Case Report of Methemoglobinemia in a Toddler Secondary to Topical Dapsone Exposure.

Aczone gel 5% contains dapsone and is a commonly used topical dermatologic therapy for acne in adolescents and adults. We describe the first reported pediatric case of a previously healthy girl presenting with acute onset of methemoglobinemia after exposure to her sibling's Aczone gel. The patient was successfully treated with methylene blue initially and subsequently needed an additional dose for rebound methemoglobinemia.

Clinical experience with and analytical confirmation of "bath salts" and "legal highs" (synthetic cathinones) in the United States.

Unlabelled: Recently, there has been a worldwide rise in the popularity and abuse of synthetic cathinones. In 2009 and 2010, a significant rise in the abuse of a new group of synthetic cathinones was reported in Western Europe. In 2010, the rapid emergence of a new drug of abuse, referred to as bath salts or "legal high," occurred in the USA.

Unintentional therapeutic errors involving insulin in the ambulatory setting reported to poison centers.

Background: Adverse drug events in the ambulatory care setting are not uncommon and can cause significant morbidity. Little research has been published on the management of adverse drug events involving insulin in the outpatient setting.

Objective: To analyze data on patients with unintentional therapeutic errors involving insulin managed by 9 regional poison control centers.

Use of antivenom for snakebites reported to United States poison centers.

Unlabelled: In 2001, a new antivenin was introduced to the United States and became widely available in the snakebite season of 2002. We investigated what impact this may have had on snakebite treatment and medical outcome.

Method: The study used a retrospective review of all snakebites to humans reported to the National Poison Center Database System from 2000 to 2007.

Benzonatate Ingestion Reported to the National Poison Center Database System (NPDS).

Little has been published on benzonatate ingestion, with the few case reports suggesting significant risk of seizures after poisoning. A 7-year retrospective review of all single substance ingestion of benzonatate reported to the National Poison Center Database System (NPDS) from 2000 to 2006. In this review, there were 2,172 patients, of which 1,280 (58%) were female.

Effect of scheduling tramadol as a controlled substance on poison center exposures to tramadol.

Background: There is limited information on the effect of scheduling a drug as a controlled substance with comparable data from both a pre-scheduling and post-scheduling time period.

Objective: To investigate the temporal changes on poisoning cases involving tramadol in 4 states: 2 states where it has been scheduled and 2 where it is not scheduled.

Methods: Databases were searched for all cases involving tramadol reported from 2003 through 2009 at 6 regional poison centers that served Arkansas, Kentucky, Ohio, and West Virginia.

Investigation of temporal changes of abuse and misuse of prescription opioids.

We analyzed intentional exposures to prescription opioids (buprenorphine, fentanyl, hydrocodone, hydromorphone, morphine, methadone and Oxycodone) using the Research Abuse, Diversion and Addiction-Related Surveillance System (RADARS) Poison Center data over a 5 year period 2003-2007 to see if there were temporal trends in the abuse and misuse of prescription drugs associated with (1) weekends vs. weekdays and (2) during select holiday periods vs. non-holiday periods.

Trends in volatile substance abuse.

The purpose of this article is to evaluate whether social, geographic, and demographic factors have a relationship to trends in volatile substance abuse. Two datasets were obtained. Dataset 1 was all patients reported to U.

Epidemiological trends in abuse and misuse of prescription opioids.

The authors evaluated trends between social, geographic, and demographic factors and cases of select scheduled drugs (buprenorphine, fentanyl, hydrocodone, hydromorphone, morphine, methadone, and oxycodone) using the Researched Abuse, Diversion and Addiction-Related Surveillance System poison center data and census data. Spontaneous calls from the public and healthcare professionals are recorded by poison centers using a standardized, electronic data collection system. We compared the annual incidence of total prescription opioid drug cases to annual data from the U.

Increasing burden of pill identification requests to US Poison Centers.

Introduction: Information calls to poison centers, particularly for pill identification (PID), have been increasing.

Methods: Retrospective review of information calls reported to U.S.

Toxicity from modafinil ingestion.

Introduction: Modafanil, a non-amphetamine stimulant, is used for narcolepsy, sleep apnea, and shift work sleep disorder. There is little available information on the toxicity of modafinil overdose.

Method: We performed a retrospective multi-poison center chart review of patients from 11 states who had a single substance ingestion of modafanil with follow up to a known outcome for the years 2000-2007.

Unintentional ingestion of bupropion in children.

Background: The incidence of seizures after unintentional bupropion ingestion in children aged < 6 years has been reported as 0.2%. However, in many poison centers, > 80% of these patients are referred to the Emergency Department (ED) for evaluation.

Multiple seizures after bupropion overdose in a small child.

Unintentional ingestion of bupropion in young children has generally resulted in limited toxicity. We report a case of pediatric bupropion ingestion resulting in multiple seizures. The patient experienced hallucinations, agitation, vomiting, tachycardia and seizures after ingestion of 1050 (48 mg/kg) of extended-release bupropion.

Methemoglobinemia due to malachite green ingestion in a child.

Malachite green is a commercially available dye used to treat parasitic and fungal disease in fish. No previous reports of human injury could be located from acute ingestion of malachite green. We report a case of methemoglobinemia of 51% in a 3 year old girl after acute ingestion of malachite green from a commercially available aquarium product.

Prolonged cardiovascular effects after unintentional ingestion of tetrahydrozoline.

Tetrahydrozoline is an imidazoline derivative with alpha receptor agonist activity widely available in over-the-counter topical ocular and nasal formulations. More than 1,600 cases of oral exposures are reported to United States poison centers annually (1,2). Reports of significant toxicity from tetrahydrozoline ingestion are unusual but have occured primarily in small children after unintentional ingestion (3-63, 6).

Fatal bupropion overdose with post mortem blood concentrations.

We report five cases of fatal bupropion overdose with post mortem bupropion concentrations ranging from 3.1 to >20 mg/L. Four patients had ingested a sustained-release formulation of bupropion and had evidence of pill "bodies" in their stomach with significantly elevated blood bupropion concentrations.

Impact of activated charcoal after acute acetaminophen overdoses treated with N-acetylcysteine.

Previous studies have suggested that patients receiving both activated charcoal (AC) and N-acetylcysteine (NAC) after acute acetaminophen (APAP) overdoses may have improved outcomes. We evaluated all acute acetaminophen overdoses that received NAC therapy reported to US poison centers for the years 1993 through 2004. Groups were separated based on therapy received: 1) both AC and NAC and 2) NAC alone.

Drug facilitated sexual assault using an over-the-counter ocular solution containing tetrahydrozoline (Visine).

Drug facilitated sexual assault (DFSA) has been defined as sexual activity occurring where consent is invalid or absent due to the effects of drugs and or alcohol. We report the use of a commonly available over-the-counter drug to induce an obtunded compliant victim with no memory of the period during the sexual assault. An adult male repeatedly used tetrahydrozoline to induce a comatose state in an adult female and four female children for the purposes of sexual assault.

Two fatal cases of selenium toxicity.

Two patients, a 36-year-old female and a 36-year-old male, separately experienced new onset nausea, vomiting, diarrhea, abdominal pain, muscle weakness and pallor. Over a period of 14-16 h these symptoms continue and progress to include hypotension refractory to therapy, pulmonary edema and cardiovascular collapse. Autopsies show hemorrhagic pulmonary edema, splenomegaly and lack of anatomical cause for sudden death.

Toxicology of oral antidiabetic medications.

Purpose: The toxicology of oral antidiabetic agents is reviewed.

Summary: Type 2 diabetes mellitus is increasing to near epidemic proportions, with a reported 190 million patients worldwide. Use of oral antidiabetic medications is increasing along with a proportional increase in adverse events.

Retrospective evaluation of tiagabine overdose.

Background: Tiagabine is an anticonvulsant that blocks reuptake of the inhibitory neurotransmitter GABA. There are no published studies or case series of tiagabine overdoses.

Methods: The records of six poison centers and one statewide poison center network were searched for all exposures to tiagabine for the years 2000-2002.

Efficacy of activated charcoal administered more than four hours after acetaminophen overdose.

To evaluate whether administration of activated charcoal, in addition to standard N-acetylcysteine (NAC) therapy, after acetaminophen overdose provides additional patient benefit over NAC therapy alone, a 1-year non-randomized prospective, multi-center, observational case series was performed at three poison centers and one poison center system. Entrance criteria were all acute acetaminophen overdoses with: 1) an acetaminophen blood concentration determined to be in the toxic range by the Rumack-Matthew nomogram; and 2) all therapies, including NAC and activated charcoal, initiated between 4 and 16 h post-ingestion. There were 145 patients meeting entrance criteria, of whom 58 patients (40%) received NAC only and 87 patients (60%) received NAC and activated charcoal.

Atomoxetine ingestions in children: a report from poison centers.

Background: Atomoxetine uses a novel non-stimulant approach to the treatment of attention deficit hyperactivity disorder. There is limited information on overdose of atomoxetine in children or adults.

Objective: To provide information on atomoxetine in overdose.

Toxic clonidine ingestion in children.

Objectives: We performed a prospective case series to seek dosage or clinical parameters to better identify patients who need direct medical evaluation.

Study Design: All clonidine ingestions in children younger than 12 years of age reported to 6 poison centers were followed for a minimum of 24 hours. Exclusion criterion was polydrug ingestion.