Abstracts

Figures & data

Table 1.

	Indirect Reports (n = 117)	OPCC Cases (n = 169)
Age (Range in Decades)	13–19 yr: 5.1% 20–29 yr: 19.7% 30–39 yr 18.8% 40–49 yr: 28.2% 50–59 yr: 23.9%	13–19 yr: 15.4% 20–29 yr: 13.0% 30–39 yr 13.0% 40–49 yr: 10.1% 50–59 yr: 13.0%
Sex	Male: 63.3%	Male: 60.4%
Substance (Top 5)	Oxycodone, Hydrocodone, Methadone, Fentanyl, Alprazolam	Cocaine, MDMA, Amphetamines, Benzodiazepines, Atypical antipsychotics

Table 1.

Factor	IC	No IC	Adjusted OR (CI)
Thrombocytopenia	31/173 (17.9%)	16/35 (45.7%)	3.4 (1.2–7.6)
Neurologic	41/174 (23.6%)	21/35 (60%)	4.2 (1.7–10.4)

Table

	EtOH Treatment (145 cases)	4-MP Treatment (44 cases)
Errors	Any Harmful Error/Any Error	Any HarmfulError/Any Error
Any error, per case	28/113	3/20
By Error Category*
Delayed antidote start	5/6	1/1
Antidote dose too high	21/49	2/7
Antidote dose too low	4/39	0/16
Inadequate pH monitoring	1/52	0/5
Inadequate serum ethanol monitoring	4/62	n/a
Antidote duration too long or short	1/16	0/0

*Each error category counted once per case

Table 1.

Finding	N (%)
Mortality	28 (52.8%)
Caustic Burn	52 (98.1%)
Nausea/Vomiting	52 (98.1%)
Renal Failure	32 (60.4%)
Hepatic Injury	40 (75.5%)

Cases receiving IVLE

Age/Sex	Implicated Drugs	Indication	Received	Survived
28 M	Verapamil	Refractory Hypotension (RH)	Bolus ×2	No; Exp HD 8
34 F	Amlodipine	Cardiac Arrest (CA)	Bolus ×3	No; Exp in ED
18 F	Amlodipine	RH	Bolus ×2	Yes
33 F	Amitriptyline	RH/Post CA	Bolus	Yes; DC HD 60
60 F	Verapamil, Amoxapine	RH	Bolus + Gtt	Yes
30 F	Amitriptyline, Cyclobenzaprine	RH (First round); CA (Second Round)	Bolus + Gtt; Repeat bolus 12 h later	Yes; DC HD 29
44 F	Verapamil, Amitriptyline	RH	Bolus + Gtt	No; Exp HD 3

Laboratory values

Date	Blood Lead Level ug/dl	Hgb g/dl
6/13/08	196
6/13/08	185	5.6
6/14/08	168	4.9
6/15/08	132	8.0
6/16/08	112	10.3
6/17/08	107	8.9
6/17/08	73	9
6/22/08	41	9.8
6/28/08	27	10.5
7/6/08	16	11.6
7/13/08	28
7/20/08	31
7/27/08	42
8/03/08	11
8/17/08	13

Characteristics of patients by rhythm changes

[table 1]	Responders (11)	Non-Responders (25)
Age (Years)	46	40
% Male	55	76
Drug Dose	2.2	2.3
Initial Rhythm
Asystole	73	60
PEA	27	36
Vfib		4

Ethylene Glycol Metabolism on Isopropanol

Time Since Ingestion	Ethylene Glycol Level
1 hour	52 mg/dL
16 hours	22 mg/dL
32 hours	14 mg/dL

Agents in controlled gastrointestinal delivery systems

Delivery System	Agent	Specific Preparation
SmartCoatTM	Bupropion	Wellbutrin XL®
SmartCoatTM	Metformin	Glumetza®
SmartCoatTM	Tramadol	Ultram® ER
OROS®	Chlorpheniramine	Efidac 24®
OROS®	Glipizide	Glucotrol XL®
OROS®	Hydromorphone	OROS® hydromorphone
OROS®	Methylphenidate	Concerta®
OROS®	Nifedipine	Adalat® CR
OROS®	Paliperidone	Invega®

Not a comprehensive list of systems, agents, or preparations

Table

	Total cases/hr	Exp/hr	Incoming	Outgoing (f/u calls)	Total min/hr
SPI	2.2	2	7.7	6.5	14.2
PIP	3.5	3	11.2	2	13.2

*In minutes per hr

Change from 2002 to 2008

	ID as % of Total Call Volume	Public IDas % of Pill IDs	HCP ID as % of Pill IDs	Law Enf ID as % of Pill IDs
Policy Center	↑23%	↓36%	↓54%	↑220%
Non-Policy Centers	↑92%	↑14%	↓68%	↑4%

Results by year

Year	AAPCC cases	Major + Moderate Outcome	Deferoxamine use	NCIPC deaths
2000	878	3	6	7
2001	805	2	6	14
2002	1383	14	8	16
2003	1288	7	7	22
2004	1384	6	3	10
2005	1388	14	11	18
2006	1579	17	0
2007	1591	11	7

*data not available

Increase in number of information calls

Rank	Increase Calls/Y	2008 Calls	Doubling Time (Y)	Major Category
1	25372	253,815	3.34	Acetaminophen Combinations
2	19886	166,857	2.25	Opioids
3	16266	167,806	3.74	Misc Sedative/Hypnotics/Antipsychotics
4	8340	82,601	3.66	Misc Muscle Relaxants
5	8046	77,530	3.45	Misc Unknown Drug
6	6328	73,928	5.01	Nonsteroidal Antiinflammatory Drugs
7	6156	65,969	4.07	Misc Cardiovascular Drugs
8	5708	58,470	4.09	Misc Antidepressants
9	4728	55,706	4.70	Misc Antihistamines
10	3798	47,491	5.77	Antibiotics
11	2878	32,949	5.00	Acetaminophen Alone
12	2849	26,722	3.16	Misc Anticonvulsants
13	1758	29,490	8.14	Misc Stimulants and Street Drugs
14	1554	17,144	4.65	Misc Diuretics
15	1341	19,287	6.86	Misc Hormones and Hormone Antagonists
16	1319	14,370	4.79	Other Miscellaneous Drugs
17	1266	11,437	3.34	Oral Hypoglycemic
18	936	13,771	7.58	Cyclic Antidepressants
19	753	9,659	5.86	Misc Gastrointestinal Preparations
20	711	9,107	4.55	Antacids

Table. % cases with VEs

Venom Effect	Start FabAV	IC/Last Loading Dose	Final Assessment
Pain	98.1	9.6	1.4
Swelling	96.2	10.1	0.0
Neurological	29.7	6.2	0.5
Gastrointestinal	28.7	3.4	0.5
Coagulopathy	23.9	21.1	7.2
Thrombocytopenia	22.5	6.2	6.7
Cardiovascular	17.2	2.4	0.5
Respiratory	16.3	3.4	0.5
Bleeding	1.4	1.0	0.5

Table 1.

Hours Post Admission	APAP (mcg/mL)	ALT(IU/L)	ALT (IU/L)
0.0	3	37	–
21.9	–	–	1000
27.9	–	–	1000
44.7	–	–	500
55	–	–	1000
55.6	27.1	435	–
60.2	33.4	–	–
63.6	36.8	555	–
68.1	35.1	502	–
71.6	31.2	439	–
79.6	24.7	302	–
83.6	24.8	–	–
98.8	16.4	–	–
115.6	11	144	–
122.2	11.4	118	–
128.4	11.2	107	–
134.8	9.6	120	–
163.5	Undetectable	–	–
175	Undetectable	–	–

Table

Age (mo)	kcal/kg/day (mean)	Formula Melamine Concentration (ppm)	Melamine intake mg/kg-bw/day
1	117	6197	141
		0.346	0.00789
		0.140	0.00319
3	95.2	6197	115
		0.346	0.00642
		0.140	0.00260
6	91.4	6197	110
		0.346	0.00617
		0.140	0.00250

Prescription opioid drug deaths in Washington state

Year	Poison Center Deaths	Death Certificate Data
2007	1	447
2006	1	452
2005		390
2004	1	342
2003		241

*It could not be determined if these deaths were unintentional

Symptoms coded

Symptom	Number (Percent)
Lethargy/CNS Depression	768 (69.4%)
Tachycardia	124 (11.2%)
Confusion	64 (5.78%)
Respiratory depression	57 (5.15%)
Unresponsive/Coma	43 (3.88%)
Nausea/Vomiting	40 (3.61%)
Hypotension	25 (2.26%)
Ataxia	24 (2.17%)
Hallucinations	23 (2.08%)
Hypertension	16 (1.45%)
Bradycardia	7 (0.63%)
Sleep Walking/Driving	6 (0.54%)
Headache	4 (0.36%)

CSPI exam passing rates for new candidates

Year	Number of Candidates	Number Who Passed the Exam	Pass Rate Percentage
2005 (Pre-Education)	5	0	0%
2006 (Pre-Education)	8	2	25%
2007 (Education)	4	2	50%
2008 (Education)	4	3	75%

WA poison center lipid emulsion therapy cases 2007–2008

Patient & Age	Agent	Clinical Toxicity	Outcome & Comments
54 y.o. male	Bupivacaine	Cardiac arrest, asystole	Full recovery (6 months)
37 y.o. female	Bupropion	Seizures, hypotension	Full recovery
51 y.o. male	Carbamazepine	Seizures, hypotension	Full recovery
3 y.o. male	Flecanide	Seizures, hypotension	Brain death, late administration
34 y.o. female	Hydroxychoroquine	Seizures, hypotension	Full recovery

Table1. Effect of Puerarin on MDA, SOD and GPX in plasma and liver tissue

group	MDA (nmol/ml)	(nmol/mgprot)	SOD (U/ml)	(U/mgprot)	GPX(U/ml)	(U/mgprot)
A(control)	6.18 ± 2.57	3.99 ± 0.87	13.1 ± 3.96	6.18 ± 1.75	14.66 ± 2.73	7.89 ± 2.44
B(alcohol)	10.11 ± 1.88	6.02 ± 1.96**	7.26 ± 1.93**	3.32 ± 1.21**	8.54 ± 1.79**	4.47 ± 1.06**
C(puerarin)	7.93 ± 2.05 #	4.00 ± 1.21 #	10.10 ± 2.32 #	5.46 ± 1.73 #	11.11 ± 2.04 #	6.00 ± 1.95#

Compared with A *P < 0.05; ** P < 0.01; Compared with B # P < 0.05; ## P < 0.01

Table

	Peak ALT	Peak INR	Peak Total Bili	Peak Lipase
Grandmother	4873 (72 hrs)	1.6 (52 hrs)	1.3 (102 hrs)	44 (72 hrs)
Grandchild A	685 (72 hrs)	1.3 (48 hrs)	1.3 (120 hrs)	396 (72 hrs)
Grandchild B	588 (68 hrs)	1.3 (76 hrs)	1.3 (120 hrs)	303 (72 hrs)

EPS in 14 Risperidone-only cases

Patients (N)	Ages	Reported risperidone dose: average (range)	Treatment(s) for EPS	Duration of EPS after treatment(s)
3	≤12 years	5 mg (2–14 mg)	Diphenhydramine (single dose)	< 3 hours
11	> 12 years	24 mg (2–120 mg)	Diphenhydramine, benztropine, lorazepam (all single doses)	< 4 hours

Table

Key Messages: Appropriate Storage or Dosing of Medicines for Children	% of Websites (N = 19) Where Key Message WasIdentified
Do not use common household spoons or tableware to measure medicines	47%
Store medicines out of the reach of children	45%
Use the dosing device that comes with the medicine	34%
Know or determine your child's weight	26%
Do not give more than the recommended dose	21%
Do not give adult medicines to children	16%

pharmacokinetics parameters of three dose groups

parameters	1200U/kg dose group	2400u/kg dose group	4800U/kg dose group
V(c)(mL/kg)	35.83	34.13	34.59
T1/α(h)	2.30	2.39	2.35
T1/2β(h)	18.76	19.02	19.72
k12(1/h)	0.17	0.16	0.16
k10(1/h)	0.07	0.06	0.06
k12(1/h)	0.10	0.10	0.10

Table

Group (n)	Proportion Correct
	Is the QRS wide (Y/N)?	Measured QRS width
All (36)	77%	44% (p = 0.0001 vs Y/N)
Wide EKGs only (36)	60%	39%
Narrow EKGs only (36)	99%	50%
No instruction (12)	77%	43%
Verbal (13)	75%	40% (p = 0.6 vs No instruction)
Written (11)	77%	49% (p = 0.4 vs No instruction)

Increase in NUMBER of human exposures

Rank	Increase Calls/Y	2008 Calls	Doubling Time (Y)	Major Category
1	9088	156,165	8.77	Misc Sedative/Hypnotics/Antipsychotics
2	5000	90,356	9.52	Misc Cardiovascular Drugs
3	3858	124,124	19.18	Misc Foreign Bodies/Toys/Misc
4	3228	80,829	14.05	Acetaminophen Alone
5	3185	88,059	15.42	Misc Antihistamines
6	3096	71,310	12.85	Acetaminophen Combinations
7	3087	77,750	14.19	Misc Alcohols
8	2883	107,474	22.03	Nonsteroidal Antiinflammatory Drugs
9	2580	37,344	6.67	Opioids
10	2414	113,887	29.20	Misc Topical Preparations
11	2371	129,292	35.21	Misc Cosmetics/Personal Care Products
12	2159	29,800	7.30	Misc Other/Unknown Nondrug Substances
13	1998	89,639	27.18	Misc Antidepressants
14	1844	44,253	13.32	Misc Anticonvulsants
15	1706	37,558	12.66	Multiple Vitamins: Pediatric Formulation
16	1698	23,980	7.45	Misc Cold and Cough Preparations
17	1603	24,410	7.30	Antacids
18	1507	24,403	8.47	Other Misc Drugs
19	1411	27,816	10.81	Disinfectants
20	1324	27,313	11.18	Misc Muscle Relaxants

Ethylene glycol and glycolic acid levels

Time of Blood Draw	Ethylene Glycol Level (mg/dL)	Glycolic Acid Level (mg/dL)
Day 1: 0915	43	82
Day 1: 1036	28	61
Day 1: 1855	5.1	31
Day 1: 2310	< 5	6
Day 2: 1043	< 5	< 5

Table 1.

Case# Age/Sex	Peak ASA (mg/dL)	PRE pH/pCO2	Vent ?/TV (mL)	POST pH/pCO2	HD before/after	NaHCO3	Death
#1 66y/f	74.6	7.58/18.4	18/500	7.50/18	Y/before	Y/before	N
#2 49y/m	53	7.38/36	20/800	7.29/na	N	Y/before	N
#3 20y/f	89	7.4/15.2	30/500	7.26/22	Y/after	Y/after	N
#4 71y/m	101	7.55/15	16/500	7.21/81	Y/after	Y/before	Asystole-lived
#5 56y/m	45	7.36/9.6	22/700	7.28/40.5	Y/after	Y/before	N
#6 36y/m	94	7.33/20	30/550	7.09/73	N	Y/before	Asystole
#7 24y/f	90	7.1/30	na	na	Y/after	Y/before	Asystole
#8 14y/f	94	na	na	na	Y/after	Y/after	Asystole

Tabel 1.

Modified snakebite severity score	Number of patients	Mean vials for IC	95% CI
1	3	4.0
2	63	6.3	5.6–7.1
3	62	7.6	6.2–9.1
4	30	9.4	7.5–11.2
5	13	9.7	6.6–12.9
6	3	14.0	0–31.9

CVVH results

Time (hours): From Initial ED Presentation	Verapamil Plasma Levels (mcg/ml)	Verapamil Ultrafiltrate Levels (mcg/ml)
21	0.92
24.5	1.0
28.5	0.73	0.46
30.5	0.55	0.29
38.5	0.82	0.33
44.5	0.8	0.24

*Verapamil Therapeutic Plasma Levels: 0.09 –08211; 0.35 mcg/ml

Case report

Age/Sex	Estimated Dose (mg)	Days of Exposure	Blood Se (mcg/L)	First Symptom/ Onset (Days)	Main Symptoms
40 y/M	576	24	732	Muscle aches(<7)	Diarrhea, abd pain, alopecia, onycholysis, memory & sensory abnormalities
38 y/ F	576	24	318	Alopecia (7)	Diarrhea, abd pain, gen. hair loss, onycholysis, memory & sensory abnormalities
16 y/ M	576	24	391	Nail changes (7)	Diarrhea, alopecia, onycholysis, memory changes
59 y/ M	1441	60	300	Diarrhea (<7)	Diarrhea, alopecia, onycholysis, memory changes
56 y/ F	1441	60	524	Diarrhea (<7)	Diarrhea, gen. hair loss, onycholysis, memory changes
45 y/ F	1153	48	150	Alopecia (<7)	Nausea, Constipation, alopecia, onycholysis
51 y/ M	432	56	660	Malaise (<7)	Diarrhea, abd pain, alopecia, onycholysis, memory changes
48 y/ F	240	10	264	Alopecia (7)	Foul breath, metallic taste, alopecia, onycholysis, memory changes

Normalized Results from RADARS® System

	Tinnitus/10,000,000 URDD	Hearing loss /10,000,000 URDD
Fentanyl	20.24	121.42
Hydrocodone	19.88	4.77
Hydromorphone	0	0
Methadone	282.23	188.15
Morphine	45.09	22.54
Oxycodone	42.76	7.55
Tramadol	21.17	10.59

Distribution of nutmeg exposures

	Intentional (%), n = 86	Unintentional (%), n = 33	Total (%), n = 119
SEX
Male	67 (77.9)	18 (54.5)	85 (71.4)
Female	18 (20.9)	15 (45.5)	33 (27.7)
Unknown	1 (1.2)	0 (0.0)	1 (0.8)
AGE (years)
<13	0 (0.0)	8 (24.2)	8 (6.7)
13–20	69 (80.2)	3 (9.1)	72 (60.5)
>20	14 (16.3)	22 (66.7)	36 (30.3)
Unknown	3 (3.5)	0 (0.0)	3 (2.5)
ROUTE OF EXPOSURE
Oral	82 (95.3)	31 (93.9)	113 (95.0)
Insufflation	4 (4.7)	0 (0.0)	4 (3.4)
Dermal	0 (0.0)	1 (3.0)	1 (0.8)
Ocular	0 (0.0)	1 (3.0)	1 (0.8)
TREATMENT SITE
Home	33 (38.4)	22 (66.7)	55 (46.2)
Doctor's office	0 (0.0)	1 (3.0)	1 (0.8)
Refer to ED	9 (10.5)	5 (15.2)	14 (11.8)
ED	39 (45.3)	3 (9.1)	42 (35.3)
Inpatient (non-ICU)	1 (1.2)	2 (6.1)	3 (2.5)
Inpatient (ICU)	4 (4.7)	0 (0.0)	4 (3.4)
OUTCOME
None	10 (11.6)	8 (24.2)	18 (15.1)
Minor	43 (50.0)	15 (45.5)	58 (48.7)
Moderate	20 (23.3)	6 (18.2)	26 (21.8)
Major	0 (0.0)	0 (0.0)	0 (0.0)
Death	0 (0.0)	0 (0.0)	0 (0.0)
Unable to follow (potentially toxic exposure)	13 (15.1)	4 (12.1)	17 (14.3)

Table

Year	HIE	HIE Mortality	Total # CCA Deaths
2002	5	4 (80%)	6
2003	7	2 (29%)	4
2004	10	0 (0%)	0
2005	1	0 (0%)	0
2006	8	1 (13%)	4
2007	6	0 (0%)	0
2008	9	2 (22%)	2

Table

Poison Center Staff	Courses
All Staff	ICS 100 Intro to ICS
	IS 700 NIMS: An Introduction
Medical & Managing Directors, Educator, 1 SPI	ICS 200 Basic ICS
	IS 800 Federal Response Plan
Medical Director & 1 SPI	ICS 300 Intermediate ICS
	ICS 400 Advanced ICS
Educator & Medical Director	Basic and Advanced PIO Training
Medical Director	HSEEP Training
	IS-139 Exercise Design

E-learning results

	Toxicological vignettes (%)	All remaining specialties (%)	Difference (%)
RELEVANCE
mild/low	27.0	34.5	−7.5
moderate/good	46.9	44.2	+2.7
high	22.8	16.2	+6.6
EDUCATIONAL QUALITY
mild/low	26.0	33.0	−7.0
moderate/good	51.3	48.9	+2.4
high	20.4	14.3	+6.1
EFFECTIVENESS
mild/low	25.1	31.7	−6.6
moderate/good	49.9	46.7	+3.2
high	19.4	13.7	+5.7

Renal function and Aluminum levels

Hospital stay (days)	Bladder irrigation	Serum creatinine (mg/dL)	Serum aluminum (mcg/L)
1		2.7
2		2.5
3		2.1
4	*	1.8
5	*	1.6
6	*	1.8	8
7	*	2.5
8	*	2.8
9		3.1	19
10		4.1
11		3.7	33
12		2.7
13		2.2
14		1.8	13
15		1.7
16		1.7	7
17		1.7

Table

Opioid	Calls-'00–'07	Incr. in Calls (%)	% of Sales	Incr. % Sales
Codeine	62620	–21	23	–24
Fentanyl	9094	193	<1	222
Hydrocodone	187728	63	26	159
Hydromorphone	4202	280	<1	234
Methadone	25193	240	5	559
Morphine	18600	96	14	159
Oxycodone	83710	90	31	182
Tramadol	42138	156	*ND	*ND
Total	433294	43	100	100.12

Table. Proportion of opioid and stimulant mentions by caller site and intent

		Caller Site Category (%)
		Residence	Healthcare	Other	Chi Square
	All Exposures	70	10	11
All Drugs	Intentional	27	65	7	p < .0001
	Unintentional	65	5	10
	All Exposures	70	9	11
Opioids	Intentional	27	65	6	p < .0001
	Unintentional	64	4	10
	All Exposures	63	17	14
Stimulants	Intentional	28	62	8	p < .0001
	Unintentional	69	12	11

Table 1. The number of cases of detectable toxic alcohol levels and clinical toxicities likely related to a toxic alcohol exposure

	Reported Exposure (RE)	Detectable Level (DL)	AGMA + RE(no DL of EG or M)	Reported Visual Disturbances in M exposure	C > 1.2 + AGMA inEG exposure(no DL of EG)
EG	38	19	10	Not applicable (NA)	2
M	4	4	1		NA
Total	42	23	11		2