UAB Synopsis, Vol. 27, No. 19, May 19, 2008
For the second consecutive year poisoning surpassed firearms as the second most prevalent cause of death (age adjusted) by injury in the United States, behind motor vehicle traffic-related injuries, according to the CDC’s National Vital Statistics System.
Children’s Hospital (CH) provides primary support for the Regional Poison Control Center-CH with longstanding support of the UAB Department of Pediatrics, Blue Cross and Blue Shield of Alabama, and the Health Resources and Services Administration-funded Poison Control Center Enhancement and Stabilization grant program.
The nation’s 59 poison control centers are accessed through a nationwide number, 800.222.1222, with calls automatically routed to the nearest center. The centers annually receive more than 2.3 million calls about human poisonings and 135,000 calls about animal poisonings. Some 38,000 calls are received each year at the Regional Poison Control Center-CH.
The local center, now celebrating its 50th anniversary, serves every county in Alabama on a toll-free, 24 hours-a-day, 7 days-a-week basis. It is certified by the American Association of Poison Control Centers.
Pediatric resident Don Palmer, MD, started the local center in 1958. Pediatrician Paul A. Palmisano, MD, a former associate dean of the School of Medicine at UAB, was named first medical director in 1966. William D. King, RPh, MPH, DrPH, began work with the center in 1977 and has been director since 1983. Current comedical directors are longtime staff member Michele H. Nichols, MD, and Erica L. Liebelt, MD. All are professors of pediatrics. Ann Slattery, DrPH, is clinical supervisor.
The majority of calls to the Birmingham center are about unintentional exposure to poisons of children younger than 6 years. Overall, pediatric poisonings comprise 57% of the center’s calls. Poison Control Center calls are analyzed on state and national levels for patterns that could indicate wide toxic exposures and even biological or chemical attacks. The center is working with the Alabama Department of Public Health’s Emergency Preparedness Division to develop, with CDC state grant funds, a real-time surveillance and notification protocol using poison center data.
Only about 10% of calls result in a hospital emergency department visit. “Poison centers are an excellent example of health care cost containment,” Dr. King says. “A recent Institute of Medicine report indicated that every $1 spent supporting poison control centers saves $7 in health care costs. Consider how many cases don’t come into busy emergency rooms because they talked to us first – about 90% of cases can be treated safely and effectively at home if people call us quickly.”
Fatal poisonings increased at a dramatic pace in recent years, with prescription narcotic opioid drugs, specifically methadone, responsible for most of the increase. Deaths from overdosing on methadone pills, increasingly prescribed for pain control in recent years, rose almost 500% between 1999 and 2005.
Dr. Liebelt points out physicians turned to methadone when other opiates such as OxyContin became frequently abused. “However, methadone is problematic because its pain-killing effects last about 6 to 8 hours but the drug stays in the body as long as several days. After 8 hours, patients may take additional methadone to reestablish pain relief effects, and toxic levels of the drug build up,” she says.
Inhalant exposures are another area of concern to poison control specialists. The University of Michigan’s annual Monitoring the Future survey shows inhalant abuse increasing about 4 years ago after several years of decline. “The increase in use occurred primarily among students in late junior high school and early high school,” Dr. Liebelt says. Most of the substances are not illegal.The board certified medical toxicologist is continually amazed at the toxic substances people intentionally or unintentionally ingest, inhale, or inject. “They’re cheap and easy to get, such as glue, spray paint, hair spray, typewriter correction fluid, paint thinners, cooking sprays, and fabric and leather protectant sprays,” she says.
Sometimes stores recognize the toxic potential of these agents. A purchase of Dust-Off, a spray including a Freon-like substance intended for cleaning electronic equipment such as computer keyboards, now results in a cash register prompt to make sure the buyer is at least 18 years old. Dr. Liebelt treated one older teenager for Dust-Off poisoning who presented with hoarseness and hypoxia from a cold thermal injury of the pharynx and lungs. The young man died several days later.
“Kids learn early that they can put nozzles in their mouths, then spray, or put model airplane glue in a bag and inhale. Aerosolized cans of whipped cream are a popular source of nitrous oxide. Young teens put the nozzle into their noses and trigger the spray without shaking the can,” Dr. Liebelt says.
She says “huffing” gasoline, paint thinner, and other volatile substances is a popular form of abuse. Individuals stuff a substance-saturated cloth in the mouth and inhale with rapid short breaths.
Young people in particular often do not see the danger in experimentation, she says, “yet many kids die from sniffing that can cause fatal heart fibrillation after only one use, termed ‘sudden sniffing death.’”
“Inhalants also can cause permanent injury with chronic use. For example, airplane glue, rubber cement, lacquers, and paint thinners are volatile substances that contain toluene, which can cause encephalopathy,” she says.
Poison cases are notoriously underreported, Dr. Liebelt says. “Parents often are unaware their kids are going through household medicine cabinets. They also don’t know that pill bottles that may be child resistant certainly are not child proof. Things are often worse when grandparents are involved – they may not be used to safely storing toxic household chemicals or keeping medicine and pill planners out of reach.”
Dr. Liebelt can be contacted by e-mail at eliebelt@uab.edu or by telephone through the national 800 number or the local number, 205.939.9201. Dr. King may be contacted at bill.king@chsys.org.