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01-26-15 What causes pediatric poisoning fatalities?

Question of the Week

January 26, 2015

What causes pediatric poisoning fatalities?

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:

70 pediatric fatalities were summarized.  As in previous years, there was a bimodal age distribution with 38% of cases under 6 years and 51% between 12 and 17 years.  Only 11% were between 6 and 11 years, all of which were due to CARBON MONOXIDE POISONING.  (See previous Question of the Week)

Compared to previous years, there was an increase in exposures in children less than 6 years old (78% vs 66% in 2012)  Seven children less than 6 years old and seven children in the 6-11 year age group died from CARBON MONOXIDE POISONING.  PLEASE EDUCATE YOUR PATIENTS ABOUT THE VALUE OF CARBON MONOXIDE DETECTORS. 

In the adolescent group, there was  an increase in deaths from designer drugs (psychogenic phenylethylamines and synthetic cannabinoids).  Exposure to prescription opioids accounted for 20% of intentional deaths in adolescents.  As in previous years, unintentional opioid deaths in the younger age group also increased.  The highest incidence of intentional exposures occurred in 17 year olds with a rate of 593/1000 cases.                                                   

Clinical Toxicology 2015, Early Online

Two concerns are apparent. First, intentional exposures in adolescents increased as well as opioid related deaths.  Not surprising when one considers the national abuse of prescription drugs.  Our own state of Tennessee ranks second in the US in number of retail prescriptions/capita. (Tennessee reports 17.2 prescriptions per capita whereas the national average is 12.0 prescriptions per capita. Kaiser Family Foundation). Second, carbon monoxide fatalities in young children have increased - a statistic that can be improved with parent education and carbon monoxide detectors.

This question prepared by:  Donna Seger, MD  Medical Toxicologist