ABSTRACTS

Figures & data

Table

	Rash	Fever	Blister	Bruising	Steroids	Antibiotics	Transfusion
Yes	62	52	37	48	43	53	18
No	2	12	27	16	21	21	46

Table

Product name	Drug Found	Labled “use”	Physical Appearence
White Lightening	mephedrone	Insect repellent	White dry powder
White Lightening	MDPV	Natural stain remover	White dry powder
Zoom	MDPV	Bath Salt	Beige powder
Energizing aromatherapy powder	MDPV and caffeine	Potpouri	Beige powder
Euphoria	Methylone and caffeine	Bath Salt	Beige powder
Cotton Cloud	Mephedrone, methylone and MDPV	Bath Salt	White Crystalline powder
Cloud 9	Methylone and MDPV	Bath Salt	Beige Powder
Bayou Ivory Flower	Mephedrone	Bath Salt	Beige Powder
Cloud 10	MDPV	Bath Salt	Beige Powder
White Dove	Methylone	Bath Salt	White Powder
Dynamite	Methylone	Bath Salt	White Powder
Dynamite “Plus”	MDPV	Bath Salt	Beige Powder
White China	MDPV and unknown compound	Bath Salt	Beige Powder
Snow Day	Methylone and MDPV	Bath Salt	Beige Powder

Table

Dates	Pre/Post Control	Number of ED presentations
16th Aug 2009 to 15th Oct 2009	Pre	7
16th Oct 2009 to 15th Dec 2009	Pre	5
16th Dec 2009 to 15th Feb 2010	Pre	14
16th Feb 2010 to 15th Apr 2010	Pre	31
16th Apr 2010 to 15th Jun 2010	Post	23
16th Jun 2010 to 15th Aug 2010	Post	14
16th Aug 2010 to 15th Oct 2010	Post	6
16th Oct 2010 to 15th Dec 2010	Post	4

Table

	Buprenorphine (n = 32) No. (%)	Methadone(n = 98) No. (%)
Admission for medical care	4 (12.5)	60 (61.2)
Admission to critical care (ICU)	0 (0)	37 (37.8)
No effect/minor effect	21 (65.6)	25 (25.5)
Moderate effect	11 (34.3)	61 (62.2)
Major effect/Death	0 (0)	12 (12.2)
Intubation/ventilation	0 (0)	10 (10.2)
Naloxone	4 (12.5)	78 (79.6)
Antiemetics	7 (21.9)	2 (2.0)
Benzodiazepines	10 (31.3)	4 (4.1)

Table

Time since ingestion in hours	Blood ethanol level in mg/dL
2.10	338
5.53	411
11.00	253
16.25	144
24.10	<10

Table

	Bath Salts (%)	Synth Cannabinoids (%)
No Effect	7	7
Minor Effect	16	26
Moderate Effect	44	42
Major Effect	4	3
Not followed; Likely Minor	7	9
Not followed; Potentially Toxic	23	14
Chest Pain	7	7
Hypotension	2	2
Hypertension	20	10
Tachycardia	43	37
Vomiting	6	16
Agitation	29	19
Confusion	16	9
Drowsy	6	19
Hallucinations	15	11

Table

	BD and GHB Serum Concentrations
Date	Time	BD mg/L	GHB mg/L
7/5	1510	58	5.8
7/5	2300	<5	3.0
7/6	0255	ND	6.3

1,4-Butanediol toxicity without gamm-ahydroxybutyrate toxicity.

Table

	Ingested (%)	Inhaled (%)
No Effect	8	6
Minor Effect	30	24
Moderate Effect	40	43
Major Effect	3	3
No F/U; Likley minor	8	10
No F/U; Potentially Toxic	13	14
Chest Pain	3	7
Hypertension	3	11
Tachycardia	33	38
Nausea	13	9
Vomiting	10	15
Abdominal Pain	5	1
Agitation	23	19
Drowsiness	15	18
Hallucinations	15	10
Dyspnea	0	5

Table 1. Clinical Presentation of Patients Exposed to ‘Spice’ Products.

Clinical Sign or Symptom	Number of Patients	Percent of Patients
Tachycardia	30	50
Altered mental status	25	42
Agitation	20	33
Vomiting	18	30
Dizziness	7	12
Mydriasis	7	12
Syncope	5	8
Hallucinating	5	8
Possible seizure activity	5	8
Other	19	32

Table

Outcome	Acetaminophen-Opioid	Lone Acetaminophen	p value
ALT >1000iU/L	1.1%	1.52%	0.55
INR >1.5	0%	1.52%	0.02
Creatinine >1.35 mg/dL (>120 micromol/L)	1.1%	1.18%	0.86
Regional liver unit transfer	0%	0.12%	0.53
Death	0%	0.12%	0.53

Table

Medication	PFAT5 t0	P value	PFAT5 t1h	P value
Normal saline (control)	0.10	NA	0.18	NA
Adenosine	0.09	NA	0.25	0.054
Amiodarone	0.12	0.38	0.26	0.02
Atropine	0.14	0.11	0.20	0.49
Calcium chloride	0.41	< 0.001	0.68	< 0.001
D50W	0.15	0.03	0.37	< 0.001
Epinephrine	0.08	NA	0.42	< 0.001
Glucagon	1.17	< 0.001	1.69	< 0.001
Insulin regular	0.11	0.59	0.70	< 0.001
Lidocaine	0.19	0.001	0.20	0.41
Magnesium sulfate	0.15	0.02	0.37	< 0.001
Naloxone	0.08	NA	0.25	0.02
Norepinephrine	0.12	0.18	0.18	0.45
Sodium bicarbonate	0.18	< 0.001	0.30	< 0.001
Vasopressin	0.11	0.28	0.42	< 0.001

Table

Patient	Quetiapine dose, galenic formulation, No of tabs	Coingestants	Endoscopic f ndings
50 y F	18 g, XR, 60	Lorazepam	Large conglomerate of agglutinated tabs material of sticky consistency in the stomach
41 y M	15 g, XR, 50	Ethanol	Sticky mass consisting of chunks of expanded aggregated tabs in the stomach
21 y F	18 g, XR, 60	PantoprazoleEscitalopramTopiramate	Mucilaginous mass of tabs all over the esophagus and in the stomach
20 y F	≥2.5 g, XR	ChloralhydrateIronLevomepromazineDuloxetineEthanol	11 sticky quetiapine tabs
20 y F	10 g, IR, 100	-	Many tabs in clusters (white gelatinous mass) in the stomach
49 y F	6 g, IR, 30	Bupropion XRVenlafaxine XRTrazodoneParoxetine	Large number of blue-white and white tabs in the stomach. Whole aggregated conglomerate extending up to the antrum. 15 tabs sticking to the mucosal membrane

Table

	# of Patients	Hepatotoxicity Rate (%)	95 CI (%)
Overall^1	7547	12.9	10.1–16.3
IV^1	3594	13.5	9.8–18.4
Oral^1	3953	12.0	8.2–17.3
Early^2	904	5.7	4.3–7.4
IV-Early^2	320	5.3	3.2–8.5
Oral-Early^2	584	5.9	4.2–8.1
Late^2	1293	26.2	23.6–29.1
IV-Late^2	270	23.3	11.7–41.1
Oral-Late^2	1023	26.3	23.7–29.1

¹Data from all articles meeting inclusion criteria (n = 19). ²Data from articles with IV vs. oral and early vs. late data (n = 14).

Table 1. Proportion of patients in each group exhibiting signs or symptoms.

	NoAC (%)	SDAC (%)	MDAC (%)
Ataxia	51	69	65
Nystagmus	30	23	52
Confusion	26	38	26
CNS depression	30	46	32
Nausea	13	8	23

Table

Time post-ingestion (hrs)	−19	1.5	3.5	9	13.5	18.5	23.5	27	38	47.5	55	80
Serum lithium (mmol/L)	1.9	3.8	4.5	4.9	2.7	2.1	1.5	1.2	0.7	0.6	0.5	<0.2

*=CVVHD initiated **=CVVHD stopped.

Table

NON-TRANSFER PTS (N=73)	ED OBS (n = 57)	Non-ED OBS (n = 16)	DIFFERENCE
Age (yrs)	39	39
Male (%)	89	75
Weight (kg)	77	81
Vials/Pt	14	16	−2
Complications/Pt (%)	28	110	−82
Additional Medications/Pt	4	7	−3
LOS/Pt	1.9	3.2	−1.3
F/U /Pt	1.5	0.5	1

TRANSFER PTS (N=164)	ED OBS (n=126)	NON-ED OBS (n=38)	DIFFERENCE
Age	38	41
Male (%)	78	89
Weight (kg)	78	79
Vials/Pt	16	21	−5
Complications/Pt (%)	17	100	−83
Additional Tx/Pt	2	19	−17
Additional Med/Pt	4	9	−5
LOS/Pt	1.7	4.1	−2.4
F/U/Pt	1.2	0.5	0.7

*Average, unless indicated.

Table

TRANSFERS (n = 126)	NO INITIAL CONTROL (n = 76)	INITIAL CONTROL (n = 50)	DIFFERENCE
Age (yrs)	37	37
Male (%)	72	86
Weight (kg)	77	78
Vials/Pt	19	12	7
Institution Vials/Pt	12	6	6
Complication A/Pt (%)	58	46	12
Complication B/Pt (%)	90	72	18
Complication C/Pt (%)	20	14	6
Additional Tx/Pt (%)	4	0	4
Additional Meds/Pt	5	5	1
LOS/Pt	2	1	1

*Average, unless stated.

Table 1. Characteristics of cases grouped by site of management and cardiovascular symptoms (CVS).

Management site	Mean Age (years)	BB cases	CCB cases	BB+CCB cases	Verapamil or Diltiazem	Dihydro Pyridine
Hospital+CVS N = 106 (hospital)	65 SD 20	44 (42%)	46 (43%)	16 (15%)	39 (37%)	18 (17%)
Hospital − CVS N = 145 (hospital)	56 SD 25	68 (47%)	62 (43%)	15 (10%)	38 (26%)	39 (27%)
Patients managed at home N = 2820	59 SD 20	1832 (65%)	829 (29%)	159 (5.6%)	466 (16.5%)	512 (18%)

Dihydropyridines V amlodipine, felodepine, nifedipine, isradipine, nicardipine, nimodipine, nisoldipine.

Table 2. Distribution of CVS of Patients at Hospital (N = 106).

Asystole	Death	Bradycardia	Conduction/EKG abnormalities	Hypotension	Tachycardia/hypertension
2	1*	59	8	49	7

*(case included diltiazem, digoxin, warfarin).

Table 3. Treatments for cases needing more than IV fluids for CVS (N = 30).

Pacemaker	Vasopressor(s)	Calcium	Glucagon	Insulin	Atropine	Anti-arrhythmic	Digibind
2	8	19	16	5	7	1	2

Table

Age Group	CDC Snakes & Lizards	NPDS Snakes & Lzards	CDC Spiders	NPDS Spiders	CDC Scorpions	NPDS Scorpions	CDC Hornets, Wasps, Bees	NPDS Hornets, Wasps, Bees
<1	0	0	0	0	1	0	1	0
1–4	3	2	0	0	1	1	2	1
5–9	3	0	2	2	0	0	0	0
10–14	1	0	0	0	0	0	0	0
15–19	1	1	0	0	0	0	1	0
20–24	0	0	2	0	1	0	8	1
25–34	7	4	2	0	0	0	23	1
35–44	16	10	11	2	0	0	96	3
45–54	12	7	17	0	0	0	145	0
55–64	7	2	17	0	1	1	91	1
65–74	5	0	9	1	0	0	75	0
75–84	3	0	7	0	1	0	45	1
>=85	1	0	3	0	0	0	12	0
Totals	59	26	70	5	5	2	499	8

Table

	Captured by OCME (N = 19)	Bypassed OCME (N = 10)
Agreement of opinion	15 (79%)	2 (20%)
Disagreement of opinion	4 (21%)	8 (80%)

Table

Number of tablets/capsules per packet	Number (%) respondents	Mean ± SD number of packets
8	185 (18.3%)	1.9 ±6.0
16	471 (46.5%)	4.4 ± 10.1
24	106 (10.5%)	1.3 ±5.0
32	110 (10.9%)	2.0 ±7.7

Table

	HA/m, Mean ± SD
Substance	Eng	US
Cocaine	13.7 ± 5.01	19.7 ± 2.48
Heroin	36.0 ± 3.27	5.40 ± 0.586
LSD	0.580 ± 0.120	0.845 ± 0.454
Marijuana	3.24 ± 0.895	10.3 ± 0.434
Methadone	12.4 ± 3.02	9.56 ± 2.73

Table

	HA/m, Change at 2009: p-values 1^st, 2^nd order
Substance	Eng	US
Cocaine	Decrease: p=0.001, 0.034	Decrease: p=ns, <0.0001
Heroin	undetermined: p=ns, ns	Increase: p=ns, 0.005
LSD	Decrease: p=0.013, 0.019	undetermined: p=ns, ns
Marijuana	Decrease: p=0.034, ns	Decrease: p=0.025, ns
Methadone	Increase: p=<0.0001, ns	At peak: p=<0.0001, 0.0006

Table

Decade	The New York Times Number of Article Found with Search “Poison” AND “Murder”
1901-1910	72
1911-1920	60
1921-1930	121
1931-1940	99
1941-1950	20
1951-1960	12
1961-1970	4
1971-1980	10
1981-1990	11
1991-2000	7
Total	416

Table

Patients With Significant Differences (N=4)
Sensation (hand composite)	2
Sensation (envenomated digit)	3
ROM (hand composite)	0
ROM (envenomated digit)	1
Strength (hand composite)	1

Table

Patient	Symptoms	Peak Digoxin Level (ng/mL)	Treatment
A (37 yo F)	VO, DI, HA, DZ, BR, PA	2.4	IVFs, KX
B (27 yo F)	VO, BR	0.6	IVFs
C (2 yo M)	VO, DH	0.5	IVFs, AE
D (24 yo F)	VO, BP	N/A	N/A

Key: VO: vomiting; DI: diarrhea; HA: headaches; DZ: dizziness; BR: bra-dycardia; PA: palpitations; DH: dehydration; BP: back pain; IVF: intravenous fluids; KX: kayexalate; AE: antiemetics.

N/A: not applicable; this patient was lost to PCC followup after calling from home to report exposure.

Table

WISCIV	2005 Premorbid	2008 Hg Exposure	2009	2010	Reliable Change Indices 2005–2008 (2008–2010)
Full Scale IQ	102 (97–107)	97 (92–102)	XXX	104 (99–109)	−1.36 (1.90)
PRI	110 (105–115)	117 (112–122)	119 (114–124)	121 (116–126)	1.17 (0.67)
VCI	102 (97–107)	102 (97–117)	108 (103–113)	104 (99–109)	0.0 (0.38)
WMI	94 (89–99)	71 (66–76)	74 (69–79)	86 (81–91)	−3.83*** (2.50**)
PSI	91 (86–96)() range	88 (83–93)	83 (78–88)	88 (83–93)	−0.41 (0.0)

***p < 0.001; **p = 0.01.

Table

Agent	ToxIC (%)	NPDS (%)
Alcohols	11.6	3.2
Analgesics	26.6	11.8
Anticonvulsants	4.2	1.6
AntiDepressants	11.2	3.6
AntiCholinergics/Histamines	6.8	3.3
AntiMicrobials	0.6	2.5
Antipsychotics-SedHyps	19.5	5.8
Plants	0.9	2.1

Table

*Rabies vaccine restricted. Time period	Calls received	Rabies PEP recommended (%)
May 1 2007 – April 30 2008	1356	436 (32.2%)
May 1 2008 – April 30 2009*	1758	554 (31.5%)
May 1 2009 – April 30 2010	1698	567 (33.4%)

Table 1. PCC Survey of PCP offices.

Survey Question “Assuming there were no regional poison control centers.”	Responses to Questions (n = 100)
	Come to the office	Call 911	Go to the ED	Other	911 or ED
The patient had an accidental ingestion of an unknown pill?	5	33	59	3	92
The patient had an accidental exposure to fumes from an oven cleaner and has eye and throat irritation?	7	45	45	3	90
The patient was stung on the foot by a scorpion and is having localized pain and paresthesias?	28	18	52	2	70

Table

Drug Name	Strength	# Containers	Qty Collected	AWP	Low-High End Street Value
diazepam	5mg	18	2,320	$167.04	$2,320 – $46,400
hydrocodone/APAP	10/325mg	4	520	$363.48	$1,040 – $10,400
Lorcet®	5/500mg	2	2	$3.27	$6 – $18
Lyrica®	75mg	6	84	$226.72	$420 – $1,680
morphine sulfate	30mg	61	10,080	$5,352.48	$80,640 – $302,400
MS Contin®	30mg	3	6	$16.67	$90 – $300
oxycodone/APAP	5/500mg	15	802	$94.64	$802 – $4,010
temazepam	30mg	2	180	$31.50	$180 – $3,600
		111	13,994	$6,255.79	$85,498 – $368,808

Table

Interventions	n = 274 (%)
ADR's initially categorized as “allergies”	211/274 (77%)
% changed to side effects	59/211 (28%)
% of patients that could tolerate the medication	25/59 (42%)
% changed to precautions	15/211 (7%)
% changed to preference	2/211 (1%)
ADR's not been previously documented	15/274 (5%)

Table 1. Demographics of Counties Targeted.

County	Number of Attendees Reached by Poison Center (Operation Lone Star data)	% Hispanic or Latino (census data)	% Spanish Language Spoken at Home (census data)
Cameron	4,203	86%	72%
Willacy	1,273	87%	46%
Hidalgo	2,890	89%	82%
Webb	2,150	95%	91%
Starr	696	99%	96%
Zapata	967	88%	84%

Table

Primary Board	ABMT 1975–1992	Subboard 1994–2000	Subboard 2002–2006	Subboard 2008–2010
Emerg Med	118 (56%)	151 (76%)	102 (86%)	71 (87%)
Pediatrics	51 (24%)	26 (13%)	6 (5%)	9 (11%)
Occup Med	20 (9%)	17 (9%)	9 (8%)	0 (0%)
Internal Med	56 (26%)	34 (17%)	8 (7%)	2 (2%)
Emerg Med only	81 (38%)	117 (59%)	94 (80%)	70 (85%)

Table

Hours from admission	0	18	24	34	44	54	67	75	83	95	107	275
AST	12	31	23	38	70	423	973	979	820	598	544	96
ALT	27	34	42	62	58	550	997	742	539	258	207	29