Periodicity of suicide attempts reported to a poison control center.

Suicide attempts make up a significant percentage of intentional overdoses and tend to utilize more poison control center (PCC) resources than any other type of call. In order to determine whether time imparts patterns on these suicide calls, we studied all suicide calls to our PCC over a 2-y period. Particular attention was given to the epidemiology and time of call. Suicide exposures (N = 4031) were extracted from PCC records from January 1988 through December 1989 with particular attention to time of day and age and sex of the patient. Data were computer analyzed using standard ANOVA, cosinor and non-linear regression techniques. Serial frequency and spectral analyses were performed using time series procedures. Significant circadian rhythms were noted for all age ranges with peak time (ie acrophase) for calling the PCC occurring in the early evening. However, individuals over the age of 50 y called earlier than younger aged groups. In addition, the 13 to 19-y age group exhibited a significant annual rhythm by peaking in suicide calls to the PCC on January 28 +/- 12.4 d.

Field test of the new fungal identification system in POISINDEX.

A new program, Fungal Identification System (FIS) was introduced in POISINDEX (PI) in 1991. We studied the accuracy of this program compared to the traditional method of consulting an expert mycologist and also the utility of FIS for the certified specialist in poison information (CSPI) and the emergency department personnel. Fifteen samples were obtained from a Chicago area forest preserve and immediately identified by a CSPI using FIS from PI of summer-fall 1991. The samples were then refrigerated overnight and identified the following morning by a PhD mycologist, using standard mycological identification techniques (SMIT). Another group of 18 mushrooms were collected in August 1992 from rural southwestern Michigan and identified by FIS and SMIT after refrigeration overnight. In 4 cases the mycologist used both SMIT and FIS to identify the mushrooms. Identification by FIS did not match SMIT in 27 of 31 samples (1 was discarded and 1 was identified by FIS but not identified by SMIT). In 2 of 4 cases where the mycologist used FIS, a different answer was obtained from that obtained by the CSPI; however, these were still incorrect identifications. Four types of problems using FIS have been identified which can lead to erroneous results; these are the use of multipart questions, emphasis on color over less variable characteristics, questions which do not account for variability in morphology, and problems which arise from the sequence of questions. These points need to be addressed before FIS can be used as a safe basis for clinical recommendations.

Seizure following brief exposure to the insect repellent N,N-diethyl-m-toluamide.

A 5-year-old boy with a history of mild developmental delay experienced a major motor seizure at day camp after topical application that morning of the insect repellent Muskol and a later application of OFF [both contain N,N-Diethyl-m-toluamide (DEET)]. The patient continued convulsing in the emergency department and was treated with diazepam. Laboratory tests were unremarkable, as were lumbar puncture, computed tomography scan, and blood cultures. Skin decontamination was performed. DEET levels in the urine were 0.003 micrograms/mL. Although seizures and encephalopathic syndrome have been described with DEET in previous case reports involving topical exposure of pediatric patients, atypical aspects with regard to this case include that this patient was a male (most other case reports involve females), exposure was relatively brief compared with other reports, and the patient developed seizures without a prodrome described in previous reports. Avoidance of high-concentration DEET formulations in pediatric patients should be considered.

Use of the scan statistic to detect temporal clustering of poisonings.

The purpose of this study is to explore the use of the scan test to detect temporal clustering of poison control center data. We applied the scan test to a computerized data set consisting of all cases of carbon monoxide poisoning reported to our Poison Control Center in 1988. Using a time window of three days, the scan test identified three statistically significant temporal clusters. A review of case and climatologic data revealed that two of the clusters were due to family outbreaks and one was due to a sudden cold spell. We conclude that the scan test is a potentially useful surveillance tool which can be easily applied to poison control center data.

Acute oral hypoglycemic ingestions.

We reviewed the poison center records of 48 consecutive reports of oral hypoglycemic exposure reported to the Rush Poison Control Center between January 1988 and December 1989. The average age of ingestion was 15.0 y (range 1 to 75 y). Twenty-three of the patients (48%) were male, while 25 (52%) were female. Twenty-nine patients ingested glyburide, 10 chlorpropamide, 6 glipizide, 2 tolbutamide, and 1 each for tolazamide and phenformin. One patient ingested both glyburide and tolbutamide. Sixteen cases (33%) involved coingestants. Accidental cause was the primary reason for ingestion in 33 cases (69%) with suicidal intent being mentioned in an additional 11 cases (23%). Thirteen patients (27%) were treated and released from a health care facility, while the same percentage of patients were admitted. There was no adverse effect in 24 patients (50%) while 9 patients (19%) had minor effects without residual disability. Only 2 patients (4%) experienced a major effect. No deaths were reported. We conclude that oral hypoglycemic ingestions generally have a successful outcome and there does not appear to be a significant difference whether a short/long acting agent or first/second-generation product was ingested.

Methylene chloride: report of five exposures and two deaths.

Five patients presented to the emergency department (ED) following exposure in an enclosed space to methylene chloride (dichloromethane), used for removing paint. Two workers and three rescuers were involved. Two rescuers complained only of dizziness and mild nausea, and were subsequently discharged from the ED. One rescuer was asymptomatic. Worker no. 1 arrived in cardiac arrest and eventually died in the ED despite resuscitation efforts. Worker no. 2 also presented to the ED in cardiac arrest, and was successfully resuscitated to pulse and blood pressure. However, he never regained consciousness or spontaneous respirations, and died on the fourth day. Of interest is that worker no. 2's carboxyhemoglobin level increased from 2% to 8% over the 9 hours following admission, despite administration of 40% to 50% oxygen by endotracheal tube. Among the conclusions that can be drawn are (1) the cause of death in these patients was not carbon monoxide poisoning, but solvent-induced narcosis; (2) carboxyhemoglobin levels may continue to rise following cessation of exposure, despite administration of high flow oxygen; (3) rescuers can easily become victims if proper protective clothing and respirators are not worn.

Skeletal muscle relaxant ingestion.

We retrospectively analyzed 56 consecutive cases involving acute skeletal muscle relaxant exposure that were reported to the Poison Control Center over a 1-year period. The age range was 9 mo to 56 years (mean 18.9 +/- 13.1) with the site of exposure being the primary residence in 54 cases (96.4%). The reasons for inquiry to the Poison Center were reported to be intentional suicide in 26 cases (46.4%), accidental in 21 cases (37.5%), with intentional misuses in 5 cases (8.9%). No deaths were reported. Eighteen cases (32.1%) were reported with co-ingestants (average number of substances taken was 2.7 +/- 0.8). Of these cases 3 patients (16.7%) had major effects with life-threatening symptoms with 6 (33.3%) patients having no symptoms. Of the remaining 38 cases, 17 (44.7%) wer cyclobenzaprine, 6 (15.8%) were methocarbamol, 5 (13.2%) were carisoprodol, 5 (13.2%) were chlorzoxazone, 3 (7.89%) were Baclofen and the remainder were either life-threatening symptoms (2.6%), while 29 (74.3%) had no or minor effects with symptoms that subsided. We conclude that morbidity and mortality are low in pure skeletal muscle relaxant ingestion, however it may be increased in multiple ingestions.