UNINTENTIONAL POISONINGS

1. UNINTENTIONAL POISONINGS Information and Prevention April 2009

2. TRAINING OBJECTIVES • Identify ways to prevent unintentional poisoning due to household chemicals. • Identify ways to prevent unintentional poisoning due to medications. • Recognize the dangers associated with kids taking prescription and over the counter (OTC) medications.

3. Identify ways to prevent unintentional poisoning due to prescription and over the counter medications. • Identify the dangers associated with carbon monoxide poisoning. • Identify ways to prevent carbon monoxide poisoning.

4. UNINTENTIONAL POISONING • Every year children die as a result of unintentional poisonings. • These poisonings are due to children receiving accidental overdoses of medications, ingesting medications not prescribed for them, carbon monoxide or ingesting household items such as cleaning supplies.

5. According to Safe Kids USA, more than one million children, ages five and under, are accidentally poisoned each year; 40 percent of these are from prescription drugs and other medications. 

6. Non-pharmaceutical products such as cosmetics, cleaning substances, plants, foreign bodies, toys, pesticides, art supplies and alcohol are responsible for 56 percent of poisoning exposures for children under five years of age. (Safe Kids USA)

7. UNINTENTIONAL POISONING • According to the Centers for Disease Control (CDC), 23,618 (72%) of the 32,691 poisoning deaths in the United States in 2005, were unintentional and 3,240 (10%) were of undetermined intent. Unintentional poisoning death rates have been rising steadily since 1992. • In 2006, unintentional poisoning caused about 703,702 emergency department (ED) visits (CDC 2008).

8. UNINTENTIONAL POISONING IN YOUNG CHILDREN • Many children who are unintentionally poisoned have accessed medicines and household chemicals that are not locked up. • Many children who are unintentionally poisoned have ingested prescription medications from someone who was visiting their home such as a grandparent.

9. UNINTENTIONAL POISONING IN MISSOURI • In 2007, 11 Missouri children died of unintentional poisoning; one eight-year old died of toxic doses of over-the-counter medications. The remaining 10 children were teens ages 12-17.

10. In 2007, an eight-year old child overdosed on an over-the-counter pain reliever/fever reducer. He apparently was self-medicating. He was taken to the hospital with high levels of acetaminophen and eventually died of liver damage.

11. A 15-year-old boy died of an overdose of prescription medications. He had a history of abuse of prescription drugs. • A 17-year-old girl died of a cocaine overdose. She had extensive history with police and EMS for prior drug abuse and delinquent behavior.

12. WAYS TO PREVENT UNINTENTIONAL POISONING (Household Chemicals) • The Soap and Detergent Association lists the following guidelines to protect children from household chemicals: • Store cleaning products in a locked closet or cabinet away from food and inaccessible to young children. • Store products in their original containers and never remove product labels.

13. Schedule routine cleaning of surfaces and dishwashing when there is a lull in activities, such as nap time or when children are not in the room. • Put products away immediately after removing • The amount needed for the cleaning job at hand. • Dispose empty cleaning product containers carefully and promptly.

14. Don’t mix cleaning chemicals. This can be dangerous. • Don’t ever mix chlorine bleach or any product containing chlorine bleach (like some tub and tile cleaners, mildew removers, all-purpose cleaners, automatic dishwashing detergents) with ammonia or products which contain ammonia or ammonia-containing compounds (some hand dishwashing detergents and window cleaners).

15. Don’t mix chlorine bleach with acidic products (toilet bowl cleaners, rust removers). • Dangerous gases can be released due to the mixing of any of these products.

16. WHAT TO DO IF A CHILD HAS INGESTED POISON • The Soap and Detergent Association gives the following guidelines adults can follow, if a child has been poisoned by household chemicals: • Quickly try to find out what the child has ingested. Unfortunately it may not be known what has been ingested.

17. If possible, quickly find the product container, check the label for first aid advice and call the Poison Control Center (PCC) immediately (800-222-1222). • If the substance ingested is known, the PCC will need to know information such as the brand name of the product, what time it was ingested, the age and weight of the child and their current condition.

18. The PCC will give instructions as to how to handle the situation. If they think the child should be taken to a hospital, they should be taken immediately along with the product container and any vomit the child has expelled.

19. WAYS TO PREVENT UNINTENTIONAL POISONING (Medications) • Keep all medicine locked and out of the reach of children • Don’t put medicine on a kitchen table or bedside table. • Read labels to find out what can be poisonous. • Never leave medicines or potentially poisonous household products unattended while you are using them. (Safe Kids USA)

20. Buy child-resistant packages when available. Keep products in their original packages to avoid confusion. • When administering medication always read labels, follow directions and give medicines to children based on their weights and ages. Only use the dispensers packaged with children’s medications. 

21. Never leave out loose pills. • Avoid confusion by keeping all medicines and potentially poisonous household products in their original packages. • Don’t take medicine or vitamins in front of kids, and don’t call them “candy.”

22. Don’t involve children as “helpers” with medication. They should not remind adults to take medicine or bring water, for example. • Tell grandparents and friends about avoiding medication poisoning, when their family visits their homes. (Safe Kids USA)

23. KIDS AND PRESCRIPTION DRUGS • Kids as young as 12 are trying or using prescription medications non-medically. These medications are used to get high or for self-medication. Teens are also using over the counter medications such as cough medicines. • According to Parents, The Anti-Drug, teens often take prescription medications from their parent’s medicine cabinet or from other family members.

24. According to Kids Health, the most commonly used prescription drugs fall into three categories: • Opioids such as OxyContin, Vicodin, and Demerol are used for pain, cough, or diarrhea. • Central Nervous System Depressants such as Nembutal, Valium, and Xanax are used to treat anxiety, panic attacks, and sleeplessness.

25. Stimulants such as Ritalin, Adderall and Strattera are used to treat narcolepsy, ADHD, depression, obesity and asthma. • Many kids don’t see the dangers of these medications, because they think if they are prescribed by a doctor, they are safe to use.

26. DANGERS OF PRESCRIPTION DRUGS • Abusing prescription drugs can have serious consequences. According to Kids Health, a single dose of an opioid can lower someone's breathing rate and even kill, when it's taken by the wrong person in the wrong circumstances. The risk is higher when opioids are taken with other substances like alcohol, antihistamines and CNS depressants.

27. According to Kids Health, taking CNS depressants with other medications, such as prescription painkillers, some over-the-counter cold and allergy medications, or alcohol can slow a person's heartbeat and breathing. This can lead to death.

28. EFFECTS OF STIMULANT USE • Kids Health states the following effects of taking stimulants: • Heart failure or seizures. • Development of a dangerously high body temperature or an irregular heartbeat. • Taking several high doses over a short period of time, may make a drug abuser aggressive or paranoid. • May be habit forming.

29. TEENS AND OVER-THE-COUNTER (OTC) MEDICATIONS • Dextromethorphan (DXM) can be found in cough medicines. High doses can cause problems with the senses (especially vision and hearing), and can lead to confusion, stomach pain, numbness and even hallucinations. Teens are using these OTC medications to get high.

30. PREVENTING PRESCRIPTION AND OTC DRUG ABUSE • The Partnership for a Drug Free America lists the following guidelines for parents in preventing teen drug use: • Adults must be educated as to what drugs teens are abusing. Information should be shared with other parents and other adults, such as teachers, coaches, and school administrators.

31. Parents must communicate with their children. They should ask children what they know about prescription and OTC drug abuse. • Parents should set clear expectations by letting their teens know that they should never take any medications without their knowledge.

32. Parents should ask healthcare providers if medications prescribed for their family can lead to abuse. • Parents should know what prescribed and OTC medications exist in their home. They should keep track of the quantities.

33. Parents should keep medications out of reach and out of easily accessible places like the medicine cabinet. • If a child needs medications during school hours, parents should speak with school officials about policies for distributing medications to students. If possible, parents should take the medications to the school nurse and make sure any unused medications are returned to them.

34. CARBON MONOXIDE POISONING • Carbon monoxide is another form of unintentional poisoning. It can not be seen, nor smelled. • It is produced when any fuel such as gas, oil, kerosene, wood or charcoal is burned. • If appliances that burn fuel are not working properly, dangerous levels of carbon monoxide can be emitted.

35. The U.S. Environmental Protection Agency (EPA) points out that people die each year from carbon monoxide produced by idling cars. • The EPA lists fetuses, infants, elderly people and people with anemia, or with a history of heart or respiratory disease, as being especially susceptible.

36. According to the EPA, low levels of carbon monoxide can cause shortness of breath, mild nausea and mild headaches. • Symptoms of exposure to moderate levels of carbon monoxide include severe headaches, dizziness, mental confusion, nausea or fainting.

37. PREVENTING CARBON MONOXIDE POISONING • The EPA suggests the following guidelines in preventing carbon monoxide poisoning: • Choose appliances that vent their fumes to the outside. Whenever possible, have them properly installed and maintain them according to manufacturers’ instructions.

38. Fuel-burning appliances (including oil and gas furnaces, gas water heaters, gas ranges and ovens, gas dryers, gas or kerosene space heaters, fireplaces and wood stoves) should be inspected by a trained professional at the beginning of every heating season. Make certain that flues and chimneys are connected, in good condition, and not blocked.

39. Read and follow all of the instructions that accompany any fuel-burning device. If an un-vented gas or kerosene space heater has to be used, carefully follow the cautions that come with the device. Use the proper fuel and keep doors to the rest of the house open. Crack a window to ensure enough air for ventilation and proper fuel-burning.

40. A car should not be idled in a garage – even if the garage door to the outside is open. Fumes can build up very quickly in the garage and living area of a home. • Don’t use a gas oven to heat your home, even for a short time. • Don’t ever use a charcoal grill indoors – even in a fireplace.

41. Don’t sleep in any room with an un-vented gas or kerosene space heater. • Don’t use any gasoline-powered engines (mowers, weed trimmers, snow blowers, chain saws, small engines or generators) in enclosed spaces. • Don’t ignore symptoms, particularly if more than one person is feeling them.

42. The EPA suggests buying a carbon monoxide detectors as a back-up, but they point out that it is not areplacement for proper use and maintenance of fuel-burning appliances.

43. Additional Resources • Centers for Disease Control, http://www.cdc.gov/ncipc/factsheets/poisoning.htm • Safe Kids USA, http://www.usa.safekids.org/poison/index.html • Environmental Protection Agency, http://www.epa.gov/iaq/pubs/coftsht.html • Poison Prevention.org, http://www.poisonprevention.org/pdf/Safe_Clean9_18_04.pdf

44. Kids Health, http://kidshealth.org/teen/drug_alcohol/drugs/prescription_drug_abuse.html • Parents, The Anti Drug, http://www.theantidrug.com/ • The Partnership for a Drug Free America, http://www.drugfree.org/Parent/Resources/Prescription_Medicine_Misuse

45. Address: PO Box 208Jefferson City, MO 65102-0208 Telephone: (573) 751-5980(800) 487-1626(8 a.m. to 5 p.m. CST, Monday – Friday) Email: dls.stat@dss.mo.gov Missouri Department of Social Services State Technical Assistance Team