2010 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 28th Annual Report

Figures & data

Table

Table of Contents
Abstract	914
Introduction	914
What's New in NPDS and the Annual Report	914
The NPDS Application	915
Limitations and Plans	915
Methods	916
Characterization of Participating Poison Centers and Population Served	916
Call Management–Specialized Poison Exposure Emergency Providers	916
NPDS–Near Real-time Data Capture	916
Annual Report Case Inclusion Criteria	917
Statistical Methods	917
NPDS Surveillance	917
Fatality Case Review and Abstract Selection	917
Pediatric Fatality Case Review	918
Results	918
Information Calls to Poison Centers	918
Exposure Calls to Poison Centers	919
Age and Gender Distributions	922
Caller Site and Exposure Site	922
Exposures in Pregnancy	922
Chronicity	922
Reason for Exposure	922
Scenarios	923
Reason by Age	923
Route of Exposure	924
Clinical Effects	924
Case Management Site	925
Medical Outcome	925
Decontamination Procedures and Specific Antidotes	925
Top Substances in Human Exposures	926
Changes from Last Year	926
Distribution of Suicides	927
Plant Exposures	928
Deaths and Exposure-related Fatalities	928
All fatalities–all ages	929
Pediatric fatalities – age ≤5 years	936
Pediatric fatalities–ages 6–12 years	937
Adolescent fatalities–ages 13–19 years	937
Pregnancy and Fatalities	937
AAPCC Surveillance Results	938
2010 Gulf of Mexico Oil Spill	939
THC Homologs and Bath Salts	940
Discussion	940
Summary	940
References	940
Disclaimer	941
Appendix
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures	i
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category	xcviii
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category	cxviii
Appendix A–Acknowledgments	cxl
NPDS Toxicology Quote of the Day	cxl
Poison Centers (PCs)	cxl
Fatality Review Team	cxlii
AAPCC Micromedex Joint Coding Group	cxliii
AAPCC Rapid Coding Team	cxliii
AAPCC Surveillance Team	cxliii
Regional Poison Center (PC) Fatality Awards	cxliii
Appendix B–Data Definitions	cxliv
Reason for Exposure	cxliv
Medical Outcome	cxliv
Relative Contribution to Fatality (RCF)	cxlv
Appendix C–Abstracts of Selected Cases	cxlv
Selection of Abstracts for Publication	cxlv
Abstracts	cxlv
Abbreviations & Normal ranges for Abstracts	clxix

Table

List of Figures and Tables
Figure 1. Human Exposure Calls, Information Calls and Animal Exposure Calls by Day since 1 January 2000	919
Figure 2. All Drug Identification and Law Enforcement Drug Identification Calls by Day since 1 January 2000	921
Figure 3. Health Care Facility (HCF) Exposure Calls and HCF Information Calls by Day since 1 January 2000	922
Figure 4. Change in Encounters from 2009 to 2010 with Graphical Breakdown of Exposure Calls	932
Figure 5. Gulf Oil Spill Encounters per Day	933
Figure 6. Emerging Trends: Bath Salts and THC Homologs Exposures	933
Figure 7. Human Exposure Calls By Year 2000–2010–Top 4 Categories	934
Table 1A. AAPCC Population Served and Reported Exposures (1983–2010)	918
Table 1B. Non-Human Exposures by Animal Type	919
Table 1C. Distribution of Information Calls	919
Table 2. Site of Call and Site of Exposure, Human Exposure Cases	922
Table 3A. Age and Gender Distribution of Human Exposures	923
Table 3B. Population-Adjusted Exposures by Age Group	923
Table 4. Distribution of Age^a and Gender for Fatalities^b	924
Table 5. Number of Substances Involved in Human Exposure Cases	924
Table 6A. Reason for Human Exposure Cases	924
Table 6B. Scenarios for Therapeutic Errors^a by Age^b	925
Table 7. Distribution of Reason for Exposure by Age	926
Table 8. Distribution of Reason for Exposure and Age for Fatalities^a	927
Table 9. Route of Exposure for Human Exposure Cases	927
Table 10. Management Site of Human Exposures	928
Table 11. Medical Outcome of Human Exposure Cases by Patient Age^a	928
Table 12. Medical Outcome by Reason for Exposure in Human Exposures^a	929
Table 13. Duration of Clinical Effects by Medical Outcome	929
Table 14. Decontamination and Therapeutic Interventions	930
Table 15. Therapy Provided in Human Exposures by Age	930
Table 16A. Decontamination Trends (1985–2009)	931
Table 16B. Decontamination Trends: Total Human and Pediatric Exposures ≤5 Years (2010)^a	932
Table 17A. Substance Categories Most Frequently Involved in Human Exposures (Top 25)	934
Table 17B. Substance Categories with the Greatest Rate of Exposure Increase (Top 25)	935
Table 17C. Substance Categories Most Frequently Involved in Pediatric (≤5 years) Exposures (Top 25)^a	935
Table 17D. Substance Categories Most Frequently Involved in Adult (≥20 years) Exposures (Top 25)^a	936
Table 17E. Substance Categories Most Frequently Involved in Pediatric (≤5 years) Deaths^a	936
Table 17F. Substance Categories Most Frequently Identified in Drug Identification Calls (Top 25)	937
Table 17G. Substance Categories Most Frequently Involved in Pregnant Exposures^a (Top 25)	937
Table 18. Categories Associated with Largest Number of Fatalities (Top 25)^a	938
Table 19A. Comparisons of Death Data (1985–2010)^a	938
Table 19B. Comparisons of Direct and Indirect Death Data (2000–2010)^a	939
Table 20. Frequency of Plant Exposures (Top 25)^a	939
Appendix
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures	i
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category	xcviii
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category	cxviii

Table

Table	Fatalities Included	RCF	Number of Deaths
4	Death only	1,2,3	1,146
5	Death only	1,2,3	1,146
8	Death only	1,2,3	1,146
9	Death only	1,2,3	1,146
11	Death and Death (indirect report)	All	1,730
12	Death and Death (indirect report)	All	1,730
17E	Death and Death (indirect report)	All	1,730
18	Death only	1,2,3	1,366
19A	Death and Death (indirect report)	All	1,730
19B	Death and Death (indirect report)	All	1,730
21	Death and Death (indirect report)	1,2,3	1,366
22	Death and Death (indirect report) - Single substance deaths only	All	764

Fig. 1. Human Exposure Calls, Information Calls and Animal Exposure Calls by Day since 1 January 2000.

Black lines show least-squares second order regression–both linear and second order (quadratic) terms were statistically significant for each of the 3 regressions. (See colour version of this figure online).

Table 1A. AAPCC Population Served and Reported Exposures (1983–2010)

Year	No. of participating centers	Population served (in millions)	Human exposures	Exposures per thousand 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
1994	65	215.9	1,926,438	8.9
1995	67	218.5	2,023,089	9.3
1996	67	232.3	2,155,952	9.3
1997	66	250.1	2,192,088	8.8
1998	65	257.5	2,241,082	8.7
1999	64	260.9	2,201,156	8.4
2000	63	270.6	2,168,248	8.0
2001	64	281.3	2,267,979	8.1
2002	64	291.6	2,380,028	8.2
2003	64	294.7	2,395,582	8.1
2004	62	293.7	2,438,643	8.3
2005	61	296.4	2,424,180	8.2
2006	61	299.4	2,403,539	8.0
2007	61	305.6	2,482,041	8.1
2008	61	308.5^b	2,491,049	8.1
2009	60	310.9^b	2,479,355	8.0
2010	60^a	313.3^b	2,384,825	7.6
Total			50,935,385

^aAs of 1 July 2010 there were 60 Participating Centers.

^bAs of 1 July Mid Year US Census (50 United States, American Samoa, District of Columbia, Federated States of Micronesia, Guam, Puerto Rico, and the US Virgin Islands).^3,4

Table 1B. Non-Human Exposures by Animal Type

Animal	N	%
Dog	85,804	90.49
Cat	7,936	8.37
Horse	259	0.27
Bird	238	0.25
Rodent/lagomorph	185	0.20
Cow	70	0.07
Sheep/goat	64	0.07
Aquatic	30	0.03
Other	237	0.25
Total	94,823	100.00

Table 1C. Distribution of Information Calls

Information call type	N	% of Info. calls
Drug identification
Public inquiry: Drug sometimes involved in abuse	462,128	31.52
Public inquiry: Drug not known to be abused	192,972	13.16
Public inquiry: Unknown abuse potential	5,416	0.37
Public inquiry: Unable to identify	86,201	5.88
HCP inquiry: Drug sometimes involved in abuse	6,819	0.47
HCP inquiry: Drug not known to be abused	12,317	0.84
HCP inquiry: Unknown abuse potential	458	0.03
HCP inquiry: Unable to identify	5,056	0.34
Law Enf. Inquiry: Drug sometimes involved in abuse	97,596	6.66
Law Enf. Inquiry: Drug not known to be abused	51,007	3.48
Law Enf. Inquiry: Unknown abuse potential	1,726	0.12
Law Enf. Inquiry: Unable to identify	14,121	0.96
Other drug ID	6,797	0.46
Subtotal	942,614	64.29
Drug information
Adverse effects (no known exposure)	13,893	0.95
Brand/generic name clarifications	3,710	0.25
Calculations	213	0.01
Compatibility of parenteral medications	309	0.02
Compounding	617	0.04
Contraindications	1,824	0.12
Dietary supplement, herbal, and homeopathic	792	0.05
Dosage	13,506	0.92
Dosage form/formulation	2,865	0.20
Drug use during breast-feeding	4,644	0.32
Drug-drug interactions	29,050	1.98
Drug-food interactions	1,659	0.11
Foreign drug	638	0.04
Generic substitution	1,108	0.08
Indications/therapeutic use	71,864	4.90
Medication administration	5,383	0.37
Medication availability	2,209	0.15
Medication disposal	4,907	0.33
Pharmacokinetics	2,615	0.18
Pharmacology	2,044	0.14
Regulatory	13,808	0.94
Stability/storage	3,446	0.24
Therapeutic drug monitoring	938	0.06
Other drug info	35,244	2.40
Subtotal	217,286	14.82
Environmental information
Air quality	1,995	0.14
Carbon monoxide - no known patient(s)	847	0.06
Carbon monoxide alarm use	507	0.03
Chem/bioterrorism/weapons (suspected or confirmed)	22	0.00
Clarification of media reports of environmental contamination	26	0.00
Clarification of substances involved in a HAZMAT incident - no known victim(s)	104	0.01
General questions about contamination of air and/or soil	559	0.04
HAZMAT planning	150	0.01
Lead - no known patient(s)	671	0.05
Mercury thermometer cleanup	2,453	0.17
Mercury (excluding thermometers) cleanup	2,996	0.20
Notification of a HAZMAT incident - no known patient(s)	357	0.02
Pesticide application by a professional pest control operator	680	0.05
Pesticides (other)	3,017	0.21
Potential toxicity of chemicals in the environment	1,352	0.09
Radiation	70	0.00
Safe disposal of chemicals	1,740	0.12
Water purity/contamination	945	0.06
Other environmental	5,251	0.36
Subtotal	23,742	1.62
Medical information
Dental questions	132	0.01
Diagnostic or treatment recommendations for diseases or conditions - non-toxicology	9,633	0.66
Disease prevention	742	0.05
Explanation of disease states	1,448	0.10
General first-aid	1,418	0.10
Interpretation of non-toxicology laboratory reports	185	0.01
Medical terminology questions	72	0.00
Rabies–no known patient(s)	373	0.03
Sunburn management	119	0.01
Other medical	17,502	1.19
Subtotal	31,624	2.16
Occupational information
Occupational treatment/first-aid guidelines - no known patient(s)	39	0.00
Information on chemicals in the workplace	150	0.01
MSDS interpretation	71	0.00
Occupational MSDS requests	1,359	0.09
Routine toxicity monitoring	30	0.00
Safe handling of workplace chemicals	117	0.01
Other occupational	216	0.01
Subtotal	1,982	0.14
Poison information
Analytical toxicology	805	0.05
Carcinogenicity	94	0.01
Food poisoning - no known patient(s)	2,815	0.19
Food preparation/handling practices	7,374	0.50
General toxicity	31,765	2.17
Mutagenicity	46	0.00
Plant toxicity	4,105	0.28
Recalls of non-drug products (including food)	856	0.06
Safe use of household products	3,743	0.26
Toxicology information for legal use/litigation	213	0.01
Other poison	18,640	1.27
Subtotal	70,456	4.81
Prevention/Safety/Education
Confirmation of poison center number	15,051	1.03
General (non-poison) injury prevention requests	677	0.05
Media requests	390	0.03
Poison prevention material requests	13,046	0.89
Poison prevention week date inquiries	59	0.00
Professional education presentation requests	407	0.03
Public education presentation requests	567	0.04
Other prevention	1,459	0.10
Subtotal	31,656	2.16
Teratogenicity information
Teratogenicity	3,058	0.21
Subtotal	3,058	0.21
Other information
Other	45,538	3.11
Subtotal	45,538	3.11
Substance Abuse
Drug screen information	7,165	0.49
Effects of illicit substances–no known patient(s)	335	0.02
New trend information	386	0.03
Withdrawal from illicit substances - no known patient(s)	207	0.01
Other substance abuse	1,006	0.07
Subtotal	9,099	0.62
Administrative
Expert witness requests	37	0.00
Faculty activities	51	0.00
Funding	47	0.00
Personnel issues	462	0.03
Poison center record request	211	0.01
Product replacement/malfunction (issues intended for the manufacturer)	2,350	0.16
Scheduling of poison center rotations	143	0.01
Other administration	20,245	1.38
Subtotal	23,546	1.61
Caller Referred
Immediate referral - animal poison center or veterinarian	16,083	1.10
Immediate referral - drug identification	15,704	1.07
Immediate referral - drug information	931	0.06
Immediate referral - health department	5,958	0.41
Immediate referral - medical advice line	1,117	0.08
Immediate referral - pediatric triage service	60	0.00
Immediate referral - pesticide hotline	319	0.02
Immediate referral - pharmacy	2,620	0.18
Immediate referral - poison center	3,550	0.24
Immediate referral - private physician	2,442	0.17
Immediate referral - psychiatric crisis line	167	0.01
Immediate referral - teratology information program	162	0.01
Other call referral	16,539	1.13
Subtotal	65,652	4.48
Total	1,466,253	100.00

Fig. 2. All Drug Identification and Law Enforcement Drug Identification Calls by Day since 1 January 2000.

Black line shows least-squares second order regression–both linear and second order (quadratic) terms were statistically significant for the Law Enforcement Drug ID Calls. (See colour version of this figure online).

Fig. 3. Health Care Facility (HCF) Exposure Calls and HCF Information Calls by Day since 1 January 2000.

Black lines show least-squares first and second order regressions–linear regression for HCF Exposure Calls (second order term was not statistically significant) and second order regression for HCF Information Calls. All terms shown were statistically significant for each of the 2 regressions. (See colour version of this figure online).

Table 2. Site of Call and Site of Exposure, Human Exposure Cases

	Site of caller		Site of exposure
Site	N	%	N	%
Residence
Own	1,736,145	72.80	2,172,987	91.12
Other	42,813	1.80	61,635	2.58
Workplace	28,429	1.19	37,707	1.58
Health care facility	418,412	17.54	7,381	0.31
School	10,901	0.46	29,568	1.24
Restaurant/food service	566	0.02	5,741	0.24
Public area	8,166	0.34	22,793	0.96
Other	131,067	5.50	26,020	1.09
Unknown	8,326	0.35	20,993	0.88

Table 3A. Age and Gender Distribution of Human Exposures

	Male		Female		Unknown gender		Total		Cumulative total
Age (y)	N	% of age group total	N	% of age group total	N	% of age group total	N	% of total exposures	N	%
Children (< 20)
< 1	61,837	51.96	56,779	47.71	401	0.34	119,017	4.99	119,017	4.99
1	196,460	51.83	182,070	48.03	539	0.14	379,069	15.90	498,086	20.89
2	209,515	52.29	190,541	47.55	629	0.16	400,685	16.80	898,771	37.69
3	96,889	54.90	79,231	44.90	358	0.20	176,478	7.40	1,075,249	45.09
4	46,270	55.91	36,300	43.86	187	0.23	82,757	3.47	1,158,006	48.56
5	26,281	56.46	20,098	43.18	167	0.36	46,546	1.95	1,204,552	50.51
Unknown ≤ 5	1,414	46.77	1,290	42.67	319	10.55	3,023	0.13	1,207,575	50.64
Child 6–12	83,114	57.95	59,525	41.50	785	0.55	143,424	6.01	1,350,999	56.65
Teen 13–19	72,506	46.43	83,122	53.23	536	0.34	156,164	6.55	1,507,163	63.20
Unknown Child	2,054	39.36	1,991	38.16	1,173	22.48	5,218	0.22	1,512,381	63.42
Subtotal	796,340	52.65	710,947	47.01	5,094	0.34	1,512,381	63.42	1,512,381	63.42
Adults (≥ 20)
20–29	90,853	46.19	105,622	53.70	198	0.10	196,673	8.25	1,709,054	71.66
30–39	65,446	43.03	86,511	56.88	135	0.09	152,092	6.38	1,861,146	78.04
40–49	58,233	41.49	82,024	58.45	85	0.06	140,342	5.88	2,001,488	83.93
50–59	46,214	39.83	69,769	60.13	51	0.04	116,034	4.87	2,117,522	88.79
60–69	27,166	37.60	45,046	62.35	34	0.05	72,246	3.03	2,189,768	91.82
70–79	15,075	34.97	28,022	65.00	17	0.04	43,114	1.81	2,232,882	93.63
80–89	9,110	32.96	18,515	66.99	12	0.04	27,637	1.16	2,260,519	94.79
≥ 90	1,530	28.60	3,816	71.34	3	0.06	5,349	0.22	2,265,868	95.01
Unknown adult	41,761	39.59	61,333	58.14	2,401	2.28	105,495	4.42	2,371,363	99.44
Subtotal	355,388	41.37	500,658	58.29	2,936	0.34	858,982	36.02	2,371,363	99.44
Other
Unknown age	4,718	35.05	5,954	44.23	2,790	20.73	13,462	0.56	2,384,825	100.00
Total	1,156,446	48.49	1,217,559	51.05	10,820	0.45	2,384,825	100.00	2,384,825	100.00

Table 3B. Population-Adjusted Exposures by Age Group

Age Group	Exposures/100k population	Number of Exposures^a	Population^b
Children (< 20)
<1	2,760	119,017	4,312,097
1	8,858	379,069	4,278,394
2	9,287	400,685	4,313,444
3	4,057	176,478	4,349,133
4	1,953	82,757	4,236,333
5	1,110	46,546	4,193,338
Child 6–12	502	143,424	28,575,574
Teen 13–19	533	156,164	29,262,563
Subtotal	1,813	1,512,381	83,520,876
Adults (> 20)
20–29	451	196,673	43,608,697
30–39	753	152,092	20,183,872
40–49	220	140,342	63,820,032
50–59	279	116,034	41,553,408
60–69	251	72,246	28,800,304
70–79	261	43,114	16,502,508
80–89	288	27,637	9,580,266
≥90	260	5,349	2,059,452
Subtotal	380	858,982	226,108,539
Overall Total	761	2,384,825	313,306,729

^aNumber of Exposures excludes UNKNOWN ages from the individual age categories, but includes them in the Subtotals and Overall Total (see Table 3A).

^bAs of 1 July Mid Year US Census (50 United States, American Samoa, District of Columbia, Federated States of Micronesia, Guam, Puerto Rico, and the US Virgin Islands).^3,4

Table 4. Distribution of Age^a and Gender for Fatalities^b

Age (y)	Male	Female	Unknown	Total (%)	Cumulative total (%)
<1 year	1	2	0	3 (0.3%)	3 (0.3%)
1 year	4	5	0	9 (0.8%)	12 (1.1%)
2 years	1	5	0	6 (0.5%)	18 (1.6%)
3 years	4	2	0	6 (0.5%)	24 (2.1%)
4 years	2	3	0	5 (0.4%)	29 (2.5%)
5 years	1	2	0	3 (0.3%)	32 (2.8%)
Child 6–12 years	2	1	0	3 (0.3%)	35 (3.1%)
Teen 13–19 years	30	26	0	56 (4.9%)	91 (7.9%)
20–29 years	95	77	0	172 (15.0%)	263 (23.0%)
30–39 years	80	104	0	184 (16.1%)	447 (39.0%)
40–49 years	103	134	0	237 (20.7%)	684 (59.7%)
50–59 years	113	110	1	224 (19.6%)	908 (79.2%)
60–69 years	61	58	0	119 (10.4%)	1,027 (89.6%)
70–79 years	25	29	0	54 (4.7%)	1,081 (94.3%)
80–89 years	23	27	0	50 (4.4%)	1,131 (98.7%)
≥90 years	4	5	0	9 (0.8%)	1,140 (99.5%)
Unknown adult	1	2	0	3 (0.3%)	1,143 (99.7%)
Unknown age	2	0	1	3 (0.3%)	1,146 (100.0%)
Total	552	592	2	1,146 (100.0%)	1,146 (100.0%)

^aAge includes cases with both actual and estimated ages as shown in Table 21.

^bIncludes cases with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory. This excludes reports with outcome of Death INDIRECT.

Table 5. Number of Substances Involved in Human Exposure Cases

	Human exposures		Fatal exposures^a
No. of Substances	N	%	N	%
1	2,147,248	90.04	474	41.36
2	151,642	6.36	270	23.56
3	48,575	2.04	159	13.87
4	19,666	0.82	97	8.46
5	8,773	0.37	67	5.85
6	3,913	0.16	31	2.71
7	2,130	0.09	20	1.75
8	1,152	0.05	12	1.05
≥9	1,726	0.07	16	1.40
Total	2,384,825	100.00	1,146	100.00

^aIncludes cases with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory. This excludes reports with outcome of Death INDIRECT.

Table 6A. Reason for Human Exposure Cases

Reason	N	% Human exposures
Unintentional
Unintentional - General	1,367,682	57.3
Unintentional - Therapeutic error	269,889	11.3
Unintentional - Misuse	128,923	5.4
Unintentional - Bite/sting	61,584	2.6
Unintentional - Environmental	57,384	2.4
Unintentional - Food poisoning	26,221	1.1
Unintentional - Occupational	24,546	1.0
Unintentional - Unknown	4,619	0.2
Subtotal	1,940,848	81.4
Intentional
Intentional - Suspected suicide	219,934	9.2
Intentional - Misuse	58,568	2.5
Intentional - Abuse	51,715	2.2
Intentional - Unknown	19,837	0.8
Subtotal	350,054	14.7
Adverse Reaction
Adverse reaction - Drug	42,201	1.8
Adverse reaction - Other	13,612	0.6
Adverse reaction - Food	5,775	0.2
Subtotal	61,588	2.6
Unknown
Unknown reason	14,332	0.6
Subtotal	14,332	0.6
Other
Other - Malicious	8,351	0.4
Other - Contamination/tampering	8,191	0.3
Other - Withdrawal	1,461	0.1
Subtotal	18,003	0.8
Total	2,384,825	100.0

Table 6B. Scenarios for Therapeutic Errors^a by Age^b

Scenario	N	≤ 5 y (Row %)	6–12 y (Row %)	13–19 y (Row %)	≥ 20 y (Row %)	Unknown child (Row %)	Unknown adult (Row %)	Unknown age (Row %)
Inadvertently took/given medication twice	83,140	20.11	12.49	5.88	55.04	0.08	6.13	0.26
Wrong medication taken/given	41,794	16.20	12.01	6.52	58.69	0.07	6.19	0.33
Other incorrect dose	36,942	31.76	11.83	6.94	44.62	0.09	4.53	0.23
Medication doses given/taken too close together	27,233	19.53	10.15	7.12	56.66	0.06	6.29	0.18
Inadvertently took/given someone else's medication	25,542	20.48	18.80	6.94	49.03	0.07	4.54	0.13
Other/unknown therapeutic error	16,361	21.26	10.70	7.26	53.85	0.20	6.19	0.54
Incorrect dosing route	16,056	8.84	4.02	3.10	72.14	0.14	11.02	0.74
Confused units of measure	10,496	56.98	17.24	4.89	18.90	0.06	1.82	0.11
Incorrect formulation or concentration given	6,135	46.36	16.45	4.74	29.54	0.10	2.62	0.20
Health professional/iatrogenic error (pharmacist/nurse/physician)	5,684	28.20	10.38	6.33	47.59	0.48	5.96	1.06
More than 1 product containing same ingredient	5,589	15.80	14.96	14.17	48.77	0.05	6.07	0.18
Dispensing cup error	5,395	62.65	18.78	4.54	13.01	0.11	0.83	0.07
Drug interaction	1,701	8.47	7.94	6.88	66.67	0.06	9.64	0.35
Incorrect formulation or concentration dispensed	1,656	43.90	15.16	4.95	31.28	0.30	4.17	0.24
10-fold dosing error	1,444	55.89	7.62	4.36	29.36	0.14	2.35	0.28
Exposure through breast milk	109	88.99	0.92	0.00	5.50	2.75	1.83	0.00

^aAll cases with a scenario category of therapeutic error regardless of reason.

^bOf the human exposure cases reported to U.S. Poison Centers in 2010, 425,655 (17.8%) were coded to 1 or more of 54 scenarios.

Table 7. Distribution of Reason for Exposure by Age

	≤5 y		6–12 y		13–19 y		≥20 y		Unknown child		Unknown adult		Unknown age		Total
Reason	N	Row %	N	Row %	N	Row %	N	Row %	N	Row %	N	Row %	N	Row %	N	%
Unintentional	1,198,972	64.55	127,612	6.87	67,487	3.63	455,897	24.54	4,577	0.25	78,768	4.24	7,535	0.41	1,940,848	81.38
Intentional	1,014	0.30	9,999	2.99	80,139	23.99	239,151	71.58	276	0.08	15,696	4.70	3,779	1.13	350,054	14.68
Adverse reaction	4,543	8.39	3,102	5.73	4,632	8.55	40,833	75.40	162	0.30	7,274	13.43	1,042	1.92	61,588	2.58
Other	2,248	14.44	1,885	12.11	2,039	13.10	9,109	58.53	149	0.96	2,291	14.72	282	1.81	18,003	0.75
Unknown	798	6.23	826	6.45	1,867	14.57	8,497	66.32	54	0.42	1,466	11.44	824	6.43	14,332	0.60
Total	1,207,575	53.10	143,424	6.31	156,164	6.87	753,487	33.13	5,218	0.23	105,495	4.64	13,462	0.59	2,384,825	100.00

Table 8. Distribution of Reason for Exposure and Age for Fatalities^a

Reason	≤5 y	6–12 y	13–19 y	≥20 y	Unknown child	Unknown adult	Unknown age	Total
Unintentional
Unintentional - General	15	0	0	24	0	0	0	39
Unintentional - Environmental	6	0	2	21	0	0	0	29
Unintentional - Occupational	0	0	2	11	0	0	0	13
Unintentional - Therapeutic error	3	0	1	22	0	0	0	26
Unintentional - Misuse	0	1	0	16	0	0	0	17
Unintentional - Bite/sting	2	0	0	3	0	0	0	5
Unintentional - Food poisoning	0	0	0	1	0	0	0	1
Unintentional - Unknown	0	0	0	4	0	0	0	4
Subtotal	26	1	5	102	0	0	0	134
Intentional
Intentional - Suspected suicide	0	0	31	603	0	3	0	637
Intentional - Misuse	1	0	1	44	0	0	0	46
Intentional - Abuse	0	1	9	88	0	0	1	99
Intentional - Unknown	0	0	5	93	0	0	0	98
Subtotal	1	1	46	828	0	3	1	880
Other
Other - Contamination/tampering	0	0	0	1	0	0	0	1
Other - Malicious	2	0	1	3	0	0	0	6
Other - Withdrawal	0	0	1	1	0	0	0	2
Subtotal	2	0	2	5	0	0	0	9
Adverse reaction
Adverse reaction - Drug	1	0	0	25	0	0	0	26
Adverse reaction - Other	0	0	0	2	0	0	0	2
Subtotal	1	0	0	27	0	0	0	28
Unknown
Unknown reason	2	1	3	87	0	0	2	95
Subtotal	2	1	3	87	0	0	2	95
Total	32	3	56	1,049	0	3	3	1,146

^aIncludes cases with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory. This excludes reports with outcome of Death INDIRECT.

Table 9. Route of Exposure for Human Exposure Cases

	Human exposures			Fatal exposures^a
Route	N	% of All Routes	% of All Cases	N	% of All Routes	% of All Cases
Ingestion	1,990,244	79.51	83.45	1,003	80.82	87.52
Dermal	172,318	6.88	7.23	18	1.45	1.57
Inhalation/nasal	136,799	5.47	5.74	88	7.09	7.68
Ocular	107,374	4.29	4.50	0	0.0	0
Bite/sting	61,606	2.46	2.58	5	0.40	0.44
Parenteral	16,865	0.67	0.71	35	2.82	3.05
Unknown	8,944	0.36	0.38	69	5.56	6.02
Other	3,016	0.12	0.13	4	0.32	0.35
Otic	2,519	0.10	0.11	0	0.0	0
Aspiration (with ingestion)	1,624	0.06	0.07	19	1.53	1.66
Vaginal	1,106	0.04	0.05	0	0.0	0
Rectal	736	0.03	0.03	0	0.0	0
Total Number of Routes	2,503,151	100.00	104.96	1,241	100.00	108.29^b

^aIncludes cases with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory. This excludes reports with outcome of Death INDIRECT.

^bEach exposure case may have more than one route.

Table 10. Management Site of Human Exposures

Site of management	N
Managed on site, nonhealth care facility	1,700,736	71.3
Managed in healthcare facility
Treated/evaluated and released	292,289	12.3
Admitted to critical care unit	97,650	4.1
Patient lost to follow-up/left AMA	96,226	4.0
Admitted to noncritical care unit	62,346	2.6
Admitted to psychiatric facility	52,686	2.2
Subtotal (managed in HCF)	601,197	25.2
Other	29,417	1.2
Refused referral	42,497	1.8
Unknown	10,978	0.5
Total	2,384,825	100.0

Table 11. Medical Outcome of Human Exposure Cases by Patient Age^a

	≤5 y		6–12 y		13–19 y		≥20 y		Unknown child		Unknown adult		Unknown age		Total
Outcome	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%
No effect	302,659	25.06	25,660	17.89	25,014	16.02	93,311	12.38	1,018	19.51	10,418	9.88	1,199	8.9	459,279	19.26
Minor effect	95,105	7.88	22,015	15.35	40,125	25.69	179,640	23.84	519	9.95	15,444	14.64	1,930	14.3	354,778	14.88
Moderate effect	10,757	0.89	4,090	2.85	20,655	13.23	99,504	13.21	97	1.86	4,038	3.83	482	3.6	139,623	5.85
Major effect	833	0.07	177	0.12	2,069	1.32	16,385	2.17	2	0.04	267	0.25	69	0.5	19,802	0.83
Death	47	0.00	3	0.00	66	0.04	1,314	0.17	0	0.00	14	0.01	11	0.1	1,455	0.06
No follow-up, nontoxic	232,671	19.27	21,810	15.21	8,698	5.57	44,926	5.96	647	12.40	10,775	10.21	837	6.2	320,364	13.43
No follow-up, minimal toxicity	528,424	43.76	62,824	43.80	41,710	26.71	236,547	31.39	2,166	41.51	45,309	42.95	3,777	28.1	920,757	38.61
No follow-up, potentially toxic	20,916	1.73	3,494	2.44	13,706	8.78	51,417	6.82	648	12.42	14,879	14.10	4,784	35.5	109,844	4.61
Unrelated effect	16,155	1.34	3,349	2.34	4,108	2.63	30,203	4.01	121	2.32	4,341	4.11	371	2.8	58,648	2.46
Death, indirect report	8	0.00	2	0.00	13	0.01	240	0.03	0	0.00	10	0.01	2	0.0	275	0.01
Total	1,207,575	100.00	143,424	100.0	156,164	100.00	753,487	100.00	5,218	100.00	105,495	100.00	13,462	100.00	2,384,825	100.00

^aTotal number of cases where Death was an outcome (1,455 + 275) is greater than the number of fatalities (1,146) judged to be exposure-related (relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).

Table 12. Medical Outcome by Reason for Exposure in Human Exposures^a

	Unintentional		Intentional		Other		Adverse reaction		Unknown		Total
Outcome	N	%	N	%	N	%	N	%	N	%	N	%
No effect	398,439	20.53	55,812	15.94	2,295	12.75	1,522	2.47	1,211	8.45	459,279	19.26
Minor effect	234,875	12.10	98,991	28.28	3,356	18.64	15,329	24.89	2,227	15.54	354,778	14.88
Moderate effect	46,532	2.40	80,998	23.14	1,265	7.03	7,914	12.85	2,914	20.33	139,623	5.85
Major effect	2,756	0.14	15,203	4.34	158	0.88	714	1.16	971	6.78	19,802	0.83
Death	172	0.01	1,023	0.29	14	0.08	62	0.10	184	1.28	1,455	0.06
No follow-up, nontoxic	313,047	16.13	4,926	1.41	1,228	6.82	891	1.45	272	1.90	320,364	13.43
No follow-up, minimal toxicity	853,887	44.00	36,708	10.49	6,547	36.37	21,727	35.28	1,888	13.17	920,757	38.61
No follow-up, potentially toxic	51,189	2.64	49,196	14.05	1,821	10.11	4,426	7.19	3,212	22.41	109,844	4.61
Unrelated effect	39,921	2.06	6,996	2.00	1,316	7.31	9,001	14.61	1,414	9.87	58,648	2.46
Death, indirect report	30	0.00	201	0.06	3	0.02	2	0.00	39	0.27	275	0.01
Total	1,940,848	100.00	350,054	100.00	18,003	100.00	61,588	100.00	14,332	100.00	2,384,825	100.00

^aTotal number of cases where Death was an outcome (1,455 + 275) is greater than the number of fatalities (1,146) judged to be exposure-related (relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).

Table 13. Duration of Clinical Effects by Medical Outcome

	Minor effect		Moderate effect		Major effect
Duration of effect	N	%	N	%	N	%
≤2 hours	122,045	34.40	8,186	5.86	443	2.24
>2 hours, ≤8 hours	94,233	26.56	30,472	21.82	1,242	6.27
>8 hours, ≤24 hours	64,672	18.23	46,587	33.37	4,826	24.37
>24 hours, ≤3 days	24,525	6.91	26,536	19.01	6,294	31.78
>3 days, ≤1 week	5,473	1.54	7,783	5.57	3,550	17.93
>1 week, ≤1 month	1,484	0.42	1,799	1.29	1,160	5.86
>1 month	568	0.16	465	0.33	170	0.86
Anticipated permanent	331	0.09	167	0.12	345	1.74
Unknown	41,447	11.68	17,628	12.63	1,772	8.95
Total	354,778	100.00	139,623	100.00	19,802	100.00

Table 14. Decontamination and Therapeutic Interventions

Therapy	N
Decontamination Only	960,389	40.3
Therapeutic Intervention Only	237,057	9.9
Decontamination and Therapeutic Intervention	405,953	17.0
Not Coded	781,426	32.8
Total	2,384,825	100.0

Table 15. Therapy Provided in Human Exposures by Age.

Therapy	≤5y	6–12 y	13–19 y	≥ 20 y	Unknown child	Unknown adult	Unknown age	Total
Decontamination
Cathartic	2,426	249	3,388	11,544	2	221	12	17,842
Charcoal, multiple doses	141	21	397	1,446	0	15	4	2,024
Charcoal, single dose	16,440	1,104	13,221	40,965	6	602	69	72,407
Dilute/irrigate/wash	592,610	59,422	35,531	202,957	1,704	34,815	2,535	929,574
Food/snack	145,624	11,454	5,911	29,105	192	4,289	183	196,758
Fresh air	6,873	5,141	4,844	41,151	600	11,456	1,042	71,107
Ipecac	163	24	55	109	0	9	0	360
Lavage	180	27	872	3,746	0	52	6	4,883
Other emetic	5,323	473	845	4,213	9	362	39	11,264
Whole bowel irrigation	115	22	331	1,484	0	18	2	1,972
Other Therapies
2-PAM	6	1	4	66	0	0	0	77
Alkalinization	127	69	1,586	8,396	0	70	12	10,260
Amyl nitrite	0	0	2	7	0	2	0	11
Antiarrhythmic	5	1	57	555	0	3	0	621
Antibiotics	2,025	919	1,245	12,084	21	925	84	17,303
Anticonvulsants^a	47	19	116	665	0	7	1	855
Antiemetics	917	335	3,734	9,878	0	149	12	15,025
Antihistamines	2,664	1,702	1,945	10,710	20	1,418	103	18,562
Antihypertensives	12	10	114	1,879	0	25	1	2,041
Antivenin (fab fragment)	418	257	170	1,326	2	26	6	2,205
Antivenin/antitoxin^b	34	34	27	246	0	5	0	346
Atropine	96	17	78	1,054	0	8	1	1,254
BAL	11	1	6	20	0	0	0	38
Benzodiazepines	871	359	4,212	20,459	4	233	34	26,172
Bronchodilators	533	312	405	4,340	29	259	18	5,896
Calcium	9,571	572	242	2,062	19	62	5	12,533
Cardioversion	3	2	26	203	0	0	0	234
CPR	31	7	75	707	0	5	2	827
Deferoxamine	2	1	29	28	0	1	0	61
ECMO	7	0	2	5	0	0	0	14
EDTA	46	2	1	12	0	0	0	61
Ethanol	2	1	5	100	0	1	2	111
Extracorp. procedure (other)	1	1	2	14	0	0	0	18
Fab fragments	39	23	19	570	0	4	2	657
Fluids, IV	6,687	1,609	21,596	102,505	8	1,126	123	133,654
Flumazenil	122	22	183	1,737	0	24	5	2,093
Folate	18	1	26	929	0	6	1	981
Fomepizole	132	17	106	1,668	0	15	3	1,941
Glucagon	31	6	57	1,436	0	16	2	1,548
Glucose, > 5%	346	24	186	2,586	0	29	3	3,174
Hemodialysis	12	4	107	2,162	0	12	1	2,298
Hemoperfusion	0	0	1	22	0	0	0	23
Hydroxocobalamin	5	0	5	37	0	6	0	53
Hyperbaric oxygen	32	37	35	302	1	14	0	421
Insulin	9	7	77	1,419	0	5	0	1,517
Intubation	502	73	1,509	16,996	0	188	40	19,308
Methylene blue	11	2	7	80	0	0	0	100
NAC, IV	210	91	3,341	13,169	0	128	22	16,961
NAC, PO	118	53	1,730	6,374	0	68	19	8,362
Nalmefene	0	0	4	20	0	0	0	24
Naloxone	1,152	131	1,603	15,509	1	197	28	18,621
Neuromuscular blocker	32	8	117	963	0	6	1	1,127
Octreotide	66	2	25	237	0	1	0	331
Other	51,470	9,878	13,882	86,302	203	6,606	712	169,053
Oxygen	1,659	618	3,406	38,675	78	710	104	45,250
Pacemaker	2	0	4	168	0	0	0	174
Penicillamine	1	1	0	2	0	0	0	4
Physostigmine	3	5	87	150	0	0	0	245
Phytonadione	28	6	57	686	0	7	2	786
Pyridoxine	14	2	68	404	0	1	2	491
Sedation (other)	304	67	1,121	11,122	0	96	15	12,725
Sodium nitrite	0	0	2	32	0	1	0	35
Sodium thiosulfate	4	0	5	51	0	3	1	64
Steroids	765	409	543	4,771	15	442	38	6,983
Succimer	117	3	7	65	0	2	0	194
Transplantation	0	0	1	21	0	0	0	22
Vasopressors	88	26	268	4,699	0	35	3	5,119
Ventilator	447	70	1,322	15,300	0	165	33	17,337

^aExcludes benzodiazepines.

^bExcludes Fab fragments.

Table 16A. Decontamination Trends (1985–2009)

Year	Human exposures	Ipecac administered (% of all exposures)	Activated charcoal administered (% of all exposures)	Exposures involving children ≤ 5 y (% of all exposures)	Ipecac administered (% of child exposures)	Activated charcoal administered (% of child exposures)
1985	886,389	132,947 (14.999)	41,063 (4.6)	568,691 (64.2)	94,919 (16.6908)	14,718 (2.59)
1986	1,095,228	145,516 (13.286)	56,481 (5.2)	690,137 (63.0)	99,688 (14.4447)	18,191 (2.64)
1987	1,164,648	117,840 (10.118)	60,310 (5.2)	730,228 (62.7)	83,443 (11.427)	18,507 (2.53)
1988	1,364,113	114,654 (8.4050)	88,876 (6.5)	843,106 (61.8)	80,749 (9.5776)	26,118 (3.10)
1989	1,578,968	110,545 (7.0011)	101,368 (6.4)	963,924 (61.0)	79,192 (8.2156)	30,345 (3.15)
1990	1,646,946	98,986 (6.0103)	108,341 (6.6)	999,751 (60.7)	73,469 (7.3487)	31,579 (3.16)
1991	1,836,364	94,877 (5.1666)	129,092 (7.0)	1,099,179 (59.9)	73,069 (6.6476)	36,177 (3.29)
1992	1,862,796	79,493 (4.2674)	135,625 (7.3)	1,094,256 (58.7)	63,486 (5.8018)	38,937 (3.56)
1993	1,747,147	65,078 (3.7248)	127,893 (7.3)	978,560 (56.0)	50,834 (5.1948)	35,791 (3.66)
1994	1,926,992	51,356 (2.6651)	138,247 (7.2)	1,042,651 (54.1)	41,489 (3.9792)	35,670 (3.42)
1995	2,023,089	47,359 (2.3409)	155,880 (7.7)	1,070,472 (52.9)	38,372 (3.5846)	38,095 (3.56)
1996	2,155,952	39,376 (1.8264)	157,331 (7.3)	1,137,263 (52.7)	32,622 (2.8685)	37,986 (3.34)
1997	2,192,088	32,098 (1.4643)	156,213 (7.1)	1,150,931 (52.5)	26,536 (2.3056)	35,856 (3.12)
1998	2,241,082	26,653 (1.1893)	152,134 (6.8)	1,180,989 (52.7)	22,247 (1.8838)	34,302 (2.90)
1999	2,201,156	21,942 (0.9968)	145,853 (6.6)	1,154,799 (52.5)	18,326 (1.5869)	33,812 (2.93)
2000	2,168,248	18,177 (0.8383)	145,911 (6.7)	1,142,796 (52.7)	15,239 (1.3335)	31,554 (2.76)
2001	2,267,979	16,058 (0.7080)	149,442 (6.6)	1,169,478 (51.6)	13,389 (1.1449)	30,367 (2.60)
2002	2,380,028	13,555 (0.5695)	149,527 (6.3)	1,227,381 (51.6)	11,163 (0.9095)	30,340 (2.47)
2003	2,395,582	9,284 (0.3875)	140,412 (5.9)	1,245,584 (52.0)	7,310 (0.5869)	28,888 (2.32)
2004	2,438,643	4,701 (0.1928)	135,969 (5.6)	1,250,536 (51.3)	3,366 (0.2692)	28,335 (2.27)
2005	2,424,180	3,027 (0.1249)	123,263 (5.1)	1,233,695 (50.9)	1,999 (0.1620)	26,338 (2.13)
2006	2,403,539	2,176 (0.0905)	111,351 (4.6)	1,223,815 (50.9)	1,337 (0.1092)	23,843 (1.95)
2007	2,482,041	1,740 (0.0701)	106,010 (4.3)	1,271,595 (51.2)	1,052 (0.0827)	22,829 (1.80)
2008	2,491,049	1,205 (0.0484)	97,297 (3.9)	1,292,754 (51.9)	641 (0.0496)	21,286 (1.65)
2009	2,479,355	658 (0.0265)	84,805 (3.4)	1,290,784 (52.1)	330 (0.0256)	19,168 (1.48)
2010	2,384,825	360 (0.0200)	74,431 (3.1)	1,207,575 (50.6)	163 (0.0100)	16,581 (1.37)

Table 16B. Decontamination Trends: Total Human and Pediatric Exposures ≤5 Years (2010)^a

	Human exposures		Exposures children ≤5 y
Therapy	N	%	N	%
Activated charcoal administered	74,431	3.12	16,581	1.37
Cathartic	17,842	0.75	2,426	0.20
Ipecac administered	360	0.02	163	0.01
Lavage	4,883	0.20	180	0.01
Other Emetic	11,264	0.47	5,323	0.44
Whole Bowel Irrigation	1,972	0.08	115	0.01
Total	110,752	4.64	24,788	2.05

^aHuman exposures = 2,384,825; Pediatric exposures = 1,207,575.

Table 17A. Substance Categories Most Frequently Involved in Human Exposures (Top 25)

Substance (Major Generic Category)	All substances	%^a	Single substance exposures	%^b
Analgesics	319,622	11.48	208,222	9.70
Cosmetics/Personal Care Products	215,387	7.73	208,321	9.70
Cleaning Substances (Household)	202,056	7.26	180,493	8.41
Sedative/Hypnotics/Antipsychotics	168,030	6.03	66,897	3.12
Foreign Bodies/Toys/Miscellaneous	116,659	4.19	113,877	5.30
Topical Preparations	110,033	3.95	107,874	5.02
Antidepressants	103,041	3.70	43,675	2.03
Cardiovascular Drugs	98,386	3.53	48,460	2.26
Antihistamines	95,880	3.44	69,291	3.23
Pesticides	91,940	3.30	86,419	4.02
Alcohols	85,205	3.06	39,404	1.84
Cold and Cough Preparations	77,899	2.80	57,793	2.69
Vitamins	71,545	2.57	62,743	2.92
Bites and Envenomations	67,692	2.43	66,944	3.12
Antimicrobials	66,021	2.37	55,139	2.57
Hormones and Hormone Antagonists	58,890	2.11	40,410	1.88
Plants	53,526	1.92	50,759	2.36
Gastrointestinal Preparations	53,388	1.92	42,797	1.99
Stimulants and Street Drugs	51,641	1.85	30,654	1.43
Anticonvulsants	48,005	1.72	21,064	0.98
Hydrocarbons	42,663	1.53	40,402	1.88
Chemicals	39,908	1.43	34,393	1.60
Arts/Crafts/Off ce Supplies	33,502	1.20	32,493	1.51
Fumes/Gases/Vapors	32,797	1.18	30,468	1.42
Electrolytes and Minerals	32,505	1.17	27,172	1.27

^aPercentages are based on the total number of substances reported in all exposures (N = 2,784,907).

^bPercentages are based on the total number of single substance exposures (N = 2,147,248).

Fig. 4. Change in Encounters from 2009 to 2010 with Graphical Breakdown of Exposure Calls.

The figure shows how the decrease of 94,530 in Human Exposure Calls divides among the 10 Medical Outcomes. The More Serious Exposures (Minor, Moderate, Major and Death) all increased and their combined increase was 22,175 calls (23.5% of the 94,530 total decrease). The Less Serious Exposures (the other 6 outcome groups) decreased by 116,705 (−123.5% of the 94,530 total decrease). (See colour version of this figure online).

Fig. 5. Gulf Oil Spill Encounters per Day.

Black line for Gulf Oil Spill Encounters (human and animal exposure and information calls) shows a spline smoothing fit (lambda V 0.0000117, rsquare V 0.710). Map shows number of calls per day. (See colour version of this figure online).

Fig. 6. Emerging Trends: Bath Salts and THC Homologs Exposures.

Black line for Bath Salt Exposures shows a spline smoothing fit (lambda = 0.01, rsquare = 0.829).

Black line for THC Homolog Exposures shows s show least-squares second order regressions: THC Exposures = −26,223 + 13.0*Year −3.83* (Year-2011)ˆ2 (rsquare = 0.708). All 3 terms in this regression were statistically significant (p < 0.05). (See colour version of this figure online).

Fig. 7. Human Exposure Calls By Year 2000–2010 – Top 4 Categories.

Solid lines show least-squares linear regressions for the Human Exposure Calls per year for that category (□). Broken lines show 95% confidence interval on the regression. (See colour version of this figure online).

Table 17B. Substance Categories with the Greatest Rate of Exposure Increase (Top 25)

	Increase in exposures per year^a
Substance (Major Generic Category)	Mean	95% CI^a	All substances in 2010
Analgesics	11,240	[9034, 13446]	319,622
Sedative/Hypnotics/Antipsychotics	8,605	[7682, 9529]	168,030
Cardiovascular Drugs	4,897	[4579, 5216]	98,386
Antihistamines	3,700	[3055, 4346]	95,880
Alcohols	2,831	[2217, 3445]	85,205
Vitamins	2,337	[2005, 2668]	71,545
Gastrointestinal Preparations	2,256	[1706, 2807]	53,388
Hormones and Hormone Antagonists	1,948	[1633, 2264]	58,890
Anticonvulsants	1,898	[1557, 2240]	48,005
Topical Preparations	1,849	[611, 3088]	110,033
Other/Unknown Nondrug Substances	1,823	[1264, 2383]	32,102
Cosmetics/Personal Care Products	1,654	[56, 3252]	215,387
Cleaning Substances (Household)	1,560	[−295, 3415]	202,056
Antidepressants	1,475	[453, 2496]	103,041
Muscle Relaxants	1,241	[1074, 1407]	28,489
Miscellaneous Drugs	1,228	[781, 1676]	24,558
Anticholinergic Drugs	1,137	[852, 1422]	11,436
Foreign Bodies/Toys/Miscellaneous	1,093	[−142, 2329]	116,659
Antimicrobials	971	[533, 1409]	66,021
Dietary Supplements/Herbals/Homeopathic	900	[448, 1351]	32,052
Unknown Drug	784	[662, 905]	20,471
Deodorizers	684	[424, 944]	25,619
Essential Oils	646	[578, 715]	10,720
Eye/Ear/Nose/Throat Preparations	599	[471, 727]	21,172
Asthma Therapies	585	[22, 1149]	21,123

^aIncrease and confidence intervals are based on least squares linear regression of the number of calls per year for 2000–2010.

Table 17C. Substance Categories Most Frequently Involved in Pediatric (≤5 years) Exposures (Top 25)^a

Substance (Major Generic Category)	All substances	%^b	Single substance exposures	%^c
Cosmetics/Personal Care Products	165,719	13.18	162,208	13.83
Analgesics	117,586	9.35	106,743	9.10
Cleaning Substances (Household)	116,203	9.24	111,817	9.53
Foreign Bodies/Toys/Miscellaneous	86,426	6.88	84,580	7.21
Topical Preparations	85,384	6.79	84,129	7.17
Vitamins	52,254	4.16	47,758	4.07
Antihistamines	47,674	3.79	42,690	3.64
Pesticides	40,418	3.22	39,333	3.35
Cold and Cough Preparations	38,410	3.06	34,865	2.97
Gastrointestinal Preparations	35,680	2.84	32,749	2.79
Plants	35,674	2.84	34,363	2.93
Antimicrobials	34,769	2.77	32,729	2.79
Cardiovascular Drugs	26,253	2.09	17,246	1.47
Arts/Crafts/Off ce Supplies	24,600	1.96	23,982	2.04
Hormones and Hormone Antagonists	24,593	1.96	19,013	1.62
Electrolytes and Minerals	22,891	1.82	20,854	1.78
Dietary Supplements/Herbals/Homeopathic	22,017	1.75	20,240	1.73
Alcohols	21,860	1.74	21,512	1.83
Deodorizers	21,799	1.73	21,571	1.84
Sedative/Hypnotics/Antipsychotics	15,746	1.25	12,314	1.05
Other/Unknown Nondrug Substances	14,258	1.13	13,790	1.18
Hydrocarbons	13,503	1.07	13,094	1.12
Asthma Therapies	13,436	1.07	12,279	1.05
Antidepressants	13,433	1.07	9,829	0.84
Information Calls	11,963	0.95	11,383	0.97

^aIncludes all children with actual or estimated ages <5 years old. Results do not include “Unknown Child” or “Unknown Age”.

^bPercentages are based on the total number of substances reported in pediatric exposures (N = 1,257,025).

^cPercentages are based on the total number of single substance pediatric exposures (N = 1,173,168).

Table 17D. Substance Categories Most Frequently Involved in Adult (≥ 20 years) Exposures (Top 25)^a

Substance (Major Generic Category)	All substances	%^b	Single substance exposures	%^c
Analgesics	149,532	12.96	69,333	10.01
Sedative/Hypnotics/Antipsychotics	128,982	11.18	42,540	6.14
Antidepressants	71,367	6.19	24,389	3.52
Cleaning Substances (Household)	69,376	6.01	54,666	7.89
Cardiovascular Drugs	63,229	5.48	25,556	3.69
Alcohols	54,128	4.69	12,829	1.85
Bites and Envenomations	44,580	3.86	44,133	6.37
Pesticides	42,737	3.70	38,861	5.61
Anticonvulsants	33,720	2.92	12,391	1.79
Cosmetics/Personal Care Products	33,009	2.86	30,516	4.41
Antihistamines	29,962	2.60	14,557	2.10
Hormones and Hormone Antagonists	29,317	2.54	17,780	2.57
Stimulants and Street Drugs	25,559	2.22	12,065	1.74
Chemicals	23,504	2.04	19,552	2.82
Hydrocarbons	23,001	1.99	21,512	3.11
Fumes/Gases/Vapors	22,977	1.99	21,190	3.06
Antimicrobials	22,905	1.99	16,212	2.34
Muscle Relaxants	22,242	1.93	7,970	1.15
Cold and Cough Preparations	20,121	1.74	10,591	1.53
Topical Preparations	18,324	1.59	17,663	2.55
Food Products/Food Poisoning	17,228	1.49	16,728	2.42
Gastrointestinal Preparations	13,942	1.21	7,381	1.07
Information Calls	13,076	1.13	12,027	1.74
Miscellaneous Drugs	13,057	1.13	6,821	0.98
Other/Unknown Nondrug Substances	12,644	1.10	11,070	1.60

^aIncludes all adults with actual or estimated ages ≥20 years old. Results also include “Unknown Adult” but do not include “Unknown Age”.

^bPercentages are based on the total number of substances reported in adult exposures (N = 1,153,827).

Percentages are based on the total number of single substance adult exposures (N = 692,666).

Table 17E. Substance Categories Most Frequently Involved in Pediatric (≤5 years) Deaths^a

Substance (Major Generic Category)	All substances	%^b	Single substance exposures	%^c
Analgesics	11	15.71	7	14.89
Antihistamines	6	8.57	3	6.38
Sedative/Hypnotics/Antipsychotics	6	8.57	3	6.38
Fumes/Gases/Vapors	5	7.14	5	10.64
Chemicals	4	5.71	2	4.26
Cold and Cough Preparations	4	5.71	2	4.26
Food Products/Food Poisoning	4	5.71	4	8.51
Pesticides	4	5.71	2	4.26
Alcohols	3	4.29	1	2.13
Cardiovascular Drugs	3	4.29	3	6.38
Hydrocarbons	3	4.29	3	6.38
Unknown Drug	3	4.29	2	4.26
Automotive/Aircraft/Boat Products	2	2.86	1	2.13
Batteries	2	2.86	2	4.26
Bites and Envenomations	2	2.86	2	4.26
Other/Unknown	2	2.86	1	2.13
Nondrug
Substances
Cleaning Substances (Household)	1	1.43	1	2.13
Dietary Supplements/	1	1.43	1	2.13
Herbals/
Homeopathic
Electrolytes and Minerals	1	1.43	1	2.13
Foreign Bodies/Toys/Miscellaneous	1	1.43	0	0.00
Hormones and Hormone Antagonists	1	1.43	1	2.13
Information Calls	1	1.43	0	0.00
Total	70	100.00	47	100.00

^aIncludes all children with actual or estimated ages ≤5 years old. Results do not include “Unknown Child” or “Unknown Age”. Includes death and death, indirect regardless of Relative Contribution to Fatality.

^bPercentages are based on the total number of substances reported in pediatric fatalities (N = 70).

Percentages are based on the total number of single substance pediatric fatalities (N = 47).

Table 17F. Substance Categories Most Frequently Identified in Drug Identification Calls (Top 25)

Substance (Major Generic Category)	All substances	%^a
Analgesics	506,838	35.05
Sedative/Hypnotics/Antipsychotics	180,009	12.45
Information Calls	139,789	9.67
Unknown Drug	77,584	5.37
Muscle Relaxants	69,595	4.81
Antidepressants	63,202	4.37
Cardiovascular Drugs	57,682	3.99
Antihistamines	50,922	3.52
Antimicrobials	48,779	3.37
Stimulants and Street Drugs	31,795	2.20
Anticonvulsants	28,709	1.99
Hormones and Hormone Antagonists	26,667	1.84
Gastrointestinal Preparations	25,151	1.74
Cold and Cough Preparations	14,326	0.99
Diuretics	14,201	0.98
Miscellaneous Drugs	13,757	0.95
Pesticides	9,939	0.69
Foreign Bodies/Toys/ Miscellaneous	7,074	0.49
Other/Unknown Nondrug Substances	6,324	0.44
Plants	5,945	0.41
Cleaning Substances (Household)	5,603	0.39
Electrolytes and Minerals	4,303	0.30
Chemicals	4,191	0.29
Vitamins	4,186	0.29
Bites and Envenomations	4,107	0.28

^aPercentages are based on the total number of substances reported in all drug identification calls (N = 1,446,038).

Table 17G. Substance Categories Most Frequently Involved in Pregnant Exposures^a (Top 25)

Substance (Major Generic Category)	All substances	%^b	Single substance exposures	%
Analgesics	1,121	12.42	685	9.75
Cleaning Substances (Household)	796	8.82	593	8.44
Pesticides	629	6.97	576	8.20
Bites and Envenomations	523	5.79	521	7.41
Fumes/Gases/Vapors	506	5.61	471	6.70
Sedative/Hypnotics/Antipsychotics	434	4.81	198	2.82
Vitamins	372	4.12	305	4.34
Antihistamines	303	3.36	186	2.65
Foreign Bodies/Toys/Miscellaneous	278	3.08	260	3.70
Antidepressants	262	2.90	131	1.86
Information Calls	249	2.76	233	3.32
Cosmetics/Personal Care Products	247	2.74	227	3.23
Antimicrobials	219	2.43	158	2.25
Chemicals	194	2.15	169	2.40
Hydrocarbons	192	2.13	178	2.53
Cold and Cough Preparations	180	1.99	107	1.52
Food Products/Food Poisoning	149	1.65	146	2.08
Cardiovascular Drugs	144	1.60	97	1.38
Hormones and Hormone Antagonists	142	1.57	120	1.71
Alcohols	136	1.51	57	0.81
Electrolytes and Minerals	136	1.51	116	1.65
Gastrointestinal Preparations	132	1.46	105	1.49
Stimulants and Street Drugs	130	1.44	84	1.20
Other/Unknown Nondrug Substances	122	1.35	104	1.48
Paints and Stripping Agents	121	1.34	111	1.58

^aIncludes all patient classified as pregnant and all female patients with a ‘duration of pregnancy’ greater than 0.

^bPercentages are based on the total number of substances reported in pregnant exposures (N = 9,027).

Percentages are based on the total number of single substance pregnant exposures (N = 7,028).

Table 18. Categories Associated with Largest Number of Fatalities (Top 25)^a

Substance (Minor Generic Category)	All substances	%^b	Single substance exposures	%^c
Miscellaneous Sedative/Hypnotics/Antipsychotics	445	15.82	29	3.80
Miscellaneous Cardiovascular Drugs	265	9.42	53	6.94
Opioids	265	9.42	59	7.72
Acetaminophen Combinations	240	8.53	65	8.51
Miscellaneous Antidepressants	212	7.54	16	2.09
Miscellaneous Alcohols	171	6.08	38	4.97
Acetaminophen Alone	130	4.62	60	7.85
Miscellaneous Anticonvulsants	121	4.30	11	1.44
Miscellaneous Stimulants and Street Drugs	117	4.16	45	5.89
Cyclic Antidepressants	88	3.13	21	2.75
Miscellaneous Muscle Relaxants	78	2.77	6	0.79
Miscellaneous Antihistamines	66	2.35	12	1.57
Acetylsalicylic Acid Alone	62	2.20	21	2.75
Nonsteroidal Antiinflammatory Drugs	58	2.06	5	0.65
Miscellaneous Fumes/Gases/Vapors	50	1.78	52	6.81
Miscellaneous Unknown Drug	41	1.46	57	7.46
Miscellaneous Chemicals	34	1.21	29	3.80
Oral Hypoglycemic	28	1.00	6	0.79
Miscellaneous Hormones and Hormone Antagonists	23	0.82	8	1.05
Other Miscellaneous Drugs	18	0.64	4	0.52
Miscellaneous Hydrocarbons	17	0.60	16	2.09
Acids	16	0.57	11	1.44
Miscellaneous Anticoagulants	13	0.46	3	0.39
Antacids	12	0.43	0	0.00
Automotive Products	12	0.43	10	1.31

^aNumbers represent total exposures associated with 1,366 fatalities (with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory); each fatality may have had exposure to more than one substance.

^bPercentages are based on the total number of substances reported in fatal exposures (N = 2,813).

^cPercentages are based on the total number of single substance fatal exposures (N = 764).

Table 19A. Comparisons of Death Data (1985–2010)^a

	Total fatalities		Suicides		Pediatric deaths^b
Year	N	% of cases	N	% of deaths	N	% of deaths
1985	328	0.036	174	(53.0)	20	(6.1)
1986	406	0.037	223	(54.9)	15	(3.7)
1987	398	0.034	227	(57.0)	22	(5.5)
1988	544	0.040	296	(54.4)	30	(5.5)
1989	590	0.037	323	(54.7)	24	(4.1)
1990	553	0.032	320	(57.9)	21	(3.8)
1991	764	0.042	408	(53.4)	44	(5.8)
1992	705	0.038	395	(56.0)	29	(4.1)
1993	626	0.036	338	(54.0)	27	(4.3)
1994	766	0.040	410	(53.5)	26	(3.4)
1995	724	0.036	405	(55.9)	20	(2.8)
1996	726	0.034	358	(49.3)	29	(4.0)
1997	786	0.036	418	(53.2)	25	(3.2)
1998	775	0.035	421	(54.3)	16	(2.1)
1999	873	0.040	472	(54.1)	24	(2.7)
2000	921	0.042	477	(51.8)	20	(2.2)
2001	1,085	0.048	553	(51.0)	27	(2.5)
2002	1,170	0.049	635	(54.3)	27	(2.3)
2003	1,109	0.046	592	(53.4)	35	(3.2)
2004	1,190	0.049	642	(53.9)	27	(2.3)
2005	1,438	0.059	674	(46.9)	32	(2.2)
2006	1,515	0.063	705	(46.5)	39	(2.6)
2007	1,597	0.064	737	(46.1)	47	(2.9)
2008	1,756	0.070	797	(45.4)	39	(2.2)
2009	1,544	0.062	779	(50.5)	37	(2.4)
2010	1,730	0.072	779	(45.0)	55	(3.2)

^aHuman exposures with medical outcome of death or death, indirect regardless of Relative Contribution to Fatality.

^bIncludes all children with actual or estimated ages ≤ 5 years old. Results do not include “Unknown Child” or “Unknown Age”. Includes death and death, indirect regardless of Relative Contribution to Fatality.

Table 19B. Comparisons of Direct and Indirect Death Data (2000–2010)^a

	All deaths			Suicides					Pediatric deaths
Year	Total	Direct	Indirect	Total	% of deaths	Direct	% of direct	Indirect	Total	% of deaths	Direct	% of direct	Indirect
2000	864	845	19	448	51.85	443	52.43	5	18	2.08	18	2.13	0
2001	1066	952	114	542	50.84	503	52.84	39	26	2.44	24	2.52	2
2002	850	739	111	455	53.53	436	59.00	19	24	2.82	15	2.03	9
2003	867	826	41	464	53.52	454	54.96	10	29	3.34	22	2.66	7
2004	955	898	57	516	54.03	501	55.79	15	25	2.62	21	2.34	4
2005	1423	1332	91	666	46.80	656	49.25	10	32	2.25	26	1.95	6
2006	1515	1415	100	705	46.53	687	48.55	18	39	2.57	32	2.26	7
2007	1597	1502	95	737	46.15	712	47.40	25	47	2.94	41	2.73	6
2008	1756	1535	221	797	45.39	750	48.86	47	39	2.22	32	2.08	7
2009	1544	1452	92	779	50.45	748	51.52	31	37	2.40	31	2.13	6
2010	1730	1455	275	779	45.03	732	50.31	47	55	3.18	47	3.23	8

^aHuman exposures with medical outcome of death or death, indirect regardless of Relative Contribution to Fatality.

Table 20. Frequency of Plant Exposures (Top 25)^a

	Botanical name or Category	AAPCC Generic Code Name	N
1	Plants-general-unknown	Unknown Toxic Types or Unknown if Toxic	2,761
2	Botanical terms	Unknown Toxic Types or Unknown if Toxic	2,201
3	Unknown Botanical Name	Unknown Toxic Types or Unknown if Toxic	2,114
4	Phytolacca americana (L.)	Gastrointestinal Irritants (Excluding Oxalate Containing Plants)	1,933
5	Spathiphyllum spp.	Oxalates	1,550
6	Ilex spp. (not otherwise specified)	Gastrointestinal Irritants (Excluding Oxalate Containing Plants)	877
7	Philodendron spp.	Oxalates	852
8	Plants-pokeweed	Other Toxic Types	823
9	Euphorbia pulcherrima (Willd.)	Gastrointestinal Irritants (Excluding Oxalate Containing Plants)	750
10	Toxicodendron radicans (L.)	Skin Irritants (Excluding Oxalate Containing Plants)	690
11	Plants-cardiac glycosides	Cardiac Glycosides (Excluding Drugs)	637
12	Cherry (Prunus spp.)	Amygdalin and/or Cyanogenic Glycosides	556
13	Plants-cyanogenic glycosides	Amygdalin and/or Cyanogenic Glycosides	537
14	Zantedeschia aethiopica	Oxalates	497
15	Malus species	Amygdalin and/or Cyanogenic Glycosides	495
16	Berry (not otherwise specified)	Unknown Toxic Types or Unknown if Toxic	495
17	Caladium spp.	Oxalates	461
18	Mold (not otherwise specified)	Unknown Toxic Types or Unknown if Toxic	451
19	Narcissus pseudonarcissus (L.)	Gastrointestinal Irritants (Excluding Oxalate Containing Plants)	424
20	Taraxacum off cinale	Non-Toxic	409
21	Epipremnum areum	Oxalates	409
22	Solanum dulcamara	Solanine	406
23	Nandina domestica (Thumb)	Unknown Toxic Types or Unknown if Toxic	384
24	Schlumbergera bridgesii	Non-Toxic	384
25	Plants-oxalates	Oxalates	375

^aNumber of substances related to a human exposure with a Major Generic Category of Plant. Unknown Botanical Name represents substances with a Major Generic Category of Plant and a NULL substance code. Total = 53, 526.

Table

Table	Fatalities Included	RCF	Number of Deaths
4	Death only	1,2,3	1,146
5	Death only	1,2,3	1,146
8	Death only	1,2,3	1,146
9	Death only	1,2,3	1,146
11	Death and Death (indirect report)	All	1,730
12	Death and Death (indirect report)	All	1,730
17E	Death and Death (indirect report)	All	1,730
18	Death and Death (indirect report)	1,2,3	1,366
19A	Death and Death (indirect report)	All	1,730
19B	Death and Death (indirect report)	All	1,730
21	Death and Death (indirect report)	1,2,3	1,366
22	Death and Death (indirect report) - Single substance deaths only	All	764

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