Ingestions considered nontoxic.

ABSTRACT

PIP: In 1980, the National Clearinghouse for Poison Control Centers (NCPCC) received 126,000 reports from Poison Control Centers, but the true incidence of ingestions was actually much higher. Only 1 in 50 ingestions may be reported, indicating that the majority of ingestions are innocuous. 70% of reported episodes occurred in children under 5 years of age. Nontoxic ingestions occur when a victim consumes a nonedible product that usually does not produce symptoms. No product is entirely safe and all can produce symptoms if a large enough concentration is consumed. Knowledge of nontoxic ingestions helps avoid overtreatment and its risks and serves as a warning of inadequate supervision or an improper and unsafe environment. The designation of nontoxic ingestion has 6 criteria: 1) absolute identification of the product 2) absolute assurance that only 1 product was ingested 3) no signal word (danger, poison, warning, caution) on the container 4) a good approximation of the amount ingested 5) assurance that the victim is free of symptoms and 6) the ability to call back at intervals to determine that no symptoms have developed. A good rule of thumb for the average drug that 5 times the therapeutic dose may be a toxic dose; opiate narcotics are the exception and require medical observation because of their narrow margin of safety. There are several points to consider in deciding wheter to decontaminate the gastrointestinal tract, including the toxicity of the ingested agent, the amount ingested, the elapsed time since ingestion, and the presence of symptoms. Emergency room referral is mandatory in case of exposure to highly toxic agents, of a dose sufficient to lead to anticipation of servere symptoms, of manifestations of toxic exposure such as alterations in vital signs already present, or of a history of intentional ingestion. A detailed discussion of frequently ingested nontoxic household items and related items that may be toxic includes writing and art materials, toiletries and laundry agents, deordorizers and disinfectants, tobacco and matches, medicinals, pesticides and insecticides, miscellaneous substances, petroleum distillate hydrocarbons, and plants. Hormonal contraceptives have been reported to produce almost no toxicity. A 1962-65 report from the NCPCC of 962 ingestions listed only 40 producing nausea nd vomiting even after consumption of 21 pills. An iron additive could make the ingestion toxic for iron.