MAGAM II - prospective observational multicentre poisons centres study on eye exposures caused by cleaning products.

Objective: Local effects on the eye following cleaning product exposures are frequently reported. According to EU chemicals legislation many cleaning products are labelled with Hazard Phrase 318 indicating risk of irreversible eye damage. The objectives of this study were to identify cleaning products with potential for irreversible eye damage by collecting human exposure data from poisons centres (PC), and to clarify to what degree exact product identification is possible during a PC telephone call. Methods: MAGAM II was a multicentre binational prospective observational PC study. All human eye exposures to detergents or maintenance products reported to nine PCs taking calls from the public and medical professionals during an 18-month period were included. The severity of eye effects was rated according to the WHO Poisoning Severity Score. Results: Five hundred and eighty-six cases were included. Product identification by name leading to formula information was successful in 533 cases (91%). Follow-up was successful in 528 exposures. Irrigation was performed in 94% of cases. Duration of symptoms was ≥24 hours in 73 patients (25%). 33 (6%) patients developed moderate eye injury. Healing was reported in all cases. The percentage of moderate cases was highest in the group of drain cleaners (25%), toilet cleaners (18%) and oven cleaners (15%). Products intended for professional use caused relatively more moderate eye injuries than products also intended for consumer use. Conclusion: MAGAM II has shown that PCs are able to identify formulas in sufficiently high quality as needed for product-directed toxicovigilance. The results underline the potential of PC exposure case data for product safety monitoring. The results indicate that irreversible eye damage is very rare after cleaning product exposure.

Angiotensin II antagonists - an assessment of their acute toxicity.

OBJECTIVE: In Germany, increasing prescription rates of angiotensin II antagonists resulted in rising enquiries to Poisons Information Centres (PICs) during the last decade. Therefore, we aimed to assess their acute toxicity for deriving triage recommendations. METHODS: An observational case series with data collected retrospectively from eight PICs in Austria, Germany and Switzerland. Inclusion criteria were monoexposure, defined dose, and documented follow-up. RESULTS: In total, 206 cases of exposures to angiotensin II antagonists were included (candesartan, 94; eprosartan, 3; irbesartan, 20; losartan, 26; olmesartan, 16; telmisartan, 18; and valsartan, 29). The median dose expressed as a multiple of their maximum daily dose for adults adjusted to body weight (MDDw) was 2.3 in children and 6.8 in adults. Patients involved were 150 children with a median age of 2 years and a median body weight of 13 kg and 56 adults with a median age of 47 years and a median body weight of 70 kg. Most children remained asymptomatic (82.7%), 16.7% developed minor symptoms. Only once, a low blood pressure of 60/40 mm Hg required intravenous fluids after ingestion of a 8.75-fold MDDw of candesartan by a 2.5-year-old toddler. Among adults, 53.6% remained asymptomatic while almost half of the patients suffered from minor (37.5%) or moderate (8.9%) symptoms. CONCLUSION: As no or only minor symptoms were observed after ingestion of less than a fivefold MDDw in both children and adults, only symptomatic patients and those who have ingested a fivefold MDDw or higher dose should be referred for medical assessment.

[Carbon monoxide poisoning from indoor barbecues--incidents reported to the German-speaking Poison Information Centers and the German Federal Institute for Risk Assessment (BfR) in Berlin]. / Kohlenmonoxidvergiftungen durch Grillen in Innenräumen--Mitteilungen an die deutschsprachigen Giftinformationszentren und das Bundesinstitut für Risikobewertung Berlin.

From 2008 to the end of 2009 the Joint Poison Information Center (PIC) in Erfurt observed 7 incidents involving 17 persons (1 fatality) with signs of carbon monoxide poisoning from indoor barbecues (COFIB). To find out whether COFIB is a regional or a general phenomenon in Germany, Austria and Switzerland, all information about COFIBs recorded by the 11 German-speaking Poison Information Centers and the BfR Berlin were retrospectively analyzed for the period 2000 to 2009. In all, 60 COFIBs (accidental: 90.0 %, suicidal: 8.3%, reason unknown: 1.7%) involving 146 individuals were reported. The number of incidents increased from one case with 2 persons in 2000 to 18 cases involving 34 persons in 2009. The 146 victims (female 26.7%, male 27.4%, gender unknown 45.9%; adults 58.2%, children 24.7%, age unknown 17.1%) lived in 15 of the 16 federal states of Germany and in Switzerland. The highest number of victims was found in Bavaria (23), Brandenburg (18), and Baden-Wuerttemberg (18). The symptoms according to the Poisoning Severity Score were none to mild in 60.3%, moderate in 13.7%, severe in 11.6%, fatal in 6.9% and unratable in 7.5%. No clear correlation was found between the carboxyhemoglobin concentration and the severity of the symptoms. As a rising number of COFIBs often involving several individuals was observed from 2000 to 2009, the general public was informed about the risks of indoor barbecues.

Escitalopram causes fewer seizures in human overdose than citalopram.

CONTEXT: Seizures are a recognized complication of acute overdose with the racemic (1:1 ratio of R- and S-enantiomers) selective serotonin reuptake inhibitor antidepressant citalopram. OBJECTIVE: We tested the hypothesis that escitalopram (the therapeutically active S-enantiomer of citalopram) causes fewer seizures in overdose than citalopram at comparable doses of the S-enantiomer. METHODS: Multicenter retrospective review of cases with citalopram and escitalopram overdose reported to German, Austrian, and Swiss Poisons Centers between 1997 and 2006. RESULTS: 316 citalopram and 63 escitalopram cases were analyzed. Somnolence, nausea, vomiting, tachycardia, QT prolongation, and tremor occurred with similar frequency in both groups. There was a striking difference in the frequency of single and multiple seizures: 43 cases (13.5%) in the citalopram group and 1 case (1.6%) with a single seizure in the escitalopram group (p=0.0065). DISCUSSION AND CONCLUSIONS: At comparable ingested doses of the S-enantiomer, the symptom profile for citalopram and escitalopram intoxications is similar except for seizures that occur more frequently in citalopram than in escitalopram poisoning.