1993 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance...

Toxicology

A special contribution from the American Associa- tion of Poison Control Centers.

1993 Annual Report of the American Association of Poison Control Centers Toxic

Exposure Surveillance System

TOBY L. LITOVITZ, MD, LYNN R. CLARK, BSN, CSPI, ROSE ANN SOLOWAY, RN, MSED, ABAT

1993 was a landmark year for the American Association of Poison Control Centers’ (AAPCC) nationwide poisoning surveillance effort. Several substantial revisions in the format and extent of data collected were implemented, with suc- cessful transition to the new system in all but two poison centers. The most significant of these changes is the imple- mentation of a system to record specific clinical effects man- ifested in each poison exposure case. Changes in field de& nitions and expanded fields to document medical outcome, age, patient disposition, and reason for exposure are evident in the data that follow.

Toxic Exposure Surveillance System (TESS) data are used to identify hazards early, preventing needless injury. TESS data have prompted product reformulations, repack- aging, recalls, and bans. Applications for conversion from prescription to over-the-counter status have been supported with TESS safety data, and TESS data have been used for postmarketing surveillance of newly released drugs and products.

From its inception in 1983 until 1992, TESS grew steadily with increases in the number of participating poison centers, population served by those centers, and reported human ex-

From the Data Collection Committee, American Association of Poison Control Centers.

The authors acknowledge the generous contribution of Mi- cromedex, Inc, to the programming and processing of this annual report.

Centers participating in this report include Children’s Hospital of Alabama Regional Poison Control Center, Birmingham, Ala- bama; Alabama Poison Center, Tuscaloosa, AL; Arizona Poison and Drug Information Center, Tucson, AZ; Samaritan Regional Poison Center, Phoenix, AZ; University of California Davis Med- ical Center Regional Poison Control Center, Sacramento, CA; San Diego Regional Poison Center, San Diego, CA; University of California Irvine Regional Poison Center, Orange, CA; Santa Clara Valley Medical Center Regional Poison Center, San Jose, CA; Central California Regional Poison Control Center, Fresno, CA; Rocky Mountain Poison and Drug Center, Denver, CO; Con- necticut Poison Control Center, Farmington, CT; National Cap- ital Poison Center, Washington, DC; Florida Poison Information Center and Toxicology Resource Center, Tampa, FL; Florida Poison Information Center-Jacksonville, Jacksonville, FL; Geor- gia Poison Control Center, Atlanta, GA; Idaho Poison Center, Boise, ID; Indiana Poison Center, Indianapolis, IN; St. Luke’s Poison Center, Sioux City, IA; Mid-America Poison Control Cen- ter, Kansas City, KS; Kentucky Regional Poison Center of Kosair Children’s Hospital, Louisville, KY; Louisiana Drug and Poison Information Center, Monroe, LA; Maryland Poison Center, Bal- timore, MD; Massachusetts Poison Control System, Boston, MA; Children’s Hospital of Michigan Poison Control Center, Detroit, MI; Blodgett Regional Poison Center, Grand Rapids, MI; Henne- pin Regional Poison Center, Minneapolis, MN; Cardinal Glen- non Children’s Hospital Regional Poison Center, St. Louis, MO; The Poison Center, Omaha, NE; New Hampshire Poison Infor- mation Center, Lebanon, NH; New Jersey Poison Information

546

and Education System, Newark, NJ; New Mexico Poison and Drug Information Center, Albuquerque, NM; New York City Poi- son Control Center, New York, NY; Hudson Valley Poison Cen- ter, Nyack, NY; Long Island Regional Poison Control Center, Mineola, NY; Finger Lakes Regional Poison Center, Rochester, NY; Central New York Poison Control Center, Syracuse, NY; Western New York Regional Poison Control Center, Buffalo, NY; Triad Poison Center, Greensboro, NC; Carolinas Poison Center, Charlotte, NC; North Dakota Poison Information Center, Fargo, ND; Akron Regional Poison Center, Akron, OH; Cincinnati Drug and Poison Information Center, Cincinnati, OH; Central Ohio Poison Center, Columbus, OH; Greater Cleveland Poison Con- trol Center, Cleveland, OH; Mahoning Valley Poison Center, Youngstown, OH; Oregon Poison Center, Portland, OR; Pitts- burgh Poison Center, Pittsburgh, PA; The Poison Control Cen- ter, Philadelphia, PA; Central Pennsylvania Poison Center, Her- shey, PA; Rhode Island Poison Center, Providence, RI; McKen- nan Poison Control Center, Sioux Falls, SD; Middle Tennessee Regional Poison and Clinical Toxicology Center, Nashville, TN; Southern Poison Center, Inc., Memphis, TN; North Texas Poison Center, Dallas, TX; Texas State Poison Center, Galveston, TX; Utah Poison Control Center, Salt Lake City, UT; Virginia Poison Center, Richmond, VA; Blue Ridge Poison Center, Charlottes- ville, VA; Washington Poison Center, Seattle, WA; Spokane Poi- son Center, Spokane, WA; West Virginia Poison Center, Charles- ton, WV; University of Wisconsin Hospital Regional Poison Cen- ter, Madison, WI; Poison Center of Eastern Wisconsin, Milwaukee, WI; Green Bay Poison Center, Green Bay, WI.

0 1985-1994 by the American Association of Poison Control Centers. Published by permission. All rights reserved.

Reprints are available at a cost of $10 each. Address requests to AAPCC, 3201 New Mexico Ave, Ste 310, Washington, DC 20016.

LITOVITZ ET AL W 1993 AAPCC ANNUAL REPORT 547

TABLE 1. Growth of the AAPCC Toxic Exposure

Surveillance System

No. of Population Human Exposures/

Participating Served Exposures Thousand

Year Centers (Millions) Reported Population

1983 16 43.1 251 ,012 5.8 1984 47 99.8 730,224 7.3 1985 56 113.6 900,513 7.9

1986 57 132.1 1,098,894 8.3 1987 63 137.5 1,166,940 8.5 1988 64 155.7 1,368,748 8.8

1989 70 182.4 1,581,540 8.7 1990 72 191.7 1,713,462 8.9 1991 73 200.7 1,837,939 9.2

1992 68 196.7 1,864,188 9.5 1993 64 181.3 1,751,476 9.7 Total 143264,936

posures (Table l).‘.” For the first time ever, in 1993, TESS participation declined, reflecting several factors: ( 1) eight poison centers that participated in 1992 had closed by the start of 1993; (2) one center was inadequately staffed, be-

cause of inadequate funding, to allow participation; and (3) two centers were unable to convert to the revised data collection system in a timely manner because of logistical prob- lems.

The cumulative AAPCC database now contains 14.2 million human poison exposure cases. This report includes 1,751,476 human exposure cases reported by 64 participating poison centers during 1993, a decline of 6% compared with 1992 poisoning reports. The decline in the number of reporting centers, reported poisonings, and population served by reporting centers undoubtedly mirrors the present funding crisis faced by our nation’s poison centers. No progress has been made toward our national goal of providing access by all United States (US) citizens to certified regional poison centers. Indeed, only 50% of the US population is currently served by the nation’s 36 certified regional poison centers. The number of certified centers decreased from 38 just 1 year ago, and the population served by these centers is down to 50% (a decrease from 59% 2 years ago). Furthermore, the tenuous funding base of those centers that remain opera- tional has, in many centers, led to impaired service, decreased surveillance efforts, and a decrease in poison prevention activity. Indeed, it is appalling that several of our

FIGURE 1. Sixty-four poison centers participated in the Toxic Exposure Surveillance System in 1993. The shaded areas denote regions served by reporting centers.

548 AMERICAN JOURNAL OF EMERGENCY MEDICINE n Volume 12, Number 5 n September 1994

nation’s largest poison centers have been forced to limit their hours of operation and/or abandon their data collection ac- tivities and poison prevention efforts. Noting the important role of poison centers in limiting health care expenditures through avoidance of unnecessary emergency department visits, as well as the role of poison centers in guiding the delivery of state-of-the-art treatment for poisonings, the sta- bilization of US poison control centers is an urgent need.

CHARACTERIZATION OF PARTICIPATING CENTERS

Of the 64 reporting centers, 55 submitted data for the entire year. Thirty-six of the 64 participating centers were certified as regional poison centers by the AAPCC in 1993. Annual center call volumes (human exposure cases only) ranged from 1,230 to 78,000 (mean 29,858) for centers participating for the entire year. Penetrance, calculated by state or portion of the state served, ranged from 3.9 to 16.8 per 1,000 with a mean of 9.7 reported exposures per 1,000 population. Penetrance is defined as the number of human poison exposure cases reported per 1,000 individuals in the population served.

A total population of 181.3 million was served by the participating centers, including portions of 43 states and the District of Columbia (Figure 1). Noting the 257.9 million 1993 United States population, the data presented represent an estimated 70% of the human poison exposures that pre- cipitated poison center contacts in the US during 1993. Ex- trapolating from the 1,75 1,476 human poison exposures reported in this database, 2.5 million human poison exposures are estimated to have been reported to all US poison centers in 1993. However, extrapolations from the number of reported poisonings to the number of actual poisonings occurring annually in the US cannot be made from these data alone, because considerable variations in poison center penetrance were noted. Indeed, assuming all centers reached the penetrance level of 16.8 poisonings per 1,000 population reported for one state, 4.3 million poisonings would have been reported to poison centers in 1993.

The data do not directly identify a trend in the overall incidence of poisonings in the US because of changing center participation from year to year and changes in center use. An analysis of data from 59 centers that participated for the entirety of both 1992 and 1993 shows only a 0.4% increase in reported poison exposures from 1992 to 1993 within the regions served by these 59 centers. Thirty of these 59 centers actually showed a decrease in usage in 1993 compared with 1992. This stands in marked contrast with the 3.2% to 3.5% annual growth seen in poison center use from 1989 to 1992 and the 7.6% average annual growth in poison center use seen in 1984 through 1989 (range 4.2% to 10.9% increase annually). Although this levelling of use could be heralded as a welcome decrease in poisoning incidence in the US, such kudos would be premature. Instead it is evident that most US poison centers remain a long way from optimal levels of use and are now showing virtually no annual improvement in use. Inadequate poison center use leads to unnecessary health care expenditures including unnecessary emergency department visits and ambulance transports. Inadequate poison center use also affects the outcome of poisoned patients. In sum, these TESS data show the impact of decreased fiscal stability of US poison centers.

REVIEW OF THE DATA

Of the 1,75 1,476 human exposures reported in 1993,90.3% occurred at a residence (Table 2). In 4% of cases (74,611 cases), multiple patients were implicated in the poison exposure episode (eg, siblings “shared” a household product, multiple patients inhaled vapors at a hazardous materials spill). Two unlikely sites of poisonings, health care facilities and schools, accounted for 8,196 (0.5%) and 21,617 (1.2%) poison exposures, respectively. Poison center peak call volumes were noted from 4 to 10 PM, although call frequency remained consistently high between 8 AM and midnight, with 92% of calls logged during this 16-hour period.

The age and gender distribution of human poison exposure victims is outlined in Table 3. Children younger than 3 years of age were involved in 42% of cases, and 56% occurred in children younger than 6 years. A male predominance is found among poison exposure victims younger than 13 years of age, but the gender distribution is reversed in teenagers and adults. Although the gender distribution was nearly equal for unintentional exposures, 60.7% of intentional exposures occurred in females, as did 64.1% of adverse reac- tions. Of all poison exposures captured, 6,443 occurred in pregnant women. Of those with known pregnancy duration, 32% occurred in the first trimester, 38% in the second trimester, and 30% in the third trimester.

Table 4 presents the age and gender distribution for the 626 reported fatalities. Although responsible for the majority of poisoning reports, children younger than 6 years of age comprised only 4.3% (27) of the fatalities. Fifty-seven per- cent of poisoning fatalities occurred in 20- to 49-year-old individuals.

A single substance was implicated in 93.2% of reports, and 1.6% of patients were exposed to more than two possibly poisonous drugs or products (Table 5). The overwhelming majority of human exposures were acute (95.7%) compared with only 64.4% of poison-related fatal exposures. Chronic exposures comprised 2.1% of all poison exposure reports, and acute-on-chronic exposures comprised 1.7%. (Chronic exposures were defined as continuous or repeated exposures occurring in a period exceeding 8 hours; the coding option “acute-on-chronic” was new in 1993.)

To enhance coding consistency and capture additional data, five new coding options for exposure reason were im-

TABLE 2. Site of Caller and Site of Exposure, Human Poison

Exposures Cases

Residence Own Other

Workplace Health care facility

School Restaurant/food service Public area Other Unknown

Site of Site of

Caller Exposure

(%) f%)

77.8 87.2

2.3 3.1 2.3 2.8

12.4 0.5 0.7 1.2 0.1 0.6 0.5 1.2

3.3 1 .o 0.6 2.3

LlTOVlTZETAL~1993AAPCCANNUAL REPORT 549

TABLEB Age and Gender Distribution of Human Poison Exposure Cases

Age (years)

Male Female Unknown Total Cumulative Total -

NO. % NO. % No % NO. % NO. %

<l 62,457 52.1 56,368 47.0 1,041 0.87 119,866 6.8 119,866 6.8 1 155,008 52.5 138,751 47.0 1,546 0.52 295,305 16.9 415,171 23.7 2 169,511 53.4 146,150 46.1 1,635 0.52 317,296 18.1 732,467 41.8 3 79,892 54.7 65,252 44.7 801 0.55 145,945 8.3 878,412 50.2 4 35,643 55.4 28,299 44.0 406 0.63 64,348 3.7 942,760 53.8 5 19,771 56.0 15,285 43.3 250 0.71 35,306 2.0 978,066 55.8 Unknown child ~5 1,189 42.5 1,034 37.0 572 20.47 2,795 0.2 980,861 56.0 6-12 60,056 55.9 46,530 43.3 910 0.85 107,496 6.1 1,088,357 62.1 13-19 47,559 40.8 68,331 58.7 581 0.50 116,471 6.7 1,204,828 68.8 Unknown child 1,591 37.3 1,419 33.3 1,254 29.41 4,264 0.2 1,209,092 69.0 Total children (<20) 632,677 52.3 567,419 46.9 8,996 0.74 1,209,092 69.0 1,209,092 69.0 20-29 59,942 44.7 73,935 55.1 330 0.25 134,207 7.7 1,343,299 76.7 30-39 51,797 43.0 68,393 56.8 214 0.18 120,404 6.9 1,463,703 83.6 40-49 28,003 41.3 39,654 58.5 137 0.20 67,794 3.9 1,531,497 87.4 50-59 12,274 38.5 19,593 61.4 52 0.16 31,919 1.8 1,563,416 89.3 60-69 8,016 37.0 13,639 62.9 37 0.17 21,692 1.2 1,585,108 90.5 70-79 5,344 34.7 10,037 65.1 38 0.25 15,419 0.9 1.600,527 91.4 80-89 2,585 30.3 5,925 69.5 20 0.23 8,530 0.5 1.609,057 91.9 90-99 400 26.3 1,120 73.5 3 0.20 1,523 0.1 1.610,580 92.0 Unknownadult 48,444 39.1 73,039 59.0 2,304 1.86 123,787 7.1 1.7349367 99.0 Total adults 216,805 41.3 305,335 58.1 3,135 0.60 525,275 30.0 1,734,367 99.0 Unknown age 5,857 34.2 8,041 47.0 3,211 18.80 17,109 1.0 1,751,476 100.0 Total 855,339 48.8 880,795 50.3 15,342 0.88 1,751,476 100.0 1,751,476 100.0

plemented in 1993. Thus, comparisons with data from pre- direct result of the person being on the job or in the work- vious years should be interpreted carefully. Definitions for place. *Therapeutic error: An unintentional deviation from a these coding options are as follows (options marked with an proper therapeutic regimen that results in the wrong dose, asterisk are new in 1993): Uninfentional general: All unin- incorrect route of administration, administration to the tentional exposures not specifically defined below. Most un- wrong person, or administration of the wrong substance. intentional exposures in children are captured here. Environ- Only exposures to medications or products substituted for mental: Any passive, nonoccupational exposure that results medications are included. Drug interactions resulting from from contamination of air, water, or soil. Environmental ex- unintentional administration of drugs or foods that are posures are usually. but not always, caused by man-made known to interact are also included. Unintentional misuse: contaminants. Occupational: An exposure that occurs as a Unintentional improper or incorrect use of a nonpharmaceu-

TABLE 4. Distribution of Age and Gender for 626 Fatalities

Age (yr) Male Female Unknown

<l 4 1 0 1 7 5 0 2 2 2 0 3 1 1 0 4 2 1 0 5 1 0 0 6-12 6 3 0 13-19 29 32 0 20-29 50 43 0 30-39 88 61 0 40-49 57 57 0 50-59 19 26 0 60-69 21 23 0 70-79 25 13 0 80-89 11 10 0 90-99 2 7 0 Unknown adult 12 3 1 Total 337 288 1

Total %

5 0.8 12 1.9 4 0.6 2 0.3 3 0.5 1 0.2 9 1.4

61 9.7 93 14.9 149 23.8 114 18.2 45 7.2 44 7.0 38 6.1 21 3.4 9 1.4 16 2.6

626 100.0

Cumulative Cumulative Total %

5 0.8 17 2.7 21 3.4 23 3.7 26 4.2 27 4.3 36 5.8 97 15.5 190 30.4 339 54.2 453 72.4 498 79.6 542 86.6 580 92.7 601 96.0 610 97.4 626 100.0

550 AMERICAN JOURNAL OF EMERGENCY MEDICINE W Volume 12, Number 5 n September 1994

TABLE 5. Number of Substances Involved in Human Poison

Exposure Cases

No. of

Substances

1

2

3

4

5

6

7

a 29

Total

No. of Cases % of Cases

1,631,914 93.2

90,992 5.2

16,464 0.9

6,191 0.4

2,426 0.1

1,026 0.1

415 0.0

237 0.0

1,809 0.1

1,751,476 100.0

tical substance. Unintentional misuse differs from intentional misuse in that the exposure was unplanned or not foreseen by the patient. *Bite/sting: All animal bites and stings, with or without envenomation, are included. *Food poisoning: Suspected or confirmed food poisoning; ingestion of food contaminated with microorganisms is included. Un- intentional unknown: An exposure determined to be unintentional but the exact reason is unknown. Suspected suicidal: An exposure resulting from the inappropriate use of a substance for reasons that are suspected to be self- destructive or manipulative. Intentional misuse: An exposure resulting from the intentional improper or incorrect use of a substance for reasons other than the pursuit of a psychotropic effect. intentional abuse: An exposure resulting from the intentional improper or incorrect use of a substance in which the victim was likely attempting to achieve a eu- phoric or psychotropic effect. All recreational use of substances for any effect is included. Intentional unknown: An exposure that is determined to be intentional but the specific motive is unknown. *Contaminant/tampering: The patient is an unintentional victim of a substance that has been adulter- ated (either maliciously or unintentionally) by the introduc- tion of an undesirable substance. *Malicious: This category is used to capture patients who are victims of another person’s intent to harm them. Adverse reaction: An adverse event occurring with normal, prescribed, labeled, or recommended use of the product, as opposed to overdose, misuse, or abuse. included are cases with an unwanted effect caused by an allergic, hypersensitive, or idiosyncratic response to the active ingredients, inactive ingredients, or excipients. Concomitant use of a contraindicated medication or food is excluded and is coded instead as a therapeutic error.

TABLE 7. Distribution of Reason for Exposure by Age

TABLE 6. Reason for Human Poison Exposure Cases

Reason No. %

Unintentional General 1,199,418 68.5 Therapeutic error 80,426 4.6 Bite/sting 57,254 3.3 Misuse 54,022 3.1 Environmental 46,669 2.7 Occupational 37,538 2.1 Food poisoning 33,950 1.9 Unknown 2,773 0.2 Total 1,512,050 86.3

Intentional Suicidal i 32,788 7.6 Misuse 26,663 1.5 Abuse 19,632 1.1 Unknown i i ,890 0.7 Total 190,973 10.9

Other Malicious 5,403 0.3 Contaminant/tampering 3,841 0.2 Total 9,244 0.5

Adverse Reaction Drug 23,230 1.3 Food 5,879 0.3 Other 4,806 0.3 Total 33,915 1.9

Unknown 5,294 0.3 Total 1,751,476 100.0

The vast majority (86.3%) of poison exposures were unintentional; suicidal intent was present in 7.6% of cases (Ta- ble 6). Therapeutic errors comprised 4.6% of exposures (80,426 cases), with unintentional nonpharmaceutical product misuse comprising another 3.1% of exposures (54,022 cases). Unintentional poisonings outnumbered intentional poisonings in all age groups (Table 7). In contrast, of the 626 human poisoning fatalities reported, 83% of adult deaths (older than 19 years of age) were intentional (Table 8).

Ingestions accounted for 75.0% of exposure routes (Table 9), followed in frequency by dermal, inhalation, and ocular exposures, bites and stings. parenteral and aspiration exposures. For the 626 fatalities, ingestion and inhalation were the predominant exposure routes.

The coding of specific clinical effects (signs, symptoms, and laboratory abnormalities) was implemented in 1993. Clinical effects were coded in 30.4% of cases (18.0% had one effect, 7.6% had two effects, 3.2% had three effects, 1.1% had four effects, 0.4% had five effects, and 0.2% had more than five effects). Of the 1.126,855 clinical effects coded, 78.4% were deemed related, 6.1% were considered not related, and 15.5% were coded as “unknown if related.”

<6 Years 6-l 2 Years 13-l 9 Years >19 Years Unknown Total

Reason NO. Row % NO. ROW % NO Row % No Row % No. ROW % No. %

Unintentional 973,966 64.4 97,006 6.4 57,428 3.8 368,430 24.4 15,220 1.0 1,512,050 86.3 Intentional 1,751 0.9 6,534 3.4 54,222 28.4 123,596 64.7 4,870 2.6 190,973 10.9 Other 1,115 12.1 1,235 13.4 i ,583 17.1 5,091 55.1 220 2.4 9,244 0.5 Adverse Reaction 3,469 10.2 2,214 6.5 2,566 7.6 24,982 73.7 684 2.0 33,915 1.9 Unknown 560 10.6 507 9.6 672 12.7 3,176 60.0 379 7.2 5,294 0.3 Total 980,861 56.0 107,496 6.1 116,471 6.7 525,275 30.0 21,373 1.2 1,751,476 100.0

LITOVITZ ET AL n 1993 AAPCC ANNUAL REPORT 551

TABLE 8. Distribution of Reason for Exposure and Age for TABLE 9. Distribution of Route of Exposure for Human Poison

626 Fatalities Exposure Cases and 626 Fatalities

Reason

<6 6-l 2 13-19 >19

Years Years Years Years Total

Unintentional

General

Environmental

Occupational

Therapeutic error

Misuse

Bite/sting

Food poisoning

Unknown

Total

Intentional

Suicide

Misuse

Abuse

Unknown

Total

Other

Adverse Reaction

Unknown

Total

14 0 0 5 19

7 2 2 6 17

0 0 1 8 9

3 2 0 24 29

0 0 1 0 1

0 0 0 1 1

0 0 0 0 0

1 0 0 5 6

25 4 4 49 82

0 1 34 303 338

0 0 0 21 21

1 0 16 73 90

0 1 3 40 44

1 2 53 437 493

0 0 0 0 0

0 0 1 13 14

1 3 3 30 37

27 9 61 529 626

The majority of cases reported to poison centers were managed in a non-health care facility (71 S%), usually at the site of exposure, the patient’s home (Table 10). Treatment in a health care facility was rendered in 24.4% of cases and recommended in another 2.0% of patients who refused the referral. Of cases managed in a health care facility, 53.8% were treated and released without admission, 1 I .9% were admitted for critical care, and 7.1% were admitted for noncritical care. When treatment was provided in a health care facility, half of the patients (50.2%) were referred in by the poison center and the other half (49.8%) were already in or en route to the health care facility when the poison center was contacted. Health care facilities used included acute care hospitals (90.4%), freestanding emergency centers (2.4%), and physicians offices or clinics (7.2%).

Table 11 displays the medical outcome of the human poison exposure cases distributed by age, showing more severe outcomes in the older age groups. Table 12 compares medical outcome and reason for exposure and shows the greater frequency of serious outcome in intentional exposures. Ta- ble 13 shows the increasing duration of the clinical effects observed with more severe outcomes. Note the revised medical outcome categories as follows (those marked with an asterisk have changed): No effect: The patient developed no signs or symptoms as a result of the exposure. Minor effect:

The patient developed some signs or symptoms as a result of the exposure, but they were minimally bothersome and gen- erally resolved rapidly with no residual disability or disfigurement. A minor effect is often limited to the skin or mu- cous membranes (eg, self-limited gastrointestinal symptoms, drowsiness, skin irritation, first degree dermal burn, sinus tachycardia without hypotension, and transient cough). Moderate effect: The patient exhibited signs or symptoms as a result of the exposure that were more pronounced, more prolonged, or more of a systemic nature than minor symp-

All Exposure Fatal Exposure

Cases Cases

Route NO. % NO. %

Ingestion 1,378,853 75.0 507 75.8 Dermal 138,147 7.5 4 0.6

Inhalation 120,770 6.6 77 11.5

Ocular 113,297 6.2 0 0.0

Bites and stings 64,835 3.5 1 0.1

Parenteral 5,489 0.3 38 5.7

Aspiration 4,220 0.2 17 2.5

Other 6,097 0.3 1 0.1

Unknown 5,818 0.3 24 3.6

Total 19837,526 100.0 669 100.0

NOTE: Multiple routes of exposure were observed in many poi-

son exposure victims. Percentage is based on the total number

of exposure routes (1,837,526 for all patients, 669 for fatal cases)

rather than the total number of human exposures (1,751,476) or

fatalities (626).

toms. Usually some form of treatment is indicated. Symp- toms were not life-threatening, and the patient has no residual disability or disfigurement (eg. cornea1 abrasion, acid- base disturbance, high fever, disorientation, hypotension that is rapidly responsive to treatment, and isolated brief seizures that respond readily to treatment). Major effect: The patient exhibited signs or symptoms as a result of the exposure that were life-threatening or resulted in significant residual disability or disfigurement (eg, repeated seizures or status epilepticus, respiratory compromise requiring intuba- tion. ventricular tachycardia with hypotension, cardiac or respiratory arrest, esophageal stricture, and disseminated in- travascular coagulation). Death: The patient died as a result of the exposure or as a direct complication of the exposure. Only those deaths that were probably or undoubtedly related to the exposure are coded here. *Not followed, judged as nontoxic exposure: No follow-up calls were made to determine the patient’s outcome because the substance impli-

TABLE 10. Management Site of Human Poison

Exposure Cases

Site No.

Managed on-site, nonhealth care facility 1,252,084 Managed in health care facility

Treated and released 230,290 Admitted to critical care 51,316 Admitted to noncritical care 30,484 Admitted to psychiatry 19,011 Lost to followup; left AMA 80,808 Unspecified level of care 16,124 Subtotal 428,033

Other 14,269 Refused referral 34,093 Unknown 22,997 Total 1,751,476

ABBREVIATION: AMA, against medical advice.

%

71.5

13.1

2.9 1.7

1.1

4.6

0.9 24.4

0.8 1.9

1.3 100.0

552 AMERICAN JOURNAL OF EMERGENCY MEDICINE n Volume 12, Number 5 I September 1994

TABLE 11. Medical Outcome of Human Poison Exposure Cases by Patient Age

Outcome

No effect Minor effect Moderate effect Major effect Death No follow-up, nontoxic No follow-up, minimal toxicity No follow-up, potentially toxic Unrelated effect Total

~6 Years 6-12 Years 13-19 Years >19 Years Unknown Total

NO. Cd %

327,599 33.3 120,306 12.2

8,834 0.9 668 0.1

27 0.0 273,233 27.8 204,073 20.6

31.701 3.2 16,474 1.7

982,917 100.0

NO COI %

20,150 la.7 26,546 24.7

2,896 2.7 171 0.2

9 0.0 22,075 20.5 25,697 24.1

6,338 5.9 3,414 3.2

107,496 100.0

No. Cal %

21,302 la.3 35,649 30.6

1

9,622 a.3 904 0.8

61 0.1 9,585 a.2

19,382 16.6 16,476 14.1 3,490 3.0

16,471 100.0

No. COI % NO. COI %

59,205 11.3 2,015 10.4 I 58,334 30.1 3,473 la.0 43,768 a.3 665 3.4

6,031 1.1 62 0.3 529 0.1 0 0.0

43,696 6.3 2,757 14.3 110,443 21 .o 3,779 19.6

75,932 14.5 5,983 31 .o 27,337 5.2 583 3.0

525,275 100.0 19,317 100.0

No. %

430,271 344,310

65,785 7,836

626 351,346 363,574 136,430

51,298 1,751,476

24.6 19.7

3.8 0.4 0.0

20.1 20.8

7.8 2.9

100.0

TABLE 12. Distribution of Medical Outcome by Reason for Exposure for Human Poison Exposure Cases

Outcome

Unintentional Intentional Other Adverse Reaction Unknown

No. Cal % No. Cal% No COI % No COI % No. Cal %

Total

No %

No effect Minor effect Moderate effect Major effect Death No follow-up, nontoxic No follow-up, minimal toxicity No follow-up, potentially toxic Unrelated effect Total

391,582 276,851

37,854 2,126

344,oE 335,634

62,503 41,330

1,512,050

25.9 la.3 2.5 0.1 0.0

22.8 22.2

5.5 2.7

100.0

36,312 19.0 53,922 28.2 24,003 12.6

5,310 2.8 493 0.3

4,639 2.4 15,380 a.1 46,898 24.6

4,016 2.1 190,973 100.0

I ,282 2;721

357 34

0 1,205 1,939 1,202

504 9,244

13.9 29.4

3.9 0.4 0.0

13.0 21 .o 13.0

5.5 100.0

9,904 3,003

168 14

1,181 9,675 4,287 4,825

33,915

1.9 29.2

a.9 0.5 0.0 3.5

29.1 12.6 14.2

100.0

912 568 198 37

233 746

1,540 623

5,294

TABLE 13. Duration of Clinical Effects by Medical Outcome

Duration of effect

Minor Moderate Major

effect effect effect

Cal (%) Cal (%) Cal (%)

~2 hours 36.82 5.82 2.16

>2 hours, ~8 hours 22.13 18.61 6.71

>8 hours, ~24 hours 15.54 26.67 23.57

>24 hours, ~3 days 4.23 14.96 29.62

>3 days, ~1 week 1.05 4.88 11.78

>l week, ~1 month .31 1.58 4.49

>l month .16 54 .94

Anticipated permanent .02 .15 2.07

Unknown 19.76 26.80 18.66

TABLE 14. Decontamination and Therapeutic Intervention

Therapy

No. of patients %

Decontamination only 926,187 52.9

No therapy provided 201,199 11.5

Observation only 197,576 11.3 Decontamination and other therapy 103,597 5.9 Other therapy only (no decontamination) 72,677 4.2

Unknown if therapy provided/patient refused 250,240 14.3

a.3 17.2 10.7 3.7 0.7 4.4

14.1 29.1 1 I .a

100.0 1

430,271 24.6 344,310 19.7

65,785 3.8 7,836 0.4

626 0.0 351,346 20.1 363,574 20.8 136,430 7.8

51,298 2.9 ,751,476 100.0

cated was nontoxic, the amount implicated was insignificant, or the route of exposure was unlikely to result in a clinical effect. *Not followed, minimal clinical effects possible: No follow-up calls were made to determine the patient’s outcome because the exposure was likely to result in only minimal toxicity of a trivial nature. (The patient was expected to experience no more than a minor effect.) Unable to follow, judged as a potentially toxic exposure: The patient was lost to follow-up, refused follow-up, or was not followed, but the exposure was significant and may have resulted in a moderate, major, or fatal outcome. Unrelated effect: The exposure was probably not responsible for the effect. *Confirmed nonexposure: This outcome option was used during coding to designate cases in which there was reliable and objective evidence that an exposure initially believed to have occurred actually never occurred (eg, all missing pills are later lo- cated). All cases coded as confirmed nonexposure are excluded from this report. In 1993, there were 5,575 such cases reported nationally.

Table 14 and 15 outline the use of decontamination pro- cedures, specific antidotes, and measures to enhance elimination in the treatment of patients reported in this database. These must be interpreted as minimum frequencies because of the limitations of telephone data gathering. Ipecac syrup was administered in 3.7% of cases. In children younger than 6 years of age, ipecac syrup was most often administered outside a health care facility. This pattern was reversed in teenagers and adults. Table 16 shows a continued decrease


TABLE 15. Therapy Provided in Human Exposure Cases

Therapy No.

Decontamination

Dilution/irrigation

Activated charcoal, single dose

Cathartic

Ipecac syrup

Gastric lavage

Activated charcoal, multidose

Other emetic

Whole bowel irrigation

Measure to Enhance Elimination

Alkalinization (with or without diuresis)

Hemodialysis

Other extracorporeal procedure

Hemoperfusion (charcoal or resin)

Specific Antidote Administration

N-acetylcysteine (oral)

Naloxone

Flumazenil

Atropine

Deferoxamine

Antivenin

Hyperbaric oxygen

Ethanol

N-acetylcysteine (IV)

Phytonadione

Pyridoxine

Pralidoxime (P-PAM)

Physostigmine

Fab fragments

Dimercaprol (BAL)

EDTA

Succimer

Penicillamine

Sodium thiosulfate

Folate

Methylene blue

Sodium nitrite

Hydroxocobalamin

Other intervention

ECMO Transplantation

lntubation

749,371

114,563

90,369

65,205

60,406

17,284

4,718

1,250

7,398

646

80

64

7,493

6,800

2,520

778

721

560

550

472

316

291

257

203

189 174

113

112

76

67

67

66

61

53

10

17

12

5,139

TABLE 16. Decontamination Trends

Year

Human Exposures Reported

% of Exposures Involving Children ~6 Years

Ipecac Administered

(% of Exposures)

Activated Charcoal

Administered (% of

Exposures)

1983 251,012 64.0 13.4 4.0 1984 730,224 64.1 12.9 4.0 1985 900,513 63.4 15.0 4.6 1986 1,098,894 63.0 13.3 5.2 1987 1,166.940 62.3 10.1 5.2 1988 1,368,748 61.8 8.4 6.5 1989 1,581,540 61.1 7.0 6.4 1990 1,713,462 60.8 6.1 6.7 1991 1,837,939 59.9 5.2 7.0 1992 1,864,188 58.8 4.3 7.3 1993 1,751,476 56.0 3.7 7.3

TABLE 17. Substances Most Frequently Involved in

Human Exposures

Substance No. %’

Cleaning substances 180,161 10.3 Analgesics 167,762 9.6 Cosmetics and personal care products 143,861 8.2 Cough and cold preparations 105,588 6.0 Plants 94,725 5.4 Bites/envenomations 72,637 4.1 Topicals 64,697 3.7 Pesticides (includes rodenticides) 64,298 3.7 Foreign bodies 61,640 3.5 Antimicrobials 60,435 3.5 Food products, food poisoning 59,997 3.4 Hydrocarbons 58,636 3.3 Sedatives/hypnotics/antipsychotics 54,521 3.1 Alcohols 46,594 2.7 Chemicals 44,240 2.5 Vitamins 41,547 2.4 Antidepressants 40,549 2.3

NOTE: Despite a high frequency of involvement, these sub-

stances are not necessarily the most toxic, but rather may only

be the most readily accessible.

*Percentages are based on the total number of human expo-

sures rather than the total number of substances.

in the use of ipecac-induced emesis in the treatment of poisoning.

Table 17 presents the most common substance categories listed by frequency of exposure. Table 18 lists the substance categories with the largest number of reported deaths; analgesics and antidepressants led this list. A remarkable chronological constancy of selected demographic data ele- ments is shown in Table 19.

A breakdown of plant exposures is provided for those most commonly implicated (Table 20). The reader is cau- tioned to interpret this as frequency of involvement of plants in calls to poison centers with no correlation to severity of toxicity. Indeed, several of the plants on this list pose little if any ingestion hazard.

TABLE 18. Categories with Largest Numbers of Deaths

% of All

Exposures in Category No. Category

Analgesics 172 0.103 Antidepressants 151 0.372 Stimulants and street drugs 92 0.395 Sedative/hypnotics/antipsychotics 80 0.147 Cardiovascular drugs 74 0.285 Alcohols 62 0.133 Gases and fumes 34 0.106 Chemicals 33 0.075 Asthma therapies 27 0.162 Hydrocarbons 22 0.038 Cleaning substances 21 0.012

554 AMERICAN JOURNAL OF EMERGENCY MEDICINE n Volume 12, Number 5 W September 1994

TABLE 19. IO-Year Comparisons of Fatality Data TABLE 20. Frequency of Plant Exposures by Plant Type

Suicides Pediatric Deaths

(~6 years)

Total Fatalities % of % of

Year NO. % NO. deaths No. deaths

1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993

95 293 328 408 397 545 590 812 764 705 826

-il.038 60 63.2 10 10.5 0.040 165 56.3 21 7.2 0.036 178 54.3 20 6.1 0.037 223 54.9 15 3.7 0.034 226 56.9 22 5.5 0.040 297 54.5 28 5.1 0.037 323 54.7 24 4.1 0.036 350 57.2 25 4.1 0.042 408 53.4 44 5.8 0.038 395 56.0 29 4.1 0.036 338 54.0 27 4.3

A summary of the 626 fatal exposures is presented in Ta- ble 21. Each of these cases was abstracted and verified by the reporting center, with only those exposures deemed “probably” or “undoubtedly” responsible for the fatality included in this compendium. Confirmation of the cause of death by a postmortem report was obtained in 28% of cases. The highest blood level of implicated substances is provided where available to the reporting poison center. Prehospital cardiac and/or respiratory arrests occurred in 35% of all fatalities, and these are indicated in Table 22.

Tables 22A and 22B provide comprehensive demographic data on patient age, reason for exposure, medical outcome, and use of a health care facility for all 1,75 1,476 exposures, presented by category. Table 22A focuses on nonpharmaceuticals; Table 22B presents drugs. Of the 1,868,836 substances logged in Tables 22A and 22B, 57.6% were nonpharmaceuticals and 42.4% were pharmaceuticals. The reason for the exposure was intentional for 26.2% of pharmaceutical substances implicated compared with only 4.1% of nonpharmaceutical substances. Correspondingly, treatment in a

Botanical Name Common Name Frequency

Philodendron species philodendron 4,726 Cap&urn annuum pepper 3,912 Dieffenbachia species dumbcane 2,837 Euphorbia pulcherrima poinsettia 2,798 flex species holly 2,651 Phytolacca americana pokeweed, inkberry 2,231 Spathiphyllum species peace lily 2,086 Crassula species jade plant 1,658 Epipremnum aureum pothos, devil’s ivy 1,401 ToxicodendronlRhus radicans poison ivy 1,306 Brassaia actinophylla umbrella tree 1,141 Saintpaulia ionantha African violet 1,137 Rhododendron species rhododendron, azalea 1,029 Taxus species yew 969 Eucalyptus Glob&s eucalyptus 945 f’yracantha species pyracantha 894 Chlorophytum comosum spider plant 787 Schlumbergera bridgesii Christmas cactus 781 Hedera he/ix English ivy 765 Solanum dulcamara climbing nightshade 754

health care facility was provided in a higher percentage of exposure to pharmaceutical substances (37.2%) compared with nonpharmaceutical substances. Correspondingly. treatment in a health care facility was provided in a higher percentage of exposures to pharmaceutical substances (37.2%) compared with nonpharmaceutical substances (19.1%). Pharmaceutical exposures also had more severe outcomes. Of substances implicated in fatal cases, 76.5% were pharmaceuticals, compared with only 42.4% in nonfatal cases. Sim- ilarly, 76.5% of substances implicated in major outcomes were pharmaceuticals.

In closing, we gratefully acknowledge the extensive con- tributions of each participating poison center and the assis- tance of the many physicians and nurses who provided comprehensive data to the poison centers for inclusion in this database.

TABLE 21. Summary of Fatal Exposures Reported to TESS in 1993

Case Age Substances Chronicity Route Reason Blood Levels

Alcohols 1p 2 3 4 5 8

7

8

9p

IO

11

12

13 14

17 yr 30 yr 36 yr 45 yr 71 yr 36 yr

69 yr

46 yr

22 yr

46 yr

31 yr

30 yr

15yr 38 yr

Ethanol Ethanol Ethanol Ethanol Ethanol (rubbing alcohol) Ethanol

acetaminophen Ethanol

acetaminophen Ethanol

acetaminophen aspirin

Ethanol air freshener propellant

Ethanol chlorpromazine

Ethanol cocaine

Ethanol propranolol nifedipine

Methanol Methanol

A A/C

: A/c C

C

A/C

U Ing/lnhal Int abuse

U Ingestion Int abuse

A Ingestion Int abuse

A!c Ingestion Int suicide

A Ingestion Int abuse A Ingestion Int abuse

Ingestion Int unknown Ingestion Int abuse Ingestion Int abuse Ingestion Int abuse Ingestion Int suicide Ingestion Int abuse

Ingestion Int unknown

400 mg/dL 186 mg/dL

84 PgimL

Int suicide

>24 h

99 PgimL

403 mg/dL

99 mg/dL 2d

(Continued on following page)

LITOVITZ ET AL = 1993 AAPCC ANNUAL REPORT 555

TABLE 21. Summary of Fatal Exposures Reported to TESS in 1993 (Cont’d)


15 44 yr Methanol A Ingestion Int suicide 129 mg/dL 16 56 yr Methanol A Ingestion Int suicide 17 75 yr Methanol U Ingestion Int abuse 314 mg/dL la >I9 yr Methanol A Ingestion Int suicide 300 mg/dL 19 44 yr Methanol A Ingestion Int abuse

isopropanol 2op 38 yr Methanol A Ingestion Int suicide 170 mg/dL

lead 70 pg/dL See a/SO CaSeS 24, 30, 52, 108. 109, 110, 124, 179, 180, 181, 182, 183, 184, 185, 186, 187, 188, 189, 190, 191, 207, 218, 220, 245, 246, 311, 312, 373, 374,

323, 355, 385, 395, 408, 443, 459, 478, 495, 503, 515, 520, 521, 524. 527, 549, 563, 589, 592, 596, 617 (ethanol); 19 (isopropanol).

Arts/crafts/office supplies 210 I6 yr Typewriter correction fluid

Automotive products 22p 40 yr Antifreeze (ethylene glycol) 23 50 yr Antifreeze (ethylene glycol)

acetaminophen 24p 48 yr Gasoline additive (methanol)

ethanol 25 20s yr Gasoline antifreeze (methanol) 26 29 yr Windshield washer fluid (methanol) 27 45 yr Windshield washer fluid (methanol) 28 31 yr Windshield washer fluid (methanol)

glass cleaner

Batteries 29 58 yr Sulfuric acid (from auto battery)

Bites and envenomations 300 40 yr

Chemrcals 31 67 yr 32p 26 yr 33p 31 yr 34” 37 yr 35 22 mo 36 14yr 37 38 yr

3a’,p 15 mo 39p 4 yr 4op 31 yr 41p 41 yr 42P 52 yr 43 24 yr 44 24 yr 45 25 yr 46 26 yr 470 39 yr 48 59 yr 49 59 yr 50 69 yr 51 39 yr

52p 46 yr

53 a7 yr 54 32 yr

55 47 yr

56 16yr

57 26 yr 5ap 27 yr

59 72 yr

Hymenoptera ethanol

Alum Ammonia, anhydrous Ammonia Ammonia, anhydrous Ammonium dichromate Bromide Bromoethylamine hydrobromide

thallous acetate thimerosal

Cyanide Cyanide Cyanide Cyanide, sodium Cyanide Ethylene glycol Ethylene glycol Ethylene glycol Ethylene glycol Ethylene glycol Ethylene glycol Ethylene glycol Ethylene glycol Ethylene glycol

diphenhydramine Ethylene glycol

ethanol Nitric acid Nitric acid

potassium ferrocyanide N,N-dimethyl aniline

long-acting anticoagulant rodenticide Potassium hydroxide

lithium hydroxide Sodium azide Strychnine

theophylline flunixin

NC

A U

A

A A A A

A

A

A A A A

: A

U A A A A A A A A A A A A A

A

A A

A

A

A A

Sulfuric acid A

Inhalation

Ingestion Ingestion

Ingestion

Ingestion Ingestion Ingestion Ingestion

Ingestion

Biteistingilng

Other Inhalation Derm/lnhal Inhalation Ingestion Ingestion Ingestion

Unknown Ingestion Ingestion Unknown Ingestion Ingestion Ingestion Ingestion Ingestion Ingestion Ingestion Ingestion Ingestion Ingestion

Ingestion

Ingestion Ingestion

Ingestion

Aspirilng

Ingestion Ingestion

Ingestion See a/so cases 712 (cyanide); 792 (ethylene glycol); and 54 (potassium rerrocyanrae).

Cleanmg substances 60 2 yr Bleach (sodium hypochlorite, 5.4%) A Inhalation 61 66 yr Bleach (sodium hypochlorite, 5-10%; A Ingestion

sodium carbonate; sodium chloride) 62 65 yr Cleaning solution (acid) A Ingestion 63 93 yr Deodorizing cleaner (cationic) A Aspirllng


Int abuse

Int suicide Int suicide

lnt suicide

Int suicide Int abuse Int suicide Int suicide

Int suicide

Bite/sting

Ther error occ occ occ Unint gen Adv rxn Int suicide

Unint unk Unint gen Int suicide Int suicide Int suicide Int suicide Int suicide Int abuse Int abuse Int abuse Unknown Int suicide Int unknown Int unknown

Int suicide


Int suicide

Unint misuse


Int suicide

Env Int suicide

Int suicide Unint gen

335 mgldL§ 13 ma/dL

100 kg/mL 282 mg/dL 2h

12 mg/dL 170 mg/dL 10 h 347 mg/dL

129 mg/dL

320 mg/dL

RBC chromium 7,795 @g/L

0.81 I*g/mL§ a pg/mL <l h

13.9 pg/mL 2.85 pgimL§ 38.6 pg/mL§

11 mg/dL 144 mg/dL 115 mg/dL 300 mg/dL§

10 mg/dL 23 mg/dL

211 mg/dL 58 mg/dL

555 mg/dL

162 mg/dL

methemoglobin 75%

5 mg/L§

6 bgimL§

20 h




64 14yr

65 66P

26 yr 59 yr

67 70 yr 66 48 yr

69 80 yr 70 61 yr 71 80 yr 72 40 yr

73 83 yr

74 75 76 77 7W

48 yr 68 yr 75 yr 79 yr 16yr

Drain opener (sodium hydroxide crystals)

Drain opener (sulfuric acid) Drain opener (hydrochloric acid) Drain opener (94% sulfuric acid) Drain opener (sodium hydroxide)

drain opener (potassium hydroxide) ant and roach killer (unspecified)

Laundry detergent (liquid) Oven cleaner (alkali) Pine oil disinfectant/cleaner Plastic/leather cleaner (butyl

celIosoIve/propane/isobutane) cocaine

Rust remover (6-8% hydrofluoric acid) acetaminophen/hydrocodone acetaminophen/diphenhydramine

Toilet bowl cleaner (HCI) Toilet bowl cleaner (HCI) Toilet bowl cleaner ~ Toilet bowl cleaner (HCI) VCR head cleaner

Ingestion Int unknown Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Inhalation Int abuse

See aiS cases 28 (glass cleaner); 56 (lithium hydroxide); 68 (potassrum hydroxide); and 248 (sodium bypochlorite household bleach).

A A

;C

A Ingestion Int suicide

Ingestion Int suicide

Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide

Aspirilng Int suicide Ingestion Int suicide Aspir/lng Unint gen Inhalation int abuse

Cosmetics and personal care products 79 75 yr Liquid soap A Aspir/lng Unint gen

See a/so cases 203 (mouthwash); and 202 (nail polish remover).

Deodorizers See also case 9 (air freshener propellant)

Food products and food poisoning See a/so case 358 (mint extract, 90% ethanol)

Foreign bodies, toys and miscellaneous See a/so case 143 (activated charcoal).

Fumes, gases and vapors 8OP 4 mo Carbon monoxide/smoke 81 2 yr Carbon monoxide 82p 2 yr Carbon monoxide 83 3 yr Carbon monoxide 84 4 yr Carbon monoxide 85 4 yr Carbon monoxide/smoke 86p 6 yr Carbon monoxide/smoke 87p 1Oyr Carbon monoxide 88P 13yr Carbon monoxide 89P 16 vr Carbon monoxide GiJp 21 jrr Carbon monoxide 91 22 yr Carbon monoxide 92p 23 $r Carbon monoxide 93p 25 yr Carbon monoxide 94p 29 yr Carbon monoxide 95 32 yr Carbon monoxide 96p 32 yr Carbon monoxide 97p 37 yr Carbon monoxide 98” 40s vr Carbon monoxide $jLP 41 ir Carbon monoxide

1 oop 42 yr Carbon monoxide 1OlP 42 yr Carbon monoxide 102p 44 yr Carbon monoxide 103p 44 yr Carbon monoxide 104p 44 vr Carbon monoxide 105p 46 i(r Carbon monoxide 106p >19yr Carbon monoxide 107p 17yr Carbon monoxide

cocaine diazepam

106 35 yr Carbon monoxide/smoke ethanol

109’ 36 yr Carbon monoxide ethanol

110 57 yr Carbon monoxide/smoke ethanol

IlIP 25 yr Hydrogen sulfide 112p 26 yr Hydrogen sulfide

cyanide methane

See a/so case 112 (methane).

A Inhalation Env A Inhalation Env A Inhalation Env A Inhalation Env A Inhalation Env A Inhalation Env A Inhalation Env A Inhalation Env A Inhalation Env A Inhalation Env A Inhalation Int suicide A Inhalation Int suicide A Inhalation Int suicide A Inhalation Int suicide A Inhalation Env A Inhalation Int suicide A Inhalation Int suicide C Inhalation Env A Inhalation Int suicide U Inhalation Int suicide A Inhalation occ A Inhalation Int suicide A Inhalation Int suicide A Inhalation Env A Inhalation Env A Inhalation Int suicide A Inhalation Int suicide A Inhalation Int suicide

lngilnhal Int suicide

Inhalation occ Inhalation occ

Env

52%

55%

15% 57%

62% 73% 19% 48% 77% 40% 67%

81% 44% 49% 47% 35% 44% 60% 66%5 98%§

.I4 pglmL§ 27%

464 mg/dL 65%!j 93 mg/dL 45%

(Con tintred on ~o/iowjng page)

LITOVITZ ET AL U 1993 AAPCC ANNUAL REPORT 557


Case Aqe Substances Chronicity Route Reason Blood Levels

Heavy metals 113 26 yr Arsenic trioxide A 114 25 yr Mercuric chloride A 115 35 yr Mercury (elemental) A

See a/so cases 20 (lead); 37 (thallous acetate); and 37 (thimerosal).

Hydrocarbons 116P 117p lisp 119p 12op 121p 122p 123P 124P

14yr 14 yr 16yr 16 yr 17 yr 17 yr 19yr 19yr 21 yr

9 yr 15mo 18 mo 62 yr

69 yr 40 yr 14 yr 26 yr 39 yr

15 mo 19yr

Butane Butane Butane Butane (lighter) Butane Butane Clorofluorocarbon Clorofluorocarbon propellant Clorofluorocarbon

ethanol Cooking oil spray Gasoline Gasoline Grease (farm equipment)

permethrin Mineral spirits Tar/asphalt Trichloroethane Trichloroethane Trichloroethylene

trichloroethane Unknown hydrocarbon Xylene

polyisobutylene amine

A A A A A A A NC NC

U A A A

A A A A C

A A

125 126P 127P 128

129 130 1310 132P 133p

134 135p

See a/so cases 735 (polyisobutylene amine); and 133 (trichloroethane)

lnsectlcides 136 74 yr Boric acid tablets A 1370 44 yr Carbaryl A

lorazepam 138 73 yr Chlorpyrifos (12%) A 139 24 yr Lindane lotion A 140 47 yr Malathion A 141 74 yr Malathion A

chlordane

Rodenticides 147 15 yr Zinc phosphide A Ingestion

See a/so case 55 (long-acting anticoagulant rodenticide).

Analgesics 148 7 yr Acetaminophen A Ingestion

149 12 yr Acetaminophen C Ingestion

150 14 yr Acetaminophen A Ingestion






156 34 yr Acetaminophen U Ingestion

157 36 yr Acetaminophen U Ingestion



160 39 yr Acetaminophen AK Ingestion


162 45 yr Acetaminophen Ingestion

163 46 yr Acetaminophen Ingestion

Ingestion Ingestion Inhalation

Inhalation Int abuse Inhalation Int abuse Inhalation Int abuse Inhalation Int abuse Inhalation Int abuse Inhalation Int abuse Inhalation Int abuse Inhalation Int abuse Ing/lnhal Int abuse

Aspirilnhal Aspirilng Aspir/lng Aspirilng

Unknown Unint gen Unint gen Unint gen

Aspirilng Dermal Inhalation Inhalation Inhalation

Unint gen occ Int abuse occ Int abuse

Aspirilng Dermilnhal

Unint gen occ

Ingestion Ingestion

Aspir/Derm/lng Ingestion Ingestion Ingestion

Int suicide Int suicide Int suicide 438 Fg/L 3d

120 mg/dL


Int suicide Ther error Int suicide Int suicide

pseudocholinesterase 1.1 UimL RBC cholinesterase

depression 99%

142 26 yr Sodium fluoride insecticide A Ingestion Int suicide

See a/so cases 747 (chlordane); 128 (permethrin); and 68 (unspecified ant and roach killer).

Mushrooms 143 34 yr Mushroom (unidentified) A Aspirilng Int misuse

activated charcoal

Paints and stripping agents 144 17yr spray paint (toluene) 145 3 yr spray paint (toluene) 146 34 yr wood stripper (toluene, isopropanol,

naphtha)

Polishes and Waxes See a/so case 247 (furniture polish).

Inhalation Inhalation lngilnhal

Int abuse Int abuse Int abuse

Int suicide

Unknown Ther error Int suicide Int suicide Int suicide Int misuse Int suicide Int suicide Int unknown Int suicide Int suicide Int suicide Ther error Int misuse Int suicide Int misuse

98 PgimL 290 pg/mL

86 PglmL

27 +g/mL 191 FgimL

>22 h

20 h

46 h

i ia PgimL 63 FgimL 44 PgimL

150 FglmL 101 pg/mL

115 *g/mL 30 KgimL 34 PglmL

22 h

36-4f 26 h 21 h

24 h 37 h





164 47 yr 165 50 yr 166 55 yr 167 57 yr 168 68 yr 169 70 yr 170 74 yr 171 74 yr 172 80 yr 173 80 yr 174 >I9 yr 175 32 yr

176 22 yr

177

178

80 yr

35 yr

179 27 yr

180 21 yr

181 31 yr

162 32 yr

183 32 yr

184 33 yr

185 33 yr

186 43 yr

187 54 yr

188 54 yr

189 56 yr

190 67 yr

191 43 yr

192 63 yr

193 25 yr

194p 62 yr

195

196

197 1 9aP 199 2oop 201 202

60 yr

60 yr

22 yr 24 yr 26 yr 35 yr 39 yr 43 yr

203 27 yr

204

205

48 yr

73 yr

Acetaminophen Acetaminophen Acetaminophen Acetaminophen Acetaminophen Acetaminophen Acetaminophen Acetaminophen Acetaminophen Acetaminophen Acetaminophen Acetaminophen

acetaminophenlsalicylamidei phenyltoloxamine

ketorolac Acetaminophen

alprazolam fluoxetine

Acetaminophen aspirin

Acetaminophen carbamazepine phenytoin

Acetaminophen cocaine ethanol

Acetaminophen ethanol











Acetaminophen ethanol ibuprofen

Acetaminophen ethylene glycol

Acetaminophen ibuprofen

Acetaminophen prednisone acetaminophen/hydrocodone

Acetaminophen salicylate

Acetaminophen/codeine acetaminophenipropoxyphene

Acetaminophen/diphenhydramine Acetaminophen/diphenhyramine AcetaminopherVdiphenhydramine Acetaminophenldiphenhydramine Acetaminophenlhydrocodone Acetaminophen/hydrocodone

diphenoxylatelatropine nail polish remover

Acetaminophen/hydrocodone mouthwash meperidine

Acetaminophenioxycodone acetaminophenlcodeine

Acetaminophenioxycodone

C A A A C U U A C C A A

A

C

A

NC

A

C

A

C

C

U

C

C

C

C

AC

C

U

A

U

C

A

A A U A U A/C

C

AC

C

Ingestion Ther error Ingestion Int suicide Ingestion Int suicide Ingestion Int unknown Ingestion Ther error Ingestion Int unknown Ingestion Int misuse Ingestion Int unknown Ingestion Unknown Ingestion Int misuse Ingestion Int unknown Ingestion Int suicide

166 FgimL

170 Fgim L

236 kg/m L 17 h

129 PgimL 99 PgimL 74 PgimL

Ingestion Int suicide 74 FglmL

Ingestion Ther error


6 pg/mL 19 mg/dL 18 kg/mL

Ingestion Int misuse 32 PgimL




Ingestion Int misuse


Ingestion Unknown




Ingestion Unknown



127 FgimL

12 Fg/mL

89 PglmL

16 FgimL

48 FgimL 150 mg/dL 37 PgimL

54 FgimL

14 rg/mL

80 rg/mL

55 PglmL

Ingestion Unknown


Ingestion Unknown

67 FgimL 9 mg/dL

18 PgimL

762 PgimL

Ingestion

Ingestion

Ingestion ingestion Ingestion Ingestion Ingestion Ingestion

Int misuse

Int suicide

149 KglmL 84 mg/dL

382 +g/mL

Int suicide Int suicide Unknown Int suicide Int unknown Int suicide

102 kg/mLli 25 h 369 kg/rnLll 3h

43 PglmLII 60 pg/rnLl’

Ingestion Int misuse 43 +gimL

Ingestion

Ingestion

Int unknown

Int misuse 41 kg/mLl’

2d

4h

30 h

>36 h

36-40 h


LITOVITZ ET AL n 1993 AAPCC ANNUAL REPORT


Case Age Substances Chronicity Route Reason

559

Blood Levels

207P

206 2090 21op

211 212

36 yr

30 yr

27 yr 29 yr 69 yr

67 yr a2 yr

213p

214p

35 yr

!j3 yr

215

216D

92 yr

a0 yr

217p

218

31 yr

45 yr

219

220

69 yr

39 yr

221p 17yr

222 223 224 225 226 227 228 229 230 231 232P 233 234 235 236 237 238 239 240 241 242

243

15 yr 23 yr 29 yr 30 yr 32 yr 33 yr 40 yr 41 yr 42 yr 46 yr 47 yr 48 yr 49 yr 59 yr 59 yr 65 yr 67 yr 72 yr 73 yr 77 yr 64 ye

56 yr

244 :>19yr

245 44 yr

246 71 yr

247 45 yr

248 48 yr

249p 47 yr

Acetaminophen/oxycodone carisoprodol

Acetaminophenioxycodone ethanol

Acetaminophenlpropoxyphene Acetaminophenlpropoxyphene Acetaminophenipropoxyphene

Acetaminophenipropoxyphene AcetaminopherVpropoxyphene

acetaminophenicodeine lorazepam

Acetaminophen/propoxyphene alprazolam diazepam

Acetaminophenipropoxyphene amitriptyline diazepam

Acetaminophenipropoxyphene aspirinibutalbitalicaffeine methyldopa

Acetaminophenlpropoxyphene buspirone ibuprofen

Acetaminophenipropoxyphene carisoprodol

Acetaminophenipropoxyphene diazepam ethanol

Acetaminophenlpropoxyphene digoxin

Acetaminophenipropoxyphene ethanol carisoprodol

Acetaminophenlpropoxyphene pentazocine amitriptyline

Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin Aspirin

acetaminophen Aspirin

captopril estrogen, conjugated

Aspirin diphenhydramine phenothiazine

Aspirin ethanol

Aspirin ethanol

Aspirin furniture polish

Aspirin sodium hypochlorite household

bleach Butorphanol

U

NC

A

NC

A

U

U

AC

A

A

Ingestion Int abuse


Ingestion Int suicide Ingestion Int unknown Ingestion Int suicide

Ingestion Int unknown Ingestion Int suicide

Ingestion

Ingestion

Ingestion

Ingestion

Ingestion

Ingestion

Ingestion

Ingestion

Ingestion

Int misuse

Int suicide

Int suicide

Unknown

Unint unk

Int suicide

Int unknown

Int suicide

Int suicide

69 &g/mLl’ 6h

72 pg/mLll

191” pg/mL§ propoxyphene .9 +g/mL§

>200 *g/mLll

>24 h

195 kg/mL’I 2.5 ng/mL

199 I*g/mLI

A

; C

:: A A A A C C A AX A

E U NC C U

A

A Ingestion Int suicide 90 mg/dL

NC Inhalation Adv rxn

Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int abuse Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Unknown Ingestion Int misuse Ingestion Int misuse Ingestion Int suicide Ingestion Int suicide Ingestion Int unknown Ingestion Unint unk Ingestion Int suicide Ingestion Int unknown Ingestion Int suicide Ingestion Ther error Ingestion Int unknown


Ingestion Int suicide a5 mg/dL

Ingestion Int suicide 57 mg/dL

Ingestion Int suicide 97 mgldL

Ingestion Int suicide 90 mg/dL

194 ngimL nortriptyline 149 ng/mL

107 mg/dL 120 mg/dL 134 mg/dL

67 mg/dL 98 mg/dL 96 mg/dL 60 mg/dL

298 mgldL§ 131 mg/dL 100 mg/dL

76 mg/dL§ 59 mg/dL

73 mg/dL 117 mg/dL



155 +g/mL 50 mg/dL

5h

6h 2.5 h

10 h

6h >7 h 46 h

Id

>ll h

3d




25OP 46 yr

251p 22 yr

252 31 yr

253 19yr

254p 30 yr 255p 50 yr

256p 34 yr

25F 41 yr

250p 41 yr 259 16 yr

260p 30 yr

261p 37 yr 262 39 yr 263p 55 yr 264 41 yr

265p 32 yr

266p

267

268 26Qp 270p 271’

40 yr

Q yr

18yr Piroxicam

Q yr Propoxyphene 46 yr Propoxyphene 37 yr Propoxyphene

272p 49 yr

273p 17 yr

274p 20 yr

275 76 yr 276 43 yr

Codeine cyclobenzaprine acetaminophen

Codeine heroin

Colchicine glyburide

Colchicine spironolactone heroin

Hydrocodone Ibuprofen

phenytoin bumetanide

Meperidine

quinine Methadone

amitriptyline

doxepine Morphine Morphine

codeine butabarbital

Morphine phenobarbital

Opiates Opiates Opiates Opiates

benzodiazepine Opiates

cocaine benzodiazepines

Opiates cocaine

Phenylbutazone

diazepam

acetaminophen Propoxyphene

A Ingestion Int suicide 9.5 pg/mLQ 593 ng/mL§ 121 pg/mL§ 170 FgimL IngilnhiParen Int abuse



U Ingestion Unknown A Ingestion Int suicide

1.7 pg/mL$

A Ingestion Unknown 4.9 &glmL§ normeperidine 0.5 kg/mL§

28 PgldL 170 ng/mL

nortriptyline 370 ng/mL 140 ng/mL

11 pg/mL

33 kg/L5 2.6 FgimL§ 19 pglmL§

710 PgimL >24 h 2 PgimL >24 h

C Ingestion Int unknown

A Ingestion Int suicide A Ingestion Int suicide


Parenteral Int abuse Unknown Unknown Ingestion Int suicide Ingestion Int abuse

Unknown Int abuse

NC

A

U A A A

Parenteral Int abuse


Ingestion Unknown Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide

670 pg/mL oxyphenbutazone 27 kg/ml

3.96 Fg/mL$ norpropoxyphene 14.57 kg/mL§

0.2 pg/mL§ 317 nglmL§

72 pg/mL§ 9.4 pgimL§

norpropoxyphene 35.0 pg/mL§ 0.3 kg/mL§

6 h A Ingestion Int suicide

hydroxyzine Propoxyphene

temazepam Propoxyphene

thiothixene propranolol

Salicylate Salicylate

codeine

A Ingestion Unknown

A Ingestion Int suicide

U Ingestion Unknown 01 mgldL A Ingestion Int suicide 119 mg/dL

diphenhydramlne See also cases 6, 7, 8, 23, 242, 250, 271, 283, 306, 458, 491, 492, 506, 625 (acetaminophen); 204, 212 (acetaminophenicodeine); 73, 493 (acetaminophenldiphenhydramine); 73, 194, 444, 523 (acetaminophenlhydrocodone); 196, 328, 468, 529 (acetaminophenlpropoxyphene); 8, 177, 380 (aspirin); 215 (aspirinlbutalbitallcaffeine); 259, 276, 309, 370, 464, 541 (codeine); 409 (colchicine); 58 (flunixin); 374 (hydrocodone); 191, 193, 216, 315 (ibuprofen); 455, 496 (indomethacin); 175 (ketoroolac); 203 (meperidine); 598 (meperidinelpromethazine); 599, 600 (methadone); 439, 546 (morphine); 386, 562, 601, 606 (opiates); 221 (pentazocine); 321, 528, 544, 603, 604 (propoxyphene); and 195, 309. 322, 522 (salicylares).

Anesthetics 277 65 yr Lidocaine A Parenteral Ther error

278 16 yr Nitrous oxide A Inhalation Int abuse 27Qp 20 yr Nitrous oxide A Inhalation Int abuse

26OP 31 yr Nitrous oxide A Inhalation Int abuse

Anticholinergic drugs 261 36 yr Amantadine U Ingestion Int suicide

clonazepam See s/SO cases 559 (amantadine); and 285, 316 (benztropine).

Anticoagulants See a/so case 606 (warfarin).





Anticonvulsants 202p 15 yr Carbamazepine NC Ingestion Int unknown 58 kg/mL 283 24 yr Carbamazepine A Ingestion Int suicide 50 FgimL

acetaminophen 45 rg/mL metoclopramide

284 39 yr Carbamazepine A Ingestion Int suicide 54 FgimL alprazolam

285P 57 yr Carbamazepine AJC Ingestion Int suicide benztropine clonazepam

286 20s yr Phenytoin AC Ingestion Int suicide 17 Fg/mL divalporex sodium cocaine

287 55 yr Valproic acid A Ingestion Int suicide See also cases 178, 388, 552 (carbamazepine); 286 (cfivalporex sodium); 178, 255, 315, 498, 523, 552 (phenytoin); and 374 (valprotc acid),

Antidepressants 288 289 290 291p 292p 293 294

295 296p 297 29% 299p 3oop 301 p 302 303 304p 305 306P

12 yr Amitriptyline 16 vr Amitriotvline A7 yr Amitriptyline 26 yr Amitriptyline 28 yr Amitriptyline GO yr Amitriptyline 30 yr Amitriptyline

32 yr Amitriptyline 39 yr Amitriptyline 41 vr AmitriDtVhne 45 yr Amitriptyline 45 yr Amitriptyline 48 yr Amitriptyline 49 vr AmitriDtvline 70 yr Amitriptyline

>19yr Amitriptyline 2-19 yr Amitriptyline >l9yr Amitriptyline

23 yr Amitriptyline

307 67 yr

308 :36 yr

309p 29 yr

3lOP 42 yr

311 19yr

312p

313

35 yr

37 yr

314

315

ethanol >19 yr Amitriptyline

316

317

318P

319p

ethanol 45 yr Amitriptyline

ibuprofen phenytoin

28 yr Amitriptyline loxapine benztropine

14yr Amitriptyline methamphetamine metoclopramide

61 yr Amitriptyline

55 yr perphenazine

Amitriptyline

acetaminophen Amitriptyline

amitriptylineiperphenazine lorazepam

Amitriptyline chlordiazepoxide alprazolam

Amitriptyline

codeine salicylate

Amitriptyline

diphenhydramine thioridazine

Amitriptyline

ethanol Amitriptyline

ethanol Amitriptyline

perphenazine albuterol

C A A A A A A

A AC A A A A A A A U A A

A

AJC

A

A

A

A

u

A

u

NC

A

A

u

Ingestion Ther error Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide

Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Unknown Ingestion Unknown Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide

Ingestion

Ingestion

Ingestion

Int suicide

Int suicide

Int suicide


Ingestion

Ingestion

Ingestion

Ingestion

Ingestion

lnt suicrde

lnt suicide

Int suicide

Int suicide

Int unknown

Ingestion

Ingestion

Ingestion

Ingestion

Int suicide

Int suicide 673 ng/mL

Int suicide

Int suicide

453 ng/mL nortriptyline 114 ng/mL

3,200 ng/mL nortriptyline 1,000 ng/mL

140 pg/mL 2,400 ng/mL

nortriptyline 200 ng/mL

8,800 ngimL§ nortriptyline 1,900 ng/mL§

5.1 pg/mL§ 8 mgidL§

t,lOO ng/mL§ nortriptyline 750 ng/mL§

.78 FgimL§

10,700 ng/mL§ nortriptyline 1,100 ng/mL§

140 mg/dL

202 mg/dL 4,709 ng/mL

nortriptyline 180 ng/mL 222 mg/dL

15.6 rg/mL

1,020 ng/mL nortriptyline 614 ng/mL





3200 45 yr

321 30 yr

322 30 yr

323’ 23 yr

324 23 yr 325 46 yr 326 48 yr 327 70 yr 32tV 37 yr

329 18 yr

330 72 yr

331 332p

17 mo 68 yr

333 41 yr

334 65 yr

335p 34 yr

336 47 yr

337p 3300 339 340

2: 343p 344 345p 346p

:: 349 35op 351 352 353 354

20 mo

2 yr 13yr 13yr 13yr 14 yr 15yr 15yr 15yr 16yr 18 yr 18 yr 26 yr 29 yr 30 yr 48 yr 60 yr 19yr

355 61 yr

356 32 yr

357 30 yr

350 35 yr

359 37 yr

360 57 yr

361 >19yr

362 49 yr

363p 17yr 364 18 yr 365!= 34 yr

Amitriptyline perphenazine lithium

Amitriptyline propoxyphene lithium

Amitriptyline salicylate phenobarbital

Amitriptyline terfenadine ethanol

Amitriptyline/perphenazine Amitriptyline/perphenazine Amitriptyline/perphenazine Amitriptyline/perphenazine Amitriptyline/perphenazine

acetaminophenipropoxyphene Amitriptylinelperphenazine

diphenhydramine Amitriptylineiperphenazine

fluoxetine Amoxapine Amoxapine

clomipramine Amoxapine

clonazepam Amoxapine

fluphenazine enalapril

Amoxapine thiothixene buspirone

Amoxapine trazodone chlorazepate

Desipramine Desipramine Desipramine Desipramine Desipramine Desipramine Desipramine Desipramine Desipramine Desipramine Desipramine Desipramine Desipramrne Desipramine Desipramine Desipramine Desipramine Desipramine

amitriptyline fluoxetine

Desipramine ethanol

Desipramine fluoxetine

Desipramine torazepam

Desipramine mint extract (90% ethanol)

Desipramine nifedipine

Desipramine nortriptyline

Desipramine propranolol haloperidol

Desipramine trazodone chlorpromazine

Doxepin Doxepin Doxepin

A

A/C

U

A

NC A A A A

A

A

A A

Ale

AC

AK

A!C

A A

;C A

I& A A A A A A A NC NC A A

A

A

A

A

A

A

U

NC

A A A





Ingestion Ingestion ingestion Ingestion Ingestion

Ingestion

Ingestion

Ingestion Ingestion

Ingestion

ingestion

Int suicide Int suicide Int suicide Int suicide Int suicide

Int suicide

Int suicide 1,239 ng/mL

Unint gen Int unknown

Int suicide 3,004 ng/mL

Int suicide



Ingestion Unint gen Ingestion Unint gen Ingestion Int suicide ingestion Int suicide ingestion Int suicide ingestion (nt suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int unknown Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide







ingestion Int suicide


Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide

3.3 mg/dL 1.2 kg/mL

8,000 ngimL§

1,192 ng/mL

3,180 ng/mL§ 1 ,I 47 ng/mL

672 ngim L 2,150 ng/mL

36 hr

2,968 ng/mL 1,970 ng/mL

2,340 ng/mL 71 ng/mL

2,098 ng/mL


LITOVITZ ET AL n 1993 AAPCC ANNUAL REPORT



563

367P 366P

36gp 37op

36 yr Doxepin 41 yr Doxepin 53 yr Doxepin

>19yr 15yr

371

37Zp

373p

47 yr

28 yr

37 yr

37‘P 50 yr

375p 22 yr 376p 27 yr

377 28 yr 37ap 41 yr 379 50 yr 380 41 yr

381 40 yr

382 19 yr

383 32 yr

384 47 yr

3a5p 38 yr

366 32 yr

387 30 yr

368 60 yr

369 32 yr

390 37 yr 391 37 yr 392 41 yr 393p 65 yr 394 63 yr

395p 44 yr

396 44 yr

397

398

399

4oop

401

21 yr

ia yr

16yr

31 yr

29 yr

43 yr

Doxepin Doxepin

codeine alprazolam

Doxepin hatoperidol

Doxepin trifluoperazine

Fluoxetine nortriptyline doxylamine

Fluoxetine valproic acid hydrocodone

lmipramine lmipramine

lmipramine lmipramine lmipramine lmipramine

aspirin trifluoperazine

lmipramine carisoprodol

lmipramine clonazepam

lmipramine cocaine

lmipramine cocaine

lmipramine ethanol

lmipramine opiate

Lithium amitriptyline nortriptyline

Lithium imipramine carbamazepine

Loxapine clomipramine

Nortriptyline Nortriptyline Nortriptyline Nortriptyline Nortriptyline

chloropromazine Nortriptyline

cocaine ethanol

Nortriptyline diltiazem (long acting) lorazepam

Nortriptyline fluphenazine bupropion

Nortriptyline omeprazole cimetidine

Nortriptyline perphenazine

Nortriptyline temazepam ranitidine

Nortriptyline trazodone clonazepam

Sertraline thioridazine triazolam

A A A

U A

AC

U

U

U

A A

A A A A

A

AX

A

A

A

A

A

AX

A

AK U U A A

A

AK

A

A

A

A

AC

A

Ingestion Ingestion Ingestion

Ingestion Ingestion

Int suicide Int suicide Int suicide


ingestion Int suicide




Ingestion Ingestion



Int suicide Int suicide Int suicide Int suicide









Ingestion

Ingestion Unknown Unknown Ingestion Ingestion

Ingestion

Int suicide

Int suicide Unknown Int suicide Int suicide Int suicide

Int unknown

Ingestion

Ingestion

Ingestion

Ingestion

Ingestion

Ingestion

Ingestion

Int suicide

Int suicide 962 ng/mL

Unknown

Int suicide

Int suicide

Int suicide

Int suicide

>l,OOO ng/mL

1,300 ng/mL§ nordoxepin 200 ng/mLg

3,010 ng/mL§ 3.0 PglmLg 110 ng/mL§

4,000 ng/mL 4,200 ng/mL

9.0 FgimL

6,300 ng/mL desipramine 460 ng/mL

1,000 ng/mL 55 mg/dL

3,695 ng/mL

6.5 mEq/L 630 ng/mL 450 ng/mL 4.66 mEqlL 100 ng/mL

13.3 rglmL§

5,000 ng/mL 954 ng/mL

1,046 ng/mL§ 55 kg/mL§

(Continued on follotving page)




403p 44 yr Tranylcypromine AC Ingestion Int suicide .44 mg/L§ 404p 14yr Trazodone A Ingestion Int suicide 4050 26 yr Tricyclic antidepressant A Ingestion Int suicide 406 50 yr Tricyclic antidepressant U Ingestion Int unknown >600 ng/mL 407p 47 yr Tricyclic antidepressant A Ingestion Int suicide

amphetamine 406 39 yr Tricyclic antidepressant U Ingestion Int suicide 1,642 ng/mL

ethanol 132 mg/dL See Sk0 cases 214, 221, 257, 354, 387, 455, 477, 503, 589 (amitriptyline); 307 (amitriptylinelperphenazine); 397, 449 (bupropion); 332, 389 (C!omipraminef; 257, 494 (doxepin); 776, 330, 354, 356, 469 (f/uoxetineJ; 388 (imipramine); 320, 321, 464 (lithium); 376 (foxapine); 360, 373, 387, 525, 541 fnortriptyfine); 547, 593 (phenelzine); 556 (tranyfcypfomine); 336, 362, 407, 525, 538 (trazodone); 522, 555 (sertraline); 528, 607, 619 (unspecified cyclic antidepressants).

Antihistamines 409 21 yr Astemizole A Ingestion Int suicide

colchicine cocaine

4100 40 yr Diphenhydramine (OTC) sleep aid A Ingestion Int suicide 4110 44 yr Diphenhydramine (OTC) A Ingestion Int suicide 4.99 PglmL 412P 46 yr Diphenhydramine A Ingestion Int suicide 413 30 yr Diphenhydramine A Ingestion Int suicide

benzodiazepines See also cases 398, 535 (cimetidine); 400, 496 (ranitidine); 51, 244, 276, 310, 329, 500, 550, 553 (diohenhydramine); 373 (doxylamine); 272, 458, 494 (hydroxyzine); and 323 (terfenadinej.

Antimicrobials 414p 28 yr lsoniazid AC Ingestion Int suicide 415p 35 yr lsoniazid A Ingestion Int suicide See a/so cases 555 (azidothymidine); 477 (cephalexin); 438 (ciproffoxin); and 447 (trimethoprimisuffamethoxazole).

14 rg/mL 56 FgimL >20 h

Antineoplastics 416 56 yr Paclitaxel

Asthma theraoies 417 416P 419p 420 421 422 423P 424 425 426 427 428 429 430 431 432 433 434p 435 436 437 438

439

440

441

15yr 18yr 20 yr 21 yr 52 yr 58 yr 60 yr 60 yr 64 yr 67 yr

70s yr 71 yr 74 yr 75 yr 79 yr 80 yr 82 yr 83 yr 84 yr 90 yr 91 yr 73 yr

37 yr

43 yr

48 yr

Theophylline (long-acting) Theophylline (long-acting) Theophylline Theophvlline Theophylline (long-acting) Theophylline Theophylline Theophylline Theophylline Theophylline Theophylline Theophylline (long-acting) Theophylline Theophylline Theophylline Theophylline Theophylline Theophylline (long-acting) Theophylline Theophylline (long-acting) Theophylline Theophylline

ciprofloxin Theophylline

clonazepam morphine

Theophylline quinine thyroxine

Theophylline timethoprimisulfamethoxazole

See afso cases 379 (afbuterol); and 58, 457 (theophyhine)

Cardiovascular drugs 442’ 26 yr Atenolol 443 57 yr Atenolol

temazepam ethanol

444p 50 yr Clonidine nifedipine acetaminophenlhydrocodone

445 74 yr Drgoxin 446 90 yr Digoxin 447 92 yr Digoxin 448 66 yr Digoxin

alprazolam

A

AC A U A C AC C A/C AC AC C C

: C C

: C

: C

AIC

AC

A

A AC

A/c

A/c C A A

Parenteral Adv rxn

Ingestion Int suicide Ingestion Int suicide Ingestion Unknown Ingestion Int unknown Ingestion Int unknown Parenteral Ther error Ingestion Ther error Ingestion Unint unknown Ingestion Ther error Ingestion Unint unknown Ingestion Unknown Ingestion Ther error Ingestion Ther error Ingestion Ther error Ingestion Unint unknown Ingestion Ther error Ingestion Unknown Ingestion Unknown Ingestion Unknown Ingestion Adv rxn Ingestion Unknown Ingestion Ther error



118 PglmL 105 kg/mL

70 WgimL 98 kgim L 39 FglmL 52 PgimL 60 pg/dL 77 kg/mL 40 bg/mL 55 Fg/mL 33 PglmL 30 FgimL 47 kg/mL 36 pg/mL 35 kg/m L 66 PgimL 58 FglmL 33 FgimL 55 bg/mL 49 pg/mL 52 kg/mL

50 pg/mL 99 ngimL§ .56 kg/mL!$ 123 FgimL


Ingestion Int suicide Ingestion Int suicide


Ingestion Int suicide 11.8 ng/mL Ingestion Adv rxn 6.1 ng/mL Ingestion Int suicide 9.8 nglmL tngestion Int suicide >4.0 nglmL

Id

lh


LITOVITZ ET AL W 1993 AAPCC ANNUAL REPORT


Case Age Substances Chronicity Route Reason

565

Blood Levels

449 04 yr

450 80 yr

451 67 yr

452 21 yr 453 39 yr 454 41 yr 455 73 yr

456

457

36 yr

76 yr

450 34 yr

459 37 yr

460p 24 yr

461 36 yr 462 90s yr 463p 9mo 464 4’1 yr

465 466

42 yr 51 yr

467 468

3 yr 40 yr

469 82 yr

47op

471

472

473

55 yr

14yr

80 yr

53 yr

474’ 37 yr 475p 60 yr 476!= >19yr 477 40 yr

478P 25 yr

479 36 yr

480 481P 482

483 484 485P 486 4.07 4W 489 490 491

492p

72 yr 75 yr 39 yr

33 yr 35 yr 35 yr 49 yr 49 yr 60 yr 62 yr 75 yr 20 yr

37 yr

Digoxin bupropion

Digoxin furosemide

Digoxin theophylline

Diltiazem Diltiazem Diltiazem (sustained release) Diltiazem

amitriptyline indomethacin

Diltiazem cocaine (crack)

Diltiazem digoxin nifedipine

Diltiazem hydroxyzine acetaminophen

Diltiazem metoprolol ethanol

Diltiazem (sustained release) unknown diuretic

Disopyramide Disopyramide Flecainide Flecainide

lithium codeine

Metoprolol Metoprolol

verapamil Nifedipine (sustained release) Nifedipine

acetaminophenipropoxyphene Nifedipine

atenolol fluoxetine

Nifedipine (sustained release) nitroglycerin

Pindolol cephalexin

Procainamide

Procainamide

digoxin Propranolol Propranolol Propranolol Propranolol

amitriptyline Propranolol

ethanol Propranolol

verapamil lisinopril

Quinidine Quinidine Quinidine

verapamil Verapamil (sustained release) Verapamil Verapamil Verapamil (sustained release) Verapamil (sustained release) Verapamil Verapamil (sustained release) Verapamil (sustained release) Verapamil

acetaminophen Verapamil (sustained release)

acetaminophen

A

A/c

C

A A

;C

A

AK

AK

A

A

A

LC A

A A

A AK

Ale

AK

A

C

C

A A A U

A

A

A C A

AK A

;C A AC AX A A

AK

Ingestion

Ingestion

IngiParen


Int suicide 11.4 ng/mL

Int suicide

Adv rxn

Int suicide Int suicide Int suicide Int suicide

Ing/lnhal

Ingestion

Int suicide 6.7 wg/mL§

Int suicide



Ingestion


Int suicide

Unknown Ther error Unint gen Int suicide

Ingestion Ingestion

Ingestion Ingestion

Ingestion


Ther error Int suicide

Int suicide



Parenteral Ther error

Parenteral Ther error

Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide



Parenteral Ther error Ingestion Unknown Ingestion Int suicide

Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide Ingestion Ther error Ingestion Int suicide Ingestion Unknown Ingestion Int suicide Ingestion Int suicide Ingestion Int suicide


5 ng/mL 34 PgimL

6.4 PglmL

12 *g/mL

30 kg/mL

21.3 rg/mL§

4.0 mEq/L 12-16 h

~~10 mg/dL

1.5 kg/mLli 1 d

1,300 ng/mL§

21.6 kg/mL N-acetylprocainamide 17.1 PgimL

19.0 pg/mL N-acetylprocainamide 59.6 PgimL

3.3 ng/mL

258 mg/dL

16.3 pg/mL!j 1.3 pglmL§


566 AMERICAN JOURNAL OF EMERGENCY MEDICINE n Volume 12, Number 5 m September 1994



493 40 yr Verapamil U Ingestion Int suicide buspirone acetaminophenidiphenhydramine

494 30 yr Verapamil A Ingestion Int suicide doxepin hydroxyzine

495 76 yr Verapamil (sustained release) AC Ingestion Unknown ethanol

496 33 yr Verapamil A Ingestion Int suicide indomethacin ranitidine

497p 20 yr Verapamil (sustained release) A Ingestion Int suicide nadolol

498 64 yr Verapamil AC Ingestion Int suicide phenytoin 17 WgimL

See a/so cases 469, 535 (atenolol); 243 (captopril); 279, 457, 473 (digoxin); 396 (diltiazem); 334 (enalapril); 479 (lisinopril); 275 (methyldopa); 459 (metoproiol); 497 @ado/of); 72, 359, 444, 457 fnifedipine); 470 (nitroglycerin); 72, 274, 361 (propranoloi); and 466, 479, 482 (verapamil).

Cough and cold preparations 499 39 yr Acetaminophenlethanol/doxylamine/ C

pseudoephedrineidextromethorphan 5oop 53 yr Acetaminophen/ethanol/doxylamine/ A

pseudoephedrineidextromethorphan

diphenhydramine thioridazine

501p 12 mo Benzonatate A 502” 8 yr Cough/cold medications containing: A

dextromethorphan, phenylpropanolamine, pseudoephedrine, doxylamine, acetaminophen

503’,p 43 yr Hydrocodoneichlorpheniraminei A phenylephrinelacetaminophenicaffeine amitriptyline ethanol

See also case 775 (acetaminophen/sa/icylamide/phenylto/oxamine)

Diagnostic agents 504 49 yr Contrast media (diatrizoate sodium, A

diatrizoate meglumine)

Ingestion

Ingestion

Ingestion Ingestion

Ingestion

Aspirilng

Int abuse

Int suicide

Unint gen Unknown

doxylamine 1.7 wg/mL§ dextromethorphan 6.4 bg/mL§

484” pglmL§ 0.7 kgimL§ 2.5 pglmL§

Int suicide

Adv rxn

1,080 I.rg/dL 1,924 &g/dL 9h

67 pg/mL 9 h 30,500 pgidl 6h

476 PgldL 4h

Electrolytes and minerals 505 20 mo Ferrous sulfate A Ingestion Unint gen

506 15 yr Ferrous sulfate A Ingestion Int suicide acetaminophen

507 11 mo Iron (prenatal supplement) A Ingestion Unint gen

508 14yr Iron A Ingestion Int suicide

509 88 yr Sodium chloride solution A Parenteral Ther error

Gastrointestinal preparations 510 30 yr diphenoxylate/atropine A Ingestion Int suicide

511 23 yr polyethylene glycol electrolyte lavage A Aspir/lng Adv rxn solution

512 79 yr polyethylene glycol electrolyte lavage A Aspirilng Adv rxn solution

513 5mo sucralfate A Parenteral Ther error See also cases 202 (diphenoxylatelatropine); 283. 377 (metoclopramide); and 398 (omeprazole).

Hormones and Hormone Antagonists 514 37 yr Insulin A Parenteral Int suicide 515p 33 yr Insulin A InglParen Int suicide 82 PUlmL

ethanol 516 27 yr Prednisone C Ingestion Int misuse

corticosteroids See also cases 576 (corticosteroid); 243 (estrogen, conjugated); 252 (glyburide); 557 (insulin); 794 (prednisone); and 440 (thyroxine).

Miscellaneous drugs 517 21 mo Arginine A Parenteral Unknown See a/so cases 533 (hydroxyurea); and 256, 440 (quinine).

Muscle relaxants 518p 31 yr Baclofen A Ingestion Int suicide 519 48yr Carisoprodol U Ingestion Int unknown 520p 28 yr Carisoprodol A Ingestion Int suicide

ethanol

Diuretics See a/so cases 255 (bumetanide); 450 (furosemide); 253 (spironolactone); and 460 (unknown diuretic).





521p 43 yr Carisoprodol A Ingestion Int suicide 44 pg/mL meprobamate 47 PgimL

ethanol 522 47 yr Carisoprodol A ingestion Int misuse

salicylate 19 mg/dL

sertraline 523 22 yr Cyclobenzaprine A Ingestion Int suicide

acetaminophenihydrocodone <IO Fg/rnLlr

phenytoin 12 WglmL

See also cases 537 (baclofen); 206, 217, 220. 381, 553 (carisoprodol); and 2.50, 531 (cyclobenzaprine).

Sedatives/hypnotics/antipsychotics 524

525

>lQ yr

72 yr

526 90 yr 527p 35 yr

528!= 5ayr

529 46 yr

530 a9 yr

531

532p 533

5340 535

42

5 yr ai yr

31 yr 43 yr

536p

537

538P

539 54op 541p

37 yr

31 yr

19 mo

68 yr 46 yr fi2 yr

542 543 5440

545p 546

33 yr 73 yr

40s yr

26 yr 31 yr

547p 44 yr

548p 51 yr

549’= 49 yr

55op 40 yr

551

552p

61 yr

39 yr

553

554

38 yr

57 yr

Alprazolam ethanol

Alprazolam trazodone nortnptyline

Barbiturates Barbiturates

ethanol Benzodiazepines

propoxyphene tricyclic antidepressant

ButalbitaVaspirin

acetaminophen/propoxyphene Butalbital

lorazepam haloperidol

Chlordiazepoxide cyclobenzaprine

Chloral hydrate Chloral hydrate

hydroxyurea Chlorpromazine Chlorpromazine

atenolol cimetidine

Chlorpromazine buspirone

Clonazepam baclofen

Clonazepam trazodone

Droperidol Ethchlorvinyl Ethchlorvynol

nortriptyline codeine

Haloperidol Haloperidol Lorazepam

propoxyphene Meprobamate Meprobamate

diazepam morphine

Meprobamate phenelzine

Meprobamate phenobarbital

Pentobarbital ethanol cocaine

Perphenazine temazepam diphenhydramine

Phenobarbital insulin

Phenobarbital phenytoin carbamazepine

Prochlorperazine diphenhydramine carisoprodol

Thioridazine

NC

A

U A

AK

A

A

A

A A

A A

U

NC

A

C A A

C AIC A

U U

U

A

A

A

AX

A

A

A



Unknown Unknown Ingestion Int unknown


Ingestion Int surcide



Ingestion Ther error Ingestion Int suicide

Ingestion Int suicide ingestion Int surcide

Ingestion lnt suicide


Ingestion Unint gen

Ingestion Adv rxn Ingestion Int suicide Ingestion Int suicide

Ingestion Adv rxn Ingestion Adv rxn Ingestion Int surcide

Ingestion Unknown Ingestion Int unknown

Unknown Int suicide


Ingestion Int abuse

Ingestion

Ing/Paren

Ingestion

Ingestion

Ingestion

Int suicide

Int suicide

Int surcide

Int suicide

Adv rxn

230 mg/dL§ 117 ng/mL

4,195 ng/mL t 98 ng/mL

1,000 ng/mL

70 ng/mL aspirin 29 mg/dL

butalbital 20 PgimL

330 ng/mLQ

2 pglmL§

28.7 FglmL 19 pg/mL

ia4 mg/dL

148 fig/mL

a0 wg/mL 33 pg/mL 12 bg/mL

3d




Case &a Substances Chronicity Route Reason Blood Levels

555’+ >19 yr Thioridazine U Ingestion Unknown 11 pg/mL

sertraline 0.9 kg/mL

azidothymidine 556 >I9 yr Thioridazine AK Ingestion Int suicide

tranylcypromine 557 96 yr Temazepam A Ingestion Int suicide

558 a5 yr Temazepam A Ingestion Int suicide

barbiturate 559 33 yr Trifluoperazine NC Ingestion Int suicide

amantadine See a/SO cases 176, 213, 284, 308, 370, 448, 588 (alprazolam); 558, 615 (barbiturate); 264, 265, 413, 591, 597, 600 (benzodiazepines); 216, 335, 493, 536 (buspirone); 259 (butabarbital); 281, 285, 333, 382, 401, 439 (clonazepam); 336 (clorazepate); 308, 616, 624 (chlordiazepoxide); 70, 362, 394 (chlorpromazine); 107, 213, 214, 218, 271, 546, 598, 604 (diazepam); 334, 397 (fluphenazine); 593 (flurazepam); 361, 371, 530 (ha/operido/); 137, 212, 307, 357, 396, 530 (lorazepam); 318, 319, 320, 399 (perphenazine); 260, 322, 548 (phenobarbital); 244 (phenothiazine); 605 (secobarbital); 273, 400, 443. 550, 618 (temazepam); 370, 402, 500 (thioridazine); 274, 335 (thiothixene); 402 (triazolam); and 372, 380 (trifluoperazine).

Stimulants and street drugs 560 layr 561p 50 yr 562P 22 yr

563p

564 565P 566P 567p 568 56gp 570 571p 572 573 574 575p 576 577 578 579p 580 581 582 583p 584 585 586p 5a7p 588

589

28 yr

Id 21 yr 21 yr 23 yr 24 yr 24 yr 25 yr 27 yr 27 yr 28 yr 30 yr 30 yr 30 yr 30 yr 32 yr 34 yr 35 yr 36 yr 36 yr 36 yr 43 yr 45 yr 45 yr 55 yr 39 yr

37 yr

590 33 yr

591 p 29 yr

592 27 yr

593 36 yr

594p

595

596’

597n

59an

30 yr

33 yr

32 yr

38 yr

35 yr

Amphetamine Amphetamine Amphetamine

cocaine opioids

Caffeine ethanol

Cocaine Cocaine Cocaine Cocaine Cocaine Cocaine Cocaine Cocaine Cocaine Cocaine (crack) Cocaine (crack) Cocaine Cocaine (crack) Cocaine Cocaine Cocaine Cocaine Cocaine (crack) Cocaine Cocaine (crack) Cocaine Cocaine (packets) Cocaine Cocaine Cocaine

alprazolam Cocaine

amitriptyline ethanol

Cocaine amphetamine

Cocaine benzodiazepine (unspecified)

Cocaine ethanol

Cocaine

flurazepam phenelzine

Cocaine heroin

Cocaine heroin

Cocaine heroin ethanol

Cocaine marijuana benzodiazepines

Cocaine meperidine/promethazine diazeDam

A A A

A

C A U

;C A A NC A A U U A A A NC A NC U A NC U C A A

NC

AK

A

A/c

A

NC

U

NC

A

A

Unknown Int abuse Ingestion Int suicide Ingestion Int abuse


Parenteral Int abuse Inhalation Int abuse Unknown Int abuse Inhalation Int abuse Parenteral Int abuse Parenteral Int abuse Unknown Int abuse Unknown Int abuse Inhalation Int unknown Inhalation Int abuse Inhalation Int abuse Unknown Unknown Ingestion Int abuse Parenteral Int abuse IngiParen Int unknown Unknown Int abuse Unknown Int abuse Inhalation Int abuse Unknown Int abuse Inhalation Int abuse Parenteral Int abuse Ingestion Int misuse Unknown Int abuse Ingestion Int misuse Ingestion Int unknown

Unknown Int abuse

Ingestion Int abuse


Ing/unknown Int unknown

Ingestion Int abuse

Inhalation Int abuse


Ing/Paren Int suicide

Ing/Paren Int abuse


>l,OOO ng/mL

2.1 WgimL

5 kg/ml

50 pg/mL

126 mg/dL

3,000 ng/mL

195 mg/dL .lO bg/mL§

benzoylecgonine 7.88 kg/mL§ ecgonine methyl ester 2.51 kg/mLFj

desalkyl flurazepam 120 ng/mL§

130 mg/dL

3-6 h

3-6 h

(Continued on follawing page)




600p

35 yr

48 yr

601 34 yr

602 39 yr

603P 34 yr

604P 26 yr

605 27 yr

606 25 yr

607p 30 yr 607p 30 yr 609 34 yr 61OP 36 yr 6119 37 yr 612 53 yr 613 >19yr 614 25 yr

615” >19 yr

616P 47 yr

6170

618P

42 yr

30 yr

619P

620p

621

622 623 624P

43 yr

30 yr

17 yr

53 yr 49 yr 37 yr

Cocaine methadone

Cocaine methadone benzodiazepines

Cocaine opiates tricyclic antidepressant

Cocaine phencyclidine

Cocaine propoxyphene

Cocaine propoxyphene diazepam

Cocaine Secobarbital

Cocaine warfarin opiates

Heroin Heroin Heroin Heroin Heroin Heroin Heroin Heroin

cocaine Heroin

cocaine barbiturates

Heroin cocaine chlordiazepoxide

Heroin ethanol

Heroin phencyclidine temazepam

Heroin unknown cyclic antidepressant

Methamphetamine cocaine

Methamphetamine heroin

Methylenedioxyamphetamine Pemoline Phencyclidine

amphetamine chlordiazepoxide

A

A/C

U

U

A

AK

A

A

A A

FJC A C A A

A

AIC

A

AK

A

A

U

A AK A

Unknown

Parenteral

Int abuse

Int abuse

InglParen Int unknown

Unknown

Unknown

lngilnhal

Int abuse

Int abuse

lngilnhal

lnhal/Paren

Int suicide

Int suicide

Int abuse

Parenteral Int abuse Unknown Int abuse Parenteral Int abuse Parenteral Int abuse Parenteral Int unknown Parenteral Int abuse Aspiration Int abuse Inhalation Int abuse

Ing/Paren Int abuse

Ing/Paren Int abuse


Ingestion Int abuse

Ing/Paren

Parenteral

Int abuse

Int abuse

Unknown Int abuse

Ingestion Ingestion Ingestion

Int suicide Int suicide Int suicide

benzoylecgonine 0.3 pg/mL§ phencyclidine 0.3 Fg/mL§

1.6 FgimL .46 FgimL

desmethyldiazepam .19 WglmL

morphine .35 &g/mL§ 110 mg/dL§

See also cases 407, 590, 624 (amphetamine); 11, 72, 707, 179, 265, 266, 286, 383, 384, 395, 409, 456, 549, 562, 614, 615, 616, 620 (cocaine); 251, 253,

594, 595, 596, 621 (heroin); 597 (marijuana); 377 (methamphetamine); and 602, 618 (phencyclidinej.

Vttamins 625 62 yr Nicotinic acid (slow release) C Ingestion Adv rxn

acetaminophen 40 kg/mL 36 h

626 23 mo Prenatal vitamins with iron A IngestIon Unint gen 251 wg/dL

ABBREVIATIONS: A, acute exposure; C, chronic exposure, iVC, acute on chronic; U, unknown. ’ Reported t0 poison center indirectly (by coroner, medical examiner, or from other source) after the fatality occurred. p Prehospital (cardiac and/or respiratory) arrest. 5 Level obtained postmortem. ‘I Acetaminophen level. (I Salicylate level. * Level includes metabolite and parent compound.


TABLE 22A. Demographic Profile of Exposure Cases by Generic Category of Substances and Products: Nonpharmaceuticals

Treated

Age (yr) Reason in Outcome Health

Substance Implicated No. of Aclv Care in the Exposure Exposures ~6 6-19 >19 Unint Int Other Rxn Facility NOW Minor Moderate Mayor Death

Adhesives/glues Cyanoacrylates

Epoxy Toluenelxylene Nontoxic Unknown

Category total Alcohols

10,647 695

2,070 1,482 7,141

22,035

21,347 5,856

145 7,774

813

36

262

229

9,011

248 68

805 46,594

846 1,721 1,389 1.952

260

245 2,919

12,456

1,781 2,465 4,828

381 31,203

3,572 1,446

73 3,136 1,203

83 1,581

274 ii ,368

1,643

96 44 39

4 58 94 18

1,719 3,580

101 58

7,452

65 1,164

3,819 1,921 3,276 10,458 149 297 50 264 677 8

18

:

$ 66

19 2,343 1,395 241 183 276 599

88 208 1,081 1,744 4,029 4,109

2,499 175 457 123

1,224 4.478

15,584 2,491 6,880 3,022 1,081 1,538

67 28 40

6,855 131 21,397

1,988 73

405

1,419 44 4

13 110 153

523 7 0 62 6 0 35 4 0

4 1 0 169 8 0 793 28 0

3,425 17,286 151 2,548 3,188 22

131 12 0 6,961 742 25

700 98 4

312 55

4 1,780 2,815 1,404 4 456 255 190

2,874 543 52 545 97 0

8 2 0 216 37 1

51 18 8

30 4

245 15

206 22

8,200 752

1 1 0

0 4 0 1

5 1 0

30

211 28 56 6

313 469 23,026 22 ,622

6

3 244

0 11 15 8

0 43 113 40

0 66 93 48

4 1,677 3,455 1,505

1 65 63 34 4 24 20 16

10 523 143 156 395 23,318 10,572 11.859

148 24 0

6 0 0 2 0 0

97 21 0 3,957 742 62

830 14 1 1,693 21 4 1,375 12 1 1,935 15 2

253 4 2

1 59 226 80 2 40 296 59 1 55 218 70 0 43 262 40 1 55 73 22

6 1 0 2 0 0 6 0 0 0 1 0 7 0 0

244 0 0 1 40 56 49 5 0 0 2,836 36 40 2 222 278 325 12 0 0

12,190 222 19 21 391 2,497 412 29 2 0

1,119 407 171 1,590 I ,989 262 149 2,419

4,715 350

30,430

150 12 3 219 578 256 14 1 1 34 1 10 76 476 114 10 1 0 75 19 14 243 760 244 48 0 0 10 1 0 29 55 26 1 0 0

593 102 56 1,472 5,775 1,697 140 6 1

3,328 1,398

3,oz 1,125

78 1,525

258 IO.816

214 17 39 6

5 0 72 16 69 4

4 1 48 1 15 2

466 47

1 1,336

:, 487

23 3 848 1 564 0 16 5 594 1 117

12 3,985

0 560

836 351

16 747 417

24 271

42 2,704

923 508

27 1,245

329 9

636 108

3,785

209 68

5 154 46 1

113 20

616

66 2 9 0

0 : 0

12 5 0 0 8 0 1 0

104 7

1,620 18 3 161 731 182

95 43 38

3 56 92 16

1,884 3,421

98 56

7,222

1 0 1 0 1 0 0 0 1 0 2 0 0 0

25 2 139

2 : 2 0

192 11

66 26

0 31 0 1 0 41 0 71 0 13 0 1,215 2 560 1 20 0 16 3 2,620

73 12 26

2 36 76

9 942 913

26 a

2,284

0 2

74 976

26 20

1,848

0 1 0 0 2 1 1

19 138

: 332

65 0 0 0 27 3 20 1 1.102 8 0 56 409 13 449 124

3 1

0 : 0 0 0 0 0 0 0 1 0 0 0 5 0 3 0 1 0 0 0

17 1

0 0 0 0

3,475

1,455

986

315

1,741

210

9,886

1,040

3,559

277

5,587

1,394

96

2.827 14,403 1,559 687 2,864

49 19 55 5,275 631 1,431

234 115 334

Ethanol (beverage) Ethanol (other) Higher aicohois lsopropanol Methanol Rubbing alcohol

Ethanol. with methvl salicyiate .

Ethanol, without 25 2 7

208 20 27

165 15 44

6,806 676 1,210

163 32 36 35 8 18

146 108 465 16,059 5,140 20,894

methyl salicylate Isopropanol, with

methyl salicylate Isopropanol, without

methyl salicylate Unknown rubbing

alcohol Other alcohol Unknown alcohol

*Category total Arts/crafts/office supplies

Artist paints, non-watercolor

Chalk Clay Cravon G&es Office supplies:

625 93 1,567 44 1,218 81 67 1,758 104 66

100 43 99

104 20 79 1,505 1.048 233 9,867 2,104 442

miscellaneous Pencil Pens/ink Typewriter correction

fluid Water color Other Unknown

‘Category total AutolaircraWboat products

Ethylene glycol Glycols: other Glycol and methanol Hydrocarbons Methanol Nontoxic Other Unknown

‘Category total Batteries

Automotive batteries Disc batteries

Alkaline (MnO,) Lithium Mercuric oxide Nickel cadmium Silver oxide Zinc-air Other Unknown

Dry cell batteries Other batteries Unknown batteries

‘Category total Bites and envenomations

Coelenterate Fish

3,751 451 396 269 53 25

23,672 4,762 i ,854

894 473 1,753 493 142 587

18 12 34 1,319 411 992

409 162 449 65 6 7

541 187 597 76 35 125

3,815 I ,428 4,544

iaa 229 822

77 11 4 17 3 12 19 1 18 0 0 0

45 8 4 48 9 30 10 6 0

1,317 276 98 2,084 804 471

54 23 12 24 12 13

3,863 I ,380 1,484

17 14 23 35 217 724



TABLE 22A. Demographic Profile of Exposure Cases by Generic Category of Substances and Products: Nonpharmaceuticals (Cont’d)

Treated Age W Reason in Outcome

Health

Substance Implicated No. of Adv Care in the Exposure ExpoSUreS ~6 6-19 >19 Unint Int Other RXIl Facility NOfIt? Minor Moderate Major Death

Other/unknown marine animal

Insects Ant/fire ant Bee/wasp/hornet Caterpillar Centipede/millipede

Scor&on Tick Other insect

Mammals Bat Cat

Dog Fox Human Raccoon Rodents/lagomorphs Skunk Other mammal

Reotile: other/unknown Snekes

Copperhead Coral Cottonmouth Crotalid: unknown Rattlesnake Exotic snakes

Poisonous Nonpoisonous Unknown if

poisonous NonpoIsonous snake Unknown snake

Spiders Black widow Brown recluse Other spider Tarantu.la

Unknown insect or spider

Other/unknown animal bite

‘Category total Building and construction

products Caulking compounds

and puttIes Cement, concrete Insulation

Asbestos Fiberglass Urea/formaldehyde Other Unknown

Soldering flux Other construction

product Unknown construction

product ‘Category total Chemjcals

Acetone Acids

Hydrochloric Hydrofluoric Other Unknown

Alkali Ammonia Borateu’boric acid

175 49 35 64 171 2 0 2 42 21 42 20 0

2,484 1,025 361 724 2,379 4 16,186 3,844 3,762 6,211 15,976 17

1,701 495 453 642 1,545 6 a5 25 la 28 al 1

226 86 46 62 220 0 7,546 642 i ,498 3,669 7,252 5 2,473 752 546 024 2,438 4 7,857 i ,887 1,414 3,445 7,429 16

2 1 0 0 0 0

6:

99 309 42 1,024 127 5 ia9 i ,881 255 7,268 719 25 149 138 50 553 53 0

3 9 7 25 1 0 6 43 4 06 15 0

288 599 105 4,088 320 10 27 549 200 468 36 1

340 1,575 327 2,516 433 6

a2 14 12 38 a2 0 0 0 47 555 ii8 110 214 537 11 0 7 265

1,360 280 502 451 1.260 a9 2 7 861 6 2 1 3 6 0 0 0 3

99 39 25 27 a7 4 6 1 34 62 3 10 38 58 0 0 4 41

1,623 437 646 327 1,592 9 a 13 369 155 19 39 48 154 0 0 1 22 559 126 164 185 545 0 0 14 232 919 403 308 132 080 11 3 15 154

13 16 50

1

G 96 17 43 77

16 133 201

0 22 17

388 32

126 267

3 13 29

: 0

ia 2 a

24

377 43 48 11

604

25

: 0

40

a5 14

9 3

100

231

:: 7

368

374 40 45 11

565

0 3 326 11 162 129 5 0 3 40 7 12 a 1 0 3 40 4 22 6 1 0 0 a 1 4 2 1 3 28 510 30 154 217 47

67 7 13 38 66 0 0 0 56 2 19 17 13 331 23 115 140 321 3 0 6 127 9 122 la 0

2 1 0 1 2 0 0 0 1 0 0 0 0 1,647 236 811 447 1,616 3 0 27 337 102 650 19 2 1,604 148 560 715 1,544 a 0 52 940 148 695 175 16

i ,818 179 266 1,036 1.786 0 1,776 179 243 1,010 1,710 0 1,341 197 258 702 1,303 1

72 10 27 18 70 0

30 608 137 743 254 7 66 906 43 474 333 24 35 297 26 521 98 2

2 13 2 42 2 0

16,951 2,900 2,956 6,487 16,808 4 4 128 4,097 235 6,550 1,007 18

563 60 234 222 470 3 1 a9 102 11 154 47 2 72.637 14,306 15,075 29,357 70,598 214 96 1,693 16,097 2,118 28,065 4,202 190

2,821 2,169 149 340 2.790 la 5 1,111 259 a3 497 1,096 10 1

a 1

2 12 2 0 0 1

9

0 35

2

2 2

13 1

20 11 IO

237 767 270 20 2 547 129 280 223 9

143 24 la 74 136 I 2 1,249 528 201 345 1,221 10 3

118 52 11 41 116 0 0 373 155 28 143 364 6 2 105 48 12 33 105 0 0 429 210 42 118 426 1 1

39 17 11 5 216 176 342 29

25 22 26 a 30 76 42 10 ia 16 23 4

151 99 125 27

1,479 a17 163 346 1.449 16 4 319 267 312 43 1

109 34 13 41 109 0 0 7,937 4,296 720 1,970 7,812 62 18

44 17 33 11 0 1,626 1,506 1,472 388 16

1,062 359 127 415 1,004

2,396 176 381 1,326 2,311 1,118 90 65 677 1,103 3,945 589 490 1,976 3,028

426 57 67 210 399 4.824 1,667 669 1,671 4,628 5,080 i .57a 611 2,126 4,834 3,317 2,075 270 758 3,102

44

57 12 79 18 86

194 174

7 377 iaa 360 52 7

13 1

11 5

75 29 ia

969 190 979 323 9 080 a9 413 346 25

i ,048 440 1.568 496 30 212 28 156 78 1

2,046 766 1,637 614 44 1,805 602 1,939 510 21

610 954 304 40 3

0

0

:,

:

i 0

0 0 0 0 0 0 0 0

i

0 0 0 0 0

0 0

0 0 0

0

z 0

0

0 1

0 0

0 0 0 0 0 0

0

0 0

0

0 0 1 0 2 3 0


572 AMERICAN JOURNAL OF EMERGENCY MEDICINE W Volume 12, Number 5 H September 1994

TABLE 22A. Demographic Profile of Exposure Cases by Generic Categoty of Substances and Products: Nonpharmaceuticals (Cont’d)

Treated

Age Wr) Reason in Outcome Health

Substance Implicated No. of Adv Care in the Exposure Exposures ~6 6-19 >19 lJn1nt Int Other Rxtl Facility NOIE Minor Moderate Ma~ot Death

Chlorates Cyanide Dioxin Formaldehvde/formalin Glycol: ethylene Glycol: other Ketones Methylene chloride Nitrates and nitrites Phenol/creosote Strychnine Toluene diisocyanate Other chemicals Unknown chemicals

‘Category total Cleaning substances

(household) Ammonia cleaners fall

purpose) Automatic dishwasher

detergents Granules Liquids Rinse agents Other/unknown

Bleaches Borate Hypochlorite Nonhypochlorite Other/unknown

Carpet/upholstery cleaners

Cleansers Anionic/nonionic Other/unknown

Disinfectants Hypochlorite Phenol Pine oil Other/unknown

Drain cleaners Acid Alkali Other/unknown

Fabric softeners/ antistatic agents

Aerosol/spray Dry/powder Liquid Solid/sheet Other/unknown

Glass cleaners Ammonia Anionic/nonionic lsopropanol Other/unknown

Hand dishwashing AoionicYnonionic Other/unknown

Laundry additives Bluing/brightening

agent Detergent booster Enzyme/microbiological

additive Water softener Other/unknown

Laundry Detergents Granules Liquids Soaps Other/unknown

38 15 7 307 19 11 15 2 0

1,442 241 225 501 102 69

1,065 505 94 844 223 66 718 105 67 791 231 235

1,216 213 139 14 3 0

401 56 39 12,654 4,016 1,559 2,066 1,019 259

44,240 13,341 5,450

14 198

65: 234 318 406 395 225 577 10

207 4,752 480

17,648

37 0 1 271 29 4 15 0 0

1,368 47 6 409 71 6

1,034 20 2 824 13 2 697 a 2 725 39 16

1,193 13 2 7 6

398 1 : 11,985 357 104 1,986 29 27

42,158 1,297 332

0 0 0 13

E, 2 3 10 4

: 149 20

271

10 7 10 215 52 95

66: 1 3

178 563 254 93 101 386 228 276 425 138 288 371 66 292 231 176 189 508 144 468

9 5 1 159 121

4,554 2,4:: 3.488 404 327 265

16,947 7,238 13,524

5 35 1

a7 46 69 92 92 42 136

1 32

830 a2

4,009

1 a 0 3 24 6 3

; 7 2

480 1

247

3,902 1,956 325 1,228 3,756 117 14 10 697 797 1.188 158 1

4,962 4,340 179 305 4,926 26 9 1.827 1,461 86 182 1.812 10 2 703 649 ta 25 702 10 902 735 53 71 895 4 2

33 1 23 1 2 0 18 1

618 328 50 136 574 13 3 27 39,824 17,777 3,781 12,668 38,223 1,244 187 113 1,331 785 73 313 1,283 23 1 21 220 90 23 80 209 8 1 2

114 3 69 2

4,469 1.773 527 1,391 4,380 61 17 7 3,404 2,269 251 640 3,201 181 13 5 10,308 7,622 623 1,397 9,869 372 25 25 2,046 1,087 209 524 1.936 95 9 5

185 2,100 879 92 728 301 20 250 81 77 337 171

89 145 168 8,229 6,750 13,651 175 295 356 50 34 66

279 845 576

738 2,548 1,408 310 542 457

1,052 a01 1,716 539 895 847

1,991 3,600 2,300 554 515 625

356 80 408 1,077 388 1,039 129 43 126

18 0 1,516 35

26 1 10 0

3,085 2,374 158 390 3,013 39 4 26 45 1

7,982 6.188 491 a31 7,760 159 24 34 2,226 1,347 153 414 2,162 38 12 6

283 6 75 5

211 a 92 5

879 94 68 500 847 23 6 2,777 558 226 1,315 2,560 192 13 340 77 22 174 321 15 2

r, 0

138 357 33

64 3

1,161 440 23

30

89: 363 19

: 65 22 0

21 62 0 3

123 1,116 28 416 4 22

0 : 0 19 0 10 0 0

2 0

26 22 1

4 10 la 0 3 0

82 350 155 27 107 28 1 5 4

277 738 564 6 16 7

211 773 532 398 1,447 1,041

408 1,725 2,402 205 295 415

2,782 2,162 240 275 2,681 a1 11 44 31 4 4 41 3 0

2,553 2,022 199 210 2,499 42 6 4,678 3,779 389 342 4,551 111 13

23

3; 38

8.357 5,557 707 1,220 8.094 98 76 78 1,870 1,101 189 414 1,787 37 16 27

77 21

49 35 7 3 45 3 1 44 25 3 11 41 3 0

23 : 21

9 11

1 0

34 24 1 5 34 0 0 0 4 12 4 2 73 29 3 13 69 0 2 0 17 14 17 1

267 194 18 32 260 2 0 4 48 64 74 15

8,661 7,333 385 562 8,429 78 16 130 1.038 2,408 2.518 169 3,552 2,569 227 516 3,362 63 11 116 420 734 977 57 105 77 10 14 100 0 0 4 14 22 26 1 312 218 20 58 293 6 3 7 05 103 61 6

9 34 1

0 0 1 0 0

4 0 2 2

0 0

0 0

0 0 2

9 1 0 0

0 7 0 0 11 1 0 0 1 0

; 6 0

33

0

0 0 0 0

0 3 0 0

0

0 0

0 0 1 1

3 3 0

0 0 0 0 0

1 0 0 0

0 0

0 0

0 0 0

0 1 0 0


JTOVITZ ET AL n 1993 AAPCC ANNUAL REPORT 573


Substance Implicated in the Exposure

Laundry prewash/stain removers

Treated

Age W) Reason in Outcome Health

No. of Adv Care Exposures c6 E-19 z-19 Unlllt IlIt Other Rxrl Facility NO%? Minor Moderate Major Death

Dry solvent-based Liquid solvent-based Spray solvent-based Other/unknown

solvent-based Dry surfactant-based Liquid surfactant-

based Spray surfactant-

based Other/unknown

surfactant-based Other/unknown

Miscellaneous cleaner Acid Alkali Anioniclnonionic Cationic Ethanol Glycols lsopropanol Methanol Phenol Other/unknown

Oven cleaner Acid Alkali Detergent type Other/unknown

Rust remover Alkali Anioniclnonionic Hydrofluoric acid Acid other Other/unknown

Spot remover/dry cleaning agent

Anionicinonionic Glycol Carbon tetrachloride Perchloroethylene Other halogenated

hydrocarbon lsopropanol Other nonhalogenated

hydrocarbon Other/unknown

Starch/fabric finishes/sizing

Toilet bowl cleaner Acid Alkali Other/unknown

Wall/floor/tile cleaner Acid Alkali Anioniclnonionic Cationic Ethanol Glycols lsopropanol Methanol Other/unknown

‘Category total Industrial cleaners

Acids Alkali Anionic/nonionic Cationic Other/unknown

1 0 199 136 476 354

0 0 11 33 26 58

11 31 27 21

62 117

11 30

5 3 6 13

51 330 609 1,657 530 1,210 306 746

32 63 al 195

130 134

: 3 3

300 732

1 4 326 1,316

1 1 47 131

6 20 0 0

100 694 22 78 11 146

1 0 0 0 197 1 0 1

463 6 2 3

160 105 739 672

155 735

2 3

1

0

2

1

1,731 1,491 1,712 11 3 4

349 292 345 3 0 0

124 112 70 43

124 0 0 0

69 0 0 1

a37 317 6,564 3.527 7,430 5,160 3,009 1,662

419 298 836 476

1,094 754 34 26 16 6

3,067 1,714

a22 10 3 1

6,327 166 38 23

7,183 151 28 49

2,894 90 5 15

411 7 1 0

al0 la 5 3

1,074 15 3 2

33 1 0 0

15 1 0 0

2,937 a0 26 ia

0 0 21 6: 55

69 122 149

17 52 26

22 217 90

la5 500 372

37 75 121

2 32 19

14 15 31

227 la2 293 1.979 1.697

989 i 1892 2.009

11818 735 775 a37

59 185

130 367 245

4 7 4

7 4 7

708 759 a55

9 3,071

4 347

2 806

1 74

9 0 0 0 6 0 2 3 0 2,977 57 22 13 1,357 247 1,243 478 25

4 0 0 0 0 0 0 0 0 339 5 2 1 114 42 117 28 1

57 23 0 0

1,532 154 227 97 275 55

55 0 0 2 15 la 19 5 0 0 0 0 0 0 0 0 0 0

1,496 33 1 0 965 176 631 410 13 216 7 3 1 75 53 59 21 1 266 6 I 2 72 39 106 27 0

249 161 21 45 239 1 6 3 a2 57 6 14 a2 0 0 0

0 0 0 0 0 0 0 0 72 35 9 23 67 5 0 0

179 60 27 67 159 16 1 3 96 72 7 11 96 0 0 0

173 110 15 37 164 7 1 1 95 43 5 32 91 2 0 2

1,129 924 a3 a5 1,095 21 3 a

2,940 1,183 229 1,002 2,802 356 213 16 79 352

2,096 1,633 112 237 2,058

119

3:

6 4

0 0

1 3

3,260 1,490 254 1,024 3,199 48 6 6 7.279 4.082 619 1,605 7,098 119 26 28

716 518 49 93 700 13 1 2 799 554 61 132 777 14 2 4

3 1 0 2 3 0 0 0

522 367 37 aa 509 7 3 3

99 67 a 7 98 0 0 1 4 1 0 2 4 0 0 0

458 232 42 127 435 16 1 5

lao,161 108,140 14,204 36,920 174,031 4,266 700 931

36 54 a5

12 26 19

0 0 0

29 25 19

52 41 41

13 35 21

35 56 58

ia 30 31

51 262 147

905 643 1,130

63 120 63

200 657 257

784 751 1,266

1,706 1,735 2,540

78 192 139 122 205 165

2 1 1

74 139 112

3 9 9 2 1 1

123 106 122 32,206 43,346 50,666

1,026 172 117 511 995 22 4 4 464 2,198 419 306 1,026 2,120 47 20 a 1,325

341 113 50 113 322 14 3 1 127 504 94 a9 209 462 34 4 1 273

1,538 324 216 671 1,481 37 11 5 777

131 99

218 209

147

228

E

215

378 131 4

906 425 23 136 31 0 206 55 4 661 177 4

0 4

20

3

4

0 0

33 1

6 0

0

1

0

0

53

466

130

134

9

27

17

:

115

0

19

2

5

0

3

2

0

0

4

15

0

0

0

7

5

1 0

2 1

239

11

33

17

0

1

213

365

15

16 1

14

0

0

32

6,653

5

5

:

0 1

0

0

0

242

0 0 0

0 0

0

0

0 0

1

E,

0

:

0

0

0

0

0

1

0

0

0

0

1

0

0

:

0

0

:

0

0

0

:

1

:

0

0

0

0

0

0

0

21

0

0

0

0 1




Treated


Substance Implicated No. of Adv Care in the Exposure Exposures ~6 6-19 >19 Un1nt Int Other RXll Facility N0I-E Minor Moderate Major Death

*Category total Cosmetics/personal care

products Bath oil, bubble bath Creams, lotions,

make-uo Dental care products

False teeth cleaning Toothpaste with

fluoride Toothpaste without

fluoride Other

Deodorants Depilatories Douches Eye products Hair care products

Coloring agents Rinses, conditioners,

relaxers Shampoos Sprays Other

Lipsticks/balms, with camphor

Lipsticks/balms, without camphor

Mouthwash Ethanol Nonethanol Fluoride Unknown

Nail products Polish Polish removers:

acetone Polish removers: other Polish removers:

unknown Other miscellaneous

Perfume, cologne, aftershave

Peroxide Powders: talc Powders: without talc Soaps Suntan/sunscreen

products *Category total Deodorizers

Air fresheners Diaper pail deodorizers Toilet bowl deodorizers Other Unknown

‘Category total Dyes

Fabric Food dye (e.g., Easter

egg) Leather Other Unknown

‘Category total Essential oils Fertilizers

Household plant food Outdoor fertilizers Plant hormones Other Unknown

5,607 1,122 778 2,530 5,380 154 42 19 2,966 730 2,287 819 35

6,481 5,962 6,376 26 11 65 23 0

13,825 10,961

281 185

866 1,451

70 680

181 141

23 24 68 170

538 509 69 206 11 27 51 115

110 458

233 352 641 801 776 607 269 466

29 14

66 36

710 1,070 104 82 205 38

91 13

473 279

229 260 141 124

579 551 348 437

1,264 1,139 1,005 2,569

156 121 38 16

692 1,217

370 238 10,887 14,396

13,193 219 51 333 75 7

1,107 261 1,082 17 5 2 9 0

2,507 1,990 2,346 34 22 102 21 0

223 161 1,038 676 9,180 7,833

515 161 235 166

1,051 828

207 5 1,007 15 8,914 125

372 39 218 7

1,008 7

1 3

26

: 1

10 13

112 101

3:

4 0 IO 2 50 3 42 0

3 0 24 0

1,422 621 1,262 20 1 136

220 1,776 802

711 2,888 1,247

94 368 134

143 725 571

23 47 33 127 222 355 370 1,075 989 136 75 189 34 85 22 75 213 99

366 280 472 91 1

3,184 2,490 8,236 6,509 4,472 2.873 3,082 2,072

3,064 62 6 48 7,940 195 10 74 4,003 395 33 30 2,895 71 13 97

167 6 77 1 79 11

129 4

502 449 495 2 1 4

730 999 675 659 1,918 1,649 621 1,083 1,277 583 802 657

21 118 56

41 305 83

2 0

2,210 2,088 2,187 11 1 9 0 0

4,351 2,277 577 369

1,144 888 151 36

3,693 586 37 23 512 53 3 7

1,120 19 0 5 131 13 6 1

811 1,420 856 132 216 109

98 16 10 0 4 0 3 0

8.250 7,381 8,141 85 11 8 67 0

2,915 2,351 1,515 1,203

2,831 73 6 4 1,404 27 3 1

23 2 12 1

6,425 5,071 2,964 1,951

6,218 177 20 2 2,901 24 6 31

52 409 75 22 22 74

564 2,336 1,531

356 1,189 543 134 545 279

777 2,222 1,074 730 658 a30

42 0 184 5

28,104 25,441 10,371 5,804

2,939 2,621 900 837

9,986 7,581

27,629 373 44 30 10,013 270 29 47

2,864 59 1 12 886 4 6 4

9,494 134 59 290

99 5 111 7

37 1 3 0

85 3

3,999 3,212 143,861 113,204

3,860 13 3 120 138,346 3,160 422 1,765

1,785 10,051 4,135 775 2,328 1,856 313 794 810

29 168 192 639 2,492 1,782

277 718 1,254 12,350 39,335 24,718

34 1 1,626 76

10,759 9,333 1,153 1,107

954 882 2,474 1,940

151 116 15,491 13,378

10,564 136 31 17 1,151 1 0 0

947 6 1 0 2,417 38 5 12

144 7 0 0 15,223 188 37 29

57 6 2 0 6 1

35 0 2 0

102 7

839 680 a27 5 0 7 3

1,033 920 109 92 440 243

81 51 2,502 1,986 3,120 2,118

4,716 3,248 1,705 1.081

135 56 286 189

1,408 992

659 559 33 8 34 23

180 248 11 21

917 859

61 50

70 26 3 11

97 76 7 10

238 181 486 371

556 666 196 310

13 41 25 40

143 191

1,011 11 2 7 108 1 0 0 413 11 0 15

74 0 1 5 2,433 28 3 34 2,915 126 24 46

4,674 31 9 1,679 11 4

132 1 0 281 3 0

1,379 12 3

: 1 2

10

763 3,361 1,662 41 433 43 81 360 74

340 808 473 32 49 34

1,257 5,011 2,486

72 256 40

16 238 34 12 33 8 55 109 49 16 16 9

171 652 140 436 734 1,174

136 1,162 194 135 445 168 34 32 18 33 66 37

150 389 149

0 0

10 2

15 45

13 27

7 4

20

0

1 0 1 1 3 1

0 0 0 0 2

1

0

0

0

0

0 0 0 0 0 0

0

0 0 0 0

0

0

1 0 0 0

0

0 0

0 0

0 0 0 0 1

0 2

1 0 0 0 0 1

0

0 0 0 0 0 0

0 0 0 0 0




Treated Age (v) Reason in Outcome

Health Substance Implicated No. of Adv Care

in the Exposure Exposures <6 &19 >19 un1nt Int Other Rxll Facility NOW Minor Moderate Major Death

‘Category total Fire extinguishers Food products/food

poisoning Foreign bodies/toys/

miscellaneous Ashes Bubble blowing

solutions Charcoal Christmas ornaments Coins Desiccants Feces/urine Glass Incense, punk Soil Thermometer Toys Other Unknown

‘Category total Fumes/gases/vapors

Carbon dioxide Carbon monoxide Chloramine Chlorine: acid mixed

with hypochlorite Chlorine: other Hydrogen sulfide Methane and natural

9s Polymer fume fever Propane/simple

asphyxiants Other Unknown

‘Category total Fungicides

Carbamate fungicide Mercurial fungicide Nonmercurial fungicide Phthalimide fungicide Other/unknown

‘Category total Heavy metals

Aluminum Arsenic (excluding

pesticides) Barium Cadmium Copper Fireplace flame colors Gold Lead Manganese Mercury Metal fume fever Selenium Thallium Other Unknown

‘Category total Herbicides

Carbamate herbicide 2,4-D or 2,4.5-T Diquat Paraquat Paraquat/diquat Triazine herbicide Urea herbicide Other

8,250 5,566 933 1,248 8,145 58 16 23 488 2,094 566 71 2 2,386 273 562 1,023 2,216 64 90 8 753 333 964 128 2

59,997 15,940 9,341 24,919 53,155 539 1,345 4,798 6,613 6,132 11,103 1,883 54

613 557 21 26 604 5 3 1 36 120 65 3 0

3,568 3,329 774 576

1,311 1,134 3.915 3,271

14.578 12,986 2,750 2,292 1,226 531

286 246 1,762 1,559

11,815 6,596 4,498 3,396

14,360 9,184 184 118

61,640 45,775

152 52 92

563 982 174 142

19 77

3,187 945

3,135 26

9,567

55 3,552 71 746 60 1,302 53 3,877

392 14,418 153 2,669 382 1,034

16 275 97 1,755

1,184 11,713 94 4,436

1,310 13,809 26 152

3,927 60,342

9 2 24 0

1 2: 1

117 30 15 56 20 160 10 1 4 2

74 11 47 8

217 253 6 24

577 552

3 4 3 2 8

4 8 0

: 6

64 2

115

113 654 64 137 87 272

1,431 1,163 445 2,049 133 536 148 253

19 72 51 331

638 1,830 243 849

1,715 2,812

5,lZ 11.1::

954 78 97

361 119 131

90 29

2:: 527

1,815 37

4,592

14 17

5 46

8 10 9 6 6 7

17 135

3 286

: 0 2 0 1

:, 0 4 0 4 0

21

431 40 114 209 401 23 2 1 179 32 139 36 5 12,879 1,764 1,903 6,444 12,553 274 1 11 5,932 1,218 4,615 1,288 165 2,804 91 167 1,952 2.707 95 1 1 833 73 1,430 360 6

790 5,044 1,144

22 494 112

9:; 155

578 770 18 1 1 240 30 422 169 0 2,584 4,939 73 6 20 1,718 251 2,470 692 11

498 1,139 1 1 0 412 115 408 95 12

2,956 480 486 1,312 2,900 50 1 0 1,107 374 1,115 172 a 11 2 0 7 11 0 0 0 0 1 4 0 0

2,177 215 452 1,042 1,964 198 3 1 792 218 777 185 11 2,028 223 259 1,061 1,982 26 7 9 878 222 761 169 10 i ,814 139 279 820 1,782 13 14 4 627 118 720 133 3

32,078 3,582 4.807 16,507 31,148 771 37 48 12,718 2,652 12,861 3,299 231

238 73 7 1

260 63 231 135 371 123

1,107 395

18

26 30 40

115

112 230 3 1 4 74 53 65 11 2 5 7 0 0 0 3 0 2 0 0

132 253 3 0 3 98 33 76 22 2 46 227 2 2 0 40 52 20 6 1

141 382 4 1 3 90 75 79 15 1 436 1,079 12 4 10 305 213 242 54 6

691 345 60 184 674 9 3 4 131 143 65 16 2

487 48 27 4 75 17

807 189 14 13

5 4 2,874 1,430

52 7 1,843 705

955 20 65 25 39 17

746 280 37 7

8,797 3,119

28 4

311 0 0

475 18

403 47

7 0

102 9

1,471

288 13 44

271

636 19

444 721

22 17

264 12

2,937

388 23 68

a22 14 4

2,758 44

1,647 945

56 31

691 33

8,198

21 40 1 1 2 1

29 15 0 0 1 0

42 19 6 0

158 8 5 1 4 0

1 2: 2

0 2 303 93

3 296 88 2 11 1 0 35 8 7 290 134 0 0 7 0 2 2

13 1,179 540 0 19 12

16 407 515 3 324 10 4 7 18 2 19 6

30 282 132 1 20 7

85 3,022 1,623

59 0

3:: 0 0

156 14

116 382

5 2

142 3

1,270

28 9 0 1 5 0

40 2 1 0 0 0

67 6 1 0

20 0 134 4

3 0 1 2

47 1 0 0

371 35

67 4 6 1,743 509 179

80 17 14 104 6 10

4 2 0 402 68 40

57 6 8 4,339 1.144 477

45 736

35 67

65 1,695

77

19; 29

2,174

89 3

391 56

4,093

2 0 0 30 24 2 20 486

1 0 1 34 12 1 0 74

0 0 1 1 6 0 5 205 1 0 0 26

75 9 155 1,143

14 386

18 9

4: 7

1,007

20 10 0 448 90 5

16 6 0 21 13 5

0 0 0 143 25 1

11 6 0 1,115 112 5

0 0

3

0

0 1 0 0 0 0

: 0 0

!! 0 1

3: 0

0 0 2

0”

:: 0

34

0 0 0 0 0 0

0

1 0 0 0 0 0 1 0 2 0 0 1 0 0 5

0 0 0 0 0 0 0 0



TABLE HA. Demographic Profile of Exposure Cases by Generic Category of Substances and Products: Nonpharmaceuticals (Cont’d)

Treated


Substance Implicated No. of Adv Care in the Exposure Exposures ~6 E-19 >19 UllllM Int Other Rxrl Facility NCIlle MIllor Moderate Major Death

- Unknown

‘Category total Hydrocarbons

Benzene Carbon tetrachloride Diesel fuel Freon and other

propellants Gasoline Halogenated

hydrocarbon: other Kerosene Lighter fluid/naphtha Lubricating oil/motor oil Mineral seal oil Mineral spirits/varsol Tolueneixylene Turpentine Other

263 7,059

110 80

1,236

6,015 19,200

1,262 3,247 3,903 3,791

276 5,089 1,674 1,296 5.574

Unknown 51083 ‘Category total 58,636 Insect&idles/pesticides

(excludina rodenticides)

Carbamate only Carbamate with other

pesticide

Arsenic pesiicides ’ 431 Berates/boric acid 2,733

5,014

806 Chlorinated

hydrocarbon only 2,645 1,240 Chlbrinated

hvdrocarbon with oiher pesticide

Metaldehyde 155 199

Nicotine 5 Organophosphate

Only 11,056 With carbamate 1,172 With chlorinated

hydrocarbon 201 With other pesticide 1,209 With carbamate &

chlorinated hydrocarbon 55 Piperonyl butoxide only 97 Piperonyl

butoxidelovrethrin 4.083 Pyrethrins dn’ly 41404 Repellants (insect) 4,751 Roienone 114 Veterinary insecticide 3,986 Other 3.095 Unknown 31167

‘Category total 49,378 Lacri&atbrs

Caosicumloeooers La&imato&: ‘dN Lacrimators: CR Lacrimators: CS Lacrimators: DM Other Unknown

*Category total Matches/fireworks/explosives

Explosives Fireworks Matches Other Unknown

*Category total Moth repellants

Naphthalene Paradichlorobenzene

944 9,570

0 620

3 76

1,807 13,020

322 485

1,668 65

5 2,545

1,777 1,468 103 137 1,755 14 3 2 395 858 113 211 171 14 17 206 3 0 1 19 101 9

82 i .a38

46 87 252 780 3,367 6,721

7 46 106 5 51 79

128 617 1,202

702 2,925 5,756 3,865 6,632 17,937

214 578 1,160 274 596 3.152 360 822 3;683 296 521 3,715

6;: 17 271

1,263 4,866 180 869 1,491 212 390 1,142 661 1,425 5,310 470 1,155 5,710

8,019 17,907 55,580

5 126

20 4

274

2 0

22

784 6,439

224 1,182

213 2,152 2,390 2,738

240 2,646

279 563

2.918 3,713

25,373

72 70

161 52

5 180 157 132 200 121

2,580

1 4 13 186

0 2 0 1 7 1

11 13 42 7

8 17 17 5 33 12 20 2

0 0 20 10

11 12 : 28 24 29 15

238 119

64 2,063

67 34

309

1,366 3,362

599 1,133 1,233

511 46

1,155 882 374

1,525 1,676

14,272

42 74 1,532 1,848

11 25 6 43

198 492

1.158 1,521 4,002 8,i 24

133 527 939 1,076

1,247 1,172 1,542 641

148 35 1,416 1,572

237 617 351 387

1,622 1,374 i ,883 1,520

14,893 19,126

332 2,231 2,490

303

32 52 411 134 286 2,668 461 1,545 4,785

94 300 775

381 766 2,430

16 2 1 149 54 3 5 325

169 25 23 1,140

17 3 9 193

102 17 89 986

224 35 954 161

1,175 910

177 240

911 499

48 14 60 151 4 0 39 21 44 157 5 30 197 0 0 ; 40 111 13

0 1 3 3 1 1 0 2 0 3

3,952 475

12 37

919 4,648 10,628 104 410 1,107

21 81 192 119 494 1,154

9 25 48 6 33 94

528 1,541 3,843 482 1.703 4.137 784 418 4,589

20 47 111 342 1,000 3,893 208 592 3,005 367 1,250 2,994

5,031 15,284 47,215

311 225 845 3,539 2,045 8,297

0 0 0 230 85 558

2 1 2 19 19 75

663 418 1,450 4,764 2,793 11,227

83 47 304 69 19 475 61 41 1,644 14 11 59

1 0 5 228 118 2,487

261 38 91 3,423 2,740 2.511 523 57 3 37 13 12 232 286 263 36 1 0

68 454

4 1 1 58 41 5 39 1 9 317 292 3:: 46

3 2 1 18 10 15 5 0 0 1 2 0 28 16 29 3 1 0

1,500 1,603 3.317

26 2,351 1,991 1,029

23,616

108 30 92 1,023 692 1,144 197 133 8 111 i ,285 847 1,172 199 48 28 80 567 1,273 1,296 70

1 0 1 26 23 36 6 45 0 43 632 1,194 831 117 64 5 15 480 756 380 55 88 50 26 990 552 694 127

1,195 229 611 II ,953 12,295 10,656 1,688

324 2,666

23: 0

14 430

3,664

24 63 6 144 266 826 19 1,426

0 0 0 0 10 43 4 147 0 1 0 0 1 0 0 25

54 272 6 337 355 1,205 35 2,079

177 387

1,544 32

3 2,143

7 6 3 98 7 3 0 51

18 3 0 72 4 1 0 17 0 0 0 1

36 13 3 239

37 629 359 5,634

0 0 36 388

0 4 3:

58 1,055 494 7,745

106 59 147 57 522 29

18 22 3 1

796 168

13 0 0 275 16 0

8 5

54

0 0 1 0 5 0

286 16 4 546 20 2

123 3 4 189 17 0 206 10 2

65 1 1 6 0 0

170 14 0 192 28 2 39 3 0

326 19 6 329 20 1

2,544 157 22

3 7

151

2 0 1 1

13 1

30 1 0

99 18 2

0 0 0 0 1 0

0 :, 0

9 0 8 0 2 0 0 0 3 1

0 z 0

132 8

23 277

0 20

0 4

55 379

13 11 1 4 0

29

13 2

1 0 9 0 0 0 0 0 0 0 0 0 0 0

10 0

1 0 1 0 0 0 0 0 0 0 2 0

2 0 0 0




Treated


Substance Implicated No. of Adv Care in the Exposure Exposures ~6 619 >19 UflW Int Other Rxn Facility NOIE MlnOr Moderate Major Death

Other Unknown

‘Category total Mushrooms

Coprine Cyclopeptide Gastrointestinal irritants Hallucmogenic lbotenic acrd Miscellaneous, nontoxic Monomethylhydrazine Muscarine Orellanine Other potentially toxic Unknown

‘Category total Paints and stripping agents

Paint: antialgae Paint: anticorrosion Paint: oil-base Paint: water-base Stains Stripping agents

Methylene chloride Other Unknown

Varnishes, lacquers Wood preservatives Other paint/varnish/

lacquer Unknown palm/varnish/

lacquer ‘Category total Photographic products

Developers/fixing/stop baths

Photographic coating fluids

Other Unknown

*Category total Plants

Amygdalinlcyanogenic glycosides

Anticholinergic Cardiac glycosides Colchicine Deoressants Dermatitis Gastrointestinal irritants Hallucinogenic Nicotine Nontoxic plant Oxalate Solanine Stimulants Toxalbumins Other Unknown

*Category total Polishes and waxes Radioisotopes Rodenticides

ANTU Anticoagulant: standard Anticoagulant:

long-acting 10,692 9,947 Barium carbonate 0 0 Cyanide 3 0 Monofluoroacetate 1 0 Strychnine 151 38 Vacor 1 0

8 5 2 1 8 0 0 0 3,121 2,549 184 254 3,058 44 8 5 5,117 4,193 303 409 5,027 61 11 8

1 0 219 21 342 36

15 12 0 3 15 0 0 0 44 6 11 23 35 6 0 3

208 127 27 45 184 22 0 1 334 77 110 108 125 203 3 2

14 4 1 7 11 3 0 0 170 82 19 58 149 7 0 13

75 4 9 47 72 3 0 0 11 2 1 8 9 2 0 0

1 0 0 1 1 0 0 0 59 35 8 11 57 0 0 1

7,045 5,575 733 582 6,649 317 15 56 7,976 5,924 919 893 7.307 563 18 76

3 1 13 8 48 16 56 92

4 5 24 7 28 17

2 3 0 0

12 1 582 162 772 312

0

:, 4 3 0 0 1 0 1 7

17

15 73

2,914 3,174 1,103

2: 1,001 2,468

455

3 a 15 0 0 0 13 28 72 1 0 0

546 1.010 2,762 133 5 9 190 367 3,123 26 8 14 129 349 1,070 22 4 5

4 0 2 24 2 0

910 145 8 287 40 0 319 45 0

1,206 216 479 113 489 146 821 306 411 99

1,155 42 3 2 464 9 2 3 475 11 1 2 803 12 3 2 406 2 0 3

536 136 9 189 56 3 177 37 1 207 44 0 117 15 0

1,227 595

111 634 35 252 39 221 86 281 44 200

164 328

984 2,121 2,344 5.799

1,184 33 4 5

0 3 684 1,365

1,098 2,327

1 8 27 10 75 86

182 73 9 1

40 62 28 12

7 1 0

23 3: 1,706 4,340 2,098 4,625

5 1 23 11

701 553 248 751 223 248

459 123 193 51 152 87 196 134

96 50

279 224 329 51 1

10,751 6,418 22,663 11,837

10,386 280 18 53 1,839 2,010 1,624 268 10 21,915 571 48 98 4,414 4,243 4.723 839 34

373 51 104 145 358 7 3 5 137 49 138 25 1

9 4 2 3 9 0 0 0 3 3 4 0 319 213 29 49 313 5 0 I 46 60 46 6

17 4 1 5 17 0 0 0 5 4 4 0 718 272 136 202 697 12 3 6 191 116 192 31

3,174 2,378 493 198 3,100 43 0 30 163 884 138 15 1 959 267 447 171 533 340 71 6 498 164 189 201 15

2,388 1,771 328 174 2,302 74 2 7 469 1,069 202 19 1 26 16 2 8 26 0 0 0 4 20 3 0 0 50 37 1 10 41 7 0 2 12 13 IO 0 0

16,287 8,800 2,301 3,302 15,603 192 88 371 1,339 2.380 3,983 431 6 17,689 14,524 1,483 1,261 17,236 307 15 112 1,183 5,944 1,378 121 8

261 148 59 37 189 64 0 7 65 88 27 22 0 371 86 97 156 350 9 2 5 176 65 164 58 1

19,053 16,369 1,501 757 18,734 150 13 144 525 3,002 695 71 3 14,243 12,643 969 449 14,055 144 9 24 572 5,544 2,033 79 0

1,853 1,542 117 138 1,813 20 2 17 279 946 172 12 0 362 247 45 55 314 29 0 18 97 165 56 9 2 237 137 49 39 226 11 0 0 91 109 37 5 0

2,374 1,710 344 227 2,222 68 1 79 279 692 248 33 5 15.398 12,098 1,817 942 14,962 240 10 168 1,426 5,185 1,525 176 3 94,725 72,773 10,053 7,924 91,706 I.698 213 990 7,178 26,270 10,860 1,252 45

6,993 5,639 407 678 6,844 115 19 8 824 2,820 1,272 93 6 166 11 20 85 154 0 4 5 55 19 14 7 0

6 5 1,427 1,260

0 1 49 86

323 542 0 0 0 2 0 1

14 67 0 1

5 1 1,368 47

0 9

29 0 1 0

12 0

4 2 0 0 0 497 526 33 6 0

10,587 327 0 0 2 0 1 0

85 41 0 1

4,230 4,637 219 51 14 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0

101 36 16 13 6 1 0 0 0 0

0 0 0

0 0 0 0 0 0 0 0 0 0 1 1

0 0 1 0 0

0 0 0 0 0

0

1 2

0

0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0

0 0

1 0 0 0 0 0


578 AMERICAN JOURNAL OF EMERGENCY MEDICINE W Volume 12, Number 5 W September 1994


Treated


Substance Implicated No. of A& Care in the Exposure Exposures ~6 6-19 >19 Unint Int Other Rxn Facility NOW Minor Moderate Major Death

Other Unknown

‘Category total Sporting equipment

Fishing bait Fishing products, other Golf balls Golf products, other Gun bluing Hunting products, other Other Unknown

‘Category total Swimming pool/aquarium Tobacco products Other/unknown nondrug

substance Total number of

nonpharmaceutical substances

% of nonpharmaceutical substances

% of all substances

1,419 14,920

670 59 178 869 71 6 2 468 307 59 19 5 1,118 72 163 1,254 125 28 2 698 549 52 19 4

13,038 517 1,041 14,171 613 85 10 6,001 6,058 379 108 29

136 96 21 15 135 21 14 4 1 20 71 6 49 11 63

0 0 0 0 0 55 26 2 21 53

405 247 a0 59 365 77 39 29 7 70

0 0 0 0 0 765 428 185 114 706

5,675 3,110 a40 1,205 5,578 8,778 7,633 415 539 a,325

1 0 0 24 41 13 0 1 a 0 :

3 13 4 ia 9 29

0 0 0 0 0 0 0 1 1 28 19 16

23 10 2 117 151 34 6 1 0 6 20 2 0 0 0 0 0 0

38 13 3 196 253 98 57 11 24 946 I ,287 i ,582

226 39 173 i ,823 3,290 2,184

5 0 0 0 9 0 0 0 2 1 5 0 0 0 0 0

21 1 289 9 148 3

:, 2

0 0 0

0 0 0 0 0 0 0

a,337 3,624 1,253 2,253 7,651 166 303 114 1,729 1,699 1,493 254 20 0

1,075.934

57.6

588,752 128,714 252,211 1,009,38i

54.7 12.0 23.4 93.8 31.5 6.9 13.5 54.0

44,509 6,746 12,998 205,694 233,369 243,453 38,174 2,548

4.1 0.6 1.2 19.1 21.7 22.6 3.5 0.2 2.4 0.4 0.7 11.0 12.5 13.0 2.0 0.1

210

0.0 0.0

NOTE: Patients with unknown age, reason, or medical outcome were omitted from the respective tabulations. ABBREVIATIONS: Adv Rxn. adverse reaction: Int, intentional; Unint. unintentional.

TABLE 22B. Demographic Profile of Exposure Cases by Generic Category of Substances and Products: Pharmaceuticals

Treated


Substance Implicated No. of Adv Care in the Exposure Exposures <6 6-19 >19 un1nt Int Other Rxn Facility None Minor Moderate Major Death

Analgesics Acetaminophen only

Adult formulations Pediatric formulations Unknown formulations

Acetaminophen in combination with

Aspirin (with other ingredients)

Aspirin (no other ingredients)

Codeine Oxycodone Propoxyphene Other narcotics Other drugs, adult

formulations Other drugs, pediatric

formulations Aspirin only

Adult formulations Pediatric formulations Unknown formulations

Aspirin in combination with

Codeine Oxycodone Propoxyphene Other narcotics/

analogs Other drugs (adult

formulations) Other drugs (pediatric

formulations

24,307 6,774 8,922 7,249 11,047 12,940 35,788 33,250 2,090 326 35,281 325

8,232 2,838 2.558 2,292 3,764 4,306

1.737 657 474 498 910 735

40 13 17 8,436 1,262 1,236 2,393 351 296 4,134 588 587 5,190 608 798

3,25! 1,403 2,517 3,113

19 21 2,482 3,392

927 1,246 1,358 2,565 1,704 2,924

5,770 1,157

260 42

1,389

46

2,740

143

1,273

3,52;

2,071 3,505

113 128

4,775 1,720 1,495 445 395 44

10,337 2,192 3.861

2,371 2,285 426 16

3,410 6,692

812 127 110 481 259 506 376 56 41 230 120 222

62 16 8 32 26 31

172 22 25 106 53 106

2,931 587 817 1,442 1,061 1,742

5 2 2 1 3 2

43 71 21

9

0 12 7

11 12

10

0

5 1

15

0 0 0

0

4

0

191 14,704 7,861 3,531 1,107 250 35 91 4,287 9,699 723 49 10 0 76 4,993 2,377 1,123 454 161 24

75 8ii 519 348 73 4 0

0 25 13 11 3 0 0 521 3,742 1,530 1,711 425 84 3 190 1,368 466 624 153 49 4 183 2,833 958 1,151 348 98 ia 510 3,053 953 1,460 363 68 4

146

18

3,738

135

2,573 96

7,078

1,467 1,496

69 67

502 79 4

12 5 0

97 1

161

1,513 818 354 25 10 190 24 6 1 0

2,575 2,277 1,099 126 24

43 33

5

13

105

0

532 143 248 78 14 230 66 93 29 7

40 la 14 a 1

108 27 56 17 1

1,909 742 811 244 52

3 2 0 1 0



TABLE 228. Demographic Profile of Exposure Cases by Generic Category of Substances and Products: Pharmaceuticals (Cont’d)

Treated Age W Reason in Outcome

Health Substance Implicated No. of

in the Exposure Exposures ~6 6-19 >19 Unint Int Other

A& Care Rxfl Facility NOlW Minor Moderate Major Death

Narcotics Codeine Meperidine Methadone Morphine Oxycodone Pentazocine Propoxyphene Other/unknown

Nonaspirin salicylates Other nonsteroidal

anti-inflammatory drugs

Colchicine Ibuprofen, OTC Ibuprofen, R, Ibuprofen, unknown if

OTC or R, lndomethacin Other Unknown

Phenacetin Phenazopyridine Salicylamide Other analgesic Unknown analgesic

‘Category total Anesthetics

Inhalation anesthetics Nitrous oxide Other/unknown Ketamine and

analogs Local and topical

anesthetics Other anesthetics Unknown anesthetic

‘Category total Anticholinergic drugs Anticoagulants

Heparin Warfarin (excluding

rodenticides) Other Unknown

‘Category total Anticonvulsants

Carbamazepine Phenytoin Succinimides Valproic acid Other Unknown

‘Category total Antidepressants

Cyclic antidepressants Amitriptyline Amoxapine Desipramine Doxepin lmipramine Maprotiline Nortriptyline Protriptyline

Other cyclic antidepressant

Unknown cyclic antidepressant

Cyclic antidepressant formulated with a benzodiazepine

1,563 517 397 505 138 282 716

1,654 990

731 69 55 79

:: 80

311 478

304 65 29 58 21 22 94

192 143

389 301 256 305

67 177 450 906 290

1,067 362 4 179 275 4 133 222 8 235 226 3

46 73 0 94 140 3

210 460 1 734 656 3 632 309 5

107 19,139

5,177

46 60 36 1 2,735 14,085 4,727 19 2,120 2,307 2,710 15

8,697 752

12,010 10 4

562

:: 183

167,762

35 13 12,224 3,537

1,401 1,235

3,038 2,570 226 114

4,503 2,030 2 3 :,

433 49 62 9 25 11 29 67

76.492 35,180

2,434 323

4,400 4

4.228 368

6,564 5 3

488

4,208 307

4,639 4

65 15 21 66

46,008

68 40 44

99,015

45 18 23

131 63,261

141 156

4 61 19 25

2 1

3,334 341 2 1 2 0

3,363 429 1,065 455

20 1

375 41 29 3

9 0 433 45

1,824 1,035 992 390

52 25 476 412

38 12 0 2

3,382 1,876

57 52 72 0 80 137 14 1

24 15 9 13

4,447 a 7

4,783 3,747

577

3” 736

1,894

4,136 120 7 0 4

4,345 1,734

220 1.726

70 32 62 A 0

761 67 11

909

286 32

140

353

566 50

9 707

2 153

5,563 3.891

110 1,938

186 6

11,696

2,357 2,157

8:: 110

5 5,552

3,179 2,105 15 2,114 1,429 16

87 21 0 1,119 711 7

140 21 1 5 2 0

6,644 4,289 39

6,710 190

1,456 2,911 3,394

97 2,617

46

973 780 32 23

231 360 199 291 659 988

14 IO 241 442

8 4

83 156

17 55

4,266 122 706

2,081 1,465

62 1,670

30

1,889 55

490 595

1,325

6;: 14

4,587 125 881

2,220 1,879

59 1,606

30

1,286

378

881 904

260 47 312

197 32 21 128 55 136

8 1

20 0 0 0 0 0 0

316

0

14 0 0

15 17

10 1 3 6

: 6 0

121 548 457 57 316 72 20 301 39 33 18

303 87

73 19

167 40 495 147

237 901 245 40 426 330

9 65 35 282 5,567 6,820 128 2,719 1,540

224 4,263 2,803 75 385 233

710 5,357 3,980 1 4 2 cl 2 1

29 155 234 2 22 40 4 34 18 8 123 38

4,515 74,500 48,354

17 69 13 0 68 16

1 14 2

162 896 1,905 1 1 3 2 2 ;

183 1,050 1,940 223 2,417 1,064

3 44 14

28 366 281

: 25 31

8 7 39 463 333

201 3,777 1,390 253 2,678 1,002

2 42 40 89 1,063 622 24 73 35

1 4 1 570 7,637 3,090

146 5,500 1,109 9 167 34

64 1,159 336 60 2,442 416

156 2,457 661 3 76 22

96 2,043 488 3 36 10

76 1,014 234 366 223 71

6 345 39 69 90 102

5 161 35 52 37 16

256 49 6 6 132 54 16 2 77 76 44 3 92 63 30 3 32 14 4 0 92 37 5 0

193 77 22 11 474 166 69 IO 187 52 5 0

8 12 3 1,754 266 16

855 171 17

1.375 285 137 31

1,969 423 1 0 2 0

81 4 15 1 9 2

35 7 24,362 7,115

41 3

54 0 0

: 3 1

i ,378

1 1 2 0 0 0

: 0

172

34 17 2 67 8 0

5 6 1 0

550 77 21 4 1 0 1 1 0

661 110 24 877 523 76

11 14 1 0

59 50 13 5 1 0 0 0 0

75 65 14

1,502 820 243 5 961 520 86 4

20 2 1 0 374 141 55 3

46 15 4 0 2 1 0 0

2,905 1,499 389 12

1,694 1.318 762 44 46 40 17 6

351 238 110 26 784 592 320 11 833 496 219 13

29 14 9 0 674 436 185 15

12 7 1 0



TABLE 22B. Demographic Profile of Exposure Cases by Generic Category of Substances and Products: Pharmaceuticals (Cont’d)


Treated


No. of Adv Care Exposures ~6 6-19 >19 Unlnt Int Other Rxn Facility NOW Minor Moderate Major Death

Cyclic antidepressant formulated with a phenothiazine

Lithium MAO inhibitors Trazodone Other antidepressants Unknown

antidepressants ‘Category total Antihistamines

H, receptor antagonists Diphenhydramine

(unknown if OTC or R,)

Diphenhydramine (R,) Diphenhydramine (OTC) Other

‘Category total Antimicrobials

Antibiotics: systemic Antibiotics: topical Antibiotics: unknown Antifungals: systemic Antifungals: topical Antifungals: unknown Anthelmintics:

diethylcarbamazine Anthelmintics:

piperazine Anthelmintics: other Anthelmintics:

unknown Antiparasitics:

antimalarial-s Antiparasitics:

metronidazole Antiparasitics: other Antituberculars:

isoniazid Antituberculars:

rifampin Antituberculars:

other Antituberculars:

unknown Antivirals: systemic Antivirals: topical Antivirals: unknown Other antimicrobials Unknown antimicrobials

‘Category total Antineoplastics Asthma therapies

Aminophylline/ theophylline

Terbutaline and other beta-2 agonists

Other beta agonists Other Unknown

‘Category total Cardiovascular drugs

Alpha blockers Antiarrhythmics Antihypertensives Beta blockers Calcium antagonists Cardiac glycosides Hydralazine Long-acting nitrates

631 110 69 4,560 348 803

556 69 15 3,808 235 475

11,651 1,352 2,356

427 2,722

249 2,858 7,759

2 14

: 17

16 508 128 164 106 51 314 3,632 1,087 1,177 710 184 102 424 106 117 139 43 111 2,925 799 1,376 419 71 744 8,424 3,350 3,077 979 215

3 6 7

59 4 9 40,549 4,607 6,857

406 181 2.778 1,417

378 196 2,609 815 6,463 3,053

35 10 24,340 11,144

47 0 1 27,001 76 1,914 31.3::

5 13 3 2 9,059 10,834 5,849 2,378 15:

3,283 1,385 468 1,131 2.105 998 6 166 1,320 1.151 401 97 18 0

10,457 6,609 1,354 2,088 7,797 2,372 36 216 3,841 3.529 2,251 658 53 6 209 84 37 72 123 74 1 7 120 51 58 18 4 0

6,924 1,533 1,456 3,349 2,594 4,123 17 164 4,231 1,448 1,928 786 74 4 13.478 5,723 2,930 3,982 8,577 4,332 38 470 6,190 4,517 2,484 831 91 4 34,351 15,334 6,245 10,622 21,196 11,899 98 1,023 15,702 10,696 7,122 2,390 240 14

41,073 24,655 6,315 5,185 4,072 326 2,098 638 592

745 416 105 6,275 4,980 322

22 12 1

5,796 102 4,152 8,807 10,370 4,490 704 64 3 67 6 96 195 1.083 253 19 1 0

657 11 361 799 418 483 62 4 0 83 3 61 151 216 68 9 2 0 56 17 72 292 1,367 568 24 2 0

1 0 1 3 3 0 1 0 0

947 677 31 6 2 0 42 264 25 3 0 0

561 460 30 599 285 68

7 2 1 56 199 28 3 0 0 IO 2 23 192 151 127 36 6 0

23 15 1

7,633 30,899 561 5,014 662 1,058 151 598 690 6,126

3 20

200 938

53 550 160 563

5 19

58 142

421 508 56 278

182 166

17 39

4 6

0 290 37;

13 45 20 27 21 86

2 4 11,202 47,460

241 513

3 1 0 5 11 2 0 0 0

196 84 28 23 0 29 118 77 26 16 0 0

962 243 161 335 212 41

277 4 169 380 205 182 31 0 0 24 0 33 73 103 31 5 1 0

453 94 133 260 0 24 341 126 59 65 59 2

61 24 14 14 0 8 32 23 14 0 1 0

17 3 7 8 0 3 12 5 3 1 0 0

1 675

52 45

102

60,43: 613

1 0 230 83

28 4 14 7 64 11

4 1 37,211 8,281

226 39

0 0 0 0 0 0 0 235 4 58 298 205 86 25

3 0 4 9 6 9 4 14 0 4 17 12 3 2

9 0 7 29 31 18 3 3 0 1 3 3 0 0

7,556 154 5,107 11,854 14,878 6,475 1,013 47 5 45 246 200 87 24

0 7 0 0

0” 147

3

4,473 1,047 1,116 1,621 20 248 2,878 1,078 1,026 782 120 27

10,666 8,366 1,295 996 287 391 507 370 77

27 7 11 16,669 10,077 2,890

2,038 2,530

812 9,580 253 421

43 447 6 12

3,152 12,990

73 122 654 904

2,352 5,054 2,406 3,437 3,774 4,835 1,059 1,848

88 165 317 626

738 47 540 4

37 0 13 2

2,949 73

275

:: 0

568

4,395 4,097 2,231 800 12 0 640 258 269 137 5 0

75 188 40 6 0 0 10 8 6 4 0 0

7,998 5,629 3,572 1,729 137 27

168 64 14 1,095 265 62 6,548 3,092 737 5,063 1,708 542 6,730 1,897 510 2,285 977 127

217 88 19 722 338 29

40 0 5 100 64 22 21 2 134 7 45 489 456 108 51 26

1,254 17 188 3,305 2,723 927 557 113 1,439 24 149 2,930 2,128 599 481 97 1,853 33 182 3.802 2,684 801 668 182

316 6 87 1,285 935 199 273 73 42 1 8 105 90 31 24 3 79 2 13 269 349 78 28 2

0 9 2

:5 10 0 0

(Continued on fallowing page)


TABLE 228. Oemoaraphic Profile of Exposure Cases by Generic Category of Substances and Products: Pharmaceuticals (Cont’dl


Treated

Age (W Reason in Outcome Health

No. of A& Care Exposures ~6 6-19 >19 Mint Int Other Rxn Facility NOIE Minor Moderate Ma]or Death

Nitroglycerin Nitroprusside Other vasodiiators Unknown types of

vasodilators Vasopressors Other cardiovascular

drugs Unknown cardiovascular

drugs ‘Category total Cough and cold

preparations Diagnostic agents Diuretics

Furosemide Thiazide Other Unknown

*Category total Electrolytes and

minerals Calcium Fluoride Iron Magnesium Potassium Sodium Zinc Other Unknown

‘Category total Eye/ear/nose/throat

preparations Nasal preparations

Tetrahydrozoline Other decongestants Other Unknown

Ophthalmic preparations

Contact lens products

Glaucoma therapies

Tetrahydrozoline Other ophthalmic

sympathomimetics Other Unknowrl

Otic preparations Combination

products Other Unknown

Steroids-topical for eye/nose/throat

Throat preparations Lozenges without

local anesthetics Lozenges with local

anesthetics Other Unknown

‘Category total Gastrointestinal

preparations Antacids:salicylate

containing Antacids: other Antidiarrheals

diphenoxyiate

2,026 1,409 119 35 3 0

531 298 35

1 12

0 3

0 5

418 1,768 24 14

171 456

I 0 4 9

203 451

13 33 11,557 19,722

14,120 89,647 120 270

398 1,001 378 964 416 1,114

87 187 1,279 3,266

169 1,438 86 3,417

684 3,595 77 222

259 690 206 2,012 222 811

27 104 1 3

1,731 12,292

232 4 18 604 1,013 147 47 9 0 0 20 33 2 5 8 2

60 3 10 189 248 52 14 1

1 2

0 0

0 1

1 10

0 3

0 5

1 1

0 0

523 147 127 43 2 24 145 143 89 29 2 0

43 20 6 25,999 10,309 2,332

9 1 0 15 16 5,304 100 750 13,282 10,854 3.06:

0 0 0 2,203 512 74

105,588 72,540 15,522 316 100 32

12,586 336 2,812 26,109 34,201 21,587 2,821 147 8 I8 0 28 132 71 62 19 0 1

1,205 640 109 1,215 650 123 1,462 752 191

258 130 29 4,140 2,172 452

I75 7 211 4 279 10

58 2 723 23

:: 57

8 116

433 436 191 61 4 478 511 145 40 3 536 572 191 54 1 111 88 45 7 0

1,558 1,607 572 162 8

1,537 1,189 135 3,483 3,088 264 4,616 3.114 649

266 109 37 832 452 61

2,165 1,482 376 885 492 91 119 66 8

5 2 2 13.908 9,994 1,623

70 3 40 3

944 5 24 6

108 3 113 20

42 0 7 0 1 1

1,349 41

24 21 63 14 27

;“o 7 0

202

188 343 92 249 1,143 503

2,420 1,794 852 75 50 57

238 325 80 333 627 391 189 167 151

19 25 9 1 0 2

3.712 4,474 2,137

21 16

247

::, 23 40

0 1

389

0 0

26 1 8 4 1 1 0

41

102 43 9 23 98 3 0 1 24 31 48 0 1 2.496 1,492 233 562 2.311 96 6 79 569 1,039 425 35 3

374 269 28 49 359 2 4 9 29 69 69 6 0 13 3 2 5 9 1 0 3 5 3 3 0 0

3,613 2,097

126 56 1,417 1,066

218 144 599 335

22 9

243 22 8

8 114

855 3,568

52 109 170 1,304

39 197 145 545

7 16

102 898 323 1,473

11 47

191 685

54 634

59 579 41 270

2 7 2,690 13,109

5 49

20 48

3

6 15

2

0 36

2 1 1

13 486 698 687 113 2

12 32 42 25 3 0 15 708 808 147 38 6

13 71 111 20 4 1 38 82 113 99 17 0

3 7 4 6 0 0

907 1,503

47

683 897

28

373

75 129

3

3 13

0

746 111 9

3 2 107 348 173 11 5 10 147 323 390 15 0 0 3 10 16 0

4 46 60 133 146 6

678

606 289

9 13,765

516 0 193

414 179

5 8,609

79

89 47

1 1,242

35

18 0 12 2

2 0 293 72

8 33

9 48 4 47 0 2

265 2,460

156 102

1 4,184

33 3

183 3 59 3

2 1 2,531 258

2,533 2.114 160 16,228 14,903 564

139 2,412 540 15,919

460 1,214

52 183

1.594 890 173 263

4 19

7

64 202 785 285 90 478 3,043 420

108 807 657 296

10 35

75

0 0 0

0

1

0 0 0

14

0 3

10

0 0 0 0

0

0 0

0 0 0

0 0 0

0

0

0 0 0 0

0 0

2

(Continued on folio wing page)



Age (yr) Reason Treated

in Health

Outcome

Adv Care Other Rxn Facility NOW MIllor Moderate Mayor Death

Substance Implicated No. of in the Exposure Exposures ~6 6-19 >19 Unint Int

Antidiarrheals: nonnarcotic

Antidiarrheals: paregoric

Antidiarrheals: other narcotic

Antispasmodics: anticholinergic

Antispasmodics: other

Laxatives Other Unknown

‘Category total Hormones and hormone

antagonists Androgens Corticosteroids Estrogens Insulin Oral contraceptives Oral hypoglycemics Progestins Thyroid preparations Other hormones Other hormone

antagonists Unknown hormones

or antagonists ‘Category total Miscellaneous drugs

L-ddpa and related drugs

Disulfiram Ergot alkaloids Homeooathic

preparations Methysergide Neuromuscular

blocking agents Other

‘Category total Muscle relaxants

Cyclobenzapine Methocarbamol Other Unknown

‘Category total Narcotic antagonists Radiopharmaceuticals Sedatives/hypnotics/

antipsychotics Barbiturates:

long-acting Barbiturates:

short-acting Barbiturates:

unknown type Benzodiazepines Chloral hydrate Ethchlorvynol Glutethimide Meprobamate Methaqualone Phenothiazines Sleep aids (OTC) Other Unknown

‘Category total Serums, toxoids, vaccines

679 635 1 19 64 152 22 2 1 0

153

561 45

114 17

182 16

586 291

2 2 9,404 1,162 2,448 199

258 30 31,462 2,659

59

16

9

523

133 0

233 231

20

15

2

536

0

1.475 836 5

8 12,493 3,185

445 39,026

4 6 i ,478 11,402

379 2,834 126 326

3,733 35,948

2 789 237

77 2,176

0 93 10 0

139

155 40 25 65 5,431 3,386 594 1,090 2,115 1,558 139 320

868 63 54 617 9,848 8,675 681 305 2.272 1,207 180 761

959 571 131 180 4,199 2,814 329 844

455 250 57 124

82 4,727 1,890

583 9,302 1,794

805 3,789

354

64 1 314 25 156 9 249 12 479 6 430 7

81 1 345 10

69 1

205

11 26,518

96 26

6 1 18,666 2.217

162 13

137 8 32 25

305 91

1,098 135 1 0

4 2 3,543 654 5,282 928

560 432 143 189 505 467

6 20 1,214 1,108

: :

65 165 28 0

4 8 4,375 23,499 2,216

1 73

265 71 220 28 0

360 577 637

179 302 37 2 367 161 328 6 199 407 161 1

1,653 2

312 1,327 181 3 0

13 6,431 9,938

5 1,696 2.830

8 5,236 7,662

762 1,499

0 25 37

2,945 1,018 4,209

8.2:: 35 11

1,676 550

2,717 20

4,963 19 4

1,036 1.815 342 634

1,192 2,813 9 46

2,579 5,308 16 15 10 0

2 3 5 0

10 0 0

3,517 833 326 2,026 1,768 1,608 10

1,159 110 158 730 305 796 a

32.3:: 556 195 42

367 62

10,975 2,984 2,033

266 54,521

1,039

3 6 21 4,203 2,636 21,513

143 57 313 25 0 139

1 9 26 45 28 260

7 9 39 1,420 1,522 6,831

153 600 1,904 291 234 I ,258

12 60 129 7,246 5,653 35,189

229 115 447

,,11: 203

47 4

105

3,4:5 411 648

21 15,114

725

22 23,289

308 140 36

251 47

6,729 2,532 1,254

235 37,247

11

0 46

5 2 1 1 1

23 4 4 2

107 3

5 38 56

0 6 40

90 782 503

0 5 2 180 1,970 2,542 100 619 821 39 110 158

695 5,081 8,759

8 55 32 354 667 1,067

55 273 533 20 398 259 54 709 2,022 31 1,669 1,017 72 145 205 49 923 1,291 30 192 146

10 56 80

1 2 2 684 5,089 6,654

15 79 102

17 152 134 78 365 84 64 364 242

131 409 541 0 1 2

37: 11 1

1,539 1,804 682 2,920 2,910

;: 2.182 623

704 250 160 2,997 691

0 37 13 270 5,920 1,577

4 21 1 6

79 2,242 817

37 873 173

0 29 2 619 24,382 5,459

36 428 78 1 149 17 0 33 6 7 265 50 1 51 5

615 8,485 2,369 23 2,464 578

111 1,379 500 3 219 27

1,532 40,999 10.081 297 411 96

30 3 1 0

66 1 0 0

326 113 11 0

3 0 0 0 2,592 216 10 0

313 88 7 3 25 14 2 1

4,378 557 45 6

7 9 0 0 347 55 4 2

82 18 2 0 101 138 19 3 284 17 1 0 278 352 48 1

41 12 1 0 187 55 7 0 105 28 3 0

11 4 0 0

1 0 0 0 1,444 688 85 6

20 6 1

61 19 0 144 71 9 113 43 3

170 0

31 0

8 0

2 1 1 1,124 217 20 1,634 388 42

874 391 85 300 61 13

1,360 460 131 15 3 1

2,549 915 230 9 4 2 2 1 0

882 412 178

381 133 59

6 10 4 10,913 3,484 877

190 87 48 51 34 16

9 7 7 108 60 21

16 10 2 2,935 1,954 315

899 408 27 578 150 28

67 33 3 17,035 6,782 1,585

253 58 5

0

0 0 0

0 0

0 2 2

3 0 9 0

12 0 0

4

4

3 33

2 2 0 4

2: 0 3 0

80 0




Treated


Substance Implicated No. of Adv Care in the Exposure Exposures ~6 6-l 9 >19 un1nt Int Other Rxn Facility None Minor Moderate Mayor Death

Stimulants and street druas

Amph;?tamines Amyl/butyl nitrites Caffeine Cocaine Diet aids: phenyl-

propanolamine Diet aids: phenyl-

propanolamine and caffeine

Diet aids: other, OTC Diet aids: other, R, Diet aids: unknown Heroin LSD Marijuana Mescaline/peyote Phencyclidine Phenvlorooanolamine

look:alike drugs Other stimulants Other hallucinogens Unknown hallucinogens Other street drugs Unknown stimulants/

street drugs *Category total Topical preoarations

Acne preparations Boric acidlborates Calamine Camphor Camohor and methvl

saiicylate Diaper products Hexachlorophene

antiseptics Hydrogen peroxide Iodine or iodide

antiseptics Mercury antiseptics Methyl salicylate Podophylin Silver nitrate Topical steroids Topical steroids with

antibiotics Wart preparations Other liniments Other topical

antiseptics ‘Categorytotal Veterinary Drugs Vitamins

Multiple vitamin tablets: adult formulations

No iron, no fluoride With iron, no fluoride With iron, with

fluoride No iron, with fluoride

Multiple vitamin tablets: pediatric formulations

No iron. no fluoride With iron, no fluoride With iron, with


Multiple vitamin liquids:

6,902 2,166 66 11

5,566 1,046 3,334 133

2,464 7

2,95; 326

1,732 4,033 2,630 41 156 30 34 31 1 0

1,161 1,962 3,365 22 174 2,454 333 2,911 24 20

3,620 1,931 1,441 30 a 21

2,606 639 1.616 3,006 436 734

1,366 666 476

627 74 11 a 2 0

664 13 1 773 219 56

2,240 726 942 456 997 1,161 0 49 269 15 0

235 57 162 91 40 14

164 55 900 25 690 26

1,032 96 167 41 346 19

94 35

a

z 513 466

43 95

70 92 137 0 5 42 106 52 1 20 12 23 13 0 3 40 70 60 1 9

719 66 793 3 5 223 114 725 34 2 330 204 760 22 15

61 97 62 1 2 205 39 291 9 0

164 63 39 73 63 36 25 15 10

104 37 37 606 65 177 633 52 167 661 87 250

75 11 46 301 17 61

35 0 11 0 5 0

19 1 250 110 237 16 176 21

21 1 105 37

169 901

2 a

40

26 99 48 216 359 272

0 12

5 9

45 143 1 0 263 597 5 9

1 1 0 0 0 a 0 0

19 20 1 0

32 0 151 a

0 0 2 1 6 1

97 16 37 23,305 4,765 6,569

17 74 5 1 6,559 13.694 171 470

1,677 766 494 259 174 14

4,549 3,717 227 7,635 6,055 457

26 7,920

210 47

466 677

3,652:

1,503 38 4 126 246 4 2 5

4,488 32 12 15 7,360 179 15 50

39

3: 74

1,209 16.607

952 15,573

79 473

129 414

1,153 20 2 33 16,546 43 4 9

163 36 51 617 205 244

1 1 1 7 2 1

20 4 9

60 12 17 14,764 4,594 5.676

166 290 625 31 62 33

336 1,026 271 1,460 3,232 1,211

219 461 256 236 2,965 569

9 14

128 74 14 30 122 3 1 2 27 33 24 1 7,912 4,511 757 1,961 7,695 155 16 35 497 1,551 1,502 62

1,639 573

6,045 51

156 5,746

662 466

5.666 15 27

4,352

245 31

603 3

47 296

562 60

1,153

:: 770

1,382 169 7 52 549 19 1 4

7,699 60 21 60 35 9 0 6

142 6 2 5 5,619 54 8 63

45 1

42 4 5

19

1,356 2,037 1,611

3,505 64,697

2,691

1,077 1,510

946

63 147 199 236 135 397

2,469 346 49,276 4,505

1,537 213

492 6,059

726

1,333 5 1,961 27 1,513 26

3,359 101 62,947 970

2,636 26

1 3 a

14 121

9

1 4

0 0

4 1

0 0

16 23 61

26 593

13

412 445 305

8;: 162 31

2.376 i .736 25 6 15 34 21 56

160 962 369

67 319 123 237 594 444 171 377 430

446 1,257 459 5,426 16,163 6,463

264 736 456

4 40 22

36 476

26

1,655 4,394

71 193

1,357 216 3,258 511

62 5 190 3

219 465

3 0

1,593 152 3,746 566

64 7 192 0

106 235 479 146 52 1,163 1,754 417

0 22 21 12 0 a 94 5

11 67

5 0

7,725 6,955 716 35 7,597 12,427 11,274 1,063 65 12,249

6 79

668 630 27 1,690 1,791 69 27

652 1,671

111 153

14 15

12 274 2.375 303 22 2.146 5,183 1,156

1 67 191 48 3 75 466 62

2 0

1 522

0 0 0

15

1 1

0 4

2 1 5 1 1 0

0 0 1

3: 4

1 5

0 0

0 0

0 0

0 0 0 0

ta 0 1 0 3

0 0 0 0 0

0 92

0 0 0 0

0 0

0 0

0 0 0 0

:

0 0 0

0 0 0

adult formulations

(Continued on fokxving page)


TABLE 228. Demographic Profile of Exposure Cases by Generic Category of Substances and Products: Pharmaceuticals (Cont’d)

Treated


Substance Implicated No. of Adv Care in the Exposure Exposures ~6 6-l 9 >19 Ulllnt Int Other Rxn Facility NOW MIllor Moderate Major Death



Multiple vitamin liquids pediatric formulations



Multiple vitamins, unspecified adult formulations

No iron, no fluoride With iron, no fluoride With iron. with


Multiple vitamins, unspecified pediatric formulations



Other vitamins Vitamin A

Niacin(B,) Pyridoxine (B,) Other B com$ex

vitamins Vitamin C Vitamin D Vitamin E Other Unknown

‘Category total Unknown drugs Total number of

pharmaceutical substances

% of pharmaceutical substances

% of all substances

273 70

3 2

185 42

37 43 9 19

2 0 0 0

227 36 0 60 11 1 6

130 19

93 21

3 0

1 2

1 2

1 0

1 0

0 0

3 1

24 8

0 0

0 0

0 0

:

209 198 363 338

5 4 18 2

3 13 :

201 1 0 6 15 55 19 0 0 359 3 0 1 34 134 34 1 0

92 89 526 505

91 0 0 0 9 28 7 0 0 0 516 2 2 6 19 131 25 0 0 0

42 27 1.727 1,381

4 8 194 116

3 1 2 4

32 6 0 4 9 7 3 0 0 0 1,537 164 3 21 465 705 181 22 2 1

12 8 9 3

10 2 0 0 7 6 2 2 0 0 6 2 0 1 3 2 2 0 0 0

125 111 140 128

6 5 30 30

12 1 11 1

1 0 0 0

81 155 161 956

27 59

103 206 221 148

12 36 73 98 48 76 93 103

3,745 2,880 2,729 5,485

124 1 0 0 6 38 5 0 0 0 138 2 0 0 23 67 12 1 0 0

5 30

1 0

0 0

0 0

1 0

0 10

0 1

0 0

0 0

950 656 1,779 410

283 172

833 70 0 43 129 265 68 11 0 0 873 107 6 790 212 88 790 40 1 1 224 35 0 23 62 79 23 12 3 0

1,085 715 1,860 1,441

163 107 1,048 849

581 432 938 690

41,547 34,042 16,116 5,642

874 112 3 91 182 269 1,698 119 3 37 144 459

143 15 4 1 39 57 975 44 0 28 89 261 511 39 2 28 101 175 799 91 2 40 242 281

38,235 1,902 37 1,329 5,955 13,800 10,736 3,380 840 538 7,961 3,683

94 131

8 47 63

3.7;: 2,724

12 10

1 1 3

15 304

1,021

0 2 0 0

: 20

210

792,902 415,303 115,966 212,227 552,722 208,020 2,916 25,468 295,333 219,715 135,314 41,050 8,293 682

42.4 52.4 14.6 26.8 69.7 26.2 0.4 3.2 37.2 27.7 17.1 5.2 1.0 0.1 22.2 6.2 11.4 29.6 11.1 0.2 1.4 15.8 11.8 7.2 2.2 0.4 0.0

NOTE: Patients with unknown age, reason, or medical outcome were omitted from the respective tabulations ABBREVIATIONS: Adv Rxn, adverse reaction; Int, intentional; Unint, unintentional.

REFERENCES

1. Veltri JC, Litovitz TL: 1983 Annual Report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1984;2:420-443

2. Litovitz TL, Veltri JC: 1984 Annual Report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1985;3:423-450

3. Litovitz TL, Normann SA, Veltri JC: 1985 Annual Report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1986;4:427-458

4. Litovitz TL, Martin TG, Schmitz 6: 1986 Annual Report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1987;5:405-445

5. Litovitz TL. Schmitz BF. Matvunas N. et al: 1987 Annual Report of the American Association of Poison Control Centers of the American Association of Poison Control Centers Tbxic National Data Collection System. Am J Emerg Med 1988;6:479- Exposure Surveillance System. Am J Emerg Med 1993;11:494- 515 555

6. Litovitz TL, Schmitz BF, Holm KC: 1988 Annual Report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1989;7:495-545

7. Litovitz TL, Schmitz EF, Bailey KM: 1989 Annual Report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1990;8:394-442

8. Litovitz TL, Bailey KM, Schmitz BF. et al: 1990 Annual Report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1991;9:461- CA_ 3”Y

9. Litovitz TL, Holm KC, Bailey KM, et al: 1991 Annual Report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1992;10:452-505

10. Litovitz TL. Holm KC, Clancv C, et al: 1992 Annual Report

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1993 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance...

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