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Background: The Hong Kong Poison Information Centre has provided consultation service to healthcare professionals and collected epidemiological data on poisoning in Hong Kong since 2005. Objective(s): To analyse and report the poisoning data of Hong Kong Poison Information Centre in 2020 during the COVID-19 pandemic. Method(s): A retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2020. Result(s): A total of 3633 poisoning cases were analysed. Compared to 2019 (pre-COVID era), there was a reduction of ~10% of total poisoning cases recorded (383 cases), with a majority (> 90%) of reduction from poisoning cases with no clinical effect (353 cases). A greater proportion of reduction was observed among the children (0-12 years), patients with general unintentional poisoning, poisoning due to therapeutic error and food poisoning. An increased number of cases was noted from abusive use, adverse herb/proprietary Chinese medicine reaction and poisoning related to household bleaches. Teenage (13-19 years) poisoning seemed to be unaffected by the COVID-19 pandemic and the previously observed increasing trend continued (up to 11.8% of total poisoning cases this year). Despite a total reduction in poisoning cases recorded, the number of deaths increased by 37% from 35 in 2019 to 48 in 2020 (mortality rate 1.5%). A total of seven interesting cases were discussed. Conclusion(s): This 15th annual report provides updated epidemiological information on poisoning patterns in Hong Kong during the COVID-19 pandemic. It also highlighted important changes and possible effects of the COVID-19 pandemic on poisoning in Hong Kong in comparison with our previous reports. Copyright © The Author(s) 2022.
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Background: Glycine is an endogenous, non-essential, simple amino acid produced in the human body. A 1.5% solution is commonly used for irrigation in gynecologic and urologic procedures as it is a sterile, clear, non-irritating liquid. It is neutral, mildly acidic and nonpyrogenic, and as it is produced by the human body it does not cause allergic reactions. If an excessive amount is absorbed during a procedure it can result in electrolyte abnormalities, such as hyponatremia or hypocalcemia. It can also result in transient vision disturbances, changes in heart rate, hypotension, hyperammonemia, or encephalopathy. Glycine has been used as a diluent in certain inhaled therapies for COVID-19 infections, such as epoprostenol. We describe a case where a 1.5% glycine solution was inadvertently used for humidified oxygen via high flow nasal cannula as opposed to distilled water. Case report: The patient was a 70-year-old male who was admitted to the hospital for hypoxia related to a COVID-19 infection with O2 saturations in the 70-80% range. He was placed on high flow nasal cannula to improve his oxygen levels. During his inpatient stay it was discovered that a 3-L bag of 1.5% glycine solution had been connected to the high flow nasal cannula instead of distilled water. This ran from Friday evening to the following Monday morning before the error was discovered. There was only 100mL of the glycine solution remaining in the bag when it was found. The patient continued to do well and had no new complaints during his stay. The case was called to the regional poison center which recommended monitoring electrolytes, watching for any possible respiratory symptoms and continuing supportive care. Initial lab work on admission showed a chemistry panel of Na 146, K 3.6, Cl 102, CO2 25.3, BUN 9, Cr 0.70, Glucose 106, Ca 9.3. Repeat lab work immediately after the mistake was found showed: Na 137, K 4.8 Cl 100, CO2 28, BUN 15, Cr 0.70, Glucose 129, Ca 9.0. On recommendations from poison control, electrolytes were monitored with repeat lab work 10 h after discontinuation of the glycine solution, showing: Na 135, K 4.3, Cl 97, CO2 26.8, Glucose 175, Ca 9.2. The patient did not develop any new complaints, had no reported altered mental status, epistaxis, nasal irritation or other symptoms related to the inhalation. He was eventually discharged home on oxygen for his persistent hypoxia related to his COVID-19 lung infection. Discussion(s): This case demonstrates that prolonged continuous inhalational exposure to a 1.5% glycine irrigation solution does not result in any mucosal irritation, metabolic or systemic toxic reactions, even though its pH is reportedly between 4.5 and 6.5. Thus, glycine solutions up to this concentration appear to be safely tolerated for its increasing use as an excipient for aerosolized medications. Conclusion(s): We describe a case where 1.5% glycine solution was inadvertently used in place of distilled water for humidified oxygen via high flow nasal cannula for approximately 3 days in a patient being treated for COVID-19 related pneumonia with no notable adverse effects.
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Background: In New Mexico from 2013 to 2017, Native Americans had the highest number of poison-related deaths (26.6/100,000 population) when compared to other ethnic groups: Hispanics (26.5/100,000), Black/African Americans (24.4/ 100,000), Whites (21.2/100,000), and Asian/Pacific Islanders (4.7/ 100,000). In addition, the poison center has traditionally experienced low call volumes from tribal communities. A survey conducted in 2018 revealed that community health representatives of the Navajo Nation reported that their respective communities preferred printed materials and radio public service announcements (PSAs) as platforms to receive educational messages. Method(s): In 2021, a radio public service announcement (PSA) was developed in English and translated into Dine by a college of pharmacy student and a medical doctor, both fluent in their native tongue. The PSAs provide examples of poisoning scenarios and advises to call the poison hotline at the end. Thirty second versions of both the English and Dine PSAs were run on the Navajo Nation internet radio station, KTNN, for the month of September 2021, and then again for the month of March 2022. Both interventions had an equal amount of radio spots. Result(s): Data were retrieved from Toxicall for zip codes that corresponded to the Navajo Nation in New Mexico. COVID calls were excluded from the data. Calls stemming from a poisoning outbreak that occurred on the Navajo Nation during the summer of 2020 were also eliminated to account for atypical patterns in call volume. There was a 48.3% increase in calls when comparing September 2021, intervention month, to September 2020. The March 2022 intervention showed a 54.5% uptick in calls when compared to March 2021. Both the September and March interventions resulted in an increase of 30 calls. To control for March also being poison prevention month in New Mexico, Navajo Nation zip codes were excluded, and then the total calls for the rest of the state were calculated. This resulted in 2147 calls in 2021 and 2073 in 2022. Conclusion(s): The significant increase in call volumes when comparing the intervention months to the preceding years, strongly suggests that radio PSAs increase poison hotline traffic. Both intervention months showing an increase of 30 calls was also striking. In addition, total calls for the state without including the Navajo Nation zip codes dropped from March 2021 to March 2022, further eliminating poison prevention month as a cofactor in the increase in calls during the March intervention. Due to the consistent decrease in calls to poison centers across the nation, it is imperative to continue investigating how certain dynamics influence call volume, such as increasing internet consumption and, perhaps, the COVID 19 pandemic. It is equally necessary to research other at-risk communities to refine the components of effective communication and to define relevant platforms for delivering those educational messages.
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Background: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup provides a weak conditional recommendation in support of hemodialysis (HD) for select patients with severe phenytoin poisoning. Despite this recommendation, the HD clearance of phenytoin is poorly studied. We present a patient who developed phenytoin toxicity that was treated with hemodialysis and report on the efficacy of phenytoin removal during HD. Case report: An 87-year-old man with epilepsy who was maintained on a stable dose of 300mg phenytoin extended-release daily was admitted to the hospital for treatment of Coronavirus Disease 2019 and congestive heart failure. On hospital day 14, the patient had a gradual onset of depressed mental status with hypothermia (nadir 35 degrees Celsius). At this time, he had a rising total blood phenytoin concentration (peak 49.3 mcg/mL [therapeutic 10-20mcg/mL] with an albumin of 3.8 g/dL [normal 3.4-5.4 g/dL]). The patient's other medications included furosemide, aspirin, atorvastatin, digoxin, doxycycline, metoprolol tartrate, and warfarin;he was also receiving albumin and crystalloid for hypovolemia (albumin nadir on hospital day 14: 2.5 g/dL). Free phenytoin concentrations were not available. Alternate etiologies of hypothermia (endocrine, infectious) were excluded. The Poison Control Center was consulted and recommended HD because of the concern for prolonged coma, as per EXTRIP guidelines. The patient received three sessions of HD over a period of 6 days at 2.5-3 h per session using an F160 Optiflux membrane filter (Fresenius Medical Care, Waltham, MA, USA), with a blood flow rate of 350mL/min and a dialysate flow rate of 700mL/min. After the first session of HD (2.5 h) on hospital day 21, his hypothermia resolved and his phenytoin concentration fell from 39.2mcg/mL to 34.2 mcg/mL with only mild improvement in his mental status. After 6 days (hospital day 27), his phenytoin concentration decreased to 19.5 mcg/mL and his mental status normalized. Effluent from the first HD session had phenytoin concentrations below the limit of detection (0.50mcg/mL). Thus, no greater than 52mg of phenytoin was removed during a 2.5-h session of hemodialysis. Discussion(s): The reason for the sudden increase in blood phenytoin concentrations in this patient is unclear in the absence of drug-drug interactions or dosing changes to the phenytoin. Although uncommonly reported, patients with phenytoin toxicity can experience hypothermia. In this case, the patient's hypothermia resolved during HD, although it is unclear if this was related to changes in phenytoin concentration or (more likely) direct extracorporeal warming via the HD machine. If the patient's phenytoin clearance from the first session were extrapolated to subsequent sessions an estimated maximum of 166.4mg of phenytoin would be removed in 8 total hours of HD, which is far less than previously reported phenytoin clearances on the order of grams. This difference may be related to the use of high cutoff dialysis membranes in prior studies, which are not routinely used. Conclusion(s): Although HD rapidly resolved this patient's hypothermia, a minimal amount of phenytoin was recovered in the patient's dialysate. Prior studies suggesting consequential clearance and efficacy of phenytoin removal by extracorporeal treatment may not apply to routine HD methods. Further studies on the utility of extracorporeal treatment for phenytoin toxicity are needed.
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SESSION TITLE: Occupational and Environmental Lung Disease Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Chlorine gas is a pulmonary irritant with pungent odor that damages the respiratory tract. Chlorine gas exposure occurs in industrial or household exposures,Chlorine gas has two forms either a liquid or gas, toxicity of chlorine gas depends on the dose and duration of exposure. Chlorine gas used in manufacturing products like paper, insecticides, Chlorine is used to treat bottled and swiming pool water. CASE PRESENTATION: A 37 Y.O Male, no PMH presents with progressive dyspnea for three days worse with activity,decreases with rest, denied cough fever or chest pain he is vaccinated for COVID,no smoking history. The patient worked at a chlorine gas factory in the Dominican Republic for 15 years. Exam: Vitals: BP 124/72 mmHg. HR 100 BPM. RR 21 BPM. SpO2 84%. General: acute distress. Heart: normal S1, S2. RRR. Lung: wheeze bilaterally. Abdomen: Soft. Musculoskeletal: no pitting edema. he was placed on 6 LPM NC saturation improved to 90%. CBC and Chemistry were unremarkable, he was started on steroid, breathing treatment with antibiotics. ABG showed hypoxemia. he was placed on Venturi mask and his saturation improved to 95%.CTA was negative for PE. EKG, troponin were unremarkable. A proBNP normal. The antibiotics were discontinued because of a negative workup. A TTE study was normal. HRCT scan of the chest, showed atelectasis and infiltrates of lower lobes. No interstitial fibrosis.A PFT showed obstructive airway disease. He was discharged on oral and inhaled steroids.Hi new onset obstructive airway could be due to chlorine gas exposure. DISCUSSION: Chlorine gas causes cellular injury through oxidative damage but further damage results from activation and recruitment of inflammatory cells with subsequent release of oxidants and proteolytic enzymes. Humans can detect chlorine gas odor at a concentration between 0.1-0.3 ppm. At 1-3 ppm,it causes irritation of oral,eye mucosal membranes. At 30-40 ppm causes cough, chest pain, and SOB. At 40-60 ppm, toxic pneumonitis and pulmonary edema and can be fatal at 430 ppm concentration or higher within thirty minutes. Chronic exposure to chlorine gas lead to chest pain, cough, sore throat, hemoptysis, recurrent asthma. Physical exam findings include tachypnea cyanosis, wheezing, intercostal retractions, decreased breath sounds. Pulmonary function tests may reveal obstructive lung function disease. Chronic exposure to a low level was found to be associated with an increased risk of asthma in swimmers. CONCLUSIONS: Chlorine exposure results in direct chemical toxicity to the airways with acute airways obstruction or airways hyperreactivity, presentation varies from acute overwhelming intoxication with acute lung injury and or death, occupational exposure increase the likelihood of chronic bronchitis or isolated wheezing attacks. Treatment for chlorine exposure is largely supportive. Reference #1: 1- Center of disease control and prevention website/emergency preparedness and response/ https://emergency.cdc.gov/agent/chlorine/basics/facts.asp Reference #2: 2- C- Morim A, Guldner GT. Chlorine Gas Toxicity. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537213/. Reference #3: A- Gummin DD, Mowry JB, Beuhler MC, et al. 2020 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021;59(12):1282-1501. doi:10.1080/15563650.2021.1989785 DISCLOSURES: No relevant relationships by Abdallah Khashan No relevant relationships by Samer Talib no disclosure on file for Matthew Yotsuya;
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PURPOSE: The objective of this study was to evaluate trends and characteristics in adolescent poison center (PC) exposure calls before and during the COVID-19 pandemic. METHODS: A retrospective review of PC calls for adolescents aged 13-17 years from January 1, 2018 through June 30, 2021. RESULTS: During the pandemic, US PCs had a higher proportion of adolescent exposure calls managed in a healthcare facility (71.9% vs. 67.4%) and hospital admissions (27.2% vs. 25.7%) than prior to the pandemic. There was a higher proportion with suicide intent (55.8% vs. 48.8%), moderate/major clinical effects (22.8% vs. 20.1%), and deaths (0.07% vs. 0.05%). Monthly calls significantly increased from 30 calls/month to 204 calls/month (p < .001). The slope of hospital admissions significantly increased (0.19% per month, p < .001) during the pandemic. DISCUSSION: During the COVID-19 pandemic, US PCs observed an increase in adolescent suicidal intent exposure calls with more severe outcomes, hospitalizations, and deaths.
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COVID-19 , Poisons , Adolescent , Humans , Poison Control Centers , Pandemics , Health FacilitiesABSTRACT
Introduction: Kratom (mitragynine speciosa) is a tree native to Southeast Asia that has both opioid, stimulant, and other unknown properties. It is currently legal in the United States and used for therapeutic and recreational purposes. There is a dearth of literature on kratom’s effects on the body. At least half of reported kratom exposures resulted in a serious medical outcome, including death (1). In contrast, there are no controlled clinical trials on safety and efficacy of kratom as a treatment (2). Case: A 32-year-old Caucasian, currently unemployed, unmarried, mother of two children presented intubated to the MICU from an outside hospital with acute fulminant hepatic failure in the setting of significant kratom use. The patient also presented febrile with intracranial hemorrhage, cerebral edema, GI bleeding, acute renal failure, and diffuse intravascular coagulation. Psychiatry was consulted for potential liver transplant candidacy. Her previous history included six years of opioid use and transition to kratom 1-2 years prior to admission, with recent ingestion up to twenty-five times the patient’s usual amount (up to 125mg). Pertinent positive labs included elevated troponin (0.4), transaminitis ( >11,000), elevated PT/PTT (99/52), D-dimer ( >20), hematuria, pyuria, serum ferritin, prolonged QTc (514), and hypoglycemia. Pertinent negatives included unrevealing serum ethanol, phosphatidylethanol, viral hepatitis, HIV, COVID-19, EBV, CMV, other viral panels, acetaminophen level, toxicology screen, and EEG. Imaging revealed interstitial pulmonary edema and diffuse cerebral edema. Given lack of published information on kratom, the team emergently listed the patient for liver transplant despite significant concern for kratom use disorder. Over the course of three days, the patient’s mental status and labs continued to worsen, ultimately resulting in death. Interventions pursued included dialysis, mechanical ventilation, intracranial pressure monitoring with pressure optimization, anticonvulsant therapy, antibiotic therapy, N-acetylcysteine, and other routine MICU care. Due to relatively unremarkable health before ingestion, lack of other significant events, and severe rapid decline, multidisciplinary team consensus cause of death was due to kratom ingestion causing “acute liver failure with hepatic coma”. Discussion: This case report will go into further detail on kratom by analyzing kratom’s mechanism of action, therapeutic use, known side effects including addictive potential, effects on the liver including acute fulminant injury, and current laws and regulations surrounding kratom in the United States with relevance to public health. This is relevant to psychiatrists in the general consult, transplant, and addictions services. References: 1. Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers: 2011–2017. Clinical Toxicology. 2019 57:10,847-854. DOI:10.1080/15563650.2019.1569236 2. Prozialeck W. Update on the Pharmacology and Legal Status of Kratom. J of the AOA. 2016, 116, 802-809. DOI: https://doi.org/10.7556/jaoa.2016.156
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Objective: This study provides an overview of the number and type of calls received by the Belgian Poison Centre (BPC) in 2020. Methods: Data of all calls to the BPC (1 January to 31 December 2020) were collected and analyzed using appropriate statistics (SAS). Results: The BPC received 65,308 calls in 2020 (60,668 in 2019, p<0.05), of which 56,106 (86%) (involving 57,523 victims) were due to an exposure, and 9,202 (14%) were an information request. Despite a minor decrease of 2.3% (21,151 in 2019 versus 20,666 in 2020, p>0.05), the vast majority (35.9%) of exposures were drug-related, of which paracetamol represented 8.2%. Drugs within the category “nervous system” (e.g. antipsychotics, antidepressants, etc.) were most frequently involved (39.6%). There were 11,836 in 2019 versus 12,247 in 2020 (p>0.05). Relating to chemical household products, in the battle against the coronavirus, people bought large quantities and often highly concentrated products, especially products for personal hygiene and cleaning. Poured into smaller containers such as water or soft drink bottles, this led to accidents in which people accidentally drank from the drink container. In an effort to improving cleaning or disinfection, people also started (accidentally) combining or mixing products, with the risk of releasing irritating vapours. Irritation of the mucous membranes and severe shortness of breath were not uncommon. The BPC received 46.1% more calls for bleach and bleach-containing products than in 2019 (835 calls in 2019 compared to 1,220 calls in 2020, p<0.05). A 12.3% increase of cosmetic- and food-related exposures was noted (8,291 in 2019 versus 9,308 in 2020, p<0.05), of which a stable number of exposures (877 in 2019 versus 876 in 2020, p>0.05) were due to essential oils. Exposures to type 1 biocides significantly increased from 322 in 2019 to 1,676 in 2020 (p<0.05), and exposures to type 2 biocides from 406 to 902 (p<0.05). Finally, a 28.2% increase in exposures related to the group “plants, mushrooms and animals” was observed, with 3,256 in 2019 and 4,175 in 2020 (p<0.05). Conclusion: In its history, the BPC has never received as many calls as in 2020, demonstrating its added value in today's and future healthcare. Trends in both, number and type of exposures were impacted by the COVID-19 pandemic.
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Objective: The present study provides an overview of the number and type of calls to the Belgian Poison Centre (BPC), and the impact of COVID-19. Methods: Data of all calls to the BPC (1 January - 31 December 2020) were collected and analysed using appropriate statistics (SAS). Results: The BPC received 65,308 calls in 2020 (60,668 in 2019, p<0.05). The vast majority (35.9%) of exposures were drugrelated (21,151 in 2019 versus 20,666 in 2020, p>0.05), followed by the use of chemical household products (11,836 in 2019 versus 12,247 in 2020 (p>0.05)). A 12.3% increase in the number of cosmetic- and food-related exposures was noted (8,291 in 2019 versus 9,308 in 2020, p<0.05). Within this group, a stable number of exposures (877 in 2019 versus 876 in 2020, p>0.05) due to essential oil exposures were observed. Partly due to the impact of the COVID-19 [1] pandemic, exposures to biocides doubled (104.9%) from 1,964 in 2019 to 4,024 in 2020 (p<0.05). Exposures to type 1 biocides (i.e. human hygiene products, which include alcohol-based hand sanitisers (ABHS)) significantly increased from 322 in 2019 to 1,676 in 2020 (p<0.05), and exposures to type 2 biocides (i.e. disinfectants and algaecides not intended for direct application to humans or animals) from 406 to 902 (p<0.05). In 2020 the BPC received a five-fold increase in the number of calls involving ABHS incidents (both liquid and gel-based, as well as ethanol and isopropanol products) compared to 2019 (1,676 versus 323 in 2019 versus 1,676 in 2020 calls, p<0.05), accounting for 2.6% of all calls in 2020. In 71% of exposures, ingestion was the primary route (1,195/1,676), followed by 28.6% accidental ocular exposures (480/1,676) of which more than half of the incidents involved children (257/480, p<0.05), primarily young children aged 1-4 years (136/257, p<0.05). Finally, as people went into the garden and nature to relax during lockdown, a 28.2% increase in exposures related to the group 'plants, mushrooms and animals' was found, with 3,256 exposures in 2019 and 4,175 in 2020 (p<0.05). Conclusion: In its history, the BPC has never received as many calls as in 2020. The COVID-19 pandemic contributed to a significant number of additional exposures, and requests for toxicologic advice.
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Objective: COVID-19 has changed the social life-style of young people. The aim of our study was to assess the difference in selected demographic and clinical characteristics of adolescents and young adults (14-24 years) treated at the Clinic of Toxicology during 2019 and 2020. Methods: The study was retrospective, observational and crosssectional, analyzing data from the Poison Information Center at the University Clinic of Toxicology during 2019 and 2020. The observed variables were age (divided into 2 groups with 19 years old as the cut off value), in/outpatient treatment, circumstances of poisoning (suicide, accidental, abuse and unknown), outcome (recovery, postponed) and agents (medicine, alcohol, psychoactive substances (PAS), chemicals and others). Results: Poisoning in young patients presented a percentage decrease of 20.4% in 2020 and without lethal outcome. There was no significant difference in gender distribution in the two study years (X2=1.456, df =1, P=0.228, RR =0.917), with an increased number of male patients of 9% in 2020 and their presentation of 57% in the total number of patients. Significant association was registered between the circumstances of poisoning and 2020 (X2= 5.607, df =1, P= 0.001) with increased accidental poisoning in patients younger than 19 years (X2=9.694, df =1, P=0.002). Suicidal poisonings in those above 19 years increased by 32.9% (X2= 3.610, df =1, P=0.057) from 2019 to 2020 and abuse decreased in both age groups, but was significantly reduced in those aged over 19 years (X2=7.921, df =1, P=0.008). There was an association of gender with suicide in patients under 19 years old (X2=4 5.483, df =1, P<0.001) with males at 3.51 higher risk for suicide (RR =3.52, 95%CI 2.283- 5.400) compared to the over 19 years group, where females were at increased risk for suicide (X2=26.923, df =1, P<0.001). Poisoning with medicines were decreased by 38.9% in the under 19 years group (P=0.837) in 2020. There was no significant association between distribution of type of poisoning and the two observed years (X2= 10.673 df= 6, P=0.099). Poisoning with medicines (P<0.001), inpatient treatment (P<0.001), and increasing age (P=0.006) were associated with increased likelihood of suicidal poisoning (χ2 (12)=583.057, P<0.001). Conclusion: Acute poisoning in patients aged 14-24 years during the pandemic in 2020 decreased with increased male patients and without registered lethal outcome. There were increased accidental poisonings in patients under 19 and suicidal poisoning in patients above 19 years. Males younger than 19 years were at higher risk of suicide compared to males aged over 19 years.
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Objective: Coronavirus disease (COVID-19) reached Europe in March, including Estonia (population 1.3 million) with two waves in 2020. Suddenly all citizens needed new information about cleaning and disinfectants including the need for information on safe usage. People remained at home while almost 90% of poisonings occur at home, therefore an increase in poisonings was expected. In addition to advising on toxicity, the EPIC was also expected to provide constant media information to target groups. Previously planned Poisoning Prevention Week (in March) rapidly required new content. The aim is to analyze the effects of the COVID-19 on EPIC's hotline in order to be better prepared for poisoning prevention in the future. Methods: A retrospective study analyzing the data from the EPIC's hotline 2019-2020. We compared the number of monthly calls in 2020, as well the number of yearly calls in 2020/2019. The information collected included: type of caller, age group, reason for exposure (accident, intentional), specific type of exposure. Increases or decreases of 10% in parameters with N > 5 were considered a change. Results: The average number of monthly calls in 2020 was around 325 (an increase of 32% from 2019), with rapid change in 2020 from March compared with February (increased by 65%). The number of calls remained high until the end of 2020. Compared to annual average statistics 2019/2020: there were more calls concerning adults (39%, 1069/1483), while calls regarding children (0-3 years/4-17 years) increased modestly (28%/26%). There was a small change in calls regarding drug poisoning (increasing 17%). Poisoning from chemicals increased 33%, including a marked increase in calls about disinfectants of 505% (22/133 compared 2019/2020), while exposures to mixed chemicals markedly decreased (-97%, 30 poisonings 2019/1 call 2020). Accidents with button batteries increased 76% (38/67 comparing 2019/2020). Many people visited woodland to avoid crowded places and this was associated with an increase in enquiries about mushrooms (149%), snakes (62%), and plants (46%) following the first COVID-19 wave. There was no significant change in the ratio of accidental/intentional poisoning or the ratio of caller type (public/medical professionals), compared 2019/2020. Conclusion: The COVID-19 pandemic impacted the activity of EPIC significantly and trends were identified. It is possible to assume that the EPIC's active role in the crisis with a strategic communication may be related to the higher number of calls through increased awareness. The identified toxicity trends need more precise targeting in the media for subsequent coronavirus outbreaks. (Table Presented).
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Objective: To investigate calls made to the Finnish Poison Information Center (FPIC) before and during the COVID-19 pandemic. We hypothesized that the number of calls concerning COVID-related drugs and disinfectants would have increased, as well as the number of calls regarding intentional poisonings, due to the social and economic stress caused by the pandemic. Methods: We analysed the FPIC call records to assess the impact of the COVID-19 pandemic on our statistics. The pandemic started in Finland in March 2020 and the highest peaks were experienced during April 2020, December 2020, March 2021 and August 2021. We compared the mean number of calls per month from the same time period (March-June) before the pandemic (years 2018-2019) and during the pandemic (years 2020-2021). Results: The FPIC receives approximately 40,000 calls yearly from healthcare professionals and the public. The total number of calls was not significantly changed by the pandemic. Compared with 2018-2019, we observed a mean 161% increase (2018, n=24;2019, n=25;2020, n=61;2021, n=67) in calls concerning hand disinfectants during the pandemic. Respectively, there was a 180% increase concerning hydrogen peroxide (2018, n=3;2019, n=2;2020 n=9;2021, n=5) and a 24% increase in calls concerning vitamin D (2018, n=38;2019, n=50;2020, n=60;2021, n=49). Hydrogen peroxide (1%) was used at the dentist as a mouth disinfectant during the pandemic, so the abundant use was seen in our call records. Most of the vitamin D and hand disinfectant exposures were accidental and concerned toddlers. There was also an increase in cases of intentional drinking of hand disinfectants due to their easy availability. Calls regarding intentional poisonings (including drug of abuse and suicide attempts) experienced a slight (13%) increase (2018, n=342;2019, n=351;2020, n=369;2021, n=413), which has also been the trend for the past few years. There was no increase in calls concerning drugs (such as antivirals) used in the treatment of COVID-19. Conclusion: The total number of calls to the FPIC was not affected by COVID-19. Some of the most prominent changes during the pandemic were the increase in calls concerning hand disinfectants and hydrogen peroxide. There was no increase in calls concerning COVID-related drugs, which has been the case in some Poison Information Centers in the United States.
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Objective: Health authorities' recommendations for containment of COVID-19 have led to a wide spread availability and use of disinfectants in Germany. The study investigates if the frequency and characteristics of poisonings with disinfectants at the workplace have changed in 2020 in comparison to previous years. Methods: The German Federal Institute for Risk Assessment (BfR) receives reports on workplace poisonings on a legal basis (German Chemicals Act §16e). Occupational exposures with disinfectants between 2018 and 2020 were evaluated in terms of frequency and characteristics (Poisoning Severity Score (PSS), route of exposure, product category). Results: The BfR received 19,431 cases of workplace exposures in 2018-2020. Biocidal disinfectants were involved in 1,066 cases (5.5%). Due to variations in the total number of annually notified cases, the proportion of cases involving biocidal disinfectants in relation to all cases was calculated for each year. With 6.9%, the highest percentage of cases involving biocidal disinfectants was registered for 2020, compared to 4.9% in the two previous years. In the majority of cases (83.5%) only minor symptoms (PSS1) were registered, mostly eye irritation (78.4%). The distribution of PSS assigned to cases showed no significant differences between 2020 and previous years (Table 1). Conclusion: The COVID-19 pandemic has led to an increase in general disinfection measures. Professional publications from numerous poison information centres around the world report an increase in the number of cases of disinfectants. This trend is also reflected in our study, analysing exposures with disinfectants at workplace. While the total number of reported cases decreased in the “shutdown year” 2020, the proportion of cases with disinfectants increased. The distribution of severity remained almost the same. In the work environment too, care should be taken to handle disinfectants and, if necessary, appropriate protective clothing, should be worn. (Table Presented).
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Objective: Paracetamol and Ibuprofen are popular over the counter analgesics and frequently involved in suicidal overdose in adolescents. The aim of the study is to determine trends of paracetamol and ibuprofen overdose in adolescents and young adults before and during the COVID-19 pandemic. Methods: A retrospective descriptive study of suicide attempts by poisoning in adolescents and young adults (10-25 years) reported to the Swiss National Poison Center before and after the beginning of the COVID-19 pandemic (1 January 2016 to 30 June 2021). Intervention date was defined as end of Q1 2020 (lockdown in Switzerland started on 16 March 2020). Preintervention period was determined as Q1 2016-Q1 2020, postintervention period as Q2 2020-Q2 2021. Data collected included age, sex, time of call (month, year), and substances. Trends for cases involving paracetamol and/or ibuprofen were analysed per quarter (Q), and by patient age. Results: Overall 7697 cases met inclusion criteria (females n=5883, males n=1808, unknown n=6). Paracetamol was involved in 1864 cases (24.2%), ibuprofen in 1021 cases (13.3%), including 394 cases combining both substances. We recognized a higher proportion of exposures in 13 to 17-year-olds (paracetamol 28.4%, ibuprofen 16.2%), with a maximum proportion in 15- year-olds (paracetamol 30.7%, ibuprofen 18.3%). Comparing the average number of cases per quarter of the preintervention period to the postintervention period revealed an increase of 1.2 with an overproportional rise in paracetamol exposures of 1.4. Suicide attempts by paracetamol were even more common in the 13 to 17-year-olds (rate 1.7) (Table 1). Due to the small numbers in 10 to 12-year-olds trends are not determined. Conclusion: Paracetamol is involved in a quarter of suicide attempts in adolescents and young adults, even up to a third in the 15-year-olds, whereas ibuprofen plays a less prominent role. The observed increase in paracetamol overdoses in the 13 to 17- year-olds during the postintervention period requires close observation.
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Objective: Poison centers frequently manage calls involving ethanol-containing hand sanitizers. During the 2020 COVID-19 pandemic, our Specialists in Poison Information sensed rising numbers of cases. The increased use was not surprising due to the desire to sanitize skin and reduce transmission of COVID-19. We sought to compare hand sanitizer trends pre-pandemic and during the pandemic including a sub-analysis for children 0-5 years. Methods: We queried the National Poison Data System for human exposures of all ages within our 4-state poison center from 1 January 2015 to 31 October 2021. Generic codes for all types of hand sanitizers were included plus 2 product codes for methanol-containing hand sanitizer. Data captured included age range, product type, reason, gender, route, clinical effect, medical outcome, month, management site, and therapies. The query was repeated for the same parameters in children 0-5 years old. Descriptive statistical analyses were utilized. Results: Our poison center managed 5,819 human hand sanitizer exposures during the study period;67% occurred in children 0-5 years old. From 2019 (n=723) to 2020 (n=1,272), hand sanitizer exposures increased by 76%, 38% [all ages, children 0-5 years];52% were male. Most [77%, 99%] of these exposures were unintentional and [89%, 96%] involved ingestion as the primary route and exposures in children 0-5 years represented 64% of the total number of ingestion cases. Exposures in 2020 occurred throughout the year with higher volumes in March and July through December. Most cases were managed on-site (non-hospital) [81%, 89%], with [18%, 11%] evaluated in or referred to a hospital. Most [87%, 89%] clinical outcomes were minor or no effect overall, with similar numbers in 2020 [82%, 87%]. The top clinical effect in children 0-5 years was vomiting. For all ages, the most common effects were vomiting, nausea, and drowsiness. There was one death involving an adult who intentionally consumed hand sanitizer as an alcohol substitute. The product was contaminated with methanol and he died from methanol intoxication. Non-ethanol or isopropanol hand sanitizers were involved in 10% of exposures during the study period and 19% of exposures in 2020. Conclusion: We confirmed our suspicion that hand sanitizer exposures rose significantly in 2020. Explanations include increased usage and availability in the home paired with more time spent at home overall due to coronavirus school restrictions, working from home, and quarantine. Fortunately, even during 2020, most medical outcomes resulted in none or minor effects. Additional sub-analyses are needed to characterize other aspects including non-ethanol hand sanitizer exposures.
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Objective: The global pandemic of coronavirus SARS-CoV-2 has been a serious stress test for healthcare systems in many countries, with a significant impact on the structure and number of acute chemical poisonings. The aim of this study was to examine the impact of the COVID-19 pandemic on the toxic-epidemiological situation in Azerbaijan. Methods: We conducted a comparative analysis of the database of the Poison Center in Baku during the 9 months of the pandemic period (20 March - 21 December 2020) with the data of the same period in 2019 and the previous decade (2009-2018). Results: The alarming dynamics of a significant increase in the number of alcohol surrogates, primarily methanol poisoning, was revealed. In the 10-year period 2009-2018, alcohol surrogates intoxication was only 0.09% (18 patients) of total poisoning cases (20,266), but during the study period of 2020 increased to 3.4% (32 patients of 946 poisoning cases). The mortality rate in the ethanol and alcohol surrogate intoxication group in 2019 was 7.5% (8/ 106) versus 28.3% (30/106) in March-December 2020. All fatal cases in the alcohol surrogate poisoning cohort were related to methanol, thus, the mortality rate of this pathology was 61.5% (16/26). At the same time, no case of methanol poisoning was recorded in March-December 2019, and in the previous decade (2010-2018), only 1 case of methanol intoxication was recorded. The source of methanol during the pandemic was ingestion of counterfeit medical alcohol and alcohol-containing disinfectant products purchased by the victims themselves in the pharmacy network. Conclusion: The COVID-19 pandemic and quarantine measures had a significant impact on the epidemiology of poisoning in Azerbaijan, with an increase in cases and mortality of methanol poisoning. The outbreak of methanol poisoning in Azerbaijan revealed many shortcomings and weaknesses in the country's public health system. Late or erroneous diagnosis, lack of knowledge and clinical experience in the diagnosis and management of poisoned patients, difficulties with laboratory and diagnostic confirmation of the diagnosis, restrictions in the treatment of patients, relating to the lack of an effective antidote (fomepizole) resulted in high mortality. Considering the almost complete absence of methanol poisoning in Azerbaijan over the previous decade, the question of the source of the methanol is raised. Until a few years ago, the only methanol plant in the Caucasus was opened in Azerbaijan with a production capacity of more than 400 thousand tons per year. The plant stores more than 48 thousand metric tons of finished product, and should be investigated for possible leakage to the illegal market.
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BACKGROUND: Poison Centers are uniquely positioned to respond to an unprecedented public health threat such as the COVID-19 pandemic, as fully operational 24-h hotlines already staffed with healthcare professionals. METHODS: On January 27, 2020 the New Jersey Poison Information and Education System (NJPIES) agreed to operate the New Jersey Coronavirus Hotline. Call patterns, subject matter, and staffing and infrastructure strategies that were implemented to meet the demand are described. In addition, a sample of 1500 individual calls were collected and analyzed in an endeavor to describe call times, call days, area from which the call originated, callers to the hotline, primary language of the caller, and why a call was placed to the hotline. Binomial regression analysis was utilized in an attempt to identify significant patterns. RESULTS: Since the inception of the hotline through October 31, NJPIES responded to 57,579 calls for COVID-19 information. Most calls (68.7%) were regarding testing for COVID-19 and for general questions/symptoms. Call types varied when they were analyzed by time of day with calls for general questions/symptoms and where to get tested for COVID-19 showing a significant association for the early morning hours, how to obtain test results being significantly associated with the afternoon hours, and how to renew or obtain a medical license showing a significant association to the evening hours. We additionally noted that specific call types became significant when analyzed on a week-to-week basis and as specific events, like the enactment of the CARES Act of 2020, occurred. CONCLUSION: Although not the traditional role of a regional Poison Control Center, pandemic response synergizes with the workflow of this hotline because the infrastructure, staffing, and healthcare expertise are already present. Poison centers can rapidly adapt through scaling and process change to meet the needs of the public during times of public health threats.
Subject(s)
COVID-19 , Hotlines , Poison Control Centers , COVID-19 Testing , Humans , New Jersey/epidemiology , Pandemics , Poison Control Centers/organization & administrationABSTRACT
An increased use of disinfectants during the coronavirus disease 2019 (COVID-19) pandemic may increase the number of adverse health effects among people who apply them or among those who are in the area being disinfected. For the 3-month period from January 1 to March 30, 2020, the number of calls about exposure to cleaners and disinfectants made to US poison centers in all states increased 20.4%, and the number of calls about exposure to disinfectants increased 16.4%. We examined calls about cleaners and disinfectants to the Michigan Poison Center (MiPC) since the onset of the COVID-19 pandemic. We compared all calls related to exposure to cleaners or disinfectants, calls with symptoms, and calls in which a health care provider was seen during the first quarters of 2019 and 2020 and in relationship to key COVID-19 dates. From 2019 to 2020, the number of all disinfectant calls increased by 42.8%, the number of calls with symptoms increased by 57.3%, the average number of calls per day doubled after the first Michigan COVID-19 case, from 4.8 to 9.0, and the proportion of calls about disinfectants among all exposure calls to the MiPC increased from 3.5% to 5.0% (P < .001). Calls for exposure to cleaners did not increase significantly. Exposure occurred at home for 94.8%97.1% of calls, and ingestion was the exposure route for 59.7% of calls. Information about the adverse health effects of disinfectants and ways to minimize exposure should be included in COVID-19 pandemic educational materials.