Poison information providers: an assessment of proficiency.

An analysis of the results of a national certification examination for poison information specialists administered by the American Association of Poison Control Centers is presented. The failure rate in nonregional centers was more than double that in regional centers, and presents a strong argument for regionalization. Poison information specialists with prior training as pharmacists or registered nurses performed significantly better than those who were high school or college graduates in other fields, emergency medical technicians, or licensed practical nurses. Poison information specialists in centers receiving more than 15,000 calls each year had significantly higher scores. Individual total work experience also had a small but significant correlation with score. The mean score for emergency physicians serving as a control group was 57.0% compared with 77.1% for poison information specialists. The data suggest that telephone consultations for poison emergencies are done best by those who do them on a specialized full-time basis. Calls should be referred to the appropriate regional poison control center.

Comparison of large and small child-resistant containers.

Two studies, a 13-month prospective survey and a clinical trial, were conducted to evaluate how children less than 5 years of age opened children's aspirin (small container) and chewable multi-vitamin (large container) bottles. In study one, teeth were used to open a closed children's aspirin container in greater than 50% of reported exposures compared to 5% for reported multivitamin exposures. A clinical trial (study two) revealed an interaction between the child's age and the characteristics of the container (F = 2.83, df = 6,28; P less than 0.05). Larger containers were harder to open in the hands of a 23-28 month old child while smaller containers were harder to open in the 32-38 month age group. Neither container were more easily opened by children between 29 and 31 months of age. These results suggest that container characteristics and a child's age are both variables which may influence future poison prevention activities.

Evaluation of activated charcoal and magnesium citrate in the prevention of aspirin absorption in humans.

Inhibition of aspirin absorption by activated charcoal and magnesium citrate solution was compared with the inhibition produced by activated charcoal alone. Following an overnight fast, eight healthy male volunteers were given three 325-mg aspirin tablets under four study regimens: (1) water 360 ml; (2) water 300 ml and activated charcoal 10 g in water 60 ml; (3) water 105 ml, activated charcoal 10 g in water 60 ml, and magnesium citrate solution 200 ml; and (4) same as (3) except that administration of magnesium citrate was delayed 30 minutes. At least one week separated each regimen. Urine samples were collected at 0, 2, 4, 8, 12, 24, 36, and 48 hours, and percent of the aspirin dose excreted in the urine was determined. The data were analyzed using analysis of variance for Latin-square design and Newman-Keuls test. The salicylate excreted with regimens 2, 3, and 4 was each significantly less compared with that excreted following regimen 1 (p less than 0.001). Salicylate excretion percentages when magnesium citrate was given with activated charcoal in regimens 3 and 4 were not significantly different from each other or the salicylate excretion with activated charcoal alone (p greater than 0.05). These findings apply only to the dose of aspirin tested, and it is possible that magnesium citrate and activated charcoal may decrease aspirin absorption to a greater extent when aspirin is taken in overdose. Hence, it is recommended that this study not be used to justify discontinuing the combined use of magnesium citrate and activated charcoal to treat aspirin overdose.