Risks of accidental poisonings explored
Risks of accidental poisonings explored
With the U.S. Consumer Product Safety Commission warning that unintentional poisonings are responsible for more than 1 million calls to poison control centers and 78,000 hospital visits for children younger than age 5 in 2003, Southwestern Oklahoma State University professor of nonprescription products and devices W. Steven Pray, PhD, DPh, outlined in U.S. Pharmacist some recent developments in poison control.
• Acetaminophen has been a leading cause of poisoning for many years. It is said to be the most common reason for poisonings in the United Kingdom, being the source of 50% of acute poison-related hospital admissions. Pray says pharmacists "must stress the toxicity of acetaminophen products at the point of sale. Alternatively, they might transfer these products to a location behind the counter to ensure that patients are properly advised of their dangers."
• Dietary supplements are more difficult to research than most other categories of poisoning. Pray said these poisonings are disappointing because dietary supplements are a group of products whose legal meaning is ill-defined and whose pharmacology and toxicology are incompletely explained due to lax strictures inherent in the Dietary Supplement Health and Education Act of 1994. "Since manufacturers are not required to conduct the research needed to prove efficacy or safety, many simply do not do so," Pray said. "Thus, the average health food store stocks hundreds of products whose safety profiles are unknown. Manufacturers have therefore neglected carrying out the standard toxicological tests, such as those required of prescription products, because they are not required to do so; they also are not required to report adverse events to FDA."
• Poison hemlock contains a variety of chemical neurotoxins, possibly resulting in nausea and vomiting, abdominal pain, tachycardia, seizures, ascending paralysis, muscular tremor, weakness, and coma and death from respiratory failure. Pray said herbal and homeopathic companies have marketed products containing hemlock using scientific names other than the most common one as a way to mislead consumers about potential toxicity. Homeopathic web sites recommend it for hundreds of unproven uses, Pray said, such as vertigo, red earwax, striped shapes in front of the eyes, corneal ulceration, cancer of the face, pain in the breast, crusty ulcers on the skin, and "hard" cancers. He said that while it is true there are no published reports of toxicity or poisoning from herbals or homeopathics containing poisonous hemlock alkaloids, the Institute of Medicine has said that "absence of evidence of risk does not indicate that there is no risk."
• Veratrum album has been described as a "violent irritant poison." Despite lack of proof of safety and efficacy for any use, it is a popular homeopathic remedy. It is allegedly effective for nonsense delirium, vertigo, suppressed urine, gallstone pain, forcible vomiting, black stools, "shriveled fingers," comatose sleep, and hundreds of other unproven uses.
• Contaminated herbal teas have been the subject of an FDA warning as early as 1991. Their availability within homes could allow children to eat the raw leaves used for brewing, or to consume the tea itself, Pray said.
• Topical pesticides often involve lindane, prescribed for head lice, Pray said. Because of toxicity issues, FDA in 1995 limited package sizes, required a boxed warning, and required dissemination of a medication guide with each new prescription. There are an estimated 1 million prescriptions written for lindane each year. Centers for Disease Control and Prevention (CDC) research in 2005 uncovered 857 cases of unintentional ingestion of topical lindane, with 8% suffering adverse effects of moderate severity and 1% experiencing effects of high severity. Signs and symptoms included vomiting (59%), nausea (18%), oral irritation (19%), and abdominal cramping, cough, and seizure in 3-4% of cases.
Pray said adults mistook lindane for cough syrup in many cases. Lindane alternatives for head lice include synergized pyrethrins, permethrin, and malathion. Those substances were responsible for an additional 523 unintentional poisoning cases during the years included in the study. CDC concluded that declining lindane use will ameliorate the danger somewhat, but pharmacists should never transfer lindane from its manufacturer-supplied 1- or 2-ounce bottles into pharmacy bottles that are identical to those used for oral medications such as cough syrups. "It might be advisable to ensure that lindane and other pesticides are not in the house to prevent causing accidental ingestion," Pray said. "The pharmacist can aid in this effort by educating physicians and consumers about nontoxic, environmentally safe alternatives to pediculosis, like thorough combing with specially designed combs that remove live lice and nits."
• Pyridoxine is thought to be useful in treating such problems as premenstrual syndrome. Pray said this is an unproven claim and women who take the product and keep it in their homes may have children who gain access to it. Overdoses may result in ataxia, incoordination, and seizures.
With the U.S. Consumer Product Safety Commission warning that unintentional poisonings are responsible for more than 1 million calls to poison control centers and 78,000 hospital visits for children younger than age 5 in 2003, Southwestern Oklahoma State University professor of nonprescription products and devices W. Steven Pray, PhD, DPh, outlined in U.S. Pharmacist some recent developments in poison control.Subscribe Now for Access
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