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Farah R, Cole RJ, Holstege CP. Increasing severity of medical outcomes and associated substances in cases reported to United States poison centers. Clin Toxicol (Phila) 2024; 62:248-255. [PMID: 38634480 DOI: 10.1080/15563650.2024.2337897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Poison centers provide free expert recommendations on the treatment of a wide variety of toxicological emergencies. Prior studies have called attention to the increasing complexity of cases reported to poison centers. We aimed first, to evaluate the trends in medical outcome severity, over a 15-year period in both the adult and pediatric populations. Second, we described the most frequently reported substances associated with major effect or death. METHODS This is a retrospective review of exposures reported to the National Poison Data System from 1 January 2007 through 31 December 2021. All closed cases, for human exposures, reported during the study period were included. We assessed trends in frequencies and rates of medical outcomes and level of care received, among the adult (age greater than 19 years) and pediatric (age 19 years and younger) populations by reason for exposure. RESULTS During the study period, the number of adult unintentional exposures resulting in major effect (37.4 percent) and death (65.3 percent) increased. The number of adult intentional exposures resulting in death increased by 233.9 percent and those resulting in a major effect increased by 133.1 percent. The rates of exposures resulting in major effect and death increased among both intentional and unintentional adult exposures. The number of pediatric unintentional exposures resulting in a major effect increased by 76.6 percent and the number of pediatric intentional exposures resulting in death and major effect increased by 122.7 and 190.1 percent, respectively. Moderate, major effect, and death rates increased in pediatric unintentional exposures and moderate and major effect rates increased in pediatric intentional exposures. CONCLUSIONS We found a worsening severity of medical outcomes in adult and pediatric cases reported to poison centers. Poison centers are increasingly managing complex cases. Monitoring trends in which substances are associated with severe outcomes is imperative for future strategic prevention efforts.
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Affiliation(s)
- Rita Farah
- Division of Medical Toxicology, Department of Emergency Medicine, University of VA, Charlottesville, VA, USA
| | - Ryan J Cole
- Division of Medical Toxicology, Department of Emergency Medicine, University of VA, Charlottesville, VA, USA
| | - Christopher P Holstege
- Division of Medical Toxicology, Department of Emergency Medicine, University of VA, Charlottesville, VA, USA
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Vodovar D, Langrand J, Caré W, Tournoud C, Evrard M, Dridi I, Le Visage L, Dufayet L, Puskarczyk E, Laborde-Casterot H. Short message service as a tool for mass follow-up of patients requesting a poison centre: a retrospective comparative study in France. Clin Toxicol (Phila) 2023; 61:982-989. [PMID: 37955599 DOI: 10.1080/15563650.2023.2276032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The short message service is an alternative to telephone follow-up of exposure cases reported to poison centres. The aim of this study was to compare the proportion of exposure cases successfully followed up and the respective cost of telephone and short message service follow-up between two poison centres, one using both methods of follow-up (Paris centre) and the other using telephone follow-up only (Nancy centre). METHODS In 2021, we included cases eligible for short message service follow-up at both centres. Eligibility criteria were calls from the public reporting non-toxic or minor toxic exposure not requiring medical consultation. We collected the follow-up type (telephone/short message service) and outcome (success/failure). The cost of each type of follow-up was estimated. RESULTS In 2021, 16,867 and 11,107 exposure cases were eligible for short message service follow-up at the Paris and Nancy centres, respectively. The Paris centre followed up 86.2 per cent of cases by short message service, and the remainder by telephone, while the Nancy centre followed up all cases by telephone. The Paris centre had a greater follow-up rate compared to the Nancy centre (93.0 per cent versus 43.6 per cent; P < 0.0001). Overall, the success rates were similar between the two centres (P = 0.06), with short message service and telephone follow-up showing comparable success rates (88.1 per cent versus 88.7 per cent; P = 0.25). On average, telephone follow-up took almost twice as long (1.51 min versus 0.85 min) and cost 1.3 times more (0.59 euros versus 0.45 euros) than short message service follow-up. DISCUSSION Short message service follow-up allows more patients to be successfully followed up at a lower cost compared to telephone-only follow-up, albeit with potential differences in information quality. CONCLUSIONS Short message service follow-up is a promising tool for poison centres to follow up with patients. Further studies are needed to assess the quality of the data collected and caller satisfaction.
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Affiliation(s)
- Dominique Vodovar
- Centre Antipoison de Paris - Hôpital Fernand Widal/AP-HP.Nord Université Paris Cité, Paris, France
- Inserm UMRS 1144 - Faculté de Pharmacie, Paris, France
- Université Paris Cité - UFR de médecine, Paris, France
| | - Jérôme Langrand
- Centre Antipoison de Paris - Hôpital Fernand Widal/AP-HP.Nord Université Paris Cité, Paris, France
- Inserm UMRS 1144 - Faculté de Pharmacie, Paris, France
| | - Weniko Caré
- Centre Antipoison de Paris - Hôpital Fernand Widal/AP-HP.Nord Université Paris Cité, Paris, France
- Inserm UMRS 1144 - Faculté de Pharmacie, Paris, France
- Service de médecine interne - Hôpital d'instruction des armées Bégin, Saint-Mandé, France
| | - Christine Tournoud
- Centre Antipoison de Nancy - Hôpital Central/CHRU de Nancy, Nancy, France
| | - Marion Evrard
- Centre Antipoison de Nancy - Hôpital Central/CHRU de Nancy, Nancy, France
| | - Inesse Dridi
- Centre Antipoison de Paris - Hôpital Fernand Widal/AP-HP.Nord Université Paris Cité, Paris, France
| | - Laurine Le Visage
- Centre Antipoison de Paris - Hôpital Fernand Widal/AP-HP.Nord Université Paris Cité, Paris, France
| | - Laurène Dufayet
- Centre Antipoison de Paris - Hôpital Fernand Widal/AP-HP.Nord Université Paris Cité, Paris, France
- Inserm UMRS 1144 - Faculté de Pharmacie, Paris, France
- Université Paris Cité - UFR de médecine, Paris, France
- Urgences Médico Judiciaires - Hôtel Dieu/APHP, Paris, France
| | | | - Hervé Laborde-Casterot
- Centre Antipoison de Paris - Hôpital Fernand Widal/AP-HP.Nord Université Paris Cité, Paris, France
- Inserm UMR 1153/CRESS/HERA/Université Paris Cité - Faculté de Pharmacie, Paris, France
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Husak N, Leonard JB, Seung H, Klein-Schwartz W. Single-substance trazodone exposures reported to US poison centers from 2000 to 2019. Clin Toxicol (Phila) 2022; 60:1032-1038. [PMID: 35475757 DOI: 10.1080/15563650.2022.2068423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Individual case reports describe trazodone overdose resulting in QTc prolongation and cardiac arrhythmias. The clinical effects and outcomes associated with trazodone exposures on a large-scale basis are less well known. OBJECTIVE The primary objective was to characterize the severity of single substance trazodone exposures and identify any relationships that may exist between dose of trazodone and severity of exposure. The secondary objective was to describe these exposures from a demographic and clinical symptom standpoint. METHODS A retrospective review of single-substance trazodone exposures reported to the National Poison Data System (NPDS) from 1 January 2000 to 31 December 2019 was performed. The primary objective was to characterize the severity of trazodone exposures and relationships between ingested dose and level of care required or medical outcome. RESULTS A total of 118,773 cases were included in the analysis of demographics and level of care required. A majority (59.5%) of cases did not require medical admission. Of the 81,698 cases with known medical outcomes, the most common clinical effects included mild-moderate CNS depression (49.7%), QTc prolongation (12.2% of cases in 2019), vomiting (9.0%), hypotension (7.0%), and tachycardia (7.0%). The median ingested dose associated with treatment, and release from the emergency department was 600 mg compared to 1500 mg in those admitted to the intensive care unit (ICU). Regarding medical outcome, median ingested dose ranged from 600 mg in those experiencing no effect to 1500 mg in those experiencing major effects. Cardiac-related clinical effects and the need for cardiac-specific interventions were overall infrequent. A dose-response relationship was identified for level of care and medical outcome. CONCLUSIONS Many trazodone exposures can be characterized as low severity due to the infrequent need for healthcare facility admission and large proportion of cases that experienced no effects or only minor effects.
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Affiliation(s)
- Nicholas Husak
- Department of Pharmacy Practice and Science, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - James Brewer Leonard
- Department of Pharmacy Practice and Science, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Hyunuk Seung
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Wendy Klein-Schwartz
- Department of Pharmacy Practice and Science, Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Farkas A, Kostic M, Huang CC, Gummin D. Poison center consultation reduces hospital length of stay. Clin Toxicol (Phila) 2022; 60:863-868. [PMID: 35261300 DOI: 10.1080/15563650.2022.2039686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
CONTEXT Prior studies have observed shorter lengths of stay when practitioners consult a US poison control center (PCC) regarding hospitalized toxicology patients, but the most recent study used data from 2010. Since then, the implementation of the Affordable Care Act, a trend toward shorter hospitalizations and substantial adjustments in hospital charges have occurred. METHODS This is a retrospective study of administrative hospital data and poison center data obtained from the Wisconsin Hospital Association and Wisconsin Poison Center for patients treated from 2010 to 2017. Stratified analysis was used to investigate the potential effects of PCC consultation on hospitalization. Univariate and multivariable regression analysis was used to characterize which factors were associated with an increased rate of PCC consultation. DISCUSSION 127,224 hospitalized cases were found, of which 44,628 were entered into a stratified hospital charge and length of stay analysis. PCC consultation was associated with an 11.6 h (95% CI 10.4-13.0 h) shorter mean length of stay overall, with children aged 0-6 having a larger reduction of 1.18 days. While total charges were higher by $600 in PCC consultation cases in the overall analysis (95% CI $390-$777), mean charges in patients aged 0-6 were $6695 lower when the PCC was consulted. PCC consultation was more likely to occur in cases involving children and adolescents, intentional overdoses (versus accidental or unknown intent), and women. CONCLUSIONS Our findings suggest that PCC consultation should be encouraged to potentially shorten hospitalizations of poisoned patients, and for pediatric patients in particular. Intentionality and demographic factors affect the rate of PCC consultation for overdose, but the nature of these relationships is unclear.
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Affiliation(s)
- Andrew Farkas
- Medical College of Wisconsin Department of Emergency Medicine, Milwaukee, WI, USA.,Wisconsin Poison Center, Children's Wisconsin, Milwaukee, WI, USA
| | - Mark Kostic
- Medical College of Wisconsin Department of Emergency Medicine, Milwaukee, WI, USA.,Wisconsin Poison Center, Children's Wisconsin, Milwaukee, WI, USA
| | - Chiang-Chin Huang
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - David Gummin
- Medical College of Wisconsin Department of Emergency Medicine, Milwaukee, WI, USA.,Wisconsin Poison Center, Children's Wisconsin, Milwaukee, WI, USA
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Reinert JP, Niyamugabo O, Harmon KS, Fenn NE. Management of Pediatric Cannabinoid Hyperemesis Syndrome: A Review. J Pediatr Pharmacol Ther 2021; 26:339-345. [PMID: 34035677 DOI: 10.5863/1551-6776-26.4.339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022]
Abstract
With significant increases noted in adolescent marijuana use across the United States, perhaps as a result of legislative changes over the past half-decade, clinicians must be increasingly aware of the potential negative health effects. One such effect that warrants concern is cannabinoid hyperemesis syndrome (CHS) in the pediatric population. A systematic review of the literature was performed to determine the safety and efficacy of management strategies for CHS using PubMed, Scopus, the Cumulative Index of Nursing and Allied Health (CINAHL), Web of Science, and Cochrane Library databases. Search terms used in each database were "pediatric OR child OR children OR adolescent" AND "cannabinoid OR marijuana" AND "hyperemesis OR cyclic vomiting OR vomiting" NOT "seizure OR chemotherapy OR pregnancy OR cancer OR AIDS OR HIV." Fourteen pieces of literature that described either effective, ineffective, or supportive management strategies for pediatric CHS were included in this review. Benzodiazepines were the most reported efficacious agents, followed by topical capsaicin cream and haloperidol. A total of 9 of the 14 studies described intravenous fluid resuscitation and hot bathing rituals as supportive measures, and 7 cases reported traditional antiemetics were ineffective for CHS. The heterogenicity of reported data, combined with the limited number of encounters, make it difficult to ascertain whether a definitive treatment strategy exists. Clinicians should be cognizant of pharmacotherapy agents that are efficacious, and perhaps more importantly, avoid using traditional antiemetic therapies that do not provide benefit.
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Leonard JB, Seung H, Klein-Schwartz W. Impact of a drug safety communication on the severity of benzonatate exposures reported to poison centers. Pharmacoepidemiol Drug Saf 2020; 30:45-52. [PMID: 32964590 DOI: 10.1002/pds.5136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE Identify if publication of the 2010 drug safety communication (DSC) regarding benzonatate was associated with a decrease in the incidence of severe benzonatate poisonings reported to United States poison centers. METHODS This retrospective database study utilized the National Poison Data System to compare the incidence of severe benzonatate poisonings before and after the publication of a drug safety communication. We utilized interrupted time series analysis to compare 2000-2010 (pre-DSC) to 2012-2019 (post-DSC). RESULTS There were 18 619 benzonatate exposures reported to US poison centers during the time period covered and 11 554 exposures were included. There was an increase in exposures throughout the time period. There was no difference in the incidence of severe outcomes in the two time periods. In the pre-DSC era, rates of severe outcomes increased by 0.4% per year followed by an immediate non-significant drop of 2.9% in incidence of severe outcomes (P = .15). Finally, the slope of severe outcomes in the post-DSC era showed an increase of 0.3% per year, which was not significantly different from the pre-DSC era (P = .78). CONCLUSION Publication of a Drug Safety Communication regarding the risks of benzonatate did not result in a decrease in the proportion of severe benzonatate poisoning reported to US poison centers. Deaths and other severe outcomes continued to occur at a similar rate after the publication.
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Affiliation(s)
- James B Leonard
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Hyunuk Seung
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Wendy Klein-Schwartz
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
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Kamaruzaman NA, Leong YH, Jaafar MH, Mohamed Khan HR, Abdul Rani NA, Razali MF, Abdul Majid MI. Epidemiology and risk factors of pesticide poisoning in Malaysia: a retrospective analysis by the National Poison Centre (NPC) from 2006 to 2015. BMJ Open 2020; 10:e036048. [PMID: 32487578 PMCID: PMC7265005 DOI: 10.1136/bmjopen-2019-036048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Pesticide poisoning is a global health problem, and its progressive deterioration is a major cause of concern. The objective of this study is to assess epidemiological characteristics and identify risk factors of pesticide poisoning in Malaysia. SETTING Pesticide poisoning database of Malaysia National Poison Centre (NPC) from 2006 to 2015. PARTICIPANTS Telephone enquiries regarding pesticide poisoning were made by healthcare professionals. Information received by the NPC was entered into a retrievable database of standardised Poison Case Report Form, as adapted from the World Health Organization (WHO). OUTCOMES The outcome of the study is to provide an overview of national epidemiological profile of pesticide poisoning. High-risk groups of people and their circumstances were also identified to ensure that appropriate measures are strategised. RESULTS Within the study period, a total of 11 087 pesticide poisoning cases were recorded. Sixty per cent of these cases were intentional in nature and most were found among male individuals (57%) of the Indian race (36.4%) aged between 20 and 29 years (25.5%), which occurred at home (90%) through the route of ingestion (94%). The highest number of poisoning was due to herbicides (44%) followed by agricultural insecticides (34%), rodenticides (9.9%), household insecticides (9.5%) and fungicides (0.5%). In addition, 93.6% of intentional pesticide poisoning cases were caused by suicide attempts. The results of this study show that there was an increasing trend in pesticide poisoning incidents over the 10-year duration. This indicates that pesticide poisoning is a prevalent public health problem in Malaysia, resulting in an average incidence rate of 3.8 per 100 000 population. CONCLUSIONS Deliberate pesticide ingestion as a method of suicide has become a disturbing trend among Malaysians. Therefore, regulation of highly hazardous pesticides must be enforced to ensure controlled and limited access to these chemicals by the public.
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Affiliation(s)
| | - Yin-Hui Leong
- Malaysia National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Mohd Hafiidz Jaafar
- Malaysia National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | | | - Noor Afiza Abdul Rani
- Malaysia National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Mohd Fadhli Razali
- Malaysia National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
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Beuhler MC, Thomas C. Time requirements for management of exposure and information cases by one regional poison center. Clin Toxicol (Phila) 2019; 58:732-735. [PMID: 31680564 DOI: 10.1080/15563650.2019.1676897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Poison control centers (PCCs) manage millions of information and exposure cases a year. Exposure cases are almost always managed on-site (i.e., at "home") or at a health care facility (HCF). Over the last 10 years, there have been significant changes in the composition of cases managed by PCCs with an overall decrease in total cases but an increase in exposures managed at an HCF. The management and documentation of HCF cases may require more time than cases managed on-site or information cases. Time-work data are needed to accurately gauge the staff resources needed to address these changes.Methods: One poison center with an annual case volume of 74,000 conducted a time-work study of total case management time for a subset of cases: exposures Managed on-site and Managed at an HCF as well as information Drug identification cases. Specialists tracked the time spent communicating, managing, researching, consulting, and documenting. Additionally, the PCC medical records and phone call database were audited to ensure all calls and documented efforts related to a case were included.Results: Cases Managed at an HCF (n = 140) took more time (mean 45.8 min, median 29.3 min) than those Managed on-site (n = 430; mean 7.4 min, median 5.9 min) or Drug identification case (n = 392; mean 2.7 min, median 2.2 min); this difference was significant (p<.0001). There were 32 cases (23%) Managed at an HCF that required more than 1 h for total management; no Managed On-site or Drug identification cases required more than 33 min.Conclusions: The time required for one PCC to manage cases at an HCF was approximately six times longer than cases that were managed on-site. With PCC case volume and composition changing, previous staffing assumptions may no longer hold true. It would be incorrect to base staffing requirements on case volume alone without scrutiny of case types.
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Affiliation(s)
- Michael C Beuhler
- North Carolina Poison Control, Carolinas Medical Center, Charlotte, NC, USA
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Tangiisuran B, Jiva M, Ariff AM, Abdul Rani NA, Misnan A, Rashid SM, Majid MIA, Dawson AH. Evaluation of types of poisoning exposure calls managed by the Malaysia National Poison Centre (2006-2015): A retrospective review. BMJ Open 2018; 8:e024162. [PMID: 30598487 PMCID: PMC6318535 DOI: 10.1136/bmjopen-2018-024162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Accidental or intentional poisoning is a public health concern requiring intervention. The current study designs to evaluate the types of poisoning exposure calls received by the Malaysia National Poison Centre (NPC) over a 10-year period. SETTINGS AND DATA SOURCES The poisoning enquiries database (2006-2015) from the Malaysia NPC was used for the analysis. PARTICIPANTS The NPC records all telephone calls that it manages using a validated and standardised form. Demographics and types of the poisoning exposure calls were extracted and descriptive analysis was applied. PRIMARY AND SECONDARY OUTCOMES The primary outcome of this study is to evaluate NPC data for trends in the poisoning exposure calls based on the types and modes of poisoning over a 10-year period. The secondary outcome is to evaluate the characteristics of human exposure cases based on the calls received by the NPC. RESULTS There was a notable increase in the number of poisoning exposure calls noticed during the 10-year period but dropped significantly in 2012. The highest number of poisoning exposure calls came from Selangor (21.0%), Perak (18.0%) and Negeri Sembilan (9.8%). More than half of the exposure was intentional (53.8%) involving more women (50.3%) as compared with men (41.9%), and in the 20-29 years age group category (33.5%). Exposure mostly occurred at home (96%) through the ingestion route (94.1%). Pharmaceutical products (40.5%), pesticides (31.7%) and household products (20.1%) were the common agents implicated for intentional exposure. CONCLUSIONS There is an increasing trend in enquiries on poisoning exposure calls made to the NPC. Most of the intentional poisoning exposures occurred among younger women and involved pharmaceuticals, pesticides or household products. Poisoning safety education and other interventions are needed to curb poisoning incidents.
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Affiliation(s)
- Balamurugan Tangiisuran
- National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Maryam Jiva
- Institute of Pharmaceutical Sciences, Kings College London, London, UK
| | | | | | - Asdariah Misnan
- National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Sazaroni Md Rashid
- National Poison Centre, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | | | - Andrew H Dawson
- Royal Prince Alfred Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Abstract
Ingestion of wild and potentially toxic mushrooms is common in the United States and many other parts of the world. US poison centers have been logging cases of mushroom exposure in The National Poison Data System (NPDS) annual publications for over 30 years. This study compiles and analyzes US mushroom exposures as reported by the NPDS from 1999 to 2016. Over the last 18 years, 133 700 cases (7428/year) of mushroom exposure, mostly by ingestion, have been reported. Cases are most frequently unintentional (83%, P < 0.001); cause no or only minor harm (86%, P < 0.001); and in children <6 years old (62%, P < 0.001). Approximately 704 (39/year) exposures have resulted in major harm. Fifty-two (2.9/year) fatalities have been reported, mostly from cyclopeptide (68-89%)-producing mushrooms ingested by older adults unintentionally. The vast majority of reported ingestions resulted in no or minor harm, although some groups of mushroom toxins or irritants, such as cyclopepides, ibotenic acid, and monomethylhydrazine, have been deadly. Misidentification of edible mushroom species appears to be the most common cause and may be preventable through education.
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Affiliation(s)
- William E Brandenburg
- a Family Medicine Residency of Idaho , RTT Caldwell, 777 N. Raymond Street, Boise , Idaho 83704-9251.,b West Valley Medical Center , 1717 Arlington Avenue, Caldwell , Idaho 83605
| | - Karlee J Ward
- c Pediatric Intensive Care Unit, Saint Luke's Hospital , 190 E Bannock Street, Boise , Idaho 83712
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