NATIONAL POISON PREVENTION WEEK
March 21-27, 1999

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National Poison Prevention Week provides an opportunity to enhance awareness of poisonings and their devastating effects, identify the types of preventative strategies that can be employed to help prevent poisonings from occurring and review appropriate treatment measures to employ when a poisoning does take place. For additional information regarding National Poison Prevention Week or for other poison related resources, visit the Illinois Poison Center web site at www.mchc.org/ipc.

The Illinois Poison Center can be accessed in a poisoning emergency. They can also provide educational material and resources specific to poisoning prevention. Listed below is their contact information and a summary of resources. Also available in this section is information about use of Activated Charcoal and Syrup of Ipecac.

Please contact the Illinois Poison Center at (800) 222-1222

If you are in need of any of the following:

1. Need assistance for a poisoning emergency in a healthcare facility or in the home

2. Have questions about a public education campaign

3. Would like to receive fact sheets about Activated Charcoal or Syrup of Ipecac, Mr. Yuk stickers, poisonous/nonpoisonous plant lists or other poison prevention materials.

4. Have questions about poison treatment related issues

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Use of Activated Charcoal

The Illinois Poison Center is changing its recommendations to parents and care providers of small children concerning what to stock in the home in case of an accidental poisoning. For decades, poison centers recommended that parents keep syrup of ipecac in the home. Due to the continuing evidence of the value of activated charcoal, the IPC advocates that parents also keep a bottle of activated charcoal in the home. A bottle of 10 to 15 grams of USP activated charcoal is considered adequate.

Ipecac has been all but abandoned in the emergency room setting. Several reasons explain this trend:

1. Ipecac requires 15-30 minutes to produce emesis. If the victim has ingested something that causes drowsiness or seizures, the child may be obtunded or seizing when the vomiting begins. This poses an aspiration risk.

2. Ipecac is relatively inefficient. Ipecac only empties approximately one quarter to one third of stomach contents, leaving much of the ingested toxin behind.

3. Ipecac delays the administration of activated charcoal, the decontamination method of choice, by as much as two hours while waiting for the multiple bouts of emesis to subside.

In contrast to ipecac, activated charcoal binds to the ingested toxin immediately upon contact. Decontamination with activated charcoal is both more rapid and more complete. It is important to note that there are the following contraindications to the use of activated charcoal:

• Ingestion of a caustic substance since it masks evidence of burns.

• Ingestion of a hydrocarbon since it does not adsorb hydrocarbons.

• Ingestion of alcohol since it does not adsorb alcohol.

• Ingestion of iron separations, lithium or lead since it does not adsorb metals.

When activated charcoal is used, parents should be aware that about one quarter of recipients will vomit part of it, which can produce quite a mess if unprepared. Complications of activated charcoal use are very rare.

NOTE: As with syrup of ipecac, parents should be encouraged to call either the Illinois Poison Center at (800) 222-1222 or their doctors office prior to administering activated charcoal. The Illinois Poison Center can be contacted for any questions regarding the appropriate use of activated charcoal or syrup of ipecac. READ FURTHER FOR ADDITIONAL INFORMATION ON THIS SUBJECT.

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Over-the-Counter Activated Charcoal for the Treatment of Accidental Poisonings

By Cheryl A. Kapustka, Pharm D, C.S.P.I. and Anthony M. Burda, R.Ph., A.B.A.T.

This article may prove to be the newest accidental, home poisoning treatment information that you have read in a long time. For decades, pharmacists, along with others interested in educating parents about poisonings, have encouraged parents to purchase syrup of ipecac (SOI) to store in the home. SOI was recognized as a safe and effective emetic for both home and emergency room use.

During the last ten to fifteen years, however, many significant limitations of SOI and contraindications to its use have come to light. At the same time, the efficacy and safety of activated charcoal (AC) as a poison treatment modality have become much more appreciated.

Several problems restrict the use of SOI both in homes and health care facilities. These include:

1. The amount of poison removed from the stomach following SOI-induced emesis is variable and decreases with time.

2. SOI administration may delay the administration or reduce the effectiveness of other oral agents such as AC, n-acetylcysteine (MucomystR) or polyethylene glycol (PEG) electrolyte solutions (i.e. GoLYTELYR) that are used for whole bowel irrigation.

3. SOI should not be given to patients at risk of rapid loss of consciousness (i.e. from tetrahydrozoline decongestants - i.e. VisineR), sedatives or tricyclic antidepressants).

4. SOI should not be given to patients at risk for rapid onset of seizures (i.e. from camphor, isoniazid, lidocaine, lindane or nicotine).

5. SOI should not be given following ingestions of caustic chemicals (i.e. drain openers or oven cleaners).

6. SOI should not be given for ingestions of hydrocarbons with high aspiration potential (i.e. charcoal lighter fluid, furniture polish or paint thinner).

For many poisonings, AC provides a safer and probably more effective alternative to SOI. This preference for AC over SOI is reflected in national statistics. According to the Toxic Exposure Surveillance System (TESS) data compiled by the American Association of Poison Control Centers (AAPCC), the use of SOI fell from 13.4% of reported poisonings in 1983 to 1.5% in 1997, a dramatic reduction of 89%. During the same period, the use of AC rose from 4% to 7.1%, an increase of 78%.

Although AC offers some distinct advantages over SOI in the management of many poisonings, there are some noteworthy limitations and contraindications to its use. AC poorly adsorbs certain poisons including iron, lithium, alcohols and caustic chemicals. For acids and alkalis, in addition to being ineffective, AC is contraindicated because it may cause vomiting and will obscure visual examination of the injured oral and gastrointestinal tissues. AC is also contraindicated following ingestions of hydrocarbons since it may cause vomiting and, thus, increase the risk of aspiration.

Pharmaceutical companies manufacture AC in a granulated form to be mixed with water or soda, as an aqueous slurry and as a slurry with sorbitol, a strong cathartic. For the purpose of home poisoning management, we recommend the purchase and use of only the sorbitol-free products because sorbitol may cause diarrhea and abdominal cramps. Products pre-mixed with sorbitol are more suitable for administration in health care facilities.

The process of educating families with small children to keep SOI in their home emergency medicine kits has been a long one, and yet some households with small children in Illinois do not have a bottle. This is where all pharmacists come into the picture. Pharmacists, as well as pediatricians and nurses, are essential for the success of any public health education campaign. Getting the important message of stocking both AC and SOI to the whole population of Illinois will be a year-round endeavor for all health care professionals and is not just limited to National Poison Prevention Week, March 21 - 27, 1999.

We urge you to set the following goals:

1. Stock in the pharmacy and promote the sale of 10-15 g bottles of AC in addition to SOI.

2. Place the toll-free Illinois Poison Center (IPC) emergency number, (800) 222-1222, on the label with a warning never to use either product without first consulting the IPC or a physician.

Simply put, the IPC needs your wholehearted support in reaching the 11.8 million people of Illinois. A continuing effort on the part of all of us will help spread the message about this unique new addition to the home medicine cabinet.

If you have a poisoning emergency in a health care facility or home, have questions about this public education campaign or would like to receive fact sheets about AC and SOI, Mr. Yuk stickers containing our emergency number, poisonous/nonpoisonous plant lists, or other poison prevention materials, please call the IPC at (800) 222-1222.