UNINTENTIONAL POISONINGS

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UNINTENTIONAL POISONINGS

• Information and Prevention

April 2009
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TRAINING OBJECTIVES

• Identify ways to prevent unintentional poisoning
  due to household chemicals.
• Identify ways to prevent unintentional poisoning
  due to medications.
• Recognize the dangers associated with kids taking
  prescription and over the counter (OTC)
  medications.

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• Identify ways to prevent unintentional poisoning
  due to prescription and over the counter
  medications.
• Identify the dangers associated with carbon
  monoxide poisoning.
• Identify ways to prevent carbon monoxide
  poisoning.

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UNINTENTIONAL POISONING

• Every year children die as a result of
  unintentional poisonings.
• These poisonings are due to children receiving
  accidental overdoses of medications, ingesting
  medications not prescribed for them, carbon
  monoxide or ingesting household items such as
  cleaning supplies.

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• According to Safe Kids USA, more than one million
  children, ages five and under, are accidentally
  poisoned each year 40 percent of these are from
  prescription drugs and other medications. 

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• Non-pharmaceutical products such as cosmetics,
  cleaning substances, plants, foreign bodies,
  toys, pesticides, art supplies and alcohol are
  responsible for 56 percent of poisoning exposures
  for children under five years of age.
• (Safe Kids USA)

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UNINTENTIONAL POISONING

• According to the Centers for Disease Control
  (CDC), 23,618 (72) of the 32,691 poisoning
  deaths in the United States in 2005, were
  unintentional and 3,240 (10) were of
  undetermined intent. Unintentional poisoning
  death rates have been rising steadily since 1992.
  
• In 2006, unintentional poisoning caused about
  703,702 emergency department (ED) visits (CDC
  2008).

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UNINTENTIONAL POISONING IN YOUNG CHILDREN

• Many children who are unintentionally poisoned
  have accessed medicines and household chemicals
  that are not locked up.
• Many children who are unintentionally poisoned
  have ingested prescription medications from
  someone who was visiting their home such as a
  grandparent.

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UNINTENTIONAL POISONING IN MISSOURI

• In 2007, 11 Missouri children died of
  unintentional poisoning one eight-year old died
  of toxic doses of over-the-counter medications.
  The remaining 10 children were teens ages 12-17.

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• In 2007, an eight-year old child overdosed on an
  over-the-counter pain reliever/fever reducer. He
  apparently was self-medicating. He was taken to
  the hospital with high levels of acetaminophen
  and eventually died of liver damage.

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• A 15-year-old boy died of an overdose of
  prescription medications. He had a history of
  abuse of prescription drugs.
• A 17-year-old girl died of a cocaine overdose.
  She had extensive history with police and EMS for
  prior drug abuse and delinquent behavior.

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WAYS TO PREVENT UNINTENTIONAL POISONING
(Household Chemicals)

• The Soap and Detergent Association lists the
  following guidelines to protect children from
  household chemicals
• Store cleaning products in a locked closet or
  cabinet away from food and inaccessible to young
  children.
• Store products in their original containers and
  never remove product labels.

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• Schedule routine cleaning of surfaces and
  dishwashing when there is a lull in activities,
  such as nap time or when children are not in the
  room.
• Put products away immediately after removing
• The amount needed for the cleaning job at hand.
• Dispose empty cleaning product containers
  carefully and promptly.

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• Dont mix cleaning chemicals. This can be
  dangerous.
• Dont ever mix chlorine bleach or any product
  containing chlorine bleach (like some tub and
  tile cleaners, mildew removers, all-purpose
  cleaners, automatic dishwashing detergents) with
  ammonia or products which contain ammonia or
  ammonia-containing compounds (some hand
  dishwashing detergents and window cleaners).

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• Dont mix chlorine bleach with acidic products
  (toilet bowl cleaners, rust removers).
• Dangerous gases can be released due to the mixing
  of any of these products.

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WHAT TO DO IF A CHILD HAS INGESTED POISON

• The Soap and Detergent Association gives the
  following guidelines adults can follow, if a
  child has been poisoned by household chemicals
• Quickly try to find out what the child has
  ingested. Unfortunately it may not be known what
  has been ingested.

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• If possible, quickly find the product container,
  check the label for first aid advice and call the
  Poison Control Center (PCC) immediately
  (800-222-1222).
• If the substance ingested is known, the PCC will
  need to know information such as the brand name
  of the product, what time it was ingested, the
  age and weight of the child and their current
  condition.

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• The PCC will give instructions as to how to
  handle the situation. If they think the child
  should be taken to a hospital, they should be
  taken immediately along with the product
  container and any vomit the child has expelled.

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WAYS TO PREVENT UNINTENTIONAL POISONING
(Medications)

• Keep all medicine locked and out of the reach of
  children
• Dont put medicine on a kitchen table or bedside
  table.
• Read labels to find out what can be poisonous.
• Never leave medicines or potentially poisonous
  household products unattended while you are using
  them.
• (Safe Kids USA)

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• Buy child-resistant packages when available. Keep
  products in their original packages to
• avoid confusion.
• When administering medication always read labels,
  follow directions and give medicines to children
  based on their weights and ages. Only use the
  dispensers packaged with childrens medications. 
  

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• Never leave out loose pills.
• Avoid confusion by keeping all medicines and
  potentially poisonous household products in their
  original packages.
• Dont take medicine or vitamins in front of kids,
  and dont call them candy.

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• Dont involve children as helpers with
  medication. They should not remind adults to
  take medicine or bring water, for example.
• Tell grandparents and friends about avoiding
  medication poisoning, when their family visits
  their homes.
• (Safe Kids USA)

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KIDS AND PRESCRIPTION DRUGS

• Kids as young as 12 are trying or using
  prescription medications non-medically. These
  medications are used to get high or for
  self-medication. Teens are also using over the
  counter medications such as cough medicines.
• According to Parents, The Anti-Drug, teens often
  take prescription medications from their parents
  medicine cabinet or from other family members.

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• According to Kids Health, the most commonly used
  prescription drugs fall into three categories
• Opioids such as OxyContin, Vicodin, and Demerol
  are used for pain, cough, or diarrhea.
• Central Nervous System Depressants such as
  Nembutal, Valium, and Xanax are used to treat
  anxiety, panic attacks, and sleeplessness.

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• Stimulants such as Ritalin, Adderall and
  Strattera are used to treat narcolepsy, ADHD,
  depression, obesity and asthma.
• Many kids dont see the dangers of these
  medications, because they think if they are
  prescribed by a doctor, they are safe to use.

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DANGERS OF PRESCRIPTION DRUGS

• Abusing prescription drugs can have serious
  consequences. According to Kids Health, a single
  dose of an opioid can lower someone's breathing
  rate and even kill, when it's taken by the wrong
  person in the wrong circumstances. The risk is
  higher when opioids are taken with other
  substances like alcohol, antihistamines and CNS
  depressants.

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• According to Kids Health, taking CNS depressants
  with other medications, such as prescription
  painkillers, some over-the-counter cold and
  allergy medications, or alcohol can slow a
  person's heartbeat and breathing. This can lead
  to death.

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EFFECTS OF STIMULANT USE

• Kids Health states the following effects of
  taking stimulants
• Heart failure or seizures.
• Development of a dangerously high body
  temperature or an irregular heartbeat.
• Taking several high doses over a short period of
  time, may make a drug abuser aggressive or
  paranoid.
• May be habit forming.

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TEENS AND OVER-THE-COUNTER (OTC) MEDICATIONS

• Dextromethorphan (DXM) can be found in cough
  medicines. High doses can cause problems with
  the senses (especially vision and hearing), and
  can lead to confusion, stomach pain, numbness and
  even hallucinations. Teens are using these OTC
  medications to get high.

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PREVENTING PRESCRIPTION AND OTC DRUG ABUSE

• The Partnership for a Drug Free America lists the
  following guidelines for parents in preventing
  teen drug use
• Adults must be educated as to what drugs teens
  are abusing. Information should be shared with
  other parents and other adults, such as teachers,
  coaches, and school administrators.

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• Parents must communicate with their children.
  They should ask children what they know about
  prescription and OTC drug abuse.
• Parents should set clear expectations by letting
  their teens know that they should never take any
  medications without their knowledge.

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• Parents should ask healthcare providers if
  medications prescribed for their family can lead
  to abuse.
• Parents should know what prescribed and OTC
  medications exist in their home. They should keep
  track of the quantities.

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• Parents should keep medications out of reach and
  out of easily accessible places like the medicine
  cabinet.
• If a child needs medications during school hours,
  parents should speak with school officials about
  policies for distributing medications to
  students. If possible, parents should take the
  medications to the school nurse and make sure any
  unused medications are returned to them.

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CARBON MONOXIDE POISONING

• Carbon monoxide is another form of unintentional
  poisoning. It can not be seen, nor smelled.
• It is produced when any fuel such as gas, oil,
  kerosene, wood or charcoal is burned.
• If appliances that burn fuel are not working
  properly, dangerous levels of carbon monoxide can
  be emitted.

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• The U.S. Environmental Protection Agency (EPA)
  points out that people die each year from carbon
  monoxide produced by idling cars.
• The EPA lists fetuses, infants, elderly people
  and people with anemia, or with a history of
  heart or respiratory disease, as being especially
  susceptible.

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• According to the EPA, low levels of carbon
  monoxide can cause shortness of breath, mild
  nausea and mild headaches.
• Symptoms of exposure to moderate levels of carbon
  monoxide include severe headaches, dizziness,
  mental confusion, nausea or fainting.

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PREVENTING CARBON MONOXIDE POISONING

• The EPA suggests the following guidelines in
  preventing carbon monoxide poisoning
• Choose appliances that vent their fumes to the
  outside. Whenever possible, have them properly
  installed and maintain them according to
  manufacturers instructions.

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• Fuel-burning appliances (including oil and gas
  furnaces, gas water heaters, gas ranges and
  ovens, gas dryers, gas or kerosene space heaters,
  fireplaces and wood stoves) should be inspected
  by a trained professional at the beginning of
  every heating season. Make certain that flues
  and chimneys are connected, in good condition,
  and not blocked.

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• Read and follow all of the instructions that
  accompany any fuel-burning device. If an
  un-vented gas or kerosene space heater has to be
  used, carefully follow the cautions that come
  with the device. Use the proper fuel and keep
  doors to the rest of the house open. Crack a
  window to ensure enough air for ventilation and
  proper fuel-burning.

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• A car should not be idled in a garage even if
  the garage door to the outside is open. Fumes
  can build up very quickly in the garage and
  living area of a home.
• Dont use a gas oven to heat your home, even for
  a short time.
• Dont ever use a charcoal grill indoors even in
  a fireplace.

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• Dont sleep in any room with an un-vented gas or
  kerosene space heater.
• Dont use any gasoline-powered engines (mowers,
  weed trimmers, snow blowers, chain saws, small
  engines or generators) in enclosed spaces.
• Dont ignore symptoms, particularly if more than
  one person is feeling them.

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• The EPA suggests buying a carbon monoxide
  detectors as a back-up, but they point out that
  it is not a replacement for proper use and
  maintenance of fuel-burning appliances.

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Additional Resources

• Centers for Disease Control, http//www.cdc.gov/nc
  ipc/factsheets/poisoning.htm
• Safe Kids USA, http//www.usa.safekids.org/poison/
  index.html
• Environmental Protection Agency,
  http//www.epa.gov/iaq/pubs/coftsht.html
• Poison Prevention.org, http//www.poisonprevention
  .org/pdf/Safe_Clean9_18_04.pdf

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• Kids Health, http//kidshealth.org/teen/drug_alcoh
  ol/drugs/prescription_drug_abuse.html
• Parents, The Anti Drug, http//www.theantidrug.com
  /
• The Partnership for a Drug Free America,
  http//www.drugfree.org/Parent/Resources/Prescript
  ion_Medicine_Misuse

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Missouri Department of Social Services State
Technical Assistance Team

• Address
• PO Box 208Jefferson City, MO 65102-0208
• Telephone [phone](800) 487-1626(8 a.m.
  to 5 p.m. CST, Monday Friday)
• Email
•  dls.stat_at_dss.mo.gov