Thank you AAPCC http://aapcc.wordpress.com/2013/03/21/poisons-in-your-home/
Thursday, March 21, 2013
Tuesday, March 19, 2013
Methanol in Libya
An interesting note just came across my desk. It is fascinating that the world is so big yet so small. Today in Libya there is a massive outbreak of methanol poisoning secondary to drinking bad homemade ethanol. As of Sunday the death toll was staggering.
Methanol is an alcohol that is sometimes added to ethanol. to give it a kick. Sometimes the result of bad distilling and production. During the time of prohibition methanol poisoning jumped due to poorly made illegal ethanol. I guess today is no different. Methanol has many actions on the body. The end for many is severe acidosis and death. For some they will survive, but be blind. Thankfully there is a treatment. The treatment, fomepizole, is very effective. That brings me to the note below. This request came from a physician and toxicologist who is the head of the Norwegian Center for NBC Medicine.
Dear all members of AACT;
I just wanted to inform you all that there is an ongoing methanol outbreak in Libya; various reports exists, but as for yesterday, up to 79 fatalities and > 700 patients were reported (depending on the source sited). Medecins Sans Frontieres (MSF) is mobilizing large scale, and we are leaving today (Dr Morten Rostrup, MD, PhD Dept of Acute Medicine, Oslo University Hospital, Oslo & former international president of MSF), and on Sunday (Raido Paasma, Estonia and myself) to support them.
We have been able to get hold of quite a bit of fomepizole from our own stock in Norway, the distributor in Scandinavia (SOBI), and we will likely also have donations from the producer in Europe, EusaPharma. We are also bringing along some equipment and enzymes to establish the formate analysis in Libya. If there are any of the AACT members who have stores of fomepizole they want to donate, also which is soon to expire (recently expired fomepizole would also do); Please contact me ASAP on the below address: If it could be in Oslo by Saturday evening or Sunday morning, I will be able to carry it along with my luggage, hence no formal papers for import to Libya is needed.
Thank you all in advance for helping our Libyan friends
Methanol is an alcohol that is sometimes added to ethanol. to give it a kick. Sometimes the result of bad distilling and production. During the time of prohibition methanol poisoning jumped due to poorly made illegal ethanol. I guess today is no different. Methanol has many actions on the body. The end for many is severe acidosis and death. For some they will survive, but be blind. Thankfully there is a treatment. The treatment, fomepizole, is very effective. That brings me to the note below. This request came from a physician and toxicologist who is the head of the Norwegian Center for NBC Medicine.
Dear all members of AACT;
I just wanted to inform you all that there is an ongoing methanol outbreak in Libya; various reports exists, but as for yesterday, up to 79 fatalities and > 700 patients were reported (depending on the source sited). Medecins Sans Frontieres (MSF) is mobilizing large scale, and we are leaving today (Dr Morten Rostrup, MD, PhD Dept of Acute Medicine, Oslo University Hospital, Oslo & former international president of MSF), and on Sunday (Raido Paasma, Estonia and myself) to support them.
We have been able to get hold of quite a bit of fomepizole from our own stock in Norway, the distributor in Scandinavia (SOBI), and we will likely also have donations from the producer in Europe, EusaPharma. We are also bringing along some equipment and enzymes to establish the formate analysis in Libya. If there are any of the AACT members who have stores of fomepizole they want to donate, also which is soon to expire (recently expired fomepizole would also do); Please contact me ASAP on the below address: If it could be in Oslo by Saturday evening or Sunday morning, I will be able to carry it along with my luggage, hence no formal papers for import to Libya is needed.
Thank you all in advance for helping our Libyan friends
US Poison Centers
From the American Association of Poison Control Centers.
Poison Centers: Protecting Health While Saving Americans Time and Money
American Association of Poison Control Centers Observes Annual National Poison Prevention Week
ALEXANDRIA, VA. – America’s 57 local poison centers save lives 24 hours a day, seven days a week by providing free, confidential medical advice to people in poison emergencies, according to Marsha Ford, MD, FACMT, FACEP, president of the American Association of Poison Control Centers.
Since 1962, the third week in March has been designated National Poison Prevention Week and has focused national attention on the dangers of poisonings and how to prevent them. America’s 57 poison centers are committed to safeguarding the health and well-being of every American through poison prevention and free, confidential, expert medical services.
“National Poison Prevention Week is a great time to acknowledge the important, life-saving work done every day by the experts at America’s poison centers,” Ford said. “People who call their local poison center can be assured that the health care professionals who answer their calls have received the highest training possible. Despite the critical services provided, however, poison centers are in jeopardy after suffering federal funding cuts of 36 percent in 2011 and additional cuts at the state and local levels.”
In 2011, U.S. poison centers fielded more than 3.6 million calls, including about 2.3 million cases of human exposures to poisons. Poison centers save lives by providing free and confidential health-care services 24 hours a day, seven days a week, 365 days a year in more than 150 languages. Highly trained, expert health-care professionals at poison centers across the country provide immediate advice to people who call with poisoning emergencies. Poison centers also save money. About 90 percent of the people who call with poison emergencies are treated at home following the advice of poison center experts – saving an estimated $1.19 billion in health-care costs each year.
“America’s system of poison centers is one of the most successful and cost-effective public health programs in the nation,” said AAPCC Executive Director Debbie Carr, MEd. “As our representatives in Washington, D.C., and in state legislatures across the country make decisions about funding for poison centers, it’s important they carefully consider the impact of those decisions on the health and finances of the American people. The millions of Americans who rely on poison centers each year illustrate the importance of the poison center system that safeguards the health of our friends, neighbors and family members.”
For more information, contact Loreeta Canton, director of public relations and member services for the American Association of Poison Control Centers, at 703.894.1858 or canton@aapcc.org or visit www.aapcc.org.
About the American Association of Poison Control Centers:
The AAPCC supports the nation’s 57 poison centers in their efforts to treat and prevent drug, consumer product, animal, environmental and food poisoning. Members staff the Poison Help hotline at 1-800-222-1222 that provides free, confidential, expert medical advice 24 hours a day, seven days a week, 365 days a year from toxicology specialists, including nurses, pharmacists, physicians and poison information providers. In addition, the AAPCC maintains the only poison information and surveillance database in the United States, providing real-time monitoring of unusual poisoning patterns, chemical exposures and other emerging public health hazards. The AAPCC partners with federal agencies such as EPA, HRSA and the CDC, as well as private industry.
To learn more, visit www.aapcc.org, like us on Facebook, follow us on Twitter, or read our blog at aapcc.wordpress.com. To join your voice with other poison center supporters, register for the AAPCC advocacy network at www.capwiz.com/aapcc – click on “Action E-List.”
Poison Centers: Protecting Health While Saving Americans Time and Money
American Association of Poison Control Centers Observes Annual National Poison Prevention Week
ALEXANDRIA, VA. – America’s 57 local poison centers save lives 24 hours a day, seven days a week by providing free, confidential medical advice to people in poison emergencies, according to Marsha Ford, MD, FACMT, FACEP, president of the American Association of Poison Control Centers.
Since 1962, the third week in March has been designated National Poison Prevention Week and has focused national attention on the dangers of poisonings and how to prevent them. America’s 57 poison centers are committed to safeguarding the health and well-being of every American through poison prevention and free, confidential, expert medical services.
“National Poison Prevention Week is a great time to acknowledge the important, life-saving work done every day by the experts at America’s poison centers,” Ford said. “People who call their local poison center can be assured that the health care professionals who answer their calls have received the highest training possible. Despite the critical services provided, however, poison centers are in jeopardy after suffering federal funding cuts of 36 percent in 2011 and additional cuts at the state and local levels.”
In 2011, U.S. poison centers fielded more than 3.6 million calls, including about 2.3 million cases of human exposures to poisons. Poison centers save lives by providing free and confidential health-care services 24 hours a day, seven days a week, 365 days a year in more than 150 languages. Highly trained, expert health-care professionals at poison centers across the country provide immediate advice to people who call with poisoning emergencies. Poison centers also save money. About 90 percent of the people who call with poison emergencies are treated at home following the advice of poison center experts – saving an estimated $1.19 billion in health-care costs each year.
“America’s system of poison centers is one of the most successful and cost-effective public health programs in the nation,” said AAPCC Executive Director Debbie Carr, MEd. “As our representatives in Washington, D.C., and in state legislatures across the country make decisions about funding for poison centers, it’s important they carefully consider the impact of those decisions on the health and finances of the American people. The millions of Americans who rely on poison centers each year illustrate the importance of the poison center system that safeguards the health of our friends, neighbors and family members.”
For more information, contact Loreeta Canton, director of public relations and member services for the American Association of Poison Control Centers, at 703.894.1858 or canton@aapcc.org or visit www.aapcc.org.
About the American Association of Poison Control Centers:
The AAPCC supports the nation’s 57 poison centers in their efforts to treat and prevent drug, consumer product, animal, environmental and food poisoning. Members staff the Poison Help hotline at 1-800-222-1222 that provides free, confidential, expert medical advice 24 hours a day, seven days a week, 365 days a year from toxicology specialists, including nurses, pharmacists, physicians and poison information providers. In addition, the AAPCC maintains the only poison information and surveillance database in the United States, providing real-time monitoring of unusual poisoning patterns, chemical exposures and other emerging public health hazards. The AAPCC partners with federal agencies such as EPA, HRSA and the CDC, as well as private industry.
To learn more, visit www.aapcc.org, like us on Facebook, follow us on Twitter, or read our blog at aapcc.wordpress.com. To join your voice with other poison center supporters, register for the AAPCC advocacy network at www.capwiz.com/aapcc – click on “Action E-List.”
Monday, March 18, 2013
Poison Prevention Week
Happy Poison Prevention Week! As pharmacists and health care providers we all share the responsibility of keeping our patients safe. But safety goes beyond that to their families. We need to teach patients the risk of medications to them and their children. At the very least we can tell them about the phone number to the local poison center, 1-800-222-1222. While thinking about medication and poison safety have you thought about your children? Your extended family? Brothers and sisters? Nieces and nephews? Keep that poison center phone number handy!
AAPCC and America’s Poison Centers Observe National Poison Prevention Week
ALEXANDRIA, VA. – The American Association of Poison Control Centers (AAPCC) is cautioning parents, grandparents and caregivers that children act fast, and so do poisons, according to Salvador Baeza, PharmD, DABAT, director of the West Texas Regional Poison Center.
“About half of all poison exposures reported to poison centers involve children younger than 6, most often occurring when parents are busy preparing meals, caring for other children, or completing everyday household chores. Poisonings also occur when the normal routine changes – during holidays or while moving, visiting or traveling,” Baeza said. “National Poison Prevention Week is the perfect time to poison-proof your home to keep your children and grandchildren safe.”
Since 1962, the third week in March has been designated National Poison Prevention Week and has focused national attention on the dangers of poisonings and how to prevent them. America’s 57 poison centers are committed to safeguarding the health and well-being of every American through poison prevention and free, confidential, expert medical services. Poison centers respond to calls 24 hours a day, seven days a week in order to help those who have been exposed to toxic substances.
In 2011, U.S. poison centers answered more than 3.6 million calls, including about 2.3 million calls about human exposures to poisons. Children younger than 6 accounted for about half of the calls placed to poison centers about poison exposures. The top five substances involved in poison exposures for children younger than 6 were cosmetics/personal care products; painkillers; household cleaning substances; foreign bodies/toys/miscellaneous; and topical preparations.
The experts at America’s 57 poison centers urge parents, grandparents and caregivers to take the following steps to keep children safe from poisonings:
AAPCC and America’s Poison Centers Observe National Poison Prevention Week
ALEXANDRIA, VA. – The American Association of Poison Control Centers (AAPCC) is cautioning parents, grandparents and caregivers that children act fast, and so do poisons, according to Salvador Baeza, PharmD, DABAT, director of the West Texas Regional Poison Center.
“About half of all poison exposures reported to poison centers involve children younger than 6, most often occurring when parents are busy preparing meals, caring for other children, or completing everyday household chores. Poisonings also occur when the normal routine changes – during holidays or while moving, visiting or traveling,” Baeza said. “National Poison Prevention Week is the perfect time to poison-proof your home to keep your children and grandchildren safe.”
Since 1962, the third week in March has been designated National Poison Prevention Week and has focused national attention on the dangers of poisonings and how to prevent them. America’s 57 poison centers are committed to safeguarding the health and well-being of every American through poison prevention and free, confidential, expert medical services. Poison centers respond to calls 24 hours a day, seven days a week in order to help those who have been exposed to toxic substances.
In 2011, U.S. poison centers answered more than 3.6 million calls, including about 2.3 million calls about human exposures to poisons. Children younger than 6 accounted for about half of the calls placed to poison centers about poison exposures. The top five substances involved in poison exposures for children younger than 6 were cosmetics/personal care products; painkillers; household cleaning substances; foreign bodies/toys/miscellaneous; and topical preparations.
The experts at America’s 57 poison centers urge parents, grandparents and caregivers to take the following steps to keep children safe from poisonings:
- Inspect
your home and garage to make sure medicines, cleaning products, pesticides
and fertilizers are stored up high, away and out of sight of children.
- Tell
children what medicine is and why you must be the one to give it to them.
Never call medicine “candy” to get them to take it.
- Don’t
leave medicines or vitamins on counters, window sills, bedside tables or
the refrigerator top.
- Take
your medicine where children can’t see you; they may try to imitate you.
- Teach
children to always ask an adult before eating, drinking or touching
anything.
- Keep
cleaning products and household chemicals in their original containers
with their original labels intact.
- Keep
batteries out of a child’s reach. Call your local poison center right away
if a child swallows a battery.
- Keep
magnetic toys and other magnetic items away from small children. Call your
local poison center right away if you think a child has swallowed a
magnet.
- Know
the name of all household plants in your home; remove any poisonous plants
from your house and yard.
- Remember
that child-resistant is not child-proof. Layer the protection: re-seal and
lock up, out of sight and reach.
Thursday, March 14, 2013
Epinephrine
Today, in 2001, Kristen Gilbert was found guilty of murder by poison. Kristen was a nurse taking care of patients at the VA hospital in Northampton Massachusetts. She injected her patients with high doses of epinephrine.
Epinephrine is a drug familiar to everyone. It is a naturally endogenous neurotransmitter that your body produces everyday. It is an alpha 1, beta 1 and beta 2 agonist. In normal levels it stimulates your heart, lungs and blood vessels. For someone in the midst of heart attack, or an asthma attack, that's good. We want to stimulate our heart to work better and beat faster and our blood pressure to go up. During an asthma attack we want our lungs to open up. But what happens when you give too much? The heart is driven so fast it can not efficiently pump blood. The normal electrical transmission of the heart is disturbed and arrhythmias result. Or the heart stops much like a heart attack.
Kristen Gilbert had a high rate of heart attacks on her watch. At first everyone marveled at how compassionate and competent she was in the midst of a crisis. But then other nurses became suspicious. Some think Kristen poisoned her patients to show off. After all, not all of them died. Others thought she did it because her boyfriend was part of the emergency response team. What better way to foster a relationship.
Kristen Gilbert was convicted of four counts of murder and two of attempted murder on this day in 2001.
Epinephrine is a drug familiar to everyone. It is a naturally endogenous neurotransmitter that your body produces everyday. It is an alpha 1, beta 1 and beta 2 agonist. In normal levels it stimulates your heart, lungs and blood vessels. For someone in the midst of heart attack, or an asthma attack, that's good. We want to stimulate our heart to work better and beat faster and our blood pressure to go up. During an asthma attack we want our lungs to open up. But what happens when you give too much? The heart is driven so fast it can not efficiently pump blood. The normal electrical transmission of the heart is disturbed and arrhythmias result. Or the heart stops much like a heart attack.
Kristen Gilbert had a high rate of heart attacks on her watch. At first everyone marveled at how compassionate and competent she was in the midst of a crisis. But then other nurses became suspicious. Some think Kristen poisoned her patients to show off. After all, not all of them died. Others thought she did it because her boyfriend was part of the emergency response team. What better way to foster a relationship.
Kristen Gilbert was convicted of four counts of murder and two of attempted murder on this day in 2001.
Tuesday, March 12, 2013
Bark Scorpion, Ouch!
Like every good Wisconsinite I am reading every word I can find about the Brewers in spring training. With Ryan Braun continue to shine? Can Carlos Gomez have a full, productive year in center field? Can John Axford lead a revamped bullpen? But what grabbed the headline late last week? Doug Melvin stung by a scorpion!
There are many species of scorpions in the US. In Texas we frequently encountered Centruoides vittatus or the stripped scorpion. The typical response to a scorpion sting was, "man up". You put an ice pack on it and went about your day. The pain at the site of the sting was said to be excruciating. But rarely were there any further problem. So man up and bite a bullet!
That is not the description given by Doug Melvin. In this article he described numbness that gradually moved up his arm into his shoulder. That on top of the excruciating pain. After a visit to the local hospital ED he did fine. The scorpion that stung Doug Melvin is the Centruoides exilcauda, the bark scorpion. That scorpion is well know for it's neurotoxin venom. It is far and away the most poisonous of the scorpions in the US. Pain and numbness are normal effects. The venom poisons sodium channels in your nerves. Functioning sodium channels are required for nerve conduction, the ability to activate muscles and to feel pain. Scorpion venom opens those channels resulting in excessive stimulation. In this case pain and numbness. That nerve stimulation and the resulting effects on muscles can be life threatening in small children.
So Doug Melvin, thank you for teaching us all about scorpions in Arizona. Now about the Brewers starting pitching...
There are many species of scorpions in the US. In Texas we frequently encountered Centruoides vittatus or the stripped scorpion. The typical response to a scorpion sting was, "man up". You put an ice pack on it and went about your day. The pain at the site of the sting was said to be excruciating. But rarely were there any further problem. So man up and bite a bullet!
That is not the description given by Doug Melvin. In this article he described numbness that gradually moved up his arm into his shoulder. That on top of the excruciating pain. After a visit to the local hospital ED he did fine. The scorpion that stung Doug Melvin is the Centruoides exilcauda, the bark scorpion. That scorpion is well know for it's neurotoxin venom. It is far and away the most poisonous of the scorpions in the US. Pain and numbness are normal effects. The venom poisons sodium channels in your nerves. Functioning sodium channels are required for nerve conduction, the ability to activate muscles and to feel pain. Scorpion venom opens those channels resulting in excessive stimulation. In this case pain and numbness. That nerve stimulation and the resulting effects on muscles can be life threatening in small children.
So Doug Melvin, thank you for teaching us all about scorpions in Arizona. Now about the Brewers starting pitching...
Thursday, March 7, 2013
I'm Going Home
Woodstock Music festival - 1968. Much has been written about the music, the people and the drugs. The story behind the festival is a must read. The movie is a must watch for anyone with an interest in the history of music in the United States.
The drugs ranged from beer and booze to LSD and quaaludes. Marijuana was said to be widely available. Yet few were hurt and less were arrested. Is there a lesson there for all of us?
For me the highlight of the music (no I was not there!) was Alvin Lee and Ten Years After. Their rendition of "I'm Going Home" became an instant classic played by every garage and cover bad in the 70's. Alvin Lee died yesterday of complication following routine surgery. Enjoy the music.
The drugs ranged from beer and booze to LSD and quaaludes. Marijuana was said to be widely available. Yet few were hurt and less were arrested. Is there a lesson there for all of us?
For me the highlight of the music (no I was not there!) was Alvin Lee and Ten Years After. Their rendition of "I'm Going Home" became an instant classic played by every garage and cover bad in the 70's. Alvin Lee died yesterday of complication following routine surgery. Enjoy the music.
Monday, March 4, 2013
The death of Cruz
So a dog got poisoned, or at least the owner thinks so. Whats the big deal? That was an everyday occurrence in Texas. When you are trying to kill feral hogs or coyotes sometimes bad things happen. This dog poisoning was covered by the New York Times. This dog was a prized pure-bred Samoyed that competed at the Westminster Kennel Club Dog Show last month.
Typical dog story. An evening meal of steak and then spending the night at a midtown hotel. The morning an uneventful show. But just a few days later falling extremely ill vomiting blood. Rush to veterinary hospital where the dog expired. The vet thought it looked like rat poison.
Rat and mouse poison commonly contain anticoagulants. Substances that are intended to change the way your body clots resulting in the animal bleeding to death. Early rodenticides contained warfarin. The same warfarin that is a common drug to prevent clot formation in people. Warfarin inhibits vitamin K clotting factors (II, VII, IX, X) plus anticoagulant proteins C and S. Specifically the C1 subunit of vitamin K epoxide reductase. In people use of warfarin comes with very close monitoring of clotting times. In addition, patients have to be very careful with their diets and physical activities. Fall and bump your head while on warfarin; the result can be catastrophic. Second generation rodenticides contain a super-warfarin. A substance that is extra potent and lasts for a long time in the body. It also takes some time to act. Its cumulative effect is devastating. An effect rodenticide.
When a dog eats the rodenticide a similar course takes place. Nothing happens at first as the body burns up its stores of the clotting factors. But slowly, over a few days, the animal bleeds internally. Breathing becomes difficult and movement painful. All due to blood being where it shouldn't be. Eventually, without treatment, the animal dies.
Was this an accidental poisoning or murder? The owners think the later while to vet believes the former. Was it a competitor? Was it an animal rights group? Was it just a dog eating the rat poison in the subway? We will never know.
Typical dog story. An evening meal of steak and then spending the night at a midtown hotel. The morning an uneventful show. But just a few days later falling extremely ill vomiting blood. Rush to veterinary hospital where the dog expired. The vet thought it looked like rat poison.
Rat and mouse poison commonly contain anticoagulants. Substances that are intended to change the way your body clots resulting in the animal bleeding to death. Early rodenticides contained warfarin. The same warfarin that is a common drug to prevent clot formation in people. Warfarin inhibits vitamin K clotting factors (II, VII, IX, X) plus anticoagulant proteins C and S. Specifically the C1 subunit of vitamin K epoxide reductase. In people use of warfarin comes with very close monitoring of clotting times. In addition, patients have to be very careful with their diets and physical activities. Fall and bump your head while on warfarin; the result can be catastrophic. Second generation rodenticides contain a super-warfarin. A substance that is extra potent and lasts for a long time in the body. It also takes some time to act. Its cumulative effect is devastating. An effect rodenticide.
When a dog eats the rodenticide a similar course takes place. Nothing happens at first as the body burns up its stores of the clotting factors. But slowly, over a few days, the animal bleeds internally. Breathing becomes difficult and movement painful. All due to blood being where it shouldn't be. Eventually, without treatment, the animal dies.
Was this an accidental poisoning or murder? The owners think the later while to vet believes the former. Was it a competitor? Was it an animal rights group? Was it just a dog eating the rat poison in the subway? We will never know.
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