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1.
Rev Environ Health ; 35(3): 239-243, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32877367

RESUMO

Two types of analytical multi-level approach to analyse symptoms after exposure to poisons were performed using numerical data extracted from reports received by the JAPAN POISON INFORMATION CENTER on the number "Poisoning 110" during 1998-2017. In the first approach, data collected in 2017, 2012, 2007 and 2002 were used, while in the second approach, all data collected during 1999-2017 were used. In the first approach, according to the odds ratio, the order of causative agents was industrial drugs>home drugs>general drugs and in the second approach, it was industrial drugs>foods/natural poisoning>agricultural drugs. However, in the first approach, the order based on the 95% confidence interval (CI) and profile likelihood was general drugs>home drugs>industrial drugs and in the second approach, the order based on 95% CI, profile likelihood and Wald value was agricultural drugs>foods/natural poisoning>industrial drugs. These multi-prospects were developed using a multilevel approach and the most optimized model was selected from the number of numerical data and the adaptability of fit of the multi-level logistic regression models in this report.


Assuntos
Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/etiologia , Venenos/efeitos adversos , Humanos , Japão , Envenenamento/classificação
2.
MMWR Morb Mortal Wkly Rep ; 69(23): 705-709, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: covidwho-546968

RESUMO

A recent report described a sharp increase in calls to poison centers related to exposures to cleaners and disinfectants since the onset of the coronavirus disease 2019 (COVID-19) pandemic (1). However, data describing cleaning and disinfection practices within household settings in the United States are limited, particularly concerning those practices intended to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. To provide contextual and behavioral insight into the reported increase in poison center calls and to inform timely and relevant prevention strategies, an opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020 to characterize knowledge and practices regarding household cleaning and disinfection during the COVID-19 pandemic. Knowledge gaps were identified in several areas, including safe preparation of cleaning and disinfectant solutions, use of recommended personal protective equipment when using cleaners and disinfectants, and safe storage of hand sanitizers, cleaners, and disinfectants. Thirty-nine percent of respondents reported engaging in nonrecommended high-risk practices with the intent of preventing SARS-CoV-2 transmission, such as washing food products with bleach, applying household cleaning or disinfectant products to bare skin, and intentionally inhaling or ingesting these products. Respondents who engaged in high-risk practices more frequently reported an adverse health effect that they believed was a result of using cleaners or disinfectants than did those who did not report engaging in these practices. Public messaging should continue to emphasize evidence-based, safe practices such as hand hygiene and recommended cleaning and disinfection of high-touch surfaces to prevent transmission of SARS-CoV-2 in household settings (2). Messaging should also emphasize avoidance of high-risk practices such as unsafe preparation of cleaning and disinfectant solutions, use of bleach on food products, application of household cleaning and disinfectant products to skin, and inhalation or ingestion of cleaners and disinfectants.


Assuntos
Infecções por Coronavirus/prevenção & controle , Desinfecção , Exposição Ambiental/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Serviço de Limpeza , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Detergentes/envenenamento , Desinfetantes/envenenamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Centros de Controle de Intoxicações/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
3.
MMWR Morb Mortal Wkly Rep ; 69(23): 705-709, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32525852

RESUMO

A recent report described a sharp increase in calls to poison centers related to exposures to cleaners and disinfectants since the onset of the coronavirus disease 2019 (COVID-19) pandemic (1). However, data describing cleaning and disinfection practices within household settings in the United States are limited, particularly concerning those practices intended to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. To provide contextual and behavioral insight into the reported increase in poison center calls and to inform timely and relevant prevention strategies, an opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020 to characterize knowledge and practices regarding household cleaning and disinfection during the COVID-19 pandemic. Knowledge gaps were identified in several areas, including safe preparation of cleaning and disinfectant solutions, use of recommended personal protective equipment when using cleaners and disinfectants, and safe storage of hand sanitizers, cleaners, and disinfectants. Thirty-nine percent of respondents reported engaging in nonrecommended high-risk practices with the intent of preventing SARS-CoV-2 transmission, such as washing food products with bleach, applying household cleaning or disinfectant products to bare skin, and intentionally inhaling or ingesting these products. Respondents who engaged in high-risk practices more frequently reported an adverse health effect that they believed was a result of using cleaners or disinfectants than did those who did not report engaging in these practices. Public messaging should continue to emphasize evidence-based, safe practices such as hand hygiene and recommended cleaning and disinfection of high-touch surfaces to prevent transmission of SARS-CoV-2 in household settings (2). Messaging should also emphasize avoidance of high-risk practices such as unsafe preparation of cleaning and disinfectant solutions, use of bleach on food products, application of household cleaning and disinfectant products to skin, and inhalation or ingestion of cleaners and disinfectants.


Assuntos
Infecções por Coronavirus/prevenção & controle , Desinfecção , Exposição Ambiental/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Serviço de Limpeza , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Detergentes/envenenamento , Desinfetantes/envenenamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Centros de Controle de Intoxicações/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
4.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32581001

RESUMO

Flualprazolam is a nonregistered drug in the benzodiazepine family and constitutes a new psychoactive substance (NPS). Since 2014, a growing number of designer benzodiazepines have become available over the Internet and on the counterfeit drug market. In June 2019, a cluster of patients intoxicated with flualprazolam was identified by the Oregon Poison Center. As an emerging drug of abuse, the clinical characteristics of flualprazolam have been poorly characterized thus far. Over a one-week period, 6 teenagers presented to local emergency departments after ingesting illegally obtained counterfeit alprazolam, which led to sedation. Other symptoms included slurred speech, confusion, and mild respiratory depression. All 6 patients had resolution of their symptoms within 6 hours of ingestion. Blood and urine samples, as well as a tablet fragment, were obtained from 3 patients. The tablet and biological samples were analyzed by using liquid chromatography-quadrupole time-of-flight mass spectrometry and were found to contain the NPS flualprazolam without other drugs or intoxicants. With this case series, we add to the medical literature a clinical description of an emerging drug of abuse. Flualprazolam appears to share the clinical properties of other benzodiazepines. As flualprazolam and other NPSs become more common, physicians must be aware of their availability and characteristics. Sedation lasting <6 hours was observed in 6 of 6 patients exposed to flualprazolam. No effects that would be unexpected from benzodiazepine intoxication were seen among the patients. Specifically, none developed prolonged symptoms or required intubation and mechanical ventilation, ICU admission, or antidotal therapy.


Assuntos
Drogas Desenhadas/efeitos adversos , Centros de Controle de Intoxicações/estatística & dados numéricos , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Surtos de Doenças , Feminino , Hospitalização/tendências , Humanos , Masculino , Espectrometria de Massas , Oregon/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
5.
Am J Public Health ; 110(8): 1242-1247, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32552030

RESUMO

Objectives. To evaluate the effect of the voluntary safety standard for liquid laundry packets on the rate of injury involving children younger than 5 years in the United States.Methods. Semiannual national estimates of child injuries involving liquid laundry packets treated in US hospital emergency departments were developed for the July 2012 through December 2018 study period. We used a negative binomial regression model to estimate the effect of the voluntary standard on the injury rate following the standard's publication at the end of 2015. The analysis controlled for the rapid growth of laundry packet use during the study period. Results are presented as relative risks and percentage changes in the injury rate.Results. The voluntary standard was associated with a 49.4% to 61.6% reduction in the rate of child injury.Conclusions. The results suggest that the requirements of the voluntary standard have effectively reduced the rate of child injury involving liquid laundry packets and may have prevented 9200 to 23 000 emergency department-treated injuries during the study period.


Assuntos
Detergentes/toxicidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Centros de Controle de Intoxicações , Segurança/normas , Acidentes Domésticos/prevenção & controle , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Centros de Controle de Intoxicações/estatística & dados numéricos , Centros de Controle de Intoxicações/tendências , Estados Unidos
6.
Wilderness Environ Med ; 31(2): 197-201, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32331949

RESUMO

INTRODUCTION: Anecdotal media reports suggest an increase in snakebites after hurricanes. After Hurricane Harvey, several households called Texas poison control centers to report snakebites that occurred when rising water flooded homes. Patterns of snakebite before and after hurricane landfalls have not been well studied. METHODS: We reviewed retrospective surveillance data from the Texas Poison Control Network to examine snakebites possibly related to tropical storms/hurricanes that hit Texas between 2000 and 2017. For that assessment, we compared 2 groups of counties: those designated for individual assistance (impact counties) by the Federal Emergency Management Agency and all others (nonimpact counties). Typically, counties with individual assistance declarations are those in which damage is worse and resident return may be delayed. RESULTS: Eleven named tropical storms/hurricanes struck Texas between 2000 and 2017; 9 received individual assistance declarations. During the 18 y, 2037 snakebites were reported in the 30 d after and the 30 d before landfalls in 9 storms; 132 (6%) occurred poststorm in impact counties, and 13 of 132 (9%) of the case narratives mentioned hurricanes as a contributing factor. Impact counties were not statistically more likely to report snakebites in the 30 d after landfall for any of the 9 storms or overall, nor did we find differences in patient demographic characteristics, type of snake, and care patterns post- and prestorm. CONCLUSIONS: There was no evidence of increases in snakebites after hurricanes in Texas during the study period. More detailed evaluations may be warranted in other regions that experience hurricanes and have venomous snake populations.


Assuntos
Tempestades Ciclônicas , Mordeduras de Serpentes/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações/estatística & dados numéricos , Estudos Retrospectivos , Texas/epidemiologia , Adulto Jovem
7.
PLoS One ; 15(3): e0229939, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130274

RESUMO

OBJECTIVE: This study aims to provide basic data on the types and frequency of chemical ingestions and the clinical outcomes of chemical ingestion injury. METHODS: This study retrospectively analyzed the data obtained from the Emergency Department-Based Injury In-depth Surveillance of the Korea Centers for Disease Control and Prevention (South Korea) from 2011 to 2016. Patients ingesting chemicals aged ≥ 18 years were included, but those ingesting unknown chemical substances or with unknown clinical outcomes were excluded. RESULTS: This study included 2,712 (47.2% were men and 52.8% were women, mean age, 47.05 years) patients ingesting chemicals. Unintentional and intentional ingestions were reported in 1,673 (61.7%) and 1,039 (38.3%), respectively. The most commonly ingested chemical substances were hypochlorites, detergents, ethanol, and acetic acid. In the unintentional ingestion group, the most common chemicals upon admission were hypochlorites (74), glacial acetic acid (60), and detergent (33). The admission rates were 60% for glacial acetic acid, 58.3% ethylene glycol, and 30.4% other alkali agents. In the intentional ingestion group, the most common chemicals upon admission were hypochlorites (242), glacial acetic acid (79), ethylene glycol (42), and detergent (41). The admission rates were 91.9% for glacial acetic acid, 87.5% ethylene glycol, 85.7% potassium cyanide, and 81.4% hydrochloric acid. In total, 79 deaths (10 unintentional ingestions, 69 intentional ingestion) were reported, and glacial acetic acid had an odds ratio of 9.299 for mortality. CONCLUSION: We compared the intentional and unintentional ingestion groups, and analyzed the factors affecting hospital admission and mortality in each group. The types and clinical outcomes of chemical ingestion varied depending on the purpose of chemical ingestion. The findings are considered beneficial in establishing treatment policies for patients ingesting chemicals.


Assuntos
Ingestão de Alimentos , Substâncias Perigosas/toxicidade , Envenenamento/epidemiologia , Ácido Acético/toxicidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antídotos/uso terapêutico , Detergentes/toxicidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Etanol/toxicidade , Etilenoglicol , Feminino , Humanos , Ácido Hipocloroso/toxicidade , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/fisiopatologia , República da Coreia/epidemiologia , Adulto Jovem
9.
PLoS One ; 15(1): e0227701, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995582

RESUMO

In the last decade, there has been a marked increase in opioid-related human deaths in the U.S. However, the effects of the growth in opioid use on vulnerable populations, such as pet dogs, are largely unknown. The objective of this study was to investigate potential risk factors at the dog, county, and state-levels that contributed to accidental dog opioid poisonings. Dog demographic information was collected during calls to the Animal Poison Control Center (APCC), operated by the American Society for the Prevention of Cruelty to Animals, about pet dog exposures to poisons from 2006-2014. Data concerning state-level opioid-related human death rates and county-level human opioid prescription rates were collected from databases accessed from the Centers for Disease Control and Prevention. A multilevel logistic regression model with random intercepts for county and state was fitted to explore associations between the odds of a call to the APCC being related to dog opioid poisonings with the following independent variables: sex, weight, age, reproductive status, breed class, year, source of calls, county-level human opioid prescription rate, and state-level opioid human death rate. There was a significant non-linear positive association between accidental opioid dog poisoning calls and county-level human opioid prescription rates. Similarly, the odds of a call being related to an opioid poisoning significantly declined over the study period. Depending on the breed class, the odds of a call being related to an opioid poisoning event were generally lower for older and heavier dogs. The odds of a call being related to an opioid poisoning were significantly higher for intact compared to neutered dogs, and if the call was made by a veterinarian compared to a member of the public. Veterinarians responding to poisonings may benefit from knowledge of trends in the use and abuse of both legal and illegal drugs in human populations.


Assuntos
Analgésicos Opioides/envenenamento , Doenças do Cão/induzido quimicamente , Overdose de Drogas/veterinária , Animais de Estimação , Animais , Bases de Dados Factuais , Doenças do Cão/epidemiologia , Cães , Overdose de Drogas/epidemiologia , Feminino , Humanos , Masculino , Centros de Controle de Intoxicações/estatística & dados numéricos , Fatores de Risco , Estados Unidos/epidemiologia
10.
Ann Epidemiol ; 42: 50-57.e2, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31992493

RESUMO

BACKGROUND: Buprenorphine prescriptions have increased dramatically within the United States, whereas methadone continues to be used widely. We investigated the trends and characteristics of buprenorphine and methadone exposures in the pediatric population. METHODS: We identified pediatric exposures to buprenorphine and methadone using the National Poison Data System from 2013 to 2016. We descriptively assessed characteristics of the exposures. Trends in exposures were evaluated using generalized linear mixed models. RESULTS: Pediatric buprenorphine exposures increased from 2013 (1097) to 2016 (1226) while methadone calls decreased (486 to 396). After adjusting for the random effects of the geographical region, the mean number of pediatric buprenorphine exposures (per 100,000 pediatric population) increased from 1.3 to 1.5 (P = .05). Conversely, the mean number of methadone exposures decreased from 0.6 to 0.4 (P = .03). Children aged ≤3 years constituted the highest percentage of both exposures. Unintentional exposures accounted for most of the buprenorphine (86.9%) and methadone (62.4%) exposures. Major clinical effects were demonstrated in 2.3% of buprenorphine exposures and were more frequent with methadone (13%). West Virginia and Maryland demonstrated the highest incidence of buprenorphine and methadone exposures, respectively. CONCLUSIONS: Pediatric buprenorphine exposures increased but demonstrated less severe effects compared to methadone exposures, which decreased during the study period.


Assuntos
Buprenorfina/envenenamento , Exposição Ambiental/estatística & dados numéricos , Metadona/envenenamento , Antagonistas de Entorpecentes/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/epidemiologia , Criança , Pré-Escolar , Bases de Dados Factuais , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Lactente , Masculino , Estados Unidos/epidemiologia
11.
J Pediatr ; 219: 254-258.e1, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31952846

RESUMO

This retrospective review of poison center calls found that there were 9122 illicit drug exposures reported in children <10 years of age between 2006 and 2016. Marijuana and methamphetamine were reported most frequently, with significant increases over the study period; methamphetamine was associated with the most deaths.


Assuntos
Drogas Ilícitas/envenenamento , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Masculino , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
13.
Rev. esp. salud pública ; 94: 0-0, 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193577

RESUMO

OBJETIVO: Existen pocos estudios epidemiológicos, sobre todo de tipo multicéntrico, sobre las intoxicaciones agudas a causa de productos químicos agroindustriales y del hogar en España. El objetivo de este trabajo fue describir el perfil epidemiológico y clínico de estas intoxicaciones en nuestro país, y analizar su evolución temporal. METODOS: El Sistema Español de Toxicovigilancia (SETv) es un registro prospectivo que incluye a 32 Servicios de Urgencias y Unidades de Cuidados intensivos de España. Se realizó un estudio descriptivo observacional de las intoxicaciones agudas por agentes químicos (excluyendo drogas y fármacos) en sus primeros 15 años de funcionamiento (1999-2014). Las comparaciones de proporciones se realizaron mediante las pruebas de Chi-cuadrado o exacta de Fisher, y entre pares de grupos independientes con la prueba de Mann-Whitney. Se consideraron significativos los valores de probabilidad menores de 0,05. RESULTADOS: Los 10.548 casos estudiados presentaban una edad media de 38,41 (+/-22,07) años, siendo significativamente superior en las mujeres (p=0,0001). El 67,7% de las intoxicaciones ocurrieron en el hogar, y las vías de entrada más frecuentes fueron la respiratoria (48,3%), la digestiva (35,3%) y la ocular (13,1%). Los grupos tóxicos más frecuentes fueron los gases tóxicos (31%), los cáusticos (25,6%) y los gases irritantes (12,1%). Un 76,2% de los casos requirieron tratamiento (27,2% con antídotos). Ingresó en un centro hospitalario un 20,6% de las personas, con una estancia media de 32 (+/-151,94) días, con diferencias significativas para los plaguicidas y disolventes (p=0,02). Presentaron secuelas al alta un 2,1%. La mortalidad fue del 1,4% (146 pacientes), con una edad media de 62,08 años (+/-19,58; p=0,0001). CONCLUSIONES: En las intoxicaciones por productos químicos, las medidas preventivas deben centrarse fundamentalmente en el ámbito doméstico, controlando las fuentes de exposición al monóxido de carbono y la manipulación de los productos de limpieza, fundamentalmente los líquidos cáusticos y la generación de gases irritantes al mezclarlos


OBJECTIVE: There are few epidemiological studies on acute poisonings from pesticides, industrials and household products in Spain. The objective of this work is to describe the epidemiological and clinical profile of acute poisonings by chemical products in our country, and analyze their annual evolution. METHODS: The Spanish Toxicovigilance System (SETv) is a prospective registry that includes 32 Emergency Departments and Intensive Care Units in Spain. An observational descriptive study of acute poisoning by chemical agents (excluding pharmacological products and illicit drugs) was carried out, within 1999-2014. Statistical analysis was performed using Chi-square or exact Fisher's tests. Non-parametric continuous variables were compared using the Mann-Whitney U test. P-value less than 0.05 were considered significant. RESULTS: The 10,548 cases studied had a mean age of 38.41 (+/-22.07) years, being significantly higher in women (p=0.0001). 67.7% of the poisonings occurred at home, and the most frequent routes of exposure were respiratory (48.3%), digestive (35.3%) and ocular (13.1%). The most frequent toxic groups were toxic gases (31%), caustics (25.6%) and irritant gases (12.1%). Of the patients that required treatment (76.2%), antidotes were used in 27.2%. 20.6% of the patients were admitted at Hospital, with a median stay of 32 (+/-151.94) days, with significant differences for pesticides and solvents (p=0.02). Sequelae were presented at discharge in 2.1% of patients. Mortality was 1.4% (146 patients) with a mean age of 62.08 years (+/-19.58) (p=0.0001). CONCLUSIONS: The reduction of chemical poisonings should be prevented in the domestic environment, taking into account the sources of exposure to carbon monoxide and the handling of household cleaning products, both caustic liquids and the generation of irritating gases when mixed


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Envenenamento/epidemiologia , Compostos Químicos/efeitos adversos , Noxas/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Exposição a Produtos Químicos , Gás Tóxico , Tentativa de Suicídio/estatística & dados numéricos , Praguicidas/envenenamento , Detergentes/envenenamento , Cáusticos/envenenamento , Espanha/epidemiologia
14.
Clin Toxicol (Phila) ; 58(1): 49-55, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31008653

RESUMO

Introduction: The purpose of this study was to characterize the frequency, reasons for exposure, clinical manifestations, treatments, duration of effects, and medical outcomes of pediatric guanfacine exposures reported to the National Poison Data System (NPDS) from 2000 to 2016.Methods: Data extracted from poison control center call records for pediatric (0-5 years, 6-12 years, and 13-19 years), single-substance guanfacine ingestions reported to NPDS between 2000 and 2016 was retrospectively analyzed.Results: A total of 10927 cases were identified for analysis. Pediatric single-substance guanfacine exposures reported to NPDS increased significantly during the study period, with a marked increase among 6-12-year-olds. The most commonly documented clinical effects across age groups were drowsiness (n = 4262, 39%), bradycardia (n = 1696, 15.5%), and hypotension (n = 1127, 10.3%). The duration of effect for most cases was >8 hours but ≤24 hours (n = 2395, 44.2%). The median documented quantity of guanfacine ingested was 0.11 mg/kg (range: 0.004-7.8 mg/kg). The difference between mg/kg ingested in no effect and minor effect groups compared to moderate and major effect groups was statistically significant in all three age groups.Conclusions: Pediatric guanfacine exposures reported to U.S. poison centers have increased significantly in the last fifteen years. The most common clinical findings secondary to guanfacine exposure were bradycardia, hypotension, and CNS depression. There was a statistically significant difference between the mg/kg of guanfacine ingested in the groups experiencing no effect or mild effect compared to moderate or major effects. However, the maximum ingested dose reported among 0-5-year-olds in the no effect group was 2.72 mg/kg, while the minimum dose eliciting a major effect in both 0-5 and 6-12-year-olds was 0.05 mg/kg. The overall incidence of major effects was very low, with the vast majority of patients experiencing minor symptoms or less. Based on this data, we agree with current recommendations that any symptomatic pediatric patient exposed to guanfacine should be observed in a health care facility for at least 24 hours.


Assuntos
Overdose de Drogas/epidemiologia , Guanfacina/envenenamento , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Centros de Controle de Intoxicações/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto Jovem
15.
Hum Exp Toxicol ; 39(1): 95-110, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31578092

RESUMO

INTRODUCTION: Our objective was to describe the characteristics of liquid laundry detergent packet (LDP) exposures and to develop referral and treatment recommendations. METHODS: This retrospective cohort study investigated LDP exposures reported to the National Poison Data System from January 1, 2013 through June 30, 2014. Three medical toxicologists reviewed the most significant exposures (n = 450). RESULTS: Of 17,857 reported LDP exposures, 13,307 involved only an LDP (no other substance) and were followed to a known medical outcome. The median age was 2 years (range 12 days to 100 years). Approximately 10% of exposures reported a major or moderate effect. The most common symptom was vomiting (51.7%; n = 6875), but stridor or aspiration pneumonia and respiratory depression secondary to central nervous system effects also occurred. Two pediatric and two adult deaths occurred, but no causal mechanism leading to death could be identified in any of the deaths. CONCLUSIONS: LDPs occasionally produce a toxidrome of vomiting, stridor, hypoxia, and sedation with metabolic acidosis and respiratory failure. These symptoms and the availability of LDPs highlight the need for referral and treatment recommendations and efforts to minimize unintentional exposures. Review of data from US poison centers may provide referral and treatment recommendations that improve patient outcomes.


Assuntos
Detergentes/toxicidade , Produtos Domésticos/toxicidade , Vômito/induzido quimicamente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Pneumopatias , Masculino , Pessoa de Meia-Idade , Centros de Controle de Intoxicações/estatística & dados numéricos , Estudos Retrospectivos , Suicídio , Adulto Jovem
16.
Rev Chil Pediatr ; 90(5): 500-507, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31859733

RESUMO

INTRODUCTION: Household cleaning products and cosmetics are necessary for daily life and widely used by the population. However, their use may not be risk-free, especially when they are not used or stored as recommended. It is important to characterize exposures, as this is useful for developing stra tegies to reduce morbidity, mortality, and health costs associated, especially in the child population. OBJECTIVE: To describe reports associated with household cleaning products and cosmetics exposure in patients under the age of 12, reported to the Poison Information Center of the Catholic University of Chile (CITUC). PATIENTS AND METHOD: Descriptive cross-sectional study of phone calls to CITUC during 2016. The analyzed variables were age, sex, product, caller, caller and incident location, ex posure circumstances, exposure route(s), symptoms, and severity from manual records and from the WHO's electronic record software 'INTOX Data Management System'. RESULTS: 3,415 cases met the inclusion criteria. Children under the age of five represented 91% of the exposures, and 58.5% were male. 99.4% were accidental exposures, and 98.6% occurred at home. Family members (57%) and health personnel (42%) made the calls. 68.3% of the patients had no symptoms after exposure. The four products with the highest incidence were household bleach (27.6%), floor cleaners and polishers (13.1%), dish soap (7.9%), and perfume/cologne (5.8%). The main exposure route was by ingestion (89.4%). CONCLUSIONS: Household cleaning products and cosmetics are common causes of exposures especially in children under the age of five. Although these products have a low morbidity and mortality rate, it is important to educate the population to prevent possible poisonings in the child population.


Assuntos
Cosméticos/envenenamento , Produtos Domésticos/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino
17.
Swiss Med Wkly ; 149: w20164, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31846508

RESUMO

AIMS OF THE STUDY: To describe the characteristics of cases presenting at the emergency department due to (suspected) poisoning for which consultation on patient management with the national Poisons Information Centre was required. METHODS: Retrospective study at the emergency department of Bern University Hospital, Switzerland, from May 2012 to December 2017. Cases were identified in the electronic patient database using appropriate full-text search terms. Cases were excluded if the contact with the National Poisons Information Centre was through an external hospital or directly by the patient. Cases in which the poison centre was not contacted and cases without the patient’s general consent to use their medical data for research purposes were also excluded. RESULTS: Overall, 667 cases from the study period were included. The median age was 32 years (range 16–94); 405 patients (61%) were female and 262 (39%) male. In most cases, the poisoning was acute (n = 631, 95%) and intentional (n = 505, 76%). The most common route of exposure was ingestion (n = 587, 88%) and the most commonly involved substances were sedatives (n = 185, 28%), antidepressants (n = 162, 24%) and non-opioid analgesics (n = 161, 24%). Impaired consciousness was documented in 299 cases (45%). Approximately half of the cases (n = 359, 54%) were of minor severity as assessed using the Poisoning Severity Score, 142 (21%) were of moderate severity, 110 (16%) were asymptomatic and 56 (8%) were severe. There were no fatalities. In most cases (n = 599, 90%), immediate therapeutic or diagnostic measures were undertaken prior to contact with the poison centre. Decontamination measures and specific antidotes undertaken or administered only after contacting the poison centre included whole bowel irrigation, haemodialysis, fomepizole, biperiden, silibinin, deferoxamine, leucovorin, dimercaptopropanesulfonic acid and hydroxocobalamin. Administration of a specific antidote/therapeutic agent was recommended in 87 cases (13%). In 70 of these 87 cases (80%), the specific agents were administered as recommended by the poison centre. In 17 cases (20%), the specific antidotes were not administered as recommended because of either clinical improvement (n = 11), termination of therapy based on laboratory results (n = 3), therapy refused by the patient (n = 2), or identification of a mushroom as non-poisonous (n = 1). In 109 cases (16%), there was no change in patient management after contacting the poison centre. CONCLUSIONS: For patients presenting at the emergency department with severe poisoning, contact with the poison information centre can help to implement specific treatment and avoid fatalities. In less severe cases involving more common agents (e.g. paracetamol, benzodiazepines), contact can help to avoid unnecessary treatment and serve as a source of information and/or confirmation.


Assuntos
Serviço Hospitalar de Emergência , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/terapia , Estudos Retrospectivos , Suíça/epidemiologia , Adulto Jovem
19.
Med J Aust ; 211(5): 218-223, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31389025

RESUMO

OBJECTIVES: To assess the numbers of paracetamol overdose-related hospital admissions and deaths in Australia since 2007-08, and the overdose size of intentional paracetamol overdoses since 2004. DESIGN, SETTING: Retrospective analysis of data on paracetamol-related exposures, hospital admissions, and deaths from the Australian Institute of Health and Welfare National Hospital Morbidity Database (NHMD; 2007-08 to 2016-17), the New South Wales Poisons Information Centre (NSWPIC; 2004-2017), and the National Coronial Information System (NCIS; 2007-08 to 2016-17). PARTICIPANTS: People who took overdoses of paracetamol in single ingredient preparations. MAIN OUTCOME MEASURES: Annual numbers of reported paracetamol-related poisonings, hospital admissions, and deaths; number of tablets taken in overdoses. RESULTS: The NHMD included 95 668 admissions with paracetamol poisoning diagnoses (2007-08 to 2016-17); the annual number of cases increased by 44.3% during the study period (3.8% per year; 95% CI, 3.2-4.6%). Toxic liver disease was documented for 1816 of these patients; the annual number increased by 108% during the study period (7.7% per year; 95% CI, 6.0-9.5%). The NSWPIC database included 22 997 reports of intentional overdose with paracetamol (2004-2017); the annual number increased by 77.0% during the study period (3.3% per year; 95% CI, 2.5-4.2%). The median number of tablets taken increased from 15 (IQR, 10-24) in 2004 to 20 (IQR, 10-35) in 2017. Modified release paracetamol ingestion report numbers increased 38% between 2004 and 2017 (95% CI, 30-47%). 126 in-hospital deaths were recorded in the NHMD, and 205 deaths (in-hospital and out of hospital) in the NCIS, with no temporal trends. CONCLUSIONS: The frequency of paracetamol overdose-related hospital admissions has increased in Australia since 2004, and the rise is associated with greater numbers of liver injury diagnoses. Overdose size and the proportion of overdoses involving modified release paracetamol have each also increased.


Assuntos
Acetaminofen/envenenamento , Analgésicos não Entorpecentes/envenenamento , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Medicamentos sem Prescrição , Estudos Retrospectivos , Adulto Jovem
20.
Int J Public Health ; 64(9): 1283-1290, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31297557

RESUMO

OBJECTIVES: This study evaluates the impact of the Belgian Poison Centre (BPC) on national healthcare expenses for calls from the public for unintentional poisonings. METHODS: The probability of either calling the BPC, consulting a general practitioner (GP) or consulting an emergency department (ED) was examined in a telephone survey (February-March 2016). Callers were asked what they would have done in case of unavailability of the BPC. The proportion and cost for ED-ambulatory care, ED 24-h observation or hospitalisation were calculated from individual invoices. A cost-benefit analysis was performed. RESULTS: Unintentional cases (n = 485) from 1045 calls to the BPC were included. After having called the BPC, 92.1% did not seek further medical help, 4.2% consulted a GP and 3.7% went to an ED. In the absence of the BPC, 13.8% would not have sought any further help, 49.3% would have consulted a GP and 36.9% would have gone to the hospital. The cost-benefit ratio of the availability of the BPC as versus its absence was estimated at 5.70. CONCLUSIONS: Financial savings can be made if people first call the BPC for unintentional poisonings.


Assuntos
Análise Custo-Benefício/estatística & dados numéricos , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Centros de Controle de Intoxicações/economia , Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/economia , Bélgica , Humanos
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