The impact of bittering agents on suicidal ingestions of antifreeze

Abstract

Background. Legislation requiring the addition of bittering agents to antifreeze enables assessment of the impact on frequency, volume and severity of suicidal antifreeze ingestions. Methods. U.S. poison control data were analyzed comparing 130 suicidal antifreeze ingestions occurring in two states after enactment of bittering requirements with 3,493 cases occurring in states (or at times) where bittering was not required. Results. The frequency of suicidal antifreeze ingestions was unchanged after implementation of bittering. The volume implicated, medical outcome distribution, and use of antidotes, hemodialysis, intubation, or critical care, showed no significant difference between bittered and non-bittered groups. Bittering was not a significant contributor (positively or negatively) in predicting lethal or life-threatening medical outcomes. Conclusion. The addition of bittering agents to antifreeze for the purpose of limiting the frequency or severity of suicidal ingestions could not be justified using U.S. poison control data.

Keywords: :

• Antifreeze poisoning
• Aversive agents
• Suicidal ingestions

Acknowledgment

The authors acknowledge the assistance of Dan Tandberg, MD, Professor Emeritus, Department of Emergency Medicine, University of New Mexico for advice on statistical methods.

Notes

¹AAPCC Disclosure Statement: The American Association of Poison Control Centers (AAPCC, www.aapcc.org) maintains the national database of information logged by the 61 U.S. poison control centers. Case records in this database are from self-reported calls; they reflect only information provided when the public or healthcare professionals report an actual or potential exposure to a substance (e.g., an ingestion, inhalation, or topical exposure), or request information. Exposures do not necessarily represent a poisoning or overdose. The AAPCC is not able to completely verify the accuracy of every report made to member centers. Additional exposures may go unreported to poison control centers and data referenced from the AAPCC should not be construed to represent the complete incidence of national exposures to any substance(s).

²TESS data were released to the authors with the stipulation that individual states would not be identified.

16. An Act Relating to Consumer Products; Requiring an Aversive or Bittering Agent in Engine Coolant and Antifreeze; Providing for a Limitation on Liability; Providing Exceptions, 2005, New Mexico Senate Bill 497, 47th Legislature. Introduced by G. P. Ortiz y Pino.

47. Consumer Product Safety Improvement Act of 1990, Pub. L. No. 101–608, § 204, 104 Stat. 3110, 1990.

48. Antifreeze Bittering Act of 2003, H.R. 1563, 108th Congress, 2003.

49. Antifreeze Bittering Act of 2005, H.R. 2567, 109th Congress, 2005.

50. Engine Coolant and Antifreeze Bittering Agent Act of 2005, S. 1110, 109th Congress, 2005.