Abstracts of the XXIX International Congress of the European Association of Poison Centres and Clinical Toxicologists, May 12–15, 2009, Stockholm, Sweden

Figures & data

Table.  Assays Recommended by the National Academy of Clinical Biochemists

Serum Assays, Quantitative	Urine Assays, Qualitative
Acetaminophen	Amphetamines
Carbamazepine	Barbiturates
Cooximetry (carboxyhemoglobin, methemoglobin, oxygen saturation)	CocaineOpiates
Digoxin	Propoxyphene
Ethanol	Phencyclidine
Iron (plus transferrin or unfilled iron-binding capacity)	Tricyclic antidepressants
Lithium
Phenobarbital
Salicylate
Theophylline
Valproic acid

Table.  Requirements of product notification in EU-GHS as a first step towards European harmonisation

		Option 1	Option 2	Option 3
EU-GHS Hazard class	Categories	EAPCCT proposal (direct translation)	Division based on EU-GHS Pictograms	Division based on EU-GHS Signal word
Acute toxicity Oral	1, 2, 3, 4	1, 2, 3 (partial)	1, 2, 3	1, 2, 3
Acute toxicity Dermal	1, 2, 3, 4	1, 2, 3 (partial)	1, 2, 3	1, 2, 3
Acute toxicity Inhalation	1, 2, 3, 4	1, 2, 3	1, 2, 3	1, 2, 3
STOT* - single exp.	1, 2, 3	1	1, 2	1
STOT* - repeated exp.	1, 2	1	1, 2	1
Aspiration hazard	1		1	1
Skin corrosion/irritation	1ABC, 2	1ABC	1ABC	1ABC
Eye damage/irritation	1, 2		1	1
Respiratory sensitisation	1		1	1
Skin sensitisation	1
Carcinogenicity	1AB, 2	1AB	1AB, 2	1AB
Germ cell mutagenicity	1AB, 2	1AB	1AB, 2	1AB
Reproductive toxicity	1AB, 2	1AB	1AB, 2	1AB
Effects on/via lactation
* Specific Target Organ Toxicity		Based on cut-off limits for T^+, T and C as used in 1999/45/EC	Pictograms: Skull/crossbones Health hazard Corrosion	Signal word: Danger

Table 1.  Symptoms of 11 patients who ingested fentanyl patches

Age	Amount	#	Patch(mcg)	Naloxone	Intubation	Symptoms
Adult	Licked	1	unkn			“stoned”
50	Gel extracted	2	100	Y	N	lethargic, hypoxic
25	Gel extracted	1	100	N	N	Ten episodes of emesis
28	Ingested	1	50	Y	N	Unconscious
Adult	Ingested	3	100	Y	N	Unconscious, cyanotic, hypoxic
35	Sucked	1	unkn	N	Y	Seizure, respiratory failure, hypotension, elevated troponin
52	Ingested	0.5	100	Y	N	Respiratory arrest
34	Ingested	1	unkn	Y	N	Unconscious, hypoxic, acute lung injury, elevated troponin
51	Adhered to pharyngeal mucosa	1	100	Y	Y	Unconscious, hypoxic, elevated troponin, creatine and liver function tests, anoxic brain injury, death

Table 1.  Laboratory values

Blood pH	7.33
HCO3 (mEq/L)	16
Anion Gap (mEq/L)	18
APAP Level (mcg/mL)	488.1
AST (U/L)	27
ALT (U/L)	Not available
Salicylate (mg/dL)	<2
Lactic acid (mmol/L)	7.4

Table.  Clinical and laboratory features according to number of days post-ingestion

Clinical and laboratory features	Days from ingestion	D1	D2	D3	D4	D5	D6	D12
Tachycardia		+	+	+	+	+	−	−
Hypertension		+	+	+	−	−	−	−
Hallucinations		+	+	+	−	−	−	−
CK serum levels (U/L; RV < 145)		689	950	2,577	1,378	587	394	151
Sibutramine serum levels (ng/mL)(Cmax = 6.6; t½ = 5.9h) (1)		2.9	1.2	0.49	0.42	0.31	0.23	ND
M1 metabolite serum levels (ng/mL)(Cmax = 4.8; t½ = 14.5h) (1)		2.3	1.8	1.7	0.98	0,94	0,91	0.43
M2 metabolite serum levels (ng/mL)(Cmax = 10.8; t½ = 13.6) (1)		4.7	2.4	1.7	1.3	1.1	0.94	0.28

* = 26h post-ingestion

Table 1.  Surfactants contained in various types of liquitabs

	Anionic Surfactants 10–30%	Non-ionic Surfactants1–5%
Bold 2 in 1 Lavender & Camomile Liquitabs	+
Daz Liquitabs	+
Ariel Colour Liquitabs	+	+
Ariel Non Biological Liquitabs	+	+

Table 1.  Health hazard classification of substances and mixtures.^1,2

Directive 1999/45EC	EU-GHS
		Categories and signal word
Classification	Hazard class	Danger	Warning
T^+ R28 / T R25 / Xn R22	Acute toxicity Oral	cat. 1 / 2 / 3	cat. 4
T^+ R27 / T R24 / Xn R21	Acute toxicity Dermal	cat. 1 / 2 / 3	cat. 4
T^+ R26 / T R23 / Xn R20	Acute toxicity Inhalation	cat. 1 / 2 / 3	cat. 4
T^+ R39 / T R39 / Xn R68 / R37 / R67	STOT - single exposure	cat. 1	cat. 2 / 3
T R48 / Xn R48	STOT - repeated exposure	cat. 1	cat. 2
Xn R65	Aspiration hazard	cat. 1
C R35 / C R34 / Xi R38	Skin corrosion/irritation	cat. 1A / 1B / 1C	cat. 2
Xi R41 / Xi R36	Eye damage/irritation	cat. 1	cat. 2
Xn R42	Respiratory sensitisation	cat. 1
Xi R43	Skin sensitisation		cat. 1
cat.1/2 (T R45/T R49) / cat.3 (Xn R40)	Carcinogenicity	cat. 1A / 1B	cat. 2
cat.1/2 (T R46) / cat.3 (Xn R68)	Germ cell mutagenicity	cat. 1A / 1B	cat. 2
cat.1/2 (T R60/T R61) / cat.3 (Xn R62/63)	Reproductive toxicity	cat. 1A / 1B	cat. 2
R64	Effects on or via lactation

* Specific Target Organ Toxicity

Table.  The correlation between 24 and 48 hour C2:C1 ratio at 1, 3, 10 15, 20 and 30 Hz and the 24 & 48 hours AUC of RBC-AChE level

Parameter	1Hz		3Hz		10Hz		15Hz		20Hz		30Hz
Time	24h	48h	24h	48h	24h	48h	24h	48h	24h	48h	24h	48h
XY pairs	46	42	46	42	46	43	45	39	43	41	43	39
Spearman's r	.196	.378	.254	.419	.266	.345	.353	.441	.369	.521	.369	.520
P value	.191	.014	.088	.006	.074	.023	.017	.005	.015	.000	.015	.001

Table.  Mean NPISE and enquirer severity grades for different pesticide groups

Category	Enquirer Mean	NPISE PSS Mean	Differencein means	Paired Wilcoxon test Z and 2 tail P value	Spearman rank correlation coefficient
All products Children (685)	0.58	0.16	0.42	Z = 12.34	Rs = 0.13
				P < 0.001	P < 0.001
All products Adults (495)	0.89	0.74	0.15	Z = 4.04	Rs = 0.34
				P < 0.001	P < 0.001
Mann-Whitney Value (P2)	Z = −6.92	Z = −15.36
	P = < 0.001	P = < 0.001
Rodenticide Children (272)	0.57	0.06	0.51	Z = 8.85	Rs = 0.03
				P < 0.001	P = 0.59
Rodenticide Adults (34)	0.59	0.32	0.27	Z = 1.9	Rs = 0.25
				P = 0.06	P = 0.15
Mann-Whitney Value (P2)	Z = 0.08	Z = −2.02
	P = 0.94	P = 0.04
Ant Killer Children (104)	0.56	0.16	0.40	Z = 4.94	Rs = 0.19
				P < 0.001	P = 0.06
Ant Killer Adults (45)	0.64	0.76	−0.12	Z = −1.12	Rs = 0.45
				P = 0.26	P < 0.01
Mann-Whitney Value (P2)	Z = −0.65	Z = −5.73
	P = 0.52	P = < 0.001
Glyphosate Children (26)	0.58	0.31	0.27	Z = 1.35	Rs = −0.03
				P = 0.18	P = 0.91
Glyphosate Adults (55)	1.02	0.69	0.33	Z = 2.62	Rs = 0.3
				P < 0.01	P = 0.02
Mann-Whitney Value (P2)	Z = −2.44	Z = −2.49
	P < 0.02	P < 0.02

Table.  Age, risk factors, cardiovascular disease and patients and controls

	Poisoning (N = 5)	Non-poisoning (N = 12)	p
Age (years)	50 [32–60]	68 [58–81]	0.03
SAPS II score	54 [48–62]	61 [46–67]	0.7
Risk factor (N)	0 [0–1]	3 [2–5]	0.008
Past cardiovasculardiseases (%)	0	58	0.04
Delay betweenmaximalcatecholamineinfusion rate (h)	48 [36–60]	0 [0–24]	0.06
Ischemic bowel (cm)	90 [28–135]	375 [170–500]	0.008
Ileal ischemia (%)	20	100	0.002
Mortality (%)	20	92	0.009

Table 1.  Profiles of chemical cases

		SIT N = 33502	TSP N = 5259
Age	< 15 years	49%	13%
Sex	Men	48.90%	50%
	Women	41.90%	50%
Type of poisoning	Domestic accident	56%	67%
	Occupational	5.50%	17%
	Suicides	2.20%	12%
Type of chemical	Caustics	8.30%	28.10%
	Pesticides	10.31%	9.20%
	Solvents	2.80%	9.70%
	Irritant Gases	1.90%	12.90%
	Toxic gases	0.40%	26.10%

Table I.  Numbers of poisoning cases, deadly cases, cases with seizures, respiratory or cardiovascular complications per 1,000,000 treatment months

	Poisoning	Death	Seizures	Respiratory complications	Cardiovascular complications
COD	328.3	0.91	0.37	2.65	6.58
DPP	162.7	0.58	0.43	1.28	3.00
TRA	167.8	0.76	3.64	3.70	5.29

Table.  Number of slimming tablet enquiries

Agent	Orlistat	Rimonabant	F, B & D	Appetite sup.	Bulking Agent
Total Enquiries	65	5	50	10	3
Agent	Sympatho.	Levocartinine	Dinitrophenol	Liothyronine	Slimming Nk
Total Enquiries	66	3	2	3	33