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Background: Cocaine is metabolized in part by plasma cholinesterase to form ecgonine methyl ester. Decreased plasma cholinesterase activity is associated with enhanced cocaine toxicity in both humans and animals. This study was designed to determine whether the administration of exogenous plasma cholinesterase is protective against cocaine toxicity. Methods: Using a blinded protocol, female Swiss albino mice were randomized to receive an intraperitoneal injection of either 13.7 mg/kg of purified human plasma cholinesterase dissolved in phosphate buffered saline, or an equal volume of phosphate buffered saline as a control. One hour later, all animals received an intraperitoneal injection of either 100 or 125 mg/kg of cocaine, and the incidence of seizures and death was recorded. In a similar fashion, another group of animals was randomized to receive a human plasma cholinesterase dose of either 13. 7 or 27.4 mg/kg, followed by 150 mg/kg of cocaine. Results: Administration of 13. 7 mg/kg of human plasma cholinesterase increased plasma cholinesterase activity by a mean of 63 [+ or -]13 fold, with a [T.sub.max] of 90 minutes and a [V.sub.d] of 85 [+ or -] 13 mL/kg. Cocaine's effects on seizures and death were attenuated by human plasma cholinesterase. A cocaine dose of 150 mg/kg represents an [ED.sub.100] for seizures and an [LD.sub.100]. At this dose, lethality was reduced to 30% (p < 0.001) and seizures were reduced to 40% (p < 0.001) by administration of 27.4 mg/kg of human plasma cholinesterase. Conclusions: Pretreatment with purified human plasma cholinesterase protects mice against the convulsive and lethal effects of cocaine., Correspondence: Dr. Robert Hoffman, New York City Poison Control Center, 455 First Avenue, Room 123, New York, NY 10016. Tel: 212/764-7667; Fax: 212/447-8223. INTRODUCTION The prevalence of cocaine use and [...]

Objective: Toxicovigilance and prevention are two major goals of a poison center. Since environment greatly contributes to the probability of a toxic exposure, we wanted to study the epidemiological features of poisonings in the penitentiary population. Methods: A descriptive analysis of cases consulted to our Poison Centre from January 1991 to December 1998 was made. Data from the Spanish Observatory for Drugs of Abuse (SODA) such as the mortality rates in prison and circumstances of prisoners related to the consumption of psychoactive agents in the emergency room were also analyzed. Results: Patients reported to the Spanish Poison Centre included 124 male and 14 female; all except one were adults (median range of age: 20-25 years). SODA data included only male, mean age 30. The first cause of intoxications in our Centre was suicide 79.7% followed by other etiologies: accidental (13.7%), occupational (0.7%), homicide (0.7%), chronic abuse (2.4%, with solvents and aerosol propellants) and others (2.8%). The majority of cases were consulted on weekdays (10:1), and the peak of suicides corresponded to November-December. Batteries were involved in more occasions than outside the penitentiary institution (16.4% versus 0.5%) as well as bleaches (16.5 versus 2.4%). Antiviral agents were other important substances ingested in high doses: 5 cases with zidovudine, up to 12 g; 2 with idoxiuridine, 1 with didanosine, 1 with stavudine, 1 with indinavir 36g; and 1 with nelfinavir 1.5g. Isoniazid and rifampicin were implicated on 2 occasions. Psychiatric drugs such as benzodiazepines or antipsychotic agents caused acute self-poisoning with a frequency of 32% versus 46% in the general population. Routes of entry and the estimated prognosis were similar. Due to their severity we would like to highlight two incidents: the intravenous administration of milk and the homicidal use of fluosilicate. According to SODA the first cause of death in the penitentiary institutions was HIV infection followed by drug abuse (50% of prisoners are drug dependent and 45% of them HIV-positive) and the fourth cause was suicide. 11.6% of consultations to the emergency room were due to psychoactive substances, mainly heroin (65.6%) and cocaine (29.1%) and 2.3% deaths of people in prison were for acute reactions after the consumption of these substances or acute intoxication. Conclusion: Due to the important percentage of suicide attempts as a cause of intoxication and the easy availability of drugs for HIV and tuberculosis infection in penitentiary centers, psychiatric evaluation and specific prevention measures are important aspects to be played by health care professionals in these institutions. Ballesteros S, Silvosa G, Ramon MF, Martinez-Arrieta R, Torrecilla JM. Servicio de Informacion Toxicologica, Instituto Nacional de Toxicologia, Madrid and Observatorio Espanol sobre Drogas, Spain

Introduction: Paracetamol is a widely used analgesic that can cause severe hepatotoxicity when taken in overdose. The number of paracetamol overdoses reported to the National Poisons Information Centre in Dublin rose by more than 25% between 1994 and 1998. In an attempt to reduce severe overdoses, the Irish Medicines Board made a number of recommendations on the sale of paracetamol in Irish retail outlets. Restrictions on pack size were introduced in October 1997 with a transition period of 3 months during which old supplies could be sold. We looked at the impact of these restrictions on the number of tablets being ingested in overdose. Methods: We examined all cases of acute paracetamol overdose reported to the NPIC in 1997 and 1998. We noted the age and sex of the patient involved and eliminated any case involving children under the age of 10. We counted the number of tablets involved in each case and compared the two years using non-parametric statistical analysis. Results: We found a total of 2020 cases of acute deliberate overdose, 1044 in 1997 and 976 in 1998. More than 50% of the cases involved 24 tablets or less. There was no significant difference between 1997 and 1998 ([chi square] = 1.276, P [is greater than] 0.1). The number of cases involving more than 48 tablets fell slightly but was not statistically significant (T = 127; [T.sub.1] = 120, [T.sub.u] = 180). Discussion: Most overdoses reported to the NPIC involved less than 24 tablets but 10% involved more than 48 tablets. Voluntary restrictions on the sale of paracetamol had no impact on the number of tablets being ingested in overdose. Legislation on the sale of paracetamol packages may be useful in reducing severe overdoses. Donohoe E, Tracey JA. National Poisons Information Centre, Beaumont Hospital, Dublin 9, Ireland

Background: Despite 50 years of educational and legislative efforts aimed at increasing public awareness of the toxicity of iron, it remains the leading cause of poisoning deaths in children under the age of 5. This study addressed the issue of preventing iron poisoning through an educational program developed for Public Health Nurses (PHNs) in the local county health department. PHNs were chosen as study subjects because of their contact with patients prescribed iron supplements during the perinatal period. Methods: Six educational programs were held at local public health departments throughout the county. A convenience sample of 70 attended. The programs consisted of a pre-test, lecture, post-test, and evaluation. In addition, a follow-up survey was conducted at 8 months post-training in order to determine the application of iron poison prevention principles. Education and evaluation of subjects were based on behavioral and cognitive approaches to iron poison prevention. Results: Prior to attending the program, 60% of the PHNs reported storage habits of medication that predispose children to poisoning. Further, 71% of the attendees were unable to identify iron as one of the three most dangerous products from a list of six hazardous household substances. The overall score in the pretest was 56% compared to the mean post-test score of 96%. Of the 45 respondents to the follow-up survey, 87% had utilized the program information to educate patients. In addition, 84% of the participants educated a family member on the dangers of iron poisoning. Conclusions: This Iron Poison Prevention Program provided a successful educational program for PHNs that was then applied to patient education. This program represented a unique interagency partnership for disseminating vital poison prevention to health professionals and can serve as a model for public health departments throughout the country., Broderick M, Dodd-Butera T, Wahl P. California Poison Control System (San Diego Division) and San Diego State University, San Diego, [...]

Background: A SCA serving a primarily farming & ranching population identified poisonings as a target for injury prevention due to perceived high number of ED visits for poisonings. A distance collaborative model was piloted, linking regional PC expertise & experience with local SCA commitment & access to the target population. Methods: The PC provided content expertise (problem overview, causes, educational material development) & prevention expertise (strategies, tools). The SCA provided knowledge of the community (audience, needs, motivators), ability to mobilize local resources (financing, organizations, people), & access to the community (schools, events). Work was conducted primarily via telephone & e-mail, after initial on-site orientation visits. Results: A variety of social marketing processes were planned & implemented to promote jointly determined goals: increase awareness of poisoning as a health concern, promote general & farm-specific practices that reduce the poisoning risk, & increase PC awareness in all age groups. A school-based age-appropriate prevention program was taught to 1400 children (kindergarten to grade 5). Existing PC prevention material was featured at 5 local fairs/exhibits (health, farm safety, rural women). Newsletters (content written by PC staff), a teacher information package, local newspaper ads, a 'Spray it Safe' theme & web pages were developed along with local media coverage, contests, promotional incentives (neoprene gloves). Conclusion: The PC & SCA prevention goals were achieved collaboratively & at a distance in a rural community, at relatively low cost to the PC. Newsletter article content is now the base for PC production of region-wide educational materials focused on agricultural poisons., Kaczowka R, Palin T, Button G, Vicas I. Alberta Poison Centre (PC), Calgary, AB; High River & District Safe Community Association (SCA), High River, AB, [...]

Objective: Distribution of poison prevention literature increases utilization of a poison center. Until 2000 our SPIs offered to mail poison prevention literature to callers, but only when the SPI remembered to ask, and was not too busy. Sending a packet meant writing the address on the envelope, and dropping the packet in the mailbox. We devised an improved method. Methods: One of the free areas in the Toxicall charting program was used as a 'send poison prevention literature' check-box. When the specialist felt the caller would benefit from prevention information, they selected the check box, and typed the caller's address in Toxicall. The address was retrieved automatically from Toxicall using Microsoft Access, and sent into a mail merge to generate mailing labels that were then affixed to the packets by support staff. After 1 year of optional use, the literature check-box was made a mandatory field; the SPI could elect to send literature, or choose several options to explain why this caller does not get literature. SPI time per packet sent was reduced from 120 sec to 30 seconds. Equally important, volume of literature mailed from the center increased (see Table). Conclusions: Lack of time is a frequently cited barrier that prevents SPIs from engaging in prevention activities. We were able to leverage existing database technology to make the prevention literature offer an integral part of a call to the poison center. Year 2000 Quarter 1 2 3 4 Packets sent 235 938 770 875 Literature check box added [up arrow] Year 2001 Quarter 1 2 3 4 Packets sent 907 1023 841 967 Literature check box added check box made mandatory field Year 2002 Quarter 1 Packets sent 2427 Literature check box added [up arrow] Abstract 72. Wolowich WR, Fuller-Pyle J, Casavant MJ. Central Ohio Poison Center, Columbus, Ohio, Wolowich WR, Fuller-Pyle J, Casavant MJ. Central Ohio Poison Center, Columbus, [...]

Introduction: Unlike pharmaceutical products, chemical substances are not systematically tested in humans. Normally, an extrapolation from animal-studies is performed to characterise possible toxic health risks in humans. Knowledge of substances [...]

Objective: The incidence of mushroom poisoning is increasing due to the rising popularity of mushroom foraging. Many edible mushrooms resemble poisonous ones and are impossible to differentiate by telephone descriptions, [...]

Background: Reduction of pesticide poisoning is a desired objective of Poison Control Centres. In order to do this, more epidemiological information is needed. Consults about poisoning with pesticides intended for [...]