POISON CONTROL

March 21, 2017

 

In honor of National Poison Prevention week (March 19-25), a few representatives from the National Capital Poison Center did an AMA (Ask Me Anything) on Reddit last week. I’ve copy/pasted some of the best questions and answers below or you can browse through the attached slides or our Poison Control photo album. Please take a few minutes to learn how to prevent and respond to a poison emergency, and please be safe!

 

 

Hello! We are pharmacist, nurse and physician toxicologists and poison specialists at the National Capital Poison Center in Washington DC. It’s hard to imagine what people swallow, splash, or inhale by mistake, but collectively we’ve responded to more than million phone calls over the years about…you name it!

 

There are two ways to get free, confidential, expert help if a poisoning occurs:

 

1) Call 1-800-222-1222, or

 

2) Logon to poison.org to use the webPOISONCONTROL® tool for online guidance based on age, substance and amount swallowed. Bookmark that site, or download the app at the App Store or Google play.

 

You don’t have to memorize that contact info. Text “poison” to 484848 (don’t type the quotes) to save the contact info directly to your smart phone.

 

The National Capital Poison Center is a not-for-profit organization and accredited poison center. Free, expert guidance for poison emergencies – whether by telephone or online – is provided 24/7. Our services focus on the DC metro area, with a national scope for our National Battery Ingestion Hotline (202-625-3333), the webPOISONCONTROL online tool, and The Poison Post®. We are not a government agency. We depend on donations from the public.

 

Now for a bit of negative advertising: We hope you never need our service! So please keep your home poison safe.

 

 

What's your rule-of-thumb for sending people to the hospital vs. staying home and treating themselves?

 

The decision to send someone to the emergency room instead of treating them at home is based on many different factors including what substance is involved, amount, how long ago the exposure occurred, age, weight, prior medical conditions, symptoms, time of day, distance from the hospital and whether they are responding to home treatments. In general if there is any chance that the person could develop serious injury or life-threatening symptoms they are referred to the emergency room. That being said, poison centers are able safely treat 67% of exposures at home. This is a good reason to call before you go. Many times you will not need to go to the emergency room for common poisoning exposures.

 

- Jess Benson, Pharm.D.

 

 

If I ever need to call you, how would you prefer that I order the information about the poisoned victim?

 

Regarding the “order” of the information, the most important initial information to give Poison Control would be: the name/description/brand of the substance that the patient was exposed to (ex: Advil Cold and Sinus liquid, D-Con Bait Pellets, Fabuloso All-Purpose Cleaner, Crayola Markers, holly berries, dog poop, a white mushroom, a brown snake, Tylenol Extra Strength tablets, etc.), how much of the substance was taken (10 tablets, a sip, 2 mouthfuls, one leaf, two pieces, a small taste, etc.), when the exposure/ingestion occurred, how the patient is doing now, what has been done for them so far, and their age/weight.

 

-RP, PharmD, MPH, Certified Specialist in Poison Information

 

 

What are some commonly overlooked areas in childproofing? Are there any items that parents don't realize are poisonous?

 

There are many. Button batteries are some of the most dangerous items that kids get into and they are found in so many products now -- remote controls, toys, hearing aids, key fobs and much more. These batteries can cause life-threatening injuries to the esophagus.

Also, rare earth magnets -- the really strong ones -- that you can find in kids' toys. If children swallow more than one, or a magnet with a metallic object, they can link up in the gut, trapping tissue between them causing the gut tissue to die.

 

Finally, I would caution parents and others involved in childcare to not rely too heavily on child resistant caps on medications. These caps are not "child-proof" (nothing is really). Even though they help to slow kids down, many children can open these caps at ages as young as 15 months!

 

- N Reid RN/BSN, DABAT

 

 

So, there is a ton of safety information out there for new parents, can you give me some simple tips for not poisoning my kid?

 

Here's the condensed version...what we tell everyone to help stay poison safe:

 

1. Up, up and away! Keep medications and poisonous household products out of your child’s sight and reach. Locked up is best.

 

2. Avoid container transfer. Some of the most devastating poisonings occur when toxic products are poured into food or beverage containers, then mistaken for food or drink.

 

3. Read the label and follow the directions. Misusing products has dire consequences.

 

4. Use child-resistant packaging. It’s not child-proof, but so much better than nothing. Sorry it’s inconvenient, but using it could save a life.

 

5. Keep button batteries away from children. Swallowed batteries can burn through your child’s esophagus and cause permanent injury or even death.

 

6. Keep laundry pods out of your child’s reach. They are as toxic as they are colorful and squishy.

 

 

If one finds themselves without access to the internet, is there an easy way to remember what poisonous substances one should induce vomiting for and which ones they should not?

 

We no longer recommend inducing vomiting for anything. There are a couple reasons why -- 1) we actually found that inducing vomiting does not improve clinical outcomes in poisoned patients; 2) the common emetics people use can often cause more poisoning or injury than the original substance that the person swallowed. Some emetics can cause heart problems, ruptured esophagus, or seizures!

 

 

What are the most common household items people swallow, splash or inhale?

 

Bleach is definitely a common exposure that people often accidentally swallow, splash and inhale. Although it is not pleasant, it is typically well tolerated, in small amounts. Other than bleach, bathroom cleaners are also pretty common.

 

- P Soto, PharmD

 

 

What are some common poisons that often get overlooked as safe?

 

In children we worry about imidazoline-containing nasal sprays (contain oxymetazoline or tetrahydrozoline). Most people will not think of them as poisonous because they are over-the-counter and generally viewed as safe. Unfortunately, small amounts can produce loss of consciousness, slowed heart rate and loss of breathing.

 

Button batteries are another example. And we also worry about laundry pods.

 

- Jess Benson, Pharm.D., DABAT

 

 

Do you think the new pod detergents are helping to prevent little kids from consuming detergent? Or are kids still trying to chow down on the packets?

 

It's a little too soon to tell if the new packaging for the pods is helping. Pods are extremely dangerous and they have caused serious injury. When a child puts a pod in his mouth and bites down, the pod pops open and the detergent is forced into the back of their throat. The liquid from the pod goes into the lung and causes injury - some children need to be on ventilators, or breathing machines. Also the irritating liquid can injure the eye as it splashes out of the mouth. Burns are also sometimes seen in the esophagus, again because of the extreme irritation. Regular liquid detergent, while irritating, does not normally cause serious injury in small amounts that children usually swallow.

 

 

What do kids mostly eat that causes problems? Is it detergents? Or something else?

 

Common ingestions include household products, such as cleaning products, personal care products like make-up and lotions, and plants. These items are responsible for about half of the calls about kids. The other half include medications, such as cold and cough products and prescription medicine.

 

 

What's the most common way for people to be exposed to poison?

 

Ingestion, or eating something is probably the most common, but people can be poisoned through the skin, by inhaling fumes, and eye injuries can occur from chemicals being splashed in the eye. Poisoning can occur from injecting drugs in the vein. The most common poisonings are due to medications found in the home.

 

 

Do I really need to call poison control if my kid swallows toothpaste? Why can't we come up with a toothpaste that is edible?

 

Absolutely, it's always prudent to call Poison Control if your child swallows toothpaste (or anything else that he/she wasn't supposed to), but in general small amounts of fluoride-containing toothpastes (ex: less than a mouthful) in children are typically well tolerated. In these cases we usually only see some mild stomach upset or an episode of vomiting. Obviously, larger amounts of toothpaste ingested (especially Rx strength) can be problematic in children. However, there are toothpastes out there that are “safer to swallow”, that do not contain fluoride. They typically contain sorbitol, which may only cause some loose stools.

 

-RP, PharmD, MPH, CSPI

 

 

What are the most common questions you guys get?

 

Over half of Poison Control calls are regarding children under 6 years old, with a peak in the 2-3 year old age group. Children this age tend to get into things of convenience - household medications, and cleaners are common. It's amazing how quickly children can get into things. Also, visitors who may have loose pills in their purses or pockets, or pill minders are often accessed and can be a danger.

 

- P Soto, PharmD

 

 

What's your most creative childproofing tip? :)

 

Oh goodness, there are so many!! Do I really have to pick one?

 

• Clean up your alcoholic drinks after a party -- young kids love to wake up before parents and sample the leftovers.

 

• Also remember, kids will get into anything that is left out or within reach. Always put medicines away (preferably high up, out of reach or under lock and key) between doses so kids don't get into them.

 

• Be especially aware of anything that looks or tastes like candy or food/drinks -- gummy vitamins and supplements, medications flavored by the pharmacy for kids to make them more palatable, brightly colored cleaners and chemicals -- all of these are especially attractive to kids especially if they smell or taste good! For some persistent kids, I have advised parents to get a tool box and a padlock or combination lock and lock up the medicines and place the box out of reach.

 

• And finally, when friends and relatives come to visit, remind them to keep their medications secure. If you can, you might even try to find out what medications exactly the visitor is bringing to the house. I can't tell you how many calls I have taken about families who had visitors with dropped pills, pills stored in baggies, etc. that the children have gotten into when the owner of the pills had gone home and the parents have no idea what the medication could be. It's a very scary situation to be in and it's mostly preventable.

 

- N. Reid, RN/BSN, DABAT

 

 

Tell the truth: What do you really think of parents that have to call multiple times a year for the same child that seems to have taste tested half the house?

 

I think children explore their environments with their mouths. This is totally normal behavior. They are quick and curious and parents are often just one step behind them when things go in the mouth. We don't judge, we want people to call -- even if it is something that seems silly. Call to be sure, don't guess. And if you are too embarrassed to call, use the webPOISONCONTROL app or online tool.

 

- N. Reid, RN/BSN, DABAT

 

 

 

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