Joseph C. Veltri

Retrospective Analysis of Calls to Poison Control Centers Resulting from Exposure to the Insect Repellent N, N-diethyl-M-Toluamide (DEET) from 1985–1989

This study analyzed 9,086 human exposures involving N,N-diethyl-m-toluamide--containing insect repellents that were reported to Poison Control Centers from 1985-1989. Nearly two-thirds of those exposed had no adverse effects or only experienced minor symptoms that resolved rapidly. Symptoms were more likely to occur after ocular or inhalation exposures and least likely to occur if the product was ingested. The only reported death occurred in a patient who suicidally ingested 8 oz of an insect repellent containing N,N-diethyl-m-toluamide. Five patients may have experienced a serious or potentially life-threatening effect but the poison center record did not provide unequivocal substantiation of the effect or clearly establish N,N-diethyl-m-toluamide as the causative agent. From the analysis of those patients calling Poison Control Centers, it appears the risk of serious medical effects with the labeled use of N,N-diethyl-m-toluamide-containing insect repellents is low in comparison with its reported annual use by about 30% of Americans. For patients contacting Poison Control Centers, the occurrence of adverse effects appears to be related to the route of exposure rather than age or gender of the patient or the concentration of N,N-diethyl-m-toluamide in the product.

Human Exposures to N, N-diethyl-m-toluamide Insect Repellents Reported to the American Association of Poison Control Centers 1993–1997

This study analyzed 20,764 exposures involving insect repellants containing N, N-diethyl-m-toluamide (DEET) that were reported to poison control centers from 1993 to 1997. Nearly 70% of the cases reported no symptoms related to the exposure. The occurrence of symptoms was related to the route of exposure, with the highest rates associated with ocular exposures, followed by inhalation, multiple exposure routes, dermal, andingestion. Two deaths were reported, one in a 26-year-old male and one in a 34-year-old female, both following a dermal exposure. Twenty-six subjects experienced major effects. The greatest number of reported exposures involved infants and children, but this group experienced lower rates of adverse effects than teens or adults. There was no clear relationship between DEET concentration and presence or severity of clinical effects. For the cases reported to poison control centers and included in this analysis, the risk of serious medical effects for labeled use of insect repellants containing N, N-diethyl-m-toluamide appears to be low.

A prospective, population-based study of acute ibuprofen overdose: Complications are rare and routine serum levels not warranted

The availability of ibuprofen without a prescription requires assessment of its acute toxicity in the general population. We report results from a prospective study of 329 cases of ibuprofen overdose from a statewide cohort that were reported to our poison center between April 1985 and November 1986; 85 patients had ibuprofen serum concentrations measured. Gastrointestinal disturbances and central nervous system depression were the most common clinical findings (42% and 30% of patients, respectively), but the severity was mild; only one patient had severe symptoms that could be attributed to ibuprofen. Ibuprofen serum concentrations correlated poorly with gastrointestinal symptoms (r = -.177), central nervous system findings (r = .176), presence of coingestants (r = .078), and presence of potentially life-threatening symptoms (r = .087). We evaluated the usefulness of a previously published nomogram to predict ibuprofen toxicity; the positive predictive value for severe symptoms was 6% for all patients and 0% for patients ingesting ibuprofen alone. We conclude that the frequency of life-threatening complications from ibuprofen overdose is low, the nomogram is not predictive of toxicity, and routine serum concentration determinations are not useful as an adjunct in the management of overdose cases.

A comparison of the frequency and severity of poisoning cases for ingestion of acetaminophen, aspirin, and ibuprofen

During 1984, 62,837 cases of human exposure to analgesics were reported to the National Data Collection System of the American Association of Poison Control Centers. We undertook a comparative study of 10,134 cases of human exposure to adult formulations of aspirin, acetaminophen, and ibuprofen from which we found that human exposures to analgesics are a common problem reported to poison control centers. All three analgesics studied appear to have minimal toxicity in children who accidentally ingest the product and report the exposure to a poison control center. Most children were managed without referral to a health care facility and without specific therapeutic intervention, other than palliative measures; only a few children develop symptoms from the exposure. When symptoms developed, most were not life-threatening and the child returned to a preexposure state of health within a short time after the onset of symptoms. In adults, the analgesics appear to be relatively safe--that is, most cases had either no effect or caused only minor symptoms; less than 5% of the patients developed a major effect and less than 0.5% died as a result of their exposure. Because the majority of adults took the analgesic intentionally, the low rate of serious effect is notable. Fewer adult patients who ingested ibuprofen were hospitalized or experienced a major effect as a result of their exposure than patients ingesting aspirin or acetaminophen. No deaths were reported in the ibuprofen group.

The volume of a swallow: Correlation of deglutition with patient and container parameters

The study purpose was to evaluate the relationships between average volume of a swallow (AVS) and age, height, weight, sex, and container-opening diameter (COD) to confirm and expand the work of Jones and Work. Forty-five males and 50 females between two and 18 years of age were studied. Each subject drank five swallows from each of four containers. AVS for each subject under each condition was calculated and the joint relationship with the independent variables analyzed by multiple regression. Age, height, and weight were highly intercorrelated, and each had similar correlations with AVS. COD was important; between 24 and 90 months of age, swallows from the 6.5 cm COD had a three- or four-fold larger AVS than swallows from the 1.5 cm COD. Sex differences in AVS were noted in subjects over seven years of age. These findings suggest that determination of the childs age and number of swallows ingested may be useful in estimating the fluid volume ingested and the potential toxicity of an exposure.

One Year's Experience in a Regional Poison Control Center: The Intermountain Regional Poison Control Center

The Intermountain Regional Poison Control Center in Salt Lake City, Utah, has served as a regional poison center since 1971. Between 1972 and 1976 the call load has more than tripled, with the highest frequency of calls per population coming from counties most proximate to the center. Two-thirds of the cases involve children age five or less, with 18 or over being the next large group. Adolescents and school-age children comprised the smallest group of cases. Two predominant types of poisonings were encountered: accidental ingestions of toxic substances in children and intentional self-poisonings in adults, but the poison center handled almost every conceivable type of poisoning or toxic situation. A detailed analysis of the centers overall experience as well as these two major categories is presented.

Recurrent Poisonings Among Paediatric Poisoning Victims

SummaryA study of 1943 potentially toxic ingestions occurring in children under 6 years of age was conducted by 3 geographically and demographically diverse poison centres to determine the incidence of exposures to poison. Of the total group, 30.1% indicated that the child had experienced a prior poison exposure (12.0% in children under 1 year of age, and 41.3% of children between the ages of 3 and 5 years). Most repeaters (68.9%) experienced only 1 prior ingestion (range 1 to 15). Two prior ingestions were reported in 17.6% of repeaters; 3 prior ingestions in 4.4%. A profound effect of age on type of substance ingested was observed, with drugs accounting for 11.0% of ingestions in children under the age of 1 year, 23.2% in 1- year-olds, and 49.9% in 2- to 5-year-olds. A corresponding age-related decline in ingestions of household and personal care products was also noted. Although less marked than the age effect, a statistically significant propensity to reingest similar types of poisons was observed. Among repeaters, those with a prior ingestion of a drug subsequently ingested another drug 1.49 times more frequently than expected. A similar trend was observed with products (1.24 times more frequently) and plants (2.00 times more frequently).

Interpretation and uses of data collected in poison control centres in the United States.

SummaryClinical toxicology and poison control have not benefited from the same epidemiological and demographical scrutiny that other health care disciplines have, because of the lack of a meaningful, appropriate database from which to undertake those analyses. Since the creation of the American Association of Poison Control Centers National Data Collection System in 1982 many of the former obstacles of data collection have been overcome. A system has been devised which apparently meets the needs of busy regional poison control centres willing to participate in data collection, and thus provide a large database of human poisoning experience. The data collected by poison control centres and maintained in the National Data Collection System afford a new, powerful tool with which to address issues of demography, epidemiology, risk assessment, product surveillance and regulatory affairs. While the system affords these potentials, certain limitations of the data must be understood so that the data are not misinterpreted. Additionally, we have attempted to identify strengths of the system as well as areas in need of improvement and refinement.

Telephone Management of Poisonings Using Syrup of Ipecac

Seven hundred and seventy-six cases were studied during a six-month period to see if induction of emesis could be successfully managed at home by telephone. Emesis was successful in 98.8% of cases. In 6.7% of all cases, symptoms were found at 4-hour follow-up that were referrable to the ingestion, but all were considered to be of minor consequence. No complications of vomiting occurred. Twenty-four hour follow-up investigation indicated no significant complications of induction of emesis or complications from managing the patient by telephone. It is our conclusion that, with appropriate telephone supervision, home-induced emesis of ingestions expected to produce mild to moderate symptoms is as effective as emergency room or physician office management of cases. Furthermore, the absence of adverse affects of complications arising from the induction of emesis at home in our cases confirms that this form of management is quite safe.