Plant nurseries: a reliable resource for plant identification?

Poison Centers frequently rely on the assistance of local plant nurseries to identify unknown plants involved in exposures. The reliability and accuracy of utilizing this method has never been studied; therefore, our objective was to evaluate this primary resource of plant identification. A study was done in which callers were instructed to take plant samples to a local nursery for visual identification. Once the patient was treated according to our normal protocol, the plant specimen was sent to a botanist for a second identification. The botanist provided his identification results through a blinded process. The collected data was gathered from 68 cases that completed the necessary study criteria. In 58% of the cases, plant nurseries were an unreliable source for plant identification. These incorrect identifications resulted in the "undertreatment" in 24% of the exposures.

Effects of a major earthquake on calls to regional poison control centers.

We retrospectively evaluated the effect of the Loma Prieta earthquake on calls to 2 designated regional poison control centers (San Francisco and Santa Clara) in the area. In the immediate 12 hours after the earthquake, there was an initial drop (31%) in call volume, related to telephone system overload and other technical problems. Calls from Bay Area counties outside of San Francisco and Santa Clara decreased more dramatically than those from within the host counties where the poison control centers are located. In the next 2 days, each poison control center then handled a 27% increase in call volume. Requests for information regarding safety of water supplies and other environmental concerns were significantly increased. The number of cases of actual poisoning exposure decreased, particularly poison and drug ingestions in children. Most calls directly related to the earthquake included spills and leaks of hazardous materials and questions about water and food safety. Regional poison control centers play an essential role in the emergency medical response to major disasters and are critically dependent on an operational telephone system.

Use of whole bowel irrigation in an infant following iron overdose.

An 11-month-old, 11-kg infant presented to the emergency department after ingesting 130 to 150 mg/kg of elemental iron. Emesis was induced twice and the child was lavaged throughout a 4-hour period with some tablet return. An abdominal radiograph after gastrointestinal decontamination showed at least 16 whole iron tablets remaining in the stomach. Serum iron drawn 2 hours postingestion was 46.7 mumol/L. Blood glucose was 7.7 mmol/L and white blood count was 21,800 mm3. Despite a second lavage 8 hours postingestion, a large number of whole tablets were visualized in the stomach per radiograph. Whole bowel irrigation with polyethylene glycol electrolyte lavage solution (Golytely, Braintree Laboratories, Inc, Braintree, MA) was begun via nasogastric tube 14 hours after the ingestion. Serial abdominal radiographs showed tablet movement out of the stomach within 4 hours after initiating whole bowel irrigation. This case demonstrates the safety and efficacy of WBI in an infant when conventional gastrointestinal decontamination has failed.

Caterpillar envenomations: a prospective study of 112 cases.

A 1-year prospective study was conducted to identify epidemiological factors associated with caterpillar envenomations. Of 117 envenomations, 112 were included in the study. Identification of the caterpillars involved was accomplished in 68% of the cases. Six caterpillar species were identified, 4 of which [Hemileuca maia (Drury), Automeris io (F), Megalopyge opercularis (JE Smith)/Lagoa crispata (Packard) and Sibine stimulea (Clemens)] were properly implicated in envenomations. Clinical effects most commonly reported were local pain, erythema and swelling in 96%, 89% and 72% of patients, respectively. Atypical responses including muscle spasms, paresthesia and radiating pain to an extremity were noted in 26% of patients. Sixteen percent of patients had a history of allergy, but no patient in this subgroup exhibited a "hive-like" dermatologic or anaphylactic allergic response. No positive correlation could be drawn between allergy history and extent of clinical effect following envenomation. Mild to moderate local response following envenomation was typical. However, 61% of patients evaluated experienced mild to moderate effects at least 24 h post-envenomation.

Effectiveness of abdominal radiographs in visualizing chewable iron supplements following overdose.

The purpose of this study was to determine the clinical effectiveness of visualizing chewable and nonchewable iron supplements remaining in the gastrointestinal tract following an overdose. A 5-year retrospective review of 93 pediatric patients who had ingested potentially toxic amounts of an iron supplement found that 58% had abdominal radiographs taken. Fifty-five percent of these patients had ingested chewable multiple vitamins with iron and 40% had ingested nonchewable tablets. After radiographic review, radiopaque densities could be marginally visualized in only one case of ingestion of a chewable iron supplement. The mean serum iron level of patients who had ingested a chewable form of iron was 270 micrograms/dL. An in vitro study was performed to determine the radiopacity of various chewable multiple vitamins with iron. It was concluded that although chewable multiple vitamins with iron are radiopaque in vitro, clinical radiographic visualization is unlikely.

Chemistry set chemicals: an evaluation of their toxic potential.

KM, a 14-year-old female packed 3 empty Sudafed SA capsules with 3 parts sodium chloride and 1 part cobalt chloride obtained from her brother's chemistry set. Following this, she ingested all 3 capsules. While the child had an uneventful hospital course, cobalt serum levels drawn 12 and 22 hr post-ingestion were measured at 7.8 micrograms/dL and 0.7 micrograms/dL, respectively. Due to the limited amount of data on the toxicity of cobalt chloride and the nature of the exposure, the case prompted a review of the potential toxicity of chemistry set chemicals available to consumers. The contents of 3 chemistry sets were evaluated. Each contained either 28, 14, or 9 chemicals. A total of 38 different chemicals were weighted and evaluated to determine whether the amount contained represented a potentially toxic or lethal dose to a 2-year-old, 12 kg child. Fifty-three percent of the chemicals evaluated contained quantities sufficient to result in toxicity. Thirteen percent of chemicals contained potentially lethal quantities, while 18% were considered non-toxic. Sixteen percent of the chemicals could not be evaluated due to lack of data in the literature. Only one chemistry set utilized child resistant closures. However, 65% of all potentially toxic chemicals and 100% of potentially lethal chemicals had appropriate first aid instructions.

Castor bean poisoning.

Although the highly toxic nature of castor bean (Ricinus communis) is well recognized, reports of human toxicity in the English medical literature are scarce. The potentially lethal doses reported for children and adults are three beans and four to eight beans respectively. Recent experience with two cases provides added insight into the expected course of toxicity. In both cases, repeated vomiting, diarrhea, and transiently elevated serum creatinine occurred. Dehydration was much more pronounced in the second case. Both patients recovered uneventfully. Other reported manifestations of castor bean toxicity, such as hepatic necrosis, renal failure, erythrocyte hemolysis, convulsions, and shock, did not occur.

Chronic salicylism in a patient with juvenile rheumatoid arthritis.

A patient who developed chronic salicylism associated with salicylate therapy for treatment of juvenile rheumatoid arthritis is described, and the clinical presentation and treatment of chronic salicylism are reviewed. A 5 1/2-year-old boy was receiving aspirin 150/mg/kg/day for treatment of juvenile rheumatoid arthritis. While on salicylate therapy, the patient developed tachypnea and became increasingly hyperthermic, lethargic, and disoriented. The patient developed a maculopapular rash, weakness, and a decreased level of consciousness during the 11 days before admission to the hospital. Physical examination and laboratory determinations revealed that the patient had hypoprothrombinemia, hypoglycemia, and severe hepatic encephalopathy secondary to long-term salicylate toxicity. The patient was treated for hypoglycemia, electrolyte imbalances, thrombocytopenia, and anemia and was discharged after 24 days. Diagnosing chronic salicylism with hepatic dysfunction was difficult because the symptoms are similar to those of stage I to stage II Reye's syndrome. Liver enzymes, including aspartate aminotransferase (also called SGOT), alanine aminotransferase (also called SGPT), alkaline phosphatase, and lactate dehydrogenase, may be elevated in juvenile arthritis patients with hepatic dysfunction. Liver dysfunction usually improves when salicylate therapy is discontinued. Supportive therapy should always be used in symptomatic patients. Children on long-term, high-dose salicylate therapy should be monitored closely, and baseline liver function tests should be performed. The clinical effectiveness of administering sodium bicarbonate in attempts to alkalinize urine and increase salicylate elimination is controversial. In patients with juvenile rheumatoid arthritis who develop chronic salicylism, careful analysis of the patient's medication history, laboratory values, and clinical presentation are necessary to rule out Reye's syndrome.

Syrup of ipecac availability: before and after a poisoning.

A retrospective review was conducted of 1,230 human poison exposures in which syrup of ipecac was administered to determine the availability of this emetic. Ipecac was available in 41.1% of the homes, while 42.5% obtained it from the pharmacy. Eight and two tenths percent were referred to a health care facility, 2.9% obtained ipecac from a neighbor, 2.3% went to an emergency room prior to calling the poison center, and 3% obtained ipecac from other sources. A randomly selected sample of 150 of these 1,230 cases were contacted 6 months after their initial call to the poison center to determine any changes in the availability of syrup of ipecac in the home. Although almost 30% more homes had syrup of ipecac than previously, 22.2% of homes still did not have ipecac available, despite the previous poisoning experience. Greater effort should be made during follow-up to educate the public regarding ipecac and its use.