Bruce Ruck

Evaluation of adverse drug reactions reported to a poison control center between 2000 and 2007

PURPOSE The likelihood of hospitalization caused by adverse drug reactions (ADRs) from commonly implicated therapeutic groups is discussed. METHODS A retrospective analysis of the computerized records of exposure cases involving pharmaceutical substances reported to the New Jersey Poison Information and Education System (NJPIES) was conducted from 2000 through 2007. The cases in the National Poisoning Data System that were categorized as an ADR were included in the study set. Only reports involving a single drug were selected for inclusion in the analyses. Characteristics of the ADRs, such as the sex and age of the patient, the therapeutic group involved, and the medical outcome of the exposure, were examined. Reports of ADRs with the most frequently implicated therapeutic groups were analyzed based on whether the patients were managed onsite, referred to a health care facility, or managed at a health care facility. The Adverse Drug Reaction Hospitalization (ADRH) index was calculated for all therapeutic groups, but the focus of the analyses was on the groups that were implicated in 5% or more of all ADRs. RESULTS A total of 454,520 cases of human poisoning exposure were reported to NJPIES from 2000 through 2007. Of these cases, 162,105 were exposures implicating a single drug, of which 5,461 (3.4%) were classified as an ADR. Of the 5,461 cases, 385 patients were admitted into a health care facility. Antidepressants had the highest ADRH index (20.4%) among the therapeutic groups implicated, and antimicrobials had the lowest (2.2%). CONCLUSION The analyses revealed a substantial variation in the likelihood of hospitalization associated with ADRs within different therapeutic groups. Among the groups that were most frequently implicated in ADRs, antidepressants showed the highest probability for an ADR-related hospitalization, followed by dietary supplements, herbals, and homeopathics and then by sedatives, hypnotics, and antipsychotics.

Case of elevated blood lead in a south Asian family that has used sindoor for food coloring

After a routine blood testing, a local pediatrician discovered that a 13-month-old boy had an elevated blood lead level (BLL) of 57 µg/dL. Since the baby was mostly breast-fed, the pediatrician did a blood test on the mother, and the result showed a BLL of 85 µg/dL. As the mother denied any history of pica behavior, the pediatrician suspected a source of lead to which the entire family might have been exposed and tested the fathers BLL. The results showed a BLL of 95 µg/dL, and the pediatrician informed the poison center. The subsequent epidemiological investigation revealed that the parents had used a product called Sindoor for food coloring. Laboratory analyses showed that the product contains more than 57.8% of acid-extractable lead by weight. Given the extremely high content of Pb in this product, Sindoor poses a serious risk of lead poisoning if it is used for food coloring.

Poison control center surge capacity during an unusual increase in call volume--results from a natural experiment

INTRODUCTION Poison Control Centers (PCCs) play an integral role in the preparation for and management of poison emergencies. Large-scale public health disasters, caused by both natural and human factors, may result in a drastic increase in the number of inquiries received and handled by PCCs in short periods of time. In order to plan and prepare for such public health emergencies, it is important for PCCs to assess their ability to handle the surge in call volume and to examine how the unusually large number of calls could affect the level of services. On 26 January 2006, the New York City Poison Center experienced a sudden loss of telephone service. The disruption in telephone service led to the need to reroute calls from that geographical catchment area to the New Jersey Poison Information and Education System (NJPIES) for several hours. METHODS Data from the NJPIES was abstracted from the telephone switchs internal reporting system and the NJPIESs electronic record system and processed with a standard spreadsheet application. RESULTS Compared to the same time and day in the previous week, the total number of calls received by the NJPIES during the four hours after the disruption increased by 148%. A substantial rise in the number of calls was observed in almost every 15-minute increment during this four-hour (h) time period (with some of these increments increasing as much as 525%). Meanwhile, the percentage of calls answered by the NJPIES decreased, and the percentage of calls abandoned during a 15-minute increment reached as high as 62%. Furthermore, the average time for handling calls was longer than usual in most of these 15-minute increments. CONCLUSIONS Limitations of the telephone technology, which impacted the ability of the NJPIES to respond to the surge of calls, were observed. While the NJPIES was able to handle the unusual increase of incoming calls using available poison specialists and staff, the experience gained from this natural experiment demonstrates the need for PCCs to have a pre-planned surge capacity protocol that can be implemented rapidly during a public health emergency. A number of challenges that PCCs must meet in order to have adequate surge capacity during such events were identified.

Poison control centers' role in glow product-related outbreak detection: implications for comprehensive surveillance system.

INTRODUCTION The development of syndromic surveillance systems to detect bioterrorist attacks and emerging infectious diseases has become an important and challenging goal to many governmental agencies and healthcare authorities. This study utilized the sharp increase of glow product-related calls to demonstrate the utility of poison control data for early detection of potential outbreaks during the week of Halloween in 2007. METHODS A review was conducted of the electronic records of exposures reported to the New Jersey Poison Information and Education System (NJPIES) Poison Control Hotline from 2002 through 2007 with generic code number 0201027 (glow products) set by the American Association of Poison Control Centers (AAPCC). Key information such as age, gender, time of the call, exposure reason, clinical effects, and medical outcomes along with telephone number, zip code, and county location were used in the analyses to determine the extent of the outbreak. RESULTS Analyses included a total of 139 glow product-related calls during the week of Halloween in 2007 with a single-day high of 59 calls on Halloween Day. More than 90% of the glow product exposures were in children 1-10 years of age. The glow product-related calls on Halloween Day increased from 14 calls in 2002 to 59 calls in 2007, a 321% increase during a six-year period. CONCLUSIONS Poison control centers in the United States are equipped with a unique and uniform input data collection system -- the National Poison Data System -- that provides an important data source in the development of a comprehensive surveillance system for early outbreak detection.

Incorporating the Treatment of Medical and Psychiatric Disorders in the Critical Care Area

Critical care areas are fast moving, often chaotic, and therefore confusing, even frightening, to patients attempting to understand what has happened to them. The nurse acts to mitigate these reactions by understanding the range of possibilities that can occur with patients, including potential psychiatric issues, and serving as patient advocate to ensure that appropriate treatment is initiated. Certainly there may be other psychiatric problems not described in the preceding text. The main possibilities are covered in this article. Assessing and acting early are tools the critical care nurse uses to meet patient needs and prevent behavioral problems that can interfere with life-preserving care.

Trends in Major Types of Poisoning Exposures in Children Reported to a Regional Poison Control Center, 1994-2001

According to the 2001 annual report of the American Association of Poison Control Centers (AAPCC) Toxic Exposure Surveillance System (TESS), a total of 1,326,090 poisoning exposure cases involving children 0 to12 years of age were reported to regional poison control centers (PCCs) in the United States during 2001.1 These cases accounted for 58.5% of all cases of human poisoning exposures reported to poison centers in 2001. The documented cases are likely to be lower than the actual number of poisoning exposures in children because of possible underreporting to PCCs.2-5 Still, the TESS data compiled by poison control centers are perhaps the most comprehensive source of information on poisoning exposures occurring among children in the United States during each year. Since 1994, the annual TESS reports compiled by AAPCC have shown a relative increase in the total number of poisonings in children 0 to 12 years of age. Because of inherent year-to-year changes in the regional poison control centers’ participation and reporting, the yearly frequencies of reported exposures aggregated by the AAPCC on a national level may not be accurate proxies for understanding the trends in the occurrence of poisonings over time. In this respect, the TESS data collected by a regional poison control center are a dependable source of continuous information allowing evaluation of the time trends in age-specific poisoning exposures that occur on the local level. In this study, we examined the changes in the major types of poisoning exposures in children reported to the New Jersey Poison Information and Education System (NJPIES) during 1994 through 2001. NJPIES is an AAPCC accredited regional poison center that began service in February 1983, replacing 35 local “poison control centers” at hospitals across the state. Since then, it has been the only resource for onsite treatment of poisoning exposures through telephone management and consultation in New Jersey. NJPIES maintains computerized records for each call that is received by the center. The poison specialists who handle the calls at NJPIES are physicians, registered nurses, or pharmacists who manage over 50,000 poison exposure cases annually. NJPIES