Jill R.K. Griffith

The value and evolving role of the U.S. poison control center system.

Henry A. Spiller, MS, DABAF Jill R.K. Griffith, BS, PharmD* Poison control centers (PCCs) in the United States play a hybrid role, function ing as part of the public health infrastructure and as direct-service providers, while offering poison treatment advice. In 2003, partially in recognition of their place in the public health infrastructure, Title XII of the Public Health Service Act was amended to specifically include authorization for PCCs. As the sophistication of the PCC system has increased, the role of poison centers has evolved over time to include involvement in health-care cost reductions and

Toxicity from modafinil ingestion

Introduction. Modafanil, a non-amphetamine stimulant, is used for narcolepsy, sleep apnea, and shift work sleep disorder. There is little available information on the toxicity of modafinil overdose. Method. We performed a retrospective multi-poison center chart review of patients from 11 states who had a single substance ingestion of modafanil with follow up to a known outcome for the years 2000–2007. Data collected included age, gender, dose ingested, clinical effects, length of hospital stay, and medical outcome. Results. There were 137 patients, of whom 85 (63%) were female. Ages ranged from 1 to 82 years with a mean and median of 22 years (+18) and 20 years, respectively, with 43 patients (31%) aged <6 years. Most frequently reported clinical effects were tachycardia (n = 38), insomnia (n = 33), agitation (n = 27), dizziness (n = 25), and anxiety (n = 24). Forty-five patients were managed at home and 92 in a health-care setting, with only 23 (17%) requiring a medical admission. Therapies included benzodiazepines (n = 14), diphenhydramine (n = 5), β-blockers (n = 3), haloperidol (n = 2), IV fluid hydration (n = 2), and one each of nitroglycerin, epinephrine, benztropine, and promethazine. Conclusions. In this case series, clinical effects of modafinil overdoses were generally mild with predominantly tachycardia and CNS toxicity. However, clinically significant effects warranting specific therapy occurred in a minority of patients.

Pregabalin overdose with benign outcome

To the Editor:Pregabalin (S-(+)-3-isobutylgaba) (Lyrica®), a lipophilic analog of γ-aminobutyric acid (GABA), is one of a group of newer antiepileptic drugs approved by the Food and Drug Administra...

Prolonged cardiovascular effects after unintentional ingestion of tetrahydrozoline

Tetrahydrozoline is an imidazoline derivative with alpha receptor agonist activity widely available in over-the-counter topical ocular and nasal formulations. More than 1,600 cases of oral exposures are reported to United States poison centers annually (). Reports of significant toxicity from tetrahydrozoline ingestion are unusual but have occured primarily in small children after unintentional ingestion (). We report a case of unintentional tetrahydrozoline ingestion with cardiovascular effects persisting for 36 hours.

Increasing burden of pill identification requests to US Poison Centers

Introduction. Information calls to poison centers, particularly for pill identification (PID), have been increasing. Methods. Retrospective review of information calls reported to U.S. poison centers for 2002–2007. Results. Total number of information calls increased by 44%, while calls related to human exposures increased by 4.3%. The subcategory “pill identification” was exclusively responsible for the increase in information calls with an increase of greater than 90%. Over the 6 years, PID requests from the public, police, and healthcare facility changed by +110, +144, and −24%, respectively. PID requests from the public, police, and healthcare facility were 78, 12 and 10%, respectively. Other information calls showed a decrease or no change: calls for poison information (−17%), medical information (−2.5%), and drug information (non-PID) (+1%). Twenty-five percent of all calls to U.S. poison centers are now to identify a pill unrelated to an exposure. Sixty-four percent of all identified pills were drugs with abuse potential. Discussion. Drugs with abuse potential are less than 4% of pharmaceutical sales, yet greater than 60% of all PID requests involved drugs with abuse potential. This suggests that PID is strongly driven by interest in drugs with abuse potential. Conclusions. PID calls are increasing dramatically and taxing limited poison center resources. The majority requests for identification of an unknown pill involved drugs with abuse potential.