St. John Bosco

"As far as possible avoid punishing, try to gain love before inspiring fear."

No tox today.  Rather a note of thanks to John Bosco, the Patron Saint of Educators.  St. John Bosco believed in educating the poor and downtrodden.  His methods were simple, instruct in scripture, reject corporal punishment and provide fatherly guidance.  In his teaching he sought to combine spiritual life with work, study and play. 

In 1859 John Bosco founded the Salesians.  They are a religious order dedicated to education and mission work.  The Salesians are still at work today.

Thank you St. John Bosco.

Zyklon B

Last month I wrote back to back posts about cyanide poisoning.  Of interest today is the death of a lottery winner in Chicago.  But the use of cyanide to kill dates back many centuries.  The most infamous use of cyanide was Zyklon B, the gas used by the Nazis to exterminate millions during World War II.   Some claim the holocaust never happened.   (Poland's population went from 10 million to 4 million during the war.  I guess it must have been some bad years for the flu!)  Thankfully there are many fighting to remind all of us of the horrors of the Holocaust.  The Nizkor Project is dedicated to the 12 million Jews that died in the holocaust.  (Nizkor is a Hebrew word which means, "We will remember".  

When you have the time please read this long, factual, horrifying and informative entry.  It contains very detailed information on how cyanide works. 

Shane

Today in 1964 actor Alan Ladd died of an overdose of alcohol and sedatives.  For those that think only today's musicians, Whitney Houston and Amy Winehouse, die of sedative and alcohol overdoses, you are mistaken.  Even cowboy actors from the 50's have used drugs to alternately enhance or dull their lives. 

Mr. Yuk

Today is the birthday of "Mr. Yuk".  The brainchild of Dr. Dick Moriarty in 1971 Mr. Yuk has been an effective deterrent for generations of children.  Mr. Yuk is also a tremendous awareness tool.  Who doesn't equate Mr. Yuk with a poison center?  The copyright for Mr. Yuk is owned by the Pittsburgh Poison Center but the stickers are widely available.  You only have to call your local poison center (1-800-222-1222). 

Thank you and Happy Birthday Mr. Yuk! 

   

Martin Luther King Day, 2013

"White America needs to understand that it is poisoned to its soul by racism and the understanding needs to be carefully documented and consequently more difficult to reject."  Martin Luther King, 1967

Today we celebrate Martin Luther King Day.  For many it is a day with no school or a day off work.  For many it is a reminder of the battles fought and the battles yet to come.  As a country is White American still "poisoned to its soul"?  We have record unemployment among African Americans in our inner cities.  We have fences going up in Arizona to keep immigrants out.  We have horrific health care and living conditions along the Rio Grande in Texas for Latinos.  We fill death row with minorities across the south.  Yet we have come a long way from the days of Martin Luther King.  We no longer have "colored" only schools, drinking fountains and lunchrooms.  We have an African American President. 

According to my Websters Dictionary a poison is "something destructive or harmful (2): an object of aversion or abhorrence."  Each day I encounter poisons of different sorts.  Usually the kind that people ingest, inhale or inject.  But today step back and think of a poison as something different, as Martin Luther King did in 1967.  

 

Snake Hunts

In Florida they are hunting pythons.  After the first three days of the hunt 11 snakes have been killed. 

The thinking behind this hunt is fascinating.  Throughout the south snake round-ups are held.  Originally those round-ups were created as a way of ridding the countryside of venomous snakes.  If snakes are killing your sheep, it makes sense to remove the snakes.  Many still believe today that snake round-ups are good.  Those round-ups have slowly devolved over the years to an excuse to hold a festival and to party.  Texas rattlesnake round-ups provide games, rides and treats for children.  They, of course, have fried rattlesnake and beer for adults.  In addition there are the multiple contests involving rattlesnakes.  How fast would it take you to put 10 rattlesnakes in a bag? 

In Florida the reason for having round-up is different.  The Python is not indigenous to the everglades.  Rather they have been introduced by irresponsible people who owned a snake until it got to big.  What to do then?  Release it into the wild.  It turns out the everglades is a great environment for pythons to live and grow.  Unfortunately they are disturbing a very delicate ecosystem.  It is estimated that there are 11,000 pythons in the everglades.  Luckily, 11 have been killed.  Boy, those Floridians are making great progress! 

In Texas they are killing snakes for just being snakes.  All they did was live life like God intended.  In Florida they are killing snakes because they are thriving in a place where man put them.  Somehow in the end the snakes, and the environment, will win. 

Sam Sebastiani Jr.

There is a saying, "There are old mushroom hunters and there are bold mushroom hunters.  But there are no old, bold mushroom hunters."  Today marks the 15th anniversary of the death of Sam Sebastiani Jr.. 

An Italian immigrant Samuele Sebastiani founded Sebastiani Winery in Sonoma in 1904.  The winery was in the family for the rest of the century.  Sam Sebastiani Jr. was the great grandson of Samuele.  On January 5, 1997 Sam went for a picnic with friends.  While on the picnic he consumed amanita phalloides mushrooms.  Later that day he became ill only to die three days later.    

Amanita phalloides poisoning resembles acetaminophen poisoning.  Both cause similar hepatic damage.  The breakdown of liver function effects everything from how your blood clots (it won't) to how your brain works (encephalopathy results).  Eventually your liver stops working, and in the case of Sam Sebastiani, death ensues.  The search for a treatment for amanita poisoning has been going on for centuries.  Today the best we can do is aggressive supportive care.  There is no antidote.  For a lucky few liver transplant can be performed.   In fact, Sam Sebastiani was on the transplant list before he became to ill. 

Isn't that amazing?  A mushroom that has been around since time began.  A mushroom that starting killing people as soon as man and animals starting picking and eating it.  A mushroom that killed in 1997 and kills today.  We still don't have an effective antidote.  Amazing.  

So today in honor of Sam Sebastiani eat a wonderful Italian meal, but hold the mushrooms.  Instead have a good bottle of California wine.  And remember, "There are old mushroom hunters and there are bold mushroom hunters. But there are no old, bold mushroom hunters." 

Cyanide... part 2

Check this Chicago Tribune article  out.  Cyanide once again rears its ugly head.  Suicide, murder or something else?  He was heard screaming, taken to the hospital, and declared dead.  In a high enough dose cyanide works quickly.  Remember, it is the dose that makes the poison.  Maybe he screamed over the taste.  Or maybe he screamed over the pain.  But his heart and brain would quickly cease to function.  And he was declared dead.  No real chance of saving him if the dose was high enough.  That is especially true if there is no suspicion of cyanide intoxication. 

Win the lottery and be set for life.  In this case that proved to be true.  It was just that life as a wealthy lottery winner was very brief. 

 

Cyanide and venlafaxine

Nine years ago, on January 3 an 18 yo man in Maryland killed his best friend.  It reads like a story of teenage angst.  Teen falls for best friend's girl friend.  Teen feels neglected by his best friend.  Teen then plans, and carries out, an elaborate plan to murder his friend.  Just another teenage friendship gone awry 

It is the behind the scenes story that makes this even more interesting.  18 yo Ryan Furlough decided months before that his friend would have to go.  He carefully researched how to murder, and poisoning was the method of choice.  He then researched what the best substance would be and decided cyanide.  In his research he found the appropriate dose and information on how to deliver it.  Finally he used his mother's credit card to order the cyanide on-line.  On January 3 he invited his friend over to the house for some video games.  While playing he added the cyanide to his friend's Vanilla Coke.  Moments later the cyanide took effect and four days later the best friend died. 

Cyanide is a substance with a long history for poisoning.  It was used in the Tylenol poisonings in Chicago.  Then again by the "Candy Man" in Houston.  Cyanide was used to murder millions by the Nazis.  Google search cyanide murders and you will get thousands of hits.

But there is more. It seems Ryan Furlough was being treated for depression.  In the months prior to this murder his treatment was changed from fluoxetine to venlafaxine.  As you could gather from the above Ryan left an extensive trail clearly showing that he planned his friend's death.  He also confessed to police that he murdered him.  His defense was that he was taking venlafaxine.  The black box warning for venlafaxine talks about suicidal thinking and behavior.  It is not much of a stretch to go beyond suicide to other impulsive behaviors.  So, was Ryan unduly under the influence of his antidepressant?  Did the venlafaxine make him act out and poison his friend?  The jury said no and found him guilty of murder.       

Merry Christmas!

Tis the Season to be Poisoned

 ‘Twas the morning post-party, when all through the house,
No adult was stirring, not even your spouse.
The children, you thought, were asleep in their beds.
But, what you didn’t know, they had other ideas in their heads.

Your house was awash in post-party trash,
And the kids thought this was a gold mine—better than cash.
There were ashtrays with butts and glasses with drink,
And a visitor’s purse lay there by the sink.

The kids were delighted and felt ever so free,
And then their bright eyes—locked onto the tree!
There was tinsel, and lights that bubbled so merry,
And a strange plant with fruits, called “Jerusalem Cherry”.
Food was left out on the table all night,
And if they could have seen the bacteria—what a horrible sight!
And there by the fireplace was a box shaped just right,
That contained some powder to make fire colors bright.
A small toy broke open, and there at their feet,
Was a round tiny battery that looked good to eat.

As you see your home, where you thought poisons naught,
On this holiday season, was NOT as safe as you thought!
As you rose from your sleep and rubbed your eyes free,
You looked for the kids, and a disaster you see!

You sprang to the phone, not a moment to spare,
And talked to the folks you knew would be there.
Your poison center sure helped you get through the mix,
And you thought—“How’d we ever get into this fix?”
For you see holidays can present problems so rare,
That before they can happen, you must be sure to prepare.

It takes just a moment to think what might be,
And clean up your trash, so your home’s poison free.
And so, my dear friends, keep the holidays bright,
Put all away, and sleep peaceful tonight.
Have a holiday bright, that is full of good cheer,
And from the staff of the poison center—“Have a Safe Year!”

Written by John H. Trestrail III, R.Ph, ABAT
Clinical and Forensic Toxicologist

Thank you to the the American Association of Poison Control Centers blog.   

Poinsettia

Yesterday we had a winter storm here in Wisconsin.  What says Christmas more than a fresh layer of snow?  Filled with the spirit I stopped on my drive home to purchase a poinsettia.  The beautiful Christmas plant now sits in a place of honor near our other decorations.  Fresh snow and a poinsettia, how festive!

The Poinsettia has a great history in the poison world.  Lore will tell us that the poinsettia is an extremely dangerous plant.  Eating just a single bud will lead to a child's death.  That fear comes from a story that originated in Hawaii.  Back in 1920 a small child supposedly ate a poinsettia plant.  Later, that child died.  But the story, like any urban myth, has grown and morphed over the years.  There has never been any verification that it ever happened.  None-the-less, is a poinsettia poisonous?  A colleague did a study looking at the ingestion of poinsettias as reported to a Poison Center.  Here is the link to the paper in the American Journal of Emergency Medicine.    There were over 22,000 exposures of which not a single patient died.  In fact, over 92 % had no problems related to the plant.  Pretty compelling work.  Poinsettias may cause some stomach upset, nausea or vomiting, if you make a salad of it.  A child tasting the plant will likely never have a problem.  Nor will your dog or cat.   But like anything else; it is always important to practice prevention and avoid any accidental ingestion. 

Today pick up a poinsettia and enjoy its beauty.  Merry Christmas!

It's poison! I tell you, it's poison!

It's a Wonderful Life is a great Christmas movie.  Released in 1947 it was nominated for multiple Academy Awards.  It is must see entertainment for this time of the year. 

Of course this is my favorite scene...

GOWER
What kind of tricks are you playing, anyway? Why didn’t you deliver them right away? Don’t you know that boy’s very sick?

GEORGE (in tears)
You’re hurting my sore ear.

INT. FRONT ROOM DRUGSTORE – DAY

CLOSE SHOT

Mary is still seated at the soda fountain. Each time she hears George being slapped, she winces.

INT. BACK ROOM DRUGSTORE – DAY

CLOSE SHOT – GEORGE AND GOWER

GOWER
You lazy loafer!

GEORGE (sobbing)
Mr. Gower, you don’t know what you’re doing. You put something
wrong in those capsules. I know you’re unhappy. You got that
telegram, and you’re upset. You put something bad in those capsules. It
wasn’t your fault, Mr. Gower . . .

George pulls the little box out of his pocket. Gower savagely
rips it away from him, breathing heavily, staring at the boy
venomously.

GEORGE
Just look and see what you did. Look at the bottle you took the
powder from. It’s poison! I tell you, it’s poison! I know you
feel bad . . . and .. .

George falters off, cupping his aching ear with a hand. Gower looks at the large brown bottle which has not been replaced on the shelf. He tears open the package, shakes the powder out of one of the capsules, cautiously tastes it, then abruptly throws the whole mess to the table and turns to look at George again. The boy is whimpering, hurt, frightened. Gower steps toward him.

GEORGE 
Don’t hurt my sore ear again.

But this time Gower sweeps the boy to him in a hug and, sobbing
hoarsely, crushes the boy in his embrace. George is crying too.

GOWER
No . . . No . . . No. . .

GEORGE
Don’t hurt my ear again!

GOWER (sobbing)
Oh, George, George . . .

GEORGE
Mr. Gower, I won’t ever tell anyone. I know what you’re feeling.
I won’t ever tell a soul. Hope to die, I won’t.

GOWER
Oh, George.

That scenes holds the two most important ingredients for greatness:  a pharmacist and poison.  Certainly, like me, you are thinking; I wonder what the poison was?  Thinking time frame and patient the list is endless.  The time is mid to late 30's. The drug is a powder.  The medication is intended for a child.  Plus it sounds like an emergency.  Was the child feverish, stomach problems, in pain, difficulty waking him up?  What could the poison be?

Mt first though was that the boy ate a barbiturate or an opiate and was sleepy.  Treatment at the time was something to get him up, nicotine, strychnine or cocaine.  All have odd tastes.  Maybe the boy broke his leg and was getting tincture of opium or laudanum.  Opium is very bitter tasting.  It could be that the child was intended to get a liquid and Mr. Gower made capsules.  The easiest answer if that he put too much aspirin in a capsule to treat a fever.  Instead of a child's low dose he made an adult dose. My guess, after much speculation - belladonna.  It would be in a bottle likely marked poison.  It would be used for stomach ailments, even colic in babies.  In a large dose it would be harmful.  Plus it tastes extremely bitter.    

Thankfully George Bailey saved the baby and Mr. Gower the pharmacist. 

Merry Christmas and remember....  "every time a bell rings an angel gets his wings."

Mustard Gas?

Once a week I get the honor of reviewing reports from US poison centers that contain items of public health interest.  Included in that list are any weapons of mass destruction.  Without that layer of review those calls would go directly to the CDC and Homeland Security.  This is a 24 hour a day service, as are poison centers, with a two hour response time as a goal. 

Last evening I reviewed a call to a poison center.  An adult male in Florida with dyspnea who was exposed to mustard gas.  Yikes!  Mustard gas was used in WWI as a chemical warfare agent.  It was known to cause skin and eye blistering on contact.  Plus difficulty breathing on inhalation of high concentrations.  Nasty stuff.  It was used against the Kurds by Iraq.  It was also found in Iraq during the second gulf war.  

So how did a homeowner in Florida get exposed to mustard gas?  It turns out he purchased an insecticide at Home Depot.  When he used it he developed difficulty breathing.  He called Home Depot to find out what was in the product.  The ever bright clerk at Home Deport, clearly feeling some holiday mischief, told him that the product contained mustard gas. Nice.  It turns out the product was likely a pyrethroid insecticide. 

In the end the patient was fine.  I wonder if the Home Depot guy knows how close he came to having someone from the CDC or FBI knocking on his door.

Holiday Hazard

The holiday season is here.  Time for fun and relaxation.  For those of you who are planning to have some serious fun, this toxicology question popped into my in box. 

Which drug is most implicated in deaths that occur in hot tubs or saunas?

The primary drug that contributes to deaths in hot tubs or saunas is ethanol with cocaine and cocaine-ethanol in combination as the second most common drug related contributors to these deaths. (Press E. The health hazards of saunas and spas and how to minimize them.  1991 Am J Pub Health 81:1034-1037)

Thank you AACT Question of the Day!

Murder by Poison

Murder by poison.  The reasons for murder - love, money and power - have been around for all of time.  But the chemicals used by poisoners change.  Socrates died from hemlock.  The Borgia's used arsenic.  Nazi Germany used cyanide.  Over the last decade there is a new poison of choice, ethylene glycol.

Ethylene glycol is in car antifreeze.  It is the chemical that keeps our radiators from overheating in the summer and turning into ice blocks in the winter.  To make it easily visible it is colored bright pink or fluorescent green.  It is great for our cars.  Unfortunately ethylene glycol is a hazard to our environment, pets and us.  Accidental ingestion of antifreeze by small children can be devastating.  The ingestion of antifreeze spills by animals leads to countless deaths every year.  But it is murder by ethylene glycol that is troubling. 

Last week I heard of an elderly gentleman being slowly poisoned with ethylene glycol by a relative. A horrible way to grab the poor man's inheritance.  But it has happened before.  Here is news story of a man that killed his wife for her life insurance.  Here in Wisconsin  Mark Jensen  was convicted of murdering his wife so that he could continue an affair with another women. 

What is common in all three of these cases, and many more, is that death by ethylene glycol is easily discovered.  All it takes is a level of suspicion.  Then men go to prison for the rest of their lives.  In addition ethylene glycol poisoning is easily treated.  Two good reasons why murder by ethylene glycol should never happen. 

Murder by poison.  What will be the substance of choice be for the next decade?