Superwarfarin poisoning in children: a prospective study.

This prospective study was undertaken to determine the incidence, severity, time of onset, and duration of coagulopathy in children following accidental ingestion of long-acting anticoagulant rodenticides, often called "superwarfarins." Of 110 children, who ingested superwarfarins and in whom one or more prothrombin time values were obtained, 8 had a prothrombin time ratio (patient to control) of greater than or equal to 1.2, indicative of anticoagulation. Prothrombin time values obtained 48 hours after ingestion were more likely to be prolonged (6/34, 17.6%) than values obtained 24 hours after ingestion (2/104, 1.9%) (P less than .005). The occurrence of an abnormal prothrombin time could not be predicted based on the history of amount ingested or on the presence of the characteristic green-blue product dye in or around the child's mouth. Acute toxicity was evidenced by transient abdominal pain, vomiting, and heme positive stools in 2 patients. The duration of prothrombin time prolongation could not be determined because of the few values obtained after 48 hours. To detect all possible abnormal prothrombin time values, 24- and 48-hour determinations are recommended after a child has ingested a superwarfarin.

Fluoride ingestion in children: a review of 87 cases.

All cases of fluoride ingestion in children younger than 12 years old reported to the Rocky Mountain Poison Center between January 1 and December 31, 1986, were retrospectively reviewed. Eighty-seven cases were identified. Eighty-four cases involved accidental ingestion of dental fluoride products in the home (tablets, drops, rinses) in children 8 months to 6 years old. Two older children (8 and 9 years old) became symptomatic after fluoride treatment by a dentist. A 13-month-old child died after ingesting an unknown amount of sodium fluoride insecticide, the only insecticide exposure in our series. Postmortem total serum calcium value was 4.8 mg/dL (normal 8.8 to 10.3). No other patients had serious symptoms or sequelae. Twenty-six (30%) of 87 became symptomatic, with gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) in 25 patients and drowsiness in 1. Only 3 patients became symptomatic later than 1 hour after ingestion. Analysis of data from 70 cases with sufficient information revealed that as the amount of fluoride ingested increased, the percentage of patients with symptoms increased. Not including the fatal case, 6 patients had serum calcium levels measured, and all were normal. Children who ingested up to 8.4 mg/kg of elemental fluoride in dental products had mild and self-limited symptoms, mostly gastrointestinal.

Laetrile and pregnancy.

Pregnancy in a woman who took laetrile as daily intramuscular injections during the last trimester resulted in a live, term infant. No laboratory or clinical evidence of elevated cyanide or thiocyanate, a pricipal metabolite, could be detected. Neurological evidence of chronic cyanide exposure may not be recognizable in infancy, and long-term follow-up is indicated.

Toxicology of urea formaldehyde and polyurethane foam insulation.

Two types of foam insulation are in wide use. Urea formaldehyde foam is a relatively inexpensive, easily installed, and efficient insulation. Toxicity from this insulation is related to release of free formaldehyde into the home. Mild to incapacitating symptoms have been reported in occupants of urea formaldehyde-insulated homes. Airborne formaldehyde levels frequently have exceeded standards set for occupational exposure. The long-term consequences of such exposure are unknown. Because of publicity over the toxicity of urea formaldehyde foam, many physicians and patients have confused urea formaldehyde and polyurethane foam. Unlike urea formaldehyde, polyurethane foam is fully cured before construction. Toxicity occurs only during manufacture and curing. To date, there have been no reports to our knowledge of toxicity in occupants of polyurethane-insulated homes. However, toxicity caused by pyrolysis products may occur during combustion in homes insulated with either type of insulation. This report details 48 patients in whom complete medical data were obtained out of the first 100 patients contacting the Rocky Mountain Poison Center.