[Poisoning in small children--assessing the incidence and intervention. II. What is effective in prevention?]. / Vergiftungen bei Kleinkindern--Inzidenzschätzung und Intervention. II. Was wirkt präventiv?

A study was started a) to assess the incidence self-poisoning in pre-school children and b) to evaluate the impact of an emergency set containing activated carbon and an antifoam. Cooperation was established with the regional legal sickness funds, the regional physician association, and two pharmaceutical companies. Incidence and extent of unintentional self-poisoning among pre-school children are to be determined. The impact of an emergency specimen given to parents of one year old children is evaluated. Families with children aged 1 to 4 year living in boroughs of Berlin are the population at risk. Study period for measuring the incidence is from January 1995 to June 1998. Cases are all accidents of poison ingestion by children of the at-risk-population. Intervention was performed between July 1995 and June 1996. The sets were handed out to parents of children born in 1994. 85% of the selected parents could be interviewed. It was studied whether the behaviour of parents in accidents of poisoning differed between those given an emergency set compared to those who had none. Data were mainly collected by telephone interviews. In this paper the theoretical aspects of the psychological effect of the intervention are discussed.

Clinical course and outcome in class IC antiarrhythmic overdose.

120 cases of class IC antiarrhythmic overdose, including propafenone, flecainide, ajmaline and prajmaline overdose, were evaluated with respect to clinical course, therapy and outcome. Whereas drug overdose in general has an overall mortality of less than 1%, intoxication with antiarrhythmic drugs of class IC was associated with a mean mortality of 22.5%. Nausea, which occurred within the first 30 minutes after ingestion, was the earliest symptom. Spontaneous vomiting probably led to self-detoxication in about half the patients. Cardiac symptoms including bradycardia and, less frequently, tachyrhythmia occurred after about 30 minutes to 2 hours. Therapeutic measures included administration of activated charcoal, gastric lavage and a saline laxative, catecholamines, and in some patients, hypertonic sodium bicarbonate, insertion of a transvenous pacemaker and hemoperfusion. Fatal outcome was mainly due to cardiac conduction disturbances progressing to electromechanical dissociation or asystolia. Resuscitation, which had to be performed in 29 patients, was successful in only two of them. No correlation was found between fatal outcome, the type of antiarrhythmic, and ingested dose. Since a specific treatment is not available and resuscitive procedures including sodium bicarbonate and insertion of a pacemaker are of limited therapeutic value, early diagnosis and primary detoxification are most important for prevention of fatal outcome.

Risk factors for the development of retinopathy in children and adolescents with type 1 (insulin-dependent) diabetes mellitus.

In our preceding paper, the prevalence and development of retinopathy in 231 Type 1 diabetic children and adolescents were reported to be associated with the duration of diabetes and its age at onset. This paper analyses the relationships between the development of retinopathy and the following factors: age, sex, puberty, blood pressure, insulin dosage, HLA antigens, long-term glycaemic control, and serum cholesterol and triglycerides. All these variables were longitudinally evaluated in a cohort of 322 insulin-dependent patients aged 16.2 +/- 4.9 years with diabetes for 7.4 +/- 5.2 years, including those 231 subjects whose eyes were examined once or repeatedly by ophthalmoscopy and fluorescein angiography. Long-term glycaemic control from the onset of diabetes to the retinal examination was assessed by both an arbitrary score comprising different parameters and by mean values of glycosylated haemoglobin, and was categorised as good, fair, and poor. With life-table analysis, the overall median individual risk for developing early retinal changes (9.1 years) was found to be significantly influenced by glycaemic control. Minimal lesions developed earlier (8.0 years) with poor control, but later with fair (10.5 years) and good glycaemic control (12.5 years) (p less than 0.01). Mean HbA1 values below 10% delayed the onset of both incipient (10.8 years) and background retinopathy (16.6 years), while values above 10% advanced it (8.0 and 11.8 years respectively) (p less than 0.05 and less than 0.008). By multivariate regression and stepwise discrimination analyses, only 4 out of 14 variables were found to exert significant independent influences on the development of retinopathy: diabetes duration, long-term glycaemic control, serum triglycerides and age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Poisoning by hypochlorite-containing disinfectants. A retrospective analysis of 594 cases of poisoning]. / Vergiftungen durch hypochlorithaltige Sanitärreiniger. Eine retrospektive Analyse von 594 Vergiftungsfällen.

Hypochlorite-containing disinfectants or bleaching fluids, if inhaled, may lead to life-threatening poisoning (56% of moderately severe cases, 5% of severe cases) through the immediate liberation of chlorine gas, if they are used together with another cleansing fluid which is very acid. A rough estimate suggests that there must be about 700 cases of such poisonings per year in the Federal Republic of Germany. The characteristic symptom is a respiratory distress syndrome when the liberated chlorine gas is inhaled. Toxic pulmonary oedema and cardiovascular failure can occur if the poisoning takes a fulminating course.

[Screening of newborn infants for hypothyroidism in Berlin (West) 1978-1982]. / Neugeborenen-Hypothyreose-Screening in Berlin (West) 1978-1982.

In July 1978 a neonatal screening program for congenital hypothyroidism was introduced in Berlin (West) covering more than 98% of the neonates born in the city area. Up to July 1982 TSH was determined on the fifth day of life in 74,350 newborns using a radioimmunoassay for TSH determination in dried blood spots. With a cut-off limit at 20 microU/ml, a control examination was necessary in 0.96% of the newborns. 32 infants with congenital hypothyroidism were detected and treated with 1-thyroxine, giving a total incidence of 1 in 2,323 newborns (permanent and transient cases). 63% of all newborns with elevated TSH levels (greater than 20 microU/ml) were born in the obstetric department of the Neukölln-Hospital, which uses PVP-Iodine for vaginal disinfection of the mothers during labor and delivery, especially after premature rupture of membranes. Those newborns had only transient TSH-elevations, which were normalized on the tenth day of life. The replacement therapy was started on the average on the ninth day of life. The symptoms present in the newborns with congenital hypothyroidism differed from patient to patient and from the "classical" signs of congenital hypothyroidism described in the literature. All infants detected by the screening program are followed in the outpatient department of the Children's Hospital of the Free University in Berlin and show a normal motor and mental development, except for two infants with other causes for retardation in psychomotor development.

[Intoxication with beta-receptor blockers (author's transl)]. / Intoxikation mit Beta-Rezeptorenblockern.

Beta-blockers are increasingly often used with suicidal intent, but are also sometimes swallowed accidentally by small children. Beta-blockers available in the Federal Republic of Germany differ in their pharmacodynamics and pharmacokinetics. After analysing 49 cases of intoxication, no certain relationship was found between the different substances and specific symptoms. Cardiovascular signs such as sinus bradycardia, arrhythmia, hypotension (30 cases), as well as dizziness and drowziness (17) were the most frequent ones. Loss of consciousness and hallucination (13), as well as seizures (3), also occurred frequently. Hypoglycaemia or symptoms due to it (12) were noted especially in young children. In addition to primary removal of the drug, repeated administration of charcoal and sodium sulphate are recommended with most of the drugs for interrupting the enterohepatic circulation. Administration of atropine for bradycardia and hypotension was usually not effective. Dopamine is recommended; glucagon for definite signs of shock. Haemodialysis is indicated only in exceptional instances and is effective for only a few of the drugs. Forced diuresis should not be practised.

[Intoxication by beta-blockers in children and adolescents (author's transl)]. / Vergiftungen mit beta-rezeptorenblockern bei Kindern und Jugendlichen.

After ingestion of beta-blocking agents 20 out of 77 children and adolescents developed clinical symptoms. 11 cases resulted from suicidal attempts. A 15 year old girl died. Neurological signs (12) predominated. Cardiovascular signs (10) were especially seen after suicidal ingestion of beta-blocking agents. Infants frequently showed hypoglycemia or symptoms based on hypoglycemia (6). After elimination from the gastrointestinal tract patients require intensive monitoring as well as symptomatic treatment. Treatment with atropin often gave insufficient results. However, treatment with glucagon was successful. Secondary detoxication generally is not required and must be evaluated after pharmacokinetic data. Forced diuresis is not indicated.

Antibody formation and insulin requirements in diabetic children during treatment with purified commercial pork insulins.

40 diabetic children (20 female, 20 male, mean age 8.5 ys, ranging from 0.8 to 14.3 ys), were treated with either of two purified porcine insulin preparations, Komb-Insulin CS (Hoechst) "CS": n = 21, and Semilente MC (Novo) "MC": n = 19, the latter being further purified by ion exchange chromatography. Circulating IgG-antibodies formed in 39 out of 40 subjects during the observation period of more than 2 years. Insulin binding-capacities below 2 mU/ml (mean value after 12 months: 0.45 mU/ml) were found following MC and considerably higher concentrations (mean value after 12 months: 5.16 mU/ml) following CS administration. However, only 52% of the CS-group (n = 11) showed high individual responses (subgroup II), many of which exceeded 5 mU/ml, while the other half (subgroup I) exhibited values as low as those in the MC-subjects. The ratio of girls to boys was high (8 vs 3) in subgroup II, and low (2 vs 8) in subgroup I. Despite great differences in antibody formation, no differences in insulin requirements were noted between the MC- and the CS-groups. Within the CS-group, however, some positive relationship between these parameters was found 6 months and 12 months after the start of therapy, but this did not necessarily apply to individual subjects. Short-term (metabolic control) and long-term effects of therapy (growth) were not different in the MC- and CS-subjects. From these results it may be concluded that antibody formation does not affect insulin requirements or metabolic control during relatively short-term treatment. Provided that antibodies have no direct relation to future vascular changes, both insulin preparations used in this study are equally well-situated for long-term treatment in children and adolescents.

Local injuries by accidental ingestion of corrosive substances by children.

Own data and analysis of previous publications show that situations where accidental ingestion of corrosive substances by children may have happened are frequent, but severe corrosive esophagitis leading to perforation or stricture formation is very rare. In case of suspected esophageal injury, esophagoscopy and glucocorticoid treatment become necessary. The evaluation of the initial symptoms in patients from our own material and from the literature indicates that all children with serious esophageal burns had one or more of the following symptoms: visible burns in the oral cavity, hypersalivation, retching, vomiting, retrosternal or epigastric pain, cardiovascular collaps, airway stenosis. Hence, children with an uncertain history of ingestion and without any of these symptoms need not be treated. After ingestion of liquid substances, but never of dry or granular products, lesions in the esophagus without accompanying burns in the oral cavity were observed. The evaluation of 1158 cases of accidental ingestions of several types of household products and a collection of data from the literature on the causticity of these substances shows that cleaners containing mainly detergents and phosphates (with pH values generally between 9 and 11), and household bleaches on sodium hypochlorite basis, are relatively harmless. Drain cleaners (NaOH), decalcifiers (formic acid) and detergents for automatic dish washing machines (metasilicates) are very caustic and are responsible for the majority of serious accidents in children.