Characterization of the phone-calls made to a poison center related to household and cosmetics products exposition in pediatrics

INTRODUCTION

Household cleaning products and cosmetics are necessary for daily life and widely used by the population. However, their use may not be risk-free, especially when they are not used or stored as recommended. It is important to characterize exposures, as this is useful for developing stra tegies to reduce morbidity, mortality, and health costs associated, especially in the child population.

OBJECTIVE

To describe reports associated with household cleaning products and cosmetics exposure in patients under the age of 12, reported to the Poison Information Center of the Catholic University of Chile (CITUC).

PATIENTS AND METHOD

Descriptive cross-sectional study of phone calls to CITUC during 2016. The analyzed variables were age, sex, product, caller, caller and incident location, ex posure circumstances, exposure route(s), symptoms, and severity from manual records and from the WHO's electronic record software 'INTOX Data Management System'.

RESULTS

3,415 cases met the inclusion criteria. Children under the age of five represented 91% of the exposures, and 58.5% were male. 99.4% were accidental exposures, and 98.6% occurred at home. Family members (57%) and health personnel (42%) made the calls. 68.3% of the patients had no symptoms after exposure. The four products with the highest incidence were household bleach (27.6%), floor cleaners and polishers (13.1%), dish soap (7.9%), and perfume/cologne (5.8%). The main exposure route was by ingestion (89.4%).

CONCLUSIONS

Household cleaning products and cosmetics are common causes of exposures especially in children under the age of five. Although these products have a low morbidity and mortality rate, it is important to educate the population to prevent possible poisonings in the child population.

Why people drink shampoo? Food Imitating Products are fooling brains and endangering consumers for marketing purposes

A Food Imitating Product (FIP) is a household cleaner or a personal care product that exhibits food attributes in order to enrich consumption experience. As revealed by many cases worldwide, such a marketing strategy led to unintentional self-poisonings and deaths. FIPs therefore constitute a very serious health and public policy issue. To understand why FIPs are a threat, we first conducted a qualitative analysis on real-life cases of household cleaners and personal care products-related phone calls at a poison control center followed by a behavioral experiment. Unintentional self-poisoning in the home following the accidental ingestion of a hygiene product by a healthy adult is very likely to result from these products being packaged like foodstuffs. Our hypothesis is that FIPs are non-verbal food metaphors that could fool the brain of consumers. We therefore conducted a subsequent functional neuroimaging (fMRI) experiment that revealed how visual processing of FIPs leads to cortical taste inferences. Considered in the grounded cognition perspective, the results of our studies reveal that healthy adults can unintentionally categorize a personal care product as something edible when a food-like package is employed to market nonedible and/or dangerous products. Our methodology combining field (qualitative) and laboratory (behavioral and functional neuroimaging) findings could be of particular relevance for policy makers, as it can help screening products prior to their market release – e.g. the way they are packaged and how they can potentially confuse the mind of consumers – and therefore save lives.

Centers for Disease Control and Prevention (CDC). Infant lead poisoning associated with use of tiro, an eye cosmetic from Nigeria--Boston, Massachusetts, 2011

Lead is highly toxic and can damage the brain, kidneys, bone marrow, and other body systems; high levels can cause convulsions, coma, and death. Young children are especially susceptible to lead exposures because of their floor-hand-mouth activity, greater gut absorption, and developing central nervous systems. In June 2011, a male infant aged 6 months of Nigerian descent was referred to the Pediatric Environmental Health Specialty Unit (PEHSU) at Boston Children's Hospital because of an elevated blood lead level (BLL). An investigation found no lead exposure except for "tiro," a Nigerian cosmetic that also is used as a folk remedy to promote visual development. The tiro applied to the infant's eyelids contained 82.6% lead. Products similar to tiro, such as "surma" and "kajal" in Asia and kohl in the Middle East, also might contain lead. This case adds to the medical literature documenting nonpaint lead sources as causes of elevated BLLs in children and highlights persons of certain immigrant populations as a risk group. Educational efforts are needed to inform immigrants from Africa, Asia, and the Middle East that tiro and similar products can cause lead poisoning in children. Health-care providers and public health workers should ask about eye cosmetics and folk remedies when seeking a source of exposure in children with elevated BLLs from certain immigrant populations.

Environmental oestrogens and breast cancer: evidence for combined involvement of dietary, household and cosmetic xenoestrogens

Many environmental compounds with oestrogenic activity are measurable in the human breast and oestrogen is a known factor in breast cancer development. Exposure to environmental oestrogens occurs through diet, household products and cosmetics, but concentrations of single compounds in breast tissue are generally lower than needed for assayable oestrogenic responses. Results presented here and elsewhere demonstrate that in combination, chemicals can give oestrogenic responses at lower concentrations, which suggests that in the breast, low doses of many compounds could sum to give a significant oestrogenic stimulus. Updated incidence figures show a continued disproportionate incidence of breast cancer in Britain in the upper outer quadrant of the breast which is also the region to which multiple cosmetic chemicals are applied.

CONCLUSION

If exposure to complex mixtures of oestrogenic chemicals in consumer products is a factor in breast cancer development, then a strategy for breast cancer prevention could become possible.

Surveillance of toxic exposures: the pilot experience of the Poison Control Centers of Milan, Pavia and Bergamo in 2006

Between 1 February and 31 March 2006, the Poison Control Centers (PPC) active in Lombardy collaborated with an integrated surveillance system carried out in Piedmont during the Olympic Games 2006. The collaborating PPC notified to the system 697 human cases of exposure occurred in Piedmont during the observation period. Among these cases, 70% were exposed accidentally, 40% were 6 years old or younger, and 45% reported at least a clinical effect. The agents more frequently reported were: cleaning substances (household) (110 cases), fumes/gases/vapors (63 cases, comprising 38 cases accidentally exposed to carbon monoxide), and sedative/hypnotics/antipsychotics (53 cases). Although very limited, the available observations focused the attention on specific hazards and were able to highlight the potential of a toxic exposure surveillance system based on the information reported by the Italian PPC.

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 microg/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 microg/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 father's BLL. The results showed a BLL of 95 microg/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.

Acetone-free nail polish removers: are they safe?

INTRODUCTION

The following case report highlights the dangers of acetone-free nail polish remover products which are widely regarded as safe.

CASE REPORT

A 15-month-old presented with coma and cardiorespiratory collapse after sucking on Boots Conditioning Nail Polish Remover Pads, which was complicated by features of upper airway obstruction, bilateral pneumothoraces, and pneumomediastinum. The child required intubation and ventilation for 5 days along with full supportive management before making a complete recovery. The clinical features in this case resemble those of poisoning due to gamma butyrolactone, the principal component of this nail polish remover. Gamma butyrolactone is rapidly metabolized to gamma hydroxybutyrate on ingestion, a compound whose toxicity is well recognized. Package labeling gave no indication of the potential toxicity of its components.

CONCLUSION

We wish to draw attention to the potential toxicity of gamma butyrolactone containing nail polish removers and the need for appropriate labeling of product packaging. Since alternative products are available, these products should be removed from the market.

[Use of kohl and severe lead poisoning in Brussels]

The authors report the observation of lead poisoning in a young Moroccan woman, which was caused by prolonged use of a khol made of lead sulphide. Khol is a black eye make-up used since Ancient Egypt. Clinically, this poisoning presented with abdominal crampoid pain, encephalopathy (manifested as anxiety and irritability), a Burtonian gingival border and microcytic sideropenic anaemia. Emergency chelate treatment permitted to improve clinical state and to decrease blood levels (initial blood concentration: 490 micrograms/dl; concentration six weeks after treatment: 49 micrograms/dl). The interest of such a case is recognizing, in French speaking regions, of a public health problem, largely ignored, although real, considering the high lead concentrations found in a majority of kohls available in Brussels and this very old cultural practice among Muslim populations.

Mercury poisoning associated with a Mexican beauty cream

OBJECTIVES

To describe demographic characteristics, patterns of use, and symptoms associated with mercury poisoning among persons who used a Mexican beauty cream containing mercurous chloride and to estimate the prevalence of cream use in Texas near the Mexico border.

DESIGN

Case series and cross-sectional survey.

SETTING

Border communities of Arizona, California, New Mexico, and Texas.

PARTICIPANTS

Persons who used the cream and contacted a health department in response to announcements about the cream and households that participated in the Survey of Health and Environmental Conditions in Texas Border Counties and Colonias, 1997.

MAIN OUTCOME MEASURES

Urine mercury concentrations, self-reported symptoms, and prevalence of cream use among households.

RESULTS

Of 330 cream users who contacted their health department, 96% were women, and 95% were Hispanic. The mean urine mercury concentration was 146.7 microg/L (reference range : 0-20 microg/L). In 5% of 2,194 randomly selected Texas households near the Mexico border, at least 1 person had used "Crema de Belleza-Manning" (Laboratorios Vida Natural, S.A., Tampico, Tamaulipas, Mexico) in the previous year.

CONCLUSIONS

Most cream users had increased urine mercury concentrations. Cream use was common in Texas near the Mexico border. Physicians should consider toxicity in patients with neurologic symptoms of unclear cause and use public health departments when investigating unusual illnesses.

Rebound severe methemoglobinemia from ingestion of a nitroethane artificial-fingernail remover

We describe life-threatening methemoglobinemia in a child who ingested a nitroethane artificial-fingernail remover initially mistaken to be an acetone-based polish remover. Nitroethane-induced methemoglobinemia may be delayed and recurrent; patients ingesting this substance may warrant close observation for at least 24 hours. Care givers are cautioned to determine the precise substance involved in ingestions of potentially toxic fingernail products.

Diagnosis and misdiagnosis of poisoning with the cyanide precursor acetonitrile: nail polish remover or nail glue remover?

Accurate diagnosis of acetonitrile ingestion is critical to management. Often this involves differentiating nail polish remover (acetone) from nail glue remover (acetonitrile). Initial symptoms of acetonitrile ingestion are indistinguishable from those of acetone and common alcohols. However, acetonitrile is metabolized to cyanide, producing severe delayed toxicity. Acetonitrile produced increased serum osmolality and osmolal gap, but these findings are non-specific and normal values cannot rule out potentially fatal exposure. Acetone, but not acetonitrile, was detectable in urine or serum with Acetest tablets; both were unreactive with a ketone dipstick. Acetone and acetonitrile could be detected with routine gas chromatography methods for alcohols. Both substances had identical retention times on the widely used stationary phase, 5% Carbowax 20M on graphitized carbon, and with GasChrom 254. Three other systems afforded unique retention times, but acetonitrile was easily mistaken for ethanol in two. Physicians and laboratories must take care to avoid misdiagnosis of acetonitrile ingestion as exposure to acetone, ethanol or another alcohol.

Epidemiology of children poisoning: comparison between telephone inquiries and emergency room visits

We studied 674 telephone inquiries to the Poison Information Centre and 532 Emergency Room (ER) visits due to suspected poisonings in 1018 children below the age of 16 y and living at Trieste. The cases were prospectively recorded during 1985-1989. Age distribution, toxic substances and consequences were different in the 2 groups. Telephone inquiries concerned children below the age of 5 y more frequently, and most of the exposures were assessed as non-toxic. Among children admitted to the hospital ER, 22.2% were more than 10-y old, and of these 79.7% were confirmed poisonings. This study demonstrated the need to take account of both Poison Control Centre and ER data to get reliable information on the occurrence of poisonings in children.

Cyanide toxicity from acetonitrile-containing false nail remover

A patient presented without symptoms 30 minutes after ingesting acetonitrile, also known as methylacyanide. He had prompt gastric lavage and activated charcoal administration. Hours later, the onset of clinical toxicity was heralded by mental status abnormalities and vomiting prior to a generalized seizure. Following administration of sodium thiosulfate, the patient made an uneventful recovery. A blood cyanide level drawn shortly after presentation, but reported after the patient had been discharged, documented significant exposure. During hospitalization, cyanide toxicity was inferred from the history of ingestion of acetonitrile, plus a significant absence of venous blood hemoglobin desaturation. Because even small amounts can be harmful and toxicity is delayed, all acetonitrile ingestions should be presumed dangerous. Patients should be observed and repeatedly evaluated for at least 24 hours. In the absence of cyanide level determinations, lethargy, vomiting, seizures, and the lack of normal venous blood hemoglobin desaturation are clues to cyanide toxicity.

Severe cyanide poisoning from the ingestion of an acetonitrile-containing cosmetic

A 39-year-old woman ingested 59 mL of Super Nail Nail Off (American International Industries, Hollywood, CA) (containing 99% acetonitrile) in a suicide attempt. Following a latent period of approximately 12 hours, the patient developed cyanide poisoning with severe metabolic acidosis, seizures, and shallow respirations. She responded to the administration of sodium nitrite and sodium thiosulfate, although the administration of nitrite produced bradycardia and hypotension. She developed several relapses over the course of her hospitalization and each time responded to sodium thiosulfate administration. The patient developed hypernatremia from the sodium load given to her; hemodialysis and charcoal hemoperfusion were initiated to correct the hypernatremia and to attempt to remove cyanide, thiocyanate, and acetonitrile. On the fifth hospital day, the patient was fully recovered and was discharged.

Pediatric cyanide intoxication and death from an acetonitrile-containing cosmetic

Two cases of pediatric accidental ingestion of an acetonitrile-containing cosmetic are reported. One of the children, a 16-month-old boy, was found dead in bed the morning after ingesting the product. No therapy had been undertaken, as the product was mistakenly assumed to be an acetone-containing nail polish remover. The second child, a 2-year-old boy, experienced signs of severe cyanide poisoning, but survived with vigorous supportive care. Both children had blood cyanide levels in the potentially lethal range. The observed delayed onset of severe toxic reactions supports the proposed mechanism of acetonitrile conversion to inorganic cyanide via hepatic microsomal enzymes. Physicians and poison centers should be alerted to the existence of this highly toxic product, sold for removal of sculptured nails and likely to be confused with the less toxic acetone-containing nail polish removers. We urge regulatory agencies to reconsider the wisdom of marketing a cosmetic that poses such an extreme health hazard.

[The problem of the use of mercurials cosmetics in Senegal (author's transl)]

The use of skin-lightening preparations appears to be a problem for the coloured women in Africa as well as for the Black People in general. The mercurial creams occupy a place of choice into the most useful products for the skin depigmentation. An epidemiological study from twenty senegalese women using mercurials cosmetics has permitted to determine a mean value of 155,75 +/- 75,38 ppm Hg in scalp hair while the normal level is less than 10 ppm. An experimental study was realised with monkeys (Papio papio) treated with a soap containing mercuric biiodide. This study has shown, after only three months of experimentation, a significative augmentation of mercury levels in all the organs and specially in the kidneys and the hair.

Chronic hydroquinone poisoning of the skin from skin-lightening cosmetics. A South African epidemic of ochronosis of the face in dark-skinned individuals

Attention is drawn to the widespread use of bleaching preparations by Black women. These products often contain hydroquinone. They act efficiently as bleaching agents, but chronic oversaturation of the skin with hydroquinone eventually produces ochronosis. This complication has reached epidemic proportions in the Transvaal. Although the assay of hydroquinone in cosmetic products has not yet been standardized, we present some provisional results. The clinical, social and industrial aspects are also significant.

[Acute intoxication by cosmetics]

Intoxications due to cosmetics are of various types, but certain substances may be particularly harmful, especially when the constituants include acetone, boric acid and borates, ethyl alcohol, bromates, formol, methyl alcohol, propylene glycol, thallium, thioglycolate.. Every cosmetic substance may induce accidental intoxications. Most often, fluid cosmetics are absorbed either by children or by feeble-minded subjects. In all intoxication, one must take account of the age and weight of the patient, of the quantity absorbed, of the toxicity and of the constituants of the substance.