Epidemiology of cannabidiol related cases reported in the National Poison Data System - 2019-2020.

INTRODUCTION: Cannabidiol (CBD) has become a popular supplement in consumer products in recent years, resulting in part from normalization of the cultivation of low THC cannabis in 2018. However, the actual content of CBD-labeled products is frequently uncertain, as oversight of such products is minimal. To date, there is little pragmatic knowledge regarding exposures to products labeled as containing CBD. METHODS: Cases reported to Poison Control Centers from April 1, 2019 and March 31, 2020, the first year in which CBD was identified uniquely as a substance in the National Poison Data System, were analyzed for demographic, temporal, and clinical trends. RESULTS: Poison Control Centers handled 1581 cases exposures to CBD-containing products between April 1, 2019 and March 31, 2020. There was a significant trend of over 5 additional cases related to this substance per month (linear regression coefficient = 5.2, 95% CI: 1.52-8.98). Patients under age 13 years made up 44.0% of reported exposures. Mild CNS depression (10.3%), tachycardia (5.7%), dizziness/vertigo (5.3%), vomiting (4.9%), nausea (4.5%), and agitation (4.4%) were the most frequently reported symptoms. 13% of cases were coded as having "moderate" or "severe" medical outcomes. There were no fatalities. CONCLUSIONS: Cases reported to Poison Control Centers regarding exposures to CBD-labeled products have been increasing, representing an emerging trend of interest to Poison Control Center professionals, clinicians, and public health officials. Further monitoring of this trend is recommended.

Setting occupational exposure limits for antimicrobial agents: A case study based on a quaternary ammonium compound-based disinfectant.

Antimicrobial agents have become an essential tool in controlling the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and guidelines on their use have been issued by various public health agencies. Through its Emerging Viral Pathogen Guidance for Antimicrobial Pesticides, the US Environmental Protection Agency has approved numerous surface disinfectant products for use against SARS-CoV-2. Despite their widespread use and range of associated health hazards, the majority of active ingredients in antimicrobial products, such as surface disinfectants, lack established occupational exposure limits (OELs) to assist occupational health professionals in characterizing risks from exposures to these chemicals. Based on established approaches from various organizations, a framework for deriving OELs specific to antimicrobial agents was developed that relies on a weight-of-evidence evaluation of the available data. This framework involves (1) a screening-level toxicological assessment based on a review of the existing literature and recommendations, (2) identification of the critical adverse effect(s) and dose-response relationship(s), (3) identification of alternative health-based exposure limits (HBELs), (4) derivation of potential OELs based on identified points of departure and uncertainty factors and/or modification of existing alternative HBELs, and (5) selection of an appropriate OEL. To demonstrate the use of this framework, a case study is described for selection of an OEL for a disinfectant product containing quaternary ammonium compounds (quats). Three potential OELs were derived for this product based on irritation toxicity data, developmental and reproductive toxicity (DART) data, and modification of an existing HBEL. The final selected OEL for the quats-containing product was 0.1 mg/m3, derived from modification of an existing HBEL. This value represented the lowest resulting value of the three approaches, and thus, was considered protective of irritation and potential DART.

Single-Use Laundry Detergent Pack Exposures in Children Under 6 Years: A Prospective Study at U.S. Poison Control Centers.

BACKGROUND: After the widespread introduction of single-use liquid laundry detergent packs (LLDPs), a prospective observational study was initiated among 12 U.S. poison control centers (PCCs), serving 25% of the population. OBJECTIVES: To evaluate qualitative and quantitative data, including demographics, route of exposure, clinical effects, medical outcome, management site, level of care, and circumstantial variables surrounding the LLDP exposure. METHODS: Analysis of LLDP exposures involving children (age < 6 years) reported to PCCs participating in the prospective study (March 2012-February 2016). PCCs captured a detailed exposure history and followed each patient to symptom resolution. Each case narrative was reviewed to isolate key patient, product, and situational variables and to verify accuracy of coded data. Trend and comparative analyses were performed on absolute case counts, relative proportions, and reporting rates normalized using Nielsen consumption data. Separately, the impact of exposure reduction interventions introduced by a single manufacturer were assessed by comparing reporting rate during pre-/postintervention periods. RESULTS: There were 11,175 childhood exposures reported, with 90.3% involving children aged ≤ 3 years. Ingestion (82.6%) and ocular (14.2%) were the major routes of exposure. The size of the market for LLDPs more than doubled from ∼2.0 to ∼4.6 million LLDPs purchased. Total exposure reports increased from Year 1 (n = 2297) to Year 4 (n = 3206), however, normalized reporting rates dropped by 37% (4.4 to 2.8 exp/million LLDPs purchased). Significant declines (p < 0.0001) were also observed for ingestions and ocular exposures with major/moderate outcome. CONCLUSIONS: There was a significant reduction in exposures that resulted in major/moderate outcomes, and the majority of patients did not require intervention in an emergency department setting.

Laundry pack exposures in children 0-5 years evaluated at a single pediatric institution.

BACKGROUND: Case reports and poison center series have highlighted increased safety concerns with laundry packs, especially when compared to traditional laundry detergents. OBJECTIVE: The purpose of this study was to examine the clinical experience with laundry pack exposures at a single institution. METHODS: A retrospective chart review was performed for exposures to laundry packs seen at a single tertiary care children's hospital medical center. Cases were identified by searching the poison center database for exposures to laundry products from March 2012 to October 2013 in children <5 years old. Medical records were reviewed for all identified cases. Data collected included demographics, treatments, laboratory and radiology data, disposition, and length of stay in the emergency department (ED). RESULTS: Forty cases were included. Thirty-two were ingestions and eight were ocular exposures. Nine children were admitted, two of which were admitted to a critical care unit. Seven other children were discharged after 1-night admissions; none received any treatments after initial ED treatment. Of these, four children were admitted for the possibility of central nervous system (CNS) depression, but none showed any progression. Twenty-nine children with ingestions were discharged directly from the ED. No children had progression of CNS symptoms. Children discharged from the ED were observed a mean of 189 min. CONCLUSIONS: Cases of laundry pack exposures seen at our institution were similar to cases described by US poison centers. No child had progression of CNS depression suggesting that prolonged observation is not necessary if the child does not have CNS depression at presentation.

The effect of poison control center consultation on accidental poisoning inpatient hospitalizations with preexisting medical conditions.

In 2005, the Kentucky Poison Control Center (PCC) recorded 46,625 poisoning calls; 27% received hospital treatment. Probabilistic data linkage of accidental poisoning inpatient hospital (IPH) discharge data and PCC data (years 2000-2004) was performed. This study compared IPH with/without preexisting medical conditions and IPH with/without PCC consultation, examining total length of stay and total hospitalization charges. When compared to the IPH reference group with no preexisting medical conditions and who did not consult the PCC (mean charges = $8748, mean length of stay = 3.2 d), PCC consultation without a preexisting medical condition was significantly associated with decreased total hospitalization charges and decreased length of stay (mean charges = $4999, mean length of stay = 1.9 d). When the patient had a preexisting medical condition, PCC consultation was still associated with decreased total hospitalization charges and length of stay (mean charges = $8145, mean length of stay = 2.4 d) compared to those patients with a preexisting medical condition who did not consult the PCC (mean charges = $10,607, mean length of stay = 3.6 d). These results suggest that after accounting for a patient's age and gender, consultation with the PCC is significantly associated with reduced total hospitalization charges and reduced length of stay for IPH, and this association holds for patients with and without a preexisting medical condition.

Toxic clonidine ingestion in children.

OBJECTIVES: We performed a prospective case series to seek dosage or clinical parameters to better identify patients who need direct medical evaluation. STUDY DESIGN: All clonidine ingestions in children younger than 12 years of age reported to 6 poison centers were followed for a minimum of 24 hours. Exclusion criterion was polydrug ingestion. RESULTS: The study included 113 patients, of whom 63 were male. Mean age was 3.8 years (+/-2.4 SD). Clinical effects were common, but severe adverse effects occurred in <10% of patients. The dose ingested was reported for 90 patients (80%); 61 (68%) children ingested <0.3 mg and none had coma, respiratory depression, or hypotension. The lowest dose ingested by history with coma and respiratory depression was 0.3 mg (0.015 mg/kg). Prior clonidine therapy did not affect outcome. Onset of full clinical effects in all cases was complete within 4 hours of ingestion. CONCLUSIONS: We recommend direct medical evaluation for (1) all children 4 years of age and younger with unintentional clonidine ingestion of >or=0.1 mg, (2) ingestion of >0.2 mg in children 5 to 8 years of age, and (3) ingestion of >or=0.4 mg in children older than 8 years of age. Observation for 4 hours may be sufficient to detect patients who will develop severe effects.