The Toxicology Question of the Week is a venue that addresses interesting questions that have been asked of the Poison Center or are topics of relevance.
The TPC toxicologists will contribute to the Question of the Week. If you have any subjects you would like to have addressed, please email Dr. Seger at donna.seger@vumc.org.
If you wish to be added to the distribution list, please email Brittaney Jenkins at brittaney.r.jenkins@vumc.org.
Sept 21, 2020: How much money does the Tennessee Poison Center save the citizens of Tennessee?
October 1, 2020
As the academic fiscal year begins, I would like to share some exciting news about the Tennessee Poison Center (TPC). First, we have now received greater than 2 million incoming calls to the Poison Help hotline since the Poison Center opened in 1988!
Sept 14, 2020: How Should “Massive” Ingestions of Acetaminophen be Treated?
October 1, 2020
Ten to fifteen percent of Acetaminophen (APAP) is metabolized via Cytochrome P450 2E1 to a toxic reactive metabolite, N-acetyl-p-benzoquinone (NAPQI), which is conjugated and detoxified by endogenous glutathione. Following APAP overdose, endogenous glutathione is depleted, and N-acetylcysteine (N-ac) is administered to donate glutathione to detoxify NAPQI.
Aug 26, 2020: What is the Treatment of Antihistamine Overdose?
October 1, 2020
Allergy season is in full swing in Tennessee and the use of allergy medication increases as a result. 2020 is a unique year; in that, Tennesseans are spending more time outside working in their yards, walking and exercising due to the quarantine and social distancing mandates. Antihistamines are one of the most common OTC medications used
Aug 12, 2020: What Medications Should be Avoided with Peanut Allergies?
October 1, 2020
Poison Centers have the unique responsibility to provide appropriate recommendations when medications are accidently ingested. Recently a mother called the Poison Center, asking if her healthy 4-year-old son would be ok after accidentally ingesting one of her Prometrium. The active ingredient in Prometrium is progesterone, which alone is not a problem.
Aug 3, 2020:What are the Predictors of Hemolysis in the Setting of Cutaneous-Hemolytic (Systemic) Loxoscelism?
October 1, 2020
I wish I knew. Especially this summer when these spiders seem to be overtaking us.
July 27, 2020:Why Should I Read the Question of the Week?
October 1, 2020
Because it is informative and, most importantly, short.
June 1, 2020: Does COVID-19 Impact the Exposures Managed by the Tennessee Poison Center?
October 1, 2020
The last few months revealed not only an increase in exposures in the homes of Tennesseans, but included unique and uncommon exposures such as boiling disinfectants to sanitize the air, dermal exposures to concentrated cleaners or disinfectants, caustic concentrations of food grade hydrogen peroxide, and questions about the safe injection or ingestion of dis
May 27, 2020: When do Signs or Symptoms of Poisoning Require Treatment?
October 1, 2020
Easy answer: when they have the potential to harm the patient.
May 19, 2020: What is the Toxicity of Azithromycin?
October 1, 2020
Azithromycin is a widely prescribed antibiotic of the macrolide class. It also is a semisynthetic derivative of erythromycin. It has recently received more attention as a potential therapy for COVID-19.
May 6, 2020:When is Bleach Dangerous?
October 1, 2020
Most household bleaches are dilute hypochlorite 3-6 % solutions. Hypochlorite is an aqueous solution produced by mixing chlorine gas with water. Household bleach containing products are commonly used as laundry bleach, toilet bowl cleaners and bathroom cleaners.
April 27, 2020: Is Chlorine Dioxide a Magic Potion to Treat Coronavirus?
October 1, 2020
Treatments billed as miracle cures have popped up over the Internet since COVID-19 began spreading into the United States in late January of this year.
April 20, 2020: What Determines Which State Poison Center Receives Your Call?
October 1, 2020
The Poison Help hotline number for Poison Control, 1-800-222-1222, is a national number. When you call that number, the call is routed based on the area code. For example, if your area code is local to TN (i.e. 615,432, etc.) your call will be routed to the Tennessee Poison Center (TPC).
April 13, 2020: Thoughts on COVID-19 Vaccine
October 1, 2020
A safe and effective vaccine for COVID 19 would be an excellent solution to the problem with this virus. For many other highly infectious diseases such as measles, polio, and smallpox, vaccines have effectively prevented their global transmission. Vaccine development for coronaviruses is progressing.
April 6, 2020: Comments from our Faculty on Hydroxychloroquine
October 1, 2020
Last week’s Question discussed issues of hydroxychloroquine in the era of coronavirus. I received several responses and thought I would share a couple with you.
March 30, 2020: What are the Myths and Facts Regarding Chloroquine/Hydroxychloroquine-in Treatment of Coronavirus and in Overdose?
October 1, 2020
I recently listened to a webinar sponsored by the American College of Medical Toxicology and the European Association of Poison Centers and Clinical Toxicology regarding the administration of chloroquine (CQ)/hydroxychloroquine (HCQ) for the treatment of COVID-19 and the treatment of overdose of these drugs. Six hundred people were listenin
March 13, 2020: Can One Make Hand Sanitizer?
October 1, 2020
As the coronavirus makes its way to Tennessee, hand sanitizers and disinfectants are flying off store shelves. With the increased use and shortage of these products, people panic and misuse disinfectants or try to make their own hand sanitizer with dangerous ingredients not intended for skin application. Online recipes for homemade hand sanitizer include bleach, powder or liquid disinfectants, vinegar, hydrogen peroxide, and concentrated essential oils.
March 2, 2020: How Many Drugs Can You Safely Administer That Prolong the QT Interval?
October 1, 2020
An EMR warning frequently occurs when prescribing concomitant drugs that have the potential to prolong the QT interval.
Feb 24, 2020: How Dangerous is Hydrogen Peroxide Ingestion?
October 1, 2020
In the past month, the Tennessee Poison Center received two calls regarding ingestion of 35% hydrogen peroxide (H2O2) - both patients developed the rare complication of portal venous gas.
Feb 3, 2020: When Does Ondansetron Prolong the QT Interval?
October 1, 2020
A common question we address in the Poison Center is if QT interval prolongation is a concern when ondansetron is administered. A 2012 safety announcement by the FDA warned healthcare professionals that administration of ondansetron could cause QT prolongation and potentially Torsades de Pointes (TdP). This announcement was based on preliminary results from a clinical study regarding an intravenous 32mg single dose of ondansetron.
Jan 29, 2020: Alcohol Vaping. Friend or Foe?
October 1, 2020
What is alcohol vaping?
Jan 6, 2020: Why Are People Taking Fish Antibiotics and Are They Safe?
October 1, 2020
The Tennessee Poison Center has recently received calls about humans taking antibiotics intended for treating fish.
Dec 16, 2019: What Perles Cause Rapid Demise with Arrhythmias and Seizures?
October 1, 2020
Answer: Tessalon Perles
Dec 9, 2019: What Holiday Hazards Can Keep Us from Being Merry and Bright on Christmas?
October 1, 2020
During the Christmas holiday, stockings are hung. Homes are decorated with ornaments and lights. Family and friends visit from near and far. What could possibly go wrong? There are several holiday hazards that you should keep in mind during the holiday season.
Nov 26, 2019: What Steps Does the FDA Recommend to Prevent Foodborne Illness?
October 1, 2020
Foodborne illness can occur at any time of the year, but the holiday season presents increased opportunities to be exposed to foodborne disease. Holiday parties, whether held at a restaurant or at home or offices as pot lucks, and family get togethers can expose people to food that has been improperly cooked, prepared, or stored.
Nov 19, 2019: Does the Recent Ranitidine (Zantac®) Recall Mean You Should Stop Taking Zantac®?
October 1, 2020
Vanderbilt University Medical Center (VUMC) is responding to a recent, widespread voluntary recall of certain ranitidine (Zantac®) oral tablets, capsules and solution from various manufacturers. The recall is due to trace contamination with a probable human carcinogen. The FDA has performed a full assessment of the contamination in multiple ranitidine products and has concluded the risk
Nov 14, 2019: What Chemical was Identified in Bronchoalveolar Lavage (BAL) Specimens of Patients Suffering from Vaping Associated Lung Injury (EVALI)?
October 1, 2020
Vitamin E acetate was detected in all 29 patient BAL samples. Among 23 patients for whom self-reported THC use information was available, 20 reported using THC-containing products. THC or its metabolites were detected in 23 of 28 patient BAL samples, including in those of three patients who said they did not use THC products.
Oct 31, 2019: When is Deferoxamine Indicated in Iron Toxicity?
October 1, 2020
Iron is a common ingredient in many multivitamin preparations and is widely available in multiple forms including liquid, tablets or capsules, and chewables - for both adults and children.
Oct 23, 2019: When Should One Drink Pruno?
October 1, 2020
My recommendation is never.
Oct 18, 2019: When is Spravato® indicated to treat depression?
October 1, 2020
Sept 10, 2019: When Should Asymptomatic Bradycardia Be Treated?
October 1, 2020
Aug 15, 2019: What is the Question of the Week?
October 1, 2020
Welcome to the Question of the Week. Hopefully our distribution lists are updated now.
June 24, 2019: Why are Bupropion Overdoses Dangerous?
October 1, 2020
What clinical effects occur following bupropion overdoses?
May 15, 2019: In Tennessee, What are the Top Substances in Poison Exposures and in Which Counties do They Occur?
October 1, 2020
Attached is our annual report for your perusal. We continue to keep people out of the Emergency Department (which saves healthcare dollars) and help manage critical overdose patients in ICUs and Emergency Departments. Our educational outreach covers the entire state. Our staff is secondary to none (just ask the Fellows and Residents who have d
May 6, 2019: Is it Just A Little Pot? What is the Impact of Edible Marijuana on Children?
October 1, 2020
Marijuana is not new in the world of toxicology, but the rise of medical and recreational marijuana legalization brings with it a new wave of consequences, particularly for children.
May 1, 2019: What is Epidiolex®?
October 1, 2020
Epidiolex is the first FDA approved medication consisting of highly purified, plant based, pharmaceutical grade cannabidiol (CBD) extract.
April 23, 2019: What's The Deal With Kratom?
October 1, 2020
April 18, 2019: What should you do if someone is bitten by a North American pit viper?
October 1, 2020
Warm weather has arrived in Tennessee which means snakebite season is upon us. The venomous snakes native to our region are the pit vipers and consist of copperheads (Agkistrodon contortrix), cottonmouths / water moccasins (Agkistrodon piscivorus), and various species of rattlesnakes (genera Crotalus and Sistrurus). Their bites are rarely life-threatening but may require treatment with antivenin.
April 10, 2019: What is LUCEMYRA®?
October 1, 2020
What is it?
April 1, 2019: What is PRIS, what are markers of severity, and how is the syndrome treated?
October 1, 2020
Propofol is one of the most commonly used intravenous anesthetic agents used in ICU and OR settings. Propofol infusion syndrome (PRIS) is a term that describes a rare clinical syndrome that was first described in the 1990s through case reports where patients suffered cardiovascular collapse in the setting of prolonged and high-dose propofol infusions.
March 27, 2019: Why do we give glucagon in beta blocker overdose?
October 1, 2020
Beta blockers competitively inhibit myocardial β1 receptors. These receptors normally act through a second messenger system (Gs proteins*) to activate adenyl cyclase (AC) and increase cyclic AMP (cAMP), which results in the influx of intracellular calcium through L-type calcium channels. β1-receptor antagonism results in decreased calcium entry and, subsequently, decreased inotropy and chronotropy.
Feb 25, 2019: What are the differences in the pharmacological effects and blood levels for THC and CBD when administered orally vs. inhalation?
October 1, 2020
There is limited information available regarding the pharmacokinetics and pharmacodynamics for either tetrahydrocannabinol (THC) and cannabidiol (CBD) in humans. Only a few studies have been published so far, and most of them were conducted in healthy adult volunteers with very small sample sizes.
Jan 17, 2019: What are the concerns with ADHD medications?
October 1, 2020
Medications used to treat Attention Deficit Hyperactivity Disorder (ADHD) fall into two categories:
Jan 10, 2019: Should you discontinue N-acetylcysteine if facial swelling and rash occur following the loading dose?
October 1, 2020
This patient was treated with N-acetylcysteine (N-ac) as her APAP concentration was above the nomogram treatment line. Following the loading dose, the patient developed facial flushing and swelling as well as a rash on her neck. She received N-ac for 101 hours due to rising transaminases. Six hours after the N-ac was discontinued, symptoms resolved.
Dec 10, 2018: My child ate some of our snow spray and took a taste of the Christmas tree preservative, should I be concerned?
October 1, 2020
The Tennessee Poison Center receives several calls about snow sprays and Christmas tree preservatives in November and December. The holidays are so busy with cooking, cleaning, laughter, and joy, that unattended children are often accidentally exposed to these products.
Dec 3, 2018: Bits and Pieces
October 1, 2020
Thanks to all who helped with updating our distribution lists. It has been a long haul but I think it is finally completed.
Nov 19, 2018: How do you identify and treat cyanide poisoning?
October 1, 2020
Cyanide is a potent mitochondrial toxin which can cause death within a matter of minutes.
Nov 12, 2018: Why shouldn’t I mix household chemicals with bleach?
October 1, 2020
Many chemicals in your home that you use on a regular basis can be dangerous. What many people don’t know is the combination of many of these chemicals can produce dangerous irritating gases.
Nov 5, 2018: How long should oxygen be administered following carbon monoxide exposure?
October 1, 2020
Last month there was a mass CO exposure. Length of time of oxygen administration following the exposure was queried by health care professionals.
Oct 8, 2018: What causes the “Red Tides” occurring in Florida?
October 1, 2020
Oct 2, 2018: What should you do about bradycardia following overdoses??
October 1, 2020
I recently received a call from a health care provider regarding a beta blocker overdose. The patient had a reasonable blood pressure but was bradycardic. (It is not unusual to get calls regarding overdoses that cause bradycardia i.e., beta blockers, clonidine, calcium channel blockers, and organophosphates.
Aug 23, 2018: What is Palytoxin?
October 1, 2020
Biotoxins are not common exposures, but if you love aquariums, this toxin could be in your home! Palytoxin is one of the most potent biotoxins reported, posing a risk to patients via ingestion, inhalation, dermal, and even ocular routes.
Aug 13, 2018: What is the Antivenom Index and how , can the Tennessee Poison Center help?
October 1, 2020
The Antivenom Index is a database containing indications for antivenom administration and location of the antivenom.
Aug 6, 2018: What do you need to know about the Tennessee Poison Center (TPC) in 2018?
October 1, 2020
The TPC consists of a 24/7 hotline phone service, and an outreach / education service.
June 25, 2018: How much muscle rub is too much?
October 1, 2020
I recently noticed a muscle rub that was made in Thailand. All the info is written in Thai, except for the active ingredients that include 31% methyl salicylate.
June 12, 2018: Can consumption of home-brewed poppy tea be lethal?
October 1, 2020
This question was prompted by the death of Stephen Hacala and recent comments from Arkansas Senator Tom Cotton to Congress about the regulation of unwashed poppy seeds. Hacala, a 24 year-old Arkansas man, was found dead in his apartment on April 3rd 2016 with no obvious cause.
May 14, 2018: Bathrooms and Nerve Agents?
October 1, 2020
Bathrooms and Nerve Agents
May 7, 2018: What do you need to know about fentanyl?
October 1, 2020
This is an amazing monograph that elucidates the history and distribution of fentanyl. Let me know if you have any questions. ds
April 30, 2018: What is “The Poor Man’s Methadone”?
October 1, 2020
Answer: The increasing rates of opioid addiction and simultaneously increasing barriers to acquiring licit opioid analgesics have forced many patients to seek alternative means managing their addiction.
April 16, 2018: What diagnosis should you consider when you see a patient with unexplained Vitamin K dependent coagulopathy?
October 1, 2020
Answer-adulterated synthetic cannabinoid. There is a widespread outbreak of synthetic cannabinoid tainted with brodiafacoum, a long-acting anticoagulant. Why this is occurring is unknown. Illinois has had the greatest number of cases, and although the initial number of cases were in the Midwest, now multiple cases have been reported from multiple states.
April 9, 2018: How Can You Dispose of Unused/Expired Medications?
October 1, 2020
Poisoning continues to be the leading cause of injury death in Tennessee. In 2017, 60% of the exposure calls to Tennessee Poison Center were for pharmaceuticals. Too often, unused prescription drugs find their way into the wrong hands. Pharmaceutical drugs can be just as dangerous as street drugs when taken without a prescription or a doctor’s supervision. That can be dangerous and often tragic.
April 4, 2018: Phenibut: Is It a Smart Drug To Take?
October 1, 2020
The Tennessee Poison Center has received several calls over the past few weeks from clinicians about a drug named phenibut.
March 26, 2018: Does naloxone reverse clonidine toxicity?
October 1, 2020
The issue of administering hi-dose naloxone to pediatric patients has caused more anxiety than you can imagine. I have had many calls from physicians when the Poison Center recommends administering 10 mg naloxone IVP to children. Pharmacists have refused to fill the order, nurses have refused to administer it, and I have even received a call from a Chief of Staff regarding our recommendations. This is not a mg/kg dose/response issue.
March 21, 2018: What causes false positives or false negatives on the Urine Drug Screen (UDS)?
October 1, 2020
We frequently get questions regarding the meaning of false positives and negatives on the urine drug screen. I’ve asked a real expert to address them. ds
March 6, 2018: What can the DEA tell you about changing patterns in use/trafficking of Drugs of Abuse?
October 1, 2020
Last week I attended the Midyear Meeting for Poison Centers, a meeting that addresses primarily issues of funding/evaluation/functioning of the poison center. Two DEA agents gave an update on current Drug of Abuse use/trafficking, I’m sharing my notes with you. I thought some of the new patterns, as well as the reason for them, was quite interesting. ds
• Much of the fentanyl is coming from China and Mexico. It is then combined with heroin in a pill press. The resultant tablet resembles oxycodone 30 mg tabs, but is much cheaper than actual oxycodone.
March 12, 2018: Who Am I and How Did I die?
October 1, 2020
Indications for Crofab include: systemic symptoms, coagulopathy , and progression of swelling. Most of the snakes in our state cause swelling as opposed to coagulopathy or systemic symptoms (although of course some do). First aid includes elevation of extremity. Progression of swelling means that swelling is progressing and the distal part of the extremity is not decreasing in size, as would occur with gravity, i.e. the swelling decreases distally and increases proximally (which is what you want). Call the TN Poison Center to discuss indications for Crofab. ds
Feb 26, 2018: Examining Prescription Drug Calls: Are National and Tennessee Poison Center Trends Changing?
October 1, 2020
There is a great deal of information in this Question. Note that acuity of overdoses is increasing. It will be interesting to see if this trend continues as heroin becomes more popular. ds
Feb 19, 2018: What is the Tide Pod Challenge?
October 1, 2020
We have had many requests for information about tide pods. There are two age groups that are exposed-the toddlers and the teenagers. Unfortunately, bad things can happen to either group. ds
Feb 12, 2018: Why is Tennessee Poison Center Celebrating?
October 1, 2020
On February 25, 1988, Vanderbilt University Medical Center (VUMC) established Middle Tennessee Poison Center (MTPC) in response to the community’s need for a comprehensive poison resource center. VUMC provided essential support to establish a poison center that would provide services for the pubic and healthcare professionals in Nashville and 43 surrounding counties. That first year, MTPC provided service to 11,649 hotline callers.
Feb 5, 2018: What is the latest update on treatment of opiate use disorder?
October 1, 2020
Attached is a commentary by Nora Volkow MD that was recently published in the Lancet. Dr.
Jan 10, 2018: Does Biotin Interfere with Lab Tests?
October 1, 2020
Thanks for all the comments about Propofol . The question of anticonvulsant activity is much misunderstood. Just remember that it is dose-dependent and that at many of the doses used for sedation, there is not anticonvulsant activity.
According to a recent JAMA article, ingesting 10 mg/d of biotin for 1 week was associated with potentially clinically important assay interference in some but not all biotinylated assays studied.
Feb 1, 2018: What is Shock Dope?
October 1, 2020
Jan 3, 2018: Does propofol have anticonvulsant properties?
October 1, 2020
Propofol is an intravenous short-acting hypnotic medication with FDA indications for the induction and maintenance of general anesthesia, monitored anesthesia care, ICU sedation for intubated adults, and procedural sedation. Most recently, propofol is being used off-label as an adjunct in the treatment of refractory status epilepticus. However, anticonvulsant doses are typically much higher than sedation requirements and are comparable to that for the induction/maintenance of general anesthesia.
Nov 13, 2017: How do toxicokinetics determine lithium toxicity and its treatment?
October 1, 2020
Lithium is a very unique drug. Prescriptions are increasing since SSRIs haven’t done as well as hoped with bipolar disorder. As prescriptions increase, lithium overdose and toxicity also increases. Understanding toxicokinetics is the key to developing a treatment strategy in a patient with lithium toxicity.
Formulation of lithium plays a part in determining length of time to complete absorption. Lithium carbonate has limited aqueous solubility and large ingestions can cause concretion in the GI tract and GI absorption can be prolonged.
Oct 26, 2017: Can a Kit predict Potential for Opiate Addiction?
October 1, 2020
A new spin on opiate addiction. ds
PAINWeek celebrated their 11th conference in Las Vegas at the beginning of September. This conference allows pain providers to get together and discuss the best practice and new options for pain patients. I had the great opportunity to attend this year as the itinerary offered educational sessions on the opioid crisis, ketamine as an adjuvant for pain, as well as an informational naloxone course where providers were encouraged to co-prescribe it with all their opioid prescriptions.
Sept 18, 201: What is the Role of ketamine in Major Depressive Disorder?
October 1, 2020
A full page ad in the Sunday New York Times promoting IV ketamine for the treatment of depression made me ponder the mechanism of action and actual clinical practice. So when Jose Vigo (AKA “Beto”), a Fellow in Psychosomatic Medicine, rotated with us, I asked him to educate all of us about this relatively new modality. See what you think…
ds
Aug 21, 2017: August 21, 2017 Why Does The Tennessee Poison Control Center Seldom Recommend GI Decontamination?
October 1, 2020
Recommendations regarding GI decontamination are not consistent between Poison Centers. With a new academic year, it is always good to review the basis for the recommendations of the TN Poison Center. Although single dose activated charcoal used to be administered in 70% of ingestions, the national data demonstrates that it is now administered in less than 10% of ingestions. Administration has markedly decreased due to understanding of the significant morbidity from charcoal aspiration. ds
July 24, 2017: What protection is required by Emergency Responders when exposed to fentanyl?
October 1, 2020
There has been a lot in the news lately about this-both information and misinformation (otherwise known as fake news). Below is a joint position statement from the American Academy of Clinical Toxicology and the American College of Medical Toxicology.
I am interested in any questions you would like answered in the Question of the Week. Please email me with any suggestion at donna.seger@vanderbilt.edu
Aug 14, 2017: How many visits to the Emergency Department does Tennessee Poison Center prevent (and how much money does that save)?
October 1, 2020
A call survey was completed of persons who called Tennessee Poison Center (TPC) in April 2017 and received treatment advice to manage the poisoning at home.
The callers answered several questions including, “Would you have gone to the ED if Tennessee Poison Center had not been available?”
52% of the callers who agreed to answer the survey replied that they would have gone to the ED if the poison center were not available. It was determined from the survey that 42% of the calls that would go to the ED receive state medical assistance or are uninsured.
July 17, 2017: What is the toxicity of fentanyl analogs?
October 1, 2020
Fentanyl and fentanyl-analogs are powerful synthetic opioids that pose an increasing public health threat. From 2012 through 2014, the number of reported deaths involving fentanyl more than doubled (from 2628 to 5544), and it is estimated that 41% of the 7100 heroin-related deaths during that period involved fentanyl. The increasing use of fentanyl reflects the drug’s potency (50-100 times more than morphine) and cheap production costs. Heroin costs approximately $65,000 per kilogram, while illicitly manufactured fentanyl is available at $3,500 per kilogram.
June 13, 2017: How does glucagon ameliorate the hypotension caused by beta-blocker toxicity?
October 1, 2020
Glucagon is a hormone secreted from pancreatic alpha cells. It has inotropic and chronotropic cardiac effects. When the beta receptor is stimulated, cAMP is increased and calcium influx (via L-type calcium channels) also increases. When the beta receptor is blocked, glucagon stimulates the same subcellular protein to increase cAMP production and increase calcium influx.
Glucagon administration is indicated for hypotension, bradycardia or conduction impairment. It may also be effective in treating hypotension in calcium channel blocker and other overdoses with cardiac toxicity.
June 5, 2017: What causes garlic breath (besides garlic bread and arsenic)?
October 1, 2020
A patient consuming large quantities of brazil nuts developed selenium (Se) toxicity and subsequent neurotoxicity. The treating physicians thought you would be interested in a short discussion of Se toxicity.
May 31, 2017: Are you aware of the FDA warning about lead testing?
October 1, 2020
The following is a press release that is going to be sent out regarding lead testing:
May 23, 2017: Can Fentanyl be absorbed transdermally?
October 1, 2020
May 16, 2017: What is Tianeptine?
October 1, 2020
A few weeks ago, I came across a drug of which I was not aware. A hospital called regarding a patient who overdosed on “tianeptine”. The patient presented with lethargy and hypotension, and the ER staff requested information on the drug and treatment recommendations.
May 16, 2017: Can Fentanyl be absorbed transdermally?
September 30, 2020
Ohio police officer accidentally overdoses on fentanyl after traffic stop
By Michelle Chavez, FOX News. Published May 15, 2017
May 8, 2017: Is that Smell Significant?
September 30, 2020
Sniffing, Sniffing with your nose
May help you treat your patient’s woes.
April 30, 2017: Is this Carrot Edible?
September 30, 2020
May 8, 2017: Hazards lurking in your garage?
September 30, 2020
When warm weather arrives. It’s time for the great outdoors. We are busy with spring cleaning and working in the yard. The garage is a resting place for many toxins and chemicals.
March 30, 2017: Why is trisodium phosphate in my cereal and is it dangerous to my health?
September 30, 2020
Recently, the Tennessee Poison Center has received numerous calls from the public about why their popular brand of cereal (e.g. Cinnamon Toast Crunch) contains a poisonous chemical called trisodium phosphate. Callers had read on the internet or heard by word of mouth that trisodium phosphate is a highly toxic industrial strength cleaner, and they were worried about their children eating it.
April 17, 2017: Are there any Prescription Drug Surveillance Programs at the Tennessee Poison Center?
September 30, 2020
Tennessee Poison Center participates in the nation-wide RADARS System surveillance program (Researched Abuse, Diversion and Addiction related Surveillance). This is a non-profit operation of the Rocky Mountain Poison and Drug Center, a division of Denver Health and Hospital Authority.
April 10, 2017: Why Would Antiretroviral Drugs Be Abused?
September 30, 2020
Over the last five years, antiretroviral (ARV) medications have gained popularity as recreational drugs. This misuse began in South Africa, which has the largest HIV/AIDS population in the world. Unfortunately, the abuse of this product has reached the United States (US) with reported use in Florida.
March 17, 2017: Is the shamrock toxic?
September 30, 2020
We boast of the green on our isle’s shores
March 9, 2017: What is “pink”?
September 30, 2020
Feb 28, 2017: Why is it important to admit an asymptomatic patient with a bupropion overdose?
September 30, 2020
Bupropion (brand name: Wellbutrin and Zyban) is medication that is FDA-approved to treat depression, to prophylactically treat seasonal affective disorder and to aid in smoking cessation. Off-label uses for bupropion include ADHD and bipolar disorder.
Feb 14, 2017: Should you take brain boosting supplements in 2017?
September 30, 2020
There are a number of advertisements regarding Brain Boosters. Now you can get the real scoop. /ds
Feb 7, 2017: Why did the DEA delay its ruling to ban Kratom?
September 30, 2020
http://www.medscape.com/viewarticle/874301?nlid=112393_745&src=WNL_mdplsfeat_170131_mscpedit_phar&uac=173893HV&spon=30&impID=1281987&faf=1
Jan31, 2017: What should I know about exposure to e-cigarettes?
September 30, 2020
E-cigarette use is increasing in both middle and high school students, according to the CDC. Up to 13% of high school students now report using e-cigarettes in the past 30 days, and increases in e-cigarette advertising is associated with increasing use in youth in the United States.
Jan 12, 2017: What are the concerns when “Snow Globes” break?
September 30, 2020
Snow Globes have long been thought of as a pretty winter decoration – interesting for young and old to watch.
Jan 5, 2017: What gives you a high, slows your GI, and causes a multitude of cardiac arrhythmias?
September 30, 2020
We recently received a call from a physician about a patient who was combative and had an altered mental status. He chronically ingested 20-40 imodium (loperamide) /day for his chronic diarrhea. He had a rocky clinical course with prolonged QRS and QTc, RBBB, TdP, and complete heart block. The sodium channel block manifested by prolonged
Jan 3, 2017: How much nutmeg should you add to your eggnog to treat the post-holiday blues?
September 30, 2020
Nutmeg is one of the two spices derived from the dried seeds of the evergreen tree Myristica fragrans, which is indigenous to the Spice Islands of Indonesia but is now widely cultivated across the tropics and South America. Since medieval times, it has been used as a stimulant, carminative (relieves flatulence), emmenagogue (induces menstruation), and abortifacient.
Dec 16, 2016: What are the dangers of button batteries?
September 30, 2020
In 2014, approximately 3,500 adults and children across the United States reported an exposure with button batteries to state poison centers. Button batteries are found in many products including toys, greeting cards, watches, hearing aids, games, and flashing jewelry – all products in the average American household during the holidays.
Dec 7, 2016: What are the health concerns regarding fire retardants used in wildfire suppression?
September 30, 2020
On December 1, the Tennessee Division of Forestry reported that ongoing wildfires in the state have devastated more than 26-thousand acres this autumn. This includes the 17-thousand acre fire that forced the evacuation of Gatlinburg, destroyed over fifteen-hundred structures, and killed 14 so far.
Oct 18, 2016: What’s new in the toxicology lab?
September 30, 2020
The toxicology section of Vanderbilt University Medical Center’s Diagnostic Laboratories serves patients treated at VUH, VCH, One Hundred Oaks, and a variety of other clinics in the Middle Tennessee region. Our specialized test menu includes confirmations for a variety of common drugs of abuse, analysis of toxic alcohols including ethylene glycol, and general unknown
Nov 21, 2016: What happens at the Tennessee Poison Center on Thanksgiving?
September 30, 2020
Thanksgiving Wishes
Oct 11, 2016: How many visits to the Emergency Department does Tennessee Poison Center prevent (and how much money does that save)?
September 30, 2020
A call survey was completed of persons who called Tennessee Poison Center (TPC) in July 2016 and received treatment advice to manage the poisoning at home.
Sept 27, 2016: What hidden toxic dangers are present in some common science fair projects?
September 30, 2020
School Days… School Days
Oct 5, 2016: Back to School – How toxic are most school supplies?
September 30, 2020
Another school year is in full swing. Classrooms are full of new and different materials to explore. Like parents at home, teachers do their best to keep everyone safe. But despite their best efforts, accidents still happen.
Sept 22, 2016: Is there hidden alcohol in your home? It’s not EXTRACT-ly what you’d expect …
September 30, 2020
One of our pediatricians asked if one could safely put vanilla in infant formula to make it taste better. Great question; this is the answer. . . /ds
Sept 16, 2016: Back to School – What are the dangers of borax slime and homemade salt dough?
September 30, 2020
Arts and crafts are a staple of young children’s education, encouraging imagination and creativity. The best teachers go the extra mile and bring in supplies for their students to make their own take home craft. Many times these crafts contain substances that could be potentially toxic with ingestion.
Aug 30, 2016: School Is In Session: Can Plants Be a Problem?
September 30, 2020
Children are very curious about the world surrounding them and tend to be “oral explorers”. This could be a concern for children starting daycare or preschool. Plants are a most commonly a choking hazard, sometimes causing nausea and vomiting, or mild oral and throat irritation.
Aug 23, 2016: Where did I put that economy sized bottle of diphenhydramine?
September 30, 2020
Diphenhydramine is a commonly available over the counter medication. It is found in the majority of American households to treat a variety of ailments including seasonal allergies, anaphylaxis, and as a sleep aid. In an attempt to get high, adolescents (13 to 19 years of age) also abuse diphenhydramine.
Aug 17, 2016: What do Medical Interns need to know about the Poison Center?
September 30, 2020
Welcome to all the new Interns, who are no longer as new as they were last month.
May 17, 2016: What are the hidden hazards at a backyard BBQ?
September 30, 2020
May is National Barbecue month. The aroma of a steak sizzling on the grill tantalizes the taste buds. Perhaps it is chicken, vegetables or even grilled fruit. Add some side dishes, family and friends and let the good times roll.
May 24, 2016:
September 30, 2020
Question of the Week
May 10, 2016: What allergy is related to tick bites and has a delayed reaction?
September 30, 2020
With the full-blown tick bite season about to make an appearance, another concern seems to be increasing in scope.
May 3, 2016: What are the commonly used but potentially toxic essential oils?
September 30, 2020
Essential oils are a class of volatile hydrocarbons that are extracted, typically by steam distillation, from a single type of plant. Each essential oil typically has one or more hydrocarbons that give the compound its aroma, therapeutic properties, and toxic profile.
April 26, 2016: What is Bromo-DragonFly?
September 30, 2020
Bromo-DragonFLY is a potent hallucinogen first synthesized in the late 1990s. It is an analogue of amphetamine and is related to the phenethylamine family of drugs. It is a Schedule I controlled substance in the United States.
April 19, 2016: Remember the Question of the Week from September 1, 2015, titled “Is female Viagra (filbanserin) efficacious?”
September 30, 2020
Well, here is the follow-up from the New York Times titled “Undone by a Drug Maker’s Dysfunction”.
What do you think?
April 13, 2016: Are there any toxicity concerns with Spring plants?
September 30, 2020
Plants make for a beautiful Spring. Many are considered poisonous. However, the good news is that the majority of the time very little of the plant is ingested so there are usually very mild symptoms, if at all. Often with a child it is a choking hazard as they take a bite, don’t chew it well, and choke.
April 4, 2016: Are there innovative approaches to address prescription opiate use?
September 30, 2020
Prescription opiate use is now recognized as a national threat. However, a police task force member told me that prescription opiates are decreasing in Nashville, and heroin use is on the rise as heroin is now easier (and cheaper) to obtain than prescription opiates. (probably due to a more functioning CSMD (controlled substance monitoring database))
Feb 17, 2016: Why do antipsychotic medications have street value?
September 30, 2020
Misuse/abuse of second-generation antipsychotics, particularly quetiapine and, less commonly, olanzapine is increasing due to increased prescribing and a dramatic rise in off-label use for insomnia and anxiety.
Jan 26, 2016: Do you DEWshine?
September 30, 2020
This past week, the poison center was involved in the care of 4 teenagers from Robertson County who drank Mountain Dew mixed with racing fuel (so called Dewshine). Racing fuel (used for drag racing) is almost 100% methanol. There were two deaths.
March 8, 2016: Do you know the seeds that kill?
September 30, 2020
Local and national media outlets recently reported a 22 year old died of complications after consuming an unknown amount of “pong seeds” purchased from Thailand via the internet.
Dec 7, 2015: How Toxic are Our Holiday Plants?
September 30, 2020
Ode to the Holiday Flora
Dec 15, 2015: Have you decorated your home with poisons for Christmas?
September 30, 2020
The Tennessee Poison Center receives many calls about exposures to holiday decorations, plants, and other seasonal products this time of year. Here are some holiday hazards to be aware of:
Dec 2, 2015: What is the leading cause of injury death in Tennessee?
September 30, 2020
It’s hard to believe that poisoning is the #1 cause of injury death– above motor vehicle crashes, gunshot wounds and drowning.
Nov 16, 2015: What happens at the Tennessee Poison Center on Thanksgiving?
September 30, 2020
Thanksgiving Wishes
Nov 3, 2015: Why is Gabapentin ingestion increasing in nonmedical prescription opioid users?
September 30, 2020
A recent letter sent to poison centers around the country notified us that Gabapentin, typically an anticonvulsant, is being diverted.
Sept 4, 2015: How many visits to the Emergency Department does Tennessee Poison Center prevent (and how much money does that save) in 2014?
September 30, 2020
A call survey was completed of persons who called Tennessee Poison Center (TPC) in April 2015 and received treatment advice which enabled the caller to stay at home.
Sept 1, 2015: Is female Viagra (flibanserin) efficacious?
September 30, 2020
(August 18, 2015) After three applications and ownership by two drug manufacturers, the Food and Drug Administration (FDA) has approved flibanserin (brand name Addyi) for the treatment of acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women.
July 27, 2015: Are e-cigarettes still a concern?
September 30, 2020
The following is TN Poison Center data that was submitted to the FDA from Tennessee Department of Health. There are two interesting facts. The number of exposures has markedly increased-from 30 exposures in 2013 to 157 exposures in 2014 and potentially more in 2015. However, the Poison Center kept most of these patients at home and prevented ED visits that were unnecessary and costly. For dis
July 6, 2015: Why did evacuations occur when acrylonitrile caught fire?
September 30, 2020
On July 2 at 0100 EDT, the National Response Center reported a CSX train car was on fire. A derailment was believed to have caused the fire. The derailed car contained acrylonitrile. Hazmat crews rushed to the scene and mandatory evacuations were initiated in Maryville TN. The Red Cross set up a shelter at Heritage High School. Physicia
July 20, 2015: What are the main points regarding oral methotrexate overdose?
September 30, 2020
Uses: Methotrexate is an antimetabolite used to treat various cancers, rheumatoid arthritis, psoriasis and other conditions. The most common situation we deal with at the poison center involving methotrexate is oral overdose (both inadvertent and intentional).
June 15, 2015: Colloidal Silver - To Take Nature’s Antibiotic or Not?
September 30, 2020
Colloidal Silver is a colloid consisting of silver particles suspended in liquid.
June 8, 2015: Did you know Tea Tree Oil can cause life threats?
September 30, 2020
Tea Tree Oil (Melaleuca Oil) is a popular essential oil marketed and sold as a fungicidal and antiseptic. It is available as 100% “pure oil” or in a diluted spray, cream, soap or similar preparation. Tea Tree Oil has gained popularity among its proponents who claim it can treat acne, warts, gingivitis, nail fungus, ear aches, thrush, eye and vaginal infections and asthma, to name a few.
May 18, 2015: What’s the important information to know about poison ivy, sumac and oak?
September 30, 2020
We find ourselves in the time of year where grass and flowers are growing, but so are those Toxicodendrons: poison ivy (Toxicodendron radicans), poison oak (Toxicodendron toxicarium, Toxicodendron diver-silobum), and poison sumac (Toxicodendron vernix). In the United States, these are the cause for most common allergic reactions. Approximately 10-50 million Americans will develop and allergic rash after being exposed.
May 4, 2015: FLAKKA – The new designer drug on the block?
September 30, 2020
A new stimulant is trending around the nation. It’s called FLAKKA. The state of Florida seems to be the epicenter for this “new” designer drug. Is Tennessee next?
April 20, 2015: Venomous spiders to watch out for in your home: what should you do if bitten by a spider?
September 30, 2020
Most spider bites are harmless as there are many non-venomous spiders that bite and may cause some minor local redness and pain. These bites can usually be managed at home by washing, applying ice, and keeping the area clean.
April 6, 2015: What is the new synthetic drug 25I-NBOMe (N-Bomb)?
September 30, 2020
March 30, 2015: Powdered Booze - What will they think up next?
September 30, 2020
March 16, 2015: What exposures occur during refining?
September 30, 2020
Crude oil is a complex mix of hydrocarbons benzene, sulfur, nitrogen, chromium, toluene, and xylene. Crude oil is used to make fuel and other petroleum products.and is refined to produce gasoline.
March 9, 2015: What are the origins of oil?
September 30, 2020
Oil is a complicated mixture of different hydrocarbons. A hydrocarbon is a large organic molecule composed of hydrogen atoms attached to a backbone, or chain of carbon atoms.
March 2, 2015: Fast Facts about TPC and National Poison Prevention Week March 15-21, 2015
September 30, 2020
Feb 2, 2015: Is RADON poisonous?
September 30, 2020
Recently I was interviewed by a television newscaster regarding radon because a couple had become concerned when they were told their dwelling contained a “high amount of radon”. Everyone has questions about radon.
Jan 26, 2015: What causes pediatric poisoning fatalities?
September 30, 2020
The 2013 National Poison Database System (NPDS) has just been released by the American Association of Poison Control Centers. For the last four years, pediatric toxicologists have reviewed all fatal pediatric poisoning reported to poison centers nationwide. This is what they reported:
Jan 19, 2015: What do you need to know about Carbon Monoxide (CO) exposure?
September 30, 2020
This is a topic we discuss every year because CO exposure has potential for devastating sequela.
Jan 5, 2015: What is the outcome of overdose patients following out of hospital cardiac arrest?
September 30, 2020
Recently the American College of Medical Toxicology presented a Grand Rounds on Cardiac arrest with an emphasis on the overdose patient. The following are comments that were made in the Grand Rounds:
Oct 13, 2014: Why should we discuss the treatment of CCB overdose again?
September 30, 2020
Because there was such a huge response to the previous Question of the Week. The following includes clarifications to some of the questions/comments and further elaboration on treatment. Comments are based on the recommendations that one would obtain if you called the Tennessee Poison Center.
Oct 6, 2014: Is “Up to date” a good resource for treatment recommendations in overdose patients?
September 30, 2020
Recently a couple of patients with Calcium Channel Blocker (CCB) overdose were transferred to Vanderbilt Children’s Hospital for higher level of care. Both of these patients had been hypotensive and placed on glucagon as the initial pressor.
Aug 4, 2014: How does naloxone work to reverse the effects of ACE inhibitor toxicity?
September 30, 2020
Angiotensin-converting enzyme (ACE) inhibitors are a class of medication used primarily for the treatment of hypertension, congestive heart failure, and diabetic nephropathy.
July 21, 2014: What can sting but cannot fly … yet?
September 30, 2020
“ … Out of the egg came a tiny and very hungry caterpillar … “ Eric Carle’s beloved children’s book depicts a colorful, sweet caterpillar. Fiction aside, beautiful and inviting does not always equal friendly.
July 14, 2014: What is the life threat of Systemic Loxsoscelism?
September 30, 2020
We are familiar with the cutaneous lesions following brown recluse spider bite (BRSB). Central necrosis can occur although the bites usually heal very well if they are left alone. No ointments, no debridement, no dapsone. Ice works better than opiates for the pain. Hard for physicians to do nothing.
July 1, 2014: How are minimum observation times determined?
September 30, 2020
The Tennessee Poison Control Center (TPC) receives approximately 45 new calls from healthcare professionals each day. “How long do we need to watch the patient?” represents one universal question often asked by these healthcare providers. So, how does the TPC devise its recommendations for minimum observation timeframes? The recommendations stem from three main fac
June 16, 2014: Why do Health Care Professionals and Law Enforcement officials frown upon Mr. Smiley?
September 30, 2020
The Nashville, TN media outlets recently reported the sale of "relaxation shots" at several smoke shops in the surrounding area. These "liquid shots" are sold under various names such as VivaZen, KXL Liquid Kratom, Mr. Smiley Kratom Shots, Mr.Smiley Eupohria Part Shots.
May 19, 2014: How does one obliterate one’s insect enemies?
September 30, 2020
With the advent of good weather, our crawling “friends” come back in force, and our yearly battle begins again. How do we deal with them? Most commonly, in the home setting, we use three main categories of insecticides: pyrethrins, organophosphates and carbamates. Used properly, these tend to work well and we go on normally with our live
April 14, 2014: Exposure to what toxin may have caused the deafness suffered by Ludwig Van Beethoven?
September 30, 2020
Recent analysis of Beethoven’s hair and bone indicates that he had lead poisoning. A lock of his hair which was removed at the time of his death and stored in an airtight case was analyzed in 2000 by researchers in Illinois. Beethoven’s parietal skull bone was later analyzed in 2005. Both showed markedly elevated lead levels consistent with lead poisoning. The potential source for lead exposure may have been wine. At that time, lead was added illegally to inexpensive wine to improve the flavor.
April 7, 2014: What are electronic cigarettes and why are they so popular?
September 30, 2020
Electronic cigarettes are also known as e-ciggs and electronic nicotine delivery system. This rechargeable or battery operated device uses a heating element to vaporize liquid containing nicotine or flavors for inhalation.
March 31, 2014: What is Ebola?
September 30, 2020
Recent news has highlighted the first Ebola virus outbreak outside of Central Africa, in the West African country of Guinea. The outbreak is occurring in the southeastern region of Guinea which borders Sierra Leone and Liberia. Several cases have been reported including about 66 deaths which include 4 healthcare workers.
March 10, 2014: Does CO poisoning occur only during winter?
September 30, 2020
This Question of the Week was prepared by Bhavana C. Anand, MD, MPH, an occupational medicine resident from Meharry who is spending time with Dr. Benitez. Please take a few minutes to complete the survey at the end of the question, as it is part of her toxicology project.
March 4, 2014: Should dental amalgams be removed due to the concern for mercury toxicity?
September 30, 2020
Mercury is found in the earth’s crust and is ubiquitous in the environment, so most people have small, measurable amounts of mercury that can be detected in their urine, regardless of whether they have mercury containing amalgams. .
Feb 10, 2014: What is the clinical picture of Neuroleptic Malignant syndrome?
September 30, 2020
One of the consults that we receive is the question as to whether a patient has neuroleptic malignant syndrome (NMS). I had a recent case where an adolescent female overdosed on a SSRI. It led to a very informative discussion between the pediatric hospitalist and their pediatric resident team, psychiatry and toxicology. I thought it might
Jan 14, 2014: West Virginia UPDATE
September 30, 2020
To clarify the event in West Virginia: the chemical release was UPSTREAM of the main water intake valve to the region’s water treatment plant. Therefore, the regional water supply was contaminated.
Jan 13, 2014: Is the water in West Virginia safe to drink?
September 30, 2020
Dec 9, 2013: What is the Toxicity of Common Holiday Hazards?
September 29, 2020
Holiday Plants
Oct 14, 2013: What are the characteristics of sarin that make it “popular” as a chemical weapon?
September 29, 2020
Sept 30, 2013: Why did the FDA require drug label changes for all fluoroquinolones?
September 29, 2020
Fluoroquinolones have become a very common antibiotic; approximately 23.1 million patients are prescribed oral fluoroquinolones (2011). The most common fluoroquinolones dispensed are ciprofloxacin (70%), levofloxacin (28%), and moxifloxacin (9%); all others account for less than 1%. Injectable fluoroquinolones were administered in the hosp
Aug 15, 2013: What is acetyl fentanyl?
September 29, 2020
In March-May of this year, Rhode Island had 14 overdose deaths that were related to a new injectable synthetic opioid. All of these cases occurred in intravenous drug users who were located in the northern part of the state. The RI Department of Health, working with the CDC, confirmed that the new synthetic opioid is acetyl fentanyl. Ages of the victims ranged from 19-57 years old, ten of the fourteen were males. Analytical toxicology analysis showed other drugs in some of the victims. Forty five percent of them died in the ED, with 36% dying in the home.
July 22, 2013: How toxic are pool chemicals?
September 29, 2020
What are pool chemicals? Are they toxic? To maintain commercial and private swimming pools, many chemicals are utilized to enhance and protect the water quality. These chemicals minimize bacterial and algal growth, and maintain a pH to enhance disinfectant action while minimizing skin and eye irritation.
July 15, 2013: Do hip prosthesis cause metal toxicity?
September 29, 2020
In 2010, Depuy, Johnson and Johnson recalled the metal-on-metal hip replacement system (articulating surfaces made of chrome cobalt steel with anatomically sized femoral head) because the five year failure rate of this product was approximately 13% which is unusually high. The recall letter recommended that cobalt and chromium blood concent
July 8, 2013: What is the status of epidurals after the fungal meningitis epidemic?
September 29, 2020
I have attached an article from the Vanderbilt Pain Management Center that addresses this question. It is a great update.
June 24, 2013: What is different about the recently FDA approved antitoxin for botulism?
September 29, 2020
Botulinum toxin has 7 known serotypes that are named for the letters of the alphabet: Types A, B, C, D, E, F and G. Types A and B which are the most common types of botulism associated with foodborne botulism in the contiguous United States (US). Alaska tends to have Type E for its foodborne botulism.
May 13, 2013: What is the “Cinnamon Challenge”?
September 29, 2020
The Cinnamon Challenge is a popular dare to swallow a tablespoon of ground cinnamon in 60 seconds without drinking fluids. It is almost impossible to do. Just watch some of the videos where people attempt the cinnamon challenge on
May 6, 2013: What is the clinical picture of ricin poisoning?
September 29, 2020
The recent publicity of a ricin laced letters sent to Senator Wicker and President Obama demonstrates that as healthcare providers, we must be vigilant in considering biological agents while caring for our patients. Ricin is a toxin that is derived from Ricinus communis, which is the castor bean plant.
March 11, 2013: Why is poison prevention education important?
September 29, 2020
Poisoning is the 2nd leading cause of injury death in Tennessee, trailing only motor vehicle accidents and ahead of guns. Education is the key to poison prevention. Since 1962, the President of the United States has proclaimed the third week of March as National Poison Prevention Week to raise awareness about the dangers of poisoning. This year National Poison Prevention Week is March 17-23.
Jan 28, 2013: What is new in the mandatory reporting requirements to the Tennessee Department of Health (TN DOH) for health care providers?
September 29, 2020
Each state has the authority to determine a list of conditions that are reportable to public health authorities. While most of these conditions are reported by laboratories, practitioners are required to report as well. Some of the diseases that require reporting are not communicable diseases.
Dec 17, 2012: What is the law regarding pharmacy compounding versus drug manufacturing?
September 29, 2020
The recent fungal meningitis outbreak associated with compounded products from the New England Compounding Center (NECC) have led many to question the regulations regarding pharmaceutical compounding.
Jan 21, 2013: What was the role of Tennessee Poison Center in the recent mass exposure of school children to carbon monoxide?
September 29, 2020
In the late morning of Monday, January 14, Drexel School was closed due to the concern of a carbon monoxide (CO) leak. Initially, the parents were not sure why there had been an early school closure, but the school subsequently sent a telephone announcement alerting the parents that the children had been exposed to carbon monoxide. Parents
Dec 10, 2012: 'Tis the Season to be Poisoned
September 29, 2020
'Tis the Season to be Poisoned
Dec 3, 2012: What is the Toxicity of Common Holiday Hazards?
September 29, 2020
Holiday Plants
Despite the common belief of toxicity, the Poinsettia is not a poisonous plant. Poinsettia leaf ingestion should not cause any symptoms. Playing with the leaves or rubbing the eyes after handling the plant may lead to local irritation. Case reports of GI upset from Poinsettia ingestion generally involve animal cases or very large ingestions.
Nov 12, 2012: What is the history behind the development of BAL?
September 29, 2020
The story behind British Anti-Lewisite (BAL) goes back to the time of World War I when there was the development of lewisite as a chemical warfare agent. Lewisite is a topical arsenical that comes as an oily, colorless liquid that has the odor of geraniums; however, it can be a vapor form as well. Lewisite is classified as a vesicant or blistering agent.
Oct 29, 2012: Is there an outpatient medical toxicology clinic?
September 29, 2020
Yes there is! The medical toxicology clinic is located at The Vanderbilt Clinic, Medical Specialties Section on the 2nd floor. It is staffed by board certified physician medical toxicologists. Some patients are referred for follow up from a recent hospitalization or from an ED visit. Many patients are referred by primary care
Sept 17, 2012: What is the difference between the Poison Center and the Toxicology Consulting Service?
September 29, 2020
The Tennessee Poison Control Center (1-800-222-1222) provides a 24/7 hotline telephone service (103,000 calls/year) to answer questions about exposures to pharmaceuticals, venoms, environmental agents, and other toxicants. Specialists in Poison Information (nurse, pharmacist, or physician) answer the hotline phone, assess the situation and provide recommendations for
July 23, 2012: What is “ozone”?
September 29, 2020
This summer we have experienced high ozone levels throughout Tennessee. The Figure shows the high ozone levels that reached part of mid-Tennessee during ONE day this past month.
July 16, 2012: Where can you find web-based learning regarding poisoning?
September 29, 2020
FROM: American Association of Poison Control Centers -
May 21, 2012: Why should you be concerned about concentrated laundry detergent packets?
September 29, 2020
This is a press release from AAPCC. Tennessee Poison Center has not received any calls about the packets. Please be aware and call the Poison Center with any questions.
NEWS RELEASE
For Immediate Release
May 17, 2012
For More Information, Contact:
Loreeta Canton, communications manager
canton@aapcc.org or 703-894-1863
April 30, 2012: How is the CDC taking steps to combat opioid deaths?
September 29, 2020
I thought you would enjoy this article (below) from http://asam-365.ascendeventmedia.com/Highlight.aspx?p=368&id=4452
April 23, 2012: Why should my differential for patients with cyclical vomiting/abdominal pain include marijuana use?
September 29, 2020
Recently, there have been increased reports of patients who are chronic cannabis users and who have a cyclical vomiting pattern requiring multiple visits to health care providers and emergency departments. This entity was described in 2004 by Allen, et al in Australia.
April 9, 2012: What is Radon and why does it matter to human health?
September 29, 2020
Radon (222Rn) is an element, formed as the sixth element in the radiation decay sequence of uranium (238U). It is odorless, colorless and radioactive. Radon itself is not toxic because of its chemical or radiological characteristics! So why worry? Radon continues to decay into several progeny, frequently called “dau
April 2, 2012:Why is Tennessee the state with the most pain meds prescribed per capita?
September 29, 2020
States with a high number of pain clinics have more diversion than states with fewer pain clinics. Pain clinics can easily become pill mills containing dispensing doctors. Tennessee has more than their share of Pain Clinics. In fact, along the freeway, you can see a billboard stating “Pain Clinic next exit”. But we can’t just get rid of the Pain Clinics as they h
March 26, 2012: Why are prescription drugs so available?
September 29, 2020
12,000 US residents die annually from unintended prescription drug overdose. The US contains 4.6% of world population yet consumes 80% of the global hydrocodone supply. The US rate of prescription drug use is 11.3 prescriptions per person. In Tennessee, there are 17.3 prescriptions per person. As this is an average, many persons have mor
Feb 20, 2012: What new product is being promoted as “Pure Energy”?
September 29, 2020
When I hear the words “Pure Energy”, I remember Leonard Nimoy’s voice on the song, “What’s on your mind”, released by the Information Society in 1988. It is one of those “turn up the volume” songs. Oh, the simple days…
Jan 23, 2012: What does mercury have to do with beauty?
September 29, 2020
On September 2, 2011, the Texas department of health issued a news release to make the public aware of the presence of inorganic mercury in beauty creams such as Crema Aguamary.
Nov 8, 2011: Did you read the New York Times article about Poison Centers?
September 29, 2020
NEW YORK TIMES - November 7, 2011
Poison Centers Facing Greater Risks All Around
By PERRI KLASS, M.D.
Oct 17, 2011: Why would anyone want to lick a toad?
September 29, 2020
Well, it depends on which toad you are talking about. While the amphibians in the Tennessee area are probably more of a hazard to dogs (eating them), there is a toad that lives in the Sonoran desert called the Colorado River toad that has quite a reputation.
Oct 24, 2011: What is a hookah?
September 29, 2020
A hookah is an apparatus that was developed somewhere between India and Persia sometime in the 16th century. It was developed as a way to heat tobacco and vaporize its’ constituents, filter the constituents through water, and then inhale the vapors. It was thought that the water would purify the vapors from harmful substances an
Sept 26, 2011: What can you do with the Tennessee Poison Center Fall 2011 Newsletter?
September 29, 2020
Feel free to distribute it to your patients!
/poison-control/sites/default/files/TENNESSEE%20POISON%20CENTER%20NEWSLETTER%20-%20FALL%202011.docx
Sept 19, 2011: What is the easiest way to find the Poison Help hotline number?
September 29, 2020
September is the month when Tennessee Poison Center’s outreach gears up with numerous health fairs and school programs. At these events, outreach staff urge residents to save the Poison Help hotline phone number in their cell phones.
Aug 29, 2011: If suboxone has naloxone in it, why do patients develop opioid toxicity when they ingest suboxone?
September 29, 2020
Suboxone is a relatively new treatment strategy for opioid addition and is a combination of buprenorphine and naloxone. Buprenorphine is a semi-synthetic opioid with partial agonist effects and is able to compete with other opioids for binding to the Mu receptor since it has a slow dissociation time from the receptor.
Sept 12, 2011: Bath Salts Again ????
September 29, 2020
NEWS RELEASE
For Immediate Release: Sept. 8, 2011
For More Information, Contact:
Loreeta Canton, communications manager
canton@aapcc.org or 703-894-1863
Poison Control Centers Applaud DEA’s Ban of Bath Salts
Aug 1, 2011:
September 29, 2020
It is summer and the snakes are quite active this season and are basking in the sun, just like we humans like to do. In Tennessee there are four types of indigenous venomous snakes: the timber rattlesnake, the pygmy rattlesnake, the cottonmouth (also known as water moccasin, however this causes confusion as some people call any snake on or
Aug 8, 2011: Where is Djibouti and what does it have to do with bath salts?
September 29, 2020
Djibouti, an independent state in the Horn of Africa, is bordered by Eritea in the north, Ethiopia in the west and south, and Somalia in the southeast. The remainder of the border is formed by the Red Sea and the Gulf of Aden. Population is 818,159 of which 66% live in the capital city (also called Djibouti) and the remainder are nomadic h
July 18, 2011: How do I tell the difference between cutaneous anthrax and a brown recluse spider bite?
September 29, 2020
Even though it has not been in the news lately, acts of bioterrorism could still occur and clinicians must maintain awareness for biologic diseases such as anthrax. The majority of naturally occurring cases of anthrax is the cutaneous form.
July 11, 2011: What rocks you like a hurricane?
September 29, 2020
According to Old Crow Medicine Show, Meth-am-phet-a-mine.
July 5, 2011: Why is it not a good idea to swallow “snake” fireworks?
September 29, 2020
June 13, 2011: What does anthrax have to do with heroin abuse?
September 29, 2020
June 13, 2011: TPC Summer Newsletter
September 29, 2020
Attached is the summer newsletter from the TN Poison Center. Feel free to make copies and give it to your patients. Have a great summer!
/poison-control/sites/default/files/TPC%20SUMMER%202011%20NEWSLETTER.pdf
June 6, 2011: What role did Tennessee Poison Center play in the flood disaster?
September 29, 2020
Situation Report
May 9, 2011: Why will I have to update my powerpoint presentations on acetaminophen?
September 29, 2020
On May 4, 2011, the Consumer Healthcare Products Association announced that the makers of over-the-counter, single ingredient liquid acetaminophen will discontinue selling the concentrated infant drops.
April 11, 2011: What’s happening in Roane County 2 years after the Fly Ash Disaster?
September 29, 2020
Two years have passed since the TVA Roane County fly ash disaster. Heavy rains resulted in failure of one of the dikes containing an 80 acre pond with fly ash sludge. The dike broke on December 22, 2008 just before 1 am and the ash-slide covered an estimated area of 250-400 acres and was up to 4-6 feet deep.
April 4, 2011:What is in Molly’s Plant Food? (one of the latest recreational drug rages to affect Tennessee’s teens and young adults)
September 29, 2020
Molly’s Plant Food is a synthetic hallucinogenic amphetamine marketed as a “plant food” that contains ingredients that produce highs similar to Ecstasy. Molly’s Plant Food is usually purchased at a convenience store and is packaged in a capsule form with a cost of $8-$12 per capsule.
March 28, 2011: What should you tell patients regarding purchase or ingestion of potassium iodide?
September 29, 2020
With the recent natural disaster in Japan and the resultant damage to the nuclear reactors in Fukushima Daiichi plant, there have been increased concerns about potential radiation exposure in the United States. As a result, there has been increased demand for potassium iodide (KI).
March 14, 2011: Are there any new issues with acetaminophen and prescription products?
September 29, 2020
On January 13, 2011, the FDA announced a rule change asking manufacturers to limit the amount of acetaminophen in prescription drug products to 325 mg per dosage unit (tablet, capsule, etc). Currently, many prescription pain medications contain 500 mg of acetaminophen per dosage unit. In addition, the FDA added a “black box warning” to the
Feb 7, 2011: How does pyridoxine work as the antidote for INH poisoning?
September 29, 2020
Isoniazid (INH) is used for the treatment of active and latent tuberculosis because of its interaction with mycobacterial enzymes; however, INH also creates a net deficiency of pyridoxine. INH and its metabolites bind to pyridoxine and pyridoxal 5’ phosphate (the activated form) and enhance their renal elimination.
Jan 31, 2011: Are bath salts for more than bathing?
September 29, 2020
Jan 24, 2011: Why should you think of the weekdays with a cholinergic poisoning toxidrome?
September 29, 2020
While the most common mnemonics used with cholinergic poisonings are SLUDGE or DUMBBELS, the mnemonic for the days of the week is also important for remembering the clinical effects of the cholinergic toxidrome.
Dec 14, 2010: Is stringing Christmas tree lights hazardous to your health?
September 29, 2020
The Tennessee Poison Center has received calls from concerned parents and the media regarding lead in Christmas tree lighting.
Jan 10, 2011: Are we going to discuss CO exposure again?
September 29, 2020
Yes we are. This topic was requested by one of our readers and this topic is important enough to discuss every year. This exposure causes unrecognized morbidity and mortality and is one of the most litigated exposures. Never underestimate the impact of CO on your patient or you.
Dec 6, 2010: What is the Toxicity of Common Holiday Hazards?
September 29, 2020
Holiday Plants
Despite the common belief of toxicity, the Poinsettia is not a poisonous plant. Poinsettia leaf ingestion should not cause any symptoms. Playing with the leaves or rubbing the eyes after handling the plant may lead to local irritation. Case reports of GI upset from Poinsettia ingestion generally involve animal cases or very large ingestions.
Nov 29, 2010: Why does pralidoxime (2PAM) NOT work for patients poisoned with carbamates?
September 29, 2020
Carbamates are a class of central nervous system agents which bind to and inactivate acetylcholinesterase. Although we commonly think of them as insecticides and link them with organophosphates, they are also used in clinical medicine. Examples include neostigmine, pyridostigmine, and physostigmine.
Nov 22, 2010: Why is pralidoxime used for organophosphate poisonings?
September 29, 2020
Organophosphates are class of xenobiotics which are available as insecticides; however, certain organophosphates are considered chemical warfare agents. “Nerve agents” are extremely potent organophosphates and examples include sarin, tabun, soman, and VX. The mechanism of action of these compounds is the same.
Oct 25, 2010: What do you do when fomepizole is not available?
September 29, 2020
Many hospitals do not stock fomepizole because of cost and because they infrequently have patients with toxic alcohol poisoning.
Sept 20, 2010: What is the life threat of Systemic Loxsoscelism?
September 29, 2020
We are familiar with the cutaneous lesions following brown recluse spider bite (BRSB). Central necrosis can occur although the bites usually heal very well if they are left alone. No ointments, no debridement, no dapsone. Ice works better than opiates for the pain. Hard for physicians to do nothing.
June 22, 2010: How do you avoid a “STARI, STARI” night?
September 29, 2020
With the time of year that brings delicate lightening bugs out at dusk, also brings one of my nemeses: ticks. My many summers as a camp counselor had certain rituals associated with the usual daily activities of swimming, canoeing, archery, horseback riding, campfires, etc. Every night after showers, I lined up the kids to do the dreaded “tick check”.
Sept 13, 2010: What is “Vitamin B-17”?
September 29, 2020
“Vitamin B-17” is a label used to promote the use of amygdalin as an alternative “treatment” for cancer.
May 24, 2010: Is nicotine solution toxic?
September 29, 2020
Recently the TPC had a call about a child who ingested the contents of a bottle containing a nicotine refill solution for an electronic cigarette. Electronic cigarettes use a tar-free, odorless, nicotine liquid which vaporizes during use. The solution may contain a high, medium, low or non-nicotine content. Several flavors are available for users. Each “cigarette” has a lithium battery, a charger and an atomizer. So is this toxic?
May 10, 2010: Are there any “PiHKALs” in Tennessee?
September 29, 2020
Absolutely. PiHKAL stands for “phenylethylamines I have known and loved” with the most readily recognized PiHKAL being 3-4 methylenedioxy-n-methylamphetamine, better known as ecstasy. This classification includes any compound whose primary structure has a phenylethylamine skeleton, which is the basic structure for most amphetamine derivatives. This skeleton is modi
April 12, 2010: What happens if you smoke potpourri that contains “Spice” or “K2”?
September 29, 2020
∆9 tetrahydrocannabinol (THC) is the active component of cannabis better known as “pot” or “weed”.
March 1, 2010: What is “parachuting” and what does it have to do with drug abuse?
September 29, 2020
“Parachuting” is a term that is used to describe the technique of crushing up a pill, placing the crumbs into a tissue, wrapping this into a “parachute”, and then swallowing the tissue wrapped crushed drug. The intent is to increase the immediate absorption of the drug by increasing its surface area. The purpose of “parachuting” is a faster onset, higher intensity effect of the xenobiotic.
Feb 15, 2010: What is HIE therapy?
September 29, 2020
HIE or Hyperinsulinemia-Euglycemia therapy is a relatively novel way of treating cases of severe calcium channel blocker (CCB) poisoning. HIE is variously known as HIET (hyperinsulinemia-euglycemia therapy), HDIT (high dose insulin therapy), and occasionally other acronyms.
Jan 11, 2010: What do you need to know about Carbon Monoxide (CO) exposure?
September 29, 2020
This is a topic we discuss every year because CO exposure has potential for devastating sequela.
Dec 8, 2009: What is the Toxicity of Common Holiday Hazards?
September 29, 2020
Holiday Plants
Despite the common belief of toxicity, the Poinsettia is not a poisonous plant. Poinsettia leaf ingestion should not cause any symptoms. Playing with the leaves or rubbing the eyes after handling the plant may lead to local irritation. Case reports of GI upset from Poinsettia ingestion generally involve animal cases or very large ingestions.
Nov 16, 2009: Are there any pharmacokinetic or pharmacodynamic concerns associated with oseltamivir?
September 29, 2020
Oseltamivir phosphate is actually a prodrug that requires ester hydrolysis to its active form, oseltamivir carboxylate. This active form is not further metabolized but eliminated from the body via the kidneys. There is no effect on absorption if the medication is taken with food.
Sept 21, 2009: What are the current indications for H1N1 vaccination?
September 29, 2020
It is flu season. The EDs are seeing many patients with the flu and many patients who are concerned that they have the flu. Therefore the Tennessee Poison Center is partnering with the Department of Health to provide a free Flu Information Line between the hours of 11 am and 7 pm. The number is 1-877-252-3432. Hopefully we can answer questions and prevent unnecessary ED visits. Donna Seger
Aug 24, 2009: Why is Torch Lamp Oil mistaken for Apple Juice?
September 29, 2020
Because of the container and the color of the liquid. Look at the picture.
Aug 10, 2009: Are garter snakes venomous?
September 29, 2020
Garter snakes belong to the Colubridae family of snakes which is one of the largest families of snakes. Garter snakes (Thamnophis sp.) actually are venomous—but you really have to work at it to become envenomated. Published case reports of envenomation involve prolonged bites (e.g.
Aug 3, 2009: How toxic are pool chemicals?
September 29, 2020
What are pool chemicals? Are they toxic? To maintain commercial and private swimming pools, many chemicals are utilized to enhance and protect the water quality. These chemicals minimize bacterial and algal growth, and maintain a pH to enhance disinfectant action while minimizing skin and eye irritation.
July 27, 2009: Does the closing of the California Poison Control System have implications for Tennessee?
September 29, 2020
As many of you are aware, the California Poison Control System is scheduled to close in September 2009. This closing is due to lack of funding, primarily from the state of California. Several of you have asked, “What will happen in California?” and “What are the implications for Tennessee?”
July 6, 2009: Is EMLA safe to use in neonates e.g. <28 days of life?
September 29, 2020
The package insert specifically advises against use in children less than 3 months of age due to the risk of methemoglobinemia.
June 29, 2009: What was the most common sign or symptom noted in the majority of affected victims of the sarin subway terrorist attack in Japan in 1995?
September 29, 2020
Bradycardia
June 23, 2009: Any toxicity from EMLA cream?
September 29, 2020
One of our readers of the Question of the Week asked to have this question addressed. Here it is.
June 8, 2009: Why do drugs of abuse cause a euphoric “high"?
September 29, 2020
Simplistically, euphoria (from either natural rewards or drugs of abuse) occurs as a result of the release of Dopamine (DA) into the neuronal synapse in the limbic area of the brain.
May 26, 2009: Where can I find reliable online information about medications and breastfeeding?
September 29, 2020
Occasionally, physicians are asked whether or not a medication is safe to take while the mother is breastfeeding. The issue at hand is usually not medication safety for the mother but rather is it safe for the breastfeeding child. Unfortunately, the mother is often told not to breastfeed her child while taking a medication.
May 18, 2009: Where can healthcare professionals learn to manage HAZMAT situations?
September 29, 2020
Situations such as acts of terrorism, industrial accidents, or chemical spills on the country's interstate or railroad systems, may cause life-threatening hazmat exposures. Pre-hospital medical care providers and hospital staff must rapidly recognize the symptoms of toxic exposure and immediately provide appropriate treatment. At the Tennessee Poison Center (TPC) we are frequently contac
April 28, 2009: What are some pitfalls with Tylenol® and Toddlers?
September 29, 2020
Acetaminophen is commonly used as an antipyretic and pain reliever in young children and overall is quite safe considering the amount used by families for their children every day. Unfortunately, on occasion a therapeutic misadventure occurs and a young child develops severe acetaminophen induced liver injury.
April 21, 2009: How toxic are fertilizers?
September 29, 2020
Planting season is upon us and therefore many homeowners are purchasing and using fertilizers. Household fertilizers typically contain nitrogen, phosphoric acid (phosphorus) and potash (potassium). Frequently, fertilizers are described by the initials NPK, which represent the content of nitrogen, phosphorus and potassium respectively or may be described by a set of 3 numbers, i.e. 10-5-4, which represent the percentages of NPK by weight.
April 14, 2009: What do you want to know about GHB?
September 29, 2020
One of our readers of the Question of the Week asked for a summary of GHB. Here it is.
March 24, 2009: Why is agranulocytosis occurring in cocaine users?
September 29, 2020
The New Mexico Department of Health (NMDOH) has issued a health alert regarding a cluster of patients who presented with agranulocytosis over the past 15 months and had cocaine use in common. Most of the cases are in New Mexico, but there also have been cases in Arizona and in Colorado. NMDOH believes that levamisole, an antimetabolic drug used in veterinary practice as a de-worming agent, may have contaminated the cocaine.
March 9, 2009: What products in the home contain ethanol?
September 29, 2020
Do you know what products contain alcohol (ethanol) in your home? Many products used on a daily basis contain ethanol as part of their normal constituents. Increasing patient awareness of these products educates and prevents accidental poisoning. Normally we think of beer, wine, whiskey and other “drinking” alcohol as containing ethanol. Typical ethanol concentrations in these products are 4-6% for beer, 10-20% wine, and “hard liquors” 20-50%.
March 2, 2009: Ahhh, Spring is in the air . . . Any toxicities with the bulbs?
September 29, 2020
Narcissus species contain lycorine and other related alkaloids. Most of the poisonings related to narcissus are from ingesting the bulbs that were mistaken for onions. Ingestion of bulbs may lead to abdominal cramping, nausea, vomiting, and diarrhea. The gastroenteritis resolves within a few hours. Interestingly, one of the alkaloids that daffodils contain is galanthamine with is a competitive reversible acetylcholinesterase inhibitor.
Feb 16, 2009: Who suffers delayed Neuropsychiatric Sequelae following Carbon Monoxide Exposure?
September 29, 2020
Tough Question. In the 1980s it was assumed that CO bound to the hemoglobin molecule and created a functional anemia. Once the CO was gone, everything was fine as long as anoxia hadn’t occurred during the time the CO was attached to hgb. However, in Korea, where homes were frequently heated with charcoal briquettes under the slats of the floor, there were over 2000 admissions/year for CO poisoning. A simple telephone survey calling the patients that had been discharged with the diagnosis of CO poiso
Feb 2, 2009: Why should you have a carbon monoxide detector in your home?
September 29, 2020
Why should you have a carbon monoxide detector in your home?
Feb 9, 2009: How do you know which CO detector to buy?
September 29, 2020
There are 3 types of carbon monoxide detection sensors: biomimetic, semiconductor, and electrochemical. Biomimetic sensors use color change in the presence of the gas for detection. Semiconductors measure change in resistance in a silicon chip when the gas is present. Electrochemical sensors send an electronic signal when a chemical reaction occurs in the presence of carbon monoxide.
Jan 26, 2009: TVA Roane County Fly Ash Disaster – What happened and what it means?
September 29, 2020
The TVA Kingston Fossil Plant produces fly ash as a result of burning coal to create electricity. Fly ash is the leftover ash from the power generating plant. In order to reduce air pollution, the air being released through the smokestacks is “scrubbed” to capture the fly ash waste. This is “wetted” (mixed with water) and then kept in retention ponds on site. Due to heavy rains, one of the dikes containing an 80 acre pond with fly ash sludge broke on December 22, 2008 just before 1 am. This ash-slide covered an estimated area of 250-400 acres and was up to 4-6 feet deep.
Jan 12, 2009: Melamine: What’s up with that??
September 29, 2020
What is melamine and how did it end up in food products?
Jan 5, 2009: Is anything new in GI decontamination?
September 29, 2020
Although GI decontamination has been considered a mainstay of treating poisoned patients, there is no evidence that GI decontamination procedures change outcome. Aggressive GI decontamination procedures are a product of this country-in Europe, toxicologists seldom recommend GI decontamination. The recommendations of the TN Poison Center are based on available literature and clinical experience.
Dec 8, 2008: Toxicity of Common Holiday Hazards
September 29, 2020
We will once again initiate the Question of the Week.-only this time it will be new and improved (changed is the operative word).
Sept 26, 2007: Are Hand Sanitizers Poisoning Children?
September 29, 2020
May 18, 2007: What are the clinical aspects of Cyanide Poisoning?
September 29, 2020
In the last Question, I addressed the new antidote for cyanide poisoning, hydroxycobalamin. This question addresses the clinical aspects of this poisoning.
Cyanide is toxic via all routes of exposure (ingestion, inhalation, and dermal).
Apri 23, 2007: What is the CYANOKIT (hydroxocobalamin) antidote?
September 29, 2020
Cyanokit was FDA approved about a month ago. Cyanokit contains hydroxocobolamin, the hydroxylated active form of vitamin B12 ,an antidote indicated for the treatment of cyanide poisoning.
March 30, 2007: Why the Agony about Ecstasy?
September 29, 2020
One percent of the population uses Ecstasy once a month. Twenty four percent of college students use this drug regularly. The majority of 16 year-olds believes Ecstasy (Adam, XTC, M&M, E) use is “safe”.
March 14, 2007: NATIONAL POISON PREVENTION WEEK MARCH 18-24, 2007
September 29, 2020
Last year, more than 127,000 Tennesseans called Tennessee Poison Center for help in a poison emergency or for information regarding poisons. As you are aware, children are the most likely victims of accidental poisoning. The lack of safety latches on cabinets, the careless handling of prescription or over-the-counter drugs, and the natural curiosity of children are only some of the conditions that contributed to these accidental poisonings.
June 19, 2006: How does Tennessee Poison Center Help Persons That Do Not Speak English?
September 29, 2020
Tennessee Poison Center is available to help all Tennessee residents. TPC has a certified poison specialist who is a native of Venezuela and who speaks Spanish fluently. In addition, if a person calls the hotline and their language is not understood by the poison specialist, TPC uses the AT&T Language Line Services.
May 22, 2006: Is DEET safe and effective?
September 29, 2020
Application of DEET has been recommended to prevent bites from insects/ticks that can cause West Nile Virus or Lyme disease. DEET (N,N-diethyl-m-toluamide) is the most effective of insect repellents. Non-DEET repellants do not demonstrate appropriate protection against insect bites. An estimated 29% of American children are exposed to DEET.
May 15, 2006: What is the efficiency and toxicity of Avon's Skin So Soft Bug Guard?
September 29, 2020
May 1, 2006: Diphenhydramine and Adenosine-A problem?
September 29, 2020
March 9, 2006: Is There a New Toxicologist in Tennessee?
September 29, 2020
March 6, 2006: What is the initial evaluation of children living in homes with methamphetamine labs?
September 29, 2020
Recently, there has been media attention regarding the medical community’s evaluation of children living in homes where there is a methamphetamine lab. The medical community is being asked to assess the child that has been found in such a house. Multiple protocols have been proposed, based on little research data. Protocols range from “do nothing” to “do everything,” including CT scans, drug analysis, etc.
Jan 23, 2006: Does education about inhalants increase the abuse of inhalants in preteens and teenagers?
September 29, 2020
Inhalant abuse is rampant in Tennessee. In fact, our state ranks number 7th in the country for incidence of inhalant abuse.
Dec 5, 2005: What is GivingMatters.com™?
September 24, 2020
Josephine Darwin, Director of Community Outreach, has some information for you about two opportunities for end of the year charitable giving.
Nov 10, 2005: What is the antidote for dabigatran-induced bleeding?
September 24, 2020
On October 16, the Food and Drug Administration (FDA) granted a special accelerated approval to Praxbind (idarucizumab). Praxbind is indicated for patients treated with Pradaxa (dabigatran etexilate) when reversal of the anticoagulant effects are needed for life-threatening or uncontrolled bleeding.
Nov 7, 2005: What is the toxicity and treatment of ethylene glycol? Part II
September 24, 2020
Last week we discussed the physiology of ethylene glycol poisoning. Treatment is based on understanding that physiology.
Treatment
The goal of antidotal therapy is to prevent the metabolism of ethylene glycol to its toxic metabolites. This is done by blocking the enzyme alcohol dehydrogenase. The parent compound (ethylene glycol) is then slowly excreted via the kidneys.
Oct 26, 2005: What is the toxicity and treatment of ethylene glycol?
September 24, 2020
One of our readers has asked to have this question addressed. It is a good subject as the treatment is based on an understanding of the toxicity and the laboratory results. Ethylene glycol ingestion occurs more frequently in TN than in most other states. I will address it in two parts.
Part I
Ethylene glycol is a colorless, odorless liquid found in antifreeze.
Absorption
Once ethylene glycol is ingested, it is rapidly absorbed with peak concentrations occurring one to four hours after ingestion.
Oct 3, 2005: What is the Stability of Refrigerated Medications at Room Temperature ?
September 24, 2020
Several common medications have labels instructing consumers to store them in the refrigerator. Following catastrophic events, such as Hurricanes Ivan last year and Katrina this year, numerous people were left without power for an extended amount of time. News journalists reported diabetics not taking their insulin due to lack of refrigeration. Non-compliance with medications such as insulin is a significant health risk.
Aug 15, 2005: Last Thoughts on Acetaminophen
September 24, 2020
The indications for NAC in the acute acetaminophen (APAP) OD and chronic supratherapeutic ingestion have been discussed. IV NAC is also indicated for the treatment of APAP-induced hepatic failure as defined by pH<7.30, PT>100s, Cr>3.4. In this setting, NAC acts as an antioxidant and free radical scavenger, increases liver blood flow and has other possible actions. A retrospective study and small unblinded controlled prospective study demonstrated IV NAC reduced mortality in APAP-induced hepatic failure.1,2 A large randomized controlled trial has not been performed.
Aug 1, 2005: What special considerations alter your approach to acetaminophen (APAP) toxicity?
September 24, 2020
In acute single-time overdose, the approach to APAP toxicity must be altered if the patient is taking a cytochrome P-450 inducer (such as certain anticonvulsants, ethanol, some AIDs drugs) or if the patient is nutritionally deplete (AIDS, Cancer).
The Rummack-Mathew nomogram should be cut in half in these cases. For example, rather than administering NAC to a patient with a 4-hour APAP concentration of 140 mg/mL, NAC should be administered if the 4-hour APAP concentration is 70 mg/mL.
(The Poison Center can help you determine if drugs are cytochrome inducers.)
July 25, 2005: IV NAC Protocol (Prescott Protocol)
September 24, 2020
The FDA has approved the administration of IV NAC (mucomyst).
Loading Dose: NAC 150mg/kg in D5W 200cc
Infuse over one hour
Followed by Continuous Infusion #1:
NAC 50mg/kg in D5W 500cc
Infuse over 4 hours
Followed by Continuous Infusion #2:
NAC 100mg/kg in D5W 1000cc
Infuse over 16 hours
Acetadote is the only FDA-approved formulation currently available for intravenous administration.
July 25, 2005: What are the indications for administering the IV preparation of N-acetylcysteine (Acetadote) in Acetaminophen toxicity?
September 24, 2020
The intravenous preparation of N-acetylcysteine (N-ac) that is now FDA approved changes the length of time a patient is required to remain in the hospital for acetaminophen (APAP) toxicity. The approach to this exposure is the same as when we were administering the oral formulation. One obtains serum concentrations 4 -16 hours after the exposure. If the concentration falls above the Rumack-Mathew treatment line on the nomogram, the patient should undergo therapy with N-ac.
July 18, 2005: Why must clinicians know about pharmacogenomics?
September 24, 2020
Clinicians must understand pharmacogenomics as it explains the variability in response to drugs. It also offers potential explanations regarding individual susceptibility to addiction.
July 5, 2005: Is there new evidence of Adderall toxicity?
September 24, 2020
Health Canada suspended the sales of Adderall XR based on 12 post-marketing cases reported to MedWatch from 1999 to 2003. After the FDA reviewed the 12 cases, they did not feel that there needed to be an immediate change to the product labeling or approved use of the drug. They did not find a cause and effect relationship between Adderall use and sudden death. Shire recently applied for approval of Adderall in adult ADHD and the company had to s
April 18, 2005: Is the administration of promethazine (Phenergan®) in pediatric patients less than 2 years of age dangerous?
September 24, 2020
Wyeth has added a black box warning regarding the use of promethazine (Phenergan®) tablets and suppositories in pediatric patients less than two years of age. The reason give is the potential for fatal respiratory depression. The use of promethazine in children less than two is also listed in the Contraindications section of the package insert. According to the company, there was not a recent increase in the number of cases of fatal respiratory depression that prom
March 21, 2005: NATIONAL POISON PREVENTION WEEK MARCH 20 - 26, 2005
September 24, 2020
Last year, more than 30,000 children in Tennessee were harmed by poisonous substances found in their own homes. The lack of safety latches on cabinets, the careless handling of prescription or over-the-counter drugs, and the natural curiosity of children are only some of the conditions that contributed to these accidental poisonings.
March 14, 2005: NATIONAL INHALANT AWARENESS WEEK MARCH 20 - 26, 2005
September 24, 2020
Josephine Darwin, Director of Community Outreach for Tennessee Poison Center, recently attended a statewide meeting of health professionals, law enforcement officials and community volunteers to discuss the widespread abuse of inhalants among Tennessee youth.
Tennessee ranks 7th in the United States for inhalant abuse, according to CDC data.
Feb 21, 2005: Has the Tennessee Poison Center’s Call Volume changed since becoming the only statewide Poison Center?
September 24, 2020
Background: Prior to February 2004, the Southern Poison Center in Memphis provided poison control coverage for west Tennessee and part of east Tennessee from 7am-11pm. Upon their closure on January 30, 2004, the Middle Tennessee Poison Center began providing service to the entire state 24 hours/day, 7 days/week based on an agreement with the Tennessee Department of Public Health.
Jan 24, 2005: What is the toxicity of Lindane?
September 24, 2020
A recent case report suggests the association of neurotoxicity from repeated application of lindane (Kwell) in a 10-month old infant with anemia and hypoproteinemia. Although toxicity from a single application is unusual, repeated applications or accidental ingestion can result in neurotoxicity.
Lindane (gamma benzene hexachloride), a scabicide, is a chlorinated hydrocarbon insecticide. The organochlorine insecticides are well absorbed from the skin, GI track and lungs. They are distributed into fat where they can accumulate.
Jan 10, 2005: What is the New Warning for Strattera?
September 24, 2020
Strattera (atomoxetine HCl) is a selective norepinephrine reuptake inhibitor that is FDA-approved for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). Mechanism of action is thought to be related to selective inhibition of the pre-synaptic norepinephrine transporter.
Dec 20, 2004: Why is elemental mercury not toxic when ingested, but potentially toxic when spilled?
September 24, 2020
Mercury is a naturally occurring metal that is mined chiefly as cinnabar ore. It is converted into elemental mercury, inorganic mercury salts, and organic mercury. This discussion will address the ingestion and inhalation of elemental mercury. The other forms will be addressed in a later question.
Nov 22, 2004: What is the toxicity of Strattera®?
September 24, 2020
Strattera® (atomoxetine)is a highly selective norepinephrine reuptake inhibitor. Its current approved indication is for the treatment of attention deficit/hyperactivity disorder (ADHD), but it is being used investigationally in the treatment of depression.
Nov 1, 2004: What is the risk of Atrovent® use in patients with peanut allergies?
September 24, 2020
Response: Atrovent® (ipratropium) inhalation aerosol is an anticholinergic bronchodilator indicated for the treatment of bronchospasm associated with COPD. The inhalation aerosol, not the nebulizing solution, contains soya lecithin as a suspending agent. Thus, the medication is contraindicated in patients with a history of hypersensitivity reactions to soya lecithin and related food products, which includes peanuts. Due to this warning, patients with documented allergies to soy and peanut products have been excluded from clinical trials evaluating Atrovent®.
Oct 18, 2004: What medications should be avoided in patients with peanut allergies?
September 24, 2020
Response: Recent epidemiologic studies suggest that nearly 4% of Americans are afflicted with food allergies, a prevalence much higher than appreciated in the past. It is estimated that peanut allergies account for 28-55% of all food allergies. In addition, the prevalence of peanut allergy was found to have doubled in American children less than 5 years of age in the past 5 years.
Oct 4, 2004: What herbs are used for performance enhancement in sports?
September 24, 2020
Tribulus terrestris is an annual herb that is most common in subtropical areas, but grows worldwide. It is administered to treat sexual impotency, abdominal distension, and cardiovascular disease in India, Chile, and Bulgaria. It is one of the growing number of herbs used in the US to enhance physical performance.
Sept 20, 2004: Did the 2004 Institute of Medicine (IOM) report regarding the possible association between thimerosal-exposure and autism produce any new findings?
September 24, 2020
Until 1999, Thimerosal (ethylmercury) was present in over 30 vaccines. The 2001 IOM study on Thimerosal and neurodevelopmental disorders stated that the evidence is inadequate to accept or reject a causal relationship. Case reports were uninformative with respect to causality, there were no published epidemiological studies, and unpublished studies provided weak and inconclusive evidence. The public health response was to discard thimerosal vaccines on the shelf and remove thimerosal from other vaccines. Thimerosal was removed from all recommended vaccines by March 2001.
Aug 17, 2004: Are Fenugreek and Milk-Thistle safe for lactating mothers?
September 24, 2020
Recently an infant had a “spell” about 45 minutes after breast feeding. Mom was taking milk thistle and fenugreek as recommended by a midwife who was caring for her. The infant’s work-up was negative. Could either of these herbs have played a role?
Aug 2, 2004: “How toxic is an ingestion of toothpaste containing fluoride in a child?”
September 24, 2020
Background: Email communication has increased the visibility of “urban legends”.
July 19, 2004: Does the treatment of ADHD with stimulants contribute to subsequent Drug Use/Abuse?
September 24, 2020
Treatment of Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) with stimulants has been and is a hot bed of controversy. Stimulant administration for this disorder has markedly increased in the last 10 years. Children with ADD or ADHD are at risk for learning disabilities and educational failure, impaired social relationships and various psychiatric disorders. PET scans have demonstrated abnormalities in children with this disorder.
July 12, 2004: Is DEET safe and effective?
September 24, 2020
Application of DEET has been recommended to prevent bites from insects/ticks that can cause West Nile Virus or Lyme disease. DEET (N,N-diethyl-m-toluamide) is the most effective of insect repellents. Non-DEET repellants do not demonstrate appropriate protection against insect bites. An estimated 29% of American children are exposed to DEET. The concern has been caused by case reports associating use in children with precipitation of seizures.
June 8, 2004: What are the conclusions of the Institute of Medicine Study?
September 24, 2020
The Institute of Medicine (IOM) was asked by the Maternal and Child Health Bureau to assist in developing a systematic approach to stabilizing poison prevention and control services. This report had a significant impact as financial recommendations as well as recommendations for the number of poison centers were included in it. At one point, a single large center serving the entire country had been considered. Fortunately the committee did not recommend a single large center.
The recommendations are as follows: (My comments are in parenthesis)
May 14, 2004: Tylenol/Motrin ALERT
September 24, 2020
This is a very important alert. If parents are alternating Motrin and Tylenol,
April 6, 2004: What is the history of lead poisoning?
September 24, 2020
This question of the week is just for fun and for those with an interest in toxicology history.
Lead Poisoning and the Demise of the Ancient Roman Empire
March 22, 2004: How much tuna is safe for pregnant women, nursing mothers, and young children?
September 24, 2020
The FDA has just released an Advisory recommending that women planning to become pregnant, pregnant women, nursing mothers, and young children may eat up to 12 ounces a week of a variety of fish and shell fish low in mercury. This group should not eat shark swordfish, King Mackerel or Tilefish, and not more than 6 ounces of albacore tuna per week. The reason is the concern about methymercury.
March 1, 2004: NATIONAL POISON PREVENTION WEEK MARCH 21 - 27, 2004
September 24, 2020
Last year, more than 30,000 children in Tennessee were harmed by poisonous substances found in their own homes. The lack of safety latches on cabinets, the careless handling of prescription or over-the-counter drugs, and the natural curiosity of children are only some of the conditions that contributed to these accidental poisonings.
The third week of March (21st - 27th) is the forty-third observance of National Poison Prevention Week. This is a time when communities should call attention to the steps we can take to prevent accidental poisonings.
Feb 16, 2004: What are the Date Rape Drugs? Part 3
September 24, 2020
Pharmacokinetically, GHB is rapidly absorbed with peak plasma levels 20-60 minutes after ingestion. The primary route of elimination is the lungs.
Feb 9, 2004: What were the concerns with the recent Ricin discovery?
September 24, 2020
Recently, ricin was discovered in a senate office and this country became concerned with potential exposure.
Fear occurred as information about ricin was distributed. Much of the information was erroneous. Facts about ingestion of ricin and inhalation of ricin were confused.
Ricin comes from castor beans. Most of our experience with ricin comes from accidental ingestions of castor beans by toddlers. One or two beans can be extremely toxic, however, the bean has to be masticated to release the ricin. If the bean is swallowed whole, there should be no toxicity.
Jan 19, 2004: What are the Date Rape Drugs? Part 2
September 24, 2020
GHB is an endogenous short-chain fatty acid that is a naturally occurring metabolite in many tissues. It induces both NREM and REM, anesthesia, hypothermia, and a trance-like state and has been considered a model for petit mal epilepsy. GHB increases brain dopamine. It is found in the CNS, kidney, heart, skeletal muscle and brown fat.
Jan 5, 2004: What are the Date Rape Drugs?
September 24, 2020
One in four women in the US will be raped in their lifetimes. Almost 75% of all rapes are date or acquaintance rapes. These numbers may be underreported due to victim’s intense feelings of guilt and the common belief that the victim was somehow responsible for the sexual assault. Date rape is one of the most serious and complicates forms of rape secondary to controversial social issues.
Rape drugs are used by perpetrators to induce sedation and amnesia prior to sexual assault. Drugs most easily used must be tasteless, colorless, and dissolve readily.
Dec 22, 2003: What will happen when Southern Poison Center closes on January 30, 2004?
September 24, 2020
On January 30, 2004, Southern Poison Center (SPC) will close due to lack of funding. At that time, Middle TN Poison Center (MTPC) will initiate state coverage. The State Dept of Health will provide the funding to expand our services. The funding will not cover the current deficit, but will cover the expansion. Continuation of services in the 38 counties served by SPC means that every county in the US remains covered by a Poison Center.
Dec 8, 2003: WHAT IS THE TOXICITY OF COMMON HOLIDAY HAZARDS?
September 24, 2020
Kim Barker Pharm D., Managing Director of the poison center, provides some insights on this topic:
Christmas trees such as cedar, fir, and other popular evergreens are non-toxic. All may cause dermal irritation or mechanical injury if ingested.
Nov 25, 2003: Who will answer the poison center calls for 38 counties on December 19 when the Southern Poison Center closes?
September 24, 2020
Due to lack of funding, Southern Poison Center will be closing on December 19, 2003. No provisions have been made to date for coverage of the 38 counties that call SPC from 7 am to 11 pm. Since 2001, Middle TN Poison Center (MTPC) has been covering the entire state from 11 pm to 7 am and will continue to do so. MTPC is certified by the American Association of Poison Control Centers and adheres to the strict requirements regarding poison control standards.
Nov 3, 2003: What is the AAP's new policy on poison treatment in the home?
September 24, 2020
The American Academy of Pediatrics announced its new policy on Poison Treatment in the Home in a plenary address yesterday at its annual meeting in New Orleans. It appears as a formal statement in this month's issue of Pediatrics (Pediatrics 2003; 112; 1182-1185). The most notable recommendation is that the AAP no longer recommends ipecac in the home as a treatment intervention. Here are the recommendations from that policy statement...
Oct 20, 2003: HOW DOES THE TOXICITY OF NEWER ANTIHISTAMINES COMPARE WITH OLDER ANTIHISTAMINES?
September 24, 2020
Background: Recent FDA approval for the over-the-counter (OTC) sale of Claritin® (loratadine) may increase ingestion of this class of antihistamine. Loratidine is a 2nd generation antihistamine. Other 2nd generation antihistamines were recalled due to concerns with QT interval prolongation. The question is unanswered as to whether high concentrations of Loratidine could prolong the QT.
There are three classes of H1 Antagonists:
Sept 22, 2003: What is the role of the Poison Center following Chemical Agent Exposure?
September 24, 2020
Chemical exposure can cause unexplained and unusual symptoms, which must be diagnosed and treated early. Protective equipment and decontamination play a significant role in preventing morbidity and mortality when there is a mass release of an agent. Previously standardized protocols have been developed to manage accidental releases of hazardous material (HAZMAT). These protocols are not applicable when there is an attack using chemical weapons.
Aug 25, 2003: WHAT IS THE CLASSIFICATION OF CHEMICAL WEAPONS?
September 24, 2020
Chemical weapons are classified according to their intended target and physiological effects.
Aug 24, 2003: What is the status of Ipecac?
September 24, 2020
Due to the recent article about Ipecac in the Tennessean, a number of readers asked me to address Ipecac (again) in the Question of the Week.
Ipecac has gained attention because the FDA is considering removing it from OTC status. This is a very interesting as there is no new data regarding ipecac. What is even more interesting is the controversy that has been generated by the FDA’s consideration. One of the reasons for removing it from the market is the potential for abuse by bulimic patients.
Aug 11, 2003: WHAT IS THE HISTORY OF CHEMICAL TERRORISM
September 24, 2020
Foremost in the mind of everyone is biological and chemical terrorism. Over the next few weeks, I am going to summarize aspects of chemical terrorism.
DEFINITION AND HISTORY
July 28, 2003: How could Ricin be used as a Weapon of Mass Destruction?
September 24, 2020
Ricin gained notoriety in 1978 (in London) when the Bulgarian journalist and political exile, Georgi Markov was stabbed by an umbrella which left a hollow metallic sphere the size of a head of a pin in his posterior thigh. He died from severe gastroenteritis and multiorgan failure as a result of the ricin injection. Ricin was recently found in the possession of known terrorists.
Ricin is readily available. Castor beans are used in the production of castor oil, a brake, and hydraulic fluid constituent.
July 14, 2003: What is the toxicity of mole beans?
September 24, 2020
The Poison Center received a call about two children who had ingested “mole beans.” These plants are popular in Tennessee. But, mole beans contain ricin.
Ricin is one of the most toxic substances known and the most toxic substance of plant origin. Ricin is a glycoprotein, which interferes with protein synthesis. The majority of the information about ricin toxicity comes from reports of castor bean ingestion. Castor beans are used in making ornamental necklaces.
June 23, 2003: What is the treatment of brown recluse spider bites (brsb)?
September 24, 2020
Answer: Brown Recluse Spiders (Loxsceles reclusa) are endemic to the state of Tenn. These spiders are also called "violin" or fiddleback" spiders due to the violin-shaped marking on the spider's back.
June 16, 2003: What is the bioavailability of rectally administered benzodiazepines?
September 24, 2020
Diazepam and lorazepam are the two drugs most frequently administered rectally to control seizures. Both are highly lipid soluble and therefore are absorbed well through rectal tissue. There have been few studies of rectal administration of lorazepam. In adult males, rectal absorption is variable, with 50-100% bioavailability (amount actually reaching the bloodstream) following rectal administration. Peak concentrations of diazepam can be reached in 4-20 minutes following rectal administration (0.7 mg/kg) Rectal absorption of diazepam is also variable. (50+/-17 % bioavailability)
May 12, 2003: What is the bioavailability of rectally administered acetaminophen (Tylenol)?
September 24, 2020
Acetaminophen (APAP) is frequently administered as a rectal suppository. The clinical assumption is that the absorption is good and that therapeutic concentrations are rapidly achieved. This is not the case. The evidence is as follows.
April 21, 2003: What are the chronic effects of toluene inhalation?
September 24, 2020
Toluene is an aromatic hydrocarbon found in gasoline, paint thinners, lacquers, and adhesives. Toluene is the inhalant that demonstrates the greatest toxicity when chronically. abused. Although all inhalants can cause neurotoxicity, toluene causes a pattern of cognitive dysfunction that includes apathy, poor attention and concentration, memory loss, visuospatial dysfunction and impaired complex cognition. White matter
April 28, 2003: Can one or two tablets be potentially fatal in children?
September 24, 2020
Dr. Hoover from Summit Medical Center has the following question: Name 5 overdoses in children that are potentially fatal with just a one or two pill ingestion.
April 14, 2003: What are the signs and patterns of inhalant abuse?
September 24, 2020
The estimated risk of starting to use inhalant drugs has increased 3-fold during the past decade.
March 10, 2003: What is National Poison Prevention Week?
September 24, 2020
NATIONAL POISON PREVENTION WEEK
MARCH 16-22
Poisoning continues to be the third leading cause of accidental death among children.
March 3, 2003: What is the toxicity of Chromated Copper Arsenate (CCA) treated wood in Playground Equipment? (Part 2)
September 24, 2020
A statement from Chairman Hal Stratton
Public Briefing on CCA Pressure-Treated Wood Playground Equipment Scheduled
Feb 24, 2003: What is the toxicity of Chromated Copper Arsenate (CCA) treated wood in Playground Equipment?
September 24, 2020
This is a long answer. The potential carcinogenic effects of CCA have been hotly debated. The evidence is far from conclusive but it appears that CCA lumber will not be used in playground equipment. I’ve also attached background info on CCA.
Feb 17, 2003: What is the new certification for dietary supplements?
September 24, 2020
I thought you would be interested in information about the USP certification for dietary supplements. The USP is a non-government organization that promotes public health by establishing standards, which are developed by a process of public involvement. The USP is a not-for-profit organization that is primarily supported by volunteers representing pharmacy, medicine, and other health care professions. For information on USP visit www.usp-dsvp.org.
Feb 10, 2003: How do you make methamphetamines?
September 24, 2020
If one assesses the number of labs that have been discovered by metro police, it appears that this information is almost common knowledge.
Methamphetamines can be manufactured in illicit laboratories using over-the counter ingredients. The following is the list of ingredients listed on the Internet as required for the manufacture of methamphetamine:
Feb 3, 2003: Does methamphetamine abuse cause long-term neurotoxicity?
September 24, 2020
Methamphetamine is toxic to dopaminergic and seratonergic neurons in rodents, but there is little data on the toxic effects of methamphetamine on the human brain. In rhesus monkeys, the neurotoxic effects of methamphetamine persist for four years.
Jan 27, 2003: What are the actions of methamphetamine?
September 24, 2020
Amphetamines selectively enhance the release of dopamine and norepinephrine and block the reuptake of these catecholamines at the synapse. The marked increase in dopamine level may be related to the “high”. There is increase of α and β receptors stimulation. Increased norepinephrine in the locus cereleus causes anorexia, increased alertness, and locomotor stimulation.
Jan 20, 2003: What is the history of methamphetamine?
September 24, 2020
Methamphetamine, (“crystal meth” “Hawaiian ice” “crank”, “zip” “crusty”) is an N-methyl homologue of amphetamine. Use of this drug originated in East Asian countries in the 80s, and then spread to Hawaii. Hawaii is centered between the continental US and Asia. Geography and culture have resulted in increased use of the smokeable meth in Hawaii, which predated more widespread use in the continental US. Tennessee ranks as one of the top 5 states where this drug is most frequently used.
Dec 16, 2002: What are the effects of “Ecstasy”?
September 24, 2020
MDMA (3,4 methyl-enedioxy-methamphetamine), is a pheyethylamine with structural similarities to both amphetamine and mescaline. It has been classified into a novel pharmacological class termed “enactogens because it has a characteristic psychoactive profile that distinguishes it from classic hallucinogens and stimulants. Acute psychological effects include euphoria, elevated self-confidence, and heightened sensory awareness. Individuals feel closer to other individuals and groups of people. Adverse effects include depersonalization, derealisation, and cognitive disturbances.
Dec 9, 2002: What are Designer Drugs? What is MDMA (Ecstasy)?
September 24, 2020
To discuss Designer Drugs, it is worthwhile to first review the history of Designer Drugs. A California pharmacist first used this term in 1980 to describe the private synthesis of drugs different from the parent compound. This rendered the drugs immune from the DEA. The loophole was that until a drug was isolated, studied, and scheduled, no laws could apply to it. Using well-known drugs such as fentanyl, mescaline, amphetamine, and meperidine, designer drugs such as MDMA, MPTP, and fentanyl derivatives were made.
Dec 2, 2002: Part IV – History of Drugs of Abuse
September 24, 2020
The mid 70s marked the second coming of cocaine. It was the perfect drug for the “Me Generation.” The new morality of young America was success, the high performance ethic. Pot bred passivity. Alcohol impaired performance and smelled. People can tell when you’ve been drinking. But cocaine fit the new value system-the tight line between high performance and self-indulgence. Subsequent drugs have continued to provide a combination of “release” and the feeling of empowerment. But the feelings are required at earlier and earlier ages.
Nov 25, 2002: Part III – History of Drugs of Abuse
September 24, 2020
The baby boom generation knew little about drugs and therefore, offered the drug culture priests a slew of ready disciples. When it was discovered that marijuana didn’t drive you mad, the government lost what little credibility it had. In this age of youth rebellion, the fact that drugs shocked parents was all the more reason to use them. Hollywood, ever sensitive to changing mores, romanticized the pot-smoking antiheroes in Easy Rider and “let it all hang out” hippies in Hair.
Nov 18, 2002: Part II – History of Drugs of Abuse
September 24, 2020
In the 1930s, cocaine and opium were driven underground. Cocaine was the narcotic of choice among musicians, actors, and artists, but decent Americans didn’t use it. It was Prohibition, after all, and most Americans were too busy finding bootleg gin to think about more exotic intoxicants.
Nov 4, 2002: What is the history of drugs of abuse?
September 24, 2020
There have been a number of questions about drugs of abuse. Therefore, I am going to do a series on drugs of abuse, starting with an overview of the history of drug abuse.
Part I
History offers ample evidence of drug abuse since early times. Opium use can be traced back to Greece and Cyprus as early as 2000 BC. Ancient Aztecs used LSD, peyote, and marijuana. In more recent times, George Washington used marijuana to ease dental pain. On the advice of Samuel Clemens, Ulysses Grant used cocaine while writing his memoirs.
Oct 22, 2002: What is the role of Outreach and Education in the Poison Center?
September 24, 2020
One of the missions of the Poison Center is Outreach and Education.
OCt 14, 2002: Which OTC products are toxic in low dose?
September 24, 2020
This is Part II of products in the home that can cause toxicity.
Sept 23, 2002: How is the Poison Center funded?
September 24, 2020
During the United Way season, we are often asked how the Poison Center is funded. It is a common misconception that the Middle Tennessee Poison Center is totally funded by the state of Tennessee. Although the majority of the poison control centers in the U.S. receive at least 50% of their operating budget from their state, our poison center and the Southern Poison Center in Memphis receive approximately 10% of their budgets from state dollars.
Sept 16, 2002: What are some common household products that have significant toxicity?
September 24, 2020
Thanks to the subscriber who asked the following question.
Sept 9, 2002: What is St. John’s Wort?
September 24, 2020
St. John’s Word is derived from the plant Hypericum perforatum. It has been used in Greece for various ailments since ancient times. Currently sold as an antidepressant it has been called “herbal Prozac.” The drug contains many active ingredients. The drug inhibits the uptake of norepinephrine, dopamine, and serotonin, but only at blood levels not generally obtained with regular use. In an recent trial where it was compared to Zoloft and placebo, St. John’s Wort did not proved efficacious in moderately severe depression. There is little data on toxicity of this herb in overdose.
Aug 26, 2002: What is Gingko Biloba?
September 24, 2020
Gingko is derived from the world’s most ancient tree that is native to China and Japan. Traditional Chinese herbal medicine recommends gingko as an antimicrobial, anti-inflammatory, and vasodilatory remedy. A concentrated standardized gingko biloba extract was developed in Germany in 1965, where it is available over the counter and by prescription. It is used in the US to enhance short-term memory, concentration, and alertness, particularly in the elderly. Earlier European and US studies indicated modest improvement in cognition of demented patients.
Aug 19, 2002: What is the toxicity of Pennyroyal?
September 24, 2020
I hope you enjoyed your time during the summer break and the hiatus from Question of the Week. I spent one week at the beach, one week in Mexico building houses, and one weekend whitewater rafting with two adolescent males. There was not one dull moment.
June 24, 2002: What are the Safety Issues with Herbal Products?
September 24, 2020
Currently, up to 50% of consumers use some type of herbal supplement. Frequently, the consumer does not consider this to be medicine and the physician is unaware of the ingestion of these products. For the next few weeks, I am going to review some of the more popular products.
June 10, 2002: WHAT IS THE TOXICITY OF POKEWEED?
September 24, 2020
Pokeweed is a perennial that grows wild throughout the eastern half of the United States. It has a green or red center stalk with oblong leaves. The small berries grow in “grape-like clusters” and ripen from green to purple in the summer. The juices of the ripe berries leave a purple stain when handled which may attract young children. The entire plant is potentially toxic. The root is the most toxic and the ripe berries the least toxic. Potentially toxic doses are as little as 0.5 teaspoonful of the root and 10 or more of the berries.
May 28, 2002: How does state funding for Tennessee’s poison control centers compare with other states in the South?
September 24, 2020
Most of the financially solvent poison control centers throughout the United States are funded by state government funds. In Tennessee, the Department of Health allocates $100,000 each for Middle Tennessee Poison Center and Southern Poison Center in Memphis and pays for a toll-free inbound telephone line that is used by both centers. In Tennessee the $220,000 annual support is the lowest amount among the Southeastern states (see table below) and represen
May 13, 2002: Do poison control centers really save money?
September 24, 2020
The answer to this question is a resounding “YES!”
May 6, 2002: What is the toxicity of common spring and summer plants?
September 24, 2020
Once again, Kim Barker, managing director of the hotlines, will address plants. Next week will conclude our summer plant series with a question about pokeweed.
April 29, 2002: What is the toxicity of common spring and summer plants?
September 8, 2020
The majority of plants and flowers blooming this time of year do not present a hazard to small children with accidental ingestions. MTPC receives the most calls about the following plants, which are nontoxic.
April 22, 2002: What is the toxicity of melatonin?
September 8, 2020
Melatonin is currently being administered to children as a potential sleep aid. Although the drug appears to be relatively safe in therapeutic doses as well as in overdose, there are still many unanswered questions regarding this drug.
April 8, 2002: What is the toxicity of muscle relaxants?
September 8, 2020
The group of drugs that are classified as muscle relaxants differ greatly in pharmacologic and toxicologic properties. Most of the skeletal muscle relaxants depress the CNS. Some of the drugs have anticholinergic (thus the hallucinations) and antihistaminic properties. Presentation of a child that has ingested a muscle relaxant includes CNS and respiratory depression, muscle flaccidity, and possibly anticholinergic effects i.e.
April 2, 2002: WHAT ARE THE MOST COMMON EXPOSURES INVOLVED IN POISONINGS?
September 8, 2020
MTPC tracks data on the type of substance involved in each exposure. Products most commonly involved include medications, plants, household cleaning products and pesticides. The following data is for calls to the MTPC in 2001.
March 26, 2002: Does the Middle Tennessee Poison Center have any statistics regarding exposures, calls, etc?
September 8, 2020
At the beginning of each year, data is compiled indicating exposure statistics for the previous year. Kim Barker, Pharm D., Assistant Director of the Middle Tennessee Poison Center, will share some of the data from our 2001 Annual Report. Also, Kim will provide additional information in the following week’s “Question of the Week”. ds
March 18, 2002: What agents are nontoxic when ingested in small amounts?
September 8, 2020
A&D Ointment, Desitin
Ashes (fireplace or charcoal)
March 4, 2002: What is the potential for drug interactions in the child who is on medication for ADD and uses street drugs such as ecstasy?
September 8, 2020
Thanks to those of you who are asking questions. I have received a number of topics and will address each one.
This question was asked by a community pediatrician.
Feb 25, 2002: What is the value of serum drug quantitation in the overdose setting? Part III (final lab discussion)
September 8, 2020
In the overdose setting, clinical parameters are more indicative of toxicity than serum concentrations. There are relatively few drugs for which quantitative measurement is beneficial. Drugs in which serum quantitation may be useful include:
Feb 19, 2002: What is the analytic Accuracy of Toxicology Screens? (Part II)
September 8, 2020
For the average analytic laboratory, confirmed false negatives occur at a rate of 10-30% and confirmed false positives occur at a rate of 0 – 10%. The most common reason for an analytic false negative is ordering a drug screen which does not test for the suspected drug. False positives are low due to high concentrations of the detected drug and confirmation of the presumptiv
Feb 11, 2002: NATIONAL POISON PREVENTION WEEK MARCH 17-23
September 8, 2020
Last year, more than 20,000 children in Tennessee were harmed
by poisonous substances found in their own homes. The lack of safety latches on
Jan 28, 2002: What is the clinical Presentation and treatment of Benzodiazepine Overdose?
September 8, 2020
Benzodiazepine (BZDP) overdose (OD) most frequently presents with sedation and CNS depression. Coma may occur. Cardiovascular stability usually does not occur with a pure BZDP OD. One of the more frequent complications of a pure BZDP OD is aspiration pneumonia, which probably occurs prior to airway protection. The morbidity and mortality is much higher if BZDPs are ingested in combination with alcohol or other sedative-hypnotic drugs.
Jan 21, 2002: What is the clinical significance of therapeutic ingestion of BZDP?
September 8, 2020
Benzodiazepines (BZDP) potentiate the activity of GABA, a major inhibitory neurtransmitter in the CNS. The drugs cause sedative-hyponotic, muscle relaxant, anxiolytic and anticonvulsant effects. Clinically one may see sedation, impaired psychomotor skills, cognitive dysfunction, and short-term memory impairment. Rarely, BZDP may cause paradoxical effects. Tolerance to the sedative effects occurs over days, possibly over periods as short as hours.
Nov 26, 2001: What is the toxicity of common holiday plants?
September 8, 2020
I thought you would be interested in potential "Christmas Toxins". Kim Barker Pharm D., assistant manager of the poison center, provides some insights on this topic:
Nov 19, 2001: What is the toxicity of serotonin reuptake inhibitors?
September 8, 2020
Serotonin Selective Reuptake Inhibitors (SSRI) and Serotonin Reuptake Inhibitors (SRI) were developed because the tricyclic antidepressants (TCAs) had significant sedative and anticholinergic side effects. SSRIs inhibit the synaptic reuptake of serotonin. In addition to affecting synaptic serotonin levels, the SRIs have variable effects on the synaptic levels of epinephrine and norepinephrine.
Nov 12, 2001: Answers to submitted questions
September 8, 2020
A number of subscribers have asked about IV NAC (N-acetylcysteine). IV NAC is not FDA approved. It has been shown to reduce morbidity and mortality in acetaminophen-induced hepatic failure (note-this is only in hepatic failure caused by acetaminophen overdose). I would certainly administer IV NAC in this setting.
Nov 6, 2001: What is the toxicity when glass cleaner is ingested?
September 8, 2020
Glass cleaners usually contain isopropyl alcohol, glycol ethers, annomium hydroxide and water. They do not contain methanol.
Oct 29, 2001: How Toxic are Detergents and Soaps?
September 8, 2020
Soaps are the product of a reaction between alkali and fats or oils. Detergents are a bit more toxic as they contain combinations of surfactants which lower the surface tension of water and allow it to remove dirt more efficiently.
Oct 22, 2001: What is the toxicity of household cleaning products? —Part II
September 8, 2020
The Middle Tennessee Poison Center received many questions regarding household cleaning products. One of the most frequent calls occurs when bleach (hypochlorite) and ammonia are mixed to use as a cleaning solution (most frequently for bathroom fixtures). The combination of these products forms the noxious chloramines gas.
Oct 15, 2001: What is the toxicity of household cleaning products? —Part I
September 8, 2020
Most household cleaning products are irritants and can cause irritation of the eyes, oropharyngeal and respiratory mucosa. Tearing, erythema, dyspnea and generalized discomfort are some of the more frequent symptoms.
Oct 8, 2001: What is the clinical presentation of the patient with salicylate toxicity?
September 8, 2020
Clinical signs and symptoms depend on age, serum concentration, and acuity of ingestion.
Oct 1, 2001: What is the pathophysiology of salicylate toxicity?
September 8, 2020
Salicylate toxicity seems to be increasing. We are receiving an increased number of calls at the Poison Center. I addressed the treatment of salicylate toxicity last week. This week and next week we will address other aspects of salicylate toxicity.
Sept 24, 2001: What is the treatment of the patient with salicylate toxicity?
September 8, 2020
As previously discussed, Ipecac administration and gastric lavage are not recommended in children. Salicylates are absorbed by activated charcoal, so early administration of charcoal should be considered. Furthermore, multiple-dose activated charcoal causes gastric dialysis, i.e., the drug is actually pulled from the blood int
Sept 17, 2001: What is the treatment of cigarette ingestion?
September 8, 2020
Nicotine is a bitter-tasking colorless liquid alkaloid that turns brown upon exposure to air. Most nicotine in the US comes from the commonly cultivated tobacco Nicotiana tabacum.
Sept 10, 2001: What is the treatment of mothball ingestion?
September 8, 2020
Mothballs are either napthalene (which can be toxic) or paradichlorobenzene (ingestion usually inconsequential). One can determine which ingredient is in the mothballs by placing the mothball in 4 ounces of tepid water in which 3 heaping tablespoonsfuls of salt have been dissolved. A napthalene mothball will float whereas a paradichlorobenzene mothball will sink.
Aug 27, 2001: Is there any association between the mercury in vaccines and autism?
September 8, 2020
There is a movement to attribute autism to the mercury (thimersol) in vaccines. Dr. Brent, past president of the American Academy of Clinical Toxicology has made a few remarks regarding that association. I thought you would find them of interest.
Aug 8, 2001: What are the indications for naloxone administration?
September 8, 2020
Naloxone, an opioid antagonist, cannot be administered orally because the liver metabolizes the first dose and there is little drug that reaches the circulation (first-pass effect). Naloxone is well absorbed IM, SQ, and endotracheally. The onset of action is one-two minutes following IV administration. Duration of action is 20-90 minutes.
July 30, 2001: What is the treatment of brown recluse spider bites (brsb)?
September 8, 2020
Brown Recluse Spiders (Loxsceles reclusa) are endemic to the state of Tenn. These spiders are also called "violin" or fiddleback" spiders due to the violin-shaped marking on the spider's back.
July 16, 2001: What is the approach to the patient with clonidine overdose?
September 8, 2020
The incidence of clonidine overdose is increasing. Traditionally, grandparent’s medication has been the source of toddler ingestion. However, due to increased prescribing of clonidine for the treatment of ADHD, the drug is more readily available.
July 2, 2001: What is the evaluation and treatment for a child who has swallowed a button battery?
September 8, 2020
The most common button battery ingested comes from hearing aids and involve the 7.9-11.6 mm diameter cells. Most ingestions (62%) occur in children less that 5 years old. 83% of all battery ingestors remain asymptomatic.
June 18, 2001: What are the current recommendations for the administration of N-acetylcysteine(NAC) following APAP overdose?
September 8, 2020
When indicated, NAC should be administered within 8 hours of ingestion of APAP. The efficacy of the drug in preventing hepatotoxicity decreases each hour after 8 hours. There is no benefit in giving the drug at hour 2 rather than at hour 7 after ingestion.
June 11, 2001: Following acetaminophen(APAP) ingestion, when is the Rummack-Mathew nomogram invalid?
September 8, 2020
The nomogram is invalid in the following situations: chronic APAP ingestion, abnormal renal function, concurrent chronic ingestion of anticonvulsants or drugs that induce cytochrome P-450, nutritionally depleted patients (AIDS and Cancer).
June 4, 2001: Please address the following questions regarding the use of activated charcoal.
September 8, 2020
1. What are the 5 most common poisonings in which there is evidence it is effective?
Feb 26, 2001: Following acetaminophen(APAP) ingestion, when is the Rummack-Mathew nomogram invalid?
September 8, 2020
Anticonvulsants are currently widely administered to treat mood disorders. If a child is taking therapeutic anticonvulsants or is nutritionally depleted (AIDS or cancer), the nomogram should be cut in half. For
Feb 21, 2001: MTPC literature states that MTPC is the only nationally certified poison control center in Tennessee. What does this mean?
September 8, 2020
MTPC received accreditation from the American Association of Poison Control Centers (AAPCC) in 1996. This past weekend the accreditation was reviewed again (AAPCC accreditation is reviewed every 5 years).
Feb 5, 2001: What is Whole Bowel Irrigation (WBI) and what are the indications for this procedure?
September 8, 2020
WBI cleanses the bowel by the enteral administration of polyethylene glycol electrolyte solution (PEG-ES) which induces a liquid stool. WBI has the potential to reduce drug absorption by decontaminating the entire GI tract by physically expelling intraluminal contents. PEG causes no net absorption or secretion of ions, so no s
Jan 29, 2001: What are the indications for multiple-dose activated charcoal (MDAC)?
September 8, 2020
The purpose of MDAC is to cause “gastric dialysis” i.e. an ingested drug is pulled from the blood into the gut by charcoal in the gut. The procedure consists of oral administration of charcoal with sorbital or aqueous charcoal every 3 to 4 hours.
Jan 22, 2001: Should single-dose activated charcoal (SDAC) be routinely administered following a potentially toxic ingestion?
September 8, 2020
The goal of administration of SDAC is absorption of the poison in the GI tract in an attempt to decrease absorption and systemic toxicity. However, there is no data to confirm that administration of AC improves outcome. The main complication of AC administration is emesis and aspiration. The Position Statements state the following:
Jan 15, 2001: Are There Ever any Indications to Administer Syrup of Lpecac or Perform Gastric Lavage?
September 8, 2020
The Position Papers noted that there was no evidence that administration of Ipecac did change outcome. Although some poison centers still recommend Ipecac on occasion, the majority of poison centers do not. The Middle Tennessee Poison Center does not recommend Ipecac and does not feel it is necessary to have Ipecac in the h
Jan 8, 2001: Why Have the Recommendation for Gastrointestinal Decontamination (GID) Changed?
August 26, 2020
Due to the lack of science and conflicting approaches to GID, a committee of members from the American Academy of Toxicology (AACT) and European Association of Poisons Centers and Clinical Toxicologist (EAPCCT) was appointed to review all available literature and make treatment recommendations.