Candy flavoring as a source of salicylate poisoning.

Methyl salicylate (oil of wintergreen) in the form of candy flavoring was ingested by a 21-month-old male infant who subsequently developed vomiting, lethargy, and hyperpnea. A "swallow" of the solution resulted in a serum salicylate concentration of 81 mg/dL six hours after ingestion. The infant was treated with parenteral fluids and sodium bicarbonate and he recovered rapidly. Hazards associated with salicylate use in this form include lack of parental awareness of the substance's toxic potential, the attractiveness of the candy-like odor, and the availability of the liquid in non-child-resistant packaging containing potentially lethal quantities.

Lead-contaminated imported tamarind candy and children's blood lead levels.

In 1999, an investigation implicated tamarind candy as the potential source of lead exposure for a child with a significantly elevated blood lead level (BLL). The Oklahoma City-County Health Department tested two types of tamarind suckers and their packaging for lead content. More than 50% of the tested suckers exceeded the US Food and Drug Administration (FDA) Level of Concern for lead in this type of product. The authors calculated that a child consuming one-quarter to one-half of either of the two types of suckers in a day would exceed the maximum FDA Provis onal Tolerable Intake for lead. High lead concentrations in the two types of wrappers suggested leaching as a potential source of contamination. The authors used the Environmental Protection Agency's Integrated Exposure Uptake Biokinetic (IEUBK) model to predict the effects of consumption of contaminated tamarind suckers on populat on BLLs. The IEUBK model predicted that consumption of either type of sucker at a rate of one per day would result in dramatic increases in mean BLLs for children ages 6-84 months in Oklahoma and in the percentage of children wth elevated BLLs (> or =10 micrograms per deciliter [microg/dL]). The authors conclude that consumption of these products represents a potential public health threat. In addition, a history of lead contamination in imported tamarind products suggests that import control measures may not be completely effective in preventing additional lead exposure.

[Generalized edema caused by licorice: a new syndrome. Apropos of 3 cases]. / Oedèmes généralisés induits par la réglisse: un nouveau syndrome. A propos de 3 observations.

Licorice abuse is a wellknown cause of high blood pressure, myopathy, and cardiac rhythm trouble. It should be considered as a cause of diffuse acute edema, as shown in the three following case-reports.

[Pseudohyperaldosteronism secondary to licorice poisoning associated with hemorrhagic gastritis]. / Pseudoiperaldosteronismo secondario ad intossicazione da liquirizia associato a gastrite emorragica.

The case is described of a 6 1/2-year-old child with pseudohyperaldosteronism due to excessive and prolonged liquorice ingestion. The authors debate its differential diagnosis, its physiopathological mechanism (glycyrrhetinic acid, the active metabolite of liquorice, inhibits the conversion of cortisol in cortisone) and its unusual association with haemorrhagic gastritis never observed in the course of liquorice intoxication.

Should we X-ray Halloween candy? Revisited.

The well-intentioned program of X-raying Halloween candy is costly. The annual expense to the 3 local hospitals in the Reno/Sparks area was $1625.62. The price to X-ray each bag ranged from $2.01 to $5.23 (average $3.38). On the basis of our total regional population statistics, the nation could be spending as much as $0.8-$1.4 million to screen Halloween candy. Radiographic screening of Halloween candy is not effective. Of the 394 X-rays taken in the 3 local hospitals, and the 669 taken in 18 outlying hospitals, no films were positive for hidden radio-opaque forein bodies. Not only is X-raying Halloween candy costly and ineffective, it also creates several problems. Children taking their candy to the hospital on Halloween night risk involvement in traffic accidents. The implication that X-rayed candy is "safe" carries potential liability. Additional drawbacks and risks arise from crowds composed mostly of children in the Radiology Dept and Emergency Room, and from disruption of vital hospital functions. In October, 1986, a program for community education and cooperation among all 3 area hospitals was developed. No X-rays were offered in the Reno/Sparks area. There were no police reports of contaminated candy for this Halloween following implementation of this program, compared to 4 reports for the preceding 2 years.

Perception of toxicity and dose by 3- and 4-year-old children.

Three and 4-year-old children from two suburban preschools were individually interviewed to assess their knowledge of the effects of ingesting a household product, a candy, and a common drug. Most children understood that scouring cleanser was toxic. Children reported that candy was safe to eat, even in large amounts. However, vitamins were not perceived by all children as having a dose-related toxicity. This understanding developed with age, and boys were better than girls at differentiating between a usual and an excessive dose of vitamins. One overdose occurred, perhaps because of an increase in the child's interest in vitamins after the interview. More research is needed to broaden our understanding of children's knowledge of the toxicity of poisons. The results of the present study provided information needed for the formulation of educational objectives for a preschool poison prevention program. We believe the primary message is that nothing should be eaten unless it is approved by an adult.

[Licorice--not just candy]. / Lakris--ikke bare sukkertøy.

BACKGROUND: Liquorice is widely used as a flavour and also as a medical drug. Possible side effects include hypertension, hypokalaemia and metabolic alkalosis. MATERIALS AND METHODS: We present a case history and a review on liquorice intoxication based on relevant literature found from searches on Medline. RESULTS AND INTERPRETATION: A 19-year-old girl was admitted to hospital with severe hypertension, hypokalaemia and metabolic alkalosis. Urine analysis showed inhibition of 11-beta-hydroxysteroid dehydrogenase. It turned out that she ingested a lot of liquorice; after she stopped eating it she became normotensive without any medication. Three months later there were no signs of inhibition of the enzyme. The active component of liquorice is glycyrrhetinic acid, which inhibits the enzyme 11-beta-hydroxysteroid dehydrogenase. This enzyme promotes the conversion of cortisol to cortisone and is thereby responsible for the specificity of the mineralocorticoid receptor to aldosterone in the collecting tubules. Inhibition of the enzyme allows cortisol to act as the major endogenous mineralocorticoid producing a marked elevation in mineralocorticoid activity, resulting in hypertension, hypokalaemia and metabolic alkalosis.

Thallium poisoning from maliciously contaminated food.

Four young adults presented two days after one of them had received marzipan balls packaged in a box from an expensive candy manufacturer. Two ate one candy ball, while two others shared a third. The next day, variable gastrointestinal symptoms developed. On the third day, two patients developed painful paresthesiae of the hands and feet, an early but nonspecific clinical marker of thallium poisoning. A tentative diagnosis of thallium poisoning was made based on symptoms, and treatment was initiated. The remaining candies were radiographed. Metallic densities in the candies supported the diagnosis, and atomic absorption spectroscopy was used to quantitate thallium content. Each candy contained a potentially fatal dose. Five to seven days later, hypertension and tachycardia developed in the two patients who had ingested an entire candy. All patients developed alopecia but recovered without overt neurologic or other sequelae. While the diagnosis of thallium poisoning is often delayed until alopecia develops, an early diagnosis favors an effective treatment strategy.