PubMed

Finkelstein, M E; George, D; Scherbinski, S; Gwiazda, R; Johnson, M; Burnett, J; Brandt, J; Lawrey, S; Pessier, A P; Clark, M; Wynne, J; Grantham, J; Smith, D R

2010-04-01

Lead poisoning is a primary factor impeding the survival and recovery of the critically endangered California Condor (Gymnogyps californianus). However, the frequency and magnitude of lead exposure in condors is not well-known in part because most blood lead monitoring occurs biannually, and biannual blood samples capture only approximately 10% of a bird's annual exposure history. We investigated the use of growing feathers from free-flying condors in California to establish a bird's lead exposure history. We show that lead concentration and stable lead isotopic composition analyses of sequential feather sections and concurrently collected blood samples provided a comprehensive history of lead exposure over the 2-4 month period of feather growth. Feather analyses identified exposure events not evident from blood monitoring efforts, and by fitting an empirically derived timeline to actively growing feathers, we were able to estimate the time frame for specific lead exposure events. Our results demonstrate the utility of using sequentially sampled feathers to reconstruct lead exposure history. Since exposure risk in individuals is one determinant of population health, our findings should increase the understanding of population-level effects from lead poisoning in condors; this information may also be helpful for other avian species potentially impacted by lead poisoning.

Feather lead concentrations and 207Pb/206Pb ratios reveal lead exposure history of California Condors (Gymnogyps californianus)

USGS Publications Warehouse

Finkelstein, M.E.; George, D.; Scherbinski, S.; Gwiazda, R.; Johnson, M.; Burnett, J.; Brandt, J.; Lawrey, S.; Pessier, Allan P.; Clark, M.R.; Wynne, J.; Grantham, And J.; Smith, D.R.

2010-01-01

Lead poisoning is a primary factor impeding the survival and recovery of the critically endangered California Condor (Gymnogyps californianus). However, the frequency and magnitude of lead exposure in condors is not well-known in part because most blood lead monitoring occurs biannually, and biannual blood samples capture only ∼10% of a bird’s annual exposure history. We investigated the use of growing feathers from free-flying condors in California to establish a bird’s lead exposure history. We show that lead concentration and stable lead isotopic composition analyses of sequential feather sections and concurrently collected blood samples provided a comprehensive history of lead exposure over the 2−4 month period of feather growth. Feather analyses identified exposure events not evident from blood monitoring efforts, and by fitting an empirically derived timeline to actively growing feathers, we were able to estimate the time frame for specific lead exposure events. Our results demonstrate the utility of using sequentially sampled feathers to reconstruct lead exposure history. Since exposure risk in individuals is one determinant of population health, our findings should increase the understanding of population-level effects from lead poisoning in condors; this information may also be helpful for other avian species potentially impacted by lead poisoning.

Anticoagulant rodenticides on our public and community lands: spatial distribution of exposure and poisoning of a rare forest carnivore

Treesearch

Mourad W Gabriel; Leslie W. Woods; Robert Poppenga; Rick A. Sweitzer; Craig Thompson; Sean M. Matthews; J. Mark Higley; Stefan M. Keller; Kathryn Purcell; Reginald H. Barrett; Greta M. Wengert; Benjamin N. Sacks; Deanna L. Clifford

2012-01-01

Anticoagulant rodenticide (AR) poisoning has emerged as a significant concern for conservation and management of nontarget wildlife. The purpose for these toxicants is to suppress pest populations in agricultural or urban settings. The potential of direct and indirect exposures and illicit use of ARs on public and community forest lands have recently raised concern for...

Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry.

PubMed

Judge, Bryan S; Ouellette, Lindsey M; VandenBerg, Melissa; Riley, Brad D; Wax, Paul M

2016-03-01

Many poisoned patients may only require a period of observation after their exposure. There are limited data describing the use of observation units for managing poisoned adult and pediatric patients. We performed a retrospective review of all patients reported to the ToxIC Case Registry between January 1, 2012 and December 31, 2013. Eligible patients included those who received a bedside consultation by a medical toxicologist and whose care was provided in an observation unit, or those who were admitted under the care of a medical toxicologist in an observation unit. A total of 15,562 poisonings were reported to the registry during the study period, of which 340 (2.2 %) involved patients who were cared for in an observation unit. Of these patients, 22.1 % were 18 years of age or younger, and the remaining 77.9 % were greater than 18 years of age. The most common reason for exposure was the intentional ingestion of a pharmaceutical agent in both adult (30.2 %) and pediatric patients (36.0 %). Alcohols (ethanol) (24.9 %), opioids (20.0 %), and sedative-hypnotics (17.7 %) were the most common agent classes involved in adult patient exposures. The most common agent classes involved in pediatric exposures were antidepressants (12.0 %), anticonvulsants (10.7 %), and envenomations (10.7 %). In adult patients, the most common signs and symptoms involved the nervous system (52.0 %), a toxidrome (17.0 %), or a major vital sign abnormality (14.7 %). In pediatric patients, the most common signs and symptoms involved the nervous system (53.3 %), a toxidrome (21.3 %), or a major vital sign abnormality (17.3 %). The results of this study demonstrate that a wide variety of poisoned patients have been cared for in an observation unit in consultation with a board-certified medical toxicologist. Patterns for the reasons for exposure, agents responsible for the exposure, and toxicological treatments will continue to evolve. Further study is needed to identify better those poisoned patients who can be appropriately managed in an observation unit.

Common plant toxicology: A comparison of national and Southwest Ohio data trends on plant poisonings in the 21st century

DOE Office of Scientific and Technical Information (OSTI.GOV)

Petersen, Dan D., E-mail: petersen.dan@epa.gov

Data from the American Association of Poison Control Centers (AAPCC) and the Cincinnati-based Drug and Poison Information Center (DPIC) were analyzed to determine the incidence and trends of human plant poisonings since the year 2000. Approximately 3.4% of the approximately 4.3 million annual calls to the AAPCC centers involved plants, with a higher fraction (4.5%) for pediatric exposures. Nearly 70% of plant exposures occurred in children under six. Only 8% of cases required treatment in a health-care facility, and only 0.1% (in 2008) were considered severe outcomes. The most prominent groups of plants involved in exposures are those containing oxalates,more » and the most common symptom is gastroenteritis. The top 12 identified plants (in descending order) nationally were Spathiphyllum species (peace lilly), Philodendron species (philodendron), Euphorbia pulcherrima (poinssettia), Ilex species (holly), Phytolacca americana (pokeweed), Toxicodendron radicans (poison ivy), Capsicum (pepper), Ficus (rubber tree, weeping fig), Crassula argentea (jade plant), Diffenbachia (dumb cane), Epipremnum areum (pothos) and Schlumbergera bridesii (Christmas cactus). Broad overlaps between the DPIC and the AAPCC incidence data were noted, with essentially the same plant species in each dataset. The nature of the various toxins, the symptomatology and potential treatments are discussed for the highest ranking plant species.« less

Exposure Calls to U. S. Poison Centers Involving Electronic Cigarettes and Conventional Cigarettes-September 2010-December 2014.

PubMed

Chatham-Stephens, Kevin; Law, Royal; Taylor, Ethel; Kieszak, Stephanie; Melstrom, Paul; Bunnell, Rebecca; Wang, Baoguang; Day, Hannah; Apelberg, Benjamin; Cantrell, Lee; Foster, Howell; Schier, Joshua G

2016-12-01

E-cigarette use is increasing, and the long-term impact on public health is unclear. We described the acute adverse health effects from e-cigarette exposures reported to U.S. poison centers. We compared monthly counts and demographic, exposure, and health effects data of calls about e-cigarettes and conventional cigarettes made to poison centers from September 2010 through December 2014. Monthly e-cigarette calls increased from 1 in September 2010, peaked at 401 in April 2014, and declined to 295 in December 2014. Monthly conventional cigarette calls during the same period ranged from 302 to 514. E-cigarette calls were more likely than conventional cigarette calls to report adverse health effects, including vomiting, eye irritation, and nausea. Five e-cigarette calls reported major health effects, such as respiratory failure, and there were two deaths associated with e-cigarette calls. E-cigarette calls to U.S. poison centers increased over the study period, and were more likely than conventional cigarettes to report adverse health effects. It is important for health care providers and the public to be aware of potential acute health effects from e-cigarettes. Developing strategies to monitor and prevent poisonings from these novel devices is critical.

Pesticide poisoning and respiratory disorders in Colorado farm residents.

PubMed

Beseler, C L; Stallones, L

2009-10-01

Respiratory hazards significantly contribute to the burden of occupational disease among farmers. Pesticide exposure has been linked to an increased prevalence of respiratory symptoms in several farming populations. The purpose of this study was to evaluate the association between respiratory symptoms and pesticide poisoning in a cross-sectional survey of farm residents. A total of 761 farm operators and their spouses, representing 479 farms in northeastern Colorado, were recruited from 1993 to 1997. A personal interview asked whether the resident had experienced a pesticide poisoning and several respiratory conditions including cough, allergy, wheeze, and organic dust toxic syndrome (ODTS). Spirometry testing was performed on 196 individuals. Logistic regression was used to model the association of pesticide poisoning with respiratory conditions, and linear regression was used to model the relationship of pesticide poisoning and forced vital capacity (FVC) and forced expiratory volume (FEV1). In unadjusted models, pesticide poisoning was associated with all four respiratory conditions, and stayed significant in adjusted models of allergies and cough in non-smokers. In age- and gender-adjusted models, pesticide poisoning was significantly associated with lower FVC and FEV1 in current smokers and in those who were not heavy drinkers. Although this study should be reproduced in a larger sample, it suggests that further evaluation of the respiratory effects of pesticide exposure is warranted.

Poisoning Safety Fact Sheet (2015)

MedlinePlus

... in emergency departments after getting into a medication, accounting for 68% of medication-related visits for young ... and under (31% of dosing errors), followed by measurement errors (30%). 2 • For every 10 poison exposures ...

[Poisonings with the herbicides glyphosate and glyphosate-trimesium].

PubMed

Mortensen, O S; Sørensen, F W; Gregersen, M; Jensen, K

2000-08-28

Generally the herbicide glyphosate is considered harmless to humans. Glyphosate-trimesium is labelled harmful (Xn), whereas glyphosate-isopropylamine carries no warning sign. As cases of serious poisoning have emerged contacts to the Poison Information Centre have been reviewed. The persons exposed were mainly smaller children and adults 20 to 59 years of age. Oral exposure was recorded in 47 persons, inhalation exposure in 24 and topical contact in 42. About one fourth of the exposed persons were asymptomatic. Most of the symptomatic poisonings demonstrated complaints from the mouth, the gastrointestinal tract and the airways. Eleven patients were admitted to hospital. Two died, one of them having ingested the isopropylamine salt, the other the trimesium salt. Death ensued quickly in the latter patient. A similar fate was observed in a child--not included in the present material--who had also ingested the trimesium compound.

Workplace chemical and toxin exposures reported to a Poisons Information Centre: a diverse range causing variable morbidity.

PubMed

Ling, Sophia L-Y; McD Taylor, David; Robinson, Jeffery

2018-04-01

The aim of this study is to determine the period prevalence, nature and causes of workplace chemical and toxin exposures reported to the Victorian Poisons Information Centre (VPIC). All cases classified as 'workplace: acute' when entered into the VPIC database (June 2005-December 2013) were analysed. Data were collected on patient sex, the nature of the chemical or toxin, route of exposure and season. Overall, 4928 cases were extracted. Exposures to men (71.5% of calls) differed from women (P<0.001), with most exposures relating to industry/trade substances (23.7%) and cleaners/bleaches/detergents (36.9%), respectively. Ocular (33.2%), inhalational (27.7%) and dermal (22.1%) exposures were most common. Exposures were most common in Spring and most seasonal variation was found for veterinary/animal, agricultural/plant and household categories (P<0.05). In all, 3445 (69.9%) cases had symptoms related to their exposure at the time of the call. However, the proportion of symptomatic cases within the major substance categories differed significantly (P<0.001). Chemicals associated with the most symptoms were cleaners/bleaches/detergents, industrial/trade substances and acids. Mild-moderately important workplace exposures are common. Significant variations exist between the sexes and seasons. Poisons Information Centres may play a role in ongoing surveillance of chemical and toxin exposures and a minimum exposure dataset is recommended.

Accidental Carbon Monoxide Poisoning While Driving: A Case Report With Review of the Literature.

PubMed

Fisher-Hubbard, Amanda O; Appleford, Colin; Kesha, Kilak; Schmidt, Carl J; Gupta, Avneesh

2018-05-16

Carbon monoxide (CO) is the cause of a significant percentage of fatal poisonings in many countries. It is known that fatalities resulting from CO poisoning are underreported and/or misclassified. Carbon monoxide exposure while driving can occur due to faulty exhaust systems, defective ventilation systems, emission from other vehicles, and even cigarette smoking. We report the case of a 23-year-old woman who was involved in a low-speed motor vehicle collision and was found unresponsive in her vehicle due to CO poisoning. A review of the literature revealed rare vehicle-related accidental CO poisonings.

Pesticide exposure in children.

PubMed

Roberts, James R; Karr, Catherine J

2012-12-01

Pesticides are a collective term for a wide array of chemicals intended to kill unwanted insects, plants, molds, and rodents. Food, water, and treatment in the home, yard, and school are all potential sources of children's exposure. Exposures to pesticides may be overt or subacute, and effects range from acute to chronic toxicity. In 2008, pesticides were the ninth most common substance reported to poison control centers, and approximately 45% of all reports of pesticide poisoning were for children. Organophosphate and carbamate poisoning are perhaps the most widely known acute poisoning syndromes, can be diagnosed by depressed red blood cell cholinesterase levels, and have available antidotal therapy. However, numerous other pesticides that may cause acute toxicity, such as pyrethroid and neonicotinoid insecticides, herbicides, fungicides, and rodenticides, also have specific toxic effects; recognition of these effects may help identify acute exposures. Evidence is increasingly emerging about chronic health implications from both acute and chronic exposure. A growing body of epidemiological evidence demonstrates associations between parental use of pesticides, particularly insecticides, with acute lymphocytic leukemia and brain tumors. Prenatal, household, and occupational exposures (maternal and paternal) appear to be the largest risks. Prospective cohort studies link early-life exposure to organophosphates and organochlorine pesticides (primarily DDT) with adverse effects on neurodevelopment and behavior. Among the findings associated with increased pesticide levels are poorer mental development by using the Bayley index and increased scores on measures assessing pervasive developmental disorder, inattention, and attention-deficit/hyperactivity disorder. Related animal toxicology studies provide supportive biological plausibility for these findings. Additional data suggest that there may also be an association between parental pesticide use and adverse birth outcomes including physical birth defects, low birth weight, and fetal death, although the data are less robust than for cancer and neurodevelopmental effects. Children's exposures to pesticides should be limited as much as possible.

Organophosphate acetylcholine esterase inhibitor poisoning from a home-made shampoo

PubMed Central

Sadaka, Yair; Broides, Arnon; Tzion, Raffi Lev; Lifshitz, Matitiahu

2011-01-01

Organophosphate acetylcholine esterase inhibitor poisoning is a major health problem in children. We report an unusual cause of organophosphate acetylcholine esterase inhibitor poisoning. Two children were admitted to the pediatric intensive care unit due to organophosphate acetylcholine esterase inhibitor poisoning after exposure from a home-made shampoo that was used for the treatment of head lice. Owing to no obvious source of poisoning, the diagnosis of organophosphate acetylcholine esterase inhibitor poisoning in one of these patients was delayed. Both patients had an uneventful recovery. Organophosphate acetylcholine esterase inhibitor poisoning from home-made shampoo is possible. In cases where the mode of poisoning is unclear, direct questioning about the use of home-made shampoo is warranted, in these cases the skin and particularly the scalp should be rinsed thoroughly as soon as possible. PMID:21887044

Outdoor Hazards & Preventive Measures: West Nile Virus: A Clinical Commentary for the Camp Health Care Community; Poison Ivy: A Primer for Prevention; Lyme Disease Prevention and Control.

ERIC Educational Resources Information Center

Reynolds, Ellen; Bauer, Holly; Ratner-Connolly, Heidi

2003-01-01

Transmitted by mosquitos, West Nile virus may cause serious illness, but the actual likelihood of infection is low. Prevention, implications, and recommendations for camps are discussed. Poison ivy identification, treatment, and complications are presented; a prevention quiz is included. Signs and symptoms of Lyme disease are described, as are…

Non-health care facility anticonvulsant medication errors in the United States.

PubMed

DeDonato, Emily A; Spiller, Henry A; Casavant, Marcel J; Chounthirath, Thitphalak; Hodges, Nichole L; Smith, Gary A

2018-06-01

This study provides an epidemiological description of non-health care facility medication errors involving anticonvulsant drugs. A retrospective analysis of National Poison Data System data was conducted on non-health care facility medication errors involving anticonvulsant drugs reported to US Poison Control Centers from 2000 through 2012. During the study period, 108,446 non-health care facility medication errors involving anticonvulsant pharmaceuticals were reported to US Poison Control Centers, averaging 8342 exposures annually. The annual frequency and rate of errors increased significantly over the study period, by 96.6 and 76.7%, respectively. The rate of exposures resulting in health care facility use increased by 83.3% and the rate of exposures resulting in serious medical outcomes increased by 62.3%. In 2012, newer anticonvulsants, including felbamate, gabapentin, lamotrigine, levetiracetam, other anticonvulsants (excluding barbiturates), other types of gamma aminobutyric acid, oxcarbazepine, topiramate, and zonisamide, accounted for 67.1% of all exposures. The rate of non-health care facility anticonvulsant medication errors reported to Poison Control Centers increased during 2000-2012, resulting in more frequent health care facility use and serious medical outcomes. Newer anticonvulsants, although often considered safer and more easily tolerated, were responsible for much of this trend and should still be administered with caution.

The growing impact of pediatric pharmaceutical poisoning.

PubMed

Bond, G Randall; Woodward, Randall W; Ho, Mona

2012-02-01

To understand which medications, under which circumstances, are responsible for the noted increase in pediatric medication poisonings, resource use, and morbidity. Patient records from 2001-2008 were obtained from the National Poison Data System of the American Association of Poison Control Centers for children aged ≤5 years evaluated in a health care facility following exposure to a potentially toxic dose of a pharmaceutical agent. Pharmaceutical agents were classified as over-the-counter or prescription and by functional category. Exposures were classified as child self-ingested the medication or as therapeutic error. For the 8-year period, emergency visits, admissions, significant injuries, and trends in these events were calculated for each substance category. We evaluated 453 559 children for ingestion of a single pharmaceutical product. Child self-exposure was responsible for 95% of visits. Child self-exposure to prescription products dominated the health care impact with 248 023 of the visits (55%), 41 847 admissions (76%), and 18 191 significant injuries (71%). The greatest resource use and morbidity followed self-ingestion of prescription products, particularly opioids, sedative-hypnotics, and cardiovascular agents. Prevention efforts have proved to be inadequate in the face of rising availability of prescription medications, particularly more dangerous medications. Copyright © 2012 Mosby, Inc. All rights reserved.

Acute hydrofluoric acid exposure reported to Taiwan Poison Control Center, 1991-2010.

PubMed

Wu, M-L; Yang, C-C; Ger, J; Tsai, W-J; Deng, J-F

2014-05-01

Hydrofluoric acid (HF) is a dangerous chemical that can cause severe cutaneous burns as well as possible systemic toxicity. We retrospectively analyzed all human HF exposure cases reported to the National Poison Control Center of Taiwan between 1991 and 2010. In this 20-year survey, 324 calls were identified, with a majority of dermal exposure (84%). Occupational exposure accounted for 80% of all cases, with workers in semiconductor industry (61%), cleaning industry (15%), chemical or metal industry (13%), and other industries (11%). Electrolyte imbalances were uncommon, hypocalcemia, hypomagnesemia, and hypokalemia were recorded in 8.6%, 1.2%, and 1.5% of all cases, respectively. Most cases (64%) of dermal exposure received antidotal treatment. Treatment modalities of dermal exposure included calcium gluconate soaking, 49.8%; intravenous calcium, 20.6%; and topical use of calcium gluconate gel, 13.9%. Twenty patients (7%) received surgery. Following HF exposure, the majority of patients presented with mild (56.5%) or moderate (36.7%) toxic effects. However, four patients were severely intoxicated; two patients died of HF-related dysrhythmia and shock. Significant symptomology may occur following HF exposure, and most of the HF exposure required hospitals evaluation. Calcium gluconate soaks appear to be effective in reducing local pain and tissue damage. Hyperkalemia should not be overemphasized as a common finding in HF exposure, hypokalemia tends to occur in cases of severe HF poisoning.

[A study of 355 consecutive acute poisoning cases admitted to an emergency ward at Copenhagen University Hospital, Bispebjerg in 2001].

PubMed

Gude, Anne-Bolette Jill; Hoegberg, Lotte C G; Pedersen, Michael; Nielsen, Jonas; Angelo, Helle R; Christensen, Hanne Rolighed

2007-05-07

Epidemiology describing poisoned patients treated at Copenhagen University Hospital, Bispebjerg has not been published since 1993. We wanted to describe the pattern of intoxications. A retrospective study of poisoned patients admitted to the emergency ward during 2001. A computer search of patients discharged with codes T36.0-T65.9 was supplemented by a hand search of the daily admittance lists. 355 patients with confirmed poisonings were found. 97% were poisoned by medications, alcohol (ethanol) or drugs of abuse. Only 3% were poisoned by other agents such as CO. 55% of poisonings were intentional, where paracetamol and benzodiazepines were the preferred agents. Sedative-hypnotics, alcohol, opioids, and drugs of abuse dominated the unintentional overdoses. Patients poisoned by paracetamol were younger and female, with an overrepresentation of young women of foreign origin. Activated charcoal was the preferred method of gastric decontamination. In 52% of the cases various discrepancies between discharge codes and actual poisonings were found. There were 5 deaths, 2 of which were from mixed overdoses with benzodiazepines involving the administration of flumazenil. The 355 cases represented 6% of all patients admitted to the department. Paracetamol, sedative-hypnotics and alcohol were the most common poisoning agents. Mortality was 1%. A general problem of discharge coding was found, which might implicate unreliability in statistics in this field.

Using Poison Center Exposure Calls to Predict Methadone Poisoning Deaths

PubMed Central

Dasgupta, Nabarun; Davis, Jonathan; Jonsson Funk, Michele; Dart, Richard

2012-01-01

Purpose There are more drug overdose deaths in the Untied States than motor vehicle fatalities. Yet the US vital statistics reporting system is of limited value because the data are delayed by four years. Poison centers report data within an hour of the event, but previous studies suggested a small proportion of poisoning deaths are reported to poison centers (PC). In an era of improved electronic surveillance capabilities, exposure calls to PCs may be an alternate indicator of trends in overdose mortality. Methods We used PC call counts for methadone that were reported to the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System in 2006 and 2007. US death certificate data were used to identify deaths due to methadone. Linear regression was used to quantify the relationship of deaths and poison center calls. Results Compared to decedents, poison center callers tended to be younger, more often female, at home and less likely to require medical attention. A strong association was found with PC calls and methadone mortality (b = 0.88, se = 0.42, t = 9.5, df = 1, p<0.0001, R2 = 0.77). These findings were robust to large changes in a sensitivity analysis assessing the impact of underreporting of methadone overdose deaths. Conclusions Our results suggest that calls to poison centers for methadone are correlated with poisoning mortality as identified on death certificates. Calls received by poison centers may be used for timely surveillance of mortality due to methadone. In the midst of the prescription opioid overdose epidemic, electronic surveillance tools that report in real-time are powerful public health tools. PMID:22829925

Calls to Florida Poison Control Centers about mercury: Trends over 2003-2013.

PubMed

Gribble, Matthew O; Deshpande, Aniruddha; Stephan, Wendy B; Hunter, Candis M; Weisman, Richard S

2017-11-01

The aim of this analysis was to contrast trends in exposure-report calls and informational queries (a measure of public interest) about mercury to the Florida Poison Control Centers over 2003-2013. Poison-control specialists coded calls to Florida Poison Control Centers by substance of concern, caller demographics, and whether the call pertained to an exposure event or was an informational query. For the present study, call records regarding mercury were de-identified and provided along with daily total number of calls for statistical analysis. We fit Poisson models using generalized estimating equations to summarize changes across years in counts of daily calls to Florida Poison Control Centers, adjusting for month. In a second stage of analysis, we further adjusted for the total number of calls each day. We also conducted analyses stratified by age of the exposed. There was an overall decrease over 2003-2013 in the number of total calls about mercury [Ratio per year: 0.89, 95% CI: (0.88, 0.90)], and calls about mercury exposure [Ratio per year: 0.84, 95% CI: (0.83, 0.85)], but the number of informational queries about mercury increased over this time [Ratio per year: 1.15 (95% CI: 1.12, 1.18)]. After adjusting for the number of calls of that type each day (e.g., call volume), the associations remained similar: a ratio of 0.88 (95% CI: 0.87, 0.89) per year for total calls, 0.85 (0.83, 0.86) for exposure-related calls, and 1.17 (1.14, 1.21) for informational queries. Although, the number of exposure-related calls decreased, informational queries increased over 2003-2013. This might suggest an increased public interest in mercury health risks despite a decrease in reported exposures over this time period. Copyright © 2017 Elsevier Inc. All rights reserved.

Knowns and unknowns on burden of disease due to chemicals: a systematic review

PubMed Central

2011-01-01

Background Continuous exposure to many chemicals, including through air, water, food, or other media and products results in health impacts which have been well assessed, however little is known about the total disease burden related to chemicals. This is important to know for overall policy actions and priorities. In this article the known burden related to selected chemicals or their mixtures, main data gaps, and the link to public health policy are reviewed. Methods A systematic review of the literature for global burden of disease estimates from chemicals was conducted. Global disease due to chemicals was estimated using standard methodology of the Global Burden of Disease. Results In total, 4.9 million deaths (8.3% of total) and 86 million Disability-Adjusted Life Years (DALYs) (5.7% of total) were attributable to environmental exposure and management of selected chemicals in 2004. The largest contributors include indoor smoke from solid fuel use, outdoor air pollution and second-hand smoke, with 2.0, 1.2 and 0.6 million deaths annually. These are followed by occupational particulates, chemicals involved in acute poisonings, and pesticides involved in self-poisonings, with 375,000, 240,000 and 186,000 annual deaths, respectively. Conclusions The known burden due to chemicals is considerable. This information supports decision-making in programmes having a role to play in reducing human exposure to toxic chemicals. These figures present only a number of chemicals for which data are available, therefore, they are more likely an underestimate of the actual burden. Chemicals with known health effects, such as dioxins, cadmium, mercury or chronic exposure to pesticides could not be included in this article due to incomplete data and information. Effective public health interventions are known to manage chemicals and limit their public health impacts and should be implemented at national and international levels. PMID:21255392

Exposure to Elevated Carbon Monoxide Levels at an Indoor Ice Arena--Wisconsin, 2014.

PubMed

Creswell, Paul D; Meiman, Jon G; Nehls-Lowe, Henry; Vogt, Christy; Wozniak, Ryan J; Werner, Mark A; Anderson, Henry

2015-11-20

On December 13, 2014, the emergency management system in Lake Delton, Wisconsin, was notified when a male hockey player aged 20 years lost consciousness after participation in an indoor hockey tournament that included approximately 50 hockey players and 100 other attendees. Elevated levels of carbon monoxide (CO) (range = 45 ppm-165 ppm) were detected by the fire department inside the arena. The emergency management system encouraged all players and attendees to seek medical evaluation for possible CO poisoning. The Wisconsin Department of Health Services (WDHS) conducted an epidemiologic investigation to determine what caused the exposure and to recommend preventive strategies. Investigators abstracted medical records from area emergency departments (EDs) for patients who sought care for CO exposure during December 13-14, 2014, conducted a follow-up survey of ED patients approximately 2 months after the event, and conducted informant interviews. Ninety-two persons sought ED evaluation for possible CO exposure, all of whom were tested for CO poisoning. Seventy-four (80%) patients had blood carboxyhemoglobin (COHb) levels consistent with CO poisoning; 32 (43%) CO poisoning cases were among hockey players. On December 15, the CO emissions from the propane-fueled ice resurfacer were demonstrated to be 4.8% of total emissions when actively resurfacing and 2.3% when idling, both above the optimal range of 0.5%-1.0%. Incomplete fuel combustion by the ice resurfacer was the most likely source of elevated CO. CO poisonings in ice arenas can be prevented through regular maintenance of ice resurfacers, installation of CO detectors, and provision of adequate ventilation.

Use of Fomepizole in Pediatric Methanol Exposure: The First Case Report in Taiwan and a Literature Review.

PubMed

Chen, Tzu-Hua; Kuo, Chang-Hung; Huang, Chia-Tsuan; Wang, Wei-Li

2016-08-01

Methanol poisoning is rare in the pediatric population, but a delay in diagnosis and intervention may cause severe morbidity and mortality. The current therapy for methanol poisoning is ethanol or fomepizole, which acts as a competitive inhibitor of hepatic alcohol dehydrogenase to inhibit the production of toxic metabolites derived from the oxidation of methanol. However, clinical experience in pediatric methanol poisoning is limited, and the safety profiles of the antidotes have not been established in children, especially in Asian populations. This is the first case to describe the use of fomepizole in a child with methanol exposure in Taiwan. Copyright © 2013. Published by Elsevier B.V.

Hospital Performance Indicators and Their Associated Factors in Acute Child Poisoning at a Single Poison Center, Central Saudi Arabia

PubMed Central

Alanazi, Menyfah Q.; Al-Jeriasy, Majed I.; Al-Assiri, Mohammed H.; Afesh, Lara Y.; Alhammad, Fahad; Salam, Mahmoud

2015-01-01

Abstract Admission rate and length of stay (LOS) are two hospital performance indicators that affect the quality of care, patients’ satisfaction, bed turnover, and health cost expenditures. The aim of the study was to identify factors associated with higher admission rates and extended average LOS among acutely poisoned children at a single poison center, central Saudi Arabia. This is a cross-sectional, poison and medical chart review between 2009 and 2011. Exposures were child characteristics, that is, gender, age, body mass index (BMI), health history, and Canadian 5-level triage scale. Poison incident characteristics were, that is, type, exposure route, amount, form, home remedy, and arrival time to center. Admission status and LOS were obtained from records. Chronic poisoning, plant allergies, and venomous bites were excluded. Bivariate and regression analyses were applied. Significance at P < 0.05. Of the 315 eligible cases, (72%) were toddlers with equal gender distribution, (58%) had normal BMI, and (77%) were previously healthy. Poison substances were pharmaceutical drugs (63%) versus chemical products (37%). Main exposure route was oral (98%). Home remedy was observed in (21.9%), which were fluids, solutes, and/or gag-induced vomiting. Almost (52%) arrived to center >1 h. Triage levels: non-urgent cases (58%), less urgent (11%), urgent (18%), emergency (12%), resuscitative (1%). Admission rate was (20.6%) whereas av. LOS was 13 ± 22 h. After adjusting and controlling for confounders, older children (adj.OR = 1.19) and more critical triage levels (adj.OR = 1.35) were significantly associated with higher admission rates compared to younger children and less critical triage levels (adj.P = 0.006) and (adj.P = 0.042) respectively. Home remedy prior arrival was significantly associated with higher av. LOS (Beta = 9.48, t = 2.99), compared to those who directly visited the center, adj.P = 0.003. Hospital administrators are cautioned that acutely poisoned children who received home remedies prior arrival are more likely to endure an extended LOS. This non-conventional practice is not recommended. PMID:26717371

The persistent problem of lead poisoning in birds from ammunition and fishing tackle

USGS Publications Warehouse

Haig, Susan M.; D'Elia, Jesse; Eagles-Smith, Collin A.; Fair, Jeanne M.; Gervais, Jennifer; Herring, Garth; Rivers, James W.; Schulz, John H.

2014-01-01

Lead (Pb) is a metabolic poison that can negatively influence biological processes, leading to illness and mortality across a large spectrum of North American avifauna (>120 species) and other organisms. Pb poisoning can result from numerous sources, including ingestion of bullet fragments and shot pellets left in animal carcasses, spent ammunition left in the field, lost fishing tackle, Pb-based paints, large-scale mining, and Pb smelting activities. Although Pb shot has been banned for waterfowl hunting in the United States (since 1991) and Canada (since 1999), Pb exposure remains a problem for many avian species. Despite a large body of scientific literature on exposure to Pb and its toxicological effects on birds, controversy still exists regarding its impacts at a population level. We explore these issues and highlight areas in need of investigation: (1) variation in sensitivity to Pb exposure among bird species; (2) spatial extent and sources of Pb contamination in habitats in relation to bird exposure in those same locations; and (3) interactions between avian Pb exposure and other landscape-level stressors that synergistically affect bird demography. We explore multiple paths taken to reduce Pb exposure in birds that (1) recognize common ground among a range of affected interests; (2) have been applied at local to national scales; and (3) engage governmental agencies, interest groups, and professional societies to communicate the impacts of Pb ammunition and fishing tackle, and to describe approaches for reducing their availability to birds. As they have in previous times, users of fish and wildlife will play a key role in resolving the Pb poisoning issue.

Multiple pesticide residues in live and poisoned honeybees - Preliminary exposure assessment.

PubMed

Kiljanek, Tomasz; Niewiadowska, Alicja; Gaweł, Marta; Semeniuk, Stanisław; Borzęcka, Milena; Posyniak, Andrzej; Pohorecka, Krystyna

2017-05-01

Study combines data about the exposure of honeybees to pesticides from plant protection products and veterinary medicinal products. Residues of 200 pesticide and pesticide metabolites in 343 live and 74 poisoned honeybee samples, obtained during the years of 2014-2015, were determined by LC-MS/MS and GC-MS/MS. In 44% of live honeybee 48 different pesticide residues were found, mainly amitraz metabolites (DMF, DMPF) and chlorpyrifos. In 98% of poisoned honeybee 57 pesticides and metabolites were detected, mainly chlorpyrifos, dimethoate and clothianidin. In total 84 different pesticides were detected both in live and poisoned honeybees, they indicate 30 various modes of action. Differences between mean number of pesticide residues detected in live and poisoned honeybees clearly indicate the impact of multiple pesticides on honeybee health. Possible impact of systemic fungicides on the health of honeybees was studied. Applicability of hazard quotient counted as ratio between concentration of pesticides in honeybees and lethal dose in the interpretation whether detected concentration indicates acute toxic effects was shown. Copyright © 2017 Elsevier Ltd. All rights reserved.

Post-exposure therapy with recombinant human BuChE following percutaneous VX challenge in guinea-pigs

PubMed Central

Mumford, Helen; Troyer, John K.

2011-01-01

Poisoning by nerve agents via the percutaneous (p.c.) route is an issue because the slow absorption of agent could result in poisoning which outlasts the protection provided by conventional pharmacological therapy. The bioscavenger approach is based on the concept of binding nerve agent in the bloodstream, thus preventing nerve agent from reaching the target tissues and inhibiting acetylcholinesterase activity. One bioscavenger that has been extensively studied is human butyrylcholinesterase (huBuChE). Protexia® is a pegylated form of recombinant huBuChE. We used a guinea-pig model of p.c. nerve agent poisoning, using an implanted telemetry system to collect physiological data. Guinea-pigs were poisoned with the nerve agent VX (0.74 mg/kg) (~2.5×LD50). Two hours following VX exposure, Protexia (72 mg/kg) or saline control was administered intramuscularly. All guinea-pigs treated with Protexia (n=8) survived, compared to no survivors in a saline-treated control group (n=8). Survival following VX and Protexia treatment was associated with minimal incapacitation and observable signs of poisoning, and the mitigation or prevention of the detrimental physiological changes (e.g. seizure, bradycardia and hypothermia) observed in control animals. The opportunity for post-exposure treatment may have utility in both civilian and military scenarios, and this is a promising indication for the use of a bioscavenger. PMID:21620937

Common plant toxicology: a comparison of national and southwest Ohio data trends on plant poisonings in the 21st century.

PubMed

Petersen, Dan D

2011-07-15

Data from the American Association of Poison Control Centers (AAPCC) and the Cincinnati-based Drug and Poison Information Center (DPIC) were analyzed to determine the incidence and trends of human plant poisonings since the year 2000. Approximately 3.4% of the approximately 4.3 million annual calls to the AAPCC centers involved plants, with a higher fraction (4.5%) for pediatric exposures. Nearly 70% of plant exposures occurred in children under six. Only 8% of cases required treatment in a health-care facility, and only 0.1% (in 2008) were considered severe outcomes. The most prominent groups of plants involved in exposures are those containing oxalates, and the most common symptom is gastroenteritis. The top 12 identified plants (in descending order) nationally were Spathiphyllum species (peace lilly), Philodendron species (philodendron), Euphorbia pulcherrima (poinssettia), Ilex species (holly), Phytolacca americana (pokeweed), Toxicodendron radicans (poison ivy), Capsicum (pepper), Ficus (rubber tree, weeping fig), Crassula argentea (jade plant), Diffenbachia (dumb cane), Epipremnum areum (pothos) and Schlumbergera bridesii (Christmas cactus). Broad overlaps between the DPIC and the AAPCC incidence data were noted, with essentially the same plant species in each dataset. The nature of the various toxins, the symptomatology and potential treatments are discussed for the highest ranking plant species. Copyright © 2011 Elsevier Inc. All rights reserved.

[Delayed neurological syndrome following carbon monoxide poisoning].

PubMed

Vázquez-Lima, Manuel J; Álvarez-Rodríguez, Cesáreo; Cruz-Landeira, Angelines; López-Rivadulla, Manuel

2015-08-16

Poisoning by carbon monoxide is the most frequent form of intoxication in our milieu as a result of exposure to poisonous gases. The effects of carbon monoxide poisoning are not limited to acute exposure, since, following apparent recovery from the acute intoxication, neurological or behavioural disorders may appear. A study was conducted to examine the cases of carbon monoxide poisoning that had occurred in a healthcare area of 80,000 inhabitants over a 10-year period. These patients were then submitted to a follow-up to appraise the appearance of delayed neurological syndrome (DNS) and its relationship with different variables in the initial exposure to the carbon monoxide, in the treatment that was administered or in the severity of the intoxication. It was observed that around 9.1% of those intoxicated by carbon dioxide detected within the healthcare district of Salnés went on to develop DNS, which is more frequent in patients with severe analytical criteria and very unlikely in those who do not have them. Patients with DNS did not express any clinical or analytical manifestations that differed from those who did not have the syndrome; no differences were observed in relation to the oxygen therapy that was administered. The rate of DNS within the healthcare district of Salnés between 2002 and 2012 is 0.84 cases per 100,000 inhabitants per year.

Lead exposure in raptors from Japan and source identification using Pb stable isotope ratios.

PubMed

Ishii, Chihiro; Nakayama, Shouta M M; Ikenaka, Yoshinori; Nakata, Hokuto; Saito, Keisuke; Watanabe, Yukiko; Mizukawa, Hazuki; Tanabe, Shinsuke; Nomiyama, Kei; Hayashi, Terutake; Ishizuka, Mayumi

2017-11-01

Lead (Pb) poisoning is widespread among raptors and water birds. In Japan, fragments of Pb ammunition are still found in endangered eagles although more than 10 years have passed since legislation regarding use of Pb ammunition was introduced. This study was performed to investigate Pb exposure in raptors from various locations in Japan. We measured hepatic and renal Pb concentrations and hepatic Pb isotope ratios of Steller's sea eagles (Haliaeetus pelagicus), white-tailed sea eagles (Haliaeetus albicilla), golden eagles (Aquila chrysaetos), and 13 other species (total 177 individuals) that were found dead, as well as blood samples from three eagles found in a weakened state during 1993-2015 from Hokkaido (northern part), Honshu (the main island), and Shikoku (a southern island) of Japan. In the present study in Hokkaido, one quarter of the sea eagles showed a high Pb concentration, suggesting exposure to abnormally high Pb levels and Pb poisoning. Pb isotope ratios indicated that endangered Steller's sea eagle and white-tailed sea eagle were poisoned by Pb ammunition that was used illegally in Hokkaido. In other areas of Japan, both surveillance and regulations were less extensive than in Hokkaido, but Pb poisoning in raptors was also noted. Therefore, Pb poisoning is still a serious problem in raptors in various areas of Japan due to accidental ingestion of materials containing Pb, especially Pb ammunition. Copyright © 2017. Published by Elsevier Ltd.

Cardiovascular Abnormalities in Carbon Monoxide Poisoning.

PubMed

Garg, Jalaj; Krishnamoorthy, Parasuram; Palaniswamy, Chandrasekar; Khera, Sahil; Ahmad, Hasan; Jain, Diwakar; Aronow, Wilbert S; Frishman, William H

Acute carbon monoxide (CO) poisoning is the most common cause of poisoning and poisoning-related death in the United States. It manifests as broad spectrum of symptoms ranging from mild headache, nausea, and fatigue to dizziness, syncope, coma, seizures resulting in cardiovascular collapse, respiratory failure, and death. Cardiovascular complications of CO poisoning has been well reported and include myocardial stunning, left ventricular dysfunction, pulmonary edema, and arrhythmias. Acute myocardial ischemia has also been reported from increased thrombogenicity due to CO poisoning. Myocardial toxicity from CO exposure is associated with increased short-term and long-term mortality. Carboxyhemoglobin (COHb) levels do not correlate well with the clinical severity of CO poisoning. Supplemental oxygen remains the cornerstone of therapy for CO poisoning. Hyperbaric oxygen therapy increases CO elimination and has been used with wide variability in patients with evidence of neurological and myocardial injury from CO poisoning, but its benefit in limiting or reversing cardiac injury is unknown. We present a comprehensive review of literature on cardiovascular manifestations of CO poisoning and propose a diagnostic algorithm for managing patients with CO poisoning.

Investigation of Childhood Lead Poisoning from Parental Take-Home Exposure from an Electronic Scrap Recycling Facility — Ohio, 2012.

PubMed

Newman, Nick; Jones, Camille; Page, Elena; Ceballos, Diana; Oza, Aalok

2015-07-17

Lead affects the developing nervous system of children, and no safe blood lead level (BLL) in children has been identified. Elevated BLLs in childhood are associated with hyperactivity, attention problems, conduct problems, and impairment in cognition. Young children are at higher risk for environmental lead exposure from putting their hands or contaminated objects in their mouth. Although deteriorating lead paint in pre-1979 housing is the most common source of lead exposure in children, data indicate that ≥30% of children with elevated BLLs were exposed through a source other than paint. Take-home contamination occurs when lead dust is transferred from the workplace on employees' skin, clothing, shoes, and other personal items to their car and home. Recycling of used electronics (e-scrap) is a relatively recent source of exposure to developmental neurotoxicants, including lead. In 2010, the Cincinnati Health Department and Cincinnati Children's Hospital Pediatric Environmental Health Specialty Unit (PEHSU) investigated two cases of childhood lead poisoning in a single family. In 2012, CDC's National Institute for Occupational Safety and Health (NIOSH) learned about the lead poisonings during an evaluation of the e-scrap recycling facility where the father of the two children with lead poisoning worked. This report summarizes the case investigation. Pediatricians should ask about parents' occupations and hobbies that might involve lead when evaluating elevated BLLs in children, in routine lead screening questionnaires, and in evaluating children with signs or symptoms of lead exposure.

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

PubMed

Borron, Stephen W; Watts, Susan H; Herrera, Jessica; Larson, Joshua; Baeza, Salvador; Kingston, Richard L

2018-05-21

The ill-defined term "energy drink" includes a disparate group of products (beverages, shots, concentrates, and workout powders) having large differences in caffeine content and concentration and intended use. Hence, inaccurate conclusions may be drawn when describing adverse events associated with "energy drinks". The FDA is considering new regulation of these products but product specificity is needed to evaluate safety. To help address this, we queried Texas Poison Center Network data for single substance exposures to "energy drinks" from 2010 to 2014, then analyzed adverse events by product type. We specifically compared energy beverage exposures with sales data for the same time period to evaluate the safety profile of this category of energy drinks. Among 855 documented "energy drink" exposures, poison center-determined outcome severity revealed 291 with no/minimal effects, 417 judged nontoxic or minor/not followed, 64 moderate and 4 major effects, and no deaths. Serious complications included 2 seizures and 1 episode of ventricular tachycardia. Outcome severity by category for beverages: 11 moderate/1 major effects (none in children <17 years); shots: 19 moderate/2 major; non-liquids: 16 moderate/1 major; concentrates: 7 moderate; unknown: 10 moderate. Call incidence to poison centers for beverage type exposures was 0.58 (for moderate effects) and 0.053 (for major) per hundred million units sold. Small volume and concentrated products were associated with a greater number of adverse effects than beverage versions of "energy drinks". Copyright © 2018 Elsevier Inc. All rights reserved.

American association of poison control centers database characterization of human tilmicosin exposures, 2001-2005.

PubMed

Oakes, Jennifer; Seifert, Steven

2008-12-01

Tilmicosin is a veterinary antibiotic with significant human toxicity at doses commonly used in animals, but the parenteral dose-response relationship has not been well characterized. Human exposures to tilmicosin in the database of the American Association of Poison Control Centers (AAPCC) from 2001 to 2005 were analyzed for demographic associations, exposure dose, clinical effects and outcomes. Over the 5-year period, there were 1,291 single-substance human exposures to tilmicosin. The mean age was 39.1 years, and 80% were male. By route there were 768 (54%) parenteral exposures. Patients with parenteral exposures had a significantly increased likelihood of being seen at a healthcare facility, admission, and admission to an ICU. With nonparenteral exposure, most had no clinical effects or minor effects, and there were no major effects or deaths. With parenteral exposure, moderate effects occurred in 46 (6%), major effects in 2 (0.3%) and there were 4 (0.5%) deaths, two of which were suicides. A dose-response relationship could be demonstrated. Clinical effect durations of up to a week occurred at even the lowest dose range. Over 250 cases of human tilmicosin exposure are reported to poison centers per year and over 150 of those are parenteral. Most exposures produce no or minor effects, but fatalities have occurred with parenteral exposure. The case fatality rate in parenteral exposures is 10 times the case fatality rate for all human exposures in the AAPCC database. Significant adverse and prolonged effects are reported at parenteral doses > 0.5 mL, suggesting that all parenteral exposures should be referred for healthcare facility evaluation.

Carbon disulfide exposure estimate and prevalence of chronic diseases after carbon disulfide poisoning-related occupational diseases.

PubMed

Chung, Hweemin; Youn, Kanwoo; Kim, Kyuyeon; Park, Kyunggeun

2017-01-01

In Korea, Carbon disulfide (CS 2 ) toxicity was an important social problem from the late 1980s to the early 1990s but there have been few large-scale studies examining the prevalence of diseases after CS 2 exposure discontinuance. So we investigated past working exposure to CS 2 characteristics from surviving ex-workers of a rayon manufacturing plant including cumulative CS 2 exposure index. Furthermore, we studied the prevalence of their chronic diseases recently after many years. We interviewed 633 ex-workers identified as CS 2 poisoning-related occupational diseases to determine demographic and occupational characteristics and reviewed their medical records. The work environment measurement data from 1992 was used as a reference. Based on the interviews and foreign measurement documents, weights were assigned to the reference concentrations followed by calculation of individual exposure index, the sum of the portion of each time period multiplied by the concentrations of CS 2 during that period. The cumulative exposure index was 128.2 ppm on average. Workers from the spinning, electrical equipment repair, and motor repair departments were exposed to high concentrations of ≥10 ppm. Workers from the maintenance of the ejector, manufacturing of CS 2, post-process, refining, maintenance and manufacturing of viscose departments were exposed to low concentrations below 10 ppm. The prevalence for hypertension, coronary artery disease, cerebrovascular disease, diabetes, arrhythmia, psychoneurotic disorder, disorders of the nervous system and sensory organ were 69.2%, 13.9%, 24.8%, 24.5%, 1.3%, 65.7%, 72.4% respectively. We estimated the individual cumulative CS 2 exposure based on interviews and foreign measurement documents, and work environment measurement data. Comparing the work environment measurement data from 1992, these values were similar to them. After identified as CS 2 poisoning, there are subjects over 70 years of average age with disorders of the nervous system and sensory organs, hypertension, psychoneurotic disorder, cerebrovascular disease, diabetes, coronary artery disease, and arrhythmia. Because among ex-workers of the rayon manufacturing plant, only 633 survivors recognized as CS 2 poisoning were studied, the others not identified as CS 2 poisoning should also be investigated in the future.

User behaviour, best practice and the risks of non-target exposure associated with anticoagulant rodenticide use.

PubMed

Tosh, David G; Shore, Richard F; Jess, Stephen; Withers, Alan; Bearhop, Stuart; Ian Montgomery, W; McDonald, Robbie A

2011-06-01

Usage of anticoagulant rodenticides (ARs) is an integral component of modern agriculture and is essential for the control of commensal rodent populations. However, the extensive deployment of ARs has led to widespread exposure of a range of non-target predatory birds and mammals to some compounds, in particular the second-generation anticoagulant rodenticides (SGARs). As a result, there has been considerable effort placed into devising voluntary best practice guidelines that increase the efficacy of rodent control and reduce the risk of non-target exposure. Currently, there is limited published information on actual practice amongst users or implementation of best practice. We assessed the behaviour of a typical group of users using an on-farm questionnaire survey. Most baited for rodents every year using SGARs. Most respondents were apparently aware of the risks of non-target exposure and adhered to some of the best practice recommendations but total compliance was rare. Our questionnaire revealed that users of first generation anticoagulant rodenticides rarely protected or checked bait stations, and so took little effort to prevent primary exposure of non-targets. Users almost never searched for and removed poisoned carcasses and many baited for prolonged periods or permanently. These factors are all likely to enhance the likelihood of primary and secondary exposure of non-target species. Copyright © 2010. Published by Elsevier Ltd.

Occupational phosphine gas poisoning at veterinary hospitals from dogs that ingested zinc phosphide--Michigan, Iowa, and Washington, 2006-2011.

PubMed

2012-04-27

Zinc phosphide (Zn3P2) is a readily available rodenticide that, on contact with stomach acid and water, produces phosphine (PH3), a highly toxic gas. Household pets that ingest Zn3P2 often will regurgitate, releasing PH3 into the air. Veterinary hospital staff members treating such animals can be poisoned from PH3 exposure. During 2006-2011, CDC's National Institute for Occupational Safety and Health (NIOSH) received reports of PH3 poisonings at four different veterinary hospitals: two in Michigan, one in Iowa, and one in Washington. Each of the four veterinary hospitals had treated a dog that ingested Zn3P2. Among hospital workers, eight poisoning victims were identified, all of whom experienced transient symptoms related to PH3 inhalation. All four dogs recovered fully. Exposure of veterinary staff members to PH3 can be minimized by following phosphine product precautions developed by the American Veterinary Medical Association (AVMA). Exposure of pets, pet owners, and veterinary staff members to PH3 can be minimized by proper storage, handling, and use of Zn3P2 and by using alternative methods for gopher and mole control, such as snap traps.

A Penny and a Half and a Pool: Lead Poisoning and Its Impact on Academic Achievement

ERIC Educational Resources Information Center

Gehrman, Matthew Paul

2011-01-01

Lead is a neurotoxin that has been shown to have a long and lasting impact on the brains, bodies, and behaviors of those who are poisoned. It also has a greater presence in communities with high levels of poverty and minority populations. Compounded over time, the effects of lead poisoning, even at low levels of exposure, impact a child's…

Flumazenil administration in poisoned pediatric patients.

PubMed

Kreshak, Allyson A; Tomaszewski, Christian A; Clark, Richard F; Cantrell, F Lee

2012-05-01

The goal of this retrospective cohort study of pediatric patients exposed to flumazenil was to identify the frequency of seizures. Included patient were those aged 12 years or younger who received flumazenil, who had evidence of clinical poisoning as defined by an altered mental status, and who were reported to the California Poison Control System for the period 1999 to 2008. Data variables were age, sex, seizure, death, acute exposure to a benzodiazepine, drugs of exposure, long-term use of benzodiazepines, history of a seizure disorder, mental status before flumazenil administration, and poison center recommendation of flumazenil (yes/no). Eighty-three patients were included. Forty-eight (58%) of this subset were female. Median age was 2 years (range, 3 months-12 years). Seventy (84%) patients were younger than 5 years. Of the 83 patients, 68 (82%) were allegedly exposed to a benzodiazepine; whereas, 12 (15%) had been allegedly exposed to a proconvulsant drug. No flumazenil-related seizures occurred (0% with 95% confidence interval, 0%-4%). The California Poison Control System recommended flumazenil use in 60 (72%) of the 83 cases, and 48 of these had been allegedly exposed to a benzodiazepine. No flumazenil-associated seizures occurred among allegedly benzodiazepine- and non-benzodiazepine-poisoned pediatric patients aged 12 years or younger.

The therapeutic use of localized cooling in the treatment of VX poisoning.

PubMed

Sawyer, T W; Mikler, J; Worek, F; Reiter, G; Thiermann, H; Tenn, C; Weatherby, K; Bohnert, S

2011-07-04

The organophosphate (OP) nerve agent VX is a weaponized chemical warfare agent that has also been used by terrorists against civilians. This contact poison produces characteristic signs of OP poisoning, including miosis, salivation, mastication, dysrhythmias and respiratory distress prior to death. Although successful treatment of OP poisoning can be obtained through decontamination and/or oxime reactivation of agent-inhibited cholinesterase, medical countermeasures that increase the therapeutic window for these measures would be of benefit. An anaesthetized swine model was utilized to examine the effects of lethal VX exposure to the skin, followed by cooling the exposure site prior to decontamination or treatment. The cooling was simply accomplished by using crushed ice in grip-seal plastic bags applied to the exposure sites. Cooling of skin exposed to lethal doses of VX significantly increased the window of opportunity for successful decontamination using the Reactive Skin Decontaminant Lotion(®) (RSDL(®)) or treatment with the oxime antidotes HI-6 and 2PAM. Analyses of blood VX levels showed that cooling acted to slow or prevent the entry of VX into the bloodstream from the skin. If the exposure site is known, the simple and non-invasive application of cooling provides a safe means with which to dramatically increase the therapeutic window in which decontamination and/or antidote treatment against VX are life-saving. Copyright © 2011. Published by Elsevier Ireland Ltd.

Cases of acute mercury poisoning by mercury vapor exposure during the demolition of a fluorescent lamp factory.

PubMed

Do, Sang Yoon; Lee, Chul Gab; Kim, Jae Yoon; Moon, Young Hoon; Kim, Min Sung; Bae, In Ho; Song, Han Soo

2017-01-01

In 2015, workers dismantling a fluorescent lamp factory in Korea were affected by mercury poisoning from exposure to mercury vapor. Eighteen out of the 21 workers who participated in the demolition project presented with symptoms of poisoning and, of these, 10 had persistent symptoms even at 18 months after the initial exposure to mercury vapor. Early symptoms of 18 workers included a general skin rash, pruritus, myalgia, sleep disturbance, and cough and sputum production. Following alleviation of these initial symptoms, late symptoms, such as easy fatigue, insomnia, bad dreams, and anxiety disorder, began to manifest in 10 out of 18 patients. Seven workers underwent psychiatric care owing to sleep disturbance, anxiety disorder, and depression, and three workers underwent dermatologic treatment for hyperpigmentation, erythematous skin eruption, and chloracne-like skin lesions. Furthermore, three workers developed a coarse jerky movement, two had swan neck deformity of the fingers, and two received care at an anesthesiology clinic for paresthesia, such as burning sensation, cold sensation, and pain. Two workers underwent urologic treatment for dysfunction of the urologic system and impotence. However, symptomatic treatment did not result in satisfactory relief of these symptoms. Awareness of the perils of mercury and prevention of mercury exposure are critical for preventing health hazards caused by mercury vapor. Chelation therapy should be performed promptly following mercury poisoning to minimize damage.

2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st Annual Report

PubMed Central

Mowry, James B.; Spyker, Daniel A.; Cantilena, Louis R.; McMillan, Naya; Ford, Marsha

2014-01-01

ABSTRACT Background: This is the 31st Annual Report of the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NPDS). As of January 1, 2013, 57 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 8.08 [7.10, 11.63] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system. Methodology: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Poison center (PC) cases with medical outcomes of death were evaluated by a team of 38 medical and clinical toxicologist reviewers using an ordinal scale of 1–6 to assess the Relative Contribution to Fatality (RCF) of the exposure to the death. Results: In 2013, 3,060,122 closed encounters were logged by NPDS: 2,188,013 human exposures, 59,496 animal exposures, 806,347 information calls, 6,116 human-confirmed nonexposures, and 150 animal-confirmed nonexposures. Total encounters showed a 9.3% decline from 2012, while health care facility human exposure calls were essentially flat, decreasing by 0.1%.All information calls decreased 21.4% and health care facility (HCF) information calls decreased 8.5%, medication identification requests (drug ID) decreased 26.8%, and human exposures reported to US PCs decreased 3.8%. Human exposures with less serious outcomes have decreased 3.7% per year since 2008 while those with more serious outcomes (moderate, major or death) have increased by 4.7% per year since 2000. The top five substance classes most frequently involved in all human exposures were analgesics (11.5%), cosmetics/personal care products (7.7%), household cleaning substances (7.6%), sedatives/hypnotics/antipsychotics (5.9%), and antidepressants (4.2%). Sedative/hypnotics/antipsychotics exposures as a class increased most rapidly (2,559 calls/year) over the last 13 years for cases showing more serious outcomes. The top five most common exposures in children of 5 years or less were cosmetics/personal care products (13.8%), household cleaning substances (10.4%), analgesics (9.8%), foreign bodies/toys/miscellaneous (6.9%), and topical preparations (6.1%). Drug identification requests comprised 50.7% of all information calls. NPDS documented 2,477 human exposures resulting in death with 2,113 human fatalities judged related (RCF of 1, undoubtedly responsible; 2, probably responsible; or 3, contributory). Conclusions: These data support the continued value of PC expertise and need for specialized medical toxicology information to manage the more severe exposures, despite a decrease in calls involving less severe exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the United States. The near real-time, always current status of NPDS represents a national public health resource to collect and monitor US exposure cases and information calls. The continuing mission of NPDS is to provide a nationwide infrastructure for public health surveillance for all types of exposures, public health event identification, resilience response and situational awareness tracking. NPDS is a model system for the nation and global public health. PMID:25559822

Calls to Poison Centers for hookah smoking exposures.

PubMed

Retzky, Sandra S; Spiller, Henry A; Callahan-Lyon, Priscilla

2018-06-01

Over the past decade, smoking behaviors have changed in the US. Hookah or waterpipe smoking is increasing, especially among youth and young adults. Social media sites describe the "hookah high" or "buzz", which may be related to nicotine, carbon monoxide, or other inhalants in hookah smoke. Most important is the risk of carbon monoxide poisoning. Case reports include a high number of victims presenting with loss of consciousness from either syncope or seizures. Anaphylaxis and a very rare respiratory hypersensitivity reaction, acute eosinophilic pneumonia, have also been reported from hookah smoking in previously healthy young adults. This article provides background information on hookah smoking, describes hookah-induced acute injuries that could precipitate poison center calls, and offers suggestions for exposure characterization.

Clinical and epidemiological aspects of methylmercury poisoning.

PubMed Central

Bakir, F.; Rustam, H.; Tikriti, S.; Al-Damluji, S. F.; Shihristani, H.

1980-01-01

An opportunity to study the effects of methylmercury poisoning in humans was provided by the large outbreak in Iraq in 1971-2. In adults, poisoning resulted from the ingestion of home-made bread prepared from methylmercury-treated seed grain and there was a highly significant correlation between the amount of bread ingested and blood mercury levels. Poisoning in infants resulted either from prior exposure in utero or from suckling or both. Blood mercury levels were higher in infants and children than in adults. There was no increased incidence of congenital defects. Symptoms and signs of poisoning and histopathological changes were mainly confined to the CNS. Symptoms developed, on average, 1-2 months after exposure. In children there was mental retardation with delayed onset of speech and impaired motor, sensory and autonomic function. Severely affected children were blind and deaf. In adults, the clinical picture could be classified as 1, mild (mainly of sensory symptoms) 2, moderate (sensory symptoms accompanied by cerebellar signs) and 3, severe (gross ataxia with marked visual and hearing loss which, in some cases, progressed to akinetic mutism followed by coma). Grades 1 and 2 carried a better prognosis thant grade 3. Interference with transmission at the myoneural junction was found in 14% of patients studied. There was no evidence of peripheral nerve involvement per se and sensory symptoms may be of central origin. The clinical differences between the Iraqi and Japanese outbreaks may be a result, in part at least, of the severe, prolonged and continuous exposure which occurred in the latter outbreak. Improvement was observed among the mild and moderate group. Treatment with chelating agents, thiol resin, haemodialysis and exchange transfusion lowered blood mercury concentrations but produced no convincing clinical benefit. To be effective, treatment may need to be instituted soon after exposure. PMID:7383945

40 CFR 745.113 - Certification and acknowledgment of disclosure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence... properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978...

40 CFR 745.113 - Certification and acknowledgment of disclosure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence... properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978...

40 CFR 745.113 - Certification and acknowledgment of disclosure.

Code of Federal Regulations, 2012 CFR

2012-07-01

... that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence... properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978...

24 CFR 35.92 - Certification and acknowledgment of disclosure.

Code of Federal Regulations, 2010 CFR

2010-04-01

... that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence... properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978...

24 CFR 35.92 - Certification and acknowledgment of disclosure.

Code of Federal Regulations, 2012 CFR

2012-04-01

... that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence... properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978...

24 CFR 35.92 - Certification and acknowledgment of disclosure.

Code of Federal Regulations, 2013 CFR

2013-04-01

... that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence... properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978...

40 CFR 745.113 - Certification and acknowledgment of disclosure.

Code of Federal Regulations, 2014 CFR

2014-07-01

... that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence... properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978...

24 CFR 35.92 - Certification and acknowledgment of disclosure.

Code of Federal Regulations, 2014 CFR

2014-04-01

... that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence... properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978...

24 CFR 35.92 - Certification and acknowledgment of disclosure.

Code of Federal Regulations, 2011 CFR

2011-04-01

... that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence... properly. Lead exposure is especially harmful to young children and pregnant women. Before renting pre-1978...

Trouble with tuna: two cases of scombrotoxin poisoning.

PubMed

Stell, I M

1997-03-01

Two cases of scombrotoxin poisoning after exposure to tuna are described, the second being unusual in that tinned, rather than fresh, tuna was involved. This relatively rare condition needs to be distinguished from an allergic reaction, for which it can easily be mistaken.

Human exposures to pesticides in the United States.

PubMed

Langley, Ricky L; Mort, Sandra Amiss

2012-01-01

Pesticides are used in most homes, businesses, and farms to control a variety of pests, including insects, weeds, fungi, rodents, and even microbial organisms. Inappropriate use of pesticides can lead to adverse effects to humans and the environment. This study provides updated information on the magnitude of adverse pesticide exposures in the United States. Data on pesticide exposure were obtained from calls to poison control centers (PCCs) reported by the American Association of Poison Control Centers. Estimates of emergency department visits, hospitalizations, and health care costs were reported by the Agency for Healthcare Research and Quality (AHRQ), and deaths from pesticide poisonings reported by the Centers for Disease Control and Prevention (CDC) WONDER (Wide-ranging Online Data for Epidemiologic Research). An average of 23 deaths occur each year with pesticides as the underlying cause of death, most due to suicidal ingestions. An average of 130,136 calls to poison control centers were reported from 2006 to 2010, with an average of 20,116 cases (17.8%) treated in health care facilities annually. AHQR reported an annual average of 7385 emergency room visits during 2006 to 2008, and 1419 annual hospitalizations during 2005 to 2009. Excluding cost from lost work time, hospital physician fees, and pesticide-induced cancers, the annual national cost associated with pesticide exposures was estimated as nearly $200 million USD based on data from emergency department visits, hospitalizations, and for deaths. Pesticide exposures remain a significant public health issue. Health care providers, cooperative extension agents, and pesticide manufactures can help prevent exposures by increasing education of parents and workers, encourage use of less toxic agents, and encourage the practice of integrated pest management.

Lead exposure and poisoning of songbirds using the Coeur d'Alene River Basin, Idaho, USA.

PubMed

Hansen, James A; Audet, Daniel; Spears, Brian L; Healy, Kate A; Brazzle, Roy E; Hoffman, David J; Dailey, Anne; Beyer, W Nelson

2011-10-01

Previous studies have found widespread Pb poisoning of waterfowl in the Coeur d'Alene River Basin in northern Idaho, USA, which has been contaminated by mining and smelting activities. We studied the exposure of ground-feeding songbirds to Pb, sampling 204 American robins (Turdus migratorius), song sparrows (Melospiza melodia), and Swainson's thrushes (Catharus ustulatus) throughout the basin. These songbirds had mean blood Pb concentrations (mg/kg, dry weight) of less than 0.19 at a reference area (25 mg Pb/kg soil), 1.09 at moderately contaminated sites (170 to 1300 mg Pb/kg soil), and 2.06 at highly contaminated sites (2000 to 5000 mg Pb/kg soil). Based on guidelines for evaluating blood Pb in birds, 6% of robins from the highly contaminated sites had background concentrations, 24% were subclinically poisoned, 52% were clinically poisoned, and 18% were severely clinically poisoned with Pb. Blood Pb concentrations were lower in song sparrows than in robins and lowest in Swainson's thrushes. More than half of the robins and song sparrows from all contaminated sites and more than half of the Swainson's thrushes from highly contaminated sites showed at least 50% inhibition of the activity of the enzyme δ-aminolevulinic acid dehydratase (ALAD), commonly used as a measure of exposure to Pb. The highest hepatic Pb concentration of 61 mg/kg (dry weight) was detected in a song sparrow. Using Al as a marker for soil in songbird ingesta, we estimated average soil ingestion rates as 20% in robins, 17% in song sparrows, and 0.7% in Swainson's thrushes. Soil Pb in ingesta accounted for almost all of the songbirds' exposure to Pb. Based on these results, it is recommended that ecological risk assessments of ground-feeding songbirds at contaminated sites include soil ingestion as a pathway of exposure to Pb. Copyright © 2011 SETAC.

Lead exposure and poisoning of songbirds using the Coeur d'Alene River Basin, Idaho

USGS Publications Warehouse

Hansen, James A.; Audet, Daniel; Spears, Brian L.; Healy, Kate A.; Brazzle, Roy E.; Hoffman, David J.; Dailey, Anne; Beyer, W. Nelson

2011-01-01

Previous studies have found widespread Pb poisoning of waterfowl in the Coeur d'Alene River Basin in northern Idaho, USA, which has been contaminated by mining and smelting activities. We studied the exposure of ground-feeding songbirds to Pb, sampling 204 American robins (Turdus migratorius), song sparrows (Melospiza melodia), and Swainson's thrushes (Catharus ustulatus) throughout the basin. These songbirds had mean blood Pb concentrations (mg/kg, dry weight) of less than 0.19 at a reference area (25 mg Pb/kg soil), 1.09 at moderately contaminated sites (170 to 1300 mg Pb/kg soil), and 2.06 at highly contaminated sites (2000 to 5000 mg Pb/kg soil). Based on guidelines for evaluating blood Pb in birds, 6% of robins from the highly contaminated sites had background concentrations, 24% were subclinically poisoned, 52% were clinically poisoned, and 18% were severely clinically poisoned with Pb. Blood Pb concentrations were lower in song sparrows than in robins and lowest in Swainson's thrushes. More than half of the robins and song sparrows from all contaminated sites and more than half of the Swainson's thrushes from highly contaminated sites showed at least 50% inhibition of the activity of the enzyme δ-aminolevulinic acid dehydratase (ALAD), commonly used as a measure of exposure to Pb. The highest hepatic Pb concentration of 61 mg/kg (dry weight) was detected in a song sparrow. Using Al as a marker for soil in songbird ingesta, we estimated average soil ingestion rates as 20% in robins, 17% in song sparrows, and 0.7% in Swainson's thrushes. Soil Pb in ingesta accounted for almost all of the songbirds' exposure to Pb. Based on these results, it is recommended that ecological risk assessments of ground-feeding songbirds at contaminated sites include soil ingestion as a pathway of exposure to Pb.

Detection of Pyrrolizidine Alkaloid DNA Adducts in Livers of Cattle Poisoned with Heliotropium europaeum.

PubMed

Fu, Peter P; Xia, Qingsu; He, Xiaobo; Barel, Shimon; Edery, Nir; Beland, Frederick A; Shimshoni, Jakob A

2017-03-20

Pyrrolizidine alkaloids are among the most common poisonous plants affecting livestock, wildlife, and humans. Exposure of humans and livestock to toxic pyrrolizidine alkaloids through the intake of contaminated food and feed may result in poisoning, leading to devastating epidemics. During February 2014, 73 mixed breed female beef cows from the Galilee region of Israel were accidently fed pyrrolizidine alkaloid contaminated hay for 42 days, resulting in the sudden death of 24 cows over a period of 63 days. The remaining cows were slaughtered 2.5 months after the last ingestion of the contaminated hay. In this study, we report the histopathological analysis of the livers from five of the slaughtered cows and quantitation of pyrrolizidine alkaloid-derived DNA adducts from their livers and three livers of control cows fed with feed free of weeds producing pyrrolizidine alkaloids. Histopathological examination revealed that the five cows suffered from varying degrees of bile duct proliferation, fibrosis, and megalocytosis. Selected reaction monitoring HPLC-ES-MS/MS analysis indicated that (±)-6,7-dihydro-7-hydroxy-1-hydroxymethyl-5H-pyrrolizine (DHP)-derived DNA adducts were formed in all five livers. The livers from the three control cows did not have any liver damage nor any indication of DHP-DNA adduct formed. These results confirm that the toxicity observed in these cattle was caused by pyrrolizidine alkaloid poisoning and that pyrrolizidine alkaloid-derived DNA adducts could still be detected and quantified in the livers of the chronically poisoned cows 2.5 months after their last exposure to the contaminated feed, suggesting that DHP-derived DNA adducts can serve as biomarkers for pyrrolizidine alkaloid exposure and poisoning.

Bioscavenger is effective as a delayed therapeutic intervention following percutaneous VX poisoning in the guinea-pig.

PubMed

Mann, T M; Price, M E; Whitmore, C L; Perrott, R L; Laws, T R; McColm, R R; Emery, E R; Tattersall, J E H; Green, A C; Rice, H

2017-11-26

The prolonged systemic exposure that follows skin contamination with low volatility nerve agents, such as VX, requires treatment to be given over a long time due to the relatively short half-lives of the therapeutic compounds used. Bioscavengers, such as butyrylcholinesterase (BChE), have been shown to provide effective post-exposure protection against percutaneous nerve agent when given immediately on signs of poisoning and to reduce reliance on additional treatments. In order to assess the benefits of administration of bioscavenger at later times, its effectiveness was assessed when administration was delayed for 2h after the appearance of signs of poisoning in guinea-pigs challenged with VX (4×LD 50 ). VX-challenged animals received atropine, HI-6 and avizafone on signs of poisoning and 2h later the same combination with or without bioscavenger. Five out of 6 animals which received BChE 2h after the appearance of signs of poisoning survived to the end of the study at 48h, compared with 6 out of 6 which received BChE immediately on signs. All the animals (n=6+6) that received only MedCM, without the addition of BChE, died within 10h of poisoning. The toxicokinetics of a sub-lethal challenge of percutaneous VX were determined in untreated animals. Blood VX concentration peaked at approximately 4h after percutaneous dosing with 0.4×LD 50 ; VX was still detectable at 36h and had declined to levels below the lower limit of quantification (10pg/mL) by 48h in 7 of 8 animals, with the remaining animal having a concentration of 12pg/mL. These studies confirm the persistent systemic exposure to nerve agent following percutaneous poisoning and demonstrate that bioscavenger can be an effective component of treatment even if its administration is delayed. Copyright © 2017. Published by Elsevier B.V.

Management of poisoning with ethylene glycol and methanol in the UK: a prospective study conducted by the National Poisons Information Service (NPIS).

PubMed

Thanacoody, Ruben H K; Gilfillan, Claire; Bradberry, Sally M; Davies, Jeremy; Jackson, Gill; Vale, Allister J; Thompson, John P; Eddleston, Michael; Thomas, Simon H L

2016-01-01

Poisoning with methanol and ethylene glycol can cause serious morbidity and mortality. Specific treatment involves the use of antidotes (fomepizole or ethanol) with or without extracorporeal elimination techniques. A prospective audit of patients with methanol or ethylene glycol poisoning reported by telephone to the National Poisons Information Service (NPIS) in the UK was conducted during the 2010 calendar year and repeated during the 2012 calendar year. The study was conducted to determine the frequency of clinically significant systemic toxicity and requirement for antidote use and to compare outcomes and rates of adverse reaction and other problems in use between ethanol and fomepizole. The NPIS received 1315 enquiries involving methanol or ethylene glycol, relating to 1070 individual exposures over the 2-year period. Of the 548 enquiries originating from hospitals, 329 involved systemic exposures (enteral or parenteral as opposed to topical exposure), of which 216 (66%) received an antidote (204 for ethylene glycol and 12 for methanol), and 90 (27%) extracorporeal treatment (86 for ethylene glycol and 4 for methanol). Comparing ethanol with fomepizole, adverse reactions (16/131 vs. 2/125, p < 0.001) and administration errors, lack of monitoring, or inappropriate use (45/131 vs. 6/125, p < 0.0001) were reported more commonly, whereas non-availability and inadequate stocks were reported less commonly (6/125 vs. 33/131, p < 0.0001). Eight fatalities and complications or sequelae occurred in 21 patients. Poor outcome (death, complications, or sequelae) was significantly associated with older age, higher poisoning severity scores, and lower pH on admission (p < 0.001). Systemic poisoning with ethylene glycol or methanol results in hospitalisation at least 2-3 times per week on average in the UK. No difference in outcome was detected between ethanol and fomepizole-treated patients, but ethanol was associated with more frequent adverse reactions.

Pesticide Exposure in Children

PubMed Central

Roberts, James R.; Karr, Catherine J.

2018-01-01

Pesticides are a collective term for a wide array of chemicals intended to kill unwanted insects, plants, molds, and rodents. Food, water, and treatment in the home, yard, and school are all potential sources of children’s exposure. Exposures to pesticides may be overt or subacute, and effects range from acute to chronic toxicity. In 2008, pesticides were the ninth most common substance reported to poison control centers, and approximately 45% of all reports of pesticide poisoning were for children. Organophosphate and carbamate poisoning are perhaps the most widely known acute poisoning syndromes, can be diagnosed by depressed red blood cell cholinesterase levels, and have available antidotal therapy. However, numerous other pesticides that may cause acute toxicity, such as pyrethroid and neonicotinoid insecticides, herbicides, fungicides, and rodenticides, also have specific toxic effects; recognition of these effects may help identify acute exposures. Evidence is increasingly emerging about chronic health implications from both acute and chronic exposure. A growing body of epidemiological evidence demonstrates associations between parental use of pesticides, particularly insecticides, with acute lymphocytic leukemia and brain tumors. Prenatal, household, and occupational exposures (maternal and paternal) appear to be the largest risks. Prospective cohort studies link early-life exposure to organophosphates and organochlorine pesticides (primarily DDT) with adverse effects on neurodevelopment and behavior. Among the findings associated with increased pesticide levels are poorer mental development by using the Bayley index and increased scores on measures assessing pervasive developmental disorder, inattention, and attention-deficit/hyperactivity disorder. Related animal toxicology studies provide supportive biological plausibility for these findings. Additional data suggest that there may also be an association between parental pesticide use and adverse birth outcomes including physical birth defects, low birth weight, and fetal death, although the data are less robust than for cancer and neurodevelopmental effects. Children’s exposures to pesticides should be limited as much as possible. PMID:23184105

[Taki Onqoy: mercury poisoning epidemic in 16TH century Huamanga].

PubMed

María, Luis Alberto Santa

2017-01-01

Taki Onqoy is a syndrome that corresponds to the poisoning from exposure to mercury. It appeared as a result of the exploitation of the mercury mines of Paras and Huancavelica in Peru during the 16th century. The Cachexia mercurial, the last stage of the disease, would be associated with the idea of pishtaco. The Taki Onqoy in 16th-century Peru represents the largest epidemic of mercury poisoning known to humanity.

Black spot poison ivy: A report of 5 cases and a review of the literature.

PubMed

Kurlan, J G; Lucky, A W

2001-08-01

Black-spot poison ivy dermatitis is a rare manifestation of a common condition. It occurs on exposure to the resins of the plants of the Rhus family also known as Toxicodendron. We describe 5 patients with black deposits on their skin and clothing after contact with poison ivy and review the literature reflecting different aspects of this phenomenon including clinical presentation, histologic findings, and historical background.

[Mortality due to pesticide poisoning in Colombia, 1998-2011].

PubMed

Chaparro-Narváez, Pablo; Castañeda-Orjuela, Carlos

2015-08-01

Poisoning due to pesticides is an important public health problem worldwide due its morbidity and mortality. In Colombia, there are no exact data on mortality due to pesticide poisoning. To estimate the trend of mortality rate due to pesticide poisoning in Colombia between 1998 and 2011. We carried out a descriptive analysis with the database reports of death as unintentional poisoning, self-inflicted intentional poisoning, aggression with pesticides, and poisoning with non-identified intentionality, population projections between 1998 and 2011, and rurality indexes. Crude and age-adjusted mortality rates were estimated and trends and Spearman coefficients were evaluated. A total of 4,835 deaths were registered (age-adjusted mortality rate of 2.38 deaths per 100,000 people). Mortality rates were higher in rural areas, for self-inflicted intentional poisoning, in men and in age groups between 15 and 39 years old. The trend has been decreasing since 2002. Municipality mortality rates due to unintentional poisoning and aggression correlated significantly with the rurality index in less rural municipalities. Mortality rates due to pesticide poisoning presented a mild decrease between 1998 and 2011. It is necessary to adjust and reinforce the measures conducive to reducing pesticide exposure in order to avoid poisoning and reduce mortality.

Paraquat poisoning calls to the Malaysia National Poison Centre following its ban and subsequent restriction of the herbicide from 2004 to 2015.

PubMed

Leong, Yin-Hui; Ariff, Adilah Mohamed; Khan, Halilol Rahman Mohamed; Rani, Noor Afiza Abdul; Majid, Mohamed Isa Abdul

2018-05-01

This study analyses the incidences and patterns of paraquat poisoning from calls received at the Malaysia National Poison Centre (NPC) since 2004 following the ban of the herbicide (2004-2006) and subsequent restriction up to year 2015. Related reported cases to the centre over twelve years (2004-2015) were retrieved and studied in respect to socio-demographic characteristics, mode and type of poisonings, exposure routes and location of incident. Ages of poisoned victims range from 10 months old to 98 years with males being intoxicated more frequently than females (ratio male to female = 2.7). The age group mainly involved in the poisoning was 20-39 years. The most common mode was intentional (62.8%) followed by unintentional (36.9%). Among the 1232 reported cases, suicidal poisoning was the highest (57.2%); accidental poisoning (30.8%) and occupational poisoning (3.3%). The findings showed an upward trend of suicidal poisoning over the years, clearly emphasizing the need for more stringent and effective enforcement to ensure the safe use of paraquat. Copyright © 2018 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Reexamining the risks of drinking-water nitrates on public health.

PubMed

Richard, Alyce M; Diaz, James H; Kaye, Alan David

2014-01-01

Nitrates in drinking water are generally considered the sole source of nitrite poisoning with methemoglobinemia in infantile methomoglobinemia (IM). However, IM, which occurs during the first 4 months of life, is actually a constellation of cyanosis and hypoxia associated with methemoglobinemia that can result from several other causes. This review reexamines the role of nitrate levels in drinking water as a cause of IM and identifies other sources of nitrates that can affect public health and cause chronic diseases. Causes of IM include nitrites in foods, environmental chemical exposures, commonly prescribed pharmaceuticals, and the endogenous generation of oxides of nitrogen. Infants with congenital enzyme deficiencies in glucose-6-phosphate dehydrogenase and methemoglobin reductase are at greater risk of nitrite-induced methemoglobinemia from nitrates in water and food and from exposures to hemoglobin oxidizers. Early epidemiological studies demonstrated significant associations between high groundwater nitrate levels and elevated methemoglobin levels in infants fed drinking water-diluted formulas. However, more recent epidemiological investigations suggest other sources of nitrogenous substance exposures in infants, including protein-based formulas and foods and the production of nitrate precursors (nitric acid) by bacterial action in the infant gut in response to inflammation and infection.

Liver lead concentrations in raptors in New Jersey, USA, 2008-2010.

PubMed

Stansley, William; Murphy, Lisa A

2011-08-01

Lead exposure in New Jersey raptors was assessed by analyzing liver samples from carcasses obtained from wildlife rehabilitators. Samples were collected from 221 individuals representing 13 species. Concentrations were within the range of normal background exposure in 12 species. One red-tailed hawk had a liver lead concentration consistent with clinical poisoning (7.4 μg/g wet weight), which represents an incidence of 1% (1/104) in that species and 0.5% (1/221) in the overall sample. A second red-tailed hawk had a liver lead concentration consistent with subclinical exposure (2.1 μg/g wet weight). The combined incidence of elevated exposure (subclinical exposure + clinical poisoning) was 2% (2/104) in red-tailed hawks and 1% (2/221) in the overall sample.

Pesticide-related incidents treated in Finnish hospitals--a review of cases registered over a 5-year period.

PubMed

Lamminpää, A; Riihimäki, V

1992-11-01

Pesticide-related incidents are uncommon in Finland. They comprised 0.11% of all hospitalizations due to poisoning in 1987-88. A search of the nationwide Hospital Discharge Register revealed 78 pesticide-related incidents in a 5-year period. Some 30 different agents were involved, the most frequent being organophosphate and MCPA. Only 36 cases (46%) were judged to be unequivocal or probable pesticide poisonings; 26 (33%) were probably other illnesses because of no or minimal exposure and of the children admitted for follow-up, nine (12%) had potentially marked exposure, but no poisoning developed owing to vigorous early treatment which limited absorption, and seven (9%) cases remained undetermined. According to our analysis, the management of patients with (suspected) pesticide poisoning at hospitals could be further improved if the following procedures were emphasised: decontamination of the skin when appropriate, systematic early estimation of the likely dose involved, analytical verification of pesticide absorption whenever feasible, and consistent collaboration with a toxicological advisory service.

[Interest of the cholinesterase assay during organophosphate poisonings].

PubMed

Jalady, A-M; Dorandeu, F

2013-12-01

Cholinesterases are the main targets of organophosphorus compounds. The two enzymes present in the blood (butyrylcholinesterase, BChE; acetylcholinesterase, AChE) are biomarkers of their systemic toxicity. Activity of the plasma BChE is very often determined as it allows a rapid diagnostic of poisoning and is a marker of the persistence of the toxicant in the blood. The activity of the red blood cell AChE gives a better picture of the synaptic inhibition in the nervous system but the assay is less commonly available in routine laboratories. Better biomarker of the exposure, it allows a diagnosis of the severity of the poisoning and helps to assess the efficacy of oxime therapy. Besides the practical aspects of blood collection and sample processing, and the interpretation of the assays, this review stresses the complementarity of both enzyme assays and recalls their crucial interest for the confirmation of poisoning with an organophosphorus in a situation of war or terrorist attack and for the monitoring of occupational exposures. Copyright © 2013. Published by Elsevier SAS.

Alcohol and the young child.

PubMed

Bradford, D E

1984-01-01

With the increasing availability of alcohol in modern times, the child neglect and abuse portrayed in Hogarth's engraving Gin Lane may once again be witnessed. Reports occur occasionally of alcohol being given deliberately to infants to quieten them, but alcohol poisoning in the slightly older child is not uncommon. The introduction of child-proof containers has altered poisoning figures recently. However, alcohol poisoning tends to occur at ages 3 and 4, that is, about 2 years after the peak of all poisonings in children. This difference may be an indication that alcohol is taken in imitation of parents' drinking, a suggestion which has some support from reported cases of mouthwash poisoning. Holidays and high days where children and alcohol mix, are potentially dangerous periods. Since alcohol poisoning can be fatal, yet if recognised is relatively easily managed, every child with the slightest degree of drowsiness should be suspect until proven or not by blood alcohol. The prevention of alcohol poisoning in the young child consists in protecting the alcohol by lock and key, not setting an example by drinking or gargling in front of children. Many substances such as mouthwash and perfume should also be under supervision. Once actual poisoning has occurred blood sugar is probably more important than the level of blood ethanol and blood sugar levels should be monitored frequently and the child treated with glucose, preferably intravenously.

Causes of mortality in common loons

USGS Publications Warehouse

Franson, J. Christian; Cliplef, David J.

1992-01-01

Summarized are necropsy results from 222 carcasses of Common Loons (Gavia immer) submitted to the National Wildlife Health Research Center from 1976 through 1991.  The carcasses were from 18 states, and 10 or more birds each were from Minnesota, Florida, Virginia, Michigan, Wisconsin, Maine, and North Carolina.  Seventy-three (33%) carcasses were emaciated, and in some of these birds emaciation was thought to be related to exposure to mercury.  OVer 40% of these emaciated birds were from Florida.  Trauma, including blunt trauma of unknown origin, outboard motor propeller wounds, and shooting caused the deaths of 49 (22%) loons, 30 of which were from Minnesota.  Diseases, primarily avian botulism type E and aspergillosis, account for 39 (18%) moralities and lead poisoning for 14 (6%), 11 of which had fishing sinkers in their stomachs.  Most of the avian botulism type E cases occurred during two outbreaks on Lake Michigan.  Seven of the 14 lead-poisoned birds were from Minnesota.  Nine (4%) birds died of miscellaneous causes and 9 (4%) of drowning, primarily from entanglement in nets.  No diagnosis could be reached for 29 (13%) carcasses.  Sample bias precludes interpretation of these data to represent actual proportional causes of mortality in the loon population.  However, the sample size is sufficient to clearly identify major causes of mortality.

Acute abdominal pain and constipation due to lead poisoning.

PubMed

Mongolu, S; Sharp, P

2013-01-01

Although uncommon, lead poisoning should be considered as a differential diagnosis in cases of unexplained acute abdominal pain in both adults and children. We present the case of a 35-year-old Asian male who presented with abdominal pain and constipation secondary to lead poisoning. Initially, the source of lead exposure was not apparent; this was later found to be due to ingestion of an Ayurvedic herbal medicine for the treatment of infertility. Lead poisoning due to the ingestion of Ayurvedic remedies is well described. We discuss the diagnosis, pathophysiology and treatment of lead poisoning. This case illustrates one of the rarer medical causes of acute abdominal pain and emphasizes the need to take a thorough history (including specific questioning regarding the use of over-the-counter and traditional/ herbal remedies) in cases of suspected poisoning or drug toxicity.

The impact of an international initiative on exposures to liquid laundry detergent capsules reported to the United Kingdom National Poisons Information Service between 2008 and 2015.

PubMed

Day, Rachael; Eddleston, Michael; Thomas, Simon H L; Thompson, John P; Vale, J Allister

2017-03-01

Although the majority of those exposed to liquid laundry detergent capsules remain asymptomatic or suffer only minor clinical features after exposure, a small proportion develop central nervous system depression, stridor, pulmonary aspiration and/or airway burns following ingestion or conjunctivitis and corneal ulceration following eye exposure. As a consequence, the International Association for Soaps, Detergents and Maintenance Products (AISE) established a Product Stewardship Programme in Europe, requiring that safety measures be implemented to reduce the visibility of, and restrict access to, these detergent capsules by small children. Implementation occurred in the United Kingdom over several months during the first half of 2013. This study investigated whether the AISE Programme had an impact on the number and severity of exposures reported to the United Kingdom National Poisons Information Service. Telephone enquiries to the National Poisons Information Service relating to liquid laundry detergent capsules were analysed for the period January 2008 to December 2015. While there was a significant difference (p = 0.0002) between the mean number of annual exposures (469.4) reported between 2008 and 2012 and the mean number reported between 2014 and 2015 (403.5), the number of exposures was decreasing steadily prior to implementation of the Programme in 2013, which did not impact this fall from 2013 onwards. In addition, the number of exposures per million units sold was not impacted by the Programme. There was no significant difference (p = 0.68) between the mean number of exposures (11.8) with PSS ≥2 reported between 2008 and 2012 and the mean number (13.0) reported between 2014 and 2015. Although there was a 28.7% decrease between 2010-2012 and 2014-2015 in the number of exposures with PSS ≥2 per million units sold, this decrease was not statistically significant (p = 0.18). There is no evidence that the Product Stewardship Programme had a beneficial impact on the number of exposures reported to the National Poisons Information Service or their severity.

Risk Factors of Pesticide Poisoning and Pesticide Users' Cholinesterase Levels in Cotton Production Areas: Glazoué and Savè Townships, in Central Republic of Benin.

PubMed

Vikkey, Hinson Antoine; Fidel, Dossou; Elisabeth, Yehouenou Pazou; Hilaire, Hountikpo; Hervé, Lawin; Badirou, Aguèmon; Alain, Koudafoke; Parfait, Houngbégnon; Fabien, Gounongbé; Benjamin, Fayomi

2017-01-01

To assess the degree of poisoning in farmers using the erythrocyte acetylcholinesterase (AChE) test before and after the exposure to pesticides in townships in central Benin (Glazoué and Savè) and to identify the associated risk factors. Using a cross-sectional study design, we recruited 264 farm pesticide sprayers, who have been working for at least 5 years. They completed a questionnaire and underwent the AChE test using the Test-mate Model 400 device (EQM Research Inc.) with a photometric sensor, based on the works of Ellman. Organophosphate/pyrethroids were the most common pesticides used by at least 72.96% of the farmworkers. We observed an inhibition of AChE between pre-exposure and post-exposure ( P = .002) for 60.61% of the farmworkers. Among them, 11.88% displayed more than 20% AChE inhibition. Pesticide poisoning is a reality, and AChE monitoring is urgently needed for farmworker surveillance.

Toxicity of lead: A review with recent updates

PubMed Central

Gupta, Deepesh; Tiwari, Archana

2012-01-01

Lead poisoning has been recognized as a major public health risk, particularly in developing countries. Though various occupational and public health measures have been undertaken in order to control lead exposure, cases of lead poisoning are still reported. Exposure to lead produces various deleterious effects on the hematopoietic, renal, reproductive and central nervous system, mainly through increased oxidative stress. These alterations play a prominent role in disease manifestations. Modulation of cellular thiols for protection against reactive oxygen species (ROS) has been used as a therapeutic strategy against lead poisoning. N-acetylcysteine, α-lipoic acid, vitamin E, quercetin and a few herbal extracts show prophylaxis against the majority of lead mediated injury in both in vitro and in vivo studies. This review provides a comprehensive account of recent updates describing health effects of lead exposure, relevant biomarkers and mechanisms involved in lead toxicity. It also updates the readers about recent advances in chelation therapy and newer therapeutic strategies, like nanoencapsulation, to treat lead induced toxic manifestations. PMID:23118587

Childhood lead poisoning: the torturous path from science to policy

PubMed Central

Bellinger, David C.; Bellinger, Andrew M.

2006-01-01

The long history of lead poisoning provides many lessons about the process by which scientific knowledge is translated into public health policy. In the United States, lead was added to paint and to gasoline in enormous quantities long after medical evidence clearly showed that excessive lead exposure caused considerable morbidity in the population. This article discusses some of the factors that contributed to the slow pace of efforts to address this problem, including the ubiquity and magnitude of lead exposure during much of the twentieth century, which produced a distorted notion about the blood lead level that can be considered “normal”; the prevailing model of disease during this period, notably the novelty of the concept of subclinical disease; the fact that childhood lead poisoning affected mostly families that were politically and economically disenfranchised, fostering a “blame the victim” attitude; and that controlling lead exposure would have impeded efforts to achieve other desirable goals, illustrating the role that value trade-offs often play in policy decisions. PMID:16585952

Reversible Poisoning of the Nickel/Zirconia Solid Oxide Fuel Cell Anodes by Hydrogen Chloride in Coal Gas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marina, Olga A.; Pederson, Larry R.; Thomsen, Edwin C.

2010-10-15

The performance of anode-supported solid oxide fuel cells (SOFC) was evaluated in synthetic coal gas containing HCl in the temperature range 650 to 850oC. Exposure to up to 800 ppm HCl resulted in reversible poisoning of the Ni/zirconia anode by chlorine species adsorption, the magnitude of which decreased with increased temperature. Performance losses increased with the concentration of HCl to ~100 ppm, above which losses were insensitive to HCl concentration. Cell voltage had no effect on poisoning. No evidence was found for long-term degradation that can be attributed to HCl exposure. Similarly, no evidence of microstructural changes or formation ofmore » new solid phases as a result of HCl exposure was found. From thermodynamic calculations, solid nickel chloride phase formation was shown to be highly unlikely in coal gas. Further, the presence of HCl at even the highest anticipated concentrations in coal gas would minimally increase the volatility of nickel.« less

Human Serum Butyrylcholinesterase: A Bioscavenger for the Protection of Humans from Organophosphorus Exposure

DTIC Science & Technology

2009-10-01

Current medical countermeasures against OP nerve agent poisoning include a combination of pretreatment with a carbamate, pyridostigmine bromide , to...The protection of primates against soman poisoning by pretreatment with pyridostigmine , J. Pharm. Pharmacol. 31 (1979) 295-299. [2] C.G. McLeod

Acute hexogen poisoning after occupational exposure.

PubMed

Testud, F; Glanclaude, J M; Descotes, J

1996-01-01

Hexogen (cyclonite, RDX) nitrate explosive is an infrequent cause of poisoning. A 42-year-old man with no prior history of epilepsy experienced grand mal seizures after sieving fine hexogen (RDX) powder for four hours in an ammunition plant. Physical examination was normal on arrival at the emergency room but recurrent seizures occurred six hour after admission. EEG, CT scan and MRI were normal and the patient recovered uneventfully. The available toxicological data on this rare occupational poisoning are reviewed.

Lead and eagles: demographic and pathological characteristics of poisoning, and exposure levels associated with other causes of mortality

USGS Publications Warehouse

Franson, J. Christian; Russell, Robin E.

2014-01-01

We conducted a retrospective analysis to evaluate demographic and pathologic characteristics in 484 bald eagles (Haliaeetus leucocephalus) and 68 golden eagles (Aquila chrysaetos) diagnosed with lead poisoning at the U.S. Geological Survey National Wildlife Health Center. As part of our analysis, we compared characteristics of lead poisoned eagles with those that died of other causes. Odds of lead poisoning were greater for bald eagles versus golden eagles, females versus males, adults versus juveniles, and eagles from the Mississippi and Central flyways versus the Atlantic and Pacific flyways. In addition to spatial, species, and demographic associations, we detected a distinct temporal trend in the collection date of lead poisoned bald eagle carcasses. These carcasses were found at greater frequency in late autumn and winter than spring and summer. Lesions in lead poisoned birds included emaciation, evidence of bile stasis, myocardial degeneration and necrosis, and renal tubular nephrosis and necrosis. Ingested lead ammunition or fragments were found in 14.2 % of bald eagles and 11.8 % of golden eagles. The overall mean liver lead concentration (wet weight basis) for eagles diagnosed with lead poisoning was 28.9 ± 0.69 SE mg/kg in bald eagles and 19.4 ± 1.84 SE mg/kg in golden eagles. In eagles diagnosed with collision trauma, electrocution, poisoning (other than lead), emaciation, infectious disease, trapping death, other, and undetermined causes, average liver lead concentrations were low (<1 mg/kg) and did not differ among causes of mortality. Thus, based on our data, we found no evidence that lead exposure of eagles predisposed them to other causes of mortality.

[Estimation of carbon monoxide poisonings frequency, based on carboxyhemoglobin determinations performed in Toxicology Laboratory in Krakow in years 2002-2010].

PubMed

Gomółka, Ewa; Gawlikowski, Tomasz

2011-01-01

Carboxyhemoglobin is a specific biomarker of carbon monoxide (CO) exposition. The source of CO indoors are most often gas, oil or carbon furnaces and stoves or bathroom gas heaters. CO intoxication during fire or exposition to car fumes are sporadic. The aim of the study was: to present the frequency of CO intoxications diagnosed in Laboratory of Analytical Toxicology UJ Collegium Medicum in years 2002 - 2010, to present the season trends of CO intoxications, show sex and age structure of CO intoxicated patients. Material were Laboratory of Analytical Toxicology and Drug Monitoring data records from years 2002 - 2010. CO intoxication was confirmed and recognized when COHb blood concentration was higher than 10%. Annual number of CO poisonings was stable in the period of time, varied from 209 to 296 (mean 256,2 CO poisonings per year). Sex structure of CO poisoned patients showed little female dominance (54.6%). Carbon monoxide poisonings distribution was seasonal. The season of intensified CO intoxications lasted from October to March, the highest intensity was in December and January. The CO poisoning problem is still actual. Society education about security, recognition, diagnosis and practice in carbon monoxide exposition is still needful.

Outbreak of fatal arsenic poisoning caused by contaminated drinking water.

PubMed

Armstrong, C W; Stroube, R B; Rubio, T; Siudyla, E A; Miller, G B

1984-01-01

An outbreak of subacute poisoning occurred among nine members of a family; eight were ill with gastrointestinal symptoms, four developed encephalopathy, and two died. Abnormal liver function tests and leukopenia were common laboratory findings. Epidemiologic and environmental investigations traced the source of arsenic exposure to a farm well with water containing 108 ppm arsenic. The soil adjacent to the well was also contaminated with arsenic, possibly from waste pesticide. Presumably, arsenic gained access to the well through obvious leaks in the well's casing. To our knowledge, this is only the second reported outbreak of fatal arsenic poisoning from contaminated drinking water and one of few instances where illness followed exposure to a toxic substance which was disposed of, or possibly disposed of, in an indiscriminate manner.

Pesticide poisoning in Costa Rica during 1996.

PubMed

Leveridge, Y R

1998-02-01

A retrospective study at the Poison Control Center of Costa Rica describes the pattern of pesticide poisoning that occurred during 1996. A total of 1274 pesticide exposures were reported. Occupational exposures were the most frequent (38.5%), followed by accidental situations (33.8%) and suicidal attempts (22.5%). The male to female ratio was 2.4:1. Eighty-percent of the patients had symptoms at the moment of the consult. Organophosphates, carbamates and bipyridyliums were the agents mostly involved (46%); clinical findings with these products were nausea, vomiting, abdominal pain, dizziness and headache. Calls came mainly from hospitals and clinics (75%) followed by home calls (18.2%). Education of the users of pesticides and the community in general is essential to creating an awareness of the toxicity of these agents and to reduce morbidity cases.

A review of the epidemiologic literature on the role of environmental arsenic exposure and cardiovascular diseases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, C.-H.; Hsiao, C.K.; Chen, C.-L.

2007-08-01

Cardiovascular disease is the leading cause of mortality worldwide. Arsenic is a ubiquitous metalloid in the crust of the earth. Chronic arsenic poisoning is becoming an emerging epidemic in Asia. Epidemiological studies have shown that chronic arsenic poisoning through ingestion of arsenic-contaminated water is associated with various cardiovascular diseases in dose-response relationships. These cardiovascular disorders include carotid atherosclerosis detected by ultrasonography, impaired microcirculation, prolonged QT interval and increased QT dispersion in electrocardiography, and clinical outcomes such as hypertension, blackfoot disease (a unique peripheral vascular disease endemic in southwestern Taiwan), coronary artery disease and cerebral infarction. Chronic arsenic poisoning is anmore » independent risk factor for cardiovascular disease. The adverse cardiovascular effects of long-term arsenic exposure may be persistent and/or irreversible. Arsenic-induced cardiovascular diseases in human population may result from the interaction among genetic, environment and nutritional factors. The major adverse cardiovascular effect of chronic arsenic poisoning has been established qualitatively and quantitatively in the high arsenic exposure areas, but the low-dose effect of arsenic on cardiovascular diseases remains to be explored. Cardiovascular death is the major cause of mortality worldwide, and a small increased risk may imply a large quantity of excess mortality.« less

Pediatric Exposure to E-Cigarettes, Nicotine, and Tobacco Products in the United States.

PubMed

Kamboj, Alisha; Spiller, Henry A; Casavant, Marcel J; Chounthirath, Thiphalak; Smith, Gary A

2016-06-01

To investigate the epidemiologic characteristics and outcomes of exposures to electronic cigarettes (e-cigarettes), nicotine, and tobacco products among young children in the United States. A retrospective analysis of exposures associated with nicotine and tobacco products among children younger than 6 years old was conducted by using National Poison Data System data. From January 2012 through April 2015, the National Poison Data System received 29 141 calls for nicotine and tobacco product exposures among children younger than 6 years, averaging 729 child exposures per month. Cigarettes accounted for 60.1% of exposures, followed by other tobacco products (16.4%) and e-cigarettes (14.2%). The monthly number of exposures associated with e-cigarettes increased by 1492.9% during the study period. Children <2 years old accounted for 44.1% of e-cigarette exposures, 91.6% of cigarette exposures, and 75.4% of other tobacco exposures. Children exposed to e-cigarettes had 5.2 times higher odds of a health care facility admission and 2.6 times higher odds of having a severe outcome than children exposed to cigarettes. One death occurred in association with a nicotine liquid exposure. The frequency of exposures to e-cigarettes and nicotine liquid among young children is increasing rapidly and severe outcomes are being reported. Swift government action is needed to regulate these products to help prevent child poisoning. Prevention strategies include public education; appropriate product storage and use away from children; warning labels; and modifications of e-cigarette devices, e-liquid, and e-liquid containers and packaging to make them less appealing and less accessible to children. Copyright © 2016 by the American Academy of Pediatrics.

Availability of treatment resources for the management of acute toxic exposures and poisonings in emergency departments among various types of hospitals in Palestine: a cross-sectional study.

PubMed

Zyoud, Sa'ed H; Al-Jabi, Samah W; Bali, Yara I; Al-Sayed, Afnan M; Sweileh, Waleed M; Awang, Rahmat

2014-02-21

Poisoning exposures continue to be a significant cause of morbidity and mortality worldwide. The lack of facilities, treatment resources, and antidotes in hospitals may affect the treatments provided and outcomes. This study aimed to determine the availability of gastrointestinal (GI) decontamination, stabilisation, elimination enhancement resources, and antidotes for the management of acute toxic exposures and poisonings in emergency departments (EDs) among various types of governmental and private hospitals in Palestine. A cross-sectional study using semi-structured questionnaire was performed. Data were collected based on hospital resources; GI decontamination, stabilisation, elimination enhancement resources and antidotes from Palestinian hospitals. Eighteen hospitals (94.7%) have responded. Among them, paracetamol poisoning was the most frequently reported cases by EDs (mean frequency score = 7.6 ± 2.1), followed by bee stings (mean = 6.9 ± 2.7) and organophosphate poisoning (mean = 6.7 ± 2.7). The availabilities of most resources related to GI decontamination items varied substantially with hospital type, but these differences were not statistical significant. The availability of stabilisation resources was not significantly different between hospitals types. For the availability of techniques used to enhance the elimination of toxic substances, there were variations between the hospitals types. However, these differences were not statistical significant, except for haemodialysis (p = 0.003) which was more available in governmental hospitals. For the availability of antidotes, none of the hospitals had sufficient stock of all antidotes listed. In relation to hospital type, there was variability in the availability of antidotes, but this did not reach statistical significance, except for deferoxamine (p < 0.001), which was available in all governmental hospitals but none of the private hospitals. The availability of treatment resources and antidotes in Palestinian hospitals was not adequate except for stabilisation resources. The availability of such resources acts as a marker for the level of readiness of hospital EDs in Palestine for the management of acute toxic exposure and poisoning. The implementation of a minimum list of antidotes and treatment resources would be useful to increase the level of resources. Coordination between Palestinian poison control and drug information centre and hospitals is also important.

Availability of treatment resources for the management of acute toxic exposures and poisonings in emergency departments among various types of hospitals in Palestine: a cross-sectional study

PubMed Central

2014-01-01

Background Poisoning exposures continue to be a significant cause of morbidity and mortality worldwide. The lack of facilities, treatment resources, and antidotes in hospitals may affect the treatments provided and outcomes. This study aimed to determine the availability of gastrointestinal (GI) decontamination, stabilisation, elimination enhancement resources, and antidotes for the management of acute toxic exposures and poisonings in emergency departments (EDs) among various types of governmental and private hospitals in Palestine. Methods A cross-sectional study using semi-structured questionnaire was performed. Data were collected based on hospital resources; GI decontamination, stabilisation, elimination enhancement resources and antidotes from Palestinian hospitals. Results Eighteen hospitals (94.7%) have responded. Among them, paracetamol poisoning was the most frequently reported cases by EDs (mean frequency score = 7.6 ± 2.1), followed by bee stings (mean = 6.9 ± 2.7) and organophosphate poisoning (mean = 6.7 ± 2.7). The availabilities of most resources related to GI decontamination items varied substantially with hospital type, but these differences were not statistical significant. The availability of stabilisation resources was not significantly different between hospitals types. For the availability of techniques used to enhance the elimination of toxic substances, there were variations between the hospitals types. However, these differences were not statistical significant, except for haemodialysis (p = 0.003) which was more available in governmental hospitals. For the availability of antidotes, none of the hospitals had sufficient stock of all antidotes listed. In relation to hospital type, there was variability in the availability of antidotes, but this did not reach statistical significance, except for deferoxamine (p < 0.001), which was available in all governmental hospitals but none of the private hospitals. Conclusions The availability of treatment resources and antidotes in Palestinian hospitals was not adequate except for stabilisation resources. The availability of such resources acts as a marker for the level of readiness of hospital EDs in Palestine for the management of acute toxic exposure and poisoning. The implementation of a minimum list of antidotes and treatment resources would be useful to increase the level of resources. Coordination between Palestinian poison control and drug information centre and hospitals is also important. PMID:24555427

The use of self-reported symptoms as a proxy for acute organophosphate poisoning after exposure to chlorpyrifos 50% plus cypermethrin 5% among Nepali farmers: a randomized, double-blind, placebo-controlled, crossover study.

PubMed

Kofod, Dea Haagensen; Jørs, Erik; Varma, Anshu; Bhatta, Shankuk; Thomsen, Jane Frølund

2016-12-13

Previous studies stating a high prevalence of occupational acute pesticide poisoning in developing countries have mainly relied on measurements of the rather non-specific self-reported acute pesticide poisoning symptoms. Only a few studies have measured the biomarker plasma cholinesterase (PchE) activity, in addition to the symptoms, when assessing occupational acute pesticide poisoning. This study evaluated self-reported symptoms as a proxy for acute organophosphate poisoning among Nepali farmers by examining self-reported acute organophosphate poisoning symptoms and PchE activity in response to occupational acute organophosphate exposure. We performed a randomized, double-blind, placebo-controlled, crossover trial among 42 Nepali commercial vegetable farmers. The farmers were randomly assigned (ratio 1:1) to a 2-h organophosphate (chlorpyrifos 50% plus cypermethrin 5%: moderately hazardous) spray session or a 2-h placebo spray session, and after 7 days' washout, the farmers were assigned to the other spray session. Before and after each spray session farmers were interviewed about acute organophosphate poisoning symptoms and PchE activity was measured. Analyses were conducted with a Two Sample T-test and Mann Whitney U-test. We found no difference in the symptom sum or PchE activity from baseline to follow up among farmers spraying with organophosphate (symptom sum difference -1, p = 0.737; PchE mean difference 0.02 U/mL, p = 0.220), placebo (symptom sum difference 9, p = 0.394; PchE mean difference 0.02 U/mL, p = 0.133), or when comparing organophosphate to placebo (symptom p = 0.378; PchE p = 0.775). However, a high percentage of the farmers reported having one or more symptoms both at baseline and at follow up in the organophosphate spray session (baseline 47.6%, follow up 45.2%) and placebo spray session (baseline 35.7%, follow up 50.0%), and 14.3% of the farmers reported three or more symptoms after the organophosphate spray session as well as after the placebo spray session. We found a general presence of acute organophosphate symptoms among the farmers regardless of organophosphate exposure or poisoning. Thus, self-reported acute organophosphate symptoms seem to be a poor proxy for acute organophosphate poisoning as the occurrence of these symptoms is not necessarily associated with acute organophosphate poisoning. ClinicalTrials.gov, NCT02838303 . Registered 19 July 2016. Retrospectively registered.

Trouble with tuna: two cases of scombrotoxin poisoning.

PubMed Central

Stell, I M

1997-01-01

Two cases of scombrotoxin poisoning after exposure to tuna are described, the second being unusual in that tinned, rather than fresh, tuna was involved. This relatively rare condition needs to be distinguished from an allergic reaction, for which it can easily be mistaken. Images p111-a PMID:9132185

The toxicity of picaridin containing insect repellent reported to the National Poison Data System.

PubMed

Charlton, Nathan P; Murphy, Lauren T; Parker Cote, Jennifer L; Vakkalanka, J Priyanka

2016-09-01

While low toxicity is reported, there are sparse data on the safety of acute picaridin (icaridin) exposures in humans. The purpose of this study was to review National Poison Data System (NPDS) data regarding ingestion of insect repellents containing picaridin and compare those to insect repellents containing DEET and other insect repellents not containing DEET. NPDS was queried for single agent human insect repellent ingestions reported between 1 January 2000 and 31 May 2015 using the American Association of Poison Control Center generic categories 201048 (Insect Repellents with DEET) and 201049 (Insect Repellents without DEET). Picaridin-containing product exposures were assessed using Poisindex(®) product ID 6744589. Insect repellents of unknown type were not included. 68,429 exposures occurred; 24% were non-DEET-containing products, of which 2% were picaridin-containing products. Among picaridin exposures, 92.9% were managed outside of a health-care facility; there were no reported cases of major effect or death, and only one case of moderate effect. Primary symptoms across all insect repellent exposures included ocular irritation/pain, vomiting, red eye/conjunctivitis, and oral irritation. Treatment primarily included dilution/irrigation/wash. Unintentional ingestion of picaridin-containing and other insect repellents was associated only with minor toxicity and was generally managed outside of a health-care facility.

Synthetic cannabinoid and marijuana exposures reported to poison centers.

PubMed

Forrester, M B; Kleinschmidt, K; Schwarz, E; Young, A

2012-10-01

Synthetic cannabinoids have recently gained popularity as a recreational drug because they are believed to result in a marijuana-like high. This investigation compared synthetic cannabinoids and marijuana exposures reported to a large statewide poison center system. Synthetic cannabinoid and marijuana exposures reported to Texas poison centers during 2010 were identified. The distribution of exposures to the two agents with respect to various demographic and clinical factors were compared by calculating the rate ratio (RR) of the synthetic cannabinoid and marijuana percentages for each subgroup and 95% confidence interval (CI). The proportion of synthetic cannabinoid and marijuana exposures, respectively, were 87.3% and 46.5% via inhalation (RR 1.88, 95% CI 1.38-2.61), 74.9% and 65.7% in male (RR 1.14, 95% CI 0.87-1.51), 40.2% and 56.6% age ≤ 19 years (RR 0.71, 95% CI 0.52-0.98), 79.2% and 58.6% occurring at a residence (RR 1.35, 95% CI 1.02-1.82), 8.4% and 16.2% managed on-site (RR 0.52. 95% CI 0.28-1.00), and 59.3% and 41.4% with serious medical outcomes (RR 1.43, 95% CI 1.03-2.05). Compared to marijuana, synthetic cannabinoid exposures were more likely to be used through inhalation, to involve adults, to be used at a residence, and to result in serious outcomes.

Post-exposure therapy with human butyrylcholinesterase following percutaneous VX challenge in guinea pigs.

PubMed

Mumford, Helen; E Price, Matthew; Lenz, David E; Cerasoli, Douglas M

2011-04-01

Human butyrylcholinesterase (huBuChE) has potential utility as a post-exposure therapy following percutaneous nerve agent poisoning as there is a slower absorption of agent by this route and hence a later onset of poisoning. METHODS. We used surgically implanted radiotelemetry devices to monitor heart rate, EEG, body temperature and locomotor activity in guinea pigs challenged with VX via the percutaneous route. RESULTS. Treatment with huBuChE (24.2 mg/kg, i.m.) at 30 or 120 min following percutaneous VX (~2.5 × LD(50)) protected 9 out of 10 animals from lethality. When i.m. huBuChE administration was delayed until the onset of observable signs of systemic cholinergic poisoning, only one out of six animals survived to 7 days. Survival increased to 50% when the same dose of huBuChE was given intravenously at the onset of signs of poisoning. This dose represents approximately 1/10th the stoichiometric equivalent of the dose of VX administered (0.74 mg/kg). Intramuscular administration of huBuChE (24.2 mg/kg) alone did not produce any changes in heart rate, brain electrical activity, temperature or locomotion compared to saline control. Survival following VX and huBuChE treatment was associated with minimal incapacitation and observable signs of poisoning, and the mitigation or prevention of detrimental physiological changes (e.g. seizure, bradycardia and hypothermia) observed in VX + saline-treated animals. At 7 days, cholinesterase activity in the erythrocytes and most brain areas of guinea pigs that received huBuChE at either 18 h prior to or 30 min following VX was not significantly different from that of naïve, weight-matched control animals. CONCLUSION. Percutaneous VX poisoning was successfully treated using post-exposure therapy with huBuChE bioscavenger. The opportunity for post-exposure treatment may have particular relevance in civilian settings, and this is a promising indication for the use of huBuChE.

Lead Poisoning: Historical Aspects of a Paradigmatic "Occupational and Environmental Disease"

PubMed Central

Lafranconi, Alessandra; D'Orso, Marco Italo; Cesana, Giancarlo

2012-01-01

Lead poisoning is one of the earliest identified and most known occupational disease. Its acute effects have been recognized from antiquity when this condition principally afflicted manual workers and slaves, actually scarcely considered by the medicine of that time. The Industrial Revolution caused an epidemic of metal intoxication, urging scientists and physician of that period to study and identify specific symptoms and organ alterations related to chronic lead poisoning. During the 20th century, the acknowledgment of occupational and environmental toxicity of lead fostered public awareness and legislation to protect health. More recently, the identification of sub-clinical effects have greatly modified the concept of lead poisoning and the approaches of medicine towards this condition. Nowadays, lead poisoning is rarely seen in developed countries, but it still represents a major environmental problem in certain areas. Consequently, it may appear as a paradigm of "occupational and environmental disease," and the history of this condition seems to parallel the historical development of modern "Occupational and Environmental Health" as a more complete medical discipline. PMID:22953225

A review of insecticide poisonings among domestic livestock in southern Ontario, Canada, 1982-1989

PubMed Central

Frank, Richard; Braun, Heinz E.; Wilkie, Ian; Ewing, Ronald

1991-01-01

From 1982 to 1989, inclusive, 20 poisonings were investigated by the Ontario Ministry of Agriculture and Food following ingestion by domestic livestock of granular insecticides including terbufos (13 poisonings), disulfoton (two poisonings), fonofos (two poisonings), phorate (two poisonings), and carbofuran (one poisoning); all are used for rootworm (Diabrotica spp.) control in corn. A further three poisonings of livestock occurred following the ingestion of the foliar insecticide, endosulfan (two poisonings), and the seed protectant insecticides diazinon plus lindane (one poisoning). There were six poisoning cases as a result of excessive topical applications of the three insecticides coumpahos, fenthion, and lindane as dusts or sprays to control external parasites. Together, these events caused the deaths of 258 domestic animals of which 200 were cattle, 23 were swine, and 35 were sheep. Not all deaths are reported to the Ministry and the cases reported here may only represent 30-50% of the actual deaths over the period. Based on total populations of livestock, the percent losses were very small but they represent serious losses to individual growers. The economic loss is estimated at $160,000 over the eight years, or $20,000 per annum, and this does not include veterinary costs. Some of the poisoned animals died within as little as three to four hours of ingestion while others were sick but survived for several days. Lethal doses of insecticide were found in the rumen, abomasum, or stomach of dead animals. Signs typical of cholinesterase inhibition caused by organophosphorus poisoning were observed in most cases. Cholinesterase readings were found to be zero in dying animals. Necropsy findings were rarely more than pulmonary edema or myocardial hemorrhage. Where organochlorine insecticides were ingested, convulsions were the major manifestation. Contamination of feed was most often accidental, and chemical analysis was most helpful in identifying both potent and minor sources, thus facilitating cleanup procedures. PMID:17423767

[Acute poisoning in patients over 65 years of age].

PubMed

Miranda Arto, P; Ferrer Dufol, A; Ruiz Ruiz, F J; Menao Guillén, S; Civeira Murillo, E

2014-01-01

There are few Spanish studies on acute poisoning in the elderly despite the associated risk factors of this group of patients. Retrospective descriptive study of acute poisonings treated in the Emergency Service of the University Hospital of Zaragoza from 1995 to 2009 on patients 65 years old or older. A total of 762 patients were selected in the study (4.74% of all acute poisonings) with a mean age of 74.16 (SD ± 6) years. Ingestion was the major route of exposure (85%) and alcohol overdose (28,7%) was the most frequent type of poisoning. A trend was also observed showing a lower emetic treatment and gastric lavage and an increase in activated charcoal. Benzodiazepines (14.3%) and toxic household products (11%) with caustic properties were also the main toxics found in the study. Acute poisonings in the elderly required more hospitalizations, have a higher mortality and more autolytic attempts which result in death.

Proteomic study of differential protein expression in mouse lung tissues after aerosolized ricin poisoning.

PubMed

Guo, Zhendong; Han, Chao; Du, Jiajun; Zhao, Siyan; Fu, Yingying; Zheng, Guanyu; Sun, Yucheng; Zhang, Yi; Liu, Wensen; Wan, Jiayu; Qian, Jun; Liu, Linna

2014-04-28

Ricin is one of the most poisonous natural toxins from plants and is classified as a Class B biological threat pathogen by the Centers for Disease Control and Prevention (CDC) of U.S.A. Ricin exposure can occur through oral or aerosol routes. Ricin poisoning has a rapid onset and a short incubation period. There is no effective treatment for ricin poisoning. In this study, an aerosolized ricin-exposed mouse model was developed and the pathology was investigated. The protein expression profile in the ricin-poisoned mouse lung tissue was analyzed using proteomic techniques to determine the proteins that were closely related to the toxicity of ricin. 2D gel electrophoresis, mass spectrometry and subsequent biological functional analysis revealed that six proteins including Apoa1 apolipoprotein, Ywhaz 14-3-3 protein, Prdx6 Uncharacterized Protein, Selenium-binding protein 1, HMGB1, and DPYL-2, were highly related to ricin poisoning.

Creatinine elevation associated with nitromethane exposure: a marker of potential methanol toxicity.

PubMed

Cook, Matthew D; Clark, Richard F

2007-10-01

Nitromethane, methanol, and oil are the common components of radio-controlled (R/C) vehicle fuels. Nitromethane can cause a false elevation of serum creatinine concentration as measured by the widely used Jaffe colorimetric method. We gathered data from our poison control system and from previously published case reports to see if a correlation exists between serum methanol concentrations and spuriously elevated serum creatinine concentrations after human exposures to R/C fuel. The California Poison Control System (CPCS) computerized database was queried for all cases of human exposure to R/C vehicle fuel reported between December 1, 2002 and December 1, 2004. Serum creatinine and methanol concentrations were recorded when available, as was the method used to determine serum creatinine. A MEDLINE search was used to obtain previously published cases of human nitromethane exposure associated with falsely elevated creatinine concentrations. During the 2-year period, serum creatinine concentrations were recorded in 7 of 26 R/C fuel exposures (all ingestions), and 6 of these were abnormal (range of 1.9-11.5 mg/dL). In this series, the higher the serum creatinine concentration measured by Jaffe method, the higher the serum methanol concentration. The MEDLINE search yielded data from six previously published case reports on this topic. The data from these case reports seem to follow the trend seen in our case series. These data suggest that a spuriously elevated serum creatinine (by Jaffe method) may have value as an early surrogate marker of methanol poisoning in those who ingest R/C fuel. Also, the degree to which the serum creatinine is elevated may indicate the severity of methanol poisoning.

Trends of Pesticide Exposure and Related Cases in the Philippines

PubMed Central

Lu, Jinky Leilanie; Cosca, Katherine Z.; Del mundo, Jocelyn

2010-01-01

The study aims to provide a comprehensive trend of pesticide poisoning cases in the Philippines as well as pesticide exposures, and risk factors related to the adverse effects of pesticide. Records were gathered from the National Poison Control and Management Center (NPCMC), the Philippine General Hospital, De La Salle Medical Center, and other hospitals, and reviewed research studies conducted in the Philippines. Based on hospital surveys, the number of pesticide cases as well as mortality trends have been increasing. Studies from 2006 to 2010 showed that human health especially those of the farmers is at risk due to pesticide exposure. Illnesses and symptoms such as headache, skin abnormalities, fatigue, fever, and weaknesses were the common health complaints experienced by the farmers as reported in the research studies. Moreover, the studies showed risk factors to pesticide exposure, work practices, and pesticide residues in environmental media that could be contributory to pesticide poisoning cases. Government agencies should intensify their surveillance and regulation on both household and agricultural pesticides. The state of pesticide-related illnesses mirrors the poor safety practices among farmers as well as lack of necessary supervision from the government agencies. PMID:25649374

Trends of pesticide exposure and related cases in the Philippines.

PubMed

Lu, Jinky Leilanie; Cosca, Katherine Z; Del Mundo, Jocelyn

2010-01-01

The study aims to provide a comprehensive trend of pesticide poisoning cases in the Philippines as well as pesticide exposures, and risk factors related to the adverse effects of pesticide. Records were gathered from the National Poison Control and Management Center (NPCMC), the Philippine General Hospital, De La Salle Medical Center, and other hospitals, and reviewed research studies conducted in the Philippines. Based on hospital surveys, the number of pesticide cases as well as mortality trends have been increasing. Studies from 2006 to 2010 showed that human health especially those of the farmers is at risk due to pesticide exposure. Illnesses and symptoms such as headache, skin abnormalities, fatigue, fever, and weaknesses were the common health complaints experienced by the farmers as reported in the research studies. Moreover, the studies showed risk factors to pesticide exposure, work practices, and pesticide residues in environmental media that could be contributory to pesticide poisoning cases. Government agencies should intensify their surveillance and regulation on both household and agricultural pesticides. The state of pesticide-related illnesses mirrors the poor safety practices among farmers as well as lack of necessary supervision from the government agencies.

40 CFR 158.1010 - Applicator exposure-criteria for testing.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) PESTICIDE PROGRAMS DATA REQUIREMENTS FOR PESTICIDES Human Exposure § 158.1010 Applicator exposure—criteria... epidemiological or poisoning incident data indicate that adverse health effects may have resulted from handling of the pesticide. (b) Exposure criteria. (1) Dermal exposure may occur during the prescribed use. (2...

40 CFR 158.1010 - Applicator exposure-criteria for testing.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) PESTICIDE PROGRAMS DATA REQUIREMENTS FOR PESTICIDES Human Exposure § 158.1010 Applicator exposure—criteria... epidemiological or poisoning incident data indicate that adverse health effects may have resulted from handling of the pesticide. (b) Exposure criteria. (1) Dermal exposure may occur during the prescribed use. (2...

40 CFR 158.1010 - Applicator exposure-criteria for testing.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) PESTICIDE PROGRAMS DATA REQUIREMENTS FOR PESTICIDES Human Exposure § 158.1010 Applicator exposure—criteria... epidemiological or poisoning incident data indicate that adverse health effects may have resulted from handling of the pesticide. (b) Exposure criteria. (1) Dermal exposure may occur during the prescribed use. (2...

40 CFR 158.1010 - Applicator exposure-criteria for testing.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) PESTICIDE PROGRAMS DATA REQUIREMENTS FOR PESTICIDES Human Exposure § 158.1010 Applicator exposure—criteria... epidemiological or poisoning incident data indicate that adverse health effects may have resulted from handling of the pesticide. (b) Exposure criteria. (1) Dermal exposure may occur during the prescribed use. (2...

40 CFR 158.1010 - Applicator exposure-criteria for testing.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) PESTICIDE PROGRAMS DATA REQUIREMENTS FOR PESTICIDES Human Exposure § 158.1010 Applicator exposure—criteria... epidemiological or poisoning incident data indicate that adverse health effects may have resulted from handling of the pesticide. (b) Exposure criteria. (1) Dermal exposure may occur during the prescribed use. (2...

Little field evidence of direct acute and short-term effects of current pesticides on the grey partridge.

PubMed

Millot, Florian; Berny, Philippe; Decors, Anouk; Bro, Elisabeth

2015-07-01

Direct lethal and sublethal effects of pesticides on farmland birds' populations are recurring questions and largely debated. In this context, we conducted an innovative study combining radiotelemetry, farmer surveys, residue analyses on carcasses and modelling to assess the unintentional effects of pesticides on terrestrial birds. We chose the grey partridge Perdix perdix as a case study because this typical bird of European cereal ecosystems is highly exposed to pesticides. In this paper we focused on acute and short-term impacts of pesticides on adult mortality during spring and summer in a one-substance approach (multiple exposure were not studied here) but for a large variety of active substances (a.s.) actually used in cultivated farmland of Northern France. The fate and the location of 529 partridges were monitored twice a day from early March to late August 2010 and 2011 on 12 sites (14,500 ha). Their daily potential exposure to 183 a.s. was determined by overlapping birds' habitat use and daily pesticide application data. Based on this procedure, we calculated mortality rates within 10 days following a potential exposure for 157 different a.s.. 5 a.s. were associated with a "10-day mortality rate" higher than 10% but a single one (thiacloprid) is reported to be highly toxic to birds. We recorded 261 mortalities among which 94 carcasses were in suitable condition for residue analyses. We detected at least one a.s in 39.4% of carcasses. However, only 2 mortality cases were attributed to poisoning (carbofuran). Furthermore, modelling results showed that these lethal pesticide-related poisonings decreased the population growth rate by less than 1%. In conclusion, we did not point out important direct acute and short-term effects of pesticides currently used by farmers during the breeding season on the grey partridge. This is discussed with regards to the complexity of potential effects in operational conditions. Copyright © 2015 Elsevier Inc. All rights reserved.

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

PubMed

Presgrave, Rosaura de Farias; Camacho, Luiz Antônio Bastos; Villas Boas, Maria Helena Simões

2008-12-01

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.

Pesticide poisoning in a preschool child: a case study examining neurocognitive and neurobehavioral effects.

PubMed

Riccio, Cynthia A; Avila, Leonor; Ash, Michael J

2010-04-01

Exposure to environmental toxins, such as pesticides, has been shown to have adverse effects in humans, particularly neurological effects. Cases of acute pesticide poisoning occur less frequently and are less well documented; specific deficits (e.g., in processing speed, working memory) have not consistently been discussed. This is a case study of a preschooler who underwent a neuropsychological assessment due to a pesticide poisoning. His parents reported attention, speech, social, and gross and fine motor concerns after the poisoning. A number of methods and measures were used, including observational data, neuropsychological, and behavioral and social-emotional measures. Consistent with past research, results from the assessment demonstrated the subtle and not-so-subtle effects of acute pesticide poisoning. Implications of the findings are discussed.

[Clinical analysis of lower limb thrombosis caused by paraquat poisoning].

PubMed

Yu, L J; Jian, X D; Zhang, Z C; Ren, Y L; Ning, Q; Wang, K; Gao, B J; Jia, J E

2018-01-20

Objective: To investigate the causes of peripheral vascular thrombosis in patients with paraquat poisoning. Methods: The patients with paraquat poisoning who were admitted to our department in recent two years were observed to screen out the patients with large vessel thrombosis. The data on toxic exposure history, clinical features, and treatment were collected to analyze the causes of thrombosis in the patients with paraquat poisoning. Results: Three patients had typical lower limb thrombosis. There was one case of right common femoral vein thrombosis, one case of bilateral calf muscle vein thrombosis, and one case of right calf superficial vein thrombosis and right calf muscle vein thrombosis. Conclusions: After paraquat poisoning, the blood is in a hypercoagulable state and prolonged bed rest may increase the risk of thrombosis.

Cardiological aspects of carbon monoxide poisoning.

PubMed

Marchewka, Jakub; Gawlik, Iwona; Dębski, Grzegorz; Popiołek, Lech; Marchewka, Wojciech; Hydzik, Piotr

2017-01-01

The aim of this study was to assess cardiological manifestations of carbon monoxide (CO) poisoning. Background/introduction: Carbon monoxide intoxication is one of the most important toxicological causes of morbidity and mortality worldwide. Early clinical manifestation of CO poisoning is cardiotoxicity. We enrolled 75 patients (34 males and 41 females, mean age 37.6 ± 17.7 y/o) hospitalized due to CO poisoning. Laboratory tests including troponin I, blood pressure measurements, HR and electrocardiograms (ECG) were collected. Pach's scale scoring and grading system was used to establish severity of poisoning. Grade of poisoning is positively correlated with troponin I levels and systolic blood pressure. Moreover, troponin levels are significantly correlated with exposition time, lactates and are higher in tachycardiac, hypertensive and positive ECG subpopulations. COHb levels are indicative of exposure but do not correlate with grade of poisoning. The main cause of CO poisoning were bathroom heaters - 83%, only 11% of examined intoxicated population were equipped with CO detectors. Complex cardiological screening covering troponin levels, ECG, blood pressure and heart rate measurements as well as complete blood count with particular attention to platelet parameters should be performed in each case where CO intoxication is suspected. More emphasis on education on CO poisoning is needed.

Two cases of acute lead poisoning due to occupational exposure to lead.

PubMed

Ogawa, Masanori; Nakajima, Yoshiaki; Kubota, Ryuichi; Endo, Yoko

2008-04-01

We experienced two cases of acute lead poisoning due to occupational exposure to lead. The patients were engaged in stripping off antirust compounds including Pb from a bridge and re-painting it at the same work place. Both patients exhibited colic, arthralgia, and anemia. Blood lead levels were 73.1 microg/dl and 96.3 microg/dl. Intravenous CaEDTA chelation therapy was therefore performed. After chelation, blood lead levels decreased and symptoms gradually disappeared. Although the patients were working with protective equipment, the workplace was in the mountains and there was no water for washing. The patients were thus unable to washing their hands and faces. We assume that they swallowed lead dust left on their hands and faces when they removed their clothing, and believe that this poisoning occurred due to lack of knowledge sufficient for protection.

Animal bites and stings reported by United States poison control centers, 2001-2005.

PubMed

Langley, Ricky L

2008-01-01

There is not a single data source for information on the extent of nonfatal injuries inflicted by animals. Although individuals bitten or stung by animals may not visit a health care provider, they may call poison control centers (PCCs) for information. These centers are one source of information on the frequency of occurrence of injuries from animals. The American Association of Poison Control Centers compiles an annual report of exposure calls to various agents, including chemicals, medications, animal bites and stings, plants, and use of antivenoms from their network of PCCs. An estimate of the severity of exposure for each call is also determined. This review examines summary data on different species of animal bites and stings reported by PCCs from 2001 to 2005. From 2001 to 2005 there were 472 760 reports of animal bites and stings, an average of 94,552 per year. There was a trend noted for increasing use of antivenom over this period. Twenty-seven deaths were recorded, most from snakebites. Poison control centers are a source of information for health care workers on management of animal bites and stings. The database maintained by the American Association of Poison Control Centers is another source of information on the magnitude and public health impact of injuries from animals.

Haiti's food and drinking water: a review of toxicological health risks.

PubMed

Schwartzbord, J R; Emmanuel, E; Brown, D L

2013-11-01

The Republic of Haiti is a developing country in the Caribbean region with a history that challenges toxicologists, yet the historical panoply of toxicological hazards in Haiti has received little scholarly attention. The primary objectives of this paper are to review what is known about Haiti's current toxicological hazards, with a focus on chronic food-borne aflatoxin exposure and heavy metal contamination of water resources, and to compare these with previous large-scale, acute exposures to toxic substances: the 1995-1996 diethylene glycol (DEG) intoxications and the 2000-2001 ackee fruit poisonings. MEDLINE/PUBMED and the library website of Cornell University were searched using the terms "Haiti" and either "heavy metals," "aflatoxin", "diethylene glycol", or "ackee". The search was inclusive of articles from 1950 to 2012, and 15 out of the 37 returned were peer-reviewed articles offering original data or comprehensive discussion. One peer-reviewed article in press, two newspaper articles, two personal communications, and one book chapter from the personal databases of the authors were also referenced, making a total of 21 citations. Elevated concentrations of aflatoxins (greater than 20 μg/kg) were documented for staples of the Haitian food supply, most notably peanut butters and maize. Human exposure to aflatoxin was confirmed with analysis of aflatoxin blood biomarkers. The implications of aflatoxin exposure were reviewed in the light of Haiti's age-adjusted liver cancer risk - the highest in the Caribbean region. Measurement of heavy metals in Port-au-Prince ground water showed contamination of lead and chromium in excess of the US Environmental Protection Agency's 15 μg/L Action Level for lead and 100 μg/L Maximum Contamination Level Goal for total chromium. The DEG contamination of paracetamol (acetaminophen) containing products in 1995-1996 claimed the lives of 109 children and the 2000-2001 epidemic of ackee fruit poisoning resulted in 60 cases of intoxication. Lessons for the Haitian Government. The DEG and ackee epidemics overwhelmed local Haitian public health resources. Yet, periods of 8 and 4 months, respectively, passed before the Haitian government sought assistance following the initial poisonings. To our knowledge, the Haitian government did not enact policy to promote drug safety and prevent future poisonings. This will not likely change in the near future because of the state's finance and personnel crises. While protection of its people remains the prerogative of the Haitian government, it is extremely limited in managing chemical exposure to environmental toxins, including aflatoxin and heavy metals. The cases of DEG and ackee fruit poisoning demonstrate that environmental exposures to chemicals have occurred in Haiti. Current low-level exposures to aflatoxin and heavy metals highlight the risk that large-scale poisonings can occur. While awareness of toxicological hazards in Haiti must be acknowledged more widely within the government and non-governmental sectors, the lessons of these exposures are relevant to all developing countries where the capacity to discern and manage toxicological risks is absent or not yet effective.

3 CFR 8784 - Proclamation 8784 of March 16, 2012. National Poison Prevention Week, 2012

Code of Federal Regulations, 2013 CFR

2013-01-01

... poisoning among children, accidental exposure to drugs and medicines, typical household chemicals, and other... locked or childproof cabinets beyond their children’s reach, and by safely disposing of unused or expired... prescription medications. IN WITNESS WHEREOF, I have hereunto set my hand this sixteenth day of March, in the...

International Implications of Lead Poisoning in School Aged Children

ERIC Educational Resources Information Center

Schultz, Susan M.

2016-01-01

The United States and the World Health Organization have worked to decrease lead exposure in children, but despite these efforts lead poisoning continues to exist in industrialized and developing countries. Prevention is the only way to preclude the health, academic and behavioral problems that occur due to the effects of lead. Public awareness…

Impaired hypothalamic-pituitary-testicular axis activity, spermatogenesis, and sperm function promote infertility in males with lead poisoning.

PubMed

Gandhi, Jason; Hernandez, Rafael J; Chen, Andrew; Smith, Noel L; Sheynkin, Yefim R; Joshi, Gargi; Khan, Sardar Ali

2017-04-01

Lead poisoning is a stealthy threat to human physiological systems as chronic exposure can remain asymptomatic for long periods of time before symptoms manifest. We presently review the biophysical mechanisms of lead poisoning that contribute to male infertility. Environmental and occupational exposure of lead may adversely affect the hypothalamic-pituitary-testicular axis, impairing the induction of spermatogenesis. Dysfunction at the reproductive axis, namely testosterone suppression, is most susceptible and irreversible during pubertal development. Lead poisoning also appears to directly impair the process of spermatogenesis itself as well as sperm function. Spermatogenesis issues may manifest as low sperm count and stem from reproductive axis dysfunction or testicular degeneration. Generation of excessive reactive oxygen species due to lead-associated oxidative stress can potentially affect sperm viability, motility, DNA fragmentation, membrane lipid peroxidation, capacitation, hyperactivation, acrosome reaction, and chemotaxis for sperm-oocyte fusion, all of which can contribute to deter fertilization. Reproductive toxicity has been tested through cross-sectional analysis studies in humans as well as in vivo and in vitro studies in animals.

The usefulness of diffusion-weighted magnetic resonance imaging performed in the acute phase as an early predictor of delayed neuropsychiatric sequelae in acute carbon monoxide poisoning.

PubMed

Kim, Y S; Cha, Y S; Kim, M S; Kim, H J; Lee, Y S; Youk, H; Kim, H I; Kim, O H; Cha, K-C; Kim, H; Lee, K H; Hwang, S O

2018-06-01

Delayed onset of neuropsychiatric symptoms after apparent recovery from acute carbon monoxide (CO) poisoning has been described as delayed neuropsychiatric sequelae (DNS). No previous study has determined whether early use of diffusion-weighted magnetic resonance imaging (DWI) can predict which patients will develop DNS in the acute CO poisoning. This retrospective observational study was performed on adult patients with acute CO poisoning consecutively treated over a 17-month period. All included patients with acute CO poisoning underwent DWI to evaluate brain injury within 72 h after CO exposure. DWI was evaluated as follows: (1) presence of pathology, (2) number of pathologies, (3) asymmetry, and (4) location of pathology. Patients were divided into two groups. The DNS group was composed of patients with delayed sequelae, while the non-DNS group included patients with no sequelae. A total of 102 patients with acute CO poisoning were finally enrolled in this study. DNS developed in 10 patients (9.8%). Between the DNS group and the non-DNS group, presence of pathology on DWI and initial Glasgow Coma Scale (GCS) showed significant difference. There was also a statistical difference between the non-DNS group and DNS group in terms of CO exposure time, troponin I, rhabdomyolysis, acute kidney injury, and pneumonia. The presence of pathology in DWI and initial GCS (cutoff: <12) at the emergency department served as an early predictors of DNS.

[Venom as a cure--some notes on ancient medicine].

PubMed

Teichfischer, Philipp

2015-01-01

Very little is known today about the linguistics and facts relating to venoms in the ancient world. The article concerns itself initially with the terminology: How were venoms conceptualized and what position did they occupy among medicines and other poisons? Additionally ancient knowledge of the constitution and location of the venoms will be examined. Furthermore, it shall be outlined how it was perceived that the poisons actually took effect. The results of our investigations indicate that it was unlikely that venoms were used for medicinal purposes in ancient times.

Toxicity resulting from exposure to oven cleaners as reported to the UK National Poisons Information Service (NPIS) from 2009 to 2015.

PubMed

Day, Rachael C; Bradberry, Sally M; Sandilands, Euan A; Thomas, Simon H L; Thompson, John P; Vale, J Allister

2017-08-01

Oven cleaning products contain corrosive substances, typically sodium or potassium hydroxide. To determine the reported toxicity from exposure to oven cleaning products. Telephone enquiries to the UK National Poisons Information Service regarding oven cleaning products were analysed retrospectively for the period January 2009 to December 2015. There were 796 enquiries relating to 780 patients. Ninety-six percent of the products involved in the reported exposures contained sodium hydroxide and/or potassium hydroxide. Ingestion alone (n = 285) or skin contact alone (n = 208) accounted for the majority of cases; inhalation alone (n = 101), eye contact alone (n = 97), and multiple routes of exposure (n = 89) accounted for the remainder. Ninety-five percent of patients exposed by inhalation, 94% exposed dermally and 85% reporting eye exposure, developed features of toxicity. Patients exposed by multiple routes developed symptoms in 70% of cases. Only 103 of the 285 patients ingested oven cleaner directly, whereas 182 patients ingested food they considered to have been contaminated with oven cleaner. In 100 of the 103 direct ingestions where the features and World Health Organisation/International Programme on Chemical Safety/European Commission/European Association of Poison Centres and Clinical Toxicologists Poisoning Severity Score were known, 56 reported symptoms which were minor in 51 cases. The most common features following ingestion were vomiting (n = 26), abdominal pain (n = 22) or pharyngitis (n = 15). Skin burns (n = 91) predominantly involving the hands or arms, occurred in 44% of dermal exposures. Following inhalation, patients frequently developed respiratory features (n = 52) including coughing and chest pain/tightness. Eye pain (n = 43) and conjunctivitis (n = 33) commonly occurred following ocular exposure. Most (71%) patients exposed to an oven cleaner irrespective of the route of exposure developed features of toxicity, though in most cases only minor features developed; moderate or severe features ensued in ∼4%. Those patients exposed dermally, ophthalmically or by inhalation developed features more frequently (≥85%) than those who ingested a product directly (56%).

DDT exposure of zebrafish embryos enhances seizure susceptibility: relationship to fetal p,p'-DDE burden and domoic acid exposure of California sea lions.

PubMed

Tiedeken, Jessica A; Ramsdell, John S

2009-01-01

California sea lions have a large body burden of organochlorine pesticides, and over the last decade they have also been subject to domoic acid poisoning. Domoic acid poisoning, previously recognized in adult animals, is now viewed as a major cause of prenatal mortality. The appearance of a chronic juvenile domoic acid disease in the sea lions, characterized by behavioral abnormalities and epilepsy, is consistent with early life poisoning and may be potentiated by organochlorine burden. We investigated the interactive effect of DDT (dichlorodiphenyltrichloroethane) on neurodevelopment using a zebrafish (Danio rerio) model for seizure behavior to examine the susceptibility to domoic acid-induced seizures after completion of neurodevelopment. Embryos were exposed (6-30 hr postfertilization) to either o,p'-DDT or p,p'-DDE (dichlorodiphenyldichloroethylene) during neurodevelopment via a 0.1% dimethyl sulfoxide solution. These larval (7 days postfertilization) fish were then exposed to either the seizure-inducing drug pentylenetetrazol (PTZ) or domoic acid; resulting seizure behavior was monitored and analyzed for changes using cameras and behavioral tracking software. Embryonic exposure to DDTs enhanced PTZ seizures and caused distinct and increased seizure behaviors to domoic acid, most notably a type of head-shaking behavior. These studies demonstrate that embryonic exposure to DDTs leads to asymptomatic animals at completion of neurodevelopment with greater sensitivity to domoic acid-induced seizures. The body burden levels of p,p'-DDE are close to the range recently found in fetal California sea lions and suggest a potential interactive effect of p,p'-DDE embryonic poisoning and domoic acid toxicity.

Relationship between oxidative stress, pathology, and behavioral signs of lead poisoning in mallards

USGS Publications Warehouse

Mateo, R.; Beyer, W.N.; Spann, J.W.; Hoffman, D.J.; Ramis, A.

2003-01-01

Some of the adverse effects of lead (Pb) may be associated with oxidative damage of lipids, proteins or DNA. In a previous study a linkage was observed between the susceptibilities of waterfowl species to Pb poisoning with oxidative stress. To investigate this relationship among the individuals of a single species, four groups of 12 mallards were fed for three weeks diets containing high or low levels of vitamin E (20 or 220 UI/kg) and high or low levels of Pb (0 or 2 g/kg). During the first week of Pb exposure, mallards developed hemolytic anemia, and during the second week, signs of neurological impairment. Histological findings in the Pb exposed mallards were hemosiderosis, demyelinization of sciatic and brachial nerves, and tumefaction of renal tubular epithelium with the presence of intranuclear inclusion bodies. Lipid peroxidation increased with Pb exposure in blood, liver, bile and brain, but decreased in nerves. Glutathione (GSH) increased with Pb exposure in liver and bile, and its oxidized/reduced ratio only increased in bile. Pb exposure inhibited GSH peroxidase activity (GPX) in plasma, liver and brain, and decreased protein thiols (PSH) in blood and liver. Vitamin E significantly prevented lipid peroxidation in nerves, but did not alleviate any sign of Pb poisoning. Pb-induced pathological changes associated with hepatic and nervous functions were significantly correlated with lower GPX activity and PSH concentrations in these tissues rather than lipid peroxidation. Data suggest that inhibition of antioxidant enzymes and interaction with sulfhydryl groups of proteins may play a more important role in Pb poisoning of waterfowl than lipid peroxidation.

Risk assessment of bearded vulture (Gypaetus barbatus) exposure to topical antiparasitics used in livestock within an ecotoxicovigilance framework.

PubMed

Mateo, Rafael; Sánchez-Barbudo, Inés S; Camarero, Pablo R; Martínez, José M

2015-12-01

Between 2004 and 2013, 486 suspected scavenger poisoning cases, including 24 bearded vultures (Gypaetus barbatus), were investigated in the Pyrenees and surrounding areas in Spain as part of a monitoring programme regarding accidental and intentional poisoning of wildlife. Poisoning was confirmed in 36% of all analysed cases where scavenger species were found dead within the distribution range of bearded vultures. Organophosphates and carbamates were the most frequently detected poisons. Four of the bearded vulture cases were positive for the presence of topical antiparasitics (3 with diazinon and 1 with permethrin). These likely represented accidental exposure due to the legal use of these veterinary pharmaceuticals. In order to confirm the risk of exposure to topical antiparasitics in bearded vultures, pig feet (n=24) and lamb feet (n=24) were analysed as these are one of the main food resources provided to bearded vultures at supplementary feeding stations. Pig feet had no detectable residues of topical antiparasitics. In contrast, 71.4% of lamb feet showed residues of antiparasitics including diazinon (64.3%), pirimiphos-methyl (25.4%), chlorpyrifos (7.1%), fenthion (1.6%), permethrin (0.8%) and cypermethrin (27.8%). Washing the feet with water significantly reduced levels of these topical antiparasitics, as such, this should be a recommended practice for lamb feet supplied at feeding stations for bearded vultures. Although the detected levels of antiparasitics were relatively low (≤1 μg/g), a risk assessment suggests that observed diazinon levels may affect brain acetylcholinesterase and thermoregulation in bearded vultures subject to chronic exposure. Copyright © 2015 Elsevier B.V. All rights reserved.

Application of 2-Aminothiazoline-4-carboxylic Acid as a Forensic Marker of Cyanide Exposure.

PubMed

Rużycka, Monika; Giebułtowicz, Joanna; Fudalej, Marcin; Krajewski, Paweł; Wroczyński, Piotr

2017-02-20

Cyanides are infamous for their highly poisonous properties. Accidental cyanide poisoning occurs frequently, but occasionally, intentional poisonings also occur. Inhalation of fumes generated by fire may also cause cyanide poisoning. There are many limitations in direct analysis of cyanide. 2-Aminothiazoline-4-carboxylic acid (ATCA), a cyanide metabolite, seems to be the only surrogate that is being used in the detection of cyanide because of its stability and its cyanide-dependent quality in a biological matrix. Unfortunately, toxicokinetic studies on diverse animal models suggest significant interspecies differences; therefore, the attempt to extrapolate animal models to human models may be unsuccessful. The aim of the present study was to evaluate the use of ATCA as a forensic marker of cyanide exposure. For this purpose, post-mortem materials (blood and organs) from fire victims (n = 32) and cyanide-poisoned persons (n = 3) were collected. The distribution of ATCA in organs and its thermal stability were evaluated. The variability of cyanides in a putrid sample and in the context of their long-term and higher temperature stability was established. The presence of ATCA was detected by using an LC-MS/MS method and that of cyanide was detected spectrofluorimetrically. This is the first report on the endogenous ATCA concentrations and the determination of ATCA distribution in tissues of fire victims and cyanide-poisoned persons. It was found that blood and heart had the highest ATCA concentrations. ATCA was observed to be thermally stable even at 90 °C. Even though the cyanide concentration was not elevated in putrid samples, it was unstable during long-term storage and at higher temperature, as expected. The relationship between ATCA and cyanides was also observed. Higher ATCA concentrations were related to increased levels of cyanide in blood and organs (less prominent). ATCA seems to be a reliable forensic marker of exposure to lethal doses of cyanide.

Childhood Lead Poisoning in the '90s.

ERIC Educational Resources Information Center

Piomelli, Sergio

1994-01-01

Notes that, despite gains in eliminating lead sources, there are still detectable effects from low-level exposure. Discusses at what level of exposure the adverse effects of lead become trivial and what measures, if any, should be taken to reduce low-level exposure. (HTH)

Clinical Marine Toxicology: A European Perspective for Clinical Toxicologists and Poison Centers

PubMed Central

Schmitt, Corinne; de Haro, Luc

2013-01-01

Clinical marine toxicology is a rapidly changing area. Many of the new discoveries reported every year in Europe involve ecological disturbances—including global warming—that have induced modifications in the chorology, behavior, and toxicity of many species of venomous or poisonous aquatic life including algae, ascidians, fish and shellfish. These changes have raised a number of public issues associated, e.g., poisoning after ingestion of contaminated seafood, envenomation by fish stings, and exposure to harmful microorganism blooms. The purpose of this review of medical and scientific literature in marine toxicology is to highlight the growing challenges induced by ecological disturbances that confront clinical toxicologists during the everyday job in the European Poison Centers. PMID:23917333

Risk Factors of Pesticide Poisoning and Pesticide Users’ Cholinesterase Levels in Cotton Production Areas: Glazoué and Savè Townships, in Central Republic of Benin

PubMed Central

Vikkey, Hinson Antoine; Fidel, Dossou; Pazou Elisabeth, Yehouenou; Hilaire, Hountikpo; Hervé, Lawin; Badirou, Aguèmon; Alain, Koudafoke; Parfait, Houngbégnon; Fabien, Gounongbé; Benjamin, Fayomi

2017-01-01

Objective: To assess the degree of poisoning in farmers using the erythrocyte acetylcholinesterase (AChE) test before and after the exposure to pesticides in townships in central Benin (Glazoué and Savè) and to identify the associated risk factors. Methods: Using a cross-sectional study design, we recruited 264 farm pesticide sprayers, who have been working for at least 5 years. They completed a questionnaire and underwent the AChE test using the Test-mate Model 400 device (EQM Research Inc.) with a photometric sensor, based on the works of Ellman. Results: Organophosphate/pyrethroids were the most common pesticides used by at least 72.96% of the farmworkers. We observed an inhibition of AChE between pre-exposure and post-exposure (P = .002) for 60.61% of the farmworkers. Among them, 11.88% displayed more than 20% AChE inhibition. Conclusions: Pesticide poisoning is a reality, and AChE monitoring is urgently needed for farmworker surveillance. PMID:28469452

Reducing lead in air and preventing childhood exposure near lead smelters: learning from the U.S. experience.

PubMed

Sullivan, Marianne

2015-05-01

Childhood lead exposure and poisoning near primary lead smelters continues in developed and developing countries. In the United States, the problem of lead poisoning in children caused by smelter emissions was first documented in the early 1970s. In 1978, Environmental Protection Agency set National Ambient Air Quality Standards for lead. Attainment of this lead standard in areas near operating lead smelters took twenty to thirty years. Childhood lead exposure and poisoning continued to occur after the lead National Ambient Air Quality Standards were set and before compliance was achieved. This article analyzes and discusses the factors that led to the eventual achievement of the 1978 lead National Ambient Air Quality Standards near primary smelters and the reduction of children's blood lead levels in surrounding communities. Factors such as federal and state regulation, monitoring of emissions, public health activities such as blood lead surveillance and health education, relocation of children, environmental group and community advocacy, and litigation all played a role. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

An outbreak of carbon monoxide poisoning after a major ice storm in Maine.

PubMed

Daley, W R; Smith, A; Paz-Argandona, E; Malilay, J; McGeehin, M

2000-01-01

Unintentional carbon monoxide (CO) exposure kills over 500 people in the U.S. annually. Outbreaks of CO poisoning have occurred after winter storms. The objective of this study was to describe clinical features and identify important risk factors of a CO poisoning outbreak occurring after a major ice storm. The study design included a case series of CO poisoning patients, a telephone survey of the general community, and a case-controlled study of households using specific CO sources. The setting was the primary service area of four hospital emergency departments located in the heavily storm-impacted interior region of Maine. Participants included all patients with a laboratory-confirmed diagnosis of CO poisoning during the 2 weeks after the storm onset, and a population-based comparison group of 522 households selected by random digit dialing. There were 100 cases identified, involving 42 common-source exposure incidents, most of them during the first week. Though classic CO symptoms of headache, dizziness, and nausea predominated, 9 patients presented with chest pain and 10 were asymptomatic. One patient died and 5 were transferred for hyperbaric oxygen therapy. Gasoline-powered electric generators were a CO source in 30 incidents, kerosene heaters in 8, and propane heaters in 4. In the community, 31.4% of households used a generator after the ice storm. The strongest risk factor for poisoning was locating a generator in a basement or an attached structure such as a garage. Cases of CO poisoning with various presentations can be expected in the early aftermath of a severe ice storm. Generators are a major CO source and generator location an important risk factor for such disasters.

[Poisonings due to Substance Abuse Reported to the Poisons Information Centre Erfurt from 2002 to 2011].

PubMed

Liebetrau, G; Prasa, D; Hentschel, H; Deters, M

2014-10-01

Because of their importance for clinical toxicology, developments of sub-stance abuse reported to the Poisons Information Centre (PIC) Erfurt were investigated and compared to other reasons of human exposures. A retrospective analysis of all human exposures (exposures of humans to substances in abuse, accidental and unknown circumstances, and suicide attempts) (n=125,130) from the beginning of 2002 to the end of 2011 was undertaken according to substance classes, reasons of exposures, symptom severity, age groups, and gender. Cases of substance abuse (3,760, 3.0% of all exposures) continuously increased from 252 (92 with one and 160 with multiple substances) in 2002 to 507 in 2011 (239 with one and 268 with multiple substances). In relation to all exposures, only the abuse of multiple substances rose significantly (p<0.001). In comparison to all substances of exposure, ethanol, amphetamine-type stimulants, benzodiazepines/analogues, and liquid ecstasy abuse significantly (p<0.005) increased while cannabis and Brugmansia/Datura species abuse significantly (p<0.05) decreased. Substance abuse significantly (p<0.001) more often caused moderate (23.7%) and severe symptoms (6.1%) than in suicide attempts (9.6%; 4.4%). First legal highs exposures were registered in 2010 and led significantly (p<0.001) more often to moderate symptoms (50%) than cannabis exposures (19.4%). The clinical significance of substance abuse is shown by the fact that it resulted more often in moderate and severe symptoms than suicide attempts. Data on substance abuse from PICs could supplement official annual drug reports in aspects of clinical toxicology. © Georg Thieme Verlag KG Stuttgart · New York.

Human exposures to tilmicosin reported to poison centres, Texas, 1998-2003.

PubMed

Forrester, Mathias B

2005-05-01

Tilmicosin, or 20-deoxo-20-(3,5-dimethylpiperidin-1-yl)-desmycosin, is a macrolide antibiotic primarily utilized in livestock. This study examined 46 human exposure calls involving tilmicosin received by Texas poison centres during 1998-2003. The majority (91%) of the calls were received from northern and central Texas. All of the cases were unintentional exposures. The most frequent route of exposure was parenteral (48%). The majority of the patients were males (80%) and adults (84%). Only 46% of the patients were managed outside of health care facilities. Some sort of adverse medical outcome was reported in 93% of parenteral exposures and 54% of other-route exposures. However, only 21% of parenteral exposures and 15% of other-route exposures involved medical outcomes that were judged to be moderate or worse. No deaths were reported. The most frequently reported clinical effects among parenteral cases were dermal (79%), while only 9% of other-route exposures had dermal effects. Cardiovascular clinical effects were observed in a single case of parenteral exposure and a single case of other-route exposure. Although the majority of cases were managed with the assistance of health care facilities, the medical outcomes were usually not serious. Outcome depended on the route of exposure.

Lead Poisoning Prevention Tips

MedlinePlus

... be done to prevent exposure to lead? Lead-Safe Work Coloring book Reduce a child’s exposure from non- ... here to print a coloring storybook on lead-safe work [PDF - 1.94 MB] . Top of Page To ...

Deliberate drug poisonings admitted to an emergency department in Paris area - a descriptive study and assessment of risk factors for intensive care admission.

PubMed

Beaune, S; Juvin, P; Beauchet, A; Casalino, E; Megarbane, B

2016-01-01

Each year, approximately 165,000 poisonings are managed in the emergency departments (ED) in France. We performed a descriptive analysis of self-poisoned patients admitted to a university hospital ED in the Paris metropolitan area (France) aimed at investigating their outcome and the risk factors for transfer to the intensive care unit (ICU). We retrospectively reviewed patients' records and performed multivariate logistic regression analysis to identify risk factors for ICU admission. During 4 years, 882 self-poisoned patients (median age, 38 years [IQR, 26-47]; sex-ratio, 1M/3F) were admitted to the ED, representing 0.7% of all referred patients. Poisonings mainly resulted from multidrug exposures (53%), including benzodiazepines (78%), serotonin reuptake inhibitors (17%), acetaminophen (13%), antipsychotics (9.5%), imidazopyridines (9.5%), antihypertensive drugs (3%), and polycyclic antidepressants (1.3%). Ethanol was involved in 20% of the exposures. Patients were briefly (<24h) monitored in the ED (55%), transferred to the psychiatric department (30%), medical ward (2%) or ICU (6%), and took an irregular discharge (7%). Among the patients transferred to the ICU, 25% were mechanically ventilated and only one died. Risk factors for ICU admission included antihypertensive (Odds ratio (OR), 40.6; 95%-confidence interval (CI), 7.5-221.9) or antipsychotic drug ingestion (OR, 5.3; CI, 2.0-14.4), male gender (OR, 3.3; CI, 1.30-8.8), and consciousness impairment (OR, 2.1; CI, 1.8-2.5 per point lost in Glasgow coma score). Deliberate drug exposure represents a frequent cause of ED admission. Psychotropic drugs are most commonly involved. Transfer to the ICU is rare and predicted by male gender, drug class, and coma depth.

Drinking water incidents due to chemical contamination in England and Wales, 2006-2008.

PubMed

Paranthaman, Karthikeyan; Harrison, Henrietta

2010-12-01

Contamination of drinking water by microbiological and chemical agents can lead to adverse health effects. In England and Wales, the Chemicals Hazards and Poisons Division (CHaPD) of the Health Protection Agency provides expert advice on the consequences to public health of chemical contamination incidents affecting drinking water. In this study, we extracted data from the National Database on the type and nature of drinking water contamination events reported to the CHaPD between 2006 and 2008. Eighty-two incidents with confirmed chemical contamination were identified. Among the 70 incidents where data was available, 40% (28/70) of incidents related to contamination of drinking water provided by private suppliers, 31% (22/70) were due to contamination occurring close to the point of consumption (i.e. near consumer) and 29% (20/70) related to incidents where public water supplies were identified as the contaminated source. For the majority of incidents, little or no information was available on the critical exposure variables such as duration of contamination and actual or estimates of the population affected. Reassuringly, the levels of exposure in most incidents were considered unlikely to cause serious immediate or long term ill health effects. Recording of exposure data for reported contamination incidents needs to be improved.

21 CFR 522.1862 - Sterile pralidoxime chloride.

Code of Federal Regulations, 2012 CFR

2012-04-01

... water for injection prior to use. (c) Sponsor. See No. 000856 in § 510.600(c) of this chapter. (d) Conditions of use. (1) It is used in horses, dogs, and cats as an antidote in the treatment of poisoning due... in horses, dogs, and cats. (2) It is administered as soon as possible after exposure to the poison...

21 CFR 522.1862 - Sterile pralidoxime chloride.

Code of Federal Regulations, 2013 CFR

2013-04-01

... water for injection prior to use. (c) Sponsor. See No. 000856 in § 510.600(c) of this chapter. (d) Conditions of use. (1) It is used in horses, dogs, and cats as an antidote in the treatment of poisoning due... in horses, dogs, and cats. (2) It is administered as soon as possible after exposure to the poison...

21 CFR 522.1862 - Sterile pralidoxime chloride.

Code of Federal Regulations, 2011 CFR

2011-04-01

... water for injection prior to use. (c) Sponsor. See No. 000856 in § 510.600(c) of this chapter. (d) Conditions of use. (1) It is used in horses, dogs, and cats as an antidote in the treatment of poisoning due... in horses, dogs, and cats. (2) It is administered as soon as possible after exposure to the poison...

[Fatal outcome of an hydrogen sulfide poisoning].

PubMed

Querellou, E; Jaffrelot, M; Savary, D; Savry, C; Perfus, J-P

2005-10-01

We report a case of fatal outcome poisoning by massive exposure to hydrogen sulfide of a sewer worker. This rare event was associated with a moderate intoxication of two members of the rescue team. The death was due to asystole and massive lung oedema. Autopsy analysis showed diffuse necrotic lesions in lungs. Hydrogen sulfide is a direct and systemic poison, produced by organic matter decomposition. The direct toxicity mechanism is still unclear. The systemic toxicity is due to an acute toxicity by oxygen depletion at cellular level. It is highly diffusable and potentially very dangerous. At low concentration, rotten egg smell must trigger hydrogen sulfide suspicion since at higher concentration it is undetectable, making intoxication possible. In case of acute intoxication, there is an almost instantaneous cardiovascular failure and a rapid death. Hydrogen sulfide exposure requires prevention measures and more specifically the use of respiratory equipment for members of the rescue team.

The Chemical Nature of Mercury in Human Brain Following Poisoning or Environmental Exposure

PubMed Central

2010-01-01

Methylmercury is among the most potentially toxic species to which human populations are exposed, both at high levels through poisonings and at lower levels through consumption of fish and other seafood. However, the molecular mechanisms of methylmercury toxicity in humans remain poorly understood. We used synchrotron X-ray absorption spectroscopy (XAS) to study mercury chemical forms in human brain tissue. Individuals poisoned with high levels of methylmercury species showed elevated cortical selenium with significant proportions of nanoparticulate mercuric selenide plus some inorganic mercury and methylmercury bound to organic sulfur. Individuals with a lifetime of high fish consumption showed much lower levels of mercuric selenide and methylmercury cysteineate. Mercury exposure did not perturb organic selenium levels. These results elucidate a key detoxification pathway in the central nervous system and provide new insights into the appropriate methods for biological monitoring. PMID:22826746

Outcomes of chlorine exposure: a 5-year poison center experience in 598 patients.

PubMed

LoVecchio, Frank; Blackwell, Scott; Stevens, Donna

2005-06-01

The outcome after chlorine exposures has been poorly described. We conducted a 5-year retrospective poison control center review of chlorine exposure cases. The inclusion criteria were self (or surrogate) reported concentrated 'chlorine' liquid (> or =10% concentration of sodium hypochorite) or tablet (> or =90% concentration) exposure. Two reviewers blinded to the main purpose of the study reviewed charts and a third reviewed 10% of the charts, and a kappa score was calculated. Parameters reviewed included the type of exposure (tablets, liquid or both), symptoms (cough, chest pain, etc.), time to symptom onset, treatment received, hospital referral rate and outcomes. A total of 598 patient records were reviewed, with a mean age of 29.63 years (range 11-82); 41.5% (248) were exposures to tablets and 53.5% (320) were exposed to liquid chlorine, with the remainder exposed to both. Complaints included shortness of breath, eye irritation, nasal complaints, cough, and skin complaints. Sixty-nine patients were evaluated at a healthcare facility (11 referred by a poison control center and 58 were self-referrals). Five patients were admitted and four out of the five had a history of reactive airway disease. The mean time to peak symptoms was 94.4 min, 63.2% reached peak symptoms within 30 min, and 82% within 120 min, with 74% of all patients asymptomatic within 150 min. All five admitted patients were discharged within 48 h, and all others remained clinically well at a 24 h telephone follow-up. Exposure to chlorine tablets and liquid rarely requires hospital referral with almost all symptoms resolving within 24 h.

[Occupational toxic exposure and the pregnant woman. 2: results of a prospective study of 100 pregnancies].

PubMed

Testud, F; Lambert-Chhum, R; Bellemin, B; Descotes, J

2001-12-01

Many women of childbearing age are occupationally exposed to chemicals and concerned with the ensuing risk when pregnant. To present the results of a prospective follow-up study of 100 pregnant women and to discuss them after a brief overview of the published data on this topic. Since January 1996 the Lyon Poison Center has been conducting a prospective follow-up of all request concerning pregnant women occupationally exposed to chemicals. A thorough evaluation of the hazards of the handled products and of the actual exposure at the workplace is done for each patient. A toxicological advice is given and the outcome of the pregnancy is followed-up. One hundred pregnant women were included between January 1996 and December 2000. Based on the nature of the handled products, two groups have been identified: the first included 73 women exposed to organic solvents and the second 27 women exposed to miscellaneous. When the exposure was considered potentially hazardous for the pregnancy, either withdrawal from the workstation (19 cases), avoidance of certain activities (9 cases) or improvement of individual protective measures (29 cases) was recommended. In 43% of the cases, the occupational exposure was not considered hazardous to the outcome of the pregnancy. No increase of adverse outcome was identified: 4 miscarriages and 96 living births were observed, with 2 major malformations and 1 minor malformation. Occupational exposure to chemicals was not found to affect adversely the outcome of these 100 pregnancies.

Animal-related fatalities--part II: characteristic autopsy findings and variable causes of death associated with envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis.

PubMed

Bury, Danielle; Langlois, Neil; Byard, Roger W

2012-03-01

In addition to blunt and sharp trauma, animal-related fatalities may result from envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis. Although the majority of envenomation deaths are caused by hornets, bees, and wasps, the mechanism of death is most often anaphylaxis. Envenomation resulting from the injection of a poison or toxin into a victim occurs with snakes, spiders, and scorpions on land. Marine animal envenomation may result from stings and bites from jellyfish, octopus, stonefish, cone fish, stingrays, and sea snakes. At autopsy, the findings may be extremely subtle, and so a history of exposure is required. Poisoning may also occur from ingesting certain fish, with three main forms of neurotoxin poisoning involving ciguatera, tetrodotoxin ingestion, and paralytic shellfish poisoning. Asphyxiation may follow upper airway occlusion or neck/chest compression by animals, and sepsis may follow bites. Autopsy analysis of cases requires extensive toxinological, toxicological, and biochemical analyses of body fluids. © 2011 American Academy of Forensic Sciences.

Gallium poisoning: a rare case report.

PubMed

Ivanoff, Chris S; Ivanoff, Athena E; Hottel, Timothy L

2012-02-01

The authors present a case of a college student who suffered acute gallium poisoning as a result of accidental exposure to gallium halide complexes. This is extremely rare and has never been reported in the literature. Acute symptoms after the incident, which initially presented as dermatitis and appeared relatively not life-threatening, rapidly progressed to dangerous episodes of tachycardia, tremors, dyspnea, vertigo, and unexpected black-outs. Had there been effective emergency medical care protocols, diagnostic testing, treatment and antidotes, the latent manifestations of irreversible cardiomyopathy may have been prevented. Given how quickly exposure led to morbidity, this article aims to raise an awareness of the toxic potential of gallium. This has particular relevance for workers involved in the production of semiconductors where there is a potential for accidental exposure to gallium by-products during device processing. It may also have implications for dentists who use gallium alloys to replace mercury containing amalgam. In the absence of threshold limit values and exposure limits for humans, as well as emergency medical guidelines for treatment of poisoning, the case calls on the National Institute for Occupational Safety and Health and the Occupational Safety and Health Administration to establish guidelines and medical management protocols specific for gallium. Copyright © 2011 Elsevier Ltd. All rights reserved.

Passive and Active Vaccination Strategies to Prevent Ricin Poisoning

PubMed Central

Pincus, Seth H.; Smallshaw, Joan E.; Song, Kejing; Berry, Jody; Vitetta, Ellen S.

2011-01-01

Ricin toxin (RT) is derived from castor beans, produced by the plant Ricinus communis. RT and its toxic A chain (RTA) have been used therapeutically to arm ligands that target disease-causing cells. In most cases these ligands are cell-binding monoclonal antibodies (MAbs). These ligand-toxin conjugates or immunotoxins (ITs) have shown success in clinical trials [1]. Ricin is also of concern in biodefense and has been classified by the CDC as a Class B biothreat. Virtually all reports of RT poisoning have been due to ingestion of castor beans, since they grow abundantly throughout the world and are readily available. RT is easily purified and stable, and is not difficult to weaponize. RT must be considered during any “white powder” incident and there have been documented cases of its use in espionage [2,3]. The clinical syndrome resulting from ricin intoxication is dependent upon the route of exposure. Countermeasures to prevent ricin poisoning are being developed and their use will depend upon whether military or civilian populations are at risk of exposure. In this review we will discuss ricin toxin, its cellular mode of action, the clinical syndromes that occur following exposure and the development of pre- and post-exposure approaches to prevent of intoxication. PMID:22069761

Passive and active vaccination strategies to prevent ricin poisoning.

PubMed

Pincus, Seth H; Smallshaw, Joan E; Song, Kejing; Berry, Jody; Vitetta, Ellen S

2011-09-01

Ricin toxin (RT) is derived from castor beans, produced by the plant Ricinus communis. RT and its toxic A chain (RTA) have been used therapeutically to arm ligands that target disease-causing cells. In most cases these ligands are cell-binding monoclonal antibodies (MAbs). These ligand-toxin conjugates or immunotoxins (ITs) have shown success in clinical trials [1]. Ricin is also of concern in biodefense and has been classified by the CDC as a Class B biothreat. Virtually all reports of RT poisoning have been due to ingestion of castor beans, since they grow abundantly throughout the world and are readily available. RT is easily purified and stable, and is not difficult to weaponize. RT must be considered during any "white powder" incident and there have been documented cases of its use in espionage [2,3]. The clinical syndrome resulting from ricin intoxication is dependent upon the route of exposure. Countermeasures to prevent ricin poisoning are being developed and their use will depend upon whether military or civilian populations are at risk of exposure. In this review we will discuss ricin toxin, its cellular mode of action, the clinical syndromes that occur following exposure and the development of pre- and post-exposure approaches to prevent of intoxication.

Evaluation of cosmetic product exposures reported to the Milan Poison Control Centre, Italy from 2005 to 2010.

PubMed

Ruggiero, Simona; Moro, Paola Angela; Davanzo, Franca; Capuano, Annalisa; Rossi, Francesco; Sautebin, Lidia

2012-12-01

To the average consumer, "cosmetics" are not considered to cause damage to human health under normal conditions of use. Thus, cosmetic "safety" does not require any particular attention to the possibility that cosmetics may result in a toxic exposure, especially for children. Poison Control Centres (PCCs) provide specialized and rapid information for consumers and health professionals to ensure management of events related to the exposures to different agents, including Cosmetics. Poison Control Centres also represent a unique source of information to investigate the frequency and type of exposures to cosmetic and the related risks. An analysis of cases concerning human exposures to cosmetics collected from 2005 to 2010 by the PCC at the Ospedale Niguarda Ca' Granda (Milan, Italy) was performed. During this period, 11 322 human exposure cases related to cosmetics were collected accounting for 4.5% of the total human clinical cases. Almost, all the requests for assistance came from consumers (53%) and hospitals (40%). The most frequently reported site of exposure was the consumer's own residence (94%). The exposures mainly involved children younger than 4 years (77%). No difference in gender distribution was observed (female 49%, male 51%). Almost, all of the exposures were unintentional (94%). Intentional exposures, mainly related to suicide attempts and accounted for 6% of cases involving persons aged more than 12 years. Personal hygiene products (30%), perfumes and hair care products (excluding hair dyes) (both 13%) were the most frequently involved categories. Symptoms were present only in 26% of the exposures and were mostly gastrointestinal (46%). Most of the cases were managed at home (43%) whereas hospital intervention was required in 38%. Since the exposure frequency seems more likely to reflect product availability and accessibility to ingestors, our results call for closer attention to this type of hazard, especially for children younger than 4 years of age.

History of Arsenic as a Poison and Medicinal

EPA Science Inventory

Since ancient times, human exposure to the metalloid arsenic has been both intentional and unintentional. The intentional exposure to arsenic has been to inflict harm on others as well as to be a curative agent for those who are ill. The unintentional exposure has either been f...

Characterization of edible marijuana product exposures reported to United States poison centers.

PubMed

Cao, Dazhe; Srisuma, Sahaphume; Bronstein, Alvin C; Hoyte, Christopher O

2016-11-01

Edible marijuana products are sold as brownies, cookies, and candies, which may be indistinguishable from counterparts without marijuana and are palatable to children and adults. The consumption of an entire product containing multiple dose-units may result in overdose. To characterize edible marijuana exposures reported to US poison centers with subgroup analysis by age. We analyzed single substance, human exposure calls coded to marijuana brownies, candies, cookies, beverages, or other foods reported to the National Poison Data System from January 2013 to December 2015. Calls were analyzed by state, age, gender, exposure route, clinical effect, therapies, and level of healthcare facility utilization. Four-hundred and thirty calls were reported: Colorado (N = 166, 1.05/100,000 population/year) and Washington (96, 0.46) yielded the highest number of exposures. Three hundred and eighty-one (91%) calls occurred in states with decriminalized medical/recreational marijuana. The number of calls increased every year of the study. The most common age groups were: ≤5 years (N = 109, 0.15/100,000 population/year) and 13-19 (78, 0.09). The most frequent clinical effects were drowsiness/lethargy (N = 118, percentage = 43%), tachycardia (84, 31%), agitated/irritable (37, 14%), and confusion (37, 14%). Children ≤5 years have more drowsiness/lethargy, ataxia, and red eye/conjunctivitis. No deaths were reported. The most common therapies administered were intravenous fluids (85, 20%), dilute/irrigate/wash (48, 11 %), and benzodiazepines (47, 11%). Three patients (ages 4, 10, and 57 years) received intubation. 97 (23%), 217 (50%), and 12 (3%) calls were managed at home, treated/released, admitted to a critical care unit, respectively. Although most clinical effects are minor, ventilatory support may be necessary for children and adults. We speculate the increasing exposures may be related to a combination of delayed absorption kinetics of Δ9-tetrahydrocannablnol, lagging packaging regulations, increased accessibility in decriminalized states, and increased familiarity of poison center specialists with edible product codes. Edible marijuana exposures are increasing and may lead to severe respiratory depression.

Abuse, misuse, and suicidal substance use by children on school property.

PubMed

Vakkalanka, J Priyanka; King, Joshua D; Holstege, Christopher P

2015-11-01

The purpose of this study was to characterize the epidemiological trends associated with substances used in intentional exposures among children while on school property reported to the U.S. National Poison Data System (NPDS). NPDS was queried for intentional (abuse, misuse, suspected suicide, and unknown intentional) exposures reported to occur on school property between calendar years 2004 and 2013. Records were restricted to children 6-18 years of age. Demographic, exposure, and clinical characteristics were assessed. A total of 56,882 substances were intentionally used on school property by 50,379 children, of which 39.8% were females (n = 20,070), 57.7% were males (n = 29,084), and 2.4% were unknown gender (n = 1,225). The most frequent pharmaceutical exposures reported included sedatives (n = 4,096; 8.1%), analgesics (n = 4,022; 8.0%), and cough and cold preparations (n = 3,529; 7.0%). The majority of exposures were managed on site (n = 21,464; 42.6%), followed by care at a healthcare facility (n = 20,048; 39.7%). Serious outcomes (moderate or major effects and death) accounted for nine percent of all reported exposures. Compared to reference groups, female gender, teenagers 17-18 years, and pharmaceutical substances (Prevalence Ratios = 4.6, 9.4, and 9.9, respectively) were associated with suspected suicides when compared with other intentional exposures. Along with other national data about behaviors in the adolescent and teenage population, additional trends in risky behavior may be gleaned by surveillance through poison centers. With over 5,000 annual reports to the poison centers about intentional exposures on school property, school personnel and parents/guardians must be vigilant about the range of pharmaceutical and non-pharmaceutical substances that are used for abuse, misuse, or suicide.

English language YouTube videos as a source of lead poisoning-related information: a cross-sectional study.

PubMed

Basch, Corey H; Jackson, Ashley M; Yin, Jingjing; Hammond, Rodney N; Adhikari, Atin; Fung, Isaac Chun-Hai

2017-07-01

Exposure to lead is detrimental to children's development. YouTube is a form of social media through which people may learn about lead poisoning. The aim of this cross-sectional study was to analyze the variation in lead poisoning-related YouTube contents between different video sources. The 100 most viewed lead poisoning-related videos were manually coded, among which, 50 were consumer-generated, 19 were created by health care professionals, and 31 were news. The 100 videos had a total of more than 8.9 million views, with news videos accounting for 63% of those views. The odds of mentioning what lead poisoning is, how to remove lead, and specifically mentioning the danger in ages 1-5 because of rapid growth among videos created by health care professionals were 7.28 times (Odds ratio, OR = 7.28, 95% CI, 2.09, 25.37, p = 0.002); 6.83 times (OR = 6.83, 95% CI, 2.05, 22.75, p = 0.002) and 9.14 times (OR = 9.14, CI, 2.05, 40.70, p = 0.004) that of consumer-generated videos, respectively. In this study, professional videos had more accurate information regarding lead but their videos were less likely to be viewed compared to consumer-generated videos and news videos. If professional videos about lead poisoning can attract more viewers, more people would be better informed and could possibly influence policy agendas, thereby helping communities being affected by lead exposure.

Evidence of paralytic shellfish poisoning toxin in milkfish in South Taiwan.

PubMed

Chou, H-N; Chung, Y-C; Cho, W-C; Chen, C-Y

2003-06-01

Natural phytoplankton blooms of the dinoflagellate Alexandrium minutum, milkfish (Chanos chanos) exposed to natural blooms, sediment and mangrove crab (Scylla serrata) were analysed for paralytic shellfish poisoning toxins by high-performance liquid chromatography. The toxin profiles of milkfish and mangrove crab were similar to that of A. minutum collected from blooming fishponds. In a laboratory A. minutum-blooming environment, the stomach and intestine of milkfish accumulated paralytic shellfish poisoning toxins during the exposure period. The non-visceral tissues were non-toxic. However, milkfish lost their entire body burden of toxin on the first day of transferring to a toxic algae-free environment. The result shows that milkfish concentrate paralytic shellfish poisoning toxins in digestive organs and did not retain toxins.

Predictors of pesticide poisoning.

PubMed

Ferguson, J A; Sellar, C; McGuigan, M A

1991-01-01

The analysis of 1,026 reports of suspected pesticide poisonings to the regional Poison Control Centre at the Hospital for Sick Children, Toronto consisted of 597 (58.2%) cases less than six years of age. Age was the strongest predictor: there was a risk of 3.1 that young children would encounter rodenticide poisoning compared to that of insecticides; a ten-fold risk of having symptoms from pesticide poisoning if the victim was over five years of age; an increased risk of 5.9 of exposure to moderate or large amounts of pesticide, compared to small quantities, for those over five years of age; and there was less treatment referral for young children, and a 5.7 risk of being referred if the victim was over the age of five years. Other significant predictor variables include the type of person making the inquiry (lay or physician/nurse), the calendar season of the event, and the location (metropolitan or nonmetropolitan) of the event.

Human Plant Exposures Reported to a Regional (Southwestern) Poison Control Center Over 8 Years.

PubMed

Enfield, Ben; Brooks, Daniel E; Welch, Sharyn; Roland, Maureen; Klemens, Jane; Greenlief, Kim; Olson, Rachel; Gerkin, Richard D

2018-03-01

There is little published data about human plant exposures reported to US poison control centers (PCCs). A retrospective chart review of all reported plant exposures to a single regional PCC between January 1, 2003 and December 31, 2010 was done to understand better the characteristics of plant exposure cases. Specific generic plant codes were used to identify cases. Recorded variables included patient demographics, plant involved, exposure variables, symptoms, management site, treatments, and outcome. Univariate and multivariate regression was used to identify outcome predictors. A total of 6492 charts met inclusion criteria. The average age was 16.6 years (2 months-94 years); 52.4% were male. The most common exposure reason was unintentional (98%), and the majority (92.4%) occurred at the patient's home. Ingestions (58.3%) and dermal exposures (34.3%) accounted for most cases. Cactus (27.5%), oleander (12.5%), Lantana (5.7%), and Bougainvillea (3.8%) were most commonly involved. Symptoms developed in 47.1% of patients, and were more likely to occur following Datura (66.7%), and Morning Glory or Milkweed (25% each) exposures. Almost 94% of patients were managed onsite (home) and only 5.2% involved evaluation in a health care facility (HCF). Only 37 (0.6%) patients required hospital admission, and 2.9% of cases resulted in more than minimal effects. Exposures resulting in more than minimal clinical effects were predicted by several variables: abnormal vital signs (OR = 35.62), abnormal labs (OR = 14.87), and management at a HCF (OR = 7.37). Hospital admissions were increased for patients already at a HCF (OR = 54.01), abnormal vital signs (OR = 23.28), and intentional exposures (OR = 14.7). Plant exposures reported to our poison control center were typically unintentional ingestions occurring at home. Most patients were managed onsite and few developed significant symptoms.

Proceedings of the American Medical Association Congress on Environmental Health Problems (1st, Chicago, Illinois, May 1-2, 1964).

ERIC Educational Resources Information Center

American Medical Association, Chicago, IL.

Included are the proceedings of the first Congress on Environmental Health. Topics related to air pollution include the extent of human exposure, its relation to disease, evaluating effects clinically, community control and the physician's role. Topics related to pesticides include treatment of poisonings, occurrence of poisonings, safe usage, and…

Metal Pollutant Exposure and Behavior Disorders: Implications for School Practices.

ERIC Educational Resources Information Center

Marlowe, Mike

1986-01-01

The article summarizes research on relationships between low (below metal poisoning) metal exposure and childhood behavior disorders. Symptoms, assessment techniques (hair analysis), and environmental and dietary factors that may increase the risk of metal pollutant exposure are described. School programs emphasizing education and the role of…

Emergency department visits by pediatric patients for poisoning by prescription opioids.

PubMed

Tadros, Allison; Layman, Shelley M; Davis, Stephen M; Bozeman, Rachel; Davidov, Danielle M

2016-09-01

Prescription medication abuse is an increasingly recognized problem in the United States. As more opioids are being prescribed and abused by adults, there is an increased risk of both accidental and intentional exposure to children and adolescents. The impact of pediatric exposures to prescription pain pills has not been well studied. We sought to evaluate emergency department (ED) visits for poisoning by prescription opioids in pediatric patients. This retrospective study looked at clinical and demographic data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2012. There were 21,928 pediatric ED visits for prescription opioid poisonings and more than half were unintentional. There was a bimodal age distribution of patients, with slightly more than half occurring in females. The majority of patients were discharged from the ED. More visits in the younger age group (0-5 years) were unintentional, while the majority of visits in the adolescent age group (15-17 years) were intentional. Mean charge per discharge was $1,840 and $14,235 for admissions and surmounted to over $81 million in total charges. Poisonings by prescription opioids largely impact both young children and adolescents. These findings can be used to help target this population for future preventive efforts.

Minamata disease revisited: an update on the acute and chronic manifestations of methyl mercury poisoning.

PubMed

Ekino, Shigeo; Susa, Mari; Ninomiya, Tadashi; Imamura, Keiko; Kitamura, Toshinori

2007-11-15

The first well-documented outbreak of acute methyl mercury (MeHg) poisoning by consumption of contaminated fish occurred in Minamata, Japan, in 1953. The clinical picture was officially recognized and called Minamata disease (MD) in 1956. However, 50 years later there are still arguments about the definition of MD in terms of clinical symptoms and extent of lesions. We provide a historical review of this epidemic and an update of the problem of MeHg toxicity. Since MeHg dispersed from Minamata to the Shiranui Sea, residents living around the sea were exposed to low-dose MeHg through fish consumption for about 20 years (at least from 1950 to 1968). These patients with chronic MeHg poisoning continue to complain of distal paresthesias of the extremities and the lips even 30 years after cessation of exposure to MeHg. Based on findings in these patients the symptoms and lesions in MeHg poisoning are reappraised. The persisting somatosensory disorders after discontinuation of exposure to MeHg were induced by diffuse damage to the somatosensory cortex, but not by damage to the peripheral nervous system, as previously believed.

A Review of Disaster-Related Carbon Monoxide Poisoning: Surveillance, Epidemiology, and Opportunities for Prevention

PubMed Central

Clower, Jacquelyn H.; Hernandez, Sandra A.; Damon, Scott A.; Yip, Fuyuen Y.

2012-01-01

Objectives. We conducted a systematic literature review to better understand aspects of disaster-related carbon monoxide (CO) poisoning surveillance and determine potentially effective prevention strategies. Methods. This review included information from 28 journal articles on disaster-related CO poisoning cases occurring between 1991 and 2009 in the United States. Results. We identified 362 incidents and 1888 disaster-related CO poisoning cases, including 75 fatalities. Fatalities occurred primarily among persons who were aged 18 years or older (88%) and male (79%). Hispanics and Asians accounted for 20% and 14% of fatal cases and 21% and 7% of nonfatal cases, respectively. Generators were the primary exposure source for 83% of fatal and 54% of nonfatal cases; 67% of these fatal cases were caused by indoor generator placement. Charcoal grills were a major source of exposure during winter storms. Most fatalities (94%) occurred at home. Nearly 89% of fatal and 53% of nonfatal cases occurred within 3 days of disaster onset. Conclusions. Public health prevention efforts could benefit from emphasizing predisaster risk communication and tailoring interventions for racial, ethnic, and linguistic minorities. These findings highlight the need for surveillance and CO-related information as components of disaster preparedness, response, and prevention. PMID:22897556

Contributory factors in herb-induced fatal aconite poisoning.

PubMed

Chan, Thomas Y K

2012-11-30

Detailed investigations of all reported cases of herb-induced aconite poisoning are necessary to identify the major contributory causes so that preventive measures can be formulated. In the present review of 12 fatal cases that were published in the medical journals during 1992 and 2011, the available clinical data and forensic toxicological analyses indicated that poor post-harvest processing of aconite roots, use of greater than the recommended doses and inadequate boiling of processed aconite roots during decoction preparation were important contributory factors in herb-induced aconite poisoning. Under such circumstances, the actual amount of Aconitum alkaloids ingested was much larger than intended. Good manufacturing practice to ensure adequate processing of aconite roots, use of the recommended doses, clear instructions for the patients and their compliance during decoction preparation are important preventive measures. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

[The rabbit experimental study for toxicokinetics of chlorpyrifos impacted by hemoperfusion].

PubMed

Guo, Xiang; Chen, Xiao; Zhang, Hongshun; Long, Xin; He, Qian; Sun, Chengye; Huang, Xianqing; He, Jian

2015-11-01

To investigate toxicokinetic parameters impacted by hemoperfusion after oral chlorpyrifos exposure, to investigate the adsorption effect of hemoperhusion for chlorpyrifos poisoning. 12 rabbits were divided into two groups after oral exposure with chlorpyrifos 300 mg/kg body weight. Control group: without hemoperfusion; hemoperfusion group: hemoperfusion starts 0.5 h after chlorpyrifos exposure and lasts for 2h. Blood samples were collected at different times, concentrations of chlorpyrifos were tested by GC, then, toxicokinetic parameterswere calculated and analysis by DAS3.0. In hemoperfusion group, peak time was (7.19±3.74) h, peak concentrations was (1.37±0.56) mg/L, clearance rate was (13.93±10.27) L/h/kg, apparent volume of distribution was (418.18±147.15) L/kg The difference of these parameter were statistically significant compared with control group (P<0.05). Hmoperfusion will decrease the inner exposure and load dose of rabbits with chlorpyrifos poisoning.

[A survey of emergency treatment of pesticides poisoning in comprehensive hospitals].

PubMed

Chen, Shu-Yang; Zhou, Jing; Li, Zhong-Jie; Wu, Yi-Qun

2004-10-01

To seek the characteristics of pesticide poisoning in emergency departments. Twenty-five hospitals were selected. Among them, they were 14 province or city level and 11 county level. The object of study was the patients with pesticide poisoning who were first visit to a doctor (including transfer to the above emergency departments of hospitals) from July 1, 2001 to June 30, 2002. There were 2 261 cases of pesticide poisoning that ranked third place of total acute poisoning cases at the same period. Gender ratio was 1 male to 1.47 female. Among 1 618 patients who first visited to emergency departments (excluding transfer), 43.9% were by emergency ambulance. 68.3% of total cases were caused by intentional exposure to pesticides, of which female accounted for 75.8%. Young people aged 15 to approximately 34 years accounted for 47.5% of all cases. Children (0 to approximately 14 years) also had relatively high pesticide poisoning rates, particularly an accident pesticide poisoning for 1- to approximately 4-year-old children accounted for 65.9% of total acute poisoning in the age group. 98.2% of all cases needed urgent medical treatment, and 52.4% were hospitalized. The leading occupation of patients was farmers followed by housekeepers, students and preschoolers. Insecticides poisoning accounted for 60.1% of all pesticides. The fatality rate in emergency department was 3.9%. 60.8% case was collected from county hospital. Pesticide poisoning rank first place of total acute poisoning cases in county hospital. A safety education of Knowledge Attitude Practice (KAP) is an effective measure for preventing pesticide poisoning.

[Problems caused by poisonous tropical marine animals].

PubMed

Lääveri, Tinja; Räisänen-Sokolowski, Anne; Jama, Timo

2014-01-01

A Finnish physician encounters problems caused by tropical marine animals either during her/his own travelling or while treating travelers who have returned home. Certain species of medusae and cone shells as well as the stings by some fish species are life-threateningly poisonous. A person stung or bitten by any of the most dangerous species must immediately be admitted to the hospital. Foreign material remaining in tissues after stings by echinoderms and spiky fish may cause problems months after the actual injury. The injuries become easily infected, and antimicrobial drug therapy must thus cover gram-negative rod-shaped bacteria as well.

Adolescent prescription ADHD medication abuse is rising along with prescriptions for these medications.

PubMed

Setlik, Jennifer; Bond, G Randall; Ho, Mona

2009-09-01

We sought to better understand the trend for prescription attention-deficit/hyperactivity disorder (ADHD) medication abuse by teenagers. We queried the American Association of Poison Control Center's National Poison Data System for the years of 1998-2005 for all cases involving people aged 13 to 19 years, for which the reason was intentional abuse or intentional misuse and the substance was a prescription medication used for ADHD treatment. For trend comparison, we sought data on the total number of exposures. In addition, we used teen and preteen ADHD medication sales data from IMS Health's National Disease and Therapeutic Index database to compare poison center call trends with likely availability. Calls related to teenaged victims of prescription ADHD medication abuse rose 76%, which is faster than calls for victims of substance abuse generally and teen substance abuse. The annual rate of total and teen exposures was unchanged. Over the 8 years, estimated prescriptions for teenagers and preteenagers increased 133% for amphetamine products, 52% for methylphenidate products, and 80% for both together. Reports of exposure to methylphenidate fell from 78% to 30%, whereas methylphenidate as a percentage of ADHD prescriptions decreased from 66% to 56%. Substance-related abuse calls per million adolescent prescriptions rose 140%. The sharp increase, out of proportion to other poison center calls, suggests a rising problem with teen ADHD stimulant medication abuse. Case severity increased over time. Sales data of ADHD medications suggest that the use and call-volume increase reflects availability, but the increase disproportionately involves amphetamines.

The cultural parameters of lead poisoning: A medical anthropologist's view of intervention in environmental lead exposure

DOE Office of Scientific and Technical Information (OSTI.GOV)

Trotter, R.T. II

1990-11-01

This article identifies four culturally shaped sources of lead exposure in human societies: modern and historic technological sources; food habits; culturally defined health beliefs; and beauty practices. Examples of these potential sources of lead poisoning are presented from current cultures. They include the use of lead-glazed cooking pottery in Mexican-American households; folk medical use of lead in Hispanic, Arabic, South Asian, Chinese, and Hmong communities; as well as the use of lead as a cosmetic in the Near East, Southeast Asia, and South Asia. Four interacting cultural conditions that create barriers to the reduction of lead exposure and lead poisoningmore » are identified and discussed. These are knowledge deficiencies, communication resistance, cultural reinterpretations, and incongruity of explanatory models.« less

Clenbuterol toxicity: a NSW poisons information centre experience.

PubMed

Brett, Jonathan; Dawson, Andrew H; Brown, Jared A

2014-03-03

To describe the epidemiology and toxicity of clenbuterol in exposures reported to the NSW Poisons Information Centre (NSWPIC). Retrospective observational study analysing data from all calls about clenbuterol exposure recorded in the NSWPIC database from 1 January 2004 to 31 December 2012. The NSWPIC coversthe Australian jurisdictions New South Wales, Tasmania and the Australian Capital Territory 24 hours a day and provides after-hours cover for the rest of Australia for 7 nights each fortnight. Total number of exposures, source of call (hospital, health care worker, member of the public), time from exposure to call, reasons for drug use, clinical features and advice given. Callers reported 63 exposures to clenbuterol, with a dramatic increase from three in 2008 to 27 in 2012. Of the 63 calls, 35 were from hospital, two from paramedics, one from general practice and 21 direct from the public. At least 53 patients (84%) required hospitalisation. The commonest reasons for use were bodybuilding and slimming. The most common features were tachycardia (24 patients), gastrointestinal disturbance (16) and tremor (11). Exposure was also associated with cardiotoxicity including one cardiac arrest in a 21-year-old man. Although a well recognised doping issue among elite athletes, clenbuterol use has spread out into the general public, especially during 2012, and should be considered in patients using bodybuilding or slimming products who present with protracted sympathomimetic features. The potential for misuse of this substance requires reconsideration of its current poison schedule registration and its availability.

Laundry pack exposures in children 0-5 years evaluated at a single pediatric institution.

PubMed

Yin, Shan; Behrman, Alysha; Colvin, Jonathan

2015-05-01

Case reports and poison center series have highlighted increased safety concerns with laundry packs, especially when compared to traditional laundry detergents. The purpose of this study was to examine the clinical experience with laundry pack exposures at a single institution. A retrospective chart review was performed for exposures to laundry packs seen at a single tertiary care children's hospital medical center. Cases were identified by searching the poison center database for exposures to laundry products from March 2012 to October 2013 in children <5 years old. Medical records were reviewed for all identified cases. Data collected included demographics, treatments, laboratory and radiology data, disposition, and length of stay in the emergency department (ED). Forty cases were included. Thirty-two were ingestions and eight were ocular exposures. Nine children were admitted, two of which were admitted to a critical care unit. Seven other children were discharged after 1-night admissions; none received any treatments after initial ED treatment. Of these, four children were admitted for the possibility of central nervous system (CNS) depression, but none showed any progression. Twenty-nine children with ingestions were discharged directly from the ED. No children had progression of CNS symptoms. Children discharged from the ED were observed a mean of 189 min. Cases of laundry pack exposures seen at our institution were similar to cases described by US poison centers. No child had progression of CNS depression suggesting that prolonged observation is not necessary if the child does not have CNS depression at presentation. Copyright © 2015 Elsevier Inc. All rights reserved.

Salicylate Toxicity from Genital Exposure to a Methylsalicylate-Containing Rubefacient

PubMed Central

Thompson, Trevonne M.; Toerne, Theodore; Erickson, Timothy B.

2016-01-01

Methylsalicylate-containing rubefacients have been reported to cause salicylate poisoning after ingestion, topical application to abnormal skin, and inappropriate topical application to normal skin. Many over-the-counter products contain methylsalicylate. Topical salicylates rarely produce systemic toxicity when used appropriately; however, methylsaliclyate can be absorbed through intact skin. Scrotal skin can have up to 40-fold greater absorption compared to other dermal regions. We report a unique case of salicylate poisoning resulting from the use of a methylsalicylate-containing rubefacient to facilitate masturbation in a male teenager. Saliclyate toxicity has not previously been reported from the genital exposure to methylsaliclyate. PMID:26973745

The severity of toxic reactions to ephedra: comparisons to other botanical products and national trends from 1993-2002.

PubMed

Woolf, Alan D; Watson, William A; Smolinske, Susan; Litovitz, Toby

2005-01-01

Ephedra is a botanical product widely used to enhance alertness, as a weight loss aide, and as a decongestant. Its reported adverse effects led the Food and Drug Administration (FDA) to ban ephedra-containing products in the United States in 2004. This study's purpose was to compare toxicity from botanical products containing ephedra to nonephedra products. The Toxic Exposure Surveillance System (TESS), a national poison center database, was utilized to determine the number and outcomes of cases involving botanical products reported from 1993-2002. Cases listing both a botanical product and any other drugs or chemicals were excluded a priori. Ten-year hazard rates (moderate outcomes + major outcomes + deaths per 1000 exposures) were used to compare botanical product categories. There were 21,533 toxic exposures with definitive medical outcomes reported over the 10 yrs where a botanical product was the only substance involved. Of these, 4306 (19.9%) had moderate or major medical outcomes and there were two deaths, for an overall hazard score of 200 per 1000 exposures. The number of ephedra reports to poison centers increased 150-fold over the 10-yr period. The hazard rate for products that contained only ephedra was 250 per 1000 exposures and 267 per 1000 exposures for products that contained ephedra and additional ingredients; whereas the hazard score for only nonephedra botanical products was 96 per 1000 exposures. The rate ratios for multibotanical products with ephedra (RR 1.33; 95% C.I. 1.27-1.40) and for single-ingredient ephedra products (RR 1.25; 95% C.I. 1.11-1.40) were both two to six times higher than those of other common botanical products. Yohimbe-containing products had the highest hazard score (417) and rate ratio (2.08; 95% C.I. 1.59-2.80). Ephedra-containing botanical products accounted for a significant number of toxic exposures with severe medical outcomes reported to poison centers. Hazard rate analysis suggests poison center-reported events involving ephedra-containing botanical products were much more likely to result in severe medical outcomes than those involving nonephedra-containing botanical products. These data support recommendations by policymakers that the sale of ephedra should be prohibited to protect consumers. Our data suggest that the botanical product, yohimbe, may also be associated with unacceptably high risks of toxicity and should receive close scrutiny from health policymakers.

A cohort study of pesticide poisoning and depression in Colorado farm residents.

PubMed

Beseler, Cheryl L; Stallones, Lorann

2008-10-01

Depressive symptoms have been associated with pesticide poisoning among farmers in cross-sectional studies, but no longitudinal studies have assessed the long-term influence of poisoning on depressive symptoms. The purpose of this study was to describe the associations between pesticide poisoning and depressive symptoms in a cohort of farm residents. Farm operators and their spouses were recruited in 1993 from farm truck registrations using stratified probability sampling. The Center for Epidemiologic Studies-Depression scale was used to evaluate depression in participants using generalized estimating equations. Baseline self-reported pesticide poisoning was the exposure of interest in longitudinal analyses. Pesticide poisoning was significantly associated with depression in three years of follow-up after adjusting for age, gender, and marital status (odds ratio [OR] 2.59; 95% confidence interval [CI] 1.20-5.58). Depression remained elevated after adjusting for health, decreased income, and increased debt (OR 2.00; CI 0.91-4.39) and was primarily due to significant associations with the symptoms being bothered by things (OR 3.29; CI 1.95-5.55) and feeling everything was an effort (OR 1.93; CI 1.14-3.27). Feeling bothered and that everything was an effort were persistently associated with a history of pesticide poisoning, supportive of the hypothesis that prolonged irritability may result from pesticide poisoning.

Poison control centers in developing countries and Asia's need for toxicology education

DOE Office of Scientific and Technical Information (OSTI.GOV)

Makalinao, Irma R.; Awang, Rahmat

2005-09-01

Poison control centers (PCCs) in developing countries have been set up in response to the challenge of decreasing mortality and morbidity from poisoning. The services range from poison information to actual clinical treatment mostly of acute cases. Lately, PCCs have expanded from their traditional role to one that actively engages in community health studies, toxicovigilance along with treatment of chronic poisoning. Recognizing that types of poisoning and specific needs may vary from country to country, toxicology education that addresses these unique regional issues has become more necessary. Toxicology education, both formal and informal, exists in various stages of development inmore » Asia. Clearly, there are gaps that need to be addressed especially in areas where there are no poison centers or where strengthening is necessary. Collaboration between PCCs in developing countries can help augment available resources including human, analytical and technical expertise. The critical mass of trained toxicologists will fill in the demand for clinical and regulatory specialists and educators as well. This paper highlights the experiences and resources available to the Philippine and Malaysian poison centers and the strengths generated by networking and collaboration. The role of Asia Pacific Association of Medical Toxicology (APAMT) as the Science NGO representative to the Intergovernmental Forum on Chemical Safety (IFCS) forum standing committee in promoting chemical safety at the regional level will be discussed. The 'Clearinghouse on the Sound Management of Chemicals', a platform for engaging multi-stakeholder and interdisciplinary partnerships, will be described as a possible model for capacity building to advance chemical safety through education and training not only in developing countries in Asia but globally as well.« less

Effects of a provincial ban of two toxic organophosphorus insecticides on pesticide poisoning hospital admissions.

PubMed

Eddleston, Michael; Adhikari, Sriyantha; Egodage, Samitha; Ranganath, Hasantha; Mohamed, Fahim; Manuweera, Gamini; Azher, Shifa; Jayamanne, Shaluka; Juzczak, Edmund; Sheriff, Mh Rezvi; Dawson, Andrew H; Buckley, Nick A

2012-03-01

Pesticide self-poisoning causes one third of global suicides. Sri Lanka halved its suicide rate by banning WHO Class I organophosphorus (OP) insecticides and then endosulfan. However, poisoning with Class II toxicity OPs, particularly dimethoate and fenthion, remains a problem. We aimed to determine the effect and feasibility of a ban of the two insecticides in one Sri Lankan district. Sale was banned in June 2003 in most of Polonnaruwa District, but not Anuradhapura District. Admissions with pesticide poisoning to the district general hospitals was prospectively recorded from 2002. Hospital admissions for dimethoate and fenthion poisoning fell by 43% after the ban in Polonnaruwa, while increasing by 23% in Anuradhapura. The pesticide case fatality fell from 14.4% to 9.0% in Polonnaruwa (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.41-0.84) and 11.3% to 10.6% in Anuradhapura (OR 0.93, 95%CI 0.70-1.25; p = 0.051). This reduction was not sustained, with case fatality in Polonnaruwa rising to 12.1% in 2006-2007. Further data analysis indicated that the fall in case fatality had actually been due to a coincidental reduction in case fatality for pesticide poisoning overall, in particular for paraquat poisoning. We found that the insecticides could be effectively banned from agricultural practice, as shown by the fall in hospital admissions, with few negative consequences. However, the ban had only a minor effect on pesticide poisoning deaths because it was too narrow. A study assessing the agricultural and health effects of a more comprehensive ban of highly toxic pesticides is necessary to determine the balance between increased costs of agriculture and reduced health care costs and fewer deaths.

Effects of a provincial ban of two toxic organophosphorus insecticides on pesticide poisoning hospital admissions

PubMed Central

2012-01-01

Background. Pesticide self-poisoning causes one third of global suicides. Sri Lanka halved its suicide rate by banning WHO Class I organophosphorus (OP) insecticides and then endosulfan. However, poisoning with Class II toxicity OPs, particularly dimethoate and fenthion, remains a problem. We aimed to determine the effect and feasibility of a ban of the two insecticides in one Sri Lankan district. Methods. Sale was banned in June 2003 in most of Polonnaruwa District, but not Anuradhapura District. Admissions with pesticide poisoning to the district general hospitals was prospectively recorded from 2002. Results. Hospital admissions for dimethoate and fenthion poisoning fell by 43% after the ban in Polonnaruwa, while increasing by 23% in Anuradhapura. The pesticide case fatality fell from 14.4% to 9.0% in Polonnaruwa (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.41–0.84) and 11.3% to 10.6% in Anuradhapura (OR 0.93, 95%CI 0.70–1.25; p = 0.051). This reduction was not sustained, with case fatality in Polonnaruwa rising to 12.1% in 2006–2007. Further data analysis indicated that the fall in case fatality had actually been due to a coincidental reduction in case fatality for pesticide poisoning overall, in particular for paraquat poisoning. Conclusions. We found that the insecticides could be effectively banned from agricultural practice, as shown by the fall in hospital admissions, with few negative consequences. However, the ban had only a minor effect on pesticide poisoning deaths because it was too narrow. A study assessing the agricultural and health effects of a more comprehensive ban of highly toxic pesticides is necessary to determine the balance between increased costs of agriculture and reduced health care costs and fewer deaths. PMID:22372788

Ricin poisoning: a comprehensive review.

PubMed

Audi, Jennifer; Belson, Martin; Patel, Manish; Schier, Joshua; Osterloh, John

2005-11-09

The recent discoveries of ricin, a deadly biologic toxin, at a South Carolina postal facility, a White House mail facility, and a US senator's office has raised concerns among public health officials, physicians, and citizens. Ricin is one of the most potent and lethal substances known, particularly when inhaled. The ease with which the native plant (Ricinus communis) can be obtained and the toxin extracted makes ricin an attractive weapon. To summarize the literature on ricin poisoning and provide recommendations based on our best professional judgment for clinicians and public health officials that are faced with deliberate release of ricin into the environment. LITERATURE ACQUISITION: Using PubMed, we searched MEDLINE and OLDMEDLINE databases (January 1950-August 2005). The Chemical and Biological Information Analysis Center database was searched for historical and military literature related to ricin toxicity. Book chapters, unpublished reports, monographs, relevant news reports, and Web material were also reviewed to find nonindexed articles. Most literature on ricin poisoning involves castor bean ingestion and experimental animal research. Aerosol release of ricin into the environment or adulteration of food and beverages are pathways to exposure likely to be exploited. Symptoms after ingestion (onset within 12 hours) are nonspecific and may include nausea, vomiting, diarrhea, and abdominal pain and may progress to hypotension, liver failure, renal dysfunction, and death due to multiorgan failure or cardiovascular collapse. Inhalation (onset of symptoms is likely within 8 hours) of ricin is expected to produce cough, dyspnea, arthralgias, and fever and may progress to respiratory distress and death, with few other organ system manifestations. Biological analytic methods for detecting ricin exposure are undergoing investigation and may soon be available through reference laboratories. Testing of environmental samples is available through federal reference laboratories. Currently, no antidote, vaccine, or other specific effective therapy is available for ricin poisoning or prevention. Prompt treatment with supportive care is necessary to limit morbidity and mortality. Health care workers and public health officials should consider ricin poisoning in patients with gastrointestinal or respiratory tract illness in the setting a credible threat. Poison control centers and public health authorities should be notified of any known illness associated with ricin exposure.

Acute adult poisoning cases admitted to a university hospital in Tabriz, Iran.

PubMed

Islambulchilar, M; Islambulchilar, Z; Kargar-Maher, M H

2009-04-01

The aim of our study was to investigate the etiological and demographical characteristics of acute adult poisoning cases admitted to a university hospital in Tabriz, Iran. This retrospective study was performed on 1342 poisoning admissions to a university hospital from 2003 to 2005, by data collection from the medical records of patients. Poisonings were 5.40% of the total admissions. There was a predominance of female patients (55.7%) compared to male patients (44.3%) with a female-to-male ratio of 1.2:1. Most poisonings occurred in the age range of 11-20 years (38.9%). Drugs were the most common cause of poisonings (60.8%). Among the drug poisonings, benzodiazepines (40.31%) were the most frequent agents, followed by antidepressants (31.98%). The seasonal distribution in poisoning patients suggested a peak in spring (28%) and summer (27.5%). In 9.8% of cases accidental and in 90.2% intentional poisonings were evident. Most suicide attempts were made by women (58.51%) and unmarried people (51.4%).The mean duration of hospitalization was 3.02 +/- 2.8 days. There were 28 (2.3%) deaths; the majority (13 cases) was due to pesticides. This was a university hospital-based study, so these results may not be representative of the general population. Despite this drawback, these data still provide important information on the characteristics of the poisoning in this part of Iran. To prevent such poisonings, the community education about the danger of central nervous system-acting drugs and reducing the exposure period of people to pesticides are recommended.

Farmers' knowledge, practices and injuries associated with pesticide exposure in rural farming villages in Tanzania.

PubMed

Lekei, Elikana E; Ngowi, Aiwerasia V; London, Leslie

2014-04-23

Pesticides in Tanzania are extensively used for pest control in agriculture. Their usage and unsafe handling practices may potentially result in high farmer exposures and adverse health effects.The aim of this study was to describe farmers' pesticide exposure profile, knowledge about pesticide hazards, experience of previous poisoning, hazardous practices that may lead to Acute Pesticide Poisoning (APP) and the extent to which APP is reported. The study involved 121 head- of-household respondents from Arumeru district in Arusha region. Data collection involved administration of a standardised questionnaire to farmers and documentation of storage practices. Unsafe pesticide handling practices were assessed through observation of pesticide storage, conditions of personal protective equipment (PPE) and through self-reports of pesticide disposal and equipment calibration. Past lifetime pesticide poisoning was reported by 93% of farmers. The agents reported as responsible for poisoning were Organophosphates (42%) and WHO Class II agents (77.6%).Storage of pesticides in the home was reported by 79% of farmers. Respondents with higher education levels were significantly less likely to store pesticides in their home (PRR High/Low = 0.3; 95% CI = 0.1-0.7) and more likely to practice calibration of spray equipment (PRR High/Low = 1.2; 95% CI = 1.03-1.4). However, knowledge of routes of exposure was not associated with safety practices particularly for disposal, equipment wash area, storage and use of PPE . The majority of farmers experiencing APP in the past (79%) did not attend hospital and of the 23 farmers who did so in the preceding year, records could be traced for only 22% of these cases. The study found a high potential for pesticide exposure in the selected community in rural Tanzania, a high frequency of self-reported APP and poor recording in hospital records. Farmers' knowledge levels appeared to be unrelated to their risk. Rather than simply focusing on knowledge-based strategies, comprehensive interventions are needed to reduce both exposure and health risks, including training, improvements in labeling, measures to reduce cost barriers to the adoption of safe behaviours, , promotion of control measures other than PPE and support for Integrated Pest Management (IPM).

Farmers' knowledge, practices and injuries associated with pesticide exposure in rural farming villages in Tanzania

PubMed Central

2014-01-01

Background Pesticides in Tanzania are extensively used for pest control in agriculture. Their usage and unsafe handling practices may potentially result in high farmer exposures and adverse health effects. The aim of this study was to describe farmers’ pesticide exposure profile, knowledge about pesticide hazards, experience of previous poisoning, hazardous practices that may lead to Acute Pesticide Poisoning (APP) and the extent to which APP is reported. Methods The study involved 121 head- of-household respondents from Arumeru district in Arusha region. Data collection involved administration of a standardised questionnaire to farmers and documentation of storage practices. Unsafe pesticide handling practices were assessed through observation of pesticide storage, conditions of personal protective equipment (PPE) and through self-reports of pesticide disposal and equipment calibration. Results Past lifetime pesticide poisoning was reported by 93% of farmers. The agents reported as responsible for poisoning were Organophosphates (42%) and WHO Class II agents (77.6%). Storage of pesticides in the home was reported by 79% of farmers. Respondents with higher education levels were significantly less likely to store pesticides in their home (PRR High/Low = 0.3; 95% CI = 0.1-0.7) and more likely to practice calibration of spray equipment (PRR High/Low = 1.2; 95% CI = 1.03-1.4). However, knowledge of routes of exposure was not associated with safety practices particularly for disposal, equipment wash area, storage and use of PPE . The majority of farmers experiencing APP in the past (79%) did not attend hospital and of the 23 farmers who did so in the preceding year, records could be traced for only 22% of these cases. Conclusions The study found a high potential for pesticide exposure in the selected community in rural Tanzania, a high frequency of self-reported APP and poor recording in hospital records. Farmers’ knowledge levels appeared to be unrelated to their risk. Rather than simply focusing on knowledge-based strategies, comprehensive interventions are needed to reduce both exposure and health risks, including training, improvements in labeling, measures to reduce cost barriers to the adoption of safe behaviours, , promotion of control measures other than PPE and support for Integrated Pest Management (IPM). PMID:24754959

Methyl Mercury Exposure at Niigata, Japan: Results of Neurological Examinations of 103 Adults

PubMed Central

Maruyama, Kimio; Yorifuji, Takashi; Tsuda, Toshihide; Sekikawa, Tomoko; Nakadaira, Hiroto; Saito, Hisashi

2012-01-01

Background. Large-scale poisonings caused by methyl mercury (MeHg) have occurred in Japan (Minamata in the 1950s and Niigata in the 1960s) and Iraq (in the 1970s). The current WHO neurological risk standard for adult exposure (hair level: 50 μg/g) was based partly on evidence from Niigata which did not consider any cases who were diagnosed later and/or exposed to low level of MeHg (hair mercury level less than 50 μg/g). Methods. Early in the Niigata epidemic in June 1965 there were two extensive surveys. From these two surveys, we examined 103 adults with hair mercury measurement who consulted two medical institutions. We compared the prevalence and the distribution of neurological signs related to MeHg poisoning between exposure categories. Result. We found 48 subjects with neurological signs related to MeHg poisoning who had hair mercury concentration less than 50 μg/g. Among the neurological signs, sensory disturbance of the bilateral distal extremities was observed more frequently, followed by disequilibrium, hearing impairment, and ataxia, in groups with hair MeHg concentration both below 50 μg/g and over 50 μg/g. Conclusion. The present study suggests the possibility that exposure to MeHg at levels below the current WHO limits could cause neurologic signs, in particular, sensory disturbance. PMID:22888201

Prevention of poison ivy dermatitis with oral homeopathic Rhus toxicodendron.

PubMed

Signore, Robert Joseph

2017-01-15

Acute allergic contact dermatitis to poison ivy is acommon and miserable dermatosis which affectsmillions of Americans each year. Preventativemeasures, such as avoidance, protective clothing,barrier creams, soaps, and solvents often fail despiteour patients' best attempts. Severe allergic reactionsto poison ivy are a significant source of decreasedemployee productivity owing to inability to work anda major health care expenditure. Patients may haveto leave their jobs and discontinue favorite outdoorrecreational activities as a result of severe urushiolsensitivity. Thus, a simple and effective method ofpreventing poison ivy dermatitis would be of greatbenefit to clinical dermatologists and their patients.Complementary and alternative medical practitionerscommonly prescribe homeopathic poison ivyproducts by mouth for the prevention of poisonivy dermatitis. Yet, conventional dermatologists aremostly unaware of this little known clinical pearl. Theauthor discusses two open studies and anecdotalexperience with administration of homeopathicpoison ivy in the prevention of acute allergic contactdermatitis related to poison ivy exposure. Potentialadvantages could include patient acceptability,ease of administration, affordability, and availability.Randomized clinical trials are needed to furtherevaluate the safety and efficacy of this interesting andpromising clinical tip.

The Risk Factors of Child Lead Poisoning in China: A Meta-Analysis

PubMed Central

Li, You; Qin, Jian; Wei, Xiao; Li, Chunhong; Wang, Jian; Jiang, Meiyu; Liang, Xue; Xia, Tianlong; Zhang, Zhiyong

2016-01-01

Background: To investigate the risk factors of child lead poisoning in China. Methods: A document retrieval was performed using MeSH (Medical subject heading terms) and key words. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies, and the pooled odd ratios with a 95% confidence interval were used to identify the risk factors. We employed Review Manager 5.2 and Stata 10.0 to analyze the data. Heterogeneity was assessed by both the Chi-square and I2 tests, and publication bias was evaluated using a funnel plot and Egger’s test. Results: Thirty-four articles reporting 13,587 lead-poisoned children met the inclusion criteria. Unhealthy lifestyle and behaviors, environmental pollution around the home and potential for parents’ occupational exposure to lead were risk factors of child lead poisoning in the pooled analyses. Our assessments yielded no severe publication biases. Conclusions: Seventeen risk factors are associated with child lead poisoning, which can be used to identify high-risk children. Health education and promotion campaigns should be designed in order to minimize or prevent child lead poisoning in China. PMID:27005641

Chronic Neuropsychological Sequelae of Cholinesterase Inhibitors in the Absence of Structural Brain Damage: Two Cases of Acute Poisoning

PubMed Central

Roldán-Tapia, Lola; Leyva, Antonia; Laynez, Francisco; Santed, Fernando Sánchez

2005-01-01

Here we describe two cases of carbamate poisoning. Patients AMF and PVM were accidentally poisoned by cholinesterase inhibitors. The medical diagnosis in both cases was overcholinergic syndrome, as demonstrated by exposure to cholinesterase inhibitors. The widespread use of cholinesterase inhibitors, especially as pesticides, produces a great number of human poisoning events annually. The main known neurotoxic effect of these substances is cholinesterase inhibition, which causes cholinergic overstimulation. Once AMF and PVM had recovered from acute intoxication, they were subjected to extensive neuropsychological evaluation 3 and 12 months after the poisoning event. These assessments point to a cognitive deficit in attention, memory, perceptual, and motor domains 3 months after intoxication. One year later these sequelae remained, even though the brain magnetic resonance imaging (MRI) and computed tomography (CT) scans were interpreted as being within normal limits. We present these cases as examples of neuropsychological profiles of long-term sequelae related to acute poisoning by cholinesterase inhibitor pesticides and show the usefulness of neuropsychological assessment in detecting central nervous system dysfunction in the absence of biochemical or structural markers. PMID:15929901

Epidemiology of acute poisoning in children presenting to the poisoning treatment center at Ain Shams University in Cairo, Egypt, 2009–2013

PubMed Central

Azab, Sonya M. S.; Hirshon, Jon Mark; Hayes, Bryan D.; El-Setouhy, Maged; Smith, Gordon S.; Sakr, Mahmoud Lotfy; Tawfik, Hany; Klein-Schwartz, Wendy

2016-01-01

Introduction Pediatric poisonings represent a major and preventable cause of morbidity and mortality throughout the world. Epidemiologic information about poisoning among children in many lower- and middle-income countries is scarce. This study describes the epidemiology of acute poisonings in children presenting to Ain Shams University's Poisoning Treatment Center (ASU-PTC) in Cairo and determines the causative agents and characteristics of acute poisoning in several pediatric age groups. Methods This retrospective study involved acutely poisoned patients, 0 to 18 years of age, who presented to the ASU-PTC between 1/1/2009 and 12/31/2013. Data were extracted from electronic records maintained by the ASU-PTC. Collected data included demographics, substance of exposure, circumstances of the poisoning, patient disposition, and outcome. Results During the 5-year study period, 38,470 patients meeting our criteria were treated by the ASU-PTC; 19,987 (52%) were younger than 6 years of age; 4,196 (11%) were 6 to 12 years; and 14,287 (37%) were >12 years. Unintentional poisoning accounted for 68.5% of the ingestions, though among adolescents 84.1% of ingestions were with self-harm intent. In all age groups, the most frequent causative drugs were non-opioid analgesics, antipyretics, and antirheumatics. The most common nonpharmaceutical agents were corrosives in preschool children and pesticides in adolescents. Most patients had no/minor effects (29,174 [75.8%]); hospitalization rates were highest among adolescents. There were 119 deaths (case fatality rate of 0.3), primarily from pesticide ingestion. Conclusion Poisoning in preschool children is mainly unintentional and commonly due to nonpharmaceutical agents while poisoning in adolescents is mainly intentional (self-harm). Pesticides, mainly organophosphorous compounds and carbamates, were the most frequent agent leading to morbidity and mortality. PMID:26653953

Epidemiology of acute poisoning in children presenting to the poisoning treatment center at Ain Shams University in Cairo, Egypt, 2009-2013.

PubMed

Azab, Sonya M S; Hirshon, Jon Mark; Hirshon, John Mark; Hayes, Bryan D; El-Setouhy, Maged; Smith, Gordon S; Sakr, Mahmoud Lotfy; Tawfik, Hany; Klein-Schwartz, Wendy

2016-01-01

Pediatric poisonings represent a major and preventable cause of morbidity and mortality throughout the world. Epidemiologic information about poisoning among children in many lower- and middle-income countries is scarce. This study describes the epidemiology of acute poisonings in children presenting to Ain Shams University's Poisoning Treatment Center (ASU-PTC) in Cairo and determines the causative agents and characteristics of acute poisoning in several pediatric age groups. This retrospective study involved acutely poisoned patients, 0-18 years of age, who presented to the ASU-PTC between 1 January 2009 and 31 December 2013. Data were extracted from electronic records maintained by the ASU-PTC. Collected data included demographics, substance of exposure, circumstances of the poisoning, patient disposition, and outcome. During the 5-year study period, 38 470 patients meeting our criteria were treated by the ASU-PTC; 19 987 (52%) were younger than 6 years of age; 4196 (11%) were 6-12 years; and 14 287 (37%) were >12 years. Unintentional poisoning accounted for 68.5% of the ingestions, though among adolescents 84.1% of ingestions were with self-harm intent. In all age groups, the most frequent causative drugs were non-opioid analgesics, antipyretics, and antirheumatics. The most common nonpharmaceutical agents were corrosives in preschool children and pesticides in adolescents. Most patients had no/minor effects (29 174 [75.8%]); hospitalization rates were highest among adolescents. There were 119 deaths (case fatality rate of 0.3), primarily from pesticide ingestion. Poisoning in preschool children is mainly unintentional and commonly due to nonpharmaceutical agents whereas poisoning in adolescents is mainly intentional (self-harm). Pesticides, mainly organophosphorous compounds and carbamates, were the most frequent agents leading to morbidity and mortality.

Exposure to Mold Toxin Linked to Gallbladder Cancer Risk

Cancer.gov

A study by the National Cancer Institute reports an association between a marker of exposure to aflatoxin, a poisonous chemical produced by a type of mold, and gallbladder cancer in a population of men and women in Shanghai, China.

Extracorporeal treatment for thallium poisoning: recommendations from the EXTRIP Workgroup.

PubMed

Ghannoum, Marc; Nolin, Thomas D; Goldfarb, David S; Roberts, Darren M; Mactier, Robert; Mowry, James B; Dargan, Paul I; Maclaren, Robert; Hoegberg, Lotte C; Laliberté, Martin; Calello, Diane; Kielstein, Jan T; Anseeuw, Kurt; Winchester, James F; Burdmann, Emmanuel A; Bunchman, Timothy E; Li, Yi; Juurlink, David N; Lavergne, Valery; Megarbane, Bruno; Gosselin, Sophie; Liu, Kathleen D; Hoffman, Robert S

2012-10-01

The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl). After an extensive search, the co-chairs reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed during a conference call. A second vote determined the final recommendations. Forty-five articles met inclusion criteria. Only case reports and case series were identified, yielding a very low quality of evidence for all recommendations. Data on 74 patients, including 11 who died, were abstracted. The workgroup concluded that Tl is slightly dialyzable and made the following recommendations: ECTR is recommended in severe Tl poisoning (1D). ECTR is indicated if Tl exposure is highly suspected on the basis of history or clinical features (2D) or if the serum Tl concentration is >1.0 mg/L (2D). ECTR should be initiated as soon as possible, ideally within 24-48 hours of Tl exposure (1D), and be continued until the serum Tl concentration is <0.1 mg/L for a minimal duration of 72 hours (2D). Despite Tl's low dialyzability and the limited evidence, the workgroup strongly recommended extracorporeal removal in the case of severe Tl poisoning.

Urban Youth Knowledge and Attitudes Regarding Lead Poisoning.

PubMed

Bogar, Sandra; Szabo, Aniko; Woodruff, Shane; Johnson, Sheri

2017-12-01

Environmental health literacy (EHL) is a promising and evolving field of research that could benefit from youth engagement. Yet studies focused on youths' environmental health awareness and concerns are limited. For example, although lead exposure remains a threat to youth development in urban environments, no published studies have measured urban youth's knowledge of lead poisoning. A CBPR partnership established a youth advisory council (YAC) who helped to design, interpret and disseminate a mixed methods study exploring environmental health perceptions among urban youths ages 10-18. Surveys assessed awareness, attitudes, and knowledge regarding lead poisoning and five environmental health issues determined by the YAC. Focus group questions further contextualized youths' lead knowledge and understanding of youths' environmental health concerns. A majority of youth could identify specific sources of lead exposure but had minimal knowledge of prevention strategies, and focus group data revealed misinformation regarding lead sources and consequences. Survey and focus group respondents' level of awareness and concern regarding YAC-selected EH issues was high in comparison to lead poisoning. In particular, job opportunities and police brutality were endorsed as both neighborhood concerns and priorities. Awareness and knowledge of environmental health issues among urban youth have not been well described. These findings reinforce the importance of addressing problems of local relevance. Moving forward, lead poisoning prevention education for youth and youth EHL partnerships may benefit from incorporating an ecological approach wherein connections to the social and economic context are made explicit.

Linking cases of illegal shootings of the endangered California condor using stable lead isotope analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Finkelstein, Myra E., E-mail: myraf@ucsc.edu; Kuspa, Zeka E.; Welch, Alacia

Lead poisoning is preventing the recovery of the critically endangered California condor (Gymnogyps californianus) and lead isotope analyses have demonstrated that ingestion of spent lead ammunition is the principal source of lead poisoning in condors. Over an 8 month period in 2009, three lead-poisoned condors were independently presented with birdshot embedded in their tissues, evidencing they had been shot. No information connecting these illegal shooting events existed and the timing of the shooting(s) was unknown. Using lead concentration and stable lead isotope analyses of feathers, blood, and recovered birdshot, we observed that: i) lead isotope ratios of embedded shot frommore » all three birds were measurably indistinguishable from each other, suggesting a common source; ii) lead exposure histories re-constructed from feather analysis suggested that the shooting(s) occurred within the same timeframe; and iii) two of the three condors were lead poisoned from a lead source isotopically indistinguishable from the embedded birdshot, implicating ingestion of this type of birdshot as the source of poisoning. One of the condors was subsequently lead poisoned the following year from ingestion of a lead buckshot (blood lead 556 µg/dL), illustrating that ingested shot possess a substantially greater lead poisoning risk compared to embedded shot retained in tissue (blood lead ∼20 µg/dL). To our knowledge, this is the first study to use lead isotopes as a tool to retrospectively link wildlife shooting events. - Highlights: • We conducted a case-based analysis of illegal shootings of California condors. • Blood and feather Pb isotopes were used to reconstruct the illegal shooting events. • Embedded birdshot from the three condors had the same Pb isotope ratios. • Feather and blood Pb isotopes indicated that the condors were shot in a common event. • Ingested shot causes substantially greater lead exposure compared to embedded shot.« less

Primary prevention of lead poisoning in children: a cross-sectional study to evaluate state specific lead-based paint risk reduction laws in preventing lead poisoning in children.

PubMed

Kennedy, Chinaro; Lordo, Robert; Sucosky, Marissa Scalia; Boehm, Rona; Brown, Mary Jean

2014-11-07

Children younger than 72 months are most at risk of environmental exposure to lead from ingestion through normal mouthing behavior. Young children are more vulnerable to lead poisoning than adults because lead is absorbed more readily in a child's gastrointestinal tract. Our focus in this study was to determine the extent to which state mandated lead laws have helped decrease the number of new cases of elevated blood-lead levels (EBLL) in homes where an index case had been identified. A cross-sectional study was conducted to compare 682 residential addresses, identified between 2000 and 2009, in two states with and one state without laws to prevent childhood lead poisoning among children younger than 72 months, to determine whether the laws were effective in preventing subsequent cases of lead poisoning detected in residential addresses after the identification of an index case. In this study, childhood lead poisoning was defined as the blood lead level (BLL) that would have triggered an environmental investigation in the residence. The two states with lead laws, Massachusetts (MA) and Ohio (OH), had trigger levels of ≥25 μg/dL and ≥15 μg/dL respectively. In Mississippi (MS), the state without legislation, the trigger level was ≥15 μg/dL. The two states with lead laws, MA and OH, were 79% less likely than the one without legislation, MS, to have residential addresses with subsequent lead poisoning cases among children younger than 72 months, adjusted OR = 0.21, 95% CI (0.08-0.54). For the three states studied, the evidence suggests that lead laws such as those studied herein effectively reduced primary exposure to lead among young children living in residential addresses that may have had lead contaminants.

Chronic pesticide poisoning from persistent low-dose exposures in Ecuadorean floriculture workers: toward validating a low-cost test battery.

PubMed

Breilh, Jaime; Pagliccia, Nino; Yassi, Annalee

2012-01-01

Chronic pesticide poisoning is difficult to detect. We sought to develop a low-cost test battery for settings such as Ecuador's floriculture industry. First we had to develop a case definition; as with all occupational diseases a case had to have both sufficient effective dose and associated health effects. For the former, using canonical discriminant analysis, we found that adding measures of protection and overall environmental stressors to occupational category and duration of exposure was useful. For the latter, factor analysis suggested three distinct manifestations of pesticide poisoning. We then determined sensitivity and specificity of various combinations of symptoms and simple neurotoxicity tests from the Pentox questionnaire, and found that doing so increased sensitivity and specificity compared to use of acethylcholinesterase alone--the current screening standard. While sensitivity and specificity varied with different case definitions, our results support the development of a low-cost test battery for screening in such settings.

Normal carboxyhaemoglobin level in carbon monoxide poisoning treated with hyperbaric oxygen therapy.

PubMed

Helgeson, Scott A; Wilson, Michael E; Guru, Pramod K

2017-07-24

Throughout the world both intentional and inadvertent exposure to carbon monoxide (CO) remains an important public health issue. While CO poisoning can be lethal, the morbidity is predominantly due to nervous system injury. A previously healthy 22-year-old woman was found unconscious at home by her sister. Her parents were found dead in the house with a recent history of a dysfunctional furnace. She was presumed to have CO poisoning despite an initial carboxyhaemoglobin level of 2.5%. Patient had both clinical and radiological evidence of neurological damage. However, with multiple sessions of hyperbaric oxygen (HBO) therapy she recovered to a near normal functional status. There is no consensus that exists among treating physicians about the role of hyperbaric oxygen in management of neurological injury. The case described here has significant neurological damage related to CO exposure but improved after HBO therapy. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

n-hexane polyneuropathy in Japan: a review of n-hexane poisoning and its preventive measures.

PubMed

Takeuchi, Y

1993-07-01

n-Hexane is used in industry as a solvent for adhesive, dry cleaning, and vegetable oil extraction. In 1963, the first case of severe polyneuropathy suspected to be caused by n-hexane was referred to us. Case studies, animal experiments, and field surveys on n-hexane poisoning were conducted, and preventive measures like threshold limit value revision and biological monitoring were also studied. I review a brief history of our investigations on n-hexane poisoning and its preventive measures in Japan. n-Hexane could cause overt polyneuropathy in workers exposed to more than 100 ppm time-weighted average concentrations [TWA]. The present threshold limit value of 40 ppm in Japan is considered low enough to prevent subclinical impairment of peripheral nerve caused by n-hexane. Urinary 2,5-hexanedione could be a good indicator for biological monitoring of n-hexane exposure. About 2.2 mg/liter of 2,5-hexanedione measured by our improved method corresponds to exposure of 40 ppm (TWA) of n-hexane.

A proposal to conserve black-footed ferrets and the prairie dog ecosystem

USGS Publications Warehouse

Miller, Brian; Wemmer, Christen; Biggins, Dean; Reading, Richard P.

1990-01-01

Prairie dogs (Cynomys spp.) have been poisoned throughout this century because of grazing competition with livestock. Recent evidence showed these early claims were exaggerated, but animal control was already entrenched in government policy. As a result, ongoing government subsidized poisoning has reduced prairie dogs to about 2% of their former distribution. The reduction of prairie dogs diminished species diversity in the arid grasslands of North America, including the potential extinction of the black-footed ferret (Mustela nigripes). Cost-benefit analysis revealed that poisoning costs more than any grazing benefits accrued. This analysis did not consider the long-term costs of reversing ecosystem degradation, the intangible value of biological diversity as a public benefit, or the depletion of biotic resources as a loss of actual or potential wealth. The government presently finances the poisoning policy and the preservation of endangered species like the black-footed ferret, two apparently conflicting programs. We, therefore, propose an integrated management plan that considers both interests. We propose that federal monies allocated to the poisoning program be converted into a rebate for ranchers who manage livestock while preserving the prairie dog community. This would redirect funds and personnel already allocated to prairie dog eradication to an incentive for ranchers who manage for livestock and wildlife. Livestock interests and grassland biotic diversity would both benefit.

A proposal to conserve black-footed ferrets and the prairie dog ecosystem

NASA Astrophysics Data System (ADS)

Miller, Brian; Wemmer, Christen; Biggins, Dean; Reading, Richard

1990-11-01

Prairie dogs ( Cynomys spp.) have been poisoned throughout this century because of grazing competition with livestock. Recent evidence showed these early claims were exaggerated, but animal control was already entrenched in government policy. As a result, ongoing government subsidized poisoning has reduced prairie dogs to about 2% of their former distribution. The reduction of prairie dogs diminished species diversity in the arid grasslands of North America, including the potential extinction of the black-footed ferret ( Mustela nigripes). Cost-benefit analysis revealed that poisoning costs more than any grazing benefits accrued. This analysis did not consider the long-term costs of reversing ecosystem degradation, the intangible value of biological diversity as a public benefit, or the depletion of biotic resources as a loss of actual or potential wealth. The government presently finances the poisoning policy and the preservation of endangered species like the black-footed ferret, two apparently conflicting programs. We, therefore, propose an integrated management plan that considers both interests. We propose that federal monies allocated to the poisoning program be converted into a rebate for ranchers who manage livestock while preserving the prairie dog community. This would redirect funds and personnel already allocated to prairie dog eradication to an incentive for ranchers who manage for livestock and wildlife. Livestock interests and grassland biotic diversity would both benefit.

Overview of developmental, reproductive, and behavioral/ neurological effects of mercury exposures in wildlife

USGS Publications Warehouse

Heinz, G.H.; Hoffman, D.; Klimstra, J.; Stebbins, K.

2007-01-01

We review wildlife/mercury literature and our own research findings that demonstrate the relevance of wildlife toxicity data in protecting human health. Methylmercury affects wildlife through reduced adult survival and reproduction, aberrant behavior, immune system effects, and teratogenic effects. Methylmercury can readily cross the blood-brain barrier, is excreted into eggs in birds, and is transferred to young mammals across the placenta and in milk. Its principal effect on wildlife is on neurological functions. Wild mink (Mustela vison) and otter (Lutra canadensis) have died from methylmercury poisoning, with signs of poisoning including anorexia, loss of weight, incoordination, tremors, and convulsions, which are symptoms similar to those experienced by mercury-poisoned humans. Mammals also may experience tonic and clonic convulsions and an increase in fetal anomalies, again paralleling toxic problems in people. Antibody-producing cells can be suppressed by methylmercury. Microscopically, the most notable lesions are in the cerebrum. Extensive vacuolation of hepatocytes in the liver and necrosis and other changes in the appearance of the proximal convoluted tubules of the kidneys are often noted. When harp seals (Pagophilus groenlandicus) were dosed with methylmercury chloride the number of circulating erythrocytes decreased and white blood cell counts greatly increased. The poisoned seals also suffered from uremia, hyperproteinemia, hypercholesterolemia, hyperbilirubinemia, and elevations in lactic dehydrogenase and alkaline phosphatase. In birds, signs of methylmercury poisoning included emaciation and weakness in the extremities, which progressed until the birds died. Mercury poisoning in birds and mammals can be diagnosed from a combination of the signs of poisoning if the animal is still alive, the pathological effects seen in a gross necropsy, the histopathological effects seen with a microscope, and the concentrations of mercury in various tissues. Our studies with mallards (Anas platyrhynchos) suggest that the dietary concentrations of mercury that cause toxicity are lower than those set in fish consumption advisories to protect humans. Because wild mammals and birds are so sensitive to methylmercury poisoning and cannot escape dietary exposure the way humans can, guidelines set to protect wild birds and mammals may very well provide a margin of safety for human health.

[Environmental lead poisoning from lead-glazed earthenware used for storing drinks].

PubMed

Sabouraud, S; Coppéré, B; Rousseau, C; Testud, F; Pulce, C; Tholly, F; Blanc, M; Culoma, F; Facchin, A; Ninet, J; Chambon, P; Medina, B; Descotes, J

2009-12-01

Current unusual environmental sources of lead exposure mainly include traditional medicines, either ayurvedic remedies or others, traditional cosmetics (kohl, surma), and the use of traditional earthenware, for storage or cooking. We report two cases of lead poisoning in adults initially identified by paroxysmal abdominal pain or anemia. In both cases, the environmental investigation evidenced one main source of lead exposure, namely a lead-glazed earthenware jug in which a drink was stored, "kefir" in the first case, and "kombucha" tea in the second one. It is recommended to search for lead intoxication in patients with unexplained anemia. Environmental sources of lead can be multiple. Their relative importance has to be ranked during the environmental investigation and among these, lead-glazed earthenware must be considered as a source of high lead exposure when drinks are stored inside and thus can soak.

Long-term pulmonary complications of chemical weapons exposure in former poison gas factory workers.

PubMed

Nishimura, Yoshifumi; Iwamoto, Hiroshi; Ishikawa, Nobuhisa; Hattori, Noboru; Horimasu, Yasushi; Ohshimo, Shinichiro; Fujitaka, Kazunori; Kondo, Keiichi; Hamada, Hironobu; Awai, Kazuo; Kohno, Nobuoki

2016-07-01

Sulfur mustard (SM) and lewisite are vesicant chemical warfare agents that can cause skin blistering and chronic lung complications. During 1929-1945, a Japanese factory produced poisonous gases, which included SM, lewisite and other chemical weapons. The aim of this study was to investigate the chest computed tomography (CT) findings among long-term survivors who worked at this factory. During 2009-2012, we evaluated chest CT findings from 346 long-term survivors who worked at the poison gas factory. Skin lesions were used as an indicator of significant exposure to vesicant agents. Among the 346 individuals, 53 (15%) individuals experienced skin lesions while working at the factory, and chest CT revealed abnormal findings in 179 individuals (52%). Emphysema was the most common CT finding and was observed in 75 individuals (22%), while honeycombing was observed in 8 individuals (2%). Emphysema and honeycombing were more prevalent among individuals with skin lesions, compared to individuals without skin lesions. Multivariate analyses revealed significant associations between the presence of emphysema and skin lesions (p = 0.008). Among individuals who never smoked, individuals with skin lesions (n = 26) exhibited a significantly higher rate of emphysema, compared to individuals without skin lesions (n = 200) (35% versus 7%, respectively; p < 0.001). Among the long-term survivors who worked at the poison gas factory, a history of skin lesions was associated with the presence of emphysema, even among never smokers, which suggests that emphysema might be a long-term complication of exposure to chemical warfare agents.

The rising incidence of intentional ingestion of ethanol-containing hand sanitizers.

PubMed

Gormley, Nicole J; Bronstein, Alvin C; Rasimas, Joseph J; Pao, Maryland; Wratney, Angela T; Sun, Junfeng; Austin, Howard A; Suffredini, Anthony F

2012-01-01

To describe a case of intentional ingestion of hand sanitizer in our hospital and to review published cases and those reported to the American Association of Poison Control Centers' National Poison Data System. A case report, a literature review of published cases, and a query of the National Poison Data System. Medical intensive care unit. Seventeen-yr-old male 37-kg with an intentional ingestion of a hand sanitizer product into his gastrostomy tube. Intubation, ventilation, and hemodialysis. Incidence and outcome of reported cases of unintentional and intentional ethanol containing-hand sanitizer ingestion in the United States from 2005 through 2009. A literature search found 14 detailed case reports of intentional alcohol-based hand sanitizer ingestions with one death. From 2005 to 2009, the National Poison Data System received reports of 68,712 exposures to 96 ethanol-based hand sanitizers. The number of new cases increased by an average of 1,894 (95% confidence interval [CI] 1266-2521) cases per year (p =.002). In 2005, the rate of exposures, per year, per million U.S. residents was 33.7 (95% CI 28.4-39.1); from 2005 to 2009, this rate increased on average by 5.87 per year (95% CI 3.70-8.04; p = .003). In 2005, the rate of intentional exposures, per year, per million U.S. residents, was 0.68 (95% CI 0.17-1.20); from 2005 to 2009, this rate increased on average by 0.32 per year (95% CI 0.11-0.53; p = .02). The number of new cases per year of intentional hand sanitizer ingestion significantly increased during this 5-yr period. Although the majority of cases of hand sanitizer ingestion have a favorable outcome, 288 moderate and 12 major medical outcomes were reported in this National Poison Data System cohort. Increased awareness of the risks associated with intentional ingestion is warranted, particularly among healthcare providers caring for persons with a history of substance abuse, risk-taking behavior, or suicidal ideation.

In-Situ Atomic Force Microscope Imaging of Calcite Etch Pit Morphology Changes in Undersaturated and 1-Hydroxyethylidene-1,1-diphosphonic Acid Poisoned Solutions

PubMed Central

Britt, David W.

2012-01-01

Morphology changes in etch pits formed on the (1014) cleavage plane of calcite were induced by varying the ratio of [Ca2+] to [CO32−] in the bulk solution as well as through the addition of the crystal poison 1-hydroxyethylidene-1,1-diphosphonic acid (HEDP). Three distinct morphologies were noted: symmetric rhombic, asymmetric rhombic, and triangular with a rough curved hypotenuse. The latter represents a transient morphology which is only observed during the actual dissolution process, while the former morphologies persist after dissolution is halted. PMID:25125794

Carbon Monoxide Poisoning: Death on Mount McKinley,

DTIC Science & Technology

1987-05-08

Additionally, studies by Astrup(5) and Thomas(6) have reported decreased erythrocytic 2, 3- diphosphoglycerate (2, 3-DPG) concentrations with acute...Halebian, et al found no significant difference in measured 02 consumption or extraction between dogs subjected to CO poisoning vs nitrogen anoxia .(9...Astrup P: Intraerythrocytic 2,3- diphosphoglycerate and carbon monoxide exposure. Ann NY Acad Sci 1970;174:252-254. 6. Thomas MF, Penny DG: Hematologic

Emergency Department Visits by Pediatric Patients for Poisoning by Prescription Opioids

PubMed Central

Tadros, Allison; Layman, Shelley M.; Davis, Stephen M.; Bozeman, Rachel; Davidov, Danielle M.

2016-01-01

Background Prescription medication abuse is an increasingly recognized problem in the United States. As more opioids are being prescribed and abused by adults, there is an increased risk of both accidental and intentional exposure to children and adolescents. The impact of pediatric exposures to prescription pain pills has not been well studied. Objectives We sought to evaluate emergency department (ED) visits for poisoning by prescription opioids in pediatric patients. Methods This retrospective study looked at clinical and demographic data from the Nationwide Emergency Department Sample (NEDS) from 2006 – 2012. Results There were 21,928 pediatric ED visits for prescription opioid poisonings and more than half were unintentional. There was a bimodal age distribution of patients with slightly more than half occurring in females. The majority of patients were discharged from the ED. More visits in the younger age group (0–5 years) were unintentional while the majority of visits in the adolescent age group (15–17 years) were intentional. Mean charge per discharge was $1,840 and $14,235 for admissions and surmounted to over $81 million in total charges. Conclusion Poisonings by prescription opioids largely impact both young children and adolescents. These findings can be used to help target this population for future preventive efforts. PMID:27398815

Organophosphorus poisoning (acute).

PubMed

2007-03-01

Acute organophosphorus poisoning occurs after dermal, respiratory, or oral exposure to either low-volatility pesticides (e.g. chlorpyrifos, dimethoate) or high-volatility nerve gases (e.g. sarin, tabun). Most cases occur in resource-poor countries as a result of occupational or deliberate exposure to organophosphorus pesticides. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute organophosphorus poisoning? We searched: Medline, Embase, The Cochrane Library and other important databases up to August 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 22 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: activated charcoal, alpha2 adrenergic receptor agonists, atropine, benzodiazepines, butyrylcholinesterase replacement therapy, cathartics, extracorporeal clearance, gastric lavage, glycopyrronium bromide, ipecacuanha, magnesium sulphate, milk or other home remedies, N-methyl-D-aspartate receptor antagonists, organophosphorus hydrolases, oximes, sodium bicarbonate, washing the poisoned person and removing contaminated clothing.

[Poisoning with household cleaning products in a city in Northeast Brazil].

PubMed

Fook, Sayonara Maria Lia; Azevedo, Esthefanye Fernandes de; Costa, Monalisa Maciel; Feitosa, Itavielly Layany França; Bragagnoli, Gerson; Mariz, Saulo Rios

2013-05-01

This study analyzes toxic exposures to household cleaning products based on data from the Center for Notification and Treatment of Poisoning (CEATOX) in Campina Grande, Paraíba State, Brazil, from 2007 to 2010. The data were collected from the reporting forms from the Information System on Notifiable Diseases (SINAN), analyzed with SPSS (Version 17). Chemical identification was performed in urine samples using high-resolution chromatography techniques (GC-MS and HPLC-UV). Six hundred and sixty cases of poisoning were reported, with pesticides as the principal causal agents (42.2%). Poisoning with household cleaning products occurred mainly in children (30.1%) and/or females (55.21%) who were exposed to the product accidentally (55.4%) by the oral route (82%). These data indicate that poisoning with household cleaning products in Campina Grande should be treated with specific prevention and control measures, including evaluation of ease of access to pesticides, in order to reach the goals set by the Brazilian National Health Plan for 2012-2015.

Black-spot poison ivy: a rare phenomenon.

PubMed

Paniagua, Carmen T; Bean, Ashley S

2011-06-01

To provide an overview of the clinical presentation, diagnosis, management, and treatment with advanced practice nursing implications of black-spot poison ivy phenomenon. Case presentation and comprehensive literature review on black-spot poison ivy. Black-spot poison ivy is a rare phenomenon and usually poses a diagnostic challenge. It usually presents after exposure to a higher concentration of uroshiol on Toxicodendron plants. Patients present with black-spot deposits on the epidermis with underlying poison ivy dermatitis. The black deposits cannot be washed off the skin and are followed by itchy blisters. They eventually peel off and the skin heals without scarring. An understanding of the pathophysiology, clinical presentation, treatment, and management of this rare phenomenon is important for the nurse practitioner (NP) to be able to make an accurate diagnosis and initiate appropriate treatment without delay. The NP's recognition and differentiation of it from other skin disorders including melanoma is paramount. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

Poisoning of raptors with organophosphorus and carbamate pesticides with emphasis on Canada, U.S. and U.K.

USGS Publications Warehouse

Mineau, P.; Fletcher, M.R.; Glaser, L.C.; Thomas, N.J.; Brassard, C.; Wilson, L.K.; Elliott, J.E.; Lyon, L.A.; Henny, C.J.; Bollinger, T.; Porter, S.L.

1999-01-01

We reviewed cases of raptor mortality resulting from cholinesterase-inhibiting pesticides. We compiled records from the U.S., U.K. and Canada for the period 1985-95 (520 incidents) and surveyed the relevant literature to identify the main routes of exposure and those products that led to the greatest number of poisoning cases. A high proportion of cases in the U.K. resulted from abusive uses of pesticides (willful poisoning). The proportion was smaller in North America where problems with labeled uses of pesticides were as frequent as abuse cases. Poisoning resulting from labeled use was possible with a large number of granular pesticides and some seed treatments through secondary poisoning or through the ingestion of contaminated invertebrates, notably earthworms. With the more toxic products, residue levels in freshly-sprayed insects were high enough to cause mortality. The use of organophosphorus products as avicides and for the topical treatment of livestock appeared to be common routes of intoxication. The use of insecticides in dormant oils also gave rise to exposure that can be lethal or which can debilitate birds and increase their vulnerability. A few pesticides of high toxicity were responsible for the bulk of poisoning cases. Based on limited information, raptors appeared to be more sensitive than other bird species to organophosphorus and carbamate pesticides. Some of the more significant risk factors that resulted in raptor poisonings were: insectivory and vermivory; opportunistic taking of debilitated prey; scavenging, especially if the gastrointestinal tracts are consumed; presence in agricultural areas; perceived status as pest species; and flocking or other gregarious behavior at some part of their life cycle. Lethal or sublethal poisoning should always be considered in the diagnosis of dead or debilitated raptors even when another diagnosis (e.g., electrocution, car or building strike) is apparent. Many cases of poisoning are not currently diagnosed as such and, even when diagnosed, the information is often not made available to regulatory authorities. The importance of pesticide intoxications relative to other sources of mortality is highly variable in time and place; on a regional level, the increased mortality of raptors resulting from cholinesterase-inhibiting pesticides can be significant, especially in the case of rare species.

Thirteen years of oxcarbazepine exposures reported to US poison centers: 2000 to 2012.

PubMed

Spiller, H A; Strauch, J; Essing-Spiller, S J; Burns, G

2016-10-01

Oxcarbazepine (OXC) is a 10-keto analogue of carbamazepine used in patients with partial and secondary generalized seizures. We evaluated ingestions of OXC reported to US poison centers for adverse effects from supratherapeutic doses and/or overdose. Retrospective analysis of data reported to National Poison Data System from single-substance OXC ingestions between January 2000 and December 2012. There were 18,867cases with a mean of 1451 exposures/year. The patients were predominantly adults with 5464 exposures in children <6 years (29%). The most commonly reported clinical effects were drowsiness (n = 4703, 25%), vomiting (n = 1559, 8%), tachycardia (n = 590, 3%), agitated (n = 342, 1.8%), hypotension (n = 178, 0.9%), electrolyte disturbance (n = 153, 0.8%), coma (n = 156, 0.8%), and seizures (n = 121, 0.6%). There were 176 patients with a major effect of which 31 involved were children and 1728 (9%) patients with moderate effects of which 300 involved were children. Five deaths were reported in adults. Intentional exposure (e.g. suicide) was the reason for exposure in 68% of patients with major effects and in all fatalities. Fifty-three percent of adults and 38% of children were managed in a health-care facility (HCF). HCF utilization levels remained consistent. Severe outcomes appear to be infrequent (<1%). Unlike other anticonvulsants OXC does not appear to be proconvulsant in overdose. Serious outcomes for OXC overdoses are unlikely in the pediatric patient. With only mild symptoms likely, observation at home may be appropriate for the majority of cases. In the adult population there appears to be few neurologic and cardiovascular complications even in the intentional exposure. © The Author(s) 2015.

The Influence of Lead Exposure and Toxicity to Children's Neurological Development and School Performance.

ERIC Educational Resources Information Center

Kimball, Sarah L.

This report discusses the effects of lead exposure and toxicity on children's cognitive development and school performance and addresses the role of schools in prevention of lead poisoning. Sources of lead exposure include mining, smelting and refining activities, lead paint, leaded gasoline, and industrial emissions. The results of lead poisoning…

[Allergic contact dermatitis to common ivy (Hedera helix L.)].

PubMed

Ozdemir, C; Schneider, L A; Hinrichs, R; Staib, G; Weber, L; Weiss, J M; Scharffetter-Kochanek, K

2003-10-01

Common ivy (Hedera helix L.) is a ubiquitous plant in Europe whose major allergen falcarinol has moderate allergic potential. It is not related to poison ivy (Toxicodendron spp.). There are no cross reactions between the allergens of common ivy (falcarinol) and poison ivy (urushiol). Contact with common ivy or falcarinol may lead to sensitization and then a delayed hypersensitivity reaction. There are only few cases described in the literature. We report on a male hobby gardener with appropriate clinical history and positive patch test. The pathogenic mechanism is a type IV reaction following a sensitization exposure. Gardeners and landscape architects with frequent exposure to common ivy and thus a high risk of sensitization should wear appropriate protective clothing.

Process for the regeneration of metallic catalysts

DOEpatents

Katzer, James R.; Windawi, Hassan

1981-01-01

A method for the regeneration of metallic hydrogenation catalysts from the class consisting of Ni, Rh, Pd, Ir, Pt and Ru poisoned with sulfur, with or without accompanying carbon deposition, comprising subjecting the catalyst to exposure to oxygen gas in a concentration of about 1-10 ppm. intermixed with an inert gas of the group consisting of He, A, Xe, Kr, N.sub.2 and air substantially free of oxygen to an extent such that the total oxygen molecule throughout is in the range of about 10 to 20 times that of the hydrogen sulfide molecular exposure producing the catalyst poisoning while maintaining the temperature in the range of about 300.degree. to 500.degree. C.

Acute occupational poisoning by octogen: first case report.

PubMed

Testud, François; Descotes, Jacques; Le Meur, Brigitte

2006-01-01

Octogen (HMX) is a polynitramine explosive closely related to hexogen, a known occupational toxin in military munitions plants. No acute human poisoning with octogen has ever been reported. A 28-year-old man with no history of epilepsy was admitted to the Emergency Department for seizures that had developed during the night after a full working day when he manually sieved large amounts of dry octogen. On admission, the clinical examination was normal and all other examinations could not substantiate the development of essential or secondary epilepsy. Elevated octogen concentrations were measured in his plasma, which confirmed occupational exposure to the explosive. The rarity of acute human poisonings by octogen is due to the infrequent use of this explosive and, more importantly, its very low oral bioavailability. However, acute poisoning can occur, but should be easily avoided by implementing adequate preventive measures.

VIGILANCE POISON: Illegal poisoning and lead intoxication are the main factors affecting avian scavenger survival in the Pyrenees (France).

PubMed

Berny, Philippe; Vilagines, Lydia; Cugnasse, Jean-Marc; Mastain, Olivier; Chollet, Jean-Yves; Joncour, Guy; Razin, Martine

2015-08-01

A specific surveillance program has been set up to monitor avian scavenger populations in the French Pyrenean Mountains, hosting a high proportion of the French populations. The two main purposes of the study were to identify all causes of death and to investigate poisoning cases. All 170 birds found dead during the 7-year program were submitted to full necropsy, X-Ray, parasitological investigations and consistent analytical toxicology screenings (Cholinesterase inhibitors, anticoagulant rodenticides, organochlorine insecticides, Pb, Cd). Over the study period, 8 Bearded Vultures, 120 Griffon Vultures, 8 Egyptian Vultures and 34 Red kites were eventually collected. Mortality events were often multifactorial, but poisoning was by far the most common cause of death (24.1%), followed by trauma/fall (12%), bacterial diseases and starvation (8%) and electrocution (6%). Illicit use of banned pesticides was identified as a common cause of poisoning (53% of all poisoning cases) and lead poisoning was also identified as a significant toxicant issue (17% of all poisoning cases). Lead isotopic signature could be associated primarily with ammunition. Last, a positive association between trauma and lead contamination was detected, indicating that lead could be a significant contributor to different causes of death. These results urge for severe restrictions on the use of lead ammunition to prevent scavengers from detrimental exposure. Copyright © 2015 Elsevier Inc. All rights reserved.

[Outbreak of carbon monoxide poisoning in the Ile-de-France region during the spring 2016 Seine flooding].

PubMed

Dufayet, Laurène; Médernach, Chantal; Bassi, Clément; Garnier, Robert; Langrand, Jérôme

2017-01-01

Heavy rainfall in May 2016 caused large-scale flooding of the Seine and its tributaries. Analysis of this unusual event showed that it could recur on an even larger scale. The sanitary consequences were less frequently assessed in this analysis, particularly the risk of accidental collective carbon monoxide (CO) poisoning caused by the use of combustion engine drainage pumps. We retrospectively reviewed all cases of acute accidental carbon monoxide exposure observed in the Ile-de-France region, related to the use of drainage pumps in spring and summer 2016 and notified to the Ile-de-France CO poisoning surveillance network. Five events were identified, including 45 people exposed to carbon monoxide. Thirty-four of these people were poisoned, 5 were not poisoned and insufficient data were available for 6 people. Three people showed signs of severity and 2 were treated by hyperbaric oxygen therapy. The other poisoned individuals were managed in hospital and treated by oxygen therapy. All were cured. Collective CO poisonings are common sanitary events during flooding and can be potentially severe. They can occur during the event or over the following days. Preventive measures may help to reduce the risk of CO poisoning, such as increased awareness among professionals, better information of individuals who rent these types of devices or even the use of CO detectors during their use.

[Clinical manifestations of lead levels in children exposed to automobile battery recycling processes in Soacha and Bogotá, D.C].

PubMed

Hurtado, Carlos Mauricio; Gutiérrez, Myriam; Echeverry, Jairo

2008-03-01

Lead is a harmless metal if not handled directly in the industrial process. Even thought lead has been eliminated from the gasoline in many countries, automobile battery recycling continues to be a potential source of exposure and intoxication for the workers and their families, particularly of low income. The current investigation was initiated after an index case of lead poisoning was reported from Soacha, Cundinamarca, in central Colombia. Clinical investigation established lead levels and lead poison frequency in children with para-occupational lead exposure in the process of recycling automobile batteries. This was designed as a descriptive study, with selection of subjects with high risk of possible lead exposure. Minors, mostly of school age were recruited based on referral by relatives, neighbors or acquaintances, all of whom were involved in para-occupational exposure. Thirty two children, less than 12 years old (majority school age), were included. General and specific examinations of the children were made, and blood samples were taken for lead and hematological determinations. All subjects showed high levels of lead (2-9 times the maximum acceptable value) and, according to established criteria, two-thirds were rated as severely poisoned. The children with high levels of lead had tendency toward more specific hematological compromise and showing black gingival bordering (Burton border). This study communicates to the sanitary authorities and government a clear sign of alarm in that measures must be taken to diminish the occupational or para-occupational lead exposure of children by way of the automobile battery recycling industry.

Occupational Health Management in the Lead Industry: The Korean Experience

PubMed Central

2011-01-01

In 1967, the problem of occupational lead exposure came to public attention in Korea. Since then, regular progress has been made in lowering workplace lead exposures, instituting new workplace controls, and implementing health examinations of exposed workers. Past serious lead poisoning episodes made it possible to introduce biological monitoring programs on a voluntary basis in high-lead-exposure facilities in Korea. Industry-specific occupational health services for lead workers in Korea during the last 22 years can be categorized into three phases. During the first phase (1988-1993), efforts were directed at increasing awareness among workers about the hazards of lead exposure, biological monitoring of blood zinc protoporphyrin began, and a respiratory protection program was introduced. During the second phase (1994-1997), a computerized health management system for lead workers was developed, blood-lead measurement was added to biologic monitoring, and engineering controls were introduced in the workplace to lower air-lead levels to comply with air-lead regulations. Finally, during the third phase (1998-present), a new biomarker, bone-lead measurement by X-ray fluorescence, was introduced. Bone-lead measurement proved to be useful for assessing body burden and to demonstrate past lead exposure in retired workers. Occupational health service practice for lead workers, including the industry-specific group occupational health system, has brought considerable success in the prevention of lead poisoning and in reducing the lead burden in Korean lead workers during the last several decades. The successful achievement of prevention of lead poisoning in Korea was a result of the combined efforts of lead workers, employers, relevant government agencies, and academic institutes. PMID:22953192

[Evaluation of different oxygen therapies on therapeutic effects in rats with acute carbon dioxide poisoning].

PubMed

Niu, Ying-mei; Hao, Feng-tong; Xue, Chang-jiang; Xia, Yu-jing; Zhou, Shuo; Lu, Qing-sheng; Liu, Jian-zhong; Zhang, Peng

2011-03-01

To study therapeutic effects by using different oxygen therapies in rats with acute carbon dioxide poisoning, to select the best oxygen therapy technology for patients with acute carbon dioxide poisoning on the spot. Sixty healthy male Sprague-Dawley rats were randomized into normal control group, carbon dioxide exposure group, hyperbaric oxygen treatment group (pressure 2 ATA, FiO(2)100%), high concentration of atmospheric oxygen treatment group (FiO(2)50%), low concentration of atmospheric oxygen treatment group (FiO(2)33%). After treated with different oxygen in rats with acute carbon dioxide poisoning, arterial pH, PO2 and PCO2 of rats were detected, in addition observe pathological changes of lung tissue and brain tissue. The arterial pH (7.31 ± 0.06) and PO2 [(68.50 ± 15.02) mm Hg] of carbon dioxide exposure group were lower than those of control group [pH (7.42 ± 0.02) and PO2 (92.83 ± 8.27) mm Hg], PCO2 [(71.66 ± 12.10) mm Hg] was higher than that of control group [(48.25 ± 2.59) mm Hg] (P < 0.05); the arterial pH (hyperbaric oxygen treatment group 7.37 ± 0.02, high concentration of atmospheric oxygen treatment group 7.39 ± 0.03, low concentration of atmospheric oxygen treatment group 7.38 ± 0.02) and PO2 of oxygen treatment groups [hyperbaric oxygen treatment group, high concentration of atmospheric oxygen treatment group, low concentration of atmospheric oxygen treatment group were (82.25 ± 12.98), (84.75 ± 11.24), (83.75 ± 16.77) mm Hg, respectively] were higher than that of carbon dioxide exposure group, PCO2 [hyperbaric oxygen treatment group, high concentration of atmospheric oxygen treatment group, low concentration of atmospheric oxygen treatment group were (52.25 ± 4.95), (51.75 ± 4.82), (52.66 ± 5.61) mm Hg, respectively] was lower than that of carbon dioxide exposure group (P < 0.05); there was no significant difference of the arterial pH, PO2 and PCO2 between oxygen treatment groups and control group (P > 0.05); there was no significant difference of the arterial pH, PO2 and PCO2 among oxygen treatment groups (P > 0.05). There was large area of bleeding of lungs in rats with carbon dioxide poisoning, the bleeding of lungs in rats with high concentration of atmospheric oxygen treatment and low concentration of atmospheric oxygen treatment was better than the rats with carbon dioxide poisoning, there was no abnormal appearance of lungs in rats with hyperbaric oxygen treatment. The light microscope observation showed that there were diffuse bleeding and exudation of lungs in rats with carbon dioxide poisoning, the bleeding and exudation of lungs in rats with high concentration of atmospheric oxygen treatment and low concentration of atmospheric oxygen treatment were better than the rats with carbon dioxide poisoning, there were only minor bleeding and exudation of lungs in rats with hyperbaric oxygen treatment. There was no difference of brain in anatomy and microscopy among all groups, there were no significant bleeding, edema, cell degeneration and necrosis. Lung pathology in acute carbon dioxide poisoning rats with hyperbaric oxygen treatment is better than the rats with high concentration of atmospheric oxygen treatment and low concentration of atmospheric oxygen treatment, there is no significant difference of effect between high concentration of atmospheric oxygen treatment group and low concentration of atmospheric oxygen treatment group, however, the results of blood gas analysis and lung pathology than the exposure group improved, so qualified medical unit for hyperbaric oxygen therapy as soon as possible, hyperbaric oxygen treatment facilities in the absence of circumstances, the emergency treatment of early oxygen is also a good measure.

Analysis of Phone Calls Regarding Fluoride Exposure made to New Jersey Poison Control Center from 2010 to 2012.

PubMed

Shah, Sneha; Quek, Samuel; Ruck, Bruce

2016-02-01

The American Association of Poison Control Center's annual reports demonstrate that acute fluoride exposure is not an uncommon occurrence. Despite its prevalence, there has been little published research on the topic in the last 10 years. The purpose of this study was to calculate the incidence of acute fluoride toxicity and lethality as it occurs in New Jersey and provide a descriptive epidemiology of acute fluoride exposures. The study design was retrospective in nature. Records of phone calls made by individuals reporting excessive fluoride exposure (in an amount greater than directed/prescribed) to New Jersey's poison control center, known as Poison Information and Education System from the years 2010 through 2012, were extracted from Toxicall® (Computer Automatic Systems, Inc.) database. A total of 2,476 human-only exposure records met the inclusion criteria and were analyzed. Incidence rates were calculated, and population characteristics, circumstances and medical outcomes of acute fluoride exposure cases were assessed and categorized. A total of 2,476 phone call records met the inclusion criteria. The fluoride exposures reported were from toothpaste with fluoride (49%, n=1,214), mouth rinse with fluoride (21.6%, n=536), multivitamin with fluoride (21.4%, n=530) and pure fluoride (0.08%, n=199). Medically speaking, 94.75% of calls were asymptomatic cases (n=2,346), 4.24% were symptomatic (n=105) and 1.01% were informational inquiries (n=25). Adverse symptoms reported were mostly minor (83.9% of symptomatic cases, n=88) and moderate (16.1% of symptomatic cases, n=17). The age group 18 months to 3 years of age showed the highest incidence of acute fluoride exposure (53.2%, n=1,317). There was a slightly higher incidence of acute fluoride exposures among males (n=1,317) vs. females (n=1,159). Most incidences occurred in the home (93.1% of records, n=2,305) and occurred unintentionally (96.7%, n=2,394). Calls were mainly made by the subject's mother (67.5%, n=1,671). Based on the data, there were no reports of lethality or toxicity due to acute fluoride exposure in New Jersey from 2010 through 2012. Symptomatic reports and informational inquiries were few. All adverse outcomes due to excessive fluoride intake were remedied with calcium as the antidote. Dental hygienists should educate patients on safety measures of fluoride-containing products and evaluate overall fluoride exposure prior to making recommendations. However, findings in this study suggest that levels of fluoride in available commercial products will not produce life-threatening events, even if taken in doses higher than recommended. Copyright © 2016 The American Dental Hygienists’ Association.

Poisoning Young Minds.

ERIC Educational Resources Information Center

Schmidt, Charles W.

1999-01-01

Notes that neurobehavioral problems from exposure to lead and other toxins can be observed at doses far below those that cause more obvious signs of exposure. Calls for refining tests of cognitive and developmental skills in exposed children, identifying additional contaminants and mechanisms for behavioral effects, and improving dose- repose…

Impact of Mandatory Carbon Monoxide Alarms: An Investigation of the Effects on Detection and Poisoning Rates in New York City

PubMed Central

Wheeler-Martin, Katherine; Soghoian, Sari; Manini, Alex F.; Marker, Elizabeth; Stajic, Marina; Prezant, David; Nelson, Lewis S.; Hoffman, Robert S.

2015-01-01

Objectives. We sought to evaluate the impact of New York City’s (NYC’s) 2004 carbon monoxide (CO) alarm legislation on CO incident detection and poisoning rates. Methods. We compared CO poisoning deaths, hospitalizations, exposures reported to Poison Control, and fire department investigations, before and after the law for 2000 to 2010. Use of CO alarms was assessed in the 2009 NYC Community Health Survey. Results. Investigations that found indoor CO levels greater than 9 parts per million increased nearly 7-fold after the law (P < .001). There were nonsignificant decreases in unintentional, nonfire-related CO poisoning hospitalization rates (P = .114) and death rates (P = .216). After we controlled for ambient temperature, the law’s effect on hospitalizations remained nonsignificantly protective (incidence rate ratio = 0.747; 95% confidence interval = 0.520, 1.074). By 2009, 83% of NYC residents reported having CO alarms; only 54% also recently tested or replaced their batteries. Conclusions. Mandating CO alarms significantly increased the detection of potentially hazardous CO levels in NYC homes. Small numbers and detection bias might have limited the discovery of significant decreases in poisoning outcomes. Investigation of individual poisoning circumstances since the law might elucidate remaining gaps in awareness and proper use of CO alarms. PMID:26066948

Variation in suicide occurrence by day and during major American holidays.

PubMed

Beauchamp, Gillian A; Ho, Mona L; Yin, Shan

2014-06-01

Due to temporal variations in completed suicides, it has been suggested that impulsivity and environmental factors may influence suicide. Our intent was to determine if particular days of the week, seasons, or holidays were associated with increased attempted and completed suicides by poisoning. All calls recorded in the National Poison Database System coded as "suspected suicide" from 2006 through 2010 were included. Exposures were evaluated by day, season, and holidays, and compared to control dates. There were 1,065,067 exposures (63% female) related to suicide attempts, with completions in 0.4% of cases. Sundays and Mondays for adults, and Mondays and Tuesdays for age < 19 years were the most common. Spring and fall had higher numbers of exposures than summer and winter. New Year's Day had a higher number of exposures, whereas Independence Day, Thanksgiving, and Christmas had fewer exposures. The beginning of the week, spring and fall, and New Year's Day were associated with higher numbers of ingestions with suicidal intent. This has implications for clinicians advising potential victims and providing emergency care for these patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Lead in the tissues of terrestrial raptors in southern Ontario, Canada, 1995-2001.

PubMed

Martin, Pamela A; Campbell, Douglas; Hughes, Kimberley; McDaniel, Tana

2008-02-25

Terrestrial raptors which feed on upland hunted game species may increase their risk to lead exposure and lead poisoning by ingesting lead shot found in the tissues of prey. Lead exposure in 225 individuals of nineteen species of terrestrial raptors, collected as carcasses in southern Ontario from 1995-2001, was examined through the analysis of bone, liver and kidney tissues. In this study, one red-tailed hawk contained liver lead concentrations and exhibited signs consistent with lead poisoning. Liver and kidney concentrations of one turkey vulture were also significantly higher than that associated with subclinical effects. This same bird, plus another turkey vulture and a northern harrier, had elevated bone lead concentrations (>10 microg/g dw) associated with possible toxicity. Turkey vultures had the highest mean concentrations of lead in bone and kidney compared to other raptor species. While it appeared only a single bird suffered acute lead poisoning, lead levels exceeded threshold concentrations associated with subclinical or acute toxicity in 4 of 225, almost 2%, of terrestrial raptors assessed. Given the association between lead exposure in raptors and hunting of game species reported in other studies, the continued use of lead shot for upland hunting in Ontario likely remains as one of the primary sources of lead and a continued risk to these birds of prey.

The Effect of Co-Administration of Death Camas (Zigadenus spp.) and Low Larkspur (Delphinium spp.) in Cattle.

PubMed

Welch, Kevin D; Green, Benedict T; Gardner, Dale R; Stonecipher, Clinton A; Pfister, James A; Cook, Daniel

2016-01-12

In many rangeland settings, there is more than one potential poisonous plant. Two poisonous plants that are often found growing simultaneously in the same location in North American rangelands are death camas (Zigadenus spp.) and low larkspur (Delphinium spp.). The objective of this study was to determine if co-administration of death camas would exacerbate the toxicity of low larkspur in cattle. Cattle dosed with 2.0 g of death camas/kg BW showed slight frothing and lethargy, whereas cattle dosed with both death camas and low larkspur showed increased clinical signs of poisoning. Although qualitative differences in clinical signs of intoxication in cattle co-treated with death camas and low larkspur were observed, there were not any significant quantitative differences in heart rate or exercise-induced muscle fatigue. Co-treatment with death camas and low larkspur did not affect the serum zygacine kinetics, however, there was a difference in the larkspur alkaloid kinetics in the co-exposure group. Overall, the results from this study suggest that co-exposure to death camas and low larkspur is not significantly more toxic to cattle than exposure to the plants individually. The results from this study increase our knowledge and understanding regarding the acute toxicity of death camas and low larkspur in cattle.

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

PubMed

Santos, Cynthia; Kieszak, Stephanie; Wang, Alice; Law, Royal; Schier, Joshua; Wolkin, Amy

2017-03-03

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.

Toxicovigilance: a new approach for the hazard identification and risk assessment of toxicants in human beings.

PubMed

Descotes, Jacques; Testud, François

2005-09-01

The concept of toxicovigilance encompasses the active detection, validation and follow-up of clinical adverse events related to toxic exposures in human beings. Poison centers are key players in this function as poisoning statistics are essential to define the cause, incidence and severity of poisonings occurring in the general population. In addition, the systematic search for unexpected shifts in the recorded causes of poisonings, e.g., following the introduction of a new product, or change in the formulation or recommended use of an old product, allows for a rapid detection of potential adverse health consequences and the implementation of preventive or corrective measures. However, toxicovigilance is genuinely a medical and not only a statistical approach of human toxicity issues. In contrast to epidemiology, toxicovigilance is based on the in-depth medical assessment of acute or chronic intoxications on an individual basis, which requires detailed information that poison centers can rarely obtain via emergency telephone calls and that epidemiologists cannot collect or process. Validation of this medical information must primarily be based on toxicological expertise to help identify causal links between otherwise unexplained pathological conditions and documented toxic exposures. Thus, toxicovigilance can contribute to hazard identification and risk assessment by providing medically validated data which are often overlooked in the process of risk assessment. So far, very few structured toxicovigilance systems have been set up and hopefully national and international initiatives will bridge this gap in our knowledge of the toxicity of many chemicals and commercial products in human beings.

Acute pesticide poisoning among agricultural workers in the United States, 1998-2005.

PubMed

Calvert, Geoffrey M; Karnik, Jennifer; Mehler, Louise; Beckman, John; Morrissey, Barbara; Sievert, Jennifer; Barrett, Rosanna; Lackovic, Michelle; Mabee, Laura; Schwartz, Abby; Mitchell, Yvette; Moraga-McHaley, Stephanie

2008-12-01

Approximately 75% of pesticide usage in the United States occurs in agriculture. As such, agricultural workers are at greater risk of pesticide exposure than non-agricultural workers. However, the magnitude, characteristics and trend of acute pesticide poisoning among agricultural workers are unknown. We identified acute pesticide poisoning cases in agricultural workers between the ages of 15 and 64 years that occurred from 1998 to 2005. The California Department of Pesticide Regulation and the SENSOR-Pesticides program provided the cases. Acute occupational pesticide poisoning incidence rates (IR) for those employed in agriculture were calculated, as were incidence rate ratios (IRR) among agricultural workers relative to non-agricultural workers. Of the 3,271 cases included in the analysis, 2,334 (71%) were employed as farmworkers. The remaining cases were employed as processing/packing plant workers (12%), farmers (3%), and other miscellaneous agricultural workers (19%). The majority of cases had low severity illness (N = 2,848, 87%), while 402 (12%) were of medium severity and 20 (0.6%) were of high severity. One case was fatal. Rates of illness among various agricultural worker categories were highly variable but all, except farmers, showed risk for agricultural workers greater than risk for non-agricultural workers by an order of magnitude or more. Also, the rate among female agricultural workers was almost twofold higher compared to males. The findings from this study suggest that acute pesticide poisoning in the agricultural industry continues to be an important problem. These findings reinforce the need for heightened efforts to better protect farmworkers from pesticide exposure. Copyright 2008 Wiley-Liss, Inc.

Toxicovigilance: A new approach for the hazard identification and risk assessment of toxicants in human beings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Descotes, Jacques; Testud, Francois

2005-09-01

The concept of toxicovigilance encompasses the active detection, validation and follow-up of clinical adverse events related to toxic exposures in human beings. Poison centers are key players in this function as poisoning statistics are essential to define the cause, incidence and severity of poisonings occurring in the general population. In addition, the systematic search for unexpected shifts in the recorded causes of poisonings, e.g., following the introduction of a new product, or change in the formulation or recommended use of an old product, allows for a rapid detection of potential adverse health consequences and the implementation of preventive or correctivemore » measures. However, toxicovigilance is genuinely a medical and not only a statistical approach of human toxicity issues. In contrast to epidemiology, toxicovigilance is based on the in-depth medical assessment of acute or chronic intoxications on an individual basis, which requires detailed information that poison centers can rarely obtain via emergency telephone calls and that epidemiologists cannot collect or process. Validation of this medical information must primarily be based on toxicological expertise to help identify causal links between otherwise unexplained pathological conditions and documented toxic exposures. Thus, toxicovigilance can contribute to hazard identification and risk assessment by providing medically validated data which are often overlooked in the process of risk assessment. So far, very few structured toxicovigilance systems have been set up and hopefully national and international initiatives will bridge this gap in our knowledge of the toxicity of many chemicals and commercial products in human beings.« less

Anthropogenic emissions of carbon monoxide.

PubMed

Horner, J M

2000-01-01

Carbon monoxide (CO) is a colorless, nonirritating, odorless and tasteless gas. Carbon monoxide combines with hemoglobin far more readily than does oxygen, leading to tissue hypoxia. Thousands of people die annually from CO poisoning, and those recovering from acute exposure commonly suffer brain damage. Chronic poisoning is of particular concern to sufferers of coronary heart disease, pregnant women, and people with certain hematological disorders. Indoor emission sources, notably fuel-burning heating appliances, cause most unintentional deaths and cases of illness and should be the main focus of concern. Motor vehicle emissions pose a chronic health risk for occupationally exposed groups. Smoking is a major source of personal exposure. Recent exposure to CO is commonly evaluated by measuring blood carboxyhemoglobin levels, which are related to the concentration of atmospheric CO. Monitoring methods are reviewed here, and monitoring is considered in relation to air quality standards and guidelines. Finally, control measures for motor vehicles and indoor heating appliances are suggested.

Childhood lead poisoning - United States: report to the Congress by the Agency for Toxic Substances and Disease Registry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

The long-term consequences of unabated exposures to environmental lead sources can be serious, particularly for children. Recent scientific studies have shown a progressive decline in the lowest exposure levels of lead at which adverse effects can be reliably detected in children. In recognition of this, Congress directed the Agency for Toxic Substances and Disease Registry (ATSDR), in consultation with the Environmental Protection Agency (EPA), to examine the nature and extent of childhood lead poisoning in the United States. The study was to address such areas as the long-term health implications of environmental lead exposure in children, the extent of leadmore » intoxication of children in terms of geographic areas and sources of lead in the United States, and methods and strategies for removing lead from the environment of US children. This article summarizes the key findings of the report.« less

Lead poisoning in pregnant women who used Ayurvedic medications from India--New York City, 2011-2012.

PubMed

2012-08-24

Lead poisoning still occurs in the United States despite extensive prevention efforts and strict regulations. Exposure to lead can damage the brain, kidneys, and nervous and reproductive systems. Fetal exposure to lead can adversely affect neurodevelopment, decrease fetal growth, and increase the risk for premature birth and miscarriage. During 2011-2012, the New York City Department of Health and Mental Hygiene (DOHMH) investigated six cases of lead poisoning associated with the use of 10 oral Ayurvedic medications made in India. All six cases were in foreign-born pregnant women assessed for lead exposure risk by health-care providers during prenatal visits, as required by New York state law. Their blood lead levels (BLLs) ranged from 16 to 64 µg/dL. Lead concentrations of the medications were as high as 2.4%; several medications also contained mercury or arsenic, which also can have adverse health effects. DOHMH distributed information about the medications to health-care providers, product manufacturers, and government agencies in the United States and abroad, via postal and electronic mail. DOHMH also ordered a local business selling contaminated products to cease sales. Health-care providers should ask patients, especially foreign-born or pregnant patients, about any use of foreign health products, supplements, and remedies such as Ayurvedic medications. Public health professionals should consider these types of products when investigating heavy metal exposures and raise awareness among health-care providers and the public regarding the health risks posed by such products.

Toxicity and recovery in the pregnant mouse after gestational exposure to the cyanobacterial toxin, cylindrospermopsin.

EPA Science Inventory

Cylindrospermopsin (CYN) is a tricyclic alkaloid toxin produced by fresh water cyanobacterial species worldwide. CYN has been responsible for both livestock and human poisoning after oral exposure. This study investigated the toxicity of CYN to pregnant mice exposed during differ...

Pancreatitis in wild zinc-poisoned waterfowl

USGS Publications Warehouse

Sileo, Louis; Beyer, W. Nelson; Mateo, Rafael

2003-01-01

Four waterfowl were collected in the TriState Mining District (Oklahoma, Kansas and Missouri, USA), an area known to be contaminated with lead, cadmium and zinc (Zn). They were part of a larger group of 20 waterfowl collected to determine the exposure of birds to metal contamination at the site. The four waterfowl (three Branta canadensis, one Anas platyrhynchos) had mild to severe degenerative abnormalities of the exocrine pancreas, as well as tissue (pancreas, liver) concentrations of Zn that were considered toxic. The mildest condition was characterized by generalized atrophy of exocrine cells that exhibited cytoplasmic vacuoles and a relative lack of zymogen. The most severe condition was characterized by acini with distended lumens and hyperplastic exocrine tissue that completely lacked zymogen; these acini were widely separated by immature fibrous tissue. Because the lesions were nearly identical to the lesions reported in chickens and captive waterfowl that had been poisoned with ingested Zn, and because the concentrations of Zn in the pancreas and liver of the four birds were consistent with the concentrations measured in Zn-poisoned birds, we concluded that these waterfowl were poisoned by Zn. This may be the first reported case of zinc poisoning in free-ranging wild birds poisoned by environmental Zn.

Carbon monoxide poisoning from waterpipe smoking: a retrospective cohort study.

PubMed

Eichhorn, Lars; Michaelis, Dirk; Kemmerer, Michael; Jüttner, Björn; Tetzlaff, Kay

2018-04-01

Waterpipe smoking may increasingly account for unintentional carbon monoxide poisoning, a serious health hazard with high morbidity and mortality. We aimed at identifying waterpipe smoking as a cause for carbon monoxide poisoning in a large critical care database of a specialty care referral center. This retrospective cohort study included patients with a history of exposure to waterpipe smoking and carbon monoxide blood gas levels >10% or presence of clinical symptoms compatible with CO poisoning admitted between January 2013 and December 2016. Patients' initial symptoms and carbon monoxide blood levels were retrieved from records and neurologic status was assessed before and after hyperbaric oxygen treatment. Sixty-one subjects with carbon monoxide poisoning were included [41 males, 20 females; mean age 23 (SD ± 6) years; range 13-45] with an initial mean carboxyhemoglobin of 26.93% (SD ± 9.72). Most common symptoms included syncope, dizziness, headache, and nausea; 75% had temporary syncope. Symptoms were not closely associated with blood COHb levels. CO poisoning after waterpipe smoking may present in young adults with a wide variability of symptoms from none to unconsciousness. Therefore diagnosis should be suspected even in the absence of symptoms.

Trends in intentional abuse or misuse of benzodiazepines and opioid analgesics and the associated mortality reported to poison centers across the United States from 2000 to 2014.

PubMed

Calcaterra, S L; Severtson, S G; Bau, G E; Margolin, Z R; Bucher-Bartelson, B; Green, J L; Dart, R C

2018-04-03

Prior works demonstrates an increased risk of death when opioid analgesics and benzodiazepines are used concomitantly to gain a high. Using poison center data, we described trends in abuse or misuse of benzodiazepines and opioid analgesics. We quantified mortality risk associated with abuse or misuse of benzodiazepines, opioid analgesics and the combination of opioid analgesics and benzodiazepines. This was a retrospective chart review of data from the National Poison Data System which collects information from 55 poison centers located across the United States. We identified reported cases of "intentional abuse or misuse" of benzodiazepine and/or opioid analgesic exposures. Poisson regression was used to compare the number of cases from each year between 2001 and 2014 to the year 2000. Logistic regression was used to determine whether cases exposed to both benzodiazepines and opioids had greater odds of death relative to cases exposed to opioid analgesics alone. From 2000 to 2014, there were 125,485 benzodiazepine exposures and 84,627 opioid exposures among "intentional abuse or misuse" cases. Of the benzodiazepine exposures, 17.3% (n = 21,660) also involved an opioid. In 2010, exposures involving both opioids and benzodiazepines were 4.26-fold (95% CI: 3.87-4.70; p < .001) higher than in 2000. The risk of death was 1.55 (95% CI: 1.01-2.37; p = .04) times greater among those who used both an opioid and a benzodiazepine compared to opioids alone. This association held after adjusting for gender and age. Intentional abuse or misuse of benzodiazepines and opioids in combination increased significantly from 2000 to 2014. Benzodiazepine abuse or misuse far exceeded cases of opioid abuse or misuse. Death was greater with co-abuse or misuse of benzodiazepines and opioids. Population-level campaigns to inform the public about the risk of death with co-abuse or misuse of benzodiazepines and opioids are urgently needed to address this overdose epidemic.

Notes from the field: calls to poison centers for exposures to electronic cigarettes--United States, September 2010-February 2014.

PubMed

Chatham-Stephens, Kevin; Law, Royal; Taylor, Ethel; Melstrom, Paul; Bunnell, Rebecca; Wang, Baoguang; Apelberg, Benjamin; Schier, Joshua G

2014-04-04

Electronic nicotine delivery devices such as electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine, flavorings (e.g., fruit, mint, and chocolate), and other chemicals via an inhaled aerosol. E-cigarettes that are marketed without a therapeutic claim by the product manufacturer are currently not regulated by the Food and Drug Administration (FDA). In many states, there are no restrictions on the sale of e-cigarettes to minors. Although e-cigarette use is increasing among U.S. adolescents and adults, its overall impact on public health remains unclear. One area of concern is the potential of e-cigarettes to cause acute nicotine toxicity. To assess the frequency of exposures to e-cigarettes and characterize the reported adverse health effects associated with e-cigarettes, CDC analyzed data on calls to U.S. poison centers (PCs) about human exposures to e-cigarettes (exposure calls) for the period September 2010 (when new, unique codes were added specifically for capturing e-cigarette calls) through February 2014. To provide a comparison to a conventional product with known toxicity, the number and characteristics of e-cigarette exposure calls were compared with those of conventional tobacco cigarette exposure calls.

Pediatric insecticide chalk exposures reported to Texas poison centers.

PubMed

Forrester, Mathias B

2013-05-01

The pesticide Miraculous Insecticide Chalk(TM) is illegal in the United States but can be obtained through a variety of sources. Because it is a stick similar in appearance to common blackboard chalk, children might play with it and put it in their mouths. All Miraculous Insecticide Chalk exposures involving children 5 years or younger reported to Texas poison centers during 2000-2010 were identified. The distribution by selected demographic and clinical factors was calculated. Of the total 188 exposures, the mean age was 1.5 years (range 6 months-5 years) and 60.6% were male. Ingestions were reported in 97.3% of the exposures, and these were reported to involve at most one stick of the chalk. The lowest exposure rates per 100,000 population of 5 years or younger were reported in the Public Health Regions in northern and eastern Texas (0.00-2.30) and the highest rates in the Public Health Regions in southern and western Texas (19.08-39.50). Of the 187 exposures not involving other substances, 96.8% were known or expected to result in at most minor effects, and 71.1% were managed on site (at residence).

An extensive review of commercial product labels the good, bad and ugly.

PubMed

Mrvos, R; Dean, B S; Krenzelok, E P

1986-02-01

Cautions and warnings on consumer products play an important role in the prevention and treatment of poison exposures. Frequently those exposed will follow the directions before calling the poison center, physician or emergency room. An extensive label review of 200 commercial products was conducted to determine if medical treatment advice was correct, if the general public was able to comprehend warning statements, and if warnings were adequate. We conclude there are products available that provide precise, correct information. However, there are many that contain incorrect, misleading, and often dangerous information to an unsuspecting public. Various examples of both types are given to make the poison information specialist aware of what information is presented.

Depressive symptoms and severity of acute occupational pesticide poisoning among male farmers.

PubMed

Kim, Jaeyoung; Ko, Yousun; Lee, Won Jin

2013-05-01

Limited evidence suggests the association between severity of acute occupational pesticide poisoning and depressive symptoms in farmers. The aim of this study was to investigate the association between occupational pesticide exposure and depressive symptoms among male farmers in South Korea. A nationwide sampling survey of male farmers was conducted in South Korea. A total of 1958 male farmers were interviewed in 2011. Severity of occupational pesticide poisoning was evaluated according to symptoms, types of treatment and number of pesticide poisonings per individual. Depressive symptoms were assessed using the Geriatric Depression Scale. A survey logistic regression model was used to estimate the multivariate OR and 95% CIs. Among total farmers, 10.4% (n=197) reported depressive symptoms. After controlling for potential confounders, occupational pesticide poisoning in the previous year was positively associated with the risk of depressive symptoms (OR=1.61; 95% CI 1.10 to 2.34). Cases of more severe pesticide poisoning, such as moderate- or severe-symptom cases (OR=2.81; 95% CI 1.71 to 4.63), outpatient or hospitalisation cases (OR=2.52; 95% CI 1.15 to 5.53), and multiple poisoning cases (OR=1.82; 95% CI 1.19 to 2.76) showed higher risks of depressive symptoms than did milder cases. Among the pesticides causing the poisonings, paraquat dichloride was found to be a significant predictor of depressive symptoms. No significant association was found with cumulative lifetime pesticide application and depressive symptoms. Our findings suggest that the risk of depression appears to be related to the severity of symptoms of poisoning, type of care received and the number of previous episodes of acute poisonings.

The critical role of the Poison Center in the recognition, mitigation and management of biological and chemical terrorism.

PubMed

Krenzelok, E P

2001-01-01

Nuclear, biological and chemical (NBC) terrorism counter measures are a major priority with healthcare providers, municipalities, states and the federal government. Significant resources are being invested to enhance civilian domestic preparedness through training in anticipation of a NBC terroristic incident. The key to a successful response, in addition to education, is integration of efforts as well as thorough communication and understanding the role that each agency would play in an actual or impending NBC incident. In anticipation of a NBC event, a regional counter-terrorism task force was established in southwestern Pennsylvania to identify resources, establish responsibilities and coordinate the response to NBC terrorism. Members of the task force include first responders, hazmat, law enforcement (local, regional, national), government officials, health departments, the statewide emergency management agency and the regional poison information center. The poison center is one of several critical components of a regional counter-terrorism response force. It can conduct active and passive toxicosurveillance and identify sentinel events. To be responsive, the poison center staff must be knowledgeable about biological and chemical agents. The development of basic protocols and a standardized staff education program is essential. The use of the RaPID-T (R-recognition, P-protection, D-detection, T-triage/treatment) course can provide basic staff education for responding to this important but rare consultation to the poison center.

Nicotinic plant poisoning.

PubMed

Schep, Leo J; Slaughter, Robin J; Beasley, D Michael G

2009-09-01

A wide range of plants contain nicotinic and nicotinic-like alkaloids. Of this diverse group, those that have been reported to cause human poisoning appear to have similar mechanisms of toxicity and presenting patients therefore have comparable toxidromes. This review describes the taxonomy and principal alkaloids of plants that contain nicotinic and nicotinic-like alkaloids, with particular focus on those that are toxic to humans. The toxicokinetics and mechanisms of toxicity of these alkaloids are reviewed and the clinical features and management of poisoning due to these plants are described. This review was compiled by systematically searching OVID MEDLINE and ISI Web of Science. This identified 9,456 papers, excluding duplicates, all of which were screened. Reviewed plants and their principal alkaloids. Plants containing nicotine and nicotine-like alkaloids that have been reported to be poisonous to humans include Conium maculatum, Nicotiana glauca and Nicotiana tabacum, Laburnum anagyroides, and Caulophyllum thalictroides. They contain the toxic alkaloids nicotine, anabasine, cytisine, n-methylcytisine, coniine, n-methylconiine, and gamma-coniceine. These alkaloids act agonistically at nicotinic-type acetylcholine (cholinergic) receptors (nAChRs). The nicotinic-type acetylcholine receptor can vary both in its subunit composition and in its distribution within the body (the central and autonomic nervous systems, the neuromuscular junctions, and the adrenal medulla). Agonistic interaction at these variable sites may explain why the alkaloids have diverse effects depending on the administered dose and duration of exposure. Nicotine and nicotine-like alkaloids are absorbed readily across all routes of exposure and are rapidly and widely distributed, readily traversing the blood-brain barrier and the placenta, and are freely distributed in breast milk. Metabolism occurs predominantly in the liver followed by rapid renal elimination. Following acute exposure, symptoms typically follow a biphasic pattern. The early phase consists of nicotinic cholinergic stimulation resulting in symptoms such as abdominal pain, hypertension, tachycardia, and tremors. The second inhibitory phase is delayed and often heralded by hypotension, bradycardia, and dyspnea, finally leading to coma and respiratory failure. Supportive care is the mainstay of management with primary emphasis on cardiovascular and respiratory support to ensure recovery. Exposure to plants containing nicotine and nicotine-like alkaloids can lead to severe poisoning but, with prompt supportive care, patients should make a full recovery.

Potential for erroneous interpretation of poisoning outcomes due to changes in National Poison Data System reporting.

PubMed

Anderson, Bruce; Ke, Xuehua; Klein-Schwartz, Wendy

2010-08-01

In 2006, the annual report of poison centers in the United States changed the method of reporting profiles for generic substance categories from all exposures to single-substance exposures only. The objective of this study is to describe the potential impact of this reporting change on longitudinal analysis of outcomes. Generic substance categories with data available for all years of the study were manually extracted from Table 22 of the National Poison Data System (NPDS) annual reports for 2002-2007. For each generic substance category, the following data were extracted for each of the 6 years: total number of substance mentions (2002-2005) or single-substance exposures (2006-2007), reason (unintentional or intentional), pediatric exposures (children age <6 years), and outcomes of major effect and death. Data were compared using descriptive analysis (Wilcoxon signed-rank test) and negative binomial regression. There were 65 generic substance categories (30 drug categories and 35 nondrug categories) that had data in all study years. For drug categories the average annual number of reported deaths by substance category decreased by 80.8%, from 2,229 in year 2002-2005 to 428 after the 2006 reporting change (p < 0.0001). The average annual number of reported major outcomes by substance category dropped by 76.0% (p < 0.0001). The impact on nondrug categories was similar: the annual average number of deaths and major effects by substance category decreased by about 50% from 394 and 4,639 per year during 2002-2005 to 198 deaths (p < 0.0001) and 2,357 major effects (p ≤ 0.0001) during 2006-2007. After controlling for potential covariates, multivariate regression showed that there were significant decreases in average rates of reported deaths (61.7 and 35.9%) and major effects (36.3 and 11.2%) for drug categories and nondrug categories, respectively (p < 0.01 for all). Overall rates of major outcomes and deaths reported to poison control centers from 2002 to 2007 have remained constant. The new method of describing demographic data in Table 22 results in outcomes that are different from those reported in previous NPDS annual reports. Comparing NPDS generic substance outcome data before and after the reporting change in 2006 will yield inaccurate results if the change in reporting methodology is not taken into account.

Carbon monoxide poisoning in Florida during the 2004 hurricane season.

PubMed

Van Sickle, David; Chertow, Daniel S; Schulte, Joann M; Ferdinands, Jill M; Patel, Prakash S; Johnson, David R; Harduar-Morano, Laurel; Blackmore, Carina; Ourso, Andre C; Cruse, Kelly M; Dunn, Kevin H; Moolenaar, Ronald L

2007-04-01

During August-September 2004, four major hurricanes hit Florida, resulting in widespread power outages affecting several million households. Carbon monoxide (CO) poisonings during this period were investigated to identify ways to prevent future poisoning. Medical records from ten hospitals (two with hyperbaric oxygen chambers) were reviewed to identify individuals diagnosed with unintentional CO poisoning between August 13 and October 15, 2004. Multiple attempts were made to interview one person from each nonfatal incident. Medical examiner records and reports of investigations conducted by the U.S. Consumer Product Safety Commission of six fatal poisonings from five additional incidents were also reviewed. A total of 167 people treated for nonfatal CO poisoning were identified, representing 51 incidents. A portable, gasoline-powered generator was implicated in nearly all nonfatal incidents and in all fatal poisonings. Generators were most often located outdoors, followed by inside the garage, and inside the home. Telephone interviews with representatives of 35 (69%) incidents revealed that concerns about theft or exhaust most often influenced the choice of location. Twenty-six (74%) households did not own a generator before the hurricanes, and 86% did not have a CO detector at the time of the poisoning. Twenty-one (67%) households reported reading or hearing CO education messages before the incident. Although exposure to public education messages may have encouraged more appropriate use of generators, a substantial number of people were poisoned even when the devices were operated outdoors. Additional educational efforts and engineering solutions that reduce CO emission from generators should be the focus of public health activities.

Inorganic mercury poisoning associated with skin-lightening cosmetic products.

PubMed

Chan, Thomas Y K

2011-12-01

Mercury and mercury salts, including mercurous chloride and mercurous oxide, are prohibited for use in cosmetic products as skin-lightening agents because of their high toxicity. Yet, the public continue to have access to these products. Reports of skin-lightening cosmetic products containing mercury and cases of mercury poisoning following the use of such products were identified using Medline (1950 - 28 March 2011) with mercury, mercury compounds, mercury poisoning, cosmetics and skin absorption as the subject headings. These searches identified 118 citations of which 31 were relevant. The rate of dermal absorption increases with the concentration of mercury and prior hydration of the skin. The degree of dermal absorption varies with the skin integrity and lipid solubility of the vehicle in the cosmetic products. Ingestion may occur after topical application around the mouth and hand-to-mouth contact. After absorption, inorganic mercury is distributed widely and elimination occurs primarily through the urine and feces. With long-term exposure, urinary excretion is the major route of elimination. The half-life is approximately 1-2 months. The kidneys are the major site of inorganic mercury deposition; renal damage includes reversible proteinuria, acute tubular necrosis and nephrotic syndrome. Gastrointestinal symptoms include a metallic taste, gingivostomatitis, nausea and hypersalivation. Although penetration of the blood-brain barrier by inorganic mercury is poor, prolonged exposure can result in central nervous system (CNS) accumulation and neurotoxicity. Inorganic mercury poisoning following the use of skin-lightening creams has been reported from Africa, Europe, USA, Mexico, Australia and Hong Kong. Nephrotic syndrome (mainly due to minimal change or membranous nephropathy) and neurotoxicity were the most common presenting features. As mercury-containing cosmetic products can contaminate the home, some close household contacts were also reported to have elevated urine mercury concentrations. Prevention from further exposure is the first step. Cream users and their close contacts should be evaluated for evidence of mercury exposure, the presence of target organ damage and the need for chelation treatment. Laboratory evaluation of affected subjects should include a complete blood count, serum electrolytes, liver and renal function tests, urinalysis, urine and blood mercury concentrations. Since blood mercury concentrations tend to return to normal within days of exposure, blood samples are useful primarily in short-term, higher-level exposures. Estimation of the urine mercury concentration is the best marker of exposure to inorganic mercury and indicator of body burden. A 24-hour urine for measurement of mercury excretion is preferred; a spot urine mercury concentration should be corrected for creatinine output. Chelation therapy is indicated in patients with features of mercury poisoning and elevated blood and/or urine mercury concentrations. Unithiol (2,3-dimercapto-1-propanesulfonic acid, DMPS) is the preferred antidote though succimer (dimercaptosuccinic acid, DMSA) has also been employed. The use of mercury in cosmetic products should be strictly prohibited. The public should be warned not to use such products as their use can result in systemic absorption and accumulation of mercury causing renal, gastrointestinal and CNS toxicity.

EFFECTS OF ACUTE AND WEEKLY EPISODIC EXPOSURES TO ANATOXIN-A ON THE MOTOR ACTIVITY OF RATS: COMPARISON WITH NICOTINE.

EPA Science Inventory

Anatoxin-a is a potent nicotinic cholinergic agonist, that is produced by many genera of cyanobacteria, and has caused several poisoning episodes of wildlife, livestock, and domestic animals. Cyanobacterial blooms and toxin exposures are likely to occur episodically as environmen...

COMPARISON OF FOUR HUMAN STUDIES OF PERINATAL EXPOSURE TO METHYLMERCURY FOR USE IN RISK ASSESSMENT

EPA Science Inventory

Newer data from human epidemiologic studies of methylmercury (MeHg) poisoning in which perinatal exposure occurred are available from four distinct populations. The results of an Iraqi grain-consuming population are compared to results from studies performed in fish-consuming gro...

An analysis of energy-drink toxicity in the National Poison Data System.

PubMed

Seifert, Sara M; Seifert, Steven A; Schaechter, Judy L; Bronstein, Alvin C; Benson, Blaine E; Hershorin, Eugene R; Arheart, Kristopher L; Franco, Vivian I; Lipshultz, Steven E

2013-08-01

Small studies have associated energy drinks-beverages that typically contain high concentrations of caffeine and other stimulants-with serious adverse health events. To assess the incidence and outcomes of toxic exposures to caffeine-containing energy drinks, including caffeinated alcoholic energy drinks, and to evaluate the effect of regulatory actions and educational initiatives on the rates of energy drink exposures. We analyzed all unique cases of energy drink exposures reported to the US National Poison Data System (NPDS) between October 1, 2010 and September 30, 2011. We analyzed only exposures to caffeine-containing energy drinks consumed as a single product ingestion and categorized them as caffeine-containing non-alcoholic, alcoholic, or "unknown" for those with unknown formulations. Non-alcoholic energy drinks were further classified as those containing caffeine from a single source and those containing multiple stimulant additives, such as guarana or yerba mate. The data were analyzed for the demographics and outcomes of exposures (unknown data were not included in the denominator for percentages). The rates of change of energy drink-related calls to poison centers were analyzed before and after major regulatory events. Of 2.3 million calls to the NPDS, 4854 (0.2%) were energy drink-related. The 3192 (65.8%) cases involving energy drinks with unknown additives were excluded. Of 1480 non-alcoholic energy drink cases, 50.7% were children < 6 years old; 76.7% were unintentional; and 60.8% were males. The incidence of moderate to major adverse effects of energy drink-related toxicity was 15.2% and 39.3% for non-alcoholic and alcoholic energy drinks, respectively. Major adverse effects consisted of three cases of seizure, two of non-ventricular dysrhythmia, one ventricular dysrhythmia, and one tachypnea. Of the 182 caffeinated alcoholic energy drink cases, 68.2% were < 20 years old; 76.7% were referred to a health care facility. Educational and legislative initiatives to enhance understanding of the health consequences of energy drink consumption were significantly associated with a decreased rate of energy drink-related cases (p = 0.036). About half the cases of energy drink-related toxicity involved unintentional exposures by children < 6 years old. Educational campaigns and legal restrictions on the sale of energy drinks were associated with decreasing calls to poison centers for energy drink toxicity and are encouraged.

Pesticide poisoning: a major health problem in Sri Lanka.

PubMed

Van der Hoek, W; Konradsen, F; Athukorala, K; Wanigadewa, T

1998-01-01

Acute pesticide poisoning is a major public health problem in Sri Lanka. In several agricultural districts, it precedes all other causes of death in government hospitals. Most of the acute poisoning cases are intentional (suicide) and occur among young adults, mainly males. Poisoning due to occupational exposure is also common, but less well documented. In an irrigation area in Sri Lanka a very high incidence of serious pesticide poisoning was observed, with 68% due to intentional ingestion of liquid pesticides. It is argued that the easy availability and widespread use of highly hazardous pesticides is the most important reason for this high number of poisoning cases. The frequent application of highly hazardous pesticides in high concentrations was often irrational and posed serious health and financial risks to the farmers. Sales promotion activities and credit facilities promoted this excessive pesticide use, which was not counteracted by an agricultural extension service. Hazardous practices when spraying pesticides were due to the impossibility of applying recommended protective measures under the local conditions, rather than to lack of knowledge. Current emphasis on programs that promote the safe use of pesticides through education and training of farmers will be ineffective in Sri Lanka because knowledge is already high and most poisoning cases are intentional. Instead, enforcement of legislation to restrict availability of the most hazardous pesticides would result in an immediate health benefit. Improved agricultural extension services to promote alternative non-chemical methods of pest control is the most important strategy, in the long term, to prevent acute pesticide poisoning.

[Methylmercury causes diffuse damage to the somatosensory cortex: how to diagnose Minamata disease].

PubMed

Ekino, Shigeo; Ninomiya, Tadashi; Imamura, Keiko; Susa, Mari

2007-01-01

The first acute case of methylmercury (MeHg) poisoning by the consumption of fish arose in Minamata, Japan, in 1953. It was officially recognized and called Minamata disease (MD) in 1956. There are still arguments about the definition of MD in terms of its associated clinical symptoms and lesions even 50 years after the initial recognition of MD. Studies on this MD epidemic are reviewed along with its historical background. Since MeHg dispersed from Minamata to the Shiranui Sea, residents living around the sea had been exposed to low-dose MeHg through fish consumption for about 20 years (at least from 1950 to 1968). These chronic MeHg poisoning patients complained of paresthesia at the distal parts of their extremities and around the lips even 30 years after the cessation of exposure to MeHg of anthropogenic origin. The persisting somatosensory disorders after the discontinuation of exposure to MeHg were induced by diffuse damage to the somatosensory cortex, but not by damage to the peripheral nervous system, as previously believed. Based on these findings, symptoms and lesions in MeHg poisoning are reappraised.

Ball and chain: the global burden of lead poisoning.

PubMed

Dissanayake, Vinodinee; Erickson, Timothy B

2012-07-01

Lead, the 82nd element in our periodic table, has accompanied humankind throughout the millennia of our history and development. As a ubiquitous heavy metal, lead is used in multiple applications and nine billion tons continue to be extracted globally every year. Although the United States has succeeded in limiting lead exposure among its own citizens by banning the use of lead in gasoline and household paint, while instituting improved working conditions for those who are exposed to lead in the workplace, the battle against lead is not won. In addition, it continues to plague the rest of the world today; the United States has played an increasing role in the world's exposure to lead and plans to stop are currently stalled. The year 2011 marked the centennial celebration of the life's work of Dr. Alice Hamilton in exposing lead poisoning among industrial workers in Chicago, Illinois. Her legacy provides us with the opportunity to look back and reevaluate our leaded history in the US. It also reminds us that there is more to be done to mitigate lead poisoning both domestically and in the developing world.

Association of Pesticide Exposure with Neurologic Dysfunction and Disease

PubMed Central

Kamel, Freya; Hoppin, Jane A.

2004-01-01

Poisoning by acute high-level exposure to certain pesticides has well-known neurotoxic effects, but whether chronic exposure to moderate levels of pesticides is also neurotoxic is more controversial. Most studies of moderate pesticide exposure have found increased prevalence of neurologic symptoms and changes in neurobehavioral performance, reflecting cognitive and psychomotor dysfunction. There is less evidence that moderate exposure is related to deficits in sensory or motor function or peripheral nerve conduction, but fewer studies have considered these outcomes. It is possible that the most sensitive manifestation of pesticide neurotoxicity is a general malaise lacking in specificity and related to mild cognitive dysfunction, similar to that described for Gulf War syndrome. Most studies have focused on organophosphate insecticides, but some found neuro-toxic effects from other pesticides, including fungicides, fumigants, and organochlorine and carbamate insecticides. Pesticide exposure may also be associated with increased risk of Parkinson disease; several classes of pesticides, including insecticides, herbicides, and fungicides, have been implicated. Studies of other neurodegenerative diseases are limited and inconclusive. Future studies will need to improve assessment of pesticide exposure in individuals and consider the role of genetic susceptibility. More studies of pesticides other than organophosphates are needed. Major unresolved issues include the relative importance of acute and chronic exposure, the effect of moderate exposure in the absence of poisoning, and the relationship of pesticide-related neurotoxicity to neurodegenerative disease. PMID:15198914

Towards the prevention of lead exposure in South Africa: contemporary and emerging challenges.

PubMed

Mathee, Angela

2014-12-01

The prevention of lead exposure continues to constitute a major public health challenge in developed countries. In well-resourced countries major lead exposure reduction interventions have resulted in significant improvements in childhood blood lead distributions. In developing countries on the other hand, while lead exposure and poisoning remain serious public health concerns, a range of prevailing factors and circumstances, such as poverty, a large informal sector, competing public health challenges, low levels of awareness of lead hazards and weak capacity to enforce legislation, contribute to an increase in the scale and intensity of the challenge, and limit the prospects of comparable success in the foreseeable future. This paper collates available information to illustrate that despite some progress, a wide range of sources of lead exist in South Africa, and that certain settings and groups continue to be at high risk of lead exposure. Lead exposure in relation to paint, mining, lead melting in subsistence fishing communities, the consumption of Ayurvedic medicines and food production is described, and discussed with regard to the key factors hindering efforts to prevent lead poisoning and exposure in South Africa and many other developing countries. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

War and hunting poisons of the New World. Part 1. Notes on the early history of curare.

PubMed

Bisset, N G

1992-02-01

The history to about 1850 of the muscle-relaxant poison curare is discussed, especially the developments leading to the botanical identification of the plants that yield the alkaloidal active principles: Loganiaceae (Strychnos species) and Menispermaceae (Abuta, Chondrodendron, and Curarea species). One of the earliest encounters with the poison appears to have been during the exploration of the Lake Maracaibo region in Colombia by Alonso Pérez de Tolosa in 1548. It is pointed out (yet again) that Sir Walter Ralegh did not bring back the poison to Europe in 1595 and that it was Keymis who first came across the word ourari when exploring the lower reaches of the Orinoco in 1596. Gumilla, La Condamine, Ulloa, Veigl, and others gave much additional information about the poison during the 18th century. Scientific studies began in the latter part of the century when Schreber listed the botanical identities of four of the plant components entering into the curare prepared by the Akawai Indians of Surinam. As far as is known, none of these people actually saw curare being made. Thereafter, progress was rapid. Humboldt and Bonpland were the first trained scientists to witness the preparation of the poison, at the very beginning of the 19th century. Subsequent exploration by Martius and Spix, Poeppig, Youd, the Schomburgk brothers, De Castelnau and Deville, Spruce, and others, up to the middle of the century, extended and deepened botanical and ethnological knowledge of curare. Study of its physiology started at about that time with the classical experiments of Rudolf von Koelliker and Claude Bernard.

Sulfur poisoning of Ni/Gadolinium-doped ceria anodes: A long-term study outlining stable solid oxide fuel cell operation

NASA Astrophysics Data System (ADS)

Riegraf, Matthias; Zekri, Atef; Knipper, Martin; Costa, Rémi; Schiller, Günter; Friedrich, K. Andreas

2018-03-01

This work presents an analysis of the long-term behavior of nickel/gadolinium-doped ceria (CGO) anode-based solid oxide fuel cells (SOFC) under sulfur poisoning conditions. A parameter study of sulfur-induced irreversible long-term degradation of commercial, high-performance single cells was carried out at 900 °C for different H2/N2/H2S fuel gas atmospheres, current densities and Ni/CGO anodes. The poisoning periods of the cells varied from 200 to 1500 h. The possibility of stable long-term Ni/CGO anode operation under sulfur exposure is established and the critical operating regime is outlined. Depending on the operating conditions, two degradation phenomena can be observed. Small degradation of the ohmic resistance was witnessed for sulfur exposure times of approximately 1000 h. Moreover, degradation of the anode charge transfer resistance was observed to be triggered by the combination of a small anodic potential step and high sulfur coverage on Ni. The microstructural evolution of altered Ni/CGO anodes was examined post-mortem by means of SEM and FIB/SEM, and is correlated to the anode performance degradation under critical operating conditions, establishing Ni depletion, porosity increase and a tripe phase boundary density decrease in the anode functional layer. It is shown that short-term sulfur poisoning behavior can be used to assess long-term stability.

Immobilization of Russian VX skin depots by localized cooling: implications for decontamination and medical countermeasures.

PubMed

Mikler, J; Tenn, C; Worek, F; Reiter, G; Thiermann, H; Garrett, M; Bohnert, S; Sawyer, T W

2011-09-25

The chemical weapon nerve agent known as Russian VX (VR) is a potent organophosphorus (OP) compound that is much less studied than its VX analogue with respect to toxicity, as well as to the effectiveness of several known countermeasures against it. An anaesthetized domestic swine model was utilized to assess several approaches in mitigating its toxicity, including the utility of cooling VR treated skin to increase the therapeutic window for treatment. The 6h LD₅₀ for VR topically applied on the ear was 100 μg/kg. Treatment of VR exposed animals (5 × LD₅₀) with pralidoxime (2PAM) very poorly regenerated inhibited blood cholinesterase activity, but was partially effective in preventing signs of OP poisoning and increasing survival. In contrast, treatment with the Hagedorn oxime HI-6 reactivated cholinesterase, eliminated all signs of poisoning and prevented death. Decontamination with the Reactive Skin Decontaminant Lotion (RSDL) 15 min after VR exposure was completely effective in preventing death. Cooling of the VR exposure sites for 2 or 6h prevented signs of OP poisoning and death during the cooling period. However, these animals died very quickly after the cessation of cooling, unless they were treated with oxime or decontaminated with RSDL. Blood analyses showed that cooling of agent exposure sites delayed the entry of VR into the bloodstream. Medical treatment with HI-6 and to a lesser extent 2PAM, or decontamination with RSDL are effective in protecting against the toxic effects of cutaneous exposure to VR. Immobilizing this agent (and related compounds) within the dermal reservoir by cooling the exposure sites, dramatically increases the therapeutic window in which these medical countermeasures are effective. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.

Use of geographic information system technology to aid Health Department decision making about childhood lead poisoning prevention activities.

PubMed Central

Reissman, D B; Staley, F; Curtis, G B; Kaufmann, R B

2001-01-01

The Centers for Disease Control and Prevention recommend that local public health agencies use local data to identify children at risk for lead exposure to ensure that they receive preventive services. The objective of this study was to demonstrate the usefulness of a geographic information system (GIS) in identifying children at risk for lead exposure. We conducted a descriptive study, using GIS technology, of the blood lead (BPb) levels and residential location of at-risk children screened for lead exposure. "At-risk children" were defined as those children living in housing built before 1950 or in an area with a high proportion of older housing. The study was conducted in Jefferson County, Kentucky, USA. Participants were the cohort of children born in 1995 and screened from 1996 through 1997, and children younger than age 7 years who were screened from 1994 through 1998. Outcome measures were the BPb level and residential location (address or target zone) of at-risk children screened from 1996 through 1997, and the number and location of homes where more than one child had been poisoned by lead from 1994 through 1998. The proportion of children screened who live within zones targeted for universal screening varied from 48% to 53%, while only 50% of the at-risk children in the entire county were screened. Between 1994 and 1998, 79 homes housed 35% of the 524 children with lead poisoning. These housing units were prioritized for lead-hazard remediation. Significant numbers of at-risk children throughout the county were not being tested for lead exposure, even in prioritized areas. GIS can be very useful to health departments in planning lead exposure screening strategies and measuring program performance. PMID:11171530

Reducing Pb poisoning in birds and Pb exposure in game meat consumers: the dual benefit of effective Pb shot regulation.

PubMed

Mateo, Rafael; Vallverdú-Coll, Núria; López-Antia, Ana; Taggart, Mark A; Martínez-Haro, Monica; Guitart, Raimon; Ortiz-Santaliestra, Manuel E

2014-02-01

The use of lead (Pb) ammunition in the form of shot pellets has been identified as a Pb exposure risk in wildlife and their human consumers. We explore the hypothesis that Pb shot ban enforcement reduces the risk of avian Pb poisoning as well as Pb exposure in game meat consumers. We assessed compliance with a partial ban on Pb shot commencing in 2003 by examination of 937 waterbirds harvested by hunters between 2007 and 2012 in the Ebro delta (Spain). Prevalence of Pb shot ingestion was determined, as were Pb concentrations in liver and muscle tissue to evaluate the potential for Pb exposure in game meat consumers. Hunted birds with only embedded Pb shot (no steel) declined from 26.9% in 2007-08 to <2% over the following three hunting seasons after ban reinforcement. Pb shot ingestion in mallards decreased from a pre-ban value of 30.2% to 15.5% in the post-ban period. Liver Pb levels were predominantly defined by the presence of ingested shot, whereas muscle levels were defined by the presence of both ingested and embedded shot. Only 2.5% of mallard muscle tissue had Pb levels above European Union regulations for meat (0.1μg/g wet weight) in the 2008-09 season, when Pb shot ingestion prevalence was also at a minimum (5.1%). Effective restrictions in Pb ammunition use have a dual benefit since this reduces Pb exposure for game meat consumers due to embedded ammunition as well as reducing Pb poisoning in waterbirds. Copyright © 2013 Elsevier Ltd. All rights reserved.

An epidemiological evaluation of 1098 acute poisoning cases from Turkey.

PubMed

Akkas, Meltem; Coskun, Figen; Ulu, Nadir; Sivri, Bulent

2004-08-01

This study evaluated the characteristics of orally poisoned patients admitted to our emergency department (ED) between January 1, 1998 and February 28, 2002. This study included 1098 patients. Poisoning cases annualy accounted for 0.5-1.3% of total patient admission during this period. The average age of the patients was 26y old. Poisoning was particulary common in students and housewives. Poisoning cases presented to the ED most commonly between 6 pm and 12 am (38%). More than half of study patients (52%) were admitted to the ED within 2 h of exposure. The incidence of concomitant alcohol intake with another intoxicant was 11%. The ingested drugs were 32% various antidepressants, 23% paracetamol, 20% analgesics (excluding paracetamol and salicylates), 10% antibiotics, 9% benzodiazepines, 7% salicylates and 7% cardiovascular drugs. Most patients received at least 1 of the following treatments: gastric lavage, oral activated charcoal, iv hydration, or diuresis. Thirty-two percent of patients were hospitalized beyond 24 h and 68% of were discharged within 24 h. The mortality rate of the overall cohort was < 1%. Psychiatric consultation was obtained for 55% of patients.

Are local laws the key to ending childhood lead poisoning?

PubMed

Korfmacher, Katrina S; Hanley, Michael L

2013-08-01

Although lead paint was banned by federal law in 1978, it continues to poison children living in homes built before that time. The lifelong effects of childhood exposure to even small amounts of lead are well established by medical research. Federal and state laws have reduced rates of lead poisoning significantly in the past three decades. However, pockets of high rates of lead poisoning remain, primarily in low-income urban neighborhoods with older housing stock. Recently, several municipalities have passed local lead laws to reduce lead hazards in high-risk areas. There has been no systematic attempt to compare the design and effectiveness of these local policies. To address this gap, we conducted comparative case studies of eight innovative lead laws promulgated since 2000. The laws used a wide variety of legal structures and tools, although certain elements were common. The impact of the policies was intertwined with local housing, economic, and legal environments. While data do not yet exist to systematically evaluate the impact of these laws on lead poisoning rates, our analysis suggests that local laws hold great promise for reducing lead hazards in children's homes.

Severe acute copper sulphate poisoning: a case report.

PubMed

Sinkovic, Andreja; Strdin, Alenka; Svensek, Franci

2008-03-01

As copper sulphate pentahydrate (CSP) is a common compound used in agriculture and industry, chronic occupational exposures to CSP are well known, but acute poisoning is rare in the Western world. This case report describes acute poisoning of a 33-year-old woman who attempted suicide by ingesting an unknown amount of CSP. On admission to the hospital, she had symptoms and signs of severe hemorrhagic gastroenteritis, dehydration, renal dysfunction and methaemoglobinaemia with normal serum copper level. Therapy included early gastric lavage, fluid replacement, vasoactive drugs, furosemide, antiemetic drugs, ranitidine, and antidotes methylene blue and 2,3-dimercaptopropane-1-sulphonate (DMPS). However, the patient developed severe intravascular haemolysis, acute severe hepatic and renal failure, as well as adrenal insufficiency. After prolonged, but successful hospital treatment, including haemodialysis and IV hydrocortisone, the patient was discharged with signs of mild renal and liver impairment. Our conclusion is that in severe cases of copper poisoning early supportive measures are essential. In addition, antidotes such as methylene blue for methaemoglobinaemia and chelating agent such as DMPS improve morbidity and survival of severely poisoned victims.

Clinical characteristics of zinc phosphide poisoning in Thailand.

PubMed

Trakulsrichai, Satariya; Kosanyawat, Natcha; Atiksawedparit, Pongsakorn; Sriapha, Charuwan; Tongpoo, Achara; Udomsubpayakul, Umaporn; Rittilert, Panee; Wananukul, Winai

2017-01-01

The objectives of this study were to describe the clinical characteristics and outcomes of poisoning by zinc phosphide, a common rodenticide in Thailand, and to evaluate whether these outcomes can be prognosticated by the clinical presentation. A 3-year retrospective cohort study was performed using data from the Ramathibodi Poison Center Toxic Exposure Surveillance System. In total, 455 poisonings were identified. Most were males (60.5%) and from the central region of Thailand (71.0%). The mean age was 39.91±19.15 years. The most common route of exposure was oral (99.3%). Most patients showed normal vital signs, oxygen saturation, and consciousness at the first presentation. The three most common clinical presentations were gastrointestinal (GI; 68.8%), cardiovascular (22.0%), and respiratory (13.8%) signs and symptoms. Most patients had normal blood chemistry laboratory results and chest X-ray findings at presentation. The median hospital stay was 2 days, and the mortality rate was 7%. Approximately 70% of patients underwent GI decontamination, including gastric lavage and a single dose of activated charcoal. In all, 31 patients were intubated and required ventilator support. Inotropic drugs were given to 4.2% of patients. Four moribund patients also received hyperinsulinemia-euglycemia therapy and intravenous hydrocortisone; however, all died. Patients who survived and died showed significant differences in age, duration from taking zinc phosphide to hospital presentation, abnormal vital signs at presentation (tachycardia, low blood pressure, and tachypnea), acidosis, hypernatremia, hyperkalemia, in-hospital acute kidney injury, in-hospital hypoglycemia, endotracheal tube intubation, and inotropic requirement during hospitalization ( P <0.05). Zinc phosphide poisoning causes fatalities. Most patients have mild symptoms, and GI symptoms are the most common. Patients who present with abnormal vital signs or electrolytes might have more severe poisoning and should be closely monitored and aggressively treated. All patients should be observed in the hospital for 2 days and followed up for cardiovascular and respiratory symptoms, electrolyte balances, kidney function, and blood glucose.

Chemical Blistering: Cellular and Macromolecular Components

DTIC Science & Technology

1989-12-31

blistering proceeds irrevocably unless the action of the chemical is neutralized within the first several minutes of exposure. Warthin and Weiler (1919...of the pathologic process is set within the first 3 min of exposure in vivo. Warthin and Weiler (1919) found that erythema, inflammation, and...Keratinocyte Culture System Following Exposure to Sulfur Mustard. J. Toxicol. Environ. Health, 23:507-518. Warthin , A.S., Poisoning. C.V. and

Self reported symptoms and inhibition of acetylcholinesterase activity among Kenyan agricultural workers.

PubMed

Ohayo-Mitoko, G J; Kromhout, H; Simwa, J M; Boleij, J S; Heederik, D

2000-03-01

This study was part of the East African pesticides project. The general objective was to assess health hazards posed by handling, storage, and use of pesticides, on agricultural estates and small farms with a view to developing strategies for prevention and control of pesticide poisoning. The aim of this paper is to describe the prevalence of symptoms in this population, to relate levels of inhibition to reported symptoms and evaluate at which levels of inhibition symptoms become increased. Complete data were available for 256 exposed subjects and 152 controls from four regions in Kenya. A structured questionnaire on symptoms experienced at the time of interview was given to all subjects and controls. Information was also obtained on sex, age, main occupation, and level of education. Symptoms reported during the high exposure period, were initially clustered in broader symptom categories from reference literature on health effects of pesticides that inhibit cholinesterase (organophosphate and carbamate). Prevalence ratios were estimated for symptoms with changes in cholinesterase activity in serum. Symptom prevalence in exposed subjects was higher during the high exposure period than the low exposure period, although these differences were not significant. Interestingly, a clear and significant change in symptoms prevalence was found in the controls with a higher prevalence in the low exposure period. Analysis of the relation between cholinesterase inhibition and symptoms showed that prevalence ratios were significantly > 1 for respiratory, eye, and central nervous system symptoms for workers with > 30% inhibition. Similar results were found for analyses with the actual level of acetylcholinesterase activity. The results suggest the presence of a relation between exposure and acetylcholinesterase inhibition, acetylcholinesterase activity, and respiratory, eye, and central nervous system symptoms. Increased symptom prevalence was found at acetylcholinesterase activities generally considered to be non-adverse.

Pediatric and young adult exposure to chemiluminescent glow sticks.

PubMed

Hoffman, Robert J; Nelson, Lewis S; Hoffman, Robert S

2002-09-01

Although chemiluminescent plastic rods, commonly called "glow sticks" or "light sticks," are typically considered to be minimally toxic or nontoxic, published data about exposure to these products are scarce. To test our hypothesis that exposure to chemiluminescent products is unlikely to result in significant morbidity or mortality and to describe factors associated with exposure by reviewing reports to our urban poison control center of human exposure to chemiluminescent products. Pediatric and young adult exposure to chemiluminescent products reported between January 1, 2000, and April 1, 2001, to our poison control center were evaluated with regard to demographic group, type of product involved, circumstances of exposure, symptoms, and management. Reported routes of exposure (n = 118) included ingestion (n = 108), ocular (n = 9), and dermal exposure (n = 1). Only patients exposed to chemiluminescent fluid from a leaking container reported symptoms (n = 27). Symptoms were limited to transient irritation of the exposure site, and no systemic toxicity occurred. All adults (n = 4) inadvertently ruptured or swallowed intact light sticks while at a dance club or dance party. Most exposure and all adult exposure occurred on holidays or weekends. Most incidences of exposure to chemiluminescent products involve asymptomatic ingestion of fluid that leaks from glow sticks or ingestion of an intact glow stick. Symptoms occur after exposure to chemiluminescent fluid and consist of transient irritation at the site of exposure. The clustering of reported exposure on weekends and in dance clubs and parties coupled with a lack of occupational or workplace exposure suggest that recreational use is a major contributory factor. Exposure to chemiluminescent products infrequently resulted in symptoms and the symptoms reported were minor. Exposure to chemiluminescent products as described is unlikely to cause significant morbidity or mortality.

Evaluate the impact of hospital types on the availability of antidotes for the management of acute toxic exposures and poisonings in Malaysia.

PubMed

Al-Sohaim, Sulaiman I; Awang, Rahmat; Zyoud, Sa'ed H; Rashid, Sazaroni M D; Hashim, Sirajuddin

2012-03-01

The availability of antidotes may be considered essential and lifesaving in the management of certain poisonings. Surveys carried out in a number of countries have demonstrated inadequate availability of a variety of poisoning antidotes. The purpose of this study was to determine the availability of antidote stocking at hospitals, based on published guidelines for antidote stocking, and to evaluate the impact of hospital types on the availability of antidotes for the management of acute toxic exposures and poisonings in Malaysia. A questionnaire on the availability of antidotes was sent to all government accident and emergency departments in Malaysia. The list of commonly required antidotes and essential drugs was compiled from published guidelines. Collected data were analysed in SPSS version 16 using descriptive and comparative analysis. The response rate was 59.06%. None of the responding hospitals stocked all of the antidotes on the lists. In relation to hospital type, there was great variability in the availability of antidotes (there were significant differences between hospitals for 13 antidotes). The availabilities of most antidotes were far better in the General Hospitals and the District Hospitals with specialists compared to District Hospitals without specialists. Calcium gluconate, sodium bicarbonate, atropine sulphate, naloxone, flumazenil, vitamin K, and pyridoxine were available at all general hospitals. Atropine sulphate and naloxone were available at all district hospitals with specialists. Most Malaysian government hospitals stocked some important antidotes. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions. Coordination between Malaysian hospitals and the National Poison Centre at Universiti Sains Malaysia is also important.

Peeling lead paint turns into poisonous dust. Guess where it ends up? A media campaign to prevent childhood lead poisoning in New York City.

PubMed

Greene, Danielle; Tehranifar, Parisa; DeMartini, Diana P; Faciano, Andrew; Nagin, Deborah

2015-06-01

Successful public health media campaigns promote messages, increase awareness, engage the public, and encourage behavior change. Between 2004 and 2006, the Lead Poisoning Prevention Program of the New York City Department of Health and Mental Hygiene conducted a media campaign grounded in social learning theory and the social marketing model to increase parents' awareness of childhood lead poisoning, ways to protect their children, and property owners' legal responsibility to fix peeling lead paint safely, and increase awareness of regulatory changes and encourage enforcement of New York City's Local Law 1 of 2004. Campaign materials were focus group tested and the campaign was refined annually. The campaign ran city-wide and in targeted high-risk neighborhoods. Neighborhoods and media venue (bus, train, kiosk, and store) changed annually, based on population risk factors and venue availability. Exposure to the campaign, campaign-related knowledge, and behavior were assessed using pre- and postcampaign street intercept surveys. Results showed that campaign reached the targeted population, and had an impact on knowledge of lead poisoning prevention measures as evidenced by increased knowledge of lead paint exposures sources in one year and increased knowledge of preventive behaviors in another year; these improvements were observed for both genders and most ethnic, primary language, educational attainment, and age groups in each year. Lessons learned indicate that well-targeted media campaigns, designed with audience participation, can reach parents through various venues, and improve key knowledge areas. Evaluation challenges faced include high levels of knowledge at baseline, competing media messages, and balancing between program needs and evaluation design. © 2015 Society for Public Health Education.

Poison control center experience with tianeptine: an unregulated pharmaceutical product with potential for abuse.

PubMed

Marraffa, Jeanna M; Stork, Christine M; Hoffman, Robert S; Su, Mark K

2018-05-25

Interest in tianeptine as a potential drug of abuse is increasing in the United States. We performed a retrospective study of calls to the New York State Poison Control Centers (PCCs) designed to characterize one state's experience with tianeptine. Data were gathered from existing records utilizing the poison center data collection system, Toxicall® entered between 1 January 2000 through 1 April 2017. Information regarding patient demographics, reported dose and formulation of tianeptine, reported coingestants, brief narrative description of the case, disposition, and case outcome was collected. There were nine reported cases of tianeptine exposure. Seven were male with a mean age of 27. Three reported therapeutic use of tianeptine and five reported intentional abuse. One case was an unintentional pediatric exposure. Doses were reported in three cases; 12.5 mg in a pediatric unintentional exposure, and 5 and 10 g daily in the two reports of intentional abuse. Of note, five patients complained of symptoms consistent with opioid withdrawal. In one of two cases in which naloxone was administered, an improvement in mental status and the respiratory drive was noted. Outcomes reported in Toxicall® were minor in two cases, moderate in five cases, major in one case, and not reported in one case. These cases, reported to the New York State PCCs should alert readers to the potential for tianeptine abuse, dependence, and withdrawal.

Mercury Poisoning Linked to Skin Products

MedlinePlus

... products, injunctions, and, in some situations, criminal prosecution. Dangers of Mercury Exposure to mercury can have serious health consequences. The danger isn’t just to people who use mercury- ...

HUMAN SCALP HAIR: AN ENVIRONMENTAL EXPOSURE INDEX FOR TRACE ELEMENTS. I. FIFTEEN TRACE ELEMENTS IN NEW YORK, N.Y. (1971-72)

EPA Science Inventory

Previous studies have revealed that hair trace element concentrations can reflect exposure in cases of frank poisoning and deficiency. Correlations have been found also in some populations living in regions where metallurgic processes are conducted. This study reports significant...

Behavioral changes from chronic exposure to pesticides used in aerial application : effects of Phosdrin on the performance of monkeys and pigeons on variable interval reinforcement schedules.

DOT National Transportation Integrated Search

1972-08-01

The need for study of behavioral difficulties resulting from exposure to pesticides is based upon reports of behavioral difficulties in aerial applicators following organophosphate poisoning and is underscored by a recent plane crash of a cropduster ...

Lead in Your Home: A Parent's Reference Guide.

ERIC Educational Resources Information Center

Environmental Protection Agency, Washington, DC.

Noting the health risks posed by lead exposure, especially for children under age 6, this guide provides U.S. Environmental Protection Agency (EPA) recommendations on how individuals can reduce the risk of lead exposure and prevent lead poisoning. These recommendations range from simple steps that can be done immediately to more rigorous…

Lessons learned on lead poisoning in children: one-hundred years on from Turner's declaration.

PubMed

Taylor, Mark P; Schniering, Carolyn A; Lanphear, Bruce P; Jones, Alison L

2011-12-01

There is significant emerging evidence showing life-long negative health, intellectual and socio-behavioural impacts as a result of childhood blood lead concentrations well below the widely used intervention level of 10 µg/dL. This issue raises serious health concerns for children in several Australian smelting and mining towns. Routine educational and home cleanliness advice to wet mop floors rather than to use a brush and pan to reduce lead exposure risks have been shown to have limited efficacy. This paper argues, as advocated 100 years ago by Queensland doctor Alfred Jefferis Turner, that childhood lead poisoning can only be mitigated via primary prevention and reduction of contaminants at source. Given that the effects of lead exposure are irreversible, there is a strong argument for the application of the precautionary principle to dealing with childhood lead exposure. There is a clear need to improve regulatory controls and emissions management to reduce environmental lead exposure risks. © 2010 The Authors. Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

XRF-measured bone lead (Pb) as a biomarker for Pb exposure and toxicity among children diagnosed with Pb poisoning.

PubMed

Specht, Aaron J; Lin, Yanfen; Weisskopf, Marc; Yan, Chonghuai; Hu, Howard; Xu, Jian; Nie, Linda H

2016-01-01

Childhood lead (Pb) poisoning remains a global issue, especially in industrial areas. In this study, 115 children with average age 5.7 years were recruited as either patient diagnosed with Pb poisoning or controls at Xinhua Hospital in China. The subjects' bone Pb was measured with a K-shell X-ray fluorescence (KXRF) and a portable X-ray fluorescence (XRF) system. A significant correlation between KXRF bone Pb and blood Pb and portable XRF and KXRF measurements were observed. The half-life of blood-lead was calculated to be 9.96 ± 3.92 d. Our results indicate that bone is a useful biomarker for Pb in children.

Unintentional carbon monoxide poisoning following a winter storm--Washington, January 1993.

PubMed

1993-02-19

Carbon monoxide (CO) poisoning was a major health consequence of a severe storm that struck the Puget Sound region of western Washington state the morning of January 20, 1993. Wind gusts up to 94 miles per hour interrupted electrical power for an estimated 776,000 residents, and during the 4 nights following the storm, temperatures fell to near freezing. Because of the use of alternative sources of energy for indoor cooking and home heating, the risk of exposure to CO increased for many persons. This report summarizes cases of storm-related CO poisoning among persons who were initially evaluated at Seattle's Harborview Medical Center (HMC) or who were referred to the Virginia Mason Medical Center (VMMC) for hyperbaric oxygen therapy.

Pediatric poisonings from household products: hydrofluoric acid and methacrylic acid.

PubMed

Perry, H E

2001-04-01

Household products continue to be a cause of poisoning morbibidity and mortality. Young children frequently are exposed to cleaning products and cosmetics in the course of exploring their environment. Most of these exposures are insignificant, but some result in death or permanent disability. This review discusses two products that have been responsible for serious injury and death in children: hydrofluoric acid and methacrylic acid. It also discusses federal initiatives designed to protect children from these and other household hazards.

Acute Cyanide Poisoning: Hydroxocobalamin and Sodium Thiosulfate Treatments with Two Outcomes following One Exposure Event.

PubMed

Meillier, Andrew; Heller, Cara

2015-01-01

Cyanide is rapidly reacting and causes arrest of aerobic metabolism. The symptoms are diffuse and lethal and require high clinical suspicion. Remediation of symptoms and mortality is highly dependent on quick treatment with a cyanide antidote. Presently, there are two widely accepted antidotes: sodium thiosulfate and hydroxocobalamin. These treatments act on different components of cyanide's metabolism. Here, we present two cases resulting from the same source of cyanide poisoning and the use of both antidotes separately used with differing outcomes.

The impact of Australian legislative changes on synthetic cannabinoid exposures reported to the New South Wales Poisons Information Centre.

PubMed

Cairns, Rose; Brown, Jared A; Gunja, Naren; Buckley, Nicholas A

2017-05-01

The emergence of new psychoactive substances (NPS), including synthetic cannabinoid receptor agonists (SCRAs) poses novel challenges for drug regulation and public health. Misconceptions of safety and legality, coupled with the fact that NPS are undetectable on routine drugs screens contributes to their popularity. Concerns over the unpredictable toxicity and abuse potential of NPS has led to a variety of legislative responses worldwide. We wish to describe Australian trends in SCRA use, examining the effects of legislative changes on calls to Australia's largest poisons centre. A retrospective review of calls to the New South Wales Poisons Information Centre (NSWPIC). Cases occurring between 1 January 2010 and 30 June 2015 with documented use of SCRAs were included. There were 146 exposures to SCRAs recorded in the NSWPIC database. Federal bans of specific SCRA compounds in 2011/2012 had little impact on call volumes. State-based legislation introduced in 2013 banning specific brand names of SCRA products was followed by a dramatic, sustained decrease in exposures. The most common symptoms reported with SCRA use were tachycardia, vomiting, drowsiness, anxiety/panic, decreased level of consciousness, chest pain, agitation, hallucinations, confusion, seizures and hypertension. Banning of specific brand names of SCRA (timed with raids and social media campaigns) appears effective at reducing SCRA exposures. We postulate that this raised awareness within the community of the illegality of these substances while also reducing supply through bricks-and-mortar shops. These results could help inform future legislative responses. Copyright © 2017 Elsevier B.V. All rights reserved.

Zolpidem (Ambien): a pediatric case series.

PubMed

Kurta, D L; Myers, L B; Krenzelok, E P

1997-01-01

In 1993, the nonbenzodiazepine sedative-hypnotic zolpidem tartrate (Ambien) was approved for use in the US. Zolpidem has an imidazopyridine structure and possesses a rapid onset of action and a short half-life. The toxic threshold and profile have not been well established in the pediatric population. All pediatric zolpidem exposures reported to a regional poison information center over 24 months were reviewed retrospectively from the American Association of Poison Control Centers Toxic Exposure Surveillance System data collection forms. Twelve pediatric zolpidem exposures were reported. Seven were unintentional (ages 20 mon-5 y) and five were intentional misuse/suicide (ages 12-16 y). The regional poison information center was contacted within 1 h in ten cases with onset of symptoms within 10 to 60 min (mean 31.6 min). One child had no effect with 2.5 mg. As little as 5 mg caused symptoms with minor outcome in six unintentional ingestions (5-30 mg). Minor to moderate symptoms were reported 1-4 h after intentional ingestions (12.5-150 mg). The duration of symptoms in the unintentional cases ranged from less than 60 min up to 4 h (mean 2.4 h) and 6-10 h (mean 7.5 h) in the intentional exposures. Treatment consisted of observation (4), syrup of ipecac (1), lavage and activated charcoal (1), activated charcoal alone (5), and unknown (1). Due to the very rapid onset of central nervous system symptoms in children, emesis is not a treatment option. Supportive care, activated charcoal in large ingestions, and observation until symptoms resolve may be sufficient in most pediatric cases.

Hospital burden of unintentional carbon monoxide poisoning in the United States, 2007.

PubMed

Iqbal, Shahed; Law, Huay-Zong; Clower, Jacquelyn H; Yip, Fuyuen Y; Elixhauser, Anne

2012-06-01

Unintentional, non-fire-related (UNFR) carbon monoxide (CO) poisoning is a leading cause of poisoning in the United States, but the overall hospital burden is unknown. This study presents patient characteristics and the most recent comprehensive national estimates of UNFR CO-related emergency department (ED) visits and hospitalizations. Data from the 2007 Nationwide Inpatient and Emergency Department Sample of the Hospitalization Cost and Utilization Project were analyzed. The Council of State and Territorial Epidemiologists' CO poisoning case definition was used to classify confirmed, probable, and suspected cases. In 2007, more than 230,000 ED visits (772 visits/million) and more than 22,000 hospitalizations (75 stays/million) were related to UNFR CO poisoning. Of these, 21,304 ED visits (71 visits/million) and 2302 hospitalizations (8 stays/million) were confirmed cases of UNFR CO poisoning. Among the confirmed cases, the highest ED visit rates were among persons aged 0 to 17 years (76 visits/million) and 18 to 44 years (87 visits/million); the highest hospitalization rate was among persons aged 85 years or older (18 stays/million). Women visited EDs more frequently than men, but men were more likely to be hospitalized. Patients residing in a nonmetropolitan area and in the northeast and midwest regions of the country had higher ED visit and hospitalization rates. Carbon monoxide exposures occurred mostly (>60%) at home. The hospitalization cost for confirmed CO poisonings was more than $26 million. Unintentional, non-fire-related CO poisonings pose significant economic and health burden; continuous monitoring and surveillance of CO poisoning are needed to guide prevention efforts. Public health programs should emphasize CO alarm use at home as the main prevention strategy. Published by Elsevier Inc.

Symptoms of carbon monoxide poisoning do not correlate with the initial carboxyhemoglobin level.

PubMed

Hampson, Neil B; Dunn, Susan L

2012-01-01

Symptoms in carbon monoxide (CO) poisoned patients have traditionally been described as being related to corresponding carboxyhemoglobin (COHb) levels without substantive support for the relationship. This study sought to determine whether prospectively collected symptoms correlate with specific COHB level ranges in a large population of CO-poisoned patients. Data from patients reported in the initial two years of operation of the joint UHMS/CDC CO Poisoning Surveillance System were used to compare presenting COHb levels with symptoms collected with a standardized questionnaire. Data from 1,323 CO-poisoned patients referred for hyperbaric oxygen therapy from August 2008 to July 2010 were analyzed with regard to initial COHb level and symptoms. Of approximately 50 categories of symptoms reported, none was associated with a specific range of COHb levels. While symptoms are common in acute CO poisoning, none can be directly correlated to COHb levels, even in a population of more than 1,000 patients. The concept of a table relating specific symptoms to specific COHb levels is invalid. One such table that has often been published comes from a 1923 U.S. government publication and appears to be based at least in part upon the symptoms experienced by three men in a total of 10 low-level laboratory CO exposures.

Assessment of lead exposure in schoolchildren from Jakarta.

PubMed Central

Heinze, I; Gross, R; Stehle, P; Dillon, D

1998-01-01

Children attending schools in urban areas with high traffic density are a high risk group for lead poisoning. We assessed the magnitude of lead exposure in schoolchildren from Jakarta by analyzing blood lead concentrations and biomarkers of heme biosynthesis. A total of 131 children from four public elementary schools in Jakarta (two in the southern district and two in the central district) were enrolled in the study. To evaluate lead pollution in each area, soil samples and tap water were collected. The mean blood lead concentration was higher in the central district than in the southern district (8.3 +/- 2.8 vs. 6.9 +/- 3.5 microg/100 ml; p<0.05); 26.7% of the children had lead levels greater than 10 microg/100 ml. In 24% of the children, zinc protoporphyrin concentrations were over 70 micromol/mol hemoglobin; in 17% of the samples, hemoglobin was less than 11 g/100 ml. All other values were within the physiological range. Blood lead concentration and hematological biomarkers were not correlated. Analyses of tap water revealed lead values under 0. 01 mg/l; lead contamination of soil ranged from 77 to 223 ppm. Our data indicate that Indonesian children living in urban areas are at increased risk for blood lead levels above the actual acceptable limit. Activities to reduce pollution (e.g., reduction of lead in gasoline) and continuous monitoring of lead exposure are strongly recommended. Images Figure 1 PMID:9681978

Boric acid poisoning

MedlinePlus

... effectively treat (adsorb) boric acid. For skin exposure, treatment may include: Surgical removal of burned skin (debridement) Transfer to a hospital that specializes in burn care Washing of the skin (irrigation), possibly every ...

Potassium hydroxide poisoning

MedlinePlus

... effectively treat (adsorb) sodium hydroxide. For skin exposure, treatment may include: Surgical removal of burned skin (debridement) Transfer to a hospital that specializes in burn care Washing of the skin (irrigation), possibly every ...

Should the Centers for Disease Control and Prevention's childhood lead poisoning intervention level be lowered?

PubMed

Bernard, Susan M

2003-08-01

The US Centers for Disease Control and Prevention (CDC) in 1991 chose 10 micro g/dL as an initial screening level for lead in children's blood. Current data on health risks and intervention options do not support generally lowering that level, but federal lead poisoning prevention efforts can be improved by revising the follow-up testing schedule for infants aged 1 year or less with blood lead levels of 5 micro g/dL or higher; universal education about lead exposure risks; universal administration of improved, locally validated risk-screening questionnaires; enhanced compliance with targeted screening recommendations and federal health program requirements; and development by regulatory agencies of primary prevention criteria that do not use the CDC's intervention level as a target "safe" lead exposure.

Edible mushroom-related poisoning: A study on circumstances of mushroom collection, transport, and storage.

PubMed

Gawlikowski, T; Romek, M; Satora, L

2015-07-01

The American Association of Poison Control Center (AAPCC) shows that in 2012 there were 0.3% of human exposures involving mushrooms. Only 17% of 6600 cases were then identified by the species. The present retrospective study was designed to identify the epidemiology of mushroom poisoning in adults admitted to Krakow's Department of Clinical Toxicology (DCT) from 2002 to 2009. This study was conducted retrospectively after examining the files of 457 adult patients with wild mushroom poisoning. Mycological analysis was made and the species of the poisoning-inducing mushroom was determined. Furthermore, the circumstances related to the mushroom gathering, transport, storage, preparation, and consumption have been analyzed. The analysis revealed that in 400 (87.53%) out of 457 cases, the clinical symptoms were caused by ingestion of identified edible mushroom species. The main reason for edible mushroom poisoning is associated with their incorrect processing after harvest. The analysis of the circumstances of mushroom collection, transport, and storage shows that the largest percentage of poisoning was connected with long-term storage of mushroom dishes, collecting, and storing them in plastic bags, and long storage of mushrooms. Based on spore analysis of the gastric content, edible mushrooms were responsible for the great majority of mushroom poisoning cases admitted to the DCT. The toxicity of edible mushroom is associated with proceeding with them during collection, transport, and storage. The medical history should be supplemented by questions concerning these circumstances. The identification of the mushroom by a mycologist is highly desirable. © The Author(s) 2014.

Oxotremorine-induced hypothermia as a method for evaluating long-term neuronal changes following poisoning by cholinesterase inhibitors in rats.

PubMed

Grauer, E; Levy, A

2007-12-05

Severe poisoning by inhibitors of cholinesterase (ChE) enzymes is often associated with prolonged central or peripheral neuronal damage. Oxotremorine is a cholinergic agonist known to induce acute hypothermia. Central and peripheral cholinergic signaling is involved in the induction of hypothermia as well as in its recovery. These processes were used in the present study to reveal prolonged neuronal abnormalities in poisoned rats, using oxotremorine with and without concomitant administration of the peripheral muscarinic antagonist methyl scopolamine. In non-poisoned naïve rats, the hypothermic effect of oxotremorine appeared faster while its recovery was delayed following co-administration of methyl scopolamine, suggesting predominantly peripheral processes in counteracting the hypothermia. One month after exposure to approximately 1LD(50) of the carbamates aldicarb and oxamyl, the hypothermic effect of oxotremorine was similar to that found in saline-treated control group. However, the effect of methyl scopolamine on the recovery process was significantly diminished, indicating that the impaired cholinergic mechanisms were predominantly peripheral. In contrast, 1 month following organophosphate (OP) poisoning by the nerve agents sarin and VX, oxotremorine-induced hypothermia was reduced, indicating mainly impaired central cholinergic mechanisms. The development of severe convulsions during nerve agent poisoning may explain the central neuronal damage in OP-poisoned rats, displayed as reduced hypothermia. As convulsions were not part of the poisoning symptoms with the carbamates tested, their long-term damage was displayed at the recovery stage. This method might be used as a relatively simple means for detecting differential long-term central and peripheral cholinergic injuries, long after toxicity signs have receded.

[The actual incidence of the population in the RF subject: assessment of economic effect (losses)].

PubMed

Ushakov, A A; Saldan, I P; Goleva, O I; Karpova, T N

2013-01-01

In the paper there is presented an analysis and evaluation of the economic losses associated with the actual incidence of the population of the Altai Region on disease classes "Poisoning by drugs, medicaments and biological substances" (T36-T50) and "Toxic effect of substances, mainly non-medical purpose" (T51-T65), including the assessment of the underproduced product in economy of the region in monetary terms, assessment changes in cash flows on the budgets of the Russian Federation (tax receipts). The time period of analysis on disease classes is 5 years (2007-2011).

An Increase in Dietary Supplement Exposures Reported to US Poison Control Centers.

PubMed

Rao, Nisha; Spiller, Henry A; Hodges, Nichole L; Chounthirath, Thiphalak; Casavant, Marcel J; Kamboj, Amrit K; Smith, Gary A

2017-09-01

The objective of this study was to investigate the epidemiology of dietary supplement exposures in the USA. A retrospective analysis was conducted of out-of-hospital dietary supplement exposures reported to the National Poison Data System from 2000 through 2012. There were 274,998 dietary supplement exposures from 2000 through 2012. The annual rate of dietary supplement exposures per 100,000 population increased by 46.1% during 2000-2002, decreased 8.8% during 2002-2005, and then increased again by 49.3% from 2005 to 2012. These trends were influenced by the decrease in ma huang exposures starting in 2002. Miscellaneous dietary supplements accounted for 43.9% of all exposures, followed by botanicals (31.9%), hormonal products (15.1%), and other supplements (5.1%). The majority of dietary supplement exposures (70.0%) occurred among children younger than 6 years old and were acute (94.0%) and unintentional (82.9%). Serious medical outcomes accounted for 4.5% of exposures and most (95.0%) occurred among individuals 6 years and older. Ma huang products, yohimbe, and energy products were the categories associated with the greatest toxicity. There was an overall increase in the rate of dietary supplement exposures from 2000 through 2012. Although the majority of these exposures did not require treatment at a health care facility or result in serious medical outcomes, exposures to yohimbe and energy products were associated with considerable toxicity. Our results demonstrate the success of the FDA ban on ma huang products and the need for FDA regulation of yohimbe and energy products in the USA.

[Cases of poisoning in Germany. Disease entity, documentation, and aspects of the event].

PubMed

Hahn, A; Begemann, K; Stürer, A

2014-06-01

Cases of poisoning account for a distinct share of accidents in Germany, which is particularly high for accidents involving children. Cases of poisoning resulting from suicidal intent or abuse are not counted as accidents. Compared to other cases of disease and accidents, the numerical documentation of cases of poisoning is inadequate. Presently, there is no institution in Germany that could make available representative and meaningful data on the current state of poisoning. Owing to intensive scientific cooperation between the poison information centers (funded by the federal states) and the Poison and Product Documentation Center at the Federal Institute for Risk Assessment (BfR DocCenter) as well as to international cooperation, harmonized and standardized tools have been developed for the appropriate documentation and reporting of procedures to account for poisoning accidents. The first evaluation for 2005-2012 based on published and processed figures for the Federal Republic of Germany yielded the following results: Of approximately 230,000 telephone inquiries received in 2012, about 207,000 involved exposure of humans to different noxae. An annual increase of 3-5 % was recorded. For 2011, analyses of subsets processed by means of standardized methods yielded the following results: Medicines were involved in about 39 % of the cases recorded (of these, medicinal products for humans in 99 %); chemical/physicochemical agents in about 26 % (of these, cleaning and maintenance products in 46 %); products of daily use in about 14 % (of these, cosmetics in 40 %); and plants in about 10 %. More than 90 % of cases were acute poisoning and less than 5 %, chronic poisoning. Regarding the degree of severity of poisoning, an asymptomatic course was reported for 44 % of the cases; minor manifestations were experienced in 30 %, moderate ones in 6 %, and severe manifestations in 2 % of the cases recorded. Fatal cases were rare (< 0.1 %). The majority of cases (67 %) were caused by poisoning accidents, followed by suicidal action (20 %), with abuse and industrial poisoning (4 %) in third position; 1 % of the cases of poisoning were attributed to adverse drug reactions (ADR) and mistaking a medicinal product for another one. Infants aged 1-2 years have the highest risk of poisoning. A panel of the BfR Committee for the Assessment of Poisonings has already developed proposals for a national monitoring scheme of poisoning incidents. The aim is to prepare annual reports similar to the report of the National Poison Data System (NPDS) maintained by the American Association of Poison Control Centers (AAPCC) in the USA.

Nitric acid poisoning

MedlinePlus

... Board on Environmental Studies and Toxicology; Division on Earth and Life Studies; National Research Council. Nitric acid: ... Board on Environmental Studies and Toxicology; Division on Earth and Life Studies; National Research Council. Acute Exposure ...

2012 Children's Health Protection Advisory Committee Letters

EPA Pesticide Factsheets

These two letters address National Ambient Air Quality Standards proposed for particulate matter (PM), and childhood lead poisoning prevention particularly as regards revision of the Integrated Exposure Uptake Biokinetic model.

Sources of lead exposure in Mexico City.

PubMed Central

Romieu, I; Palazuelos, E; Hernandez Avila, M; Rios, C; Muñoz, I; Jimenez, C; Cahero, G

1994-01-01

Many countries, including Mexico, are facing a largely unrecognized epidemic of low-level lead poisoning. Mexico is the sixth largest lead-producing country in the world, and 40% of its production is used locally in different industrial processes that cause lead contamination of the environment. The major sources and pathways of lead exposure among the Mexican population are gasoline emissions, lead-glazed ceramics, leaded paint, and lead in canned foods and beverages. In this paper we present evidence for the presence of lead in different environmental media and its impact on blood lead levels of the Mexican population. Although during the last few years important measures have been implemented to decrease lead exposure, our findings suggest that lead poisoning is still an important problem in Mexico. There is an urgent need for regulatory policies that implement stricter control to protect the Mexican population. There is also a need to develop adequate programs to reduce the lead burden and the associated health effects in the population that has been chronically exposed. Images Figure 1. PMID:7523102

Carboxyhemoglobin: a primer for clinicians.

PubMed

Hampson, Neil B

2018-01-01

One of carbon monoxide's several mechanisms of toxicity is binding with circulating hemoglobin to form carboxyhemoglobin, resulting in a functional anemia. While patients with carbon monoxide poisoning are often said to be "cherry-red," such discoloration is rarely seen. Carboxyhemoglobin levels cannot be measured with conventional pulse oximetry, can be approximated with pulse CO-oximetry, and are most accurately measured with a laboratory CO-oximeter. Carboxyhemoglobin levels are quite stable and can be accurately measured on a transported blood sample. For clinical purposes, arterial and venous carboxyhemoglobin levels can be considered to be equivalent. Carboxyhemoglobin levels are typically lower than 2% in non-smokers and lower than 5% in smokers. A level over 9% is almost always due to exogenous carbon monoxide exposure, even among smokers. Conversely, a low level does not exclude significant exposure under certain circumstances. As carboxyhemoglobin levels of poisoned patients do not correlate with symptoms or outcome, their greatest utility is a marker of exposure. Copyright© Undersea and Hyperbaric Medical Society.

Environmental Mercury and Its Toxic Effects

PubMed Central

Rice, Kevin M.; Walker, Ernest M.; Wu, Miaozong; Gillette, Chris

2014-01-01

Mercury exists naturally and as a man-made contaminant. The release of processed mercury can lead to a progressive increase in the amount of atmospheric mercury, which enters the atmospheric-soil-water distribution cycles where it can remain in circulation for years. Mercury poisoning is the result of exposure to mercury or mercury compounds resulting in various toxic effects depend on its chemical form and route of exposure. The major route of human exposure to methylmercury (MeHg) is largely through eating contaminated fish, seafood, and wildlife which have been exposed to mercury through ingestion of contaminated lower organisms. MeHg toxicity is associated with nervous system damage in adults and impaired neurological development in infants and children. Ingested mercury may undergo bioaccumulation leading to progressive increases in body burdens. This review addresses the systemic pathophysiology of individual organ systems associated with mercury poisoning. Mercury has profound cellular, cardiovascular, hematological, pulmonary, renal, immunological, neurological, endocrine, reproductive, and embryonic toxicological effects. PMID:24744824

Sources of lead exposure in Mexico City.

PubMed

Romieu, I; Palazuelos, E; Hernandez Avila, M; Rios, C; Muñoz, I; Jimenez, C; Cahero, G

1994-04-01

Many countries, including Mexico, are facing a largely unrecognized epidemic of low-level lead poisoning. Mexico is the sixth largest lead-producing country in the world, and 40% of its production is used locally in different industrial processes that cause lead contamination of the environment. The major sources and pathways of lead exposure among the Mexican population are gasoline emissions, lead-glazed ceramics, leaded paint, and lead in canned foods and beverages. In this paper we present evidence for the presence of lead in different environmental media and its impact on blood lead levels of the Mexican population. Although during the last few years important measures have been implemented to decrease lead exposure, our findings suggest that lead poisoning is still an important problem in Mexico. There is an urgent need for regulatory policies that implement stricter control to protect the Mexican population. There is also a need to develop adequate programs to reduce the lead burden and the associated health effects in the population that has been chronically exposed.

Evaluation of poison information services provided by a new poison information center.

PubMed

Churi, Shobha; Abraham, Lovin; Ramesh, M; Narahari, M G

2013-01-01

The aim of this study is to assess the nature and quality of services provided by poison information center established at a tertiary-care teaching hospital, Mysore. This was a prospective observational study. The poison information center was officially established in September 2010 and began its functioning thereafter. The center is equipped with required resources and facility (e.g., text books, Poisindex, Drugdex, toll free telephone service, internet and online services) to provide poison information services. The poison information services provided by the center were recorded in documentation forms. The documentation form consists of numerous sections to collect information on: (a) Type of population (children, adult, elderly or pregnant) (b) poisoning agents (c) route of exposure (d) type of poisoning (intentional, accidental or environmental) (e) demographic details of patient (age, gender and bodyweight) (f) enquirer details (background, place of call and mode of request) (g) category and purpose of query and (h) details of provided service (information provided, mode of provision, time taken to provide information and references consulted). The nature and quality of poison information services provided was assessed using a quality assessment checklist developed in accordance with DSE/World Health Organization guidelines. Chi-Square test (χ(2)). A total of 419 queries were received by the center. A majority (n = 333; 79.5%) of the queries were asked by the doctors to provide optimal care (n = 400; 95.5%). Most of the queries were received during ward rounds (n = 201; 48.0%), followed by direct access (n = 147; 35.1%). The poison information services were predominantly provided through verbal communication (n = 352; 84.0%). Upon receipt of queries, the required service was provided immediately (n = 103; 24.6%) or within 10-20 min (n = 296; 70.6%). The queries were mainly related to intentional poisoning (n = 258; 64.5%), followed by accidental poisoning (n = 142; 35.5%). The most common poisoning agents were medicines (n = 124; 31.0%). The service provided was graded as "Excellent" for the majority of queries (n = 360; 86%; P < 0.001), followed by "Very Good" (n = 50; 12%) and "Good" (n = 9; 2%). The poison information center provided requested services in a skillful, efficient and evidence-based manner to meet the needs of the requestor. The enquiries and information provided is documented in a clear and systematic manner.

Characterizing risk factors for pediatric lamp oil product exposures.

PubMed

Sheikh, S; Chang, A; Kieszak, S; Law, R; Bennett, H K W; Ernst, E; Bond, G R; Spiller, H A; Schurz-Rogers, H; Chu, A; Bronstein, A C; Schier, J G

2013-11-01

Poisonings from lamp oil ingestion continue to occur worldwide among the pediatric population despite preventive measures such as restricted sale of colored and scented lamp oils. This suggests that optimal prevention practices for unintentional pediatric exposures to lamp oil have yet to be identified and/or properly implemented. To characterize demographic, health data, and potential risk factors associated with reported exposures to lamp oil by callers to poison centers (PCs) in the US and discuss their public health implications. This was a two part study in which the first part included characterizing all exposures to a lamp oil product reported to the National Poison Data System (NPDS) with regard to demographics, exposure, health, and outcome data from 1/1/2000 to 12/31/2010. Regional penetrance was calculated using NPDS data by grouping states into four regions and dividing the number of exposure calls by pediatric population per region (from the 2000 US census). Temporal analyses were performed on NPDS data by comparing number of exposures by season and around the July 4th holiday. Poisson regression was used to model the count of exposures for these analyses. In the second part of this project, in order to identify risk factors we conducted a telephone-based survey to the parents of children from five PCs in five different states. The 10 most recent lamp oil product exposure calls for each poison center were systematically selected for inclusion. Calls in which a parent or guardian witnessed a pediatric lamp oil product ingestion were eligible for inclusion. Data on demographics, exposure information, behavioral traits, and health were collected. A descriptive analysis was performed and Fisher's exact test was used to evaluate associations between variables. All analyses were conducted using SAS v9.3. Among NPDS data, 2 years was the most common patient age reported and states in the Midwestern region had the highest numbers of exposure calls compared to other regions. Exposure calls differed by season (p < 0.0001) and were higher around the July 4th holiday compared to the rest of the days in July (2.09 vs. 1.89 calls/day, p < 0.002). Most exposures occurred inside a house, were managed on-site and also had a "no effect" medical outcome. Of the 50 PC-administered surveys to parents or guardians, 39 (78%) met inclusion criteria for analysis. The majority of ingestions occurred in children that were 2 years of age, that were not alone, involved tiki torch fuel products located on a table or shelf, and occurred inside the home. The amount of lamp oil ingested did not appear to be associated with either the smell (p = 0.19) or the color of the oil (p = 1.00) in this small sample. Approximately half were asymptomatic (n = 18; 46%), and of those that reported symptoms, cough was the most common (n = 20, 95%) complaint. Lamp oil product exposures are most common among young children (around 2 years of age) while at home, not alone and likely as a result of the product being in a child-accessible location. Increasing parental awareness about potential health risks to children from these products and teaching safe storage and handling practices may help prevent both exposures and associated illness. These activities may be of greater benefit in Midwestern states and during summer months (including the period around the July 4th holiday).

Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy.

PubMed

Rose, Jason J; Wang, Ling; Xu, Qinzi; McTiernan, Charles F; Shiva, Sruti; Tejero, Jesus; Gladwin, Mark T

2017-03-01

Carbon monoxide (CO) poisoning affects 50,000 people a year in the United States. The clinical presentation runs a spectrum, ranging from headache and dizziness to coma and death, with a mortality rate ranging from 1 to 3%. A significant number of patients who survive CO poisoning suffer from long-term neurological and affective sequelae. The neurologic deficits do not necessarily correlate with blood CO levels but likely result from the pleiotropic effects of CO on cellular mitochondrial respiration, cellular energy utilization, inflammation, and free radical generation, especially in the brain and heart. Long-term neurocognitive deficits occur in 15-40% of patients, whereas approximately one-third of moderate to severely poisoned patients exhibit cardiac dysfunction, including arrhythmia, left ventricular systolic dysfunction, and myocardial infarction. Imaging studies reveal cerebral white matter hyperintensities, with delayed posthypoxic leukoencephalopathy or diffuse brain atrophy. Management of these patients requires the identification of accompanying drug ingestions, especially in the setting of intentional poisoning, fire-related toxic gas exposures, and inhalational injuries. Conventional therapy is limited to normobaric and hyperbaric oxygen, with no available antidotal therapy. Although hyperbaric oxygen significantly reduces the permanent neurological and affective effects of CO poisoning, a portion of survivors still have substantial morbidity. There has been some early success in therapies targeting the downstream inflammatory and oxidative effects of CO poisoning. New methods to directly target the toxic effect of CO, such as CO scavenging agents, are currently under development.

Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy

PubMed Central

Xu, Qinzi; Shiva, Sruti

2017-01-01

Carbon monoxide (CO) poisoning affects 50,000 people a year in the United States. The clinical presentation runs a spectrum, ranging from headache and dizziness to coma and death, with a mortality rate ranging from 1 to 3%. A significant number of patients who survive CO poisoning suffer from long-term neurological and affective sequelae. The neurologic deficits do not necessarily correlate with blood CO levels but likely result from the pleiotropic effects of CO on cellular mitochondrial respiration, cellular energy utilization, inflammation, and free radical generation, especially in the brain and heart. Long-term neurocognitive deficits occur in 15–40% of patients, whereas approximately one-third of moderate to severely poisoned patients exhibit cardiac dysfunction, including arrhythmia, left ventricular systolic dysfunction, and myocardial infarction. Imaging studies reveal cerebral white matter hyperintensities, with delayed posthypoxic leukoencephalopathy or diffuse brain atrophy. Management of these patients requires the identification of accompanying drug ingestions, especially in the setting of intentional poisoning, fire-related toxic gas exposures, and inhalational injuries. Conventional therapy is limited to normobaric and hyperbaric oxygen, with no available antidotal therapy. Although hyperbaric oxygen significantly reduces the permanent neurological and affective effects of CO poisoning, a portion of survivors still have substantial morbidity. There has been some early success in therapies targeting the downstream inflammatory and oxidative effects of CO poisoning. New methods to directly target the toxic effect of CO, such as CO scavenging agents, are currently under development. PMID:27753502

Health Aspects of Organophosphorous Pesticides in Asian Countries

PubMed Central

Balali-Mood, M; Balali-Mood, K; Moodi, M; Balali-Mood, B

2012-01-01

Organophosphorous (OP) pesticides are used frequently in agriculture, particularly in Asian countries over the past decades. Poisoning by these agents, either as acute or chronic in these nations, is a serious health problem. OP pesticides residue in fruits and vegetables that may not induce early clinical features, could also affect the human health. Therefore, medical and health professionals should be aware and learn more on the toxicology, prevention and proper management of OP poisoning. The well-known mechanism of OP toxicity is the inhibition of acetyl cholinesterase, resulting in an accumulation of acetylcholine and continued stimulation of acetylcholine receptors. Therefore, they are also called anticholinesterase agents. Determination of blood acetyl cholinesterase and butyryl cholinesterase activities remains a mainstay for the rapid initial screening of OP pesticides. Quantitative analysis of OP and their degradation products in plasma and urine by mass spectrometric methods is a more specific method, but is expensive and limited to specialized laboratories. Therefore, history of OP pesticides exposure and clinical manifestations of a cholinergic syndrome is sufficient for management of the exposed patients. However, electrophysiological tests may be required for the diagnosis of delayed neuropathy of OP poisoning. The standard management of OP poisoning includes decontamination, atropine sulphate with an oxime. Recent advances focus on blood alkalinisation and magnesium sulphate as promising adjunctive therapies. Preventive measures in OP exposure are of great importance in human health in developing countries. Therefore, regulations and controls on safe use of OP particularly in Asian countries are recommended. PMID:23304659

Suspected lead poisoning in two captive cheetahs (Acinonyx jubatus jubatus) in South Africa, in 2008 and 2013.

PubMed

North, Michelle A; Lane, Emily P; Marnewick, Kelly; Caldwell, Peter; Carlisle, Glen; Hoffman, Louw C

2015-08-13

Whilst lead poisoning in raptors, scavenging birds and waterfowl is well studied and common knowledge, there is surprisingly little literature detailing the risk to mammalian scavengers and captive carnivores fed hunted meat. This case report describes the death of two captive cheetahs (Acinonyx jubatus jubatus) following acute onset of nervous symptoms. Clinical signs included hyper-excitability, seizures, arched back, tail held abnormally high and hyper-salivation. Necropsy findings included bullets or a bullet in their stomachs. Kidney and liver lead levels from one cheetah (15.6 ppm and 17 ppm respectively) were consistent with a diagnosis of lead poisoning; liver from the second cheetah was not available for testing. Both animals were routinely fed hunted antelope or game birds. This is the first report of oral lead poisoning in captive large carnivores, although these are unlikely to be the first cases. Without awareness of the risks of feeding hunted game, lead exposure will continue to be an underdiagnosed reality in the rehabilitation of endangered carnivores.

Erythema multiforme associated with contact dermatitis to poison ivy: three cases and a review of the literature.

PubMed

Cohen, L M; Cohen, J L

1998-09-01

Erythema multiforme (EM) is a hypersensitivity reaction that occurs mainly after exposure to certain medications or in the setting of infection, most commonly that due to herpes simplex virus. Rare cases of EM have been reported after allergic contact dermatitis due to various substances. There has been one case in the literature of EM following Rhus contact dermatitis. We report three patients who developed EM after allergic contact dermatitis due to poison ivy. In all three patients, targetoid lesions developed primarily on the palms and soles, either after a brief course of prednisone or during its taper. Two of the patients have had more than one episode of EM after poison ivy dermatitis. Although EM has been described after allergic contact dermatitis due to a variety of antigens (nickel being the most common), there is only one report in the literature of EM following Rhus contact dermatitis. Given the prevalence of allergic contact dermatitis due to poison ivy, this may be an under-reported complication.

[Lead poisoning and marginalization in newborns of Morelos, Mexico].

PubMed

Téllez-Rojo, Martha María; Bautista-Arredondo, Luis F; Richardson, Vesta; Estrada-Sánchez, Daniel; Ávila-Jiménez, Laura; Ríos, Camilo; Cantoral-Preciado, Alejandra; Romero-Martínez, Martín; Flores-Pimentel, Delia; Melo-Zurita, María Del Carmen; Romero-Ramírez, Anita; León-Mazón, Marco Antonio; Montes, Sergio; Fuller, Richard; Hernández-Ávila, Mauricio

2017-01-01

To determine the prevalence of lead (Pb) poisoning at birth in Morelos, analyze its distribution by social marginalization level, and estimate the association with the use of lead glazed ceramics (LGC). Blood lead level (BLL) in umbilical cord was measured in a representative sample of 300 randomly selected births at the Morelos Health Services and state IMSS. The prevalence of Pb poisoning at birth (BLL> 5μg/dL) was 14.7% (95%CI: 11.1, 19.3) and 22.2% (95%CI: 14.4, 32.5) in the most socially marginalized municipalities. 57.1% (95%CI: 51.3, 62.7) of the mothers used LGC during pregnancy, and the frequency of use was significantly associated with BLL. This is the first study to document the proportion of newborns with Pb poisoning who are at risk of experiencing the related adverse effects. It is recommended to monitor BLL at birth and take action to reduce this exposure, especially in socially marginalized populations.

[Global lessons of Minamata disease--a man's worth].

PubMed

Harada, Masazumi

2009-02-01

Minamata disease (MD) was first recognized in May 1956. Its first recognized victims were 3 and 5 years old children. Environmental contamination most rapidly and seriously affected the physiologically and socially weak among the residents. Methylmercury (MeHg) had accumulated in fishes and shellfishes and those who ate them had been poisoning with it. MD is an indirect poisoning by MeHg through the food chain as a result of environmental contamination, and is the first known disease to cause abnormalities in the fetus due to a toxic substances passing through the placenta. In 1962 MeHg poisoning through the placenta was found for the first time in the world. It used to be considered that poisoning was caused by direct exposure to a toxic substance, and that toxic substances did not pass the placenta. MD had implications in various fields. Namely it also stirred up legal, ethical, and eugenic arguments concerning fetal protection. Also man thought about a man's worth.

Lessons from a primary-prevention program for lead poisoning among inner-city children.

PubMed

Dugbatey, Kwesi; Croskey, Valda; Evans, R Gregory; Narayan, Gopal; Osamudiamen, Osa-Edoh

2005-12-01

This study evaluated the impact on childhood lead poisoning of a primary-prevention educational-intervention program for pregnant women in St. Louis, Missouri. The women were predominantly poor and of African-American, Hispanic, Asian, and Caucasian backgrounds. The interventions, tailored for each woman on the basis of responses to a survey and environmental measurements, included case management with hands-on instruction on cleaning techniques, property maintenance, hygiene, and nutrition to reduce exposure of newborns to lead. It was hypothesized that the probability of lead poisoning (blood lead levels greater than 10 microg/dL) would be reduced among mothers who received the interventions compared with those who received only printed educational material. Contrary to expectations, none of the interventions reduced the likelihood of lead poisoning among participating children. In the process of the study, however, a number of valuable lessons related to recruitment and commitment of participants emerged that can inform future efforts of this nature.

Latex Allergy

MedlinePlus

... skin reactions when using latex. They include: Allergic contact dermatitis. This reaction results from the chemical additives used ... hours after exposure, similar to poison ivy. Irritant contact dermatitis. Not an allergy, this skin irritation is caused ...

Health hazards of China's lead-acid battery industry: a review of its market drivers, production processes, and health impacts.

PubMed

van der Kuijp, Tsering Jan; Huang, Lei; Cherry, Christopher R

2013-08-03

Despite China's leaded gasoline phase out in 2000, the continued high rates of lead poisoning found in children's blood lead levels reflect the need for identifying and controlling other sources of lead pollution. From 2001 to 2007, 24% of children in China studied (N = 94,778) were lead poisoned with levels exceeding 100 μg/L. These levels stand well above the global average of 16%. These trends reveal that China still faces significant public health challenges, with millions of children currently at risk of lead poisoning. The unprecedented growth of China's lead-acid battery industry from the electric bike, automotive, and photovoltaic industries may explain these persistently high levels, as China remains the world's leading producer, refiner, and consumer of both lead and lead-acid batteries.This review assesses the role of China's rising lead-acid battery industry on lead pollution and exposure. It starts with a synthesis of biological mechanisms of lead exposure followed by an analysis of the key technologies driving the rapid growth of this industry. It then details the four main stages of lead battery production, explaining how each stage results in significant lead loss and pollution. A province-level accounting of each of these industrial operations is also included. Next, reviews of the literature describe how this industry may have contributed to mass lead poisonings throughout China. Finally, the paper closes with a discussion of new policies that address the lead-acid battery industry and identifies policy frameworks to mitigate exposure.This paper is the first to integrate the market factors, production processes, and health impacts of China's growing lead-acid battery industry to illustrate its vast public health consequences. The implications of this review are two-fold: it validates calls for a nationwide assessment of lead exposure pathways and levels in China as well as for a more comprehensive investigation into the health impacts of the lead-acid battery industry. The continuous growth of this industry signals the urgent need for effective regulatory action to protect the health and lives of China's future generations.

Health hazards of China’s lead-acid battery industry: a review of its market drivers, production processes, and health impacts

PubMed Central

2013-01-01

Despite China’s leaded gasoline phase out in 2000, the continued high rates of lead poisoning found in children’s blood lead levels reflect the need for identifying and controlling other sources of lead pollution. From 2001 to 2007, 24% of children in China studied (N = 94,778) were lead poisoned with levels exceeding 100 μg/L. These levels stand well above the global average of 16%. These trends reveal that China still faces significant public health challenges, with millions of children currently at risk of lead poisoning. The unprecedented growth of China’s lead-acid battery industry from the electric bike, automotive, and photovoltaic industries may explain these persistently high levels, as China remains the world’s leading producer, refiner, and consumer of both lead and lead-acid batteries. This review assesses the role of China’s rising lead-acid battery industry on lead pollution and exposure. It starts with a synthesis of biological mechanisms of lead exposure followed by an analysis of the key technologies driving the rapid growth of this industry. It then details the four main stages of lead battery production, explaining how each stage results in significant lead loss and pollution. A province-level accounting of each of these industrial operations is also included. Next, reviews of the literature describe how this industry may have contributed to mass lead poisonings throughout China. Finally, the paper closes with a discussion of new policies that address the lead-acid battery industry and identifies policy frameworks to mitigate exposure. This paper is the first to integrate the market factors, production processes, and health impacts of China’s growing lead-acid battery industry to illustrate its vast public health consequences. The implications of this review are two-fold: it validates calls for a nationwide assessment of lead exposure pathways and levels in China as well as for a more comprehensive investigation into the health impacts of the lead-acid battery industry. The continuous growth of this industry signals the urgent need for effective regulatory action to protect the health and lives of China’s future generations. PMID:23915167

The poison center role in biological and chemical terrorism.

PubMed

Krenzelok, E P; Allswede, M P; Mrvos, R

2000-10-01

Nuclear, biological and chemical (NBC) terrorism countermeasures are a major priority with municipalities, healthcare providers, and the federal government. Significant resources are being invested to enhance civilian domestic preparedness by conducting education at every response level in anticipation of a NBC terroristic incident. The key to a successful response, in addition to education, is integration of efforts as well as thorough communication and understanding the role that each agency would play in an actual or impending NBC incident. In anticipation of a NBC event, a regional counter-terrorism task force was established to identify resources, establish responsibilities and coordinate the response to NBC terrorism. Members of the task force included first responders, hazmat, law enforcement (local, regional, national), government officials, the health department, and the regional poison information center. Response protocols were developed and education was conducted, culminating in all members of the response task force becoming certified NBC instructors. The poison center participated actively in 3 incidents of suspected biologic and chemical terrorism: an alleged anthrax-contaminated letter sent to a women's health clinic; a possible sarin gas release in a high school: and a potential anthrax/ebola contamination incident at an international airport. All incidents were determined hoaxes. The regional response plan establishes the poison information center as a common repository for all cases in a biological or chemical incident. The poison center is one of several critical components of a regional counterterrorism response force. It can conduct active and passive toxicosurveillance and identify sentinel events. To be responsive, the poison center staff must be knowledgeable about biological and chemical agents. The development of basic protocols and a standardized staff education program is essential. The use of the RaPiD-T (R-recognition, P-protection, D-detection, T-triage/treatment) course can provide basic staff education for responding to this important but rare consultation to the poison center.

Cyanotoxins: producing organisms, occurrence, toxicity, mechanism of action and human health toxicological risk evaluation.

PubMed

Buratti, Franca M; Manganelli, Maura; Vichi, Susanna; Stefanelli, Mara; Scardala, Simona; Testai, Emanuela; Funari, Enzo

2017-03-01

Cyanobacteria were present on the earth 3.5 billion years ago; since then they have colonized almost all terrestrial and aquatic ecosystems. They produce a high number of bioactive molecules, among which some are cyanotoxins. Cyanobacterial growth at high densities, forming blooms, is increasing in extension and frequency, following anthropogenic activities and climate changes, giving rise to some concern for human health and animal life exposed to cyanotoxins. Numerous cases of lethal poisonings have been associated with cyanotoxins ingestion in wild animal and livestock. In humans few episodes of lethal or severe human poisonings have been recorded after acute or short-term exposure, but the repeated/chronic exposure to low cyanotoxin levels remains a critical issue. The properties of the most frequently detected cyanotoxins (namely, microcystins, nodularins, cylindrospermopsin and neurotoxins) are here critically reviewed, describing for each toxin the available information on producing organisms, biosynthesis/genetic and occurrence, with a focus on the toxicological profile (including kinetics, acute systemic toxicity, mechanism and mode of action, local effects, repeated toxicity, genotoxicity, carcinogenicity, reproductive toxicity; human health effects and epidemiological studies; animal poisoning) with the derivation of health-based values and considerations on the risks for human health.

Lead poisoning in precious metals refinery assayers: a failure to notify workers at high risk.

PubMed

Kern, D G

1994-05-01

Lead poisoning in a precious metals refinery fire assayer and a routine OSHA inspection prompted an investigation of the index facility, a survey of the industry, and efforts to notify assayers of this previously unrecognized hazard. Air and blood samples were obtained at the index facility. Management personnel from all fire assay laboratories in Rhode Island and southern Massachusetts were interviewed. The industry's trade association, OSHA, NIOSH, trade unions, and the media were asked to assist in a nationwide notification effort. Assayers at the index facility had excessive exposures to lead due to an age-old, lead-based assaying method that remains the industry gold standard. Blood lead levels of the three assayers (mean 61.3 micrograms/dl, range 48-86 micrograms/dl) were considerably higher than those of 16 other refinery workers (mean 27.4 micrograms/dl, range 13-49 micrograms/dl). The industry survey revealed inadequate knowledge of both the lead hazard and the applicability of the OSHA lead standard. Notification efforts failed in large part due to economic obstacles. The notification of workers at high risk of lead exposure and the eradication of occupational lead poisoning will require greater attention to economic forces.

Correlation of computed tomography, magnetic resonance imaging and clinical outcome in acute carbon monoxide poisoning.

PubMed

Ozcan, Namik; Ozcam, Giray; Kosar, Pinar; Ozcan, Ayse; Basar, Hulya; Kaymak, Cetin

2016-01-01

Carbon monoxide is a toxic gas for humans and is still a silent killer in both developed and developing countries. The aim of this case series was to evaluate early radiological images as a predictor of subsequent neuropsychological sequelae, following carbon monoxide poisoning. After carbon monoxide exposure, early computed tomography scans and magnetic resonance imaging findings of a 52-year-old woman showed bilateral lesions in the globus pallidus. This patient was discharged and followed for 90 days. The patient recovered without any neurological sequela. In a 58-year-old woman exposed to carbon monoxide, computed tomography showed lesions in bilateral globus pallidus and periventricular white matter. Early magnetic resonance imaging revealed changes similar to that like in early tomography images. The patient recovered and was discharged from hospital. On the 27th day of exposure, the patient developed disorientation and memory impairment. Late magnetic resonance imaging showed diffuse hyperintensity in the cerebral white matter. White matter lesions which progress to demyelination and end up in neuropsychological sequelae cannot always be diagnosed by early computed tomography and magnetic resonance imaging in carbon monoxide poisoning. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Are Local Laws the Key to Ending Childhood Lead Poisoning?

PubMed Central

Korfmacher, Katrina S.; Hanley, Michael L.

2014-01-01

Although lead paint was banned by federal law in 1978, it continues to poison children living in homes built before that time. The lifelong effects of childhood exposure to even small amounts of lead are well established by medical research and include learning and behavior problems, hypertension, osteoporosis, and kidney disease. Federal and state laws have reduced rates of lead poisoning significantly in the past three decades. However, pockets of high rates of lead poisoning remain, primarily in low-income urban neighborhoods with older housing stock. Recently, several municipalities have passed local lead laws in an attempt to reduce lead hazards in these remaining areas. There has been no systematic attempt to compare the design and effectiveness of these local policies. To address this gap, we conducted comparative case studies of eight innovative lead laws promulgated since 2010. The laws used a wide variety of legal structures and tools, although certain elements were common. The impact of the policies was intertwined with local housing, economic, and legal environments. While data do not yet exist to systematically evaluate the impact on lead poisoning rates, our analysis suggests that local laws hold great promise for reducing lead hazards in children’s homes. PMID:23645870

Genome-wide Gene Expression Profiling of Acute Metal Exposures in Male Zebrafish

DTIC Science & Technology

2014-10-23

Data in Brief Genome-wide gene expression profiling of acute metal exposures in male zebrafish Christine E. Baer a,⁎, Danielle L. Ippolito b, Naissan... Zebrafish Whole organism Nickel Chromium Cobalt Toxicogenomics To capture global responses to metal poisoning and mechanistic insights into metal...toxicity, gene expression changes were evaluated in whole adult male zebrafish following acute 24 h high dose exposure to three metals with known human

The Poisoning of America's Children: Lead Exposure, Children's Brains, and the Ability To Learn. National Health/Education Consortium Occasional Paper #6.

ERIC Educational Resources Information Center

Needleman, Herbert L.

Despite years of concern about the toxic effects of high lead exposure and recent knowledge about the less apparent effects of exposure to low doses of lead, a total of 3 to 4 million children in the United States are still being exposed to concentrations of lead that could compromise their cognitive and social development. This paper discusses:…

Environmental contaminants in California condors

USGS Publications Warehouse

Wiemeyer, Stanley N.; Scott, J.M.; Anderson, M.P.; Bloom, P.H.; Stafford, C.J.

1988-01-01

Five wild Califorinia condors (Gymnogyps californianus) that died in 1980-86 were necropsied and tissues were analyzed for environmental contaminants. Three died of lead (Pb) poisoning, 1 presumably of cyanide (CN) poisoning, and 1 nestling of handling shock. Organochlorine concentrations were low in 4 condors that were analyzed for these contaminants. Blood samples from 14 wild and 14 captive condors were analyzed primarily for Pb. Five of 14 wild condors sampled had elevated (> 0.70 ppm) concentrations of Pb in blood whereas Pb concentrations in all captive condors were low. Lead levels in individual birds often fluctuated over time. Lead exposure, especially poisoning, was a major factor affecting the wild California condor population during 1982-86. The probable source of Pb was bullet fragments in carrion on which condors were feeding.

The history of arsenical pesticides and health risks related to the use of Agent Blue.

PubMed

Bencko, Vladimir; Yan Li Foong, Florence

2017-06-12

Arsenicals in agriculture. Beginning in the 1970s, the use of arsenic compounds for such purposes as wood preservatives, began to grow. By 1980, in the USA, 70% of arsenic had been consumed for the production of wood preservatives. This practice was later stopped, due to the US Environmental Protection Agency (EPA) ban of the arsenic-and chromium-based wood preservative chromated copper arsenate. In the past, arsenical herbicides containing cacodylic acid as an active ingredient have been used extensively in the USA, from golf courses to cotton fields, and drying-out the plants before harvesting. The original commercial form of Agent Blue was among 10 toxic insecticides, fungicides and herbicides partially deregulated by the US EPA in February 2004, and specific limits on toxic residues in meat, milk, poultry and eggs, were removed. Today, however, they are no longer used as weed-killers, with one exception - monosodium methanearsonate (MSMA), a broadleaf weed herbicide for use on cotton. Severe poisonings from cacodylic acid caused headache, dizziness, vomiting, profuse and watery diarrhea, followed by dehydration, gradual fall in blood pressure, stupor, convulsions, general paralysis and possible risk of death within 3-14 days.The relatively frequent use of arsenic and its compounds in both industry and agriculture points to a wide spectrum of opportunities for human exposure. This exposure can be via inhalation of airborne arsenic, contaminated drinking water, beverages, or from food and drugs. Today, acute organic arsenical poisonings are mostly accidental. Considerable concern has developed surrounding its delayed effects, for its genotoxic and carcinogenic potential, which has been demonstrated in epidemiological studies and subsequent animal experiments. Conclusions. There is substantial epidemiological evidence for an excessive risk, mostly for skin and lung cancer, among humans exposed to organic arsenicals in occupational and environmental settings. Furthermore, the genotoxic and carcinogenic effects have only been observed at relatively high exposure rates. Current epidemiological and experimental studies are attempting to elucidate the mechanism of this action, pointing to the question whether arsenic is actually a true genotoxic, or rather an epigenetic carcinogen. Due to the complexity of its effects, both options remain plausible. Its interactions with other toxic substances still represent another important field of interest.

NBOMe and 2C substitute phenylethylamine exposures reported to the National Poison Data System.

PubMed

Srisuma, Sahaphume; Bronstein, Alvin C; Hoyte, Christopher O

2015-01-01

Hallucinogenic designer drugs, especially NBOMe and the 2C substitute phenylethylamine series, have been increasing ubiquitous in past years. The purpose of this study is to characterize and compare clinical features of NBOMe and 2C exposures in humans. This is a retrospective cohort study of all single agent exposures to NBOMe and 2C substitute phenylethlamine reported to the National Poison Data System (NPDS) from 1st September 2012 to 30th September 2014. Over the study period, there were a total 341 cases including 148 NBOMe exposures and 193 2C exposures. The majority cases involved men (73.9%); median age was 18 years (Interquartile-range, 16-21). Similar clinical effects were reported in both groups including tachycardia (45.2%), agitation/irritable (44.3%), hallucination/delusion (32.0%), confusion (19.1%) and hypertension (18.5%). There were higher incidences of hallucination/delusion, single episode seizure and benzodiazepine administration in NBOMe exposures (40.5%, 8.8% and 50.0%respectively) than those of 2C exposures (25.4%, 3.1%, and 32.6% respectively). There were 2.3% death; no difference between two groups. The higher rate of symptoms in NBOMe is consistent with the higher 5HT2A agonistic effects of NBOMe described in both molecular and animal studies. Common clinical effects of NBOMe and 2C exposures were tachycardia, agitation/irritable, hallucination/delusion, confusion, and hypertension. There were higher incidences of hallucination/delusion, single episode seizure and benzodiazepine administration in NBOMe.

Human exposures to pentobarbital-phenytoin combination veterinary drugs.

PubMed

Forrester, M B

2017-07-01

A combination of pentobarbital and phenytoin is used as a veterinary euthanasia drug. Because of its lethal effect, this study described pentobarbital-phenytoin combination veterinary drug human exposures reported to Texas poison centers during 2000-2015. Of 66 exposures, 73% involved female and 27% male patients. The distribution by patient age was 3% 0-5 years, 5% 6-19 years, 91% 20+ years, and 2% unknown. The most common routes were ocular (41%), ingestion (32%), injection (23%), and dermal (18%). The exposure reasons were unintentional (77%) and intentional (23%). The exposure site was the workplace (52%), patient's own residence (38%), health-care facility (2%), and other/unknown (9%). The management site was managed on site (48%), at/en route to health-care facility (45%), referred to health-care facility (5%), and other (2%). The medical outcomes were no effect (23%), minor effect (30%), moderate effect (8%), major effect (8%), not followed nontoxic (3%), not followed minimal effects (24%), unable to follow potentially toxic (2%), and unrelated (3%). The most common adverse effects were ocular irritation/pain (18%), drowsiness/lethargy (15%), and coma (9%). The most common treatments were dilution/irrigation (70%), intravenous fluids (21%), and oxygen (14%). This study found few pentobarbital-phenytoin combination veterinary drug exposures were reported to Texas poison centers during a 16-year period. Although meant to be administered intravenously, the most common exposure routes were ocular and ingestion. Many of the exposures appeared to be unintentional and occurred at the workplace.

Hazard of household cleaning products: a study undertaken by the UK National Poisons Information Service.

PubMed

Williams, Hayley; Moyns, Emma; Bateman, D Nicholas; Thomas, Simon H L; Thompson, John P; Vale, J Allister

2012-09-01

To ascertain the reported toxicity of current United Kingdom (UK) household products following the launch of new products, such as liquid detergent capsules, and the manufacture of more concentrated formulations. Between 1 March 2008 and 30 April 2009 the UK National Poisons Information Service (NPIS) collected prospectively 5939 telephone enquiries relating to household products, approximately 10% of all telephone enquiries received over this period. The majority of enquiries (n = 3893; 65.5%) concerned children 5 years of age or less and were received predominantly from hospitals (n = 1905; 32.1%), general practitioners (n = 1768; 29.8%) and NHS Direct/NHS 24 (n = 1694; 28.5%). The majority of exposures occurred at home (n = 5795; 97.6%); most exposures were accidental (n = 5561; 93.6%). Liquid detergent capsules were most commonly involved (n = 647), followed by bleaches (n = 481), air fresheners (n = 429), multipurpose cleaners (n = 408), dishwasher products (n = 399) and descalers (n = 397). Exposure to household products occurred mainly as a result of ingestion (n = 4616; 75.8%), with eye contact (n = 513; 8.4%), inhalation (n = 420; 6.9%) and skin contact (n = 187; 3.1%) being less common; 5.1% (n = 313) of enquiries involved multiple routes of exposure. The most commonly reported features were vomiting (ingestion), pain (eye contact), dyspnoea (inhalation) and burns (skin contact). In 5840 of 5939 enquiries the Poisoning Severity Score (PSS) was known. The majority of patients (n = 4117; 70.5%) were asymptomatic (PSS 0), 28.0% (n = 1638) developed minor features (PSS 1), 1.3% (75 patients) developed moderate features (PSS 2) and 0.15% (nine patients) developed serious features (PSS 3). Four of these nine patients made a complete recovery, two died from exposure to drain cleaner and PVC solvent cleaner; the outcome in three was unknown. In the UK, advice from the NPIS is sought commonly regarding household products, but such exposures only rarely result in clinically serious features. As 65.5% of exposures were in children less than 5 years of age, parents clearly have an important role to play in ensuring that household products are stored safely at all times.

Lithium Poisoning.

PubMed

Baird-Gunning, Jonathan; Lea-Henry, Tom; Hoegberg, Lotte C G; Gosselin, Sophie; Roberts, Darren M

2017-05-01

Lithium is a commonly prescribed treatment for bipolar affective disorder. However, treatment is complicated by lithium's narrow therapeutic index and the influence of kidney function, both of which increase the risk of toxicity. Therefore, careful attention to dosing, monitoring, and titration is required. The cause of lithium poisoning influences treatment and 3 patterns are described: acute, acute-on-chronic, and chronic. Chronic poisoning is the most common etiology, is usually unintentional, and results from lithium intake exceeding elimination. This is most commonly due to impaired kidney function caused by volume depletion from lithium-induced nephrogenic diabetes insipidus or intercurrent illnesses and is also drug-induced. Lithium poisoning can affect multiple organs; however, the primary site of toxicity is the central nervous system and clinical manifestations vary from asymptomatic supratherapeutic drug concentrations to clinical toxicity such as confusion, ataxia, or seizures. Lithium poisoning has a low mortality rate; however, chronic lithium poisoning can require a prolonged hospital length of stay from impaired mobility and cognition and associated nosocomial complications. Persistent neurological deficits, in particular cerebellar, are described and the incidence and risk factors for its development are poorly understood, but it appears to be uncommon in uncomplicated acute poisoning. Lithium is readily dialyzable, and rationale support extracorporeal treatments to reduce the risk or the duration of toxicity in high-risk exposures. There is disagreement in the literature regarding factors that define patients most likely to benefit from treatments that enhance lithium elimination, including specific plasma lithium concentration thresholds. In the case of extracorporeal treatments, there are observational data in its favor, without evidence from randomized controlled trials (none have been performed), which may lead to conservative practices and potentially unnecessary interventions in some circumstances. More data are required to define the risk-benefit of extracorporeal treatments and their use (modality, duration) in the management of lithium poisoning.

Occupational carbon monoxide poisoning in the State of Washington, 1994-1999.

PubMed

Lofgren, Don J

2002-04-01

Carbon monoxide poisonings continue to be significant and preventable for a number of work operations. This study assesses occupational carbon monoxide morbidity and mortality for the state of Washington based on a review of workers' compensation records for the years 1994-1999. The study characterizes sources, industries, and causative factors, and further attempts to identify work operations most at risk. Records were identified by both injury source and diagnostic codes. The study limits itself to non-fire-related carbon monoxide poisonings and primarily those from acute exposure. A decline in the number of claims was not evident, but the number of incidents per year showed a slight decline. Carbon monoxide poisonings were found to occur throughout all types of industries. The greatest number of claims was found in agriculture, followed by construction and wholesale trade, with these three accounting for more than half the claims and nearly half of the incidents. The more severe poisonings did not necessarily occur in industries with the greatest number of incidents. The major source for carbon monoxide poisoning was forklift trucks, followed by auto/truck/bus, portable saws, and more than 20 other sources. Fruit packing and storage had the highest number of incidents mostly due to fuel-powered forklift activity, with nearly half of the incidents occurring in cold rooms. Adverse health effects as measured by carboxyhemoglobin, hyperbaric oxygen treatment, unconsciousness, and number and cost of claims were indexed by source. Though several specific work operations were identified, the episodic nature of carbon monoxide poisonings, as well as the diverse industries and sources, and the opportunity for a severe poisoning in any number of operations, poses challenges for effective intervention.

[Perspectives in the treatments of poisonings by organophosphorus insecticides and warfare nerve agents].

PubMed

Sogorb-Sánchez, M A; Vilanova-Gisbert, E; Carrera-González, V

Organophosphorus compounds are worldwide employed as insecticides and are yearly responsible of several millions of poisonings. The chemical structure of most of the warfare nerve agents also corresponds with an organophosphorus compound. Organophosphorus insecticides and warfare nerve agents exert their main toxicological effects through inhibition of acetylcholinesterase. Current treatments of patients poisoned with organophosphorus compounds include atropine (in order to protect muscarinic receptors), oximes (in order to accelerate the reactivation of the inhibited acetylcholinesterase) and benzodiazepines (in order to avoid convulsions). The administration of phosphotriesterases (enzymes involved in the detoxication of organophosphorus compounds through hydrolysis) is a very effective treatment against poisonings by organophosphorus insecticides and warfare nerve agents. There are experimental preventive treatments based on the simultaneous administration of carbamates and certain antimuscarinic drugs, different from atropine, which notably improve the efficacy of the classical treatments applied after poisonings by warfare nerve agents. The treatments based in the administration of phosphotriesterases might be the response to the call of the World Health Organization for searching new treatments with capability to reduce the high mortality recorded in the cases of poisonings by organophosphorus compounds. These treatments can be applied in a preventive way without the intrinsic neurotoxicity associated to the preventive treatments based on carbamates and antimuscarinic drugs. Therefore, these treatments are specially interesting for people susceptible to suffer severe exposures, i.e. sprayers in the farms.

Requests for emergency hyperbaric oxygen treatment for carbon monoxide poisoning in Ankara, Turkey.

PubMed

Özgök-Kangal, Münïre Kübra; Karatop-Cesur, Iclal; Akcali, Gökhan; Yildiz, Senol; Uzun, Günalp

2016-09-01

Carbon monoxide (CO) poisoning is common in Turkey. Our department is the main provider of emergency hyperbaric oxygen therapy (HBOT) in Ankara and neighboring cities. In this study, we analyzed the characteristics of CO-poisoned patients who were referred by phone to our department for emergency HBOT. We retrospectively reviewed the records of phone consultations with emergency departments regarding the need for treatment of CO-poisoned patients with HBOT between 14 January 2014 and 14 January 2015. The following information was extracted from medical records: age, gender, CO source, exposure duration, carboxyhemoglobin (COHb) level, symptoms, electrocardiography (ECG) findings, cardiac enzymes, pregnancy, the distance of referring hospital to our centre, time between admission and consultation and HBOT decision. Over the one-year period, 562 patients with CO poisoning were referred for HBOT. We recommended HBOT for 289 (51%) patients. HBOT was recommended for 58% (n = 194) of the patients with COHb ≥ 25%, 72% (n = 163) of the patients with a history of syncope, 67% (n = 35) of the patients with ECG abnormality, and 67% (n = 14) of pregnant patients. Patients for whom HBOT was not recommended despite having positive signs of severe poisoning were referred significantly later compared to patients for whom HBOT was recommended. We found that the duration from admission to an emergency department to HBOT consultation affected our decision-making.

Lead poisoning in a 16-year-old girl: a case report and a review of the literature (CARE compliant).

PubMed

Mărginean, Cristina Oana; Meliţ, Lorena Elena; Moldovan, Horaţiu; Lupu, Vasile Valeriu; Mărginean, Maria Oana

2016-09-01

Lead is a toxic element of the environment which leads to major complications once it enters the blood stream, affecting multiple organs and systems of the body. We present the case of a 16-year-old girl, diagnosed with lead poisoning after occupational exposure due to the fact that the girl was actively involved in the family's pottery business.History revealed that the girl participated in the process of pottery, her father was also diagnosed with lead poisoning 2 years before. The patient's personal history underlined that approximately 1 year ago she presented with severe abdominal pain, being diagnosed with acute appendicitis and she underwent appendectomy, but the pain persisted, thus due to family history of lead poisoning, the suspicion of saturnine colic rose, and she was diagnosed with lead poisoning. The main symptoms and signs were severe abdominal pain, vomiting, and arterial hypertension. The clinical evolution was favorable under symptomatic treatment and chelation therapy. Lead toxicity is a life-threatening condition because of its severe acute and chronic complications. In children, there is no safe blood lead level, prevention methods are, therefore, very important in order to avoid toxic multiorganic effects of this metal. Even though the diagnosis of lead poisoning remains difficult in children, it must also be taken into consideration by the clinician facing a child with gastrointestinal or neurological involvement.

The lead-poisoned genius: saturnism in famous artists across five centuries.

PubMed

Montes-Santiago, Julio

2013-01-01

Lead poisoning (saturnism) has been present throughout the history of mankind. In addition to possible ingestion from contaminated food, one of the most important ways in which poisoning caused morbid processes was by occupational exposure. This exposition was pandemic in the Roman Empire, and it has been claimed that it contributed to its fall, but it also caused numerous epidemics in Western countries until the nineteenth century. In the case of artists, and since the Renaissance period, this toxicity has been called painter's colic or painter's madness. The latter term is partly due to the mental disorders displayed by some of the great masters, including Michelangelo and Caravaggio, although it was long recognized that even house and industrial painters were prone to the disorder. This chapter examines the historical evidence of recognition of such toxicity and discusses the controversies raised by the possibility of professional lead poisoning in great artists. In addition to those mentioned above, many other artists across several centuries will be discussed, some being Rubens, Goya, Fortuny, Van Gogh, Renoir, Dufy, Klee, Frida Kahlo, and Portinari. This chapter also briefly mentions the possibility of lead poisoning in two famous composers: Beethoven and Handel. Whether suffering from lead poisoning or not, about which we cannot always be sure, we should still highlight and admire such geniuses fighting their disorders to bequeath us their immortals works. © 2013 Elsevier B.V. All rights reserved.

Citizen's Guide to Pest Control and Pesticide Safety

EPA Pesticide Factsheets

Teaches consumers how to control pests, choose, use, store, and dispose pesticides safely, reduce exposure when others use pesticides, prevent pesticide poisoning, handle an emergency, and how to choose a pest control company.

A plastic stabilizer dibutyltin dilaurate induces subchronic neurotoxicity in rats☆

PubMed Central

Jin, Minghua; Song, Peilin; Li, Na; Li, Xuejun; Chen, Jiajun

2012-01-01

Dibutyltin dilaurate functions as a stabilizer for polyvinyl chloride. In this study, experimental rats were intragastrically administered 5, 10, or 20 mg/kg dibutyltin dilaurate to model sub-chronic poisoning. After exposure, our results showed the activities of superoxide dismutase and glutathione peroxidase decreased in rat brain tissue, while the malondialdehyde and nitric oxide content, as well as nitric oxide synthase activity in rat brain tissue increased. The cell cycle in the right parietal cortex was disordered and the rate of apoptosis increased. DNA damage was aggravated in the cerebral cortex, and the ultrastructure of the right parietal cortex tissues was altered. The above changes became more apparent with exposure to increasing doses of dibutyltin dilaurate. Our experimental findings confirmed the neurotoxicity of dibutyltin dilaurate in rat brain tissues, and demonstrated that the poisoning was dose-dependent. PMID:25538742

Critical appraisal of the 1977 diagnostic criteria for Minamata disease.

PubMed

Yorifuji, Takashi; Tsuda, Toshihide; Inoue, Sachiko; Takao, Soshi; Harada, Masazumi; Kawachi, Ichiro

2013-01-01

Large-scale food poisoning caused by methylmercury was identified in Minamata, Japan, in the 1950s (Minamata disease). Although the diagnostic criteria for the disease remain current, few studies have been carried out to assess the diagnostic accuracy of the criteria. From a 1971 population-based investigation, data from 2 villages were selected: Minamata (high-exposure area; n = 779) and Ariake (low-exposure area; n = 755). The authors examined the prevalence of neurologic signs characteristic of methylmercury poisoning and the validity of the criteria. A substantial number of residents in the exposed area exhibited neurologic signs even after excluding officially certified patients. Using paresthesia of the extremities as the gold standard of diagnosis, the criteria had a sensitivity of 66%. The current diagnostic criteria as well as the official certification system substantially underestimate the incidence of Minamata disease.

Should the Centers for Disease Control and Prevention’s Childhood Lead Poisoning Intervention Level Be Lowered?

PubMed Central

Bernard, Susan M.

2003-01-01

The US Centers for Disease Control and Prevention (CDC) in 1991 chose 10 μg/dL as an initial screening level for lead in children’s blood. Current data on health risks and intervention options do not support generally lowering that level, but federal lead poisoning prevention efforts can be improved by revising the follow-up testing schedule for infants aged 1 year or less with blood lead levels of 5 μg/dL or higher; universal education about lead exposure risks; universal administration of improved, locally validated risk-screening questionnaires; enhanced compliance with targeted screening recommendations and federal health program requirements; and development by regulatory agencies of primary prevention criteria that do not use the CDC’s intervention level as a target “safe” lead exposure. PMID:12893607

Environmental and biological monitoring for lead exposure in California workplaces.

PubMed Central

Rudolph, L; Sharp, D S; Samuels, S; Perkins, C; Rosenberg, J

1990-01-01

Patterns of environmental and biological monitoring for lead exposure were surveyed in lead-using industries in California. Employer self-reporting indicates a large proportion of potentially lead-exposed workers have never participated in a monitoring program. Only 2.6 percent of facilities have done environmental monitoring for lead, and only 1.4 percent have routine biological monitoring programs. Monitoring practices vary by size of facility, with higher proportions in industries in which larger facilities predominate. Almost 80 percent of battery manufacturing employees work in job classifications which have been monitored, versus only 1 percent of radiator-repair workers. These findings suggest that laboratory-based surveillance for occupational lead poisoning may seriously underestimate the true number of lead poisoned workers and raise serious questions regarding compliance with key elements of the OSHA Lead Standard. PMID:2368850

Effect of organomercurial poisoning on the peripheral blood and metabolite levels of a freshwater fish.

PubMed

Gill, T S; Pant, J C

1985-10-01

This work evaluated the hematological and biochemical changes in the fish, Puntius conchonius, under experimental organomercurial poisoning. Long-term (8 weeks) exposure to 3.63 and 6.03 mg/liter methoxyethyl mercuric chloride (MEMC) (0.2 and 0.33 fractions of 96-hr LC50) led to morphological aberrations in mature erythrocytes including nuclear and cytoplasmic deterioration, vacuolation, chromatin condensation, and hypochromia. Immature erythrocytes showing membrane leakage were also encountered. Erythrocyte count and hemoglobin (Hb) were significantly lowered after 1 and 3 weeks followed by a marginal rise persisting upto 8 weeks. Differential leucocyte counts revealed significant thrombocytopenia, lymphocytosis, and neutropenia. Collateral evaluation of blood glucose and tissue glycogen levels revealed significant hyperglycemia as well as glycogen depletion in liver and brain. Heart glycogen content evinced a substantial increase after 5 and 8 weeks exposure.

Characteristics of pesticide-related hospitalizations, Louisiana, 1998-2007.

PubMed

Badakhsh, Roshan; Lackovic, Michelle; Ratard, Raoult

2010-01-01

Pesticides are widely used on agricultural crops and in homes, workplaces, and public spaces. Exposure to pesticides can cause acute and chronic health effects. We analyzed data from the Louisiana Hospital Inpatient Discharge Database from 1998 through 2007 to characterize hospitalizations involving pesticides. Data for the study period consisted of 384 pesticide-related hospitalizations. We used demographic information and diagnosis codes for analysis. Males consistently had higher hospitalization rates than females (p=0.0073). Children aged 0-4 years had the highest pesticide-related hospitalization rate of all age groups (2.69 hospitalizations per 100,000); children aged 5-9 years had the lowest rate (0.36 hospitalizations per 100,000). Compared with adults, children had a higher rate of disinfectant exposure (15% vs. 5%; odds ratio [OR] = 3.41, 95% confidence interval [CI] 1.61, 7.21; p=0.0008) and rodenticide exposure (14% vs. 2%; OR=8.55, 95% CI 3.07, 23.78; p<0.0001). Rural parishes (counties) were more likely than urban parishes to have higher pesticide hospitalization rates (OR=4.72, 95% CI 2.34, 9.54; p<0.0001). Intentional poisonings accounted for 27% of cases. Only eight cases were coded as work-related. Analyzing pesticide-related hospitalization data provides important information about some of the most severe pesticide poisoning cases. Significant findings include the elevated rate of hospitalizations among young children and men, and the large proportion of self-inflicted poisonings. Health departments and health-care providers may use these findings to target outreach and prevention activities.

Acute Cyanide Poisoning: Hydroxocobalamin and Sodium Thiosulfate Treatments with Two Outcomes following One Exposure Event

PubMed Central

Meillier, Andrew; Heller, Cara

2015-01-01

Cyanide is rapidly reacting and causes arrest of aerobic metabolism. The symptoms are diffuse and lethal and require high clinical suspicion. Remediation of symptoms and mortality is highly dependent on quick treatment with a cyanide antidote. Presently, there are two widely accepted antidotes: sodium thiosulfate and hydroxocobalamin. These treatments act on different components of cyanide's metabolism. Here, we present two cases resulting from the same source of cyanide poisoning and the use of both antidotes separately used with differing outcomes. PMID:26543483

Chlorophacinone residues in mammalian prey at a black-tailed prairie dog colony

USGS Publications Warehouse

Vyas, Nimish B.; Hulse, Craig S.; Rice, Clifford P.

2012-01-01

Black-tailed prairie dogs (BTPDs), Cynomys ludovicianus, are an important prey for raptors; therefore, the use of the rodenticide Rozol (0.005% chlorophacinone active ingredient) to control BTPDs raises concern for secondary poisonings resulting from the consumption of contaminated prey by raptors. In the present study, the authors observed Rozol exposure and adverse effects to mammalian prey on 11 of 12 search days of the study. Mammalian hepatic chlorophacinone residues ranged from 0.44 to 7.56 µg/g. Poisoned prey availability was greater than previously reported.

Early brain magnetic resonance imaging can predict short and long-term outcomes after organophosphate poisoning in a rat model.

PubMed

Shrot, Shai; Tauber, Maya; Shiyovich, Arthur; Milk, Nadav; Rosman, Yossi; Eisenkraft, Arik; Kadar, Tamar; Kassirer, Michael; Cohen, Yoram

2015-05-01

Magnetic resonance (MR) imaging is a sensitive modality for demonstrating in vivo alterations in brain structure and function after acute organophosphate (OP) poisoning. The goals of this study were to explore early imaging findings in organophosphate-poisoned animals, to assess the efficacy of centrally acting antidotes and to find whether early MR findings can predict post-poisoning cognitive dysfunction. Sprague-Dawley rats were poisoned with the agricultural OP paraoxon and were treated with immediate atropine and obidoxime (ATOX) to reduce acute mortality caused by peripheral inhibition of acetylcholinesterase. Animals were randomly divided into three groups based on the protocol of centrally acting antidotal treatment: group 1 - no central antidotal treatment (n=10); group 2 - treated with midazolam (MID) at 30 min after poisoning (n=9), group 3 - treated with a combination of MID and scopolamine (SCOP) at 30 min after poisoning (n=9) and controls (n=6). Each animal had a brain MR examination 3 and 24 h after poisoning. Each MR examination included the acquisition of a T2 map and a single-voxel (1)H MR spectroscopy (localized on the thalami, to measure total creatine [Cr], N-acetyl-aspartate [NAA] and cholines [Cho] levels). Eleven days after poisoning each animal underwent a Morris water maze to assess hippocampal learning. Eighteen days after poisoning, animals were euthanized, and their brains were dissected, fixed and processed for histology. All paraoxon poisoned animals developed generalized convulsions, starting within a few minutes following paraoxon injection. Brain edema was maximal on MR imaging 3 h after poisoning. Both MID and MID+SCOP prevented most of the cortical edema, with equivalent efficacy. Brain metabolic dysfunction, manifested as decreased NAA/Cr, appeared in all poisoned animals as early as 3h after exposure (1.1 ± 0.07 and 1.42 ± 0.05 in ATOX and control groups, respectively) and remained lower compared to non-poisoned animals even 24h after poisoning. MID and MID+SCOP prevented much of the 3h NAA/Cr decrease (1.22 ± 0.05 and 1.32 ± 0.1, respectively). Significant correlations were found between imaging findings (brain edema and spectroscopic changes) and clinical outcomes (poor learning, weight loss and pathological score) with correlation coefficients of 0.4-0.75 (p<0.05). MR imaging is a sensitive modality to explore organophosphate-induced brain damage. Delayed treatment with midazolam with or without scopolamine provides only transient neuroprotection with some advantage in adding scopolamine. Early imaging findings were found to correlate with clinical consequences of organophosphate poisoning and could be potentially used in the future to predict long-term prognosis of poisoned casualties. Copyright © 2015 Elsevier Inc. All rights reserved.

Health effects of agrochemicals among farm workers in commercial farms of Kwekwe district, Zimbabwe

PubMed Central

Magauzi, Regis; Mabaera, Bigboy; Rusakaniko, Simbarashe; Chimusoro, Anderson; Ndlovu, Nqobile; Tshimanga, Mufuta; Shambira, Gerald; Chadambuka, Addmore; Gombe, Notion

2011-01-01

Introduction Farm workers are at a very high risk of occupational diseases due to exposure to pesticides resulting from inadequate education, training and safety systems. The farm worker spends a lot of time exposed to these harmful agrochemicals. Numerous acute cases with symptoms typical of agrochemical exposure were reported from the commercial farms. We assessed the health effects of agrochemicals in farm workers in commercial farms of Kwekwe District (Zimbabwe), in 2006. Methods An analytical cross sectional study was conducted amongst a sample of 246 farm workers who handled agrochemicals when discharging their duties in the commercial farms. Plasma cholinesterase activity in blood specimens obtained from farm workers was measured using spectrophotometry to establish levels of poisoning by organophosphate and/or carbamates. Information on the knowledge, attitudes and practices of farm workers on agrochemicals use was collected using a pre-tested interviewer administered questionnaire. Bivariate and multivariate analyses were conducted to determine factors that were associated with abnormal cholinesterase activity. Results The prevalence of organophosphate poisoning, indicated by cholinesterase activity of 75% or less, was 24.1%. The median period of exposure to agrochemicals was 3 years (Q1:=1 year, Q3:=7 years). Ninety eight (41.5%) farm workers knew the triangle colour code for the most dangerous agrochemicals. Not being provided with personal protective equipment (OR 2.00; 95% CI: 1.07 – 3.68) and lack of knowledge of the triangle colour code for most dangerous agrochemicals (OR 2.02; 95% CI: 1.02 – 4.03) were significantly associated with abnormal cholinesterase activity. Conclusion There was organophosphate poisoning in the commercial farms. Factors that were significantly associated with the poisoning were lack of protective clothing and lack of knowledge of the triangle colour code for most dangerous agrochemicals. We recommended intensive health education and training of farm workers on the use of agrochemicals, provision of adequate and proper personal protective equipment as mitigation measures to this problem. PMID:22145061

Severe paramethoxymethamphetamine (PMMA) and paramethoxyamphetamine (PMA) outbreak in Israel.

PubMed

Lurie, Yael; Gopher, Asher; Lavon, Ophir; Almog, Shlomo; Sulimani, Liron; Bentur, Yedidia

2012-01-01

Paramethoxymethamphetamine (PMMA) is a hallucinogenic synthetic substituted amphetamine that was not included in the Israeli Controlled Substance Act (CSA). To report a severe PMMA and paramethoxyamphetamine (PMA) outbreak. The Israeli national forensic toxicology laboratory analyzes the body fluids of unnatural deaths by means of screening immunoassays and chromatographic confirmation and quantification. Samples are referred to this laboratory by the Israeli Forensic Medicine Institute and by hospitals following consultation with the Israel Poison Information Center. The forensic toxicology laboratory began determining PMMA and PMA in February 2007. In all fatal cases with a positive immunoassay screen for amphetamines, a chromatographic analysis of PMA and PMMA was performed. The laboratory and demographic data of consecutive patients in whom PMMA or PMA were detected, were collected during 1 year and subjected to descriptive analysis. Of 108 fatal cases with a positive screen for amphetamines, 32 were confirmed. Twenty-four of the 32 cases tested positive for PMMA and PMA--age 27 ± 5 years, 79.2% males, post mortem whole blood PMMA and PMA concentrations 0.35 ± 0.24 and 2.72 ± 1.67 mcg/mL, respectively. Co-exposures were detected in 17 (70.8%) fatalities; including methylenedioxymethamphetamine, methylenedioxyamphetamine, cocaine, cannabinoids, cathinone derivatives, ephedrine/pseudoephedrine, opiates, and ethanol. In addition, five non-fatal male cases were identified; age 32 ± 5 years, four had co-exposures to cocaine, cathinone derivatives, and cannabinoids. These findings led to the inclusion of PMMA in the CSA in July 2007, resulting in only three more fatalities in the following year. We report an outbreak of PMMA and PMA poisoning resulting in 24 fatalities, and the post mortem whole blood and urine concentrations of these two compounds. PMA was probably the result of PMMA metabolism. Stimulant co-exposures may have contributed to the severity of the poisoning. Forensic laboratory and poison center co-operation is important in identifying a new drug of abuse.

Health effects of agrochemicals among farm workers in commercial farms of Kwekwe district, Zimbabwe.

PubMed

Magauzi, Regis; Mabaera, Bigboy; Rusakaniko, Simbarashe; Chimusoro, Anderson; Ndlovu, Nqobile; Tshimanga, Mufuta; Shambira, Gerald; Chadambuka, Addmore; Gombe, Notion

2011-01-01

Farm workers are at a very high risk of occupational diseases due to exposure to pesticides resulting from inadequate education, training and safety systems. The farm worker spends a lot of time exposed to these harmful agrochemicals. Numerous acute cases with symptoms typical of agrochemical exposure were reported from the commercial farms. We assessed the health effects of agrochemicals in farm workers in commercial farms of Kwekwe District (Zimbabwe), in 2006. An analytical cross sectional study was conducted amongst a sample of 246 farm workers who handled agrochemicals when discharging their duties in the commercial farms. Plasma cholinesterase activity in blood specimens obtained from farm workers was measured using spectrophotometry to establish levels of poisoning by organophosphate and/or carbamates. Information on the knowledge, attitudes and practices of farm workers on agrochemicals use was collected using a pre-tested interviewer administered questionnaire. Bivariate and multivariate analyses were conducted to determine factors that were associated with abnormal cholinesterase activity. The prevalence of organophosphate poisoning, indicated by cholinesterase activity of 75% or less, was 24.1%. The median period of exposure to agrochemicals was 3 years (Q(1):=1 year, Q(3):=7 years). Ninety eight (41.5%) farm workers knew the triangle colour code for the most dangerous agrochemicals. Not being provided with personal protective equipment (OR 2.00; 95% CI: 1.07 - 3.68) and lack of knowledge of the triangle colour code for most dangerous agrochemicals (OR 2.02; 95% CI: 1.02 - 4.03) were significantly associated with abnormal cholinesterase activity. There was organophosphate poisoning in the commercial farms. Factors that were significantly associated with the poisoning were lack of protective clothing and lack of knowledge of the triangle colour code for most dangerous agrochemicals. We recommended intensive health education and training of farm workers on the use of agrochemicals, provision of adequate and proper personal protective equipment as mitigation measures to this problem.

Epigenetic marker (LINE-1 promoter) methylation level was associated with occupational lead exposure.

PubMed

Li, Chunping; Yang, Xiaolin; Xu, Ming; Zhang, Jinlong; Sun, Na

2013-05-01

Occupational and environmental exposures to lead (Pb) are a worldwide concern. DNA methylation plays an important role in the development of Pb toxicity. Here, we try to find out the evidence to prove that the methylation of the LINE-1 promoter may be involved in Pb toxicity. To determine whether the methylation level of the LINE-1 is associated with the risk of Pb poisoning, we first constructed a Pb acetate-treated cell model to detect the association between LINE-1 methylation and Pb exposure. A case-control study involving 53 workers from a battery plant and 57 healthy volunteers with matching age and gender distribution was carried out. We employed methylation-specific real-time PCR to determine the relationship between LINE-1 methylation level and Pb exposure. In the cell model, Pb exposure significantly decreased the level of LINE-1 methylation (p = 0.009). Significant difference in methylation frequencies was found between the exposed and control samples (p < 0.001). We also found a decreasing trend of LINE-1 methylation level with increasing blood Pb level (p < 0.001). Therefore, the LINE-1 promoter methylation might contribute to the risk of Pb poisoning and identified a possible epigenetic biomarker for Pb toxicity, especially in individuals occupationally exposed to Pb.

Early Childhood Lead Exposure and Academic Achievement: Evidence From Detroit Public Schools, 2008–2010

PubMed Central

Baker, Harolyn W.; Tufts, Margaret; Raymond, Randall E.; Salihu, Hamisu; Elliott, Michael R.

2013-01-01

Objectives. We assessed the long-term effect of early childhood lead exposure on academic achievement in mathematics, science, and reading among elementary and junior high school children. Methods. We linked early childhood blood lead testing surveillance data from the Detroit Department of Health and Wellness Promotion to educational testing data from the Detroit, Michigan, public schools. We used the linked data to investigate the effect of early childhood lead exposure on academic achievement among school-aged children, both marginally and adjusted for grade level, gender, race, language, maternal education, and socioeconomic status. Results. High blood lead levels before age 6 years were strongly associated with poor academic achievement in grades 3, 5, and 8. The odds of scoring less than proficient for those whose blood lead levels were greater than 10 micrograms per deciliter were more than twice the odds for those whose blood lead levels were less than 1 micrograms per deciliter after adjustment for potential confounders. Conclusions. Early childhood lead exposure was negatively associated with academic achievement in elementary and junior high school, after adjusting for key potential confounders. The control of lead poisoning should focus on primary prevention of lead exposure in children and development of special education programs for students with lead poisoning. PMID:23327265

Risk factors for mortality in Asian Taiwanese patients with methanol poisoning.

PubMed

Lee, Chen-Yen; Chang, Eileen Kevyn; Lin, Ja-Liang; Weng, Cheng-Hao; Lee, Shen-Yang; Juan, Kuo-Chang; Yang, Huang-Yu; Lin, Chemin; Lee, Shwu-Hua; Wang, I-Kwan; Yen, Tzung-Hai

2014-01-01

Methanol poisoning continues to be a serious public health issue in Taiwan, but very little work has been done to study the outcomes of methanol toxicity in the Asian population. In this study, we examined the value of multiple clinical variables in predicting mortality after methanol exposure. We performed a retrospective observational study on patients with acute poisoning who were admitted to the Chang Gung Memorial Hospital over a period of 9 years (2000-2008). Out of the 6,347 patients, only 32 suffered methanol intoxication. The demographic, clinical, laboratory, and mortality data were obtained for analysis. Most patients were middle aged (46.1±13.8 years), male (87.5%), and habitual alcohol consumers (75.0%). All the poisonings were from an oral exposure (96.9%), except for one case of intentionally injected methanol (3.1%). After a latent period of 9.3±10.1 hours, many patients began to experience hypothermia (50.0%), hypotension (15.6%), renal failure (59.4%), respiratory failure (50.0%), and consciousness disturbance (Glasgow coma scale [GCS] score 10.5±5.4). Notably, the majority of patients were treated with ethanol antidote (59.4%) and hemodialysis (58.1%). The remaining 41.6% of patients did not meet the indications for ethanol therapy. At the end of analysis, there were six (18.8%), 15 (46.9%), and eleven (34.4%) patients alive, alive with chronic complications, and dead, respectively. In a multivariate Cox regression model, it was revealed that the GCS score (odds ratio [OR] 0.816, 95% confidence interval [CI] 0.682-0.976) (P=0.026), hypothermia (OR 168.686, 95% CI 2.685-10,595.977) (P=0.015), and serum creatinine level (OR 4.799, 95% CI 1.321-17.440) (P=0.017) were significant risk factors associated with mortality. The outcomes (mortality rate 34.4%) of the Taiwanese patients subjected to intensive detoxification protocols were comparable with published data from other international poison centers. Furthermore, the analytical results indicate that GCS score, hypothermia, and serum creatinine level help predict mortality after methanol poisoning.

[Human Single Drug Exposures to Non-opioid Analgesics Reported to the Poisons Information Centre Erfurt from 2003 to 2012].

PubMed

Hentschel, H; Prasa, D; Bergmann, I; Enden, G; Plenert, B; Frimlova, G; Just, S; Liebetrau, G; Stürzebecher, A; Deters, M

2016-01-01

Because of their frequency, non-opioid analgesics (NOA) single drug exposures registered by Poisons Information Centre (PIC) Erfurt have been studied over a decade. A retrospective analysis of frequencies, circumstances of exposure, symptom severity, and age groups in NOA single drug exposures received by the PIC Erfurt from the beginning of 2003 to the end of 2012 was undertaken. Of all 4749 NOA single drug exposures, the 10 most frequent were caused by paracetamol (n=1 686), ibuprofen (n=1 439), acetylsalicylic acid (n=456), dipyrone (n=274), diclofenac (n=267), flupirtine (n=138), naproxen (n=41), etoricoxib (n=36), indomethacin (n=24), and dexketoprofen (n=19). Paracetamol single drug exposures increased from 158 in 2003 to 216 in 2007 and fell afterwards to 133 in 2012. Ibuprofen single drug exposures continously rose from 57 in 2003 to 258 in 2012. Adults were more often involved in NOA (53.8%) and all single drug exposures (54.1%) than children (45.9% and 45.6%, respectively). Suicidal attempts were more frequent in NOA (43.1%) than in all single drug exposures (34.2%), whereas accidental exposures or exposures in abuse were less often (33.4 and 0.2%, 46.0 and 0.9% respectively). NOA single drug exposures resulted mostly in none to minor symptoms (77.0%) and rarely in moderate (2.1%) or severe symptoms (1.0%). One adult was found dead after probable ingestion of 32 g of acetylsalicylic acid in suicidal intention. Because many NOA are over-the-counter drugs, it is difficult to obtain data on their use. PIC data could provide information on the NOA use in the population. © Georg Thieme Verlag KG Stuttgart · New York.

USE OF THE FUNGICIDE CARBENDAZIM AS A MODEL COMPOUND TO DETERMINE THE IMPACT OF ACUTE CHEMICAL EXPOSURE DURING OOCYTE MATURATION AND FERTILIZATION ON PREGNANCY OUTCOME IN THE HAMSTER

EPA Science Inventory

Here we use a hamster animal model to identify early pregnancy loss due to an acute chemical exposure to the female during the perifertilization interval. The fungicide carbendazim (methyl 1H-benzimidazole-2-carbamate), a microtubule poison with antimitotic activity, was selected...

Oxidative Damage Induced by Arsenic in Mice or Rats: A Systematic Review and Meta-Analysis.

PubMed

Xu, Mengchuan; Rui, Dongsheng; Yan, Yizhong; Xu, Shangzhi; Niu, Qiang; Feng, Gangling; Wang, Yan; Li, Shugang; Jing, Mingxia

2017-03-01

In this meta-analysis, studies reporting arsenic-induced oxidative damage in mouse models were systematically evaluated to provide a scientific understanding of oxidative stress mechanisms associated with arsenic poisoning. Fifty-eight relevant peer-reviewed publications were identified through exhaustive database searching. Oxidative stress indexes assessed included superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), glutathione peroxidase (GPx), glutathione-s-transferase (GST), glutathione reductase (GR), oxidized glutathione (GSSG), malondialdehyde (MDA), and reactive oxygen species (ROS). Our meta-analysis showed that arsenic exposure generally suppressed measured levels of the antioxidants, SOD, CAT, GSH, GPx, GST, and GR, but increased levels of the oxidants, GSSG, MDA, and ROS. Arsenic valence was important and GR and MDA levels increased to a significantly (P < 0.05) greater extent upon exposure to As 3+ than to As 5+ . Other factors that contributed to a greater overall oxidative effect from arsenic exposure included intervention time, intervention method, dosage, age of animals, and the sample source from which the indexes were estimated. Our meta-analysis effectively summarized a wide range of studies and detected a positive relationship between arsenic exposure and oxidative damage. These data provide a scientific basis for the prevention and treatment of arsenic poisoning.

[Exposure to liquid detergent capsules: a study of the cases reported to the Paris Poison Center, 2011-2012].

PubMed

Villa, A; Médernach, C; Arropetian, N; Lagrange, F; Langrand, J; Garnier, R

2014-06-01

To evaluate the toxicity of liquid detergent capsules for children. Analysis of 684 consecutive cases from the Paris Poison Center (2011-2012). Most enquiries (97 %) concerned children 5 years of age or younger. The main circumstances of exposure were ingestion alone (72.4 %) or together with eye or skin contact (7.5 % and 7.3 %, respectively). The effects observed were generally due to the irritating properties of concentrated detergents: minor digestive disturbances (particularly vomiting in nearly 50 % of cases) after ingestion and conjunctivitis and/or keratitis after eye contact. The main complications were 24 cases of keratitis and one case of pulmonary toxicity after ingestion. A rash was observed in nine patients; it was delayed in two. The effects observed with liquid detergent capsules were very similar to those resulting from exposure to other detergents. However, exposure to these agents are very frequent and often results in eye contact, which may be responsible for keratitis, and after ingestion detergent inhalation is a possible complication. All cases with eye symptoms or cough after liquid detergent capsule exposure deserve prompt medical examination and assistance. Greater awareness of both health professionals and consumers on the dangers and risks of these laundry detergent pods is required for better treatment of exposure accidents and for their prevention. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Anticoagulant Rodenticides on our Public and Community Lands: Spatial Distribution of Exposure and Poisoning of a Rare Forest Carnivore

PubMed Central

Gabriel, Mourad W.; Woods, Leslie W.; Poppenga, Robert; Sweitzer, Rick A.; Thompson, Craig; Matthews, Sean M.; Higley, J. Mark; Keller, Stefan M.; Purcell, Kathryn; Barrett, Reginald H.; Wengert, Greta M.; Sacks, Benjamin N.; Clifford, Deana L.

2012-01-01

Anticoagulant rodenticide (AR) poisoning has emerged as a significant concern for conservation and management of non-target wildlife. The purpose for these toxicants is to suppress pest populations in agricultural or urban settings. The potential of direct and indirect exposures and illicit use of ARs on public and community forest lands have recently raised concern for fishers (Martes pennanti), a candidate for listing under the federal Endangered Species Act in the Pacific states. In an investigation of threats to fisher population persistence in the two isolated California populations, we investigate the magnitude of this previously undocumented threat to fishers, we tested 58 carcasses for the presence and quantification of ARs, conducted spatial analysis of exposed fishers in an effort to identify potential point sources of AR, and identified fishers that died directly due to AR poisoning. We found 46 of 58 (79%) fishers exposed to an AR with 96% of those individuals having been exposed to one or more second-generation AR compounds. No spatial clustering of AR exposure was detected and the spatial distribution of exposure suggests that AR contamination is widespread within the fisher’s range in California, which encompasses mostly public forest and park lands Additionally, we diagnosed four fisher deaths, including a lactating female, that were directly attributed to AR toxicosis and documented the first neonatal or milk transfer of an AR to an altricial fisher kit. These ARs, which some are acutely toxic, pose both a direct mortality or fitness risk to fishers, and a significant indirect risk to these isolated populations. Future research should be directed towards investigating risks to prey populations fishers are dependent on, exposure in other rare forest carnivores, and potential AR point sources such as illegal marijuana cultivation in the range of fishers on California public lands. PMID:22808110

Repeated conservation threats across the Americas: High levels of blood and bone lead in the Andean Condor widen the problem to a continental scale.

PubMed

Wiemeyer, Guillermo M; Pérez, Miguel A; Torres Bianchini, Laura; Sampietro, Luciano; Bravo, Guillermo F; Jácome, N Luis; Astore, Vanesa; Lambertucci, Sergio A

2017-01-01

Wildlife lead exposure is an increasing conservation threat that is being widely investigated. However, for some areas of the world (e.g., South America) and certain species, research on this subject is still scarce or only local information is available. We analyzed the extent and intensity of lead exposure for a widely distributed threatened species, the Andean Condor (Vultur gryphus). We conducted the study at two different scales: 1) sampling of birds received for rehabilitation or necropsy in Argentina, and 2) bibliographic review and extensive survey considering exposure event for the species' distribution in South America. Wild condors from Argentina (n = 76) presented high lead levels consistent with both recent and previous exposure (up to 104 μg/dL blood level, mean 15.47 ± 21.21 μg/dL and up to 148.20 ppm bone level, mean 23.08 ± 31.39 ppm). In contrast, captive bred individuals -not exposed to lead contamination- had much lower lead levels (mean blood level 5.63 ± 3.08 μg/dL, and mean bone level 2.76 ± 3.06 ppm). Condors were exposed to lead throughout their entire range in continental Argentina, which represents almost sixty percent (>4000 km) of their geographical distribution. We also present evidence of lead exposure events in Chile, Ecuador, and Peru. Lead poisoning is a widespread major conservation threat for the Andean Condor, and probably other sympatric carnivores from South America. The high number and wide range of Andean Condors with lead values complement the results for the California Condor and other scavengers in North America suggesting lead poisoning is a continental threat. Urgent actions are needed to reduce this poison in the wild. Copyright © 2016 Elsevier Ltd. All rights reserved.

Intramuscular Cobinamide Sulfite in a Rabbit Model of Sub-Lethal Cyanide Toxicity

PubMed Central

Brenner, Matthew; Kim, Jae G.; Mahon, Sari B.; Lee, Jangwoen; Kreuter, Kelly A.; Blackledge, William; Mukai, David; Patterson, Steve; Mohammad, Othman; Sharma, Vijay S.; Boss, Gerry R.

2009-01-01

Objective To determine the ability of an intramuscular cobinamide sulfite injection to rapidly reverse the physiologic effects of cyanide toxicity. Background Exposure to cyanide in fires and industrial exposures and intentional cyanide poisoning by terrorists leading to mass casualties is an ongoing threat. Current treatments for cyanide poisoning must be administered intravenously, and no rapid treatment methods are available for mass casualty cyanide exposures. Cobinamide is a cobalamin (vitamin B12) analog with an extraordinarily high affinity for cyanide that is more water-soluble than cobalamin. We investigated the use of intramuscular cobinamide sulfite to reverse cyanide toxicity induced physiologic changes in a sublethal cyanide exposure animal model. Methods New Zealand white rabbits were given 10 mg sodium cyanide intravenously over 60 minutes. Quantitative diffuse optical spectroscopy and continuous wave near infrared spectroscopy monitoring of tissue oxy- and deoxyhemoglobin concentrations were performed concurrently with blood cyanide level measurements and cobinamide levels. Immediately after completion of the cyanide infusion, the rabbits were injected intramuscularly with cobinamide sulfite (n=6) or inactive vehicle (controls, n=5). Results Intramuscular administration led to rapid mobilization of cobinamide and was extremely effective at reversing the physiologic effects of cyanide on oxyhemoglobin and deoxyhemoglobin extraction. Recovery time to 63% of their baseline values in the central nervous system was in a mean of 1032 minutes in the control group and 9 minutes in the cobinamide group with a difference of 1023 minutes (95% confidence interval [CI] 116, 1874 minutes). In muscle tissue, recovery times were 76 and 24 minutes with a difference of 52 minutes (95% CI 7, 98min). Red blood cell cyanide levels returned towards normal significantly faster in cobinamide sulfite-treated animals than in control animals. Conclusions Intramuscular cobinamide sulfite rapidly and effectively reverses the physiologic effects of cyanide poisoning, suggesting that a compact cyanide antidote kit can be developed for mass casualty cyanide exposures. PMID:20045579

International Variability in Gastrointestinal Decontamination With Acute Poisonings.

PubMed

Mintegi, Santiago; Dalziel, Stuart R; Azkunaga, Beatriz; Prego, Javier; Arana-Arri, Eunate; Acedo, Yordana; Martinez-Indart, Lorea; Benito, Javier; Kuppermann, Nathan

2017-08-01

Identifying international differences in the management of acute pediatric poisonings may help improve the quality of care. The objective of this study was to assess the international variation and appropriateness of gastrointestinal decontamination (GID) procedures performed in children and adolescents who present with acute poisonings to emergency departments. This was an international, multicenter, cross-sectional prospective study including children <18 years with poisoning exposures presenting to 105 emergency departments in 20 countries from 8 global regions belonging to the Pediatric Emergency Research Networks. Data collection started between January and September 2013 and continued for 1 year. The appropriateness of GID procedures performed was analyzed using the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists' recommendations. Multivariate logistic regression was performed to identify independent risk factors for performing GID procedures. We included 1688 patients, 338 of whom (20.0%, 95% confidence interval 18.1%-22.0%) underwent the following GID procedures: activated charcoal (166, 49.1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%), and ipecac (3, 0.9%). In 155 (45.8%, 40.5%-51.2%), the GID procedure was considered appropriate, with significant differences between regions. Independent risk factors for GID procedures included age, toxin category, mechanism of poisoning, absence of symptoms, and the region where the intoxication occurred ( P < .001). Globally, there are substantial differences in the use and appropriateness of GID procedures in the management of pediatric poisonings. International best practices need to be better implemented. Copyright © 2017 by the American Academy of Pediatrics.

Generation rate of carbon monoxide from CO2 arc welding.

PubMed

Ojima, Jun

2013-01-01

CO poisoning has been a serious industrial hazard in Japanese workplaces. Although incomplete combustion is the major cause of CO generation, there is a risk of CO poisoning during some welding operations. The aim of the present study was to evaluate the generation rate of CO from CO2 arc welding under controlled laboratory conditions and estimate the ventilation requirements for the prevention of CO poisoning. Bead on plate welding was carried out with an automatic welding robot on a rolled steel base metal under several conditions. The concentration of emitted CO from the welding was measured by a real-time CO monitor in a well-ventilated laboratory that was free from ambient CO contamination. The generation rate of CO was obtained from the three measurements-the flow rate of the welding exhaust gas, CO concentration in the exhaust gas and the arcing time. Then the ventilation requirement to prevent CO poisoning was calculated. The generation rate of CO was found to be 386-883 ml/min with a solid wire and 331-1,293 ml/min with a flux cored wire respectively. It was found that the CO concentration in a room would be maintained theoretically below the OSHA PEL (50 ppm) providing the ventilation rate in the room was 6.6-25.9 m3/min. The actual ventilation requirement was then estimated to be 6.6-259 m3/min considering incomplete mixing. In order to prevent CO poisoning, some countermeasures against gaseous emission as well as welding fumes should be taken eagerly.

[Toxic nephropathy secondary to occupational exposure to metallic mercury].

PubMed

Voitzuk, Ana; Greco, Vanina; Caputo, Daniel; Alvarez, Estela

2014-01-01

Toxic nephrophaties secondary to occupational exposure to metals have been widely studied, including membranous nephropathy by mercury, which is rare. Occupational poisoning by mercury is frequent, neurological symptoms are the main form of clinical presentation. Secondary renal involvement in chronic exposure to metallic mercury can cause glomerular disease by deposit of immune-complexes. Membranous glomerulopathy and minimal change disease are the most frequently reported forms. Here we describe the case of a patient with occupational exposure to metallic mercury, where nephrotic syndrome due to membranous glomerulonephritis responded favorably to both chelation and immunosuppressive therapy.

Neurotoxic disorders of organophosphorus compounds and their managements.

PubMed

Balali-Mood, Mahdi; Balali-Mood, Kia

2008-01-01

Organophosphorus compounds have been used as pesticides and as chemical warfare nerve agents. The mechanism of toxicity of organophosphorus compounds is the inhibition of acetylcholinesterase, which results in accumulation of acetylcholine and the continued stimulation of acetylcholine receptors. Therefore, they are also called anticholinesterase agents. Organophosphorus pesticides have largely been used worldwide, and poisoning by these agents, particularly in developing countries, is a serious health problem. Organophosphorus nerve agents were used by Iraqi army against Iranian combatants and even civilian population in 1983 - 1988. They were also used for chemical terrorism in Japan in 1994 - 1995. Their use is still a constant threat to the population. Therefore, medical and health professionals should be aware and learn more about the toxicology and proper management of organophosphorus poisoning. Determination of acetylcholinesterase and butyrylcholinesterase activity in blood remains a mainstay for the fast initial screening of organophosphorus compounds but lacks sensitivity and specificity. Quantitative analysis of organophosphorus compounds and their degradation products in plasma and urine by mass spectrometric methods may prove exposure but is expensive and is limited to specialized laboratories. However, history of exposure to organophosphorous compounds and clinical manifestations of a cholinergic syndrome are sufficient for management of the affected patients. The standard management of poisoning with organophosphorous compounds consists of decontamination, and injection of atropine sulfate with an oxime. Recent advances on treatment of organophosphorus pesticides poisoning revealed that blood alkalinization with sodium bicarbonate and also magnesium sulfate as adjunctive therapies are promising. Patients who receive prompt proper treatment usually recover from acute toxicity but may suffer from neurologic complications.

A Pilot Study in Cameroon to Understand Safe Uses of Pesticides in Agriculture, Risk Factors for Farmers’ Exposure and Management of Accidental Cases

PubMed Central

Pouokam, Guy Bertrand; Lemnyuy Album, William; Ndikontar, Alice S.; SIDATT, Mohamed El Hady

2017-01-01

Chemical pesticides are widely used in Cameroon for agricultural production. In 2015, more than 600 pesticide products were approved for use in various foodstuffs. Much misuse of these chemicals by farmers has been documented in rural and urban settings. This pilot study aims to contribute to the improvement of the health of the population and the environmental preservation by identifying pesticide-poisoning cases, the most incriminated products and critical risk factors of exposure. Questionnaires were administered to pesticide vendors, farmers and health personnel, and observations made on farmers’ practices at their work places. From July to September 2016, 24 villages from five sites, representing the most important agricultural production areas of the five agro-ecological zones of Cameroon, were visited. In total, 519 people were interviewed: 412 farmers, 69 pesticide vendors and 38 health personnel. A total of 180 pesticide formulations out of 610 registered in 2015 were said to be used by farmers. In the 38 health centers visited, 56 cases of pesticide poisonings and intoxications were reported between 2011 and 2016. Paraquat-, glyphosate-, cypermethrin- and metalaxyl-formulated pesticides were the most incriminated. In total, 78% of poisoning cases were accidental, 12% suicide attempts, 4% criminal. Entry of pesticide products from neighboring countries needs to be better regulated, and the quality of pesticides sold on the market should be monitored periodically. Empty pesticide containers should be recuperated from smallholder farmers. Authorities should set up a harmonized pesticide-poisoning management procedure, and create a toxico-vigilance system for surveillance cases and preventive actions. PMID:29104250

Supralethal poisoning by any of the classical nerve agents is effectively counteracted by procyclidine regimens in rats.

PubMed

Myhrer, Trond; Mariussen, Espen; Enger, Siri; Aas, Pål

2015-09-01

A treatment regimen consisting of HI-6, levetiracetam, and procyclidine (termed the triple regimen) has previously been shown to work as a universal therapy against soman poisoning in rats, since it has capacities to function as both prophylactic and therapeutic measure. The purpose of the present study was to examine whether the triple regimen may have antidotal efficacy against intoxication by other classical nerve agents than soman. The treatment was given 1 and 5 min after exposure to a supralethal dose of nerve agents, and the results showed that the triple regimen successfully prevented or terminated seizures and preserved the lives of rats exposed to 5×LD50 of soman, sarin, cyclosarin, or VX, but solely 3×LD50 of tabun was managed by this regimen. To meet the particular antidotal requirements of tabun, the triple regimen was reinforced with obidoxime and was made to a quadruple regimen that effectively treated rats intoxicated by 5×LD50 of tabun. The rats recovered very well and the majority gained pre-exposure body weight within 7 days. Neuropathology was seen in all groups regardless of whether the rats seized or not. The most extensive damage was produced by sarin and cyclosarin. Differentiation between the nerve agents' potency to cause lesions was probably seen because the efficacious treatments ensured survival of supralethal poisoning. A combination of 2 oximes and 2 anticonvulsants may be a prerequisite to counteract effectively high levels of poisoning by any classical nerve agent. Copyright © 2015 Elsevier Inc. All rights reserved.

The Combination of Cobinamide and Sulfanegen Is Highly Effective in Mouse Models of Cyanide Poisoning

PubMed Central

Chan, Adriano; Crankshaw, Daune L.; Monteil, Alexandre; Patterson, Steven E.; Nagasawa, Herbert T.; Briggs, Jackie E.; Kozocas, Joseph A.; Mahon, Sari B.; Brenner, Matthew; Pilz, Renate B.; Bigby, Timothy D.; Boss, Gerry R.

2013-01-01

SUMMARY Context Cyanide poisoning is a major contributor to death in smoke inhalation victims and accidental exposure to cyanide occurs in a variety of industries. Moreover, cyanide has the potential to be used by terrorists, particularly in a closed space such as an airport or train station. Current therapies for cyanide poisoning must be given by intravenous administration, limiting their use in treating mass casualties. Objective We are developing two new cyanide antidotes—cobinamide, a vitamin B12 analog, and sulfanegen, a 3-mercaptopyruvate prodrug. Both drugs can be given by intramuscular administration, and therefore could be used to treat a large number of people quickly. We now asked if the two drugs would have an augmented effect when combined. Materials and Methods We used a non-lethal and two different lethal models of cyanide poisoning in mice. The non-lethal model assesses neurologic recovery by quantitatively evaluating the innate righting reflex time of a mouse. The two lethal models are a cyanide injection and a cyanide inhalation model. Results We found that the two drugs are at least additive when used together in both the non-lethal and lethal models: at doses where all animals died with either drug alone, the combination yielded 80 and 40% survival in the injection and inhalation models, respectively. Similarly, drug doses that yielded 40% survival with either drug alone yielded 80 and 100% survival in the injection and inhalatiion models, respectively. As part of the inhalation model, we developed a new paradigm in which animals are exposed to cyanide gas, injected intramuscularly with antidote, and then re-exposed to cyanide gas. This simulates cyanide exposure of a large number of people in a closed space, because people would remain exposed to cyanide, even after receiving an antidote. Conclusion The combination of cobinamide and sulfanegen shows great promise as a new approach to treating cyanide poisoning. PMID:21740135

A Metabolic Murder Mystery: A Case-Based Experiment for the Undergraduate Biochemistry Laboratory

ERIC Educational Resources Information Center

Childs-Disney, Jessica L.; Kauffmann, Andrew D.; Poplawski, Shane G.; Lysiak, Daniel R.; Stewart, Robert J.; Arcadi, Jane K.; Dinan, Frank J.

2010-01-01

In 1990, a woman was wrongly convicted of poisoning her infant son and was sentenced to life in prison. Her conviction was based on laboratory work that wrongly identified ethylene glycol as present in her son's blood and in the formula he drank prior to his death. The actual cause of the infant's death, a metabolic disease, was eventually…

Relation between brain temperature and white matter damage in subacute carbon monoxide poisoning

PubMed Central

Fujiwara, Shunrou; Yoshioka, Yoshichika; Matsuda, Tsuyoshi; Nishimoto, Hideaki; Ogawa, Akira; Ogasawara, Kuniaki; Beppu, Takaaki

2016-01-01

In the previous studies, carbon monoxide (CO) poisoning showed an imbalance between cerebral perfusion and metabolism in the acute phase and the brain temperature (BT) in these patients remained abnormally high from the acute to the subacute phase. As observed in chronic ischemic patients, BT can continuously remain high depending on impairments of cerebral blood flow and metabolism; this is because heat removal and production system in the brain may mainly be maintained by the balance of these two factors; thus, cerebral white matter damage (WMD) affecting normal metabolism may affect the BT in patients with CO poisoning. Here, we investigated whether the BT correlates with the degree of WMD in patients with subacute CO-poisoning. In 16 patients with subacute CO-poisoning, the BT and degree of WMD were quantitatively measured by using magnetic resonance spectroscopy and the fractional anisotropy (FA) value from diffusion tensor imaging dataset. Consequently, the BT significantly correlated with the degree of WMD. In particular, BT observed in patients with delayed neuropsychiatric sequelae, a crucial symptom with sudden-onset in the chronic phase after CO exposure, might indicate cerebral hypo-metabolism and abnormal hemodynamics like “matched perfusion,” in which the reduced perfusion matches the reduced metabolism. PMID:27819312

Treatment of severe poison ivy: a randomized, controlled trial of long versus short course oral prednisone.

PubMed

Curtis, Gabrielle; Lewis, Amy C

2014-12-01

Toxidendron (poison ivy, oak, and sumac) contact dermatitis is a common complaint in the outpatient primary care setting with little evidence-based guidance on best treatment duration. This randomized, controlled trial examined the efficacy and side effects of a 5-day regimen of 40 mg oral prednisone daily (short course) compared to the same 5-day regimen followed by a prednisone taper of 30 mg daily for 2 days, 20 mg daily for 2 days, 10 mg daily for 2 days, and 5 mg daily for 4 days over a total of 15 days (long course) in patients with severe poison ivy dermatitis. In 49 patients with severe poison ivy, non-adherence rates, rash return, medication side effects, and time to improvement and complete healing of the rash were not significantly different between the two groups. Patients receiving the long course regimen were significantly less likely to utilize other medications (22.7% vs. 55.6%, P = 0.02, number needed to treat 3.05). This study suggests that a longer course prescription may save patients' time and exposure to excess medication in the treatment of severe poison ivy. Application of this information to clinical practice will save return visits and reduce excess non-prescription medication administration to individual patients.

Biomass and toxicity responses of poison ivy (Toxicodendron radicans) to elevated atmospheric CO2.

PubMed

Mohan, Jacqueline E; Ziska, Lewis H; Schlesinger, William H; Thomas, Richard B; Sicher, Richard C; George, Kate; Clark, James S

2006-06-13

Contact with poison ivy (Toxicodendron radicans) is one of the most widely reported ailments at poison centers in the United States, and this plant has been introduced throughout the world, where it occurs with other allergenic members of the cashew family (Anacardiaceae). Approximately 80% of humans develop dermatitis upon exposure to the carbon-based active compound, urushiol. It is not known how poison ivy might respond to increasing concentrations of atmospheric carbon dioxide (CO(2)), but previous work done in controlled growth chambers shows that other vines exhibit large growth enhancement from elevated CO(2). Rising CO(2) is potentially responsible for the increased vine abundance that is inhibiting forest regeneration and increasing tree mortality around the world. In this 6-year study at the Duke University Free-Air CO(2) Enrichment experiment, we show that elevated atmospheric CO(2) in an intact forest ecosystem increases photosynthesis, water use efficiency, growth, and population biomass of poison ivy. The CO(2) growth stimulation exceeds that of most other woody species. Furthermore, high-CO(2) plants produce a more allergenic form of urushiol. Our results indicate that Toxicodendron taxa will become more abundant and more "toxic" in the future, potentially affecting global forest dynamics and human health.

Biomass and toxicity responses of poison ivy (Toxicodendron radicans) to elevated atmospheric CO2

PubMed Central

Mohan, Jacqueline E.; Ziska, Lewis H.; Schlesinger, William H.; Thomas, Richard B.; Sicher, Richard C.; George, Kate; Clark, James S.

2006-01-01

Contact with poison ivy (Toxicodendron radicans) is one of the most widely reported ailments at poison centers in the United States, and this plant has been introduced throughout the world, where it occurs with other allergenic members of the cashew family (Anacardiaceae). Approximately 80% of humans develop dermatitis upon exposure to the carbon-based active compound, urushiol. It is not known how poison ivy might respond to increasing concentrations of atmospheric carbon dioxide (CO2), but previous work done in controlled growth chambers shows that other vines exhibit large growth enhancement from elevated CO2. Rising CO2 is potentially responsible for the increased vine abundance that is inhibiting forest regeneration and increasing tree mortality around the world. In this 6-year study at the Duke University Free-Air CO2 Enrichment experiment, we show that elevated atmospheric CO2 in an intact forest ecosystem increases photosynthesis, water use efficiency, growth, and population biomass of poison ivy. The CO2 growth stimulation exceeds that of most other woody species. Furthermore, high-CO2 plants produce a more allergenic form of urushiol. Our results indicate that Toxicodendron taxa will become more abundant and more “toxic” in the future, potentially affecting global forest dynamics and human health. PMID:16754866

Treatment of Severe Poison Ivy: A Randomized, Controlled Trial of Long Versus Short Course Oral Prednisone

PubMed Central

Curtis, Gabrielle; Lewis, Amy C.

2014-01-01

Background Toxidendron (poison ivy, oak, and sumac) contact dermatitis is a common complaint in the outpatient primary care setting with little evidence-based guidance on best treatment duration. Methods This randomized, controlled trial examined the efficacy and side effects of a 5-day regimen of 40 mg oral prednisone daily (short course) compared to the same 5-day regimen followed by a prednisone taper of 30 mg daily for 2 days, 20 mg daily for 2 days, 10 mg daily for 2 days, and 5 mg daily for 4 days over a total of 15 days (long course) in patients with severe poison ivy dermatitis. Results In 49 patients with severe poison ivy, non-adherence rates, rash return, medication side effects, and time to improvement and complete healing of the rash were not significantly different between the two groups. Patients receiving the long course regimen were significantly less likely to utilize other medications (22.7% vs. 55.6%, P = 0.02, number needed to treat 3.05). Conclusions This study suggests that a longer course prescription may save patients’ time and exposure to excess medication in the treatment of severe poison ivy. Application of this information to clinical practice will save return visits and reduce excess non-prescription medication administration to individual patients. PMID:25247016

Is there a role for progesterone in the management of acute organophosphate poisoning during pregnancy?

PubMed

Jafarzadeh, Mostafa; Nasrabadi, Zeynab Nasri; Sheikhazadi, Ardeshir; Abbaspour, Abdollah; Vasigh, Shayesteh; Yousefinejad, Vahid; Marashi, Sayed Mahdi

2013-06-01

Organophosphates are commonly used pesticides and cause about one million unintentional and 2 million suicidal exposures with up to 300,000 fatalities every year around the world. Toxicity of organophosphates is due to inhibition cholinesterase activity and prolonging the effects of acetylcholine in the receptor site. Clinical features of organophosphate poisoning are defecation, urination, miosis, bronchorrhea, emesis, lacrimation and salivation. Spontaneous abortion reported some when in pregnant patients. Intravenous administration of benzodiazepines, atropine and pralidoxime is the formal treatment of this toxicity. Atropine and pralidoxime have been assigned to pregnancy class C by the FDA and should be recommended for use in pregnant women clinically suffer organophosphate poisoning. Benzodiazepines have been assigned to pregnancy class D and should be avoided during pregnancy. Clinical experiments suggest transplacental transfer of organophosphates is possible, and fetal sensitivity is probable, but a single acute overdose most likely don't make any physical deformities, therefore termination of pregnancy is not imperative. Nonetheless, no definite strategy focused on maintaining pregnancy. Here we propose an idea that in any female case of acute organophosphate poisoning in childbearing range of age, maternal serum Beta-HCG should be tested for pregnancy and prophylactic progesterone should be used in pregnant cases of organophosphate poisoning. Copyright © 2013 Elsevier Ltd. All rights reserved.

Carbon Monoxide Poisoning - Multiple Languages

MedlinePlus

... Prevention Guidelines: You Can Prevent Carbon Monoxide Exposure - English PDF Prevention Guidelines: You Can Prevent Carbon Monoxide ... Expand Section Carbon Monoxide - Furnace Safety Fact Sheet - English PDF Carbon Monoxide - Furnace Safety Fact Sheet - العربية ( ...

Hyperbaric oxygen treatment for carbon monoxide intoxication acquired in the sealed room during the Persian Gulf war.

PubMed

Adir, Y; Bitterman, H; Kol, S; Melamed, Y

1991-01-01

During the recent Persian Gulf war, the civilian population in Israel was frequently instructed to stay in sealed rooms in preparation for a possible chemical missile attack. The war broke out in mid-winter, and in many instances it was necessary to heat the rooms. The use of open fires or malfunctioning heating appliances inside sealed rooms could create ideal conditions for carbon monoxide (CO) poisoning. Six patients with CO intoxication resulting from confinement inside sealed rooms were referred for hyperbaric oxygen (HBO) treatment. Indications for HBO therapy were loss of consciousness and metabolic acidosis. The treatment protocol consisted of 90-min exposure to 100% oxygen at 2.5 atmospheres absolute (ATA), with repeated exposures when required. All patients made a full recovery. The risk of CO poisoning should be taken into consideration and should determine the selection of heating devices for future use in similar circumstances.

Pesticide-induced quadriplegia in a 55-year-old woman.

PubMed

Beavers, Charles T; Parker, Joseph J; Flinchum, Dane A; Weakley-Jones, Barbara A; Jortani, Saeed A

2014-12-01

Acephate is a commercial organophosphate pesticide formerly used in households and now used primarily for agriculture. Poisoning symptoms include salivation, lacrimation, urination, defecation, gastrointestinal illness, and emesis. In addition to these classic symptoms, neurodegeneration can result from increased and continued exposure of organophosphates. This 55-year-old woman presented with organophosphate-induced delayed neuropathy in the form of quadriplegia due to the commonly used pesticide acephate. She was exposed to this pesticide through multiple sprayings in her work office with underrecognized poisoning symptoms. She presented to her primary care physician with neuropathic pain and paralysis in her arm following the sprayings and eventual complete paralysis. The patient lived for 2 years following her toxic exposure and quadriplegia. A complete autopsy after her death confirmed a transverse myelitis in her spinal cord. We conclude that in susceptible individuals, acephate in excessive amounts can produce severe delayed neurotoxicity as demonstrated in animal studies.

Search of medical literature for indoor carbon monoxide exposure

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brennan, T.; Ivanovich, M.

1995-12-01

This report documents a literature search on carbon monoxide. The search was limited to the medical and toxicological databases at the National Library of Medicine (MEDLARS). The databases searched were Medline, Toxline and TOXNET. Searches were performed using a variety of strategies. Combinations of the following keywords were used: carbon, monoxide, accidental, residential, occult, diagnosis, misdiagnosis, heating, furnace, and indoor. The literature was searched from 1966 to the present. Over 1000 references were identified and summarized using the following abbreviations: The major findings of the search are: (1) Acute and subacute carbon monoxide exposures result in a large number ofmore » symptoms affecting the brain, kidneys, respiratory system, retina, and motor functions. (2) Acute and subacute carbon monoxide (CO) poisonings have been misdiagnosed on many occasions. (3) Very few systematic investigations have been made into the frequency and consequences of carbon monoxide poisonings.« less

Current approaches of the management of mercury poisoning: need of the hour

PubMed Central

2014-01-01

Mercury poisoning cases have been reported in many parts of the world, resulting in many deaths every year. Mercury compounds are classified in different chemical types such as elemental, inorganic and organic forms. Long term exposure to mercury compounds from different sources e.g. water, food, soil and air lead to toxic effects on cardiovascular, pulmonary, urinary, gastrointestinal, neurological systems and skin. Mercury level can be measured in plasma, urine, feces and hair samples. Urinary concentration is a good indicator of poisoning of elemental and inorganic mercury, but organic mercury (e.g. methyl mercury) can be detected easily in feces. Gold nanoparticles (AuNPs) are a rapid, cheap and sensitive method for detection of thymine bound mercuric ions. Silver nanoparticles are used as a sensitive detector of low concentration Hg2+ ions in homogeneous aqueous solutions. Besides supportive therapy, British anti lewisite, dimercaprol (BAL), 2,3-dimercaptosuccinic acid (DMSA. succimer) and dimercaptopropanesulfoxid acid (DMPS) are currently used as chelating agents in mercury poisoning. Natural biologic scavengers such as algae, azolla and other aquatic plants possess the ability to uptake mercury traces from the environment. PMID:24888360

Evaluation of the Effect of Sulfur on the Performance of Nickel/Gadolinium‐Doped Ceria Based Solid Oxide Fuel Cell Anodes

PubMed Central

Yurkiv, Vitaliy; Costa, Rémi; Schiller, Günter; Friedrich, K. Andreas

2016-01-01

Abstract The focus of this study is the measurement and understanding of the sulfur poisoning phenomena of Ni/gadolinium‐doped ceria (CGO) based solid oxide fuel cells (SOFC). Cells with Ni/CGO10 and NiCu5/CGO40 anodes were characterized by using impedance spectroscopy at different temperatures and H2/H2O fuel ratios. The short‐term sulfur poisoning behavior was investigated systematically at temperatures of 800–950 °C, current densities of 0–0.75 A cm−2, and H2S concentrations of 1–20 ppm. A sulfur poisoning mitigation effect was observed at high current loads and temperatures. The poisoning behavior was reversible for short exposure times. It was observed that the sulfur‐affected processes exhibited significantly different relaxation times that depend on the Gd content in the CGO phase. Moreover, it was demonstrated that the capacitance of Ni/CGO10 anodes is strongly dependent on the temperature and gas‐phase composition, which reflects a changing Ce3+/Ce4+ ratio. PMID:27863123

Palytoxin-Containing Aquarium Soft Corals as an Emerging Sanitary Problem.

PubMed

Pelin, Marco; Brovedani, Valentina; Sosa, Silvio; Tubaro, Aurelia

2016-02-04

Palytoxin (PLTX), one the most potent marine toxins, and/or its analogs, have been identified in different marine organisms, such as Palythoa soft corals, Ostreopsis dinoflagellates, and Trichodesmium cyanobacteria. Although the main concern for human health is PLTXs entrance in the human food chain, there is growing evidence of adverse effects associated with inhalational, cutaneous, and/or ocular exposure to aquarium soft corals contaminated by PLTXs or aquaria waters. Indeed, the number of case reports describing human poisonings after handling these cnidarians is continuously increasing. In general, the signs and symptoms involve mainly the respiratory (rhinorrhea and coughing), skeletomuscular (myalgia, weakness, spasms), cardiovascular (electrocardiogram alterations), gastrointestinal (nausea), and nervous (paresthesia, ataxia, tremors) systems or apparates. The widespread phenomenon, the entity of the signs and symptoms of poisoning and the lack of control in the trade of corals as aquaria decorative elements led to consider these poisonings an emerging sanitary problem. This review summarizes literature data on human poisonings due to, or ascribed to, PLTX-containing soft corals, focusing on the different PLTX congeners identified in these organisms and their toxic potential.

Serum and Plasma Cholinesterase Activity in the Cape Griffon Vulture (Gyps coprotheres).

PubMed

Naidoo, Vinny; Wolter, Kerri

2016-04-28

Vulture (Accipitridae) poisonings are a concern in South Africa, with hundreds of birds dying annually. Although some of these poisonings are accidental, there has been an increase in the number of intentional baiting of poached rhinoceros (Rhinocerotidae) and elephant (Elephantidae) carcasses to kill vultures that alert officials to poaching sites by circling overhead. The primary chemicals implicated are the organophosphorous and carbamate compounds. Although most poisoning events can be identified by dead vultures surrounding the scavenged carcass, weak birds are occasionally found and brought to rehabilitation centers for treatment. The treating veterinarian needs to make an informed decision on the cause of illness or poisoning prior to treatment. We established the reference interval for serum and plasma cholinesterase activity in the Cape Griffon Vulture ( Gyps coprotheres ) as 591.58-1,528.26 U/L, providing a clinical assay for determining potential exposure to cholinesterase-depressing pesticides. Both manual and automated samplers were used with the butyrylthiocholine method. Species reference intervals for both serum and plasma cholinesterase showed good correlation and manual and automated measurements yielded similar results.

Palytoxin-Containing Aquarium Soft Corals as an Emerging Sanitary Problem

PubMed Central

Pelin, Marco; Brovedani, Valentina; Sosa, Silvio; Tubaro, Aurelia

2016-01-01

Palytoxin (PLTX), one the most potent marine toxins, and/or its analogs, have been identified in different marine organisms, such as Palythoa soft corals, Ostreopsis dinoflagellates, and Trichodesmium cyanobacteria. Although the main concern for human health is PLTXs entrance in the human food chain, there is growing evidence of adverse effects associated with inhalational, cutaneous, and/or ocular exposure to aquarium soft corals contaminated by PLTXs or aquaria waters. Indeed, the number of case reports describing human poisonings after handling these cnidarians is continuously increasing. In general, the signs and symptoms involve mainly the respiratory (rhinorrhea and coughing), skeletomuscular (myalgia, weakness, spasms), cardiovascular (electrocardiogram alterations), gastrointestinal (nausea), and nervous (paresthesia, ataxia, tremors) systems or apparates. The widespread phenomenon, the entity of the signs and symptoms of poisoning and the lack of control in the trade of corals as aquaria decorative elements led to consider these poisonings an emerging sanitary problem. This review summarizes literature data on human poisonings due to, or ascribed to, PLTX-containing soft corals, focusing on the different PLTX congeners identified in these organisms and their toxic potential. PMID:26861356

Cholinesterase reactivators and bioscavengers for pre- and post-exposure treatments of organophosphorus poisoning.

PubMed

Masson, Patrick; Nachon, Florian

2017-08-01

Organophosphorus agents (OPs) irreversibly inhibit acetylcholinesterase (AChE) causing a major cholinergic syndrome. The medical counter-measures of OP poisoning have not evolved for the last 30 years with carbamates for pretreatment, pyridinium oximes-based AChE reactivators, antimuscarinic drugs and neuroprotective benzodiazepines for post-exposure treatment. These drugs ensure protection of peripheral nervous system and mitigate acute effects of OP lethal doses. However, they have significant limitations. Pyridostigmine and oximes do not protect/reactivate central AChE. Oximes poorly reactivate AChE inhibited by phosphoramidates. In addition, current neuroprotectants do not protect the central nervous system shortly after the onset of seizures when brain damage becomes irreversible. New therapeutic approaches for pre- and post-exposure treatments involve detoxification of OP molecules before they reach their molecular targets by administrating catalytic bioscavengers, among them phosphotriesterases are the most promising. Novel generation of broad spectrum reactivators are designed for crossing the blood-brain barrier and reactivate central AChE. This is an article for the special issue XVth International Symposium on Cholinergic Mechanisms. © 2017 International Society for Neurochemistry.

Chlordane Contamination of Government Quarters and Personal Property, Webb AFB, Texas

DTIC Science & Technology

1970-03-12

that chlorinated hydrocarbons do not inhibit cholinesterase as is the case with organophosphate and carbamate insecticides. Symptoms of acute poisoning...cardboard lined conduits within the concrete slab. Subsequent activation of the heating systems resulted in extensive human exposure and gross pesticide...they were considered ul.affected by their exposures to cholinesterase depressants. Such indexes of toxicity are now considered incomplete. 0. Table

The Long-Term Effects of Organophosphates Poisoning as a Risk Factor of CVDs: A Nationwide Population-Based Cohort Study

PubMed Central

Lin, Cheng-Li; Chang, Shih-Yu; Sung, Fung-Chang; Tai, Sally C. W.

2015-01-01

Background Organophosphorus pesticides are widely used throughout the world. Because of their ease of availability, organophosphorus compounds are commonly used for self-poisoning in developing countries. The acute effects of exposure to organophosphorus pesticides are well known, but the chronic effects are unclear. Recent studies suggest that abnormalities of the central and peripheral nervous systems persisted for up to 5 years after acute poisoning due to a single large dose of organophosphates (OPs). However, the long-term effects on cardiovascular diseases are poorly understood. Methodology/Principal Findings An OPs-exposed cohort (N = 7,561) and an age- and gender-matched control cohort (N = 30,244), both identified from the National Health Insurance Research Database, were compared. We utilized the multivariable Cox proportional model to estimate the risks of developing arrhythmia, coronary artery disease (CAD) and congestive heart failure (CHF). The patients with acute poisoning from OPs had higher incidence rates of arrhythmia (5.89 vs. 3.61 per 1,000 person-years), CAD (9.10 vs. 6.88 per 1,000 person-years), and CHF (3.89 vs. 2.98 per 1,000 person-years) compared with that of the non-OPs poisoning cohort, with a crude subhazard ratio (SHR) of 1.40, 1.13, and 1.12, respectively. Additionally, a significantly higher risk of arrhythmia was observed in the OPs poisoning cohort (adjusted SHR = 1.25) compared with the non-OPs poisoning cohort, particularly in male patients (adjusted SHR = 1.33) and those under 49 years of age (adjusted SHR = 3.16). After accounting for the competing risks of death, there was a higher risk of arrhythmia and CAD during a three year follow-up period (adjusted SHR = 1.50 for arrhythmia; adjusted SHR = 1.10 for CAD). We also found an adjusted SHR of 1.36 associated with developing CHF after 6 years of follow-up for OPs poisoning cohort. Conclusions Acute OPs poisoning may continuously impact human health through mechanisms that are unclear. Any supportive measurements that could contribute to a reduction in the risk of heart disease may be beneficial in cases of OPs poisoning survivors. PMID:26339906

[Health effects of pyrethrins and pyrethroids].

PubMed

Macan, Jelena; Varnai, Veda Marija; Turk, Rajka

2006-06-01

Pyrethrins, natural extracts of Chrysanthemum cinerariaefolium and Chrysanthemum cocineum flowers, and pyrethroids, synthetic analogues and derivatives of pyrethrins, are powerful insecticides. They are widely used in households and insect control in pets or livestock, in textiles such as carpets, wallpapers, furniture and clothes, as well as in agriculture, forestry and public health services. This article brings a list of pyrethrin and pyrethroid insecticides registered for use in plant protection in Croatia. Pyrethrins and pyrethroids can enter the organism by ingestion (accidental or suicidal ingestion or in food), by inhalation and/or by skin contact. Although these pesticides pose a relatively low risk to mammals due to rapid metabolism with no significant accumulation, they can induce adverse health effects, more often in acute poisoning, but also due to chronic exposure. The primary target of pyrethrin and pyrethroid toxicity is the nervous system, since they act directly on the sodium channels of nerve cell axons, leading to hyperexcitation. Another important toxicological mechanism is allergenicity, which is more pronounced with pyrethrins than with synthetic pyrethroids. Because there is no antidote for pyrethrin and pyrethroid poisoning, treatment is symptomatic and supportive. The article discusses the measures for poisoning prevention and alleviation of exposure to pyrethrins and pyrethroids in occupational settings and in general population.

Health hazards and mitigation of chronic poisoning from arsenic in drinking water: Taiwan experiences.

PubMed

Chen, Chien-Jen

2014-01-01

There are two endemic areas of long-term exposure to arsenic from drinking water in Taiwan. Residents in the southwestern and northeastern endemic areas started using high-arsenic artesian well water in the early 1910s and late 1940s, respectively. Public water supply system using surface water was implemented in southwestern and northeastern endemic areas in the 1970s and 1990s, respectively. Systemic health hazards of long-term exposure to arsenic in drinking water have been intensively investigated since the 1960s, especially after 1985 in Taiwan. Several diseases have been well documented to be associated with chronic arsenic poisoning from drinking water showing a dose-response relation. They include characteristic skin lesions like hyperpigmentation or depigmentation, hyperkeratosis in palms and soles, and Bowen disease, peripheral vascular disease (specifically blackfoot disease), ischemic heart disease, cerebral infarction, microvascular diseases, abnormal peripheral microcirculation, carotid atherosclerosis, QT prolongation and increased dispersion in electrocardiography, hypertension, goiter, diabetes mellitus, cataract (specifically posterior subcapsular lens opacity), pterygium, slow neural conduction, retarded neurobehavioral development, erectile dysfunction, and cancers of the skin, lung, urinary bladder, kidney, and liver. The method of choice to mitigate arsenic poisoning through drinking water is to use safe drinking water from uncontaminated sources.

Lithium poisoning in the intensive care unit: predictive factors of severity and indications for extracorporeal toxin removal to improve outcome.

PubMed

Vodovar, Dominique; El Balkhi, Souleiman; Curis, Emmanuel; Deye, Nicolas; Mégarbane, Bruno

2016-09-01

Lithium is responsible for life-threatening poisoning, not consistently improved by extracorporeal toxin removal (ECTR). Our aim was to identify predictive factors on admission of poisoning severity and based on an evaluation of practice, report indications for ECTR susceptible to improve outcome Methods: We performed a retrospective cohort study including all lithium-poisoned patients admitted to the ICU in a university hospital. The usual clinical, biological and toxicological variables were collected. Poisoning severity was defined by seizures, catecholamine infusion, mechanical ventilation >48 h and/or fatality. Univariate followed by multiple logistic regression analyses were performed to identify prognosticators of poisoning severity and ECTR use. From 1992 to 2013, 128 lithium-poisoned patients including acutely (10%), acute-on-chronically (63%) and chronically poisoned patients (27%) were included. The presumed ingested dose of lithium was 17.0 g [8.0-24.5] (median [25th-75th percentiles]). Serum lithium concentrations were 2.6 mmol/l [1.5-4.6], 2.8 mmol/l [1.8-4.5] and 2.8 mmol/l [2.1-3.0] on admission, peaking at 3.6 mmol/l [2.6; 6.2], 4.3 mmol/l [2.4; 6.2] and 2.8 mmol/l [2.1; 3.1] in the three groups, respectively. Severe poisoning occurred in 48 patients (38%) including four fatalities. Using the regression analysis, predictive factors of poisoning severity were Glasgow coma score ≤10 (Odds ratio (OR), 11.1; 95% confidence interval (CI), [4.1-33.3], p < 0.0001) and lithium concentration ≥5.2 mmol/l (OR, 6.0; CI, [1.7-25.5], p = 0.005). Ninety-eight patients (77%) developed acute kidney injury according to KDIGO criteria and 22 (17%) were treated with ECTR. Peak lithium concentration ≥5.2 mmol/l (OR, 22.4; CI, [6.4-96.4]; p < 0.0001) and peak creatinine concentration ≥200 μmol/l (OR, 5.0; CI, [1.4-19.2]; p = 0.01) were associated with ECTR use. Only 21/46 patients who presented one of these two criteria were actually treated with ECTR. More significant neurological impairment persisted on discharge in patients not treated with ECTR (p = 0.0007) despite not significantly shorter length of ICU stay. Lithium poisoning is responsible for severe impairments but rare fatalities. Severity can be predicted on admission using Glasgow coma score and lithium concentration. Our results suggest that ECTR could be indicated if serum lithium ≥5.2 mmol/l or creatinine ≥200 μmol/l.

A sensitivity study of s-process: the impact of uncertainties from nuclear reaction rates

NASA Astrophysics Data System (ADS)

Vinyoles, N.; Serenelli, A.

2016-01-01

The slow neutron capture process (s-process) is responsible for the production of about half the elements beyond the Fe-peak. The production sites and the conditions under which the different components of s-process occur are relatively well established. A detailed quantitative understanding of s-process nucleosynthesis may yield light in physical processes, e.g. convection and mixing, taking place in the production sites. For this, it is important that the impact of uncertainties in the nuclear physics is well understood. In this work we perform a study of the sensitivity of s-process nucleosynthesis, with particular emphasis in the main component, on the nuclear reaction rates. Our aims are: to quantify the current uncertainties in the production factors of s-process elements originating from nuclear physics and, to identify key nuclear reactions that require more precise experimental determinations. In this work we studied two different production sites in which s-process occurs with very different neutron exposures: 1) a low-mass extremely metal-poor star during the He-core flash (nn reaching up to values of ∼ 1014cm-3); 2) the TP-AGB phase of a M⊙, Z=0.01 model, the typical site of the main s-process component (nn up to 108 — 109cm-3). In the first case, the main variation in the production of s-process elements comes from the neutron poisons and with relative variations around 30%-50%. In the second, the neutron poison are not as important because of the higher metallicity of the star that actually acts as a seed and therefore, the final error of the abundances are much lower around 10%-25%.

Chronic health effects in people exposed to arsenic via the drinking water: dose-response relationships in review.

PubMed

Yoshida, Takahiko; Yamauchi, Hiroshi; Fan Sun, Gui

2004-08-01

Chronic arsenic (As) poisoning has become a worldwide public health issue. Most human As exposure occurs from consumption of drinking water containing high amounts of inorganic As (iAs). In this paper, epidemiological studies conducted on the dose-response relationships between iAs exposure via the drinking water and related adverse health effects are reviewed. Before the review, the methods for evaluation of the individual As exposure are summarized and classified into two types, that is, the methods depending on As concentration of the drinking water and the methods depending on biological monitoring for As exposure; certain methods may be applied as optimum As exposure indexes to study dose-response relationship based on various As exposure situation. Chronic effects of iAs exposure via drinking water include skin lesions, neurological effects, hypertension, peripheral vascular disease, cardiovascular disease, respiratory disease, diabetes mellitus, and malignancies including skin cancer. The skin is quite sensitive to arsenic, and skin lesions are some of the most common and earliest nonmalignant effects related to chronic As exposure. The increase of prevalence in the skin lesions has been observed even at the exposure levels in the range of 0.005-0.01 mg/l As in drinking waters. Skin, lung, bladder, kidney, liver, and uterus are considered as sites As-induced malignancies, and the skin is though to be perhaps the most sensitive site. Prospective studies in large area of endemic As poisoning, like Bangladesh or China, where the rate of malignancies is expected to increase within the next several decades, will help to clarify the dose-response relationship between As exposure levels and adverse health effects with enhanced accuracy.

Storm-Related Carbon Monoxide Poisoning: An Investigation of Target Audience Knowledge and Risk Behaviors.

PubMed

Damon, Scott A; Poehlman, Jon A; Rupert, Douglas J; Williams, Peyton N

Carbon monoxide (CO) poisonings in the United States consistently occur when residents improperly use portable gasoline-powered generators and other tools following severe storms and power outages. However, protective behaviors-such as installing CO alarms and placing generators more than 20 feet away from indoor structures-can prevent these poisonings. This study identified knowledge, attitudes, and beliefs that lead consumers to adopt risk and protective behaviors for storm-related CO poisoning and post-storm generator use. Four focus groups (32 participants in total) were conducted with generator owners in winter and summer storm-prone areas to explore home safety, portable generator use, CO poisoning knowledge, and generator safety messages. Discussions were transcribed, and findings analyzed using an ordered meta-matrix approach. Although most generator owners were aware of CO poisoning, many were unsure what constitutes a safe location for generator operation and incorrectly stated that enclosed areas outside the home-such as attached garages, sheds, and covered porches-were safe. Convenience and access to appliances often dictated generator placement. Participants were receptive to installing CO alarms in their homes but were unsure where to place them. These findings suggest a deficit in understanding how to operate portable generators safely and a need to correct misconceptions around safe placement. In terms of behavioral price, the simple installation and maintenance of inexpensive CO alarms may be the most important strategy for ultimately protecting homes from both storm-related and other CO exposures.

Storm-Related Carbon Monoxide Poisoning: An Investigation of Target Audience Knowledge and Risk Behaviors

PubMed Central

Damon, Scott A.; Poehlman, Jon A.; Rupert, Douglas J.; Williams, Peyton N.

2015-01-01

Carbon monoxide (CO) poisonings in the United States consistently occur when residents improperly use portable gasoline-powered generators and other tools following severe storms and power outages. However, protective behaviors—such as installing CO alarms and placing generators more than 20 feet away from indoor structures—can prevent these poisonings. This study identified knowledge, attitudes, and beliefs that lead consumers to adopt risk and protective behaviors for storm-related CO poisoning and post-storm generator use. Four focus groups (32 participants in total) were conducted with generator owners in winter and summer storm-prone areas to explore home safety, portable generator use, CO poisoning knowledge, and generator safety messages. Discussions were transcribed, and findings analyzed using an ordered meta-matrix approach. Although most generator owners were aware of CO poisoning, many were unsure what constitutes a safe location for generator operation and incorrectly stated that enclosed areas outside the home—such as attached garages, sheds, and covered porches—were safe. Convenience and access to appliances often dictated generator placement. Participants were receptive to installing CO alarms in their homes but were unsure where to place them. These findings suggest a deficit in understanding how to operate portable generators safely and a need to correct misconceptions around safe placement. In terms of behavioral price, the simple installation and maintenance of inexpensive CO alarms may be the most important strategy for ultimately protecting homes from both storm-related and other CO exposures. PMID:26345640

The study of etiological and demographic characteristics of acute household accidental poisoning in children - a consecutive case series study from Pakistan

PubMed Central

2010-01-01

Background To determine the agents of poisoning and demographic distribution of children brought to Civil Hospital Karachi (CHK) with a history of accidental poison intake and to examine the factors associated with it. Methods This hospital based descriptive study of first 100 patients from both sexes who presented to Pediatric department, CHK from 1st January 2006 till 31st December 2008 with exposure to a known poisonous agent and fulfilling other inclusion criteria were included in the study. Data regarding their demographic profile and potential risk factors was collected on a well structured proforma, cases were followed until discharge or expiry. Data was analyzed using frequencies, proportions, group means, median and standard deviations. Results The male to female ratio in our study was 1.2:1, with kerosene (50%) being the most common household agent followed by medicines (38%), insecticides (7%) and bathroom cleaners (5%). Factors such as mother's education level, number of siblings and storage place of poison correlated significantly with the cases of accidental poisoning. Most of the children (70%) presented within 3 hours of ingestion. Dyspnea was the most common symptom observed. The mortality rate in our study was 3%. Conclusions Children belonging to age group 2-3 years are the most susceptible both in terms of morbidity and mortality. Preventive strategies need to be adopted at a national level to spread awareness among parents. PMID:20438635

Risk and protective behaviours for residential carbon monoxide poisoning.

PubMed

Rupert, Douglas J; Poehlman, Jon A; Damon, Scott A; Williams, Peyton N

2013-04-01

Unintentional, non-fire-related carbon monoxide (CO) poisoning is a leading cause of poisoning death and injury in the USA. Residential poisonings caused by faulty furnaces are the most common type of CO exposure. However, these poisonings are largely preventable with annual furnace inspections and CO alarm installation. This study aimed to identify the knowledge, attitudes and beliefs that might lead consumers to adopt these protective behaviours. In August 2009, four focus groups (n=29) were conducted with homeowners in Chicago, Illinois, USA, to identify the knowledge, attitudes and beliefs that lead consumers to adopt risk and protective behaviours. Discussions were transcribed and the findings were analysed using an ordered meta-matrix. Focus group participants were aware of CO poisoning and supported the idea of regular furnace inspections. However, few participants consistently scheduled professional inspections for fear of costly repairs and unscrupulous contractors. Participants often owned CO alarms, but many did not locate them properly, nor maintain them. Some participants confused CO and natural gas and were unsure how to react if a CO alarm sounds. Participants stated that incentives, such as discounts and inspector selection tips, would make them more likely to schedule furnace inspections. Participants also identified trustworthy sources for CO education, including realtors, fire departments, home insurance agents and local media outlets. Participants' residential CO risk behaviours are not random but driven by underlying knowledge, attitudes and beliefs. Correcting misperceptions, providing incentives and partnering with trustworthy sources might encourage greater consumer adoption of protective behaviours.

Pediatric exposure to laundry detergent pods.

PubMed

Valdez, Amanda L; Casavant, Marcel J; Spiller, Henry A; Chounthirath, Thiphalak; Xiang, Huiyun; Smith, Gary A

2014-12-01

Laundry detergent pods are a new product in the US marketplace. This study investigates the epidemiologic characteristics and outcomes of laundry detergent pod exposures among young children in the United States. Using data from the National Poison Data System, exposures to laundry detergent pods among children younger than 6 years of age during 2012-2013 were investigated. There were 17 230 children younger than 6 years exposed to laundry detergent pods in 2012-2013. From March 2012 to April 2013, the monthly number of exposures increased by 645.3%, followed by a 25.1% decrease from April to December 2013. Children younger than 3 years accounted for 73.5% of cases. The major route of exposure was ingestion, accounting for 79.7% of cases. Among exposed children, 4.4% were hospitalized and 7.5% experienced a moderate or major medical outcome. A spectrum of clinical effects from minor to serious was seen with ingestion and ocular exposures. There were 102 patients (0.6%) exposed to a detergent pod via ingestion, aspiration, or a combination of routes, including ingestion, who required tracheal intubation. There was 1 confirmed death. Laundry detergent pods pose a serious poisoning risk to young children. This nationwide study underscores the need for increased efforts to prevent exposure of young children to these products, which may include improvements in product packaging and labeling, development of a voluntary product safety standard, and public education. Product constituent reformulation is another potential strategy to mitigate the severity of clinical effects of laundry detergent pod exposure. Copyright © 2014 by the American Academy of Pediatrics.

Inconsistencies in emergency instructions on common household product labels.

PubMed

Cantrell, F Lee; Nordt, Sean Patrick; Krauss, Jamey R

2013-10-01

Human exposures to non-pharmaceutical products often results in serious injury and death annually in the United States. Studies performed more than 25 years ago described inadequate first aid advice on the majority of household products. The current study evaluates contemporary non-pharmaceutical products with respect to location, uniformity and type of their first aid and emergency contact instructions. A random, convenience sample of commercial product label information was obtained from local retail stores over an 8 month period. Twelve common non-pharmaceutical product categories, with large numbers of annual human exposures, were identified from National Poison Data Systems data. A minimum of 10 unique products for each category utilized. The following information identified: product name and manufacturer, location on container, presence and type of route-specific treatment, medical assistance referral information. A total of 259 product labels were examined. First aid/contact information was located on container: rear 162 (63 %), side 28 (11 %), front 3 (1 %), bottom 2 (0.77 %), behind label 14 (5 %), missing entirely 50 (19 %). Fifty-five products (21 %) lacked any first aid instructions. Suggested contacts for accidental poisoning: none listed 75 (29 %), physician 144 (56 %), poison control centers 102 (39 %), manufacturer 44 (17 %), "Call 911" 10 (4 %). Suggested contacts for unintentional exposure and content of first aid instructions on household products were inconsistent, frequently incomplete and at times absent. Instruction locations similarly lacked uniformity. Household product labels need to provide concise, accurate first aid and emergency contact instructions in easy-to-understand language in a universal format on product labels.

Reviews of the environmental effects of pollutants: IV. Cadmium

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hammons, A.S.; Huff, J.E.; Braunstein, H.M.

This report is a comprehensive, multidisciplinary review of the health and environmental effects of cadmium and specific cadmium derivatives. More than 500 references are cited. The cadmium body burden in animals and humans results mainly from the diet. In the United States, the normal intake of cadmium for adult humans is estimated at about 50 ..mu..g per day. Tobacco smoke is a significant additional source of cadmium exposure. The kidneys and liver together contain about 50% of the total cadmium body burden. Acute cadmium poisoning is primarily an occupational problem, generally from inhalation of cadmium fumes or dusts. In themore » general population, incidents of acute poisoning by inhaled or ingested cadmium or its compounds are relatively rare. The kidney is the primary target organ for toxicity from prolonged low-level exposure to cadmium. No causal relationship has been established between cadmium exposure and human cancer, although a possible link between cadmium and prostate cancer has been indicated. Cadmium has been shown to be teratogenic in rats, hamsters, and mice, but no such effects have been proven in humans. Cadmium has been reported to increase the frequency of chromosomal aberrations in cultured Chinese hamster ovary cells and in human peripheral leukocytes. The major concern about environmental cadmium is the potential effects on the general population. There is no substantial evidence of hazard from current levels of cadmium in air, water, or food. However, because cadmium is a cumulative poison and because present intake provides a relatively small safety margin, there are adequate reasons for concern over possible future increases in background levels.« less

Active surveillance of abused and misused prescription opioids using poison center data: a pilot study and descriptive comparison.

PubMed

Hughes, Alice A; Bogdan, Gregory M; Dart, Richard C

2007-01-01

Prescription opioids are abused throughout the United States. Several monitoring programs are in existence, however, none of these systems provide up-to-date information on prescription opioid abuse. This article describes the use of poison centers as a real-time, geographically specific, surveillance system for prescription opioid abuse and compares our system with an existing prescription drug abuse monitoring program, the Drug Abuse Warning Network (DAWN). Data were collected from eight geographically dispersed poison centers for a period of twelve months. Any call involving buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone was considered a case. Any case coded as intentional exposure (abuse, intentional misuse, suicide, or intentional unknown) was regarded as misuse and abuse. Comparative data were obtained from DAWN. Poison center rates of abuse and misuse were highest for hydrocodone at 3.75 per 100,000 population, followed by oxycodone at 1.81 per 100,000 population. DAWN emergency department (ED) data illustrate a similar pattern of abuse with most mentions involving hydrocodone and oxycodone. Poison center data indicate that people aged 18 to 25 had the highest rates of abuse. DAWN reported the majority of ED mentions among 35 to 44-year-olds. Geographically, Kentucky had the uppermost rates of abuse and misuse for all opioids combined at 20.69 per 100,000 population. CONCLUSIONS. Comparing poison center data to DAWN yielded mostly comparable results, including hydrocodone as the most commonly mentioned drug. Our results suggest poison center data can be used as an indicator for prescription opioid abuse and misuse and can provide timely, geographically specific information on prescription drug abuse.

Lead poisoning outbreak among opium users in the Islamic Republic of Iran, 2016–2017

PubMed Central

Ghane, Talat; Zamani, Nasim; Beyrami, Ali; Noroozi, Alireza

2018-01-01

Abstract Objective To describe an outbreak of lead poisoning among opium users in the Islamic Republic of Iran and estimate the number of affected people in the country. Methods We used data from the country’s largest poison treatment centre to illustrate the epidemiology of an outbreak of lead poisoning in oral opium users. We describe the government’s referral and treatment guidelines in response to the outbreak. Based on the number of individuals treated and previous studies on the prevalence of oral opium use we estimated the total number of people at risk of lead-contaminated opium nationwide. Findings In February 2016, we noticed a steep increase in the numbers of oral opium users referred to our poison treatment centre with abdominal pain, anaemia and constipation. Numbers peaked in June 2016 but the outbreak was ongoing in August 2017. The mean blood lead level in a sample of 80 patients was 140.3 µg/dL (standard deviation: 122.6). Analysis of an illegal opium sample showed 3.55 mg lead in 1 g opium. Treatment was exposure reduction with opioid substitutes and laxatives, or chelation therapy if indicated. Over 7 months, 4294 poison cases were seen at main referral hospitals in Tehran out of an estimated 31 914 oral opium users in the city. We estimate more than 260 000 out of 773 800 users nationwide remain untreated and at risk of poisoning. Conclusion Lead-contaminated opium and heroin that has transited through the Iranian markets is a global risk and highlights a need for better monitoring of illegal drug supplies. PMID:29531415

Building a Healthy Environment.

ERIC Educational Resources Information Center

Simon, Elizabeth

1997-01-01

Describes how school districts, with the help of a good architect, can construct or renovate schools and avoid most environmental hazards. Issues concerning indoor air quality, asbestos, lead poisoning, ergonomics, and adverse exposure to radon and electric and magnetic fields are addressed. (GR)

Dehydropyrrolizidine alkaloid toxicity, cytotoxicity, and carcinogenicity

USDA-ARS?s Scientific Manuscript database

Dehyro-pyrrolizidine alkaloid (PA)-containing plants compose about 5% of the world’s flowering plants and they commonly poison livestock, wildlife and humans. Previous work has produced considerable understanding of PA toxicity, species susceptibility, conditions and routes of exposure, toxin metab...

76 FR 44506 - Petition Requesting Non-See-Through Packaging for Torch Fuel and Lamp Oil

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... New Jersey Poison Information and Education System stated in June 2008 that four people were... Control Centers' National Data System has chronicled the exposure of many young children to lamp oils...