Is melatonin poisonous?

A recent study raised alarms about the increasing number of calls to poison centers across the country about children and teens who took too much melatonin, or took melatonin not intended for them. We have been seeing this same trend at the Northern New England Poison Center: we had more than two and a half times as many cases in 2021 as we did in 2012. So just how dangerous is melatonin?

Let’s start by talking about what melatonin is: melatonin is a hormone produced naturally by humans and animals to help regulate sleep. Because of this natural function, melatonin is also chemically manufactured and sold over the counter as a supplement with the intention of aiding sleeping or lessening the effects of jet lag.

Generally speaking, melatonin is very safe for adults and unlikely to cause problems if you use it according to the directions on the label. However, taking too much—relative to your weight—or taking it with medications that cause drowsiness can lead to symptoms like dizziness and confusion. This is especially true for young children who get into melatonin while exploring. Taking what is a small amount for an adult can be a big amount for a little body.

Fortunately, most children who get into melatonin can be managed at home with advice from the poison center—a trip to the emergency department is rarely necessary. Give us a call any time at 1-800-222-1222.

The increase in exposures to melatonin likely suggests that more and more people have it in their homes, especially since the start of the pandemic, which has negatively affected many people’s sleeping habits. It’s a good reminder that we need to keep all medications and supplements up high, out of reach of children and pets. It’s also a good reminder to check with your doctor or other primary care provider before you or your child starts using a new supplement. Your doctor can talk to you about possible interactions, side effects and other considerations.

Don’t hesitate to contact the poison center with questions about melatonin. We’re available 24/7 by calling 1-800-222-1222, chatting online or texting POISON to 85511.

Posted in Medication Safety, National News, Poison Prevention | Comments Off on Is melatonin poisonous?

Poison Center Pointers: Spring Cleaning

Chris and Carolyn from the Poison Help Line sat down during National Poison Prevention Week to discuss some potential hazards from using cleaning products in your home, including ways both children and adults get poisoned from cleaners, along with ways to prevent these types of poisonings.

TRANSCRIPT

Karlee: Poison Center Pointers is brought to you by the Northern New England Poison Center. This podcast is not to replace timely advice or recommendations. If you have an actual poisoning emergency, scenario or question, contact the Northern New England Poison Center by calling 1-800-222-1222, text the word POISON to 85511, or chat online at nnepc.org.

 

Chris: Welcome to Poison Center Pointers, a podcast presented to you by the Northern New England Poison Center.

 

Chris: Hello to all our listeners out there, and welcome back to Poison Center Pointers.  My name’s Chris and I have Carolyn here with me.

 

Carolyn: Hi everybody!

Chris: We don’t have Karlee with us this week, and why is that?

Carolyn: Karlee is on vacation. She’s going to be so sad she missed this podcast, just down in Florida with the warm weather…

Chris: I’m sure she’s just looking at toxic snakes and bugs and all that. I’m sure she’s actually not enjoying the weather. She’s studying up on poisons.

Carolyn laughs

Carolyn: Oh that’s probably true.

Both laugh

Carolyn: We miss you, Karlee! But at least this way any jokes we can make about Karlee instead of me and my age.

Chris laughs

Chris: That’s right! No age jokes…

Carolyn: Just poison information, just the facts.

Chris laughs

Chris: Karlee did choose a good week to take off, it’s a pretty exciting week here.

Carolyn: That’s right, very exciting.

Chris: It’s National Poison Prevention Week!

Carolyn: Wahoo!

Chris: It’s the third week of March every year, from March 20st to 26th this year. It’s a week dedicated to raising awareness about poison centers and the Poison Help hotline. What’s that phone number again?

Carolyn: 1-800-222-1222!

Chris: They want us to plug that.

Both laugh

Chris: So National Poison Prevention Week was started in 1961 by Congress. As I said it’s to raise awareness, reduce unintentional poisonings, and promote poison prevention. We even have a National Poison Prevention Week Council. Each year they hold various virtual events, even an artwork contest. A lot of that is available at AAPCC.org, which stands for American Association of Poison Control Centers.
There is a banner you can click on that will bring up more information. I believe all the virtual events this week are hosted on their Facebook page. Additionally you can find the link from there. 

So it’s National Poison Prevention Week, but it also happens to fall on….

Carolyn: Spring!

Chris: Spring! That’s right! What’s that called again?

Both laugh

Chris: So, it’s a week after daylight saving time…

Carolyn: Above freezing some of the time…

Chris: Yeah some of the time. It got into the 50s last week. It’s after March 21st. What do we like to do this time of year?

Carolyn: Go outside and play!

Chris: Well, yeah…

Carolyn: But inside we do spring cleaning.

Chris: The responsible folk do some spring cleaning.     

Both laugh

Chris: So we figured, to go along with Poison Prevention Week we’ll talk about one of our, um, a topic that we get numerous calls—this is a daily call for us.

Carolyn: Yeah we get calls about cleaners all the time, but we thought you know, it’s spring, spring cleaning, let’s talk some about cleaners in depth.

Chris: Yes, let’s talk about household cleaners and chemicals. I compiled a nice bulleted list…

Carolyn: It’s very nice.

Chris: Yeah it’s very nice.

Both laugh

Chris: …of quite a few different cleaner types categorized by what might use them for. Figured we’d just go through briefly what kind of toxicity we worry about, and go through a few exposure scenarios, how to deal with them, and as always, some helpful prevention tips.

Carolyn: Sounds good!

Chris: Alright. The first cleaner topic…

Carolyn: The first one: oven cleaners and degreasers. Dun dun dun!

Chris laughs

Carolyn: I’m gonna give these a three skull and crossbones on the skull and crossbones scale. That’s a scale I just made up, by the way.

Chris: Sounds scary.

Carolyn: Yeah, it’s top three.

Chris laughs

Carolyn: Oven cleaners and degreasers are corrosive. They can definitely cause burns, so we need to take care of it right away. You definitely want to be careful when using those products.

Chris: Right, so you’ve been using your oven all winter because no one wants to go out and grill, except if you’re a hearty New Englander.

Carolyn: A Mainer!

Both laugh

Chris: New Hampshire and Vermont too, they may still be getting out there. You know you gotta clean out that oven, but those chemicals can be very nasty and corrosive as she said.

Carolyn: What’s the next one, Chris?

Chris: Let’s go with bleach. That’s a heavy hitter. And going along with that I guess we should just say mold and mildew cleaners as well, if you have any buildup from the winter. What are your thoughts?

Carolyn: Well with bleach, it depends on the percentage. And this is probably a good time to say when you do call us make sure make sure you have access, if you can, to the bottle so you can tell us exactly what the product is because all these cleaners, they’re all different. There isn’t just one name brand or one type, even bleach, there’s different percentages. They’re often low, the household cleaners, and those usually can be dealt with at home, but sometimes some cleaners can be more concentrated.

Chris: Right. And that’s what the percentage kind of, indicates. And we worry about the concentrated ones. Concentrated bleach can cause a burn, absolutely, if you get it on your lips, in your mouth…

Carolyn: …eyes…

Chris: Yep, skin, eyes, or you inhale it. It’s going to be very irritating. Generally household bleach is better tolerated.

Carolyn: Thankfully, it tends to do that, because it’s actually a fairly common call, most people have it in their house.

Chris: The chemical in it is called sodium hypochlorite, and you find that in mold and mildew cleaners a lot. So a lot of the same concerns there. Again a lot of variability, but we’re just, kind of going by use, that’s how we’re categorizing them here. But, there is variability in what they contain, but a lot of these contain bleach.

Chris: How about toilet bowl cleaners? Hopefully you don’t just use these during spring and you clean your toilet regularly.

Carolyn: Right!

Both laugh

Chris: They can be a concern right?

Carolyn: They definitely can! And again there’s a really wide range of toilet cleaners. Some of them can be, for example, strong acids, so again can cause burns. So again, knowing the exact name of the product. And, there’s the kind that that you use when use when you do your bathroom spring, well hopefully year round…

Chris laughs

Carolyn: But then there’s also the tablets that you put in the tank or put in the bowl, so there’s a very wide variety of those.

Chris: But again a lot of the sprays contain acids which can cause an immediate burn.

Carolyn: Immediate.

Chris: Some have ingredients that are called alkaline, which means they have a high pH instead of a low pH like an acid. Now it sounds maybe less scary than an acid, but it can cause just as bad if not worse of a burn.

Carolyn: Absolutely.

Chris: Let’s keep rolling with the scary ones: drain openers.

Carolyn: That also gets a three skull and crossbones on my list.

Chris laughs

Carolyn: Again that’s my own list. Drain openers as you can imagine, they’re meant to dissolve hair and dirt or whatever gets thrown down a drain accidentally or on purpose. They are very, they can cause burns very easily and very quickly.

Chris: Again they can be concentrated acids or alkalines.

Carolyn: Yeah, either one, right, and again, either direction can cause burns so be careful with these products.

Chris: How about laundry detergent? And everybody’s favorite, if there’s one thing you might know one the poison center for, it might be the Tide Pod challenge, huh?

Chris laughs

Carolyn: Oh, let’s hope not!

Carolyn: Laundry pods in general are very concentrated. We follow those closely, even for a day or more in some cases to make sure they’re not causing a burn. The pods are more concentrated, we worry about laundry detergent too, but pods are much more concentrated.

Chris: They don’t contain those acids and alkalines that we talked about but they are high concentration detergents, which is a chemical used to clean. It’s just the concentration of it that is so irritating.  

Carolyn: Exactly.

Chris: Laundry detergents can have a little more of a variety.

Carolyn: Yes, huge variety. You’re talking liquid, powder or a combo. There is so much variety.

The dishwasher pods are not the same as the laundry pods. Again, there’s detergents in there and we’re careful with them, and of course they’re at eye level.  But…

Chris: They are not tasty and you don’t want to bite into them.

Carolyn: Laundry pods, I’m telling you, even as an adult I want to play with that thing! They just look so fun and squishy but it very easily can break and get into your eye, and now you’re in trouble.

Chris: Let it be known that we do not recommend that.

Carolyn: No we don`t! And I never have done that.

Chris: That’s an official stance of the Northern New England Poison Center.

Carolyn: Of course, of course.

Chris: I guess we can talk about the more commonly encountered cleaners that are maybe a little bit less of a concern, but in the right circumstance absolutely can be a problem. Ones we get a lot of calls on, what are you thinking?

Carolyn: Dish soap would be the first thing, dish soap and hand soap, you know the pumps, right? Or the squeezy bottles.

Chris: Dawn, Ajax, whatever brand you like.

Carolyn: Yeah, exactly. Yeah those, they will definitely cause vomiting is what they usually do, they irritate the stomach and they make you throw up sometimes. But usually, they don’t do more than that. We generally don’t see burns with those. I mean certainly in the eye, that can be a different scenario but thankfully we tend to… We can handle those pretty quickly and easily when you call us.

Chris: Room sprays, deodorizers, you know, like fragrances generally not as big of a deal. Obviously you don’t want to drink from them.

Carolyn: Unless you spray them right in the face.

Chris: Yeah, they can be a little irritating. Honestly you smell enough of them it’ll give you a headache more than anything.

Carolyn: That’s true. That’s true with a lot of these cleaners actually. Disinfecting wipes are another one, we are using those a lot lately, right? As a whole society, everybody is and you just have to be careful with them. As always, wash your hands after you use them but we generally don’t see a lot of issues with those. We generally don’t have to send to the hospital.

Chris: A couple of atypicals. Atypical cleaners I guess so to speak that tend to be an issue. Wheel cleaner, wheel cleaner contains a chemical, some of them do anyway, contains a chemical called hydrofluoric acid and that’s really bad stuff if you get it on your skin, your hands or anywhere, um, it has the potential to cause some severe toxicity so that is one you want to keep stored away from the children. Keep it in a safe environment, make sure you are following the directions.

Carolyn: We’re talking about wheels of a car. So obviously you wouldn’t as likely have this in the house but you might have it in the garage.

Chris: Another good one to keep stored away: gun cleaners, gun-bluing agents.

Carolyn: Yeah, some of those can be very poisonous.

Chris: Gun-cleaning solutions. And then we kind of mentioned briefly with the percentage or concentration in bleach. I think you might have mentioned the word industrial I’m not sure but, industrial cleaners, right?

Carolyn: Yeah.

Chris: What are we worried about with those?

Carolyn: Well, they are just more concentrated, they have higher concentrations of some of these things that can cause a burn. So, be careful. Typically, typically people don’t have them in their house but maybe they use them at work or they might think to bring a product home because it works so well there, but they’re a different ball game.

Chris: I think that’s a pretty good list of what we’re using inside the house for spring cleaning. Maybe we’ll touch on the outside of the house cleaners and products we might be using once it gets a little warmer.

Carolyn: Another time! Something to look forward to!

Chris: Yeah, the grass is still dead, we’ll wait a second on that.

Carolyn: It is not green yet.

Chris: What are some of our common exposure scenarios that we encounter with children?

Carolyn: Yeah, so most of our—we have calls about adults getting exposed to cleaners, and children. So, first of all, with children, there are things like a lot of—when you put these products at the children’s eye level. For example, in buckets on the floor, a child thinks, oh a bucket full of water, and might want to even taste it or play with it. Same thing with the dish washer pods: dishwasher is open, the child wants to help, and they see that dispenser and they stick their finger in there ’cause they think it’s something to eat. And then with the toilet bowls. You know again, those are at eye level for a child and if they have that pretty blue water, they might actually stick a cup in there or certainly their fingers and taste it. So thinking about what’s at eye level, what they can be exposed to because they’re going to be attracted to that. You know if it looks like something fun.

Chris: Maybe one of the most common calls we get: kids opening up a door, like a pantry door, or storage closet, and just grabbing a bottle off the ground underneath there, right?

Carolyn: Yeah, of course.

Chris: Spraying themselves in the face or the eyes or inside the mouth

Carolyn: They want to help. They see what the parent is doing and they grab the bottle and they just don’t know to turn the sprayer away from their face and they spray it in their face or another child’s face. Definitely can be a problem. You know unfortunately once they’re old enough to really be helpful for cleaning the house, they don’t want to anymore!

Chris: Yeah.

Carolyn: But when they are little they can get into some trouble there and cause some issues.

Chris: How about with the adults? What are some of the more common situations?

Carolyn: The adult situations are more like not using gloves when maybe you need to. Not being in a well ventilated room.

Chris: Mixing cleaners!

Carolyn: Mixing cleaners, that’s probably number one, right? I can’t believe I didn’t say that first.

Chris: When you mix them it makes them stronger – get that grit out.

Carolyn: No! Chris, no! When you mix them it can cause a reaction and it can be more poisonous.

Chris: Right, cleaners we mix because we think it can increase strength, the strength of the product. Or adding a cleaner after you use the drain opener.

Carolyn: Right, yeah, all of those.

Chris: Mixing bleach with an acid or mixing bleach with ammonia can produce toxic fumes that can be a problem.

Carolyn: Or bleach on urine, like animal or a person.

Chris: Like cat urine.

Carolyn: That’s a big one, yeah.

Chris: Again, that’s all kind of dependent on the circumstances, and it can be an issue and is irritating. Don’t mix cleaners!

Carolyn: Yeah—don’t mix them! And you know, when you look online, which a lot of people do, it’s really scary, and as always, of course we want you to call. We can help with those situations.

Chris: We can put it into context.

Carolyn: Exactly. And another thing about kids, sometimes they get into—you put the cleaner away, you dump the bucket, you’re all set and you forget about the rag or the sponge. And you know, especially a little one crawling around, maybe teething, they’ll stick that thing in their mouth.

Chris: And now they get bacteria and cleaner in their mouth.

Carolyn: Yeah, or sometimes the new baby doesn’t smell too good because they have a dirty diaper and they’re spraying deodorizer all around, you know, on the child.

Chris: Well, how would we handle a situation, say the kid grabs a bottle and sprays themselves on their skin or in the eye—what’s the best thing to do?

Carolyn: Well, of course, call us. But first, you want to get it off, right? You want to get it off, so let’s start with eye. If it gets in the eye, no matter what the product is, the most important thing is to get it out of the eye. And we can, we will definitely help you with that when you call. Just to get you started, what we always recommend is using room temperature water, so it’s comfortable for the eye. You want to pour it over the bridge of the nose so it’s flowing through the eye, not being poured directly on the eye. In other words, we don’t want pressure, don’t grab a garden hose or something. You don’t want pressure on the eye. And we want to do that for 15 minutes, sometimes more, depends on the cleaner. And when you call we’ll tell you.

Chris: A lot of times, the flush can be the solution.

Carolyn: Right!

Chris: Other times, if it’s a nasty enough cleaner, it may still require evaluation in a health care facility, but the best first step is almost always a flush. But, if something gets in your eye, give us a ring.

Carolyn: Yeah, we can definitely help with that.

Chris: Same goes for skin, right? Um, and again, it’s all dependent on what kind of cleaner you got here. We talked about oven cleaners and drain openers being super corrosive potentially. Dish soap, not so much. Obviously you’re putting hand soap on your hands it’s probably not going to cause a burn. But there are ones that can cause a nasty burn and you need to wash off the area with warm water.

Carolyn: Right, anything left on the skin, you know you get a little bleach on your pants and you don’t think anything of it, and hours later you realize you end up with a chemical burn, so we have to be careful. Same thing with—and that’s a good thing to note too, if a child gets into it, they probably got it on their clothes. You need to change them and wash them up.

Chris: Right, might be time for a bath. How about an inhalation exposure?  I mean, this can occur with kids and adults. Maybe even more so with adults, we get calls on where they are cleaning in a poorly ventilated room and they inhaled quite a bit, or combined cleaners. Created a fume. What do we do in that circumstance?

Carolyn: Fresh air right? Number one, fresh air.

Chris: Get out of the room.

Carolyn: If you can easily open the window, but don’t stay in the room for any longer than you need to—get some fresh air. Go sit outside. If it’s the middle of winter, which of course we’re talking about spring, just for future reference, you can open a window and sit right there. But you really want to…

Chris: Get some fans going potentially if you want to get a cross breeze.

Carolyn: Exactly.

Chris: It’s all about getting fresh air and if you have like a condition like asthma or COPD and your airways are a bit more reactive we might have to consider things differently so it’s something worth noting, or if you’re having persistent coughing, chest pain, difficulty breathing—anything like that, obviously concerning, and regardless we want you to give us a ring and we can talk about management from there.

Carolyn: Don’t wait until it’s really bothering you.

Chris: Last big piece is probably ingestion or swallowing some of these chemicals, right?

Carolyn: Yeah, that’s probably our most common one I would say for cleaners. And, you know, you can always rinse out the mouth, but you don’t always push fluids, and that’s something that people don’t—that happens sometimes, but we don’t want necessarily to give a ton of fluids, it really depends on the cleaner.

Chris: Don’t make yourself vomit either!

Carolyn: And definitely don’t do that—yes, right—thanks, Chris. Because if it burns going down, it’s gonna burn coming back up. So, be really careful. Rinse mouth, give us a call.

Chris: Another one, there’s a great range of what’s in these types of cleaners. Some of them, if you swallow a little bit, it’s not a problem at all.  Some of it’s a big deal. So, it’s another area where we can provide context. How about prevention tips? It is National Poison Prevention Week, as I mentioned!

Carolyn: Oh, that’s true! We shouldn’t leave that out, right?

Chris: That’s our big piece here, that’s what we’re doing this week!

Carolyn: That’s true.

Chris: So, I think we probably touched on a couple of the big ones but do we have any helpful hints right now?

Carolyn: I think, you know, one simple one obviously we can all do is reading the label. I know that sounds silly, but you know sometimes we forget to read the label. Should we be wearing gloves? Should we, does it say right there open the windows because this has strong fumes, right?

Chris: Do you need a mask?

Carolyn: Do you need a mask, right? Just making sure what, what you need to do. Is it supposed to be diluted—you know—were you supposed to use this with water instead of straight?

Chris: That’s a great one.

Carolyn: You know, sometimes you don’t know until you take a look at the label.

Chris: Um, something we’ve mentioned on previous podcasts, I think we talked about antifreeze in this sort of context—store products in their original containers, right? Don’t put them in a milk jug, don’t put them in a soda bottle, a glass. How many times have we had people drink cleaner that they thought was a cup of water?

Carolyn: So often, so often, yeah.

Chris: And that can be a problem.

Carolyn: And it’s not just kids, it’s kids and adults. You see a glass full of something, it’s by the sink, you just assume it’s water.

Chris: That’s right. I think we hit enough on do not mix cleaners, they get the message.

Carolyn: Yeah, I think so.

Chris: Don’t mix them!

Carolyn: Yes, don’t, just don’t!

Chris: As you’ve said, we just mentioned storing products in the original containers. We definitely get calls where, cap was left off, kid just happens to grab it, put it down in a matter of seconds.

Carolyn: Yeah, I mean kids are fast.

Chris: Keep those products high and out of the reach of children and pets.

Carolyn: Yup, or a locked cabinet if you have one.

Chris: Make sure you’ve got safe conditions for cleaning. Mask, gloves, good ventilation!

Carolyn: Right—there you go!

Chris: We got anything else on the list?

Carolyn: I think that sums it up. I think that’s pretty good. We just need a little bit warmer weather so we all open our windows and start doing this.

Chris: Another couple weeks. We’re getting another cold snap and some snow, let’s be real. In April, it’s going to happen once.

Carolyn: It did snow last night.

Chris: After that it will be all right.

Carolyn: OK.

Chris: We should plug that the NNEPC does have a blog on this exact topic. If you go on NNEPC.org and search: Stay safe while spring cleaning.

Carolyn: Nice.

Chris: You’ll find a nice blog post we have on some of what we covered. Hopefully we gave you a little more insight. Again, can’t encourage you enough to go on aapcc.org and check out some of the links they have on National Poison Prevention Week. Again there are virtual events available on Facebook. We want to thank you all again for listening to this episode of Poison Center Pointers. You can like, share and subscribe to us on Facebook, Twitter, and visit our website at nnepc.org. If you have an actual poisoning emergency, scenario or even just a question, contact the NNEPC by calling—what was the number again?

Carolyn: 1-800-222-1222.

Chris: Text the word POISON to 85511 and chat online at nnepc.org. Best of luck cleaning everyone!

Carolyn: Yup—happy spring!

Chris: Happy spring!

Carolyn: And happy Poison Prevention Week!

Chris: It’s going to be in the 70s next time we have something hopefully.

Carolyn: That would be awesome. Bye, everybody!

End music

Posted in Poison Center Pointers Podcast, Poison Prevention | Comments Off on Poison Center Pointers: Spring Cleaning

Medication errors up during pandemic

Over the course of the COVID-19 pandemic, the NNEPC has seen a significant increase in medication errors among adults. These potential poisonings are occurring in every age group, from young adults in their 20s all the way to older adults in their 90s. In addition, medication errors were up among children and teens in 2021 after falling for the previous several years.

There are many types of medication errors. Accidentally taking a dose twice is the most common type we receive calls about. Calls about other types of dosing errors, such as measuring out the wrong amount, are also fairly common, along with calls about taking the wrong medication, such as taking a spouse’s, sibling’s or pet’s medication by mistake.

Heart medications and antidepressants were the drug categories most often involved in medication errors we helped manage in 2021, and these were also the categories with the biggest increases over the past two years.

Errors involving hormone-related medications (such as for diabetes or thyroid issues), antihistamines, and anticonvulsants or mood stabilizers (such as lamotrigine or gabapentin) are also up significantly. There has been an increase in errors involving acetaminophen, and pain medications as a group (both prescription and over-the-counter) are the third most common type of drug involved in medication mistakes.

Graph showing the rise in medication errors involving common drug categories from 2016-2021.There are many possible reasons for these increases. The pandemic has brought on many new stresses and distractions, which can make errors more likely. In the case of antidepressants and other mental health medications, CDC survey data suggest there has been a notable increase in the number of prescriptions over the past year and a half or so, and with any substance, wider availability means more opportunity for poisonings.

Tools for preventing medication mishaps

Fortunately, there are many tools available to help you and your family manage your medications, including a number available on our website.

  • Our 2012 booklet Medication: What You Need to Know covers the basics of medication in an easy-to-read format. The booklet is available as a PDF download, or you can request a hard copy. While the booklet is specifically aimed at adults 60 and older, the information can be of use to people of all ages.
  • Along with the booklet, we have a ready-made medication calendar to help you keep track of your medications and when you’ve taken them. Even if you don’t use our calendar, consider using it as a template to create your own. A calendar can help ensure you don’t miss a dose or take one twice.
  • Keeping a list of your medications is important for you and your health care providers to prevent interactions. Consider downloading our medication chart, medication wallet card, or both to keep track of the medications, vitamins and supplements you take.
  • Keeping your medications in their original container is the ideal storage method. However, we know that doesn’t work for everyone. A child-resistant pill box is the second best way to store and track your medications. Make sure any pill box you choose is labelled as child-resistant, and keep in mind that it is only resistant–nothing is truly child-proof. Given more than a few minutes, some children can get into anything! We have some child-resistant pill boxes available to order for free from our website.

Safely using, storing and disposing of your medications also helps prevent poisonings of children and pets. Learn more about safe disposal on our Medication Disposal page.

Remember, we are here to provide fast help 24/7 regarding any kind of medication error, whether you gave your child a double dose, you took the dog’s medication, or anything in between. Call us at 1-800-222-1222, chat online or text the word POISON to 85511.

Posted in Data, Medication Safety, Poison Prevention, Regional News | Comments Off on Medication errors up during pandemic

Poison Center Pointers: Carbon monoxide ft. Dr. Mark Neavyn

NNEPC Medical Director Dr. Mark Neavyn joins our host, Chris, for a discussion of carbon monoxide. What makes this poisonous gas so dangerous? Where does carbon monoxide come from and why are CO poisonings more prevalent in winter? What should I do if my carbon monoxide alarm is going off? Dr. Neavyn addresses these questions and more in our February episode.

TRANSCRIPT

Karlee: Poison Center Pointers is brought to you by the Northern New England Poison Center. This podcast is not to replace timely advice or recommendations. If you have an actual poisoning emergency, scenario, or question, contact the Northern New England Poison Center by calling 1-800-222-1222, text the word POISON to 85511, or chat online at nnepc.org.

Chris: Welcome to Poison Center Pointers, a podcast presented to you by the Northern New England Poison Center.

Chris: Hello and welcome back to Poison Center Pointers. My name is Chris. Today, I am not joined by Karlee and Carolyn, but instead we have a special guest for you today. I’m joined by Dr. Mark J. Neavyn. Mark, thanks for being here.

Dr. Neavyn: Thanks for having me, Chris!

Chris: So, Mark is the medical director here at the Northern New England Poison Center. He is also an emergency physician, and we are very thankful and honored to have his time. We figured since we have his time, we would talk about one of the more important topics we encounter this time of year: carbon monoxide. Mark, do you have a lot of experience with carbon monoxide?

Dr. Neavyn: Uh, I do and I hate it so, so, so much. You have no idea. Carbon monoxide is the worst. It really is.

Chris: The worst. What’s your justification for that?

Dr. Neavyn: Well, you know it’s this thing that forms for who knows why? It’s something about combustion and, you know, it’s invisible. You can’t smell it. It’s not like gas from your stove where you smell something. You can’t smell it at all. You don’t know it’s there unless you have a working carbon monoxide detector and—

Chris: Oh, we’re going to hit on that pretty heavily today.

Dr. Neavyn: —I don’t know about you, but I’m paranoid about smoke detectors and carbon monoxide detectors and… I don’t know. Are they working? Are they not working? I feel like I have to constantly remind myself to change the batteries.

Chris: I am certain mine are working because I’ve changed every battery in every carbon monoxide detector in my house over the last year, and they always seem to go off at three in the morning. I don’t know if that happens to you, too? It turns into a nightmare.

Dr. Neavyn: Yep. Yeah that little reminder beep that happens every 6 1/2 minutes.

Chris: You have to convince yourself you didn’t actually hear it the first couple times?

Dr. Neavyn: Right. Yeah, oh, that must have been the house down the street. That couldn’t be our house.

Chris: Well, so, as Mark hinted at, what exactly is carbon monoxide? It is an odorless, colorless gas that is produced through combustion or burning things that contain carbon. What do we commonly encounter that contains carbon that we would be burning? Fuels.

Dr. Neavyn: Charcoal.

Chris: Natural gas. A lot of our heating systems, right? And carbon monoxide is produced when it’s in this sort of system, some sort of engine where active combustion is occurring, but it doesn’t have enough oxygen in it to create CO2 as a byproduct, otherwise known as carbon dioxide; instead we end up with carbon monoxide. And just a little brief overview as to what exactly it is, but why are we talking about it today?

Dr. Neavyn: Well, I mean, typically, Chris, winter time is the time for carbon monoxide cases to come to my attention. In particular, not only through working with the poison center, but also in my own clinical practice as an emergency physician. And some of the most tragic cases that I have involve carbon monoxide. Mostly because nobody means for that to happen. Nobody means to be sleeping and not realize that there’s carbon monoxide leaking from your generator or your furnace. And so it can be really tragic, and it can be really life threatening.

Chris: Yes, and as you’re kind of alluding to, it is kind of a common poisoning and a leading cause of toxicological death. I found some data that’s a little bit older, about a decade old, that suggested that CO exposure results in nearly 400 or so deaths yearly in the United States, up to 2,000 hospitalizations, and more than 20,000 emergency department visits. Now, some newer data from the CDC suggests that could be more like 40-50,000. You did kind of hint at some sources of exposure, and a lot of them are residential. Are there any kind of common sources of exposure that you’ve encountered so far in your practice?

Dr. Neavyn: I think the most common cases for me have either involved a furnace, a charcoal grill, a generator, or a blockage of an automobile exhaust. So, I can think of pretty tragic cases in all those scenarios, and often times it has to do with poor ventilation. In particular, in the winter months, what I really worry about is one, electricity going out and people using generators that are poorly ventilated, particularly if you’re putting the generator in your basement or in your garage and allowing that exhaust to seep into your home. The other situation that is particularly tragic is when somebody is trying to shovel out their car in these New England winters, and the snow bank has kind of blocked off their muffler. When that happens, the typical catalytic converter that all these cars have can’t kind of wash out your carbon monoxide, and so the carbon monoxide will back up into the cabin of the car and lead to really high levels of carbon monoxide for whoever might be waiting inside the car while the car warms up.

Chris: Some excellent points. Just to kind of list off a couple more common calls that we do receive here in poison center as to a potential source of exposure—and those are the major ones—again, he hit on heating systems, so whether it’s your home furnace, water boiler, as he said generator. Even fuel-powered space heaters can be a problem, as well. So, kerosene space heaters are a common one. House fires can be a source. It’s not really something that we’re going to touch on much today. Again, he brought up grills, even gas powered appliances, wood stoves, so even cooking appliances to some degree. Again, automobiles. And there are other odd exposures that are a little less common; those are the big heavy hitters.

Dr. Neavyn: And it’s not to say that winter is the only time you can get carbon monoxide poisoning. I’ve definitely seen it in the summer time, too. Either, like, you get a rainy day and you bring your charcoal grill into your garage so you can continue that grill-out, or one of the other common things with us being in lake country around here is boating. Boat, the motor boats can also off-gas carbon monoxide. So we have had some pretty bad cases in the news over the past couple of years of small children who are water skiing who are exposed to large amounts of carbon monoxide while they’re water skiing, which is not something that people would anticipate.

Chris: One of the things I love since having you come on as our medical director here is your ability to teach complex topics and simplify them in ways that I can understand them. And I thought it’d be great to kind of hear your thoughts on what exactly it is that carbon monoxide does inside the body. Why is it a concern? Why is it toxic?

Dr. Neavyn: Yeah. Well, thank you. I guess the reason why I like to simplify things is ’cause I’m a pretty simple person myself. *laughter* I don’t really like to clutter my brain with too much complicated information. But there is a lot of research on carbon monoxide, in particular in the way it poisons the brain and poisons the heart. But, basically, the way I think about carbon monoxide is it is taking up a space on your oxygen transportation. So, it prevents oxygen from getting transported to vital tissues. So, for example, somebody exposed to carbon monoxide may develop a heart attack, or they may develop stroke like symptoms. Those are in severe cases. The more difficult cases that I find are cases with lower level exposures over a long period of time who are developing these more vague symptoms like headache, nausea, vomiting. All of these things that really, if they didn’t know they were exposed to carbon monoxide, it would be hard for even an experienced ER doc to recognize those symptoms as being carbon monoxide poisoning.

Chris: I think you used the term “vagary” when you described it? I like that.

Dr. Neavyn: Yes, yes. The long list of vagary that happens with carbon monoxide, especially when kids are sleeping in the home—the carbon monoxide detectors have run out of juice and the child wakes up with a headache or wakes up with nausea. Your first instinct is to think, oh, that’s just a viral bug or something. It’s not really on our kind of—it’s not really at the top of our differential, so to speak, for what could be causing those symptoms. So around this time of year is when I start really reminding my trainees and emergency departments and in the poison center that, you know, if somebody is complaining of headache or nausea or some of these vague symptoms, it’s a good idea to just ask about whether they have carbon monoxide detectors and whether they have any risks.

Chris: So I polled some colleagues in the poison center as to what are commonly encountered calls that we get, and I came up with a couple scenarios here. Figured we could kind of just run through them and think about what the next best steps are—what exactly is the concern here? How should we address it? ‘Cause I think these are questions that some people who are listening at home might have if they were ever to run into a situation like this, and obviously the most common one—my detector, my carbon monoxide detector, is going off in my house and I don’t know why. What should I do?

Dr. Neavyn: Yeah, I mean if a detector is going off in your house, you want to get out of the house. You don’t want to continue to be exposed to carbon monoxide if it’s in the house and these carbon monoxide detectors—I think we’ll get into it a little bit later, but they do have cutoffs of when they start to alert you to carbon monoxide, and if it’s going off, it means there could be an exposure and you want to stop that exposure as soon as possible.

Chris: Can’t ever assume that it’s not functioning, and we never want people to ignore a carbon monoxide alarm, so get the family together, children, pets. Leave the house and alert emergency services, right? The fire department has equipment exactly for this sort of scenario where they can ensure that the house is safe. They can determine what level of carbon monoxide is present in the house. So really, the best thing to do is to get out of the source of exposure.

Dr. Neavyn: Exactly, exactly.

Chris: This is one that sounds like you’ve probably encountered in the emergency department, as well, but we’ve had a variation of similar calls where the caller is concerned because their car or even their tractor, or they had what would normally be an outside grill running inside the garage. The garage is connected to the house and the caller is concerned because family is reporting that they feel a little bit lightheaded, maybe a little bit nauseous. Could carbon monoxide make its way into the house?

Dr. Neavyn: Absolutely. Oh. this is a classic one, especially with, like I said before, charcoal grills or generators running on fuel for this to happen, and people might not recognize that that’s an issue because they’re not going to, again, they’re not going to smell the carbon monoxide. They’re not going to see it, it’s not smoke. It’s not like you can see smoke coming into your house, right? It’s a gas, so it’s invisible. And it’s lighter than air actually, so it will dissipate through the house pretty easily. It’s not one of these other types of gases that is heavy and goes to the lowest ground point. This is lighter than air. Colorless, odorless, invisible to the eye and if people start developing symptoms, particularly, I would say if a group of people all have similar symptoms, that’s a concern to me that there’s multiple people getting exposed at the same time.

Chris: And I like to bring it up. Regrettably, I recently traded in cars and I no longer have a remote start on my car and when it’s, you know, negative 2 degrees in the morning before trying to get into work early. I know a lot of people like to start up their car, warm it up, right? I found a study that was done through Iowa State that found just warming up your vehicle for only two minutes with, you know, an overhead garage door open raised CO concentrations in the garage up to 500 parts per million. And what does that number mean? It’s enough that if you’re exposed to it, it’s going to produce symptoms and potential toxicity with prolonged exposure, so even just having the garage door open is not enough. We don’t want it in any sort of partially enclosed area. Another one I know I’ve got, another scenario I know I’ve got quite a few calls on—someone reporting that for the last couple weeks is every time they get in their car to drive to work or, you know, they have errands to run and they’re in the car for more than a couple of minutes, they start feeling dizzy and lightheaded. Do you have any thoughts on that? Is there ever really a potential for CO exposure in the car if it’s not a situation where, as you mentioned, the snow embankment clogs up the ventilation for the exhaust?

Dr. Neavyn: Typically, automobiles nowadays have really efficient catalytic converters that can kind of wash away your carbon monoxide that’s getting formed by your combustion engine. You know, it’s always possible that that system where air is flowing through can get blocked in some way, so if you’re starting to notice those types of symptoms while your car is running, it might be a good idea to get your car checked out to make sure that everything is functioning appropriately.

Chris: Another scenario I personally have had quite a few calls—someone calling after reporting that they’re running their space heater inside of the house. They’ll call and they’ll complain that they’re starting to feel weird—they have a headache, they’ve been nauseous, they actually vomited. Have you ever encountered any scenarios like that in the emergency department?

Dr. Neavyn: Yeah, yes, a lot of these space heaters run on kerosene and if there’s not adequate ventilation, you will get carbon monoxide building up, and I think the population at risk that I’ve seen tends to be construction workers where they potentially are working in a home that maybe has no electricity to it yet, or doesn’t have heating running quite yet, so they use these kerosene heaters to warm the home while they’re constructing it, and I’ve seen that a few times actually, so, that’s something to keep in mind that those kerosene heaters can really cause problems if you don’t have adequate ventilation.

Chris: Right. And even just keeping a couple windows and doors open might not be enough, as we had said, with keeping cars or tractors or grills in the garage. Last scenario I have here—we’ll just go with the classic. It’s something we’ve already mentioned a couple times here. I am working on having a generator installed and want to make sure we are safe from the exhaust that comes with the generator. How exactly do we go about this? I found online that, through some research, that the rule of thumb is to keep your generator 20 feet away from the house?

Dr. Neavyn: Yeah, I would definitely err on the side of caution with these things, and also, sounds obvious in retrospect, but close your windows. Oftentimes people will have a window open in one room when it’s getting warm in that particular room and they don’t realize that the fumes from whatever it is that’s causing the carbon monoxide is just kind of drifting right into that window.

Chris: Similar to having exhaust from your car blocked up—say it gets a little snowy, a little bit icy—we can have that issue with ventilation for generators, too, as well. So, the best way to go from here, considering that we have an emergency physician on the podcast, can you walk us through what management might be like in a situation where a patient has to come in to the hospital for evaluation?

Dr. Neavyn: Well, I think, first and foremost—so carbon monoxide poisoning is really a spectrum. So you can have mild symptoms, but you can also have pretty major symptoms—like symptoms of a heart attack, so you can develop chest pain, you can faint—if you have any of those serious symptoms you need to call 911 immediately because we do not want to delay getting you the care that you need. If you have mild symptoms and drive yourself in, I guess that’s appropriate in some cases, but if there’s any question of the symptoms being more severe, I would always say err on the side of calling 911 and getting to the emergency department as fast as possible. And actually, you know, the primary treatment for carbon monoxide is oxygen therapy, and so calling 911 gets you connected to oxygen as soon as that ambulance arrives at your home, which is super important.

Chris: And just to throw it in there, we’re always available as a resource. If you’re questioning whether or not you do require evaluation in the hospital, obviously emergency services is there, but so is the poison center—we’re all trained for this certain topic. So if there’s ever any sort of shadow of a doubt you can always give us a ring. I think probably the most important thing we can talk about today, much like a lot of the other podcasts here: helpful prevention tips. What can you do to make sure your family, your loved ones, even just yourself, that you’re healthy and you’re not exposed to CO?

Dr. Neavyn: Yeah, we’ve talked about it before, but carbon monoxide detectors are the single most important way to prevent carbon monoxide poisoning. ‘Cause there’s so many different ways carbon monoxide can build up in a home, and we will not know it unless we have a detector.

Chris: A couple helpful hints on maintenance and management of carbon monoxide detectors: generally recommended to check or replace batteries one to two times yearly—not always a good idea to wait till that annoying beep wakes you up at 3:00 in the morning, right? They say to replace the unit generally every five years or so. A couple key points I wanted to get into is placement of the car monoxide detector. As Mark previously pointed out, it’s lighter than air. It can diffuse throughout the house with ease, and it’s not going to stay down at ground level since it’s lighter than air. So generally we recommend having carbon monoxide detectors high on the wall. We want them on all levels of the home. Best not to put it next to any heating vents or have it covered by furniture or drapes. And we want it in all hallways where there’s people that are sleeping. Another key piece is making sure that you have a quality product. Generally they’ll run you somewhere in the 30 to 50 dollar range. We like to recommend products that have a UL mark on the back—that stands for Underwriters Laboratories. And that just means it was third-party tested to show that it meets the standards of what is recommended for the reliability of these products. For home use, look for a statement that says single station carbon monoxide alarm and make sure it’s battery powered, or if it’s electric, it has a battery backup in case of loss of power. Any other helpful hints that you have stored away for us there that we haven’t already mentioned?

Dr. Neavyn: Yeah, I think the big one is not ignoring that alarm and not assuming that if you open the windows, everything is going to be fine because that carbon monoxide detector is just detecting the carbon monoxide in its little area and you don’t know if the carbon monoxide levels where you’re sleeping might be higher and not only that, like you don’t know, if there’s children in the home, how much carbon monoxide exposure they’ve had. And I really worry about children because you know they’re still developing. Their brains are growing like crazy, and anything that might affect that brain development really needs to be treated appropriately. So I would say don’t blow off an alarm—if the alarm is going off, get your kids out of the house, get the family and dogs out of the house, and you know, make sure the fire department comes to your house and determines the carbon monoxide levels in your home and make sure that it’s safe to return. The other thing is, you know, if you have one of these mixed use detectors that detect smoke and carbon monoxide at the same time—I know my smoke detectors go off all the time because of my terrible cooking.

Chris: Yes.

Dr. Neavyn: And so, like, don’t be tempted, just don’t be tempted to take the battery out. You need to have that functioning carbon monoxide detector, even if occasionally you’re burning stuff on the stove.

Chris: That’s right. Couple other prevention tips: having your heating system and water heater serviced yearly; if you have a chimney, making sure that you have it cleaned and serviced every year ’cause that flue can get all gunked up, or the ventilation can have issues; as I previously mentioned, having a mechanic check the exhaust system in your car and truck yearly; big one is not to use your oven appliances as a heating source. Again, all the other recommendations we previously made: not bringing your generator inside, your space heater, grill—those are the heavy hitters that we can think of from calls that we receive here. I don’t know if you had any last pointers or important information you wanted to get across to our listeners regarding carbon monoxide?

Dr. Neavyn: Yeah, I think for me the key points that I want everybody to really recognize is that carbon monoxide is the silent killer, in the winter months particularly, but all year round. We don’t know it’s there unless you have a detector. And if you have symptoms like headache, dizziness, lightheadedness, nausea, vomiting—more significantly, if the rest of your family is having the same symptoms at the same time—that could be a sign that you’re having carbon monoxide issues. So if in doubt, call your local fire department to have your home assessed for carbon monoxide levels if you’re not sure if your carbon monoxide detector is working.

Chris: Definitely want to say thank you again for taking the time to chat with us. We appreciate you being here with us, Mark.

Dr. Neavyn: Yeah, thanks for having me, Chris. This was fun.

Chris: Hope to have you again soon. Maybe we’ll have a less scary topic next time because Mark is full of all sorts incredible factoids and stuff you would never know otherwise, so.

Dr. Neavyn: Well, poisonings are always scary, but, uh, hopefully I can help kind of explain stuff in in a less scary way next time.

Chris: Absolutely. Well, we want to say thanks again for all our listeners out there for checking in to this episode of Poison Center Pointers. You can like, share, and subscribe to us on Facebook and Twitter, and visit our website at nnepc.org. Remember, if you have an actual poisoning emergency, scenario, or even just a question, contact the Northern New England Poison Center by calling 1-800-222-1222; text the word POISON to 85511; or chat online at nnepc.org. Thanks again for listening.

Dr. Neavyn: Thanks, everybody!

Posted in Poison Center Pointers Podcast, Poison Prevention, Regional News | Comments Off on Poison Center Pointers: Carbon monoxide ft. Dr. Mark Neavyn

Poison Center Pointers: Preparing for Winter

Our panel of poison experts takes a look in the garage (and beyond) to uncover common winter poisons, such as antifreeze, ice melt and carbon monoxide.


TRANSCRIPT

Disclaimer: Poison Center Pointers is brought to you by the Northern New England Poison Center. This podcast is not to replace timely advice or recommendations. If you have an actual poisoning emergency, scenario, or question, contact the Northern New England Poison Center by calling 1-800-222-1222, text the word poison to 85511, or chat online at nnepc.org.

Welcome to Poison Center Pointers: a podcast presented to you by the Northern New England Poison Center.

Chris: No improvising, you’re saying? 

Karlee: No, do.

Chris: Okay, well what if I mentioned the fact that I walked outside of my house this morning to find that I could see my breath? I got to my car and it took roughly 10 minutes to defrost my windshield before I could get here. 

Karlee: You don’t just take your ice scraper and do a tiny hole so you can see?

Carolyn: Right. That’s what I see people on the road doing.

Chris: I haven’t felt my fingertips in about three weeks now.

Carolyn: Chris is from a warmer climate.

Chris: If you consider Philadelphia warm? Sure. 

Carolyn: Compared to Maine? Yes, yes I do. 

Chris: Hi guys. Welcome back to Poison Center Pointers. My name’s Chris. I’m here with Carolyn and Karlee. We just alluded to what we want to talk about today: preparing for winter. It’s getting frigid out there.

So just a quick reminder of what we like to do here at Poison Center Pointers—we’re here to share knowledge and experience dealing with everyday situations we help manage at the poison center. Our goal is to keep our community safe by preventing poisoning and make sure you know what to do if one occurs.

So, it’s getting cold out. We gotta set up shop so that we’re ready for four to five to seven months of cold here. 

Carolyn: At least.

Chris: We find ourselves in the garage. What commonly encountered and super toxic chemical could there be in the garage?

Carolyn: Well, number one on the list is probably antifreeze, and it’s certainly one we get a lot of calls on, actually year round, but particularly right now. Could be because people are getting their cars ready for the winter.

Chris: What particular types of antifreeze do we worry about?

Carolyn: Well, the two most poisonous ones would be windshield washer fluid, which contains methanol and radiator antifreeze, which contains ethylene glycol. Both of these are very poisonous and if any amount is ingested, you need to call. And a lot of things we talk about here at the poison center, we were talking about sort of children getting into them; this one is one we see adults getting into as well, and—even though it’s accidental. For example, you’re working on a car and the radiator antifreeze or the windshield washer goes—sprays into your mouth. And that’s worth a call here, actually. 

Karlee: More common than you think. I’ve gotten that call many times.

Carolyn: Right, right. 

Chris: Something else about these chemicals: the way they taste.

Karlee: Very sweet. 

Chris: Yeah, yeah. 

Karlee: Believe it or not—don’t taste it though.

Chris: So what else could we worry about then? 

Karlee: Pets. So especially, you know, kids and pets, certainly if something’s sweet they’ll continue to drink it if they have access to it.

Carolyn: Right.

Karlee: But even as Carolyn was saying, a very small amount can be toxic in the antifreezes that contained the toxic chemicals. It can even cause blindness or kidney injury so we really do worry about any exposures.

Carolyn: Right. And even if it’s some just spilled on the ground on the floor of your garage or on the driveway. As Karlee was just mentioning, pets especially. They’ll lick it up because it does taste good, and so it’s actually quite poisonous and we’re very careful with it.

Chris: Yeah, so our threshold is low. If you think it’s an exposure to something like that please don’t hesitate to reach out to us.

Something a little bit more festive, especially this time of year, surprisingly could contain similar chemicals: snow globes. 

Karlee: Uh huh, fun fact, yeah.

Chris: Yeah, yeah, we did a little bit of reading—research here. There was a study done by the Florida Poison Information Center where they called around to manufacturers of snow globes, and four out of 11—this is back in 2007—reported that they use lower concentrations of ethylene glycol, which is what we find in radiator cooler.

Carolyn: Radiator, right.

Karlee: Good to note. The way, though, that we’re exposed to snow gloves, if you think about it, it will break open on the floor, so limiting the exposure. But just think about pets who might lap up spills.

Carolyn: Right, yeah, and you know it’s just interesting because it’s a type of product you wouldn’t expect to have something poisonous in it, but sometimes that is the case. And just to go back around to antifreeze or the radiator and windshield washer fluid for just a second…

Karlee: We got stuck on snow globes.

Carolyn: Snow globes, yeah we were a little stuck in there for a bit. Everyone was gazing into the snow globe… But with the antifreeze that is poisonous, there are different percentages in different products, so it is helpful when you do call if you have the actual container—you can let us know what it is and we can see what percentage of antifreeze is in there.

Chris: Sure. Something else we might find in the garage, or if you find yourself tinkering with some of your smaller engine products: siphoning this time of year. Why do we run into a lot of calls with siphoning?

Karlee: Yeah, very common right now, especially when people are putting away the lawn mower, getting out the snow blower, getting out the snow sled, and if you…

Carolyn: Snow sled? Wait. Sleds don’t have engines.

Karlee: What?

Chris: Snowmobiles. It’s a snowmobile.

Carolyn: Oh! Yeah, snowmobile.

Karlee: Well, snow sled.

Chris: Continue.

Carolyn: All right, you’re from Maine. We’ll let you go ahead.

Karlee: Anywho, so siphoning—if you don’t know what it is, good, because we don’t recommend it, but it’s essentially when you’re trying to move gas from one machine to the other and you’re using your mouth as reverse suction, so as you can probably imagine, that’s where you get an exposure, is the gas can go in your mouth.

Carolyn: Right, and it’s, you know, you can swallow some, but you can also choke on it. And if it gets into your lungs, that’s actually quite poisonous. Even a very small amount can cause, basically it’s a chemical pneumonia—we call it aspiration pneumonitis—and that actually requires treatment, so any amount even, like I said, even if it’s really small, we’re very careful with it.

Chris: Say you’re out there siphoning, or a family member is siphoning, and they immediately, you hear him start coughing up, anything like that. They think it might have gone down the wrong pipe. That’s really where we start to worry, so please don’t hesitate to give us a ring in that scenario.

Carolyn: And sometimes the effects are delayed, so that’s why if you talk to us, we can let you know exactly what to look for.

Chris: Maybe moving a little bit outside of the garage.

Carolyn: Sure, let’s go out of the garage.

Chris: Still something we all need this time of year…

Karlee: Take a stroll on the slippery ice.

Chris: That’s right… rock salt or ice melts, quite a few different names for it. Get a lot of calls this time of year, huh? 

Carolyn: Right, yeah, absolutely, it should be starting soon. I feel like we haven’t had a lot yet, but we will. 

Chris: I had one three days ago.

Carolyn: You did?! Oh my gosh.

Chris: It feels like winter.

Carolyn: Wow.

Karlee: First one of the season!

Chris: Yup, first one of the season.

Carolyn: I have seen ice, but not covering the steps, but, we do have to be careful with it. It does contain—actually several different types of formulations. Most of them are a type of salt, which people think, “Oh, it’s just salt,” but actually salt—several different types of salts can be a problem, depending on the amount. Like we always say, dose makes the poison, right? But so we have to be very careful with it, and kids get into it. Not usually because they’re grabbing the container. It’s actually often more accidental. For example, a child puts their mittens along the railing or along the steps to touch the snow, and now they have a piece of it on their mitten, and now they suck on it ’cause that’s what kids do sometimes, and it tastes kind of good.

Karlee: Yeah, certainly. And people could track it in on their shoes or boots or what have you inside. And then kiddos who are crawling/walking around can pick it up and put it in their mouth.

Carolyn: Right, and pets, too, get into it. So yeah.

Chris: Absolutely. Generally, a taste ingestion isn’t going to be too much of a problem, more than happy to talk about that, but larger amounts, we can run into some issues.

Carolyn: So just be careful.

Chris: Staying outside—so you get that big first storm and you’re getting, you know, it’s that first nor’easter and you’re going to get 12 to 18 inches of snow and you want to go play outside with family or kids. 

Carolyn: Woohoo! Yes, I do!

Chris: Yes. Snowball fight. What’s something we commonly encounter that people use to stay warm in that sort of scenario?

Karlee: Yeah, hand warmers!

Carolyn: That’s what I think he’s talking about, Karlee.

Karlee: Yeah, I think so too. Or you know if you want to go to a Patriots game in December or January—put them in your boots.

Carolyn: Yeah, absolutely. Toe warmers.

Karlee: You won’t be disappointed.

Chris: I can’t escape the Patriots.

Carolyn: Excuse me? Is there a problem here, Chris?

Chris: Super Bowl, I believe it was LII, the final score was 38-33.

Karlee: You’re fired.

Carolyn: I don’t know what you’re talking about.

Chris: Philadelphia Eagles.

Karlee: Get outta here!

Carolyn: Don’t worry folks, Chris will not be joining us after today’s episode.

Chris: We don’t have enough time to discuss that, but with hand warmers in particular, there is kind of an interesting chemical inside it that we worry about. What’s that?

Karlee: Iron. Yeah, it’s interesting. So the way that hand warmers work is there is iron in there, which when exposed to oxygen forms essentially a reaction that will form heat as a byproduct and that’s why it gets warm, but it will also produce rust. And rust is actually non-toxic. So depending on when someone gets into something, if it’s a brand new hand warmer the iron could be very, you know, potentially toxic depending, especially if it’s a pet. But if it’s after the hand warmer is used, it is essentially a lot less toxic.

Chris: But if it is pre-use, say you walk downstairs and you find your kids covered in all these black little granules or powder all over their face or the dog chewed up a whole bunch of packets.

Carolyn: Right. Yeah, definitely can be an issue and you probably heard of iron more with vitamins, right? But it is found in these products, as well, so you know—keep an eye on them.

Chris: I know you’re trying to stay warm, but we’re also trying to stay careful, right? 

Carolyn: Careful, yes.

Chris: One of the biggest parts of preparing for winter, right? As I already alluded to: those storms coming through. And what do we worry about with storms? 

All: Losing power! 

Chris: If you’re not fortunate enough to have a generator, which I am not.

Carolyn: We don’t—me either.

Karlee: Me either.

Carolyn: Sad.

Chris: Two kinds of categories of calls that we get very commonly in this scenario: the first being potential for food poisoning, right? What’s the context of that?

Karlee: It’s really, you know, when the power goes out, your fridge is not working, and so we’ll get a lot of calls to say, “Well, how long is the food in my fridge good? The food in my freezer? Can I eat it? What if I opened the door?” There’s just lots of different potential questions of your food going bad in this situation.

Carolyn: The most important thing is keeping the doors closed, actually.

Karlee: Exactly.

Carolyn: It stays cold longer.

Chris: I’ll go ahead and plug another website: foodsafety.gov. Actually, this is through the CDC. They have a nice little infographic which has information on what to do before the storm’s coming. Importantly, if you have lost power, you don’t know if something safe to eat, as Carolyn just said: keep the doors closed—food in the refrigerator is only good for four hours after losing power, food in a full freezer is good for two days, and food in a half-full freezer is generally good for about 24 hours. And a lot of times we’ll get calls after power is restored and they’ve got some tasty treats in the refrigerator that they want to know if they can still eat it or if they gotta throw it in the trash. What’s our mantra for that sort of scenario?

Karlee: When in doubt, throw it out.

Chris: That’s right. 

Carolyn: Yeah, we can’t determine, you know, if it’s going to be good or bad—unless it’s obviously stinky.

Chris: Yeah, you got salmon that’s been there for four days. 

Carolyn: Ew. We can’t predict, so if you think it’s not good, then don’t eat it.

Chris: When in doubt…

All: Throw it out. 

Carolyn: Yeah, that’s a good one. Did you get that off your fancy infographic?

Chris: Yes, yes I did, I stole that. I didn’t come up with that.

Carolyn: It’s just a fancy brochure.

Chris: The other piece is one that we do get a lot of calls on, and can be very concerning: carbon monoxide, right? Or CO.

Carolyn: Carbon monoxide is really poisonous. It’s a deadly gas and we get a lot of calls about it in the winter. It’s CO or carbon monoxide, and it’s produced in many different ways, and we’re going to talk more about that in a minute, but I just want to say for today we’re very concerned with power outages with generators being too close to a house, even too close to the windows outside, and we’re also concerned about people bringing grills into the garage, for example. Even if the garage door’s open that’s not enough ventilation to prevent carbon monoxide poisoning. And it’s colorless. It’s odorless. You cannot tell, unless you have a carbon monoxide monitor. So that is a big point for today is make sure that you have a monitor.

Chris: Make sure the batteries are checked on that monitor. 

Carolyn: Yes.

Chris: It is a very important topic that we have here in the poison center, so much so that we were going to dedicate our next episode in January just to carbon monoxide. And I think we have a little special guest, right? 

Carolyn: Yes, we do.

Karlee: We will have one of our toxicologists on to discuss a lot of different information that’s so important about carbon monoxide: how it works, why we’re concerned, how to keep yourself safe, that sort of thing.

Carolyn: And why the Patriots are better than the Eagles.

Karlee: Yes… He’s speechless.

Carolyn: See, there you go.

Chris: Yeah. Trying to come up with comebacks for seven Super Bowls in 20 years.

Carolyn: No can do. 

Chris: There’s only so much you can do.

Carolyn: Exactly, no.

Chris: So transitioning from that—again, another plug for the CDC. They actually have online an entire section of their website that is dedicated to natural disasters and severe weather, and under that they have the website just for preparing for winter storm with some general tips, right? Checking the batteries in your smoke and CO detectors, as we just said, before winter, having your chimney and flue inspected, making sure that your wood stove or fireplace has proper ventilation, and having emergency kits with supplies in your house and in your car. So, just so everyone’s aware: Karlee, Carolyn, do you still come to work when you get a big snowstorm or do you like to have a snow day? 

Carolyn: Well, because I’m so old I don’t have to drive in the snow, right, Chris? Just kidding. 

Karlee: No, we are here 24/7/365. All amounts of snow.

Carolyn: If we have a big huge storm coming, then somebody will actually stay here overnight, even if they’re not on the phone so that they can be prepared to take over in the morning.

Chris: Yeah, just a little humblebrag there. That’s how dedicated we are to the residents of Northern New England.

Carolyn: To be fair, I’ve never spent the night. That’s because I can drive in snow.

Karlee: There ya go.

Chris: So we wanted to thank everyone for listening again to this episode of Poison Center Pointers. Again, as always, you can like, share, and subscribe to us on Facebook and Twitter, and visit our website at nnepc.org. Remember though, if you have an actual poisoning emergency, scenario, and even just a question, contact the Northern New England Poison Center by calling 1-800-222-1222, you can text the word poison to 85511, and chat online at NNEPC.org. I think we just wanted to say happy holiday season to everyone.

Carolyn: That’s right. Happy holidays, yes.

Chris: Stay warm. Bundle up.

Carolyn: Stay safe.

Karlee: It’s getting cold out there, bub… yikes.

Carolyn: Bye everybody.

Posted in Poison Center Pointers Podcast, Poison Prevention | Comments Off on Poison Center Pointers: Preparing for Winter

Poison Center Pointers: Childhood Poisonings

TRANSCRIPT

Disclaimer: Poison Center Pointers is brought to you by the Northern New England Poison Center. This podcast is not to replace timely advice or recommendations. If you have an actual poisoning emergency, scenario, or question, contact the Northern New England Poison Center by calling 1-800-222-1222, text the word “poison” to 85511, or chat online at nnepc.org.

Welcome to Poison Center Pointers, a podcast presented to you by the Northern New England.

Upbeat music

Chris: Hello to our listeners and welcome back to Poison Center Pointers. My name is Chris. I’m here yet with my cohosts Karlee and Carolyn.

Carolyn: Hi everybody!

Karlee: Hello!

Chris: We are your friendly, neighborhood specialists in poison information. Just as a reminder what we like to do here on Poison Center Pointers—we just want to share our knowledge and experiences dealing with everyday situations we help manage at the poison center, and our goal is to keep our community safe by preventing a poisoning or making sure you know what to do if a poisoning occurs. This one might be a little more exciting than giving you some background information or talking about bugs…

Karlee and Carolyn laugh

Chris: …depending on your interests, because today we’re talking about common childhood exposures. The “meat and potatoes” of what poison centers do, if you will.

Carolyn: Yes

Chris: And, it’s great to have Carolyn here because you know, she’s been taking calls on children getting into substances they shouldn’t since my mother had me!

Karlee laughs

Carolyn: And boy did she call all the time!

Karlee: Chris was ‘that’ kid.

All laugh

Carolyn: He still is!

Carolyn laughs

Chris: That is neither here nor there…

Chris and Karlee laugh

Chris: …but, what we do want to cover today, first off, is what it is like when you call the poison center. A situation happens, you’re panicked, a child gets into something—what is it going to be like when you call us? And just talk briefly about a couple of things that your child might get into. And top of that, some prevention tips so maybe you won’t even have to call us in the first place.

Carolyn: Right. We do want to hear from you but we don’t want anyone to get hurt.

Karlee laughs

Chris: In that instance, say, a little kiddo gets into something, you’re worried, you pick up the phone and dial our number, what’s it going to be like when you call the poison center?

Karlee: That definitely is stressful but we’re here for you. So, you call the number, which is 1-800-222-1222…

Chris: She knows it by heart!

Karlee: I do! I’ve worked here for a little bit now, I know the number!

Laughs

Karlee: So you’ll get a menu at first and be prompted to select a number that goes alone with why you’re calling. So, there’s a number that you’ll select for “exposure” and you’ll get us right away.

Carolyn: But don’t worry if you press the wrong number, we’ll help you no matter what.

Karlee: Yeah, we’ll still help you!

Laughs

Karlee: So first we’ll ask you for some information. Kind of like Starbucks, we’ll ask you for your first name and some other personal information.

Carolyn: You don’t get a coffee though.

Laughs

Karlee: And for the most part, the most important thing, we’re going to assess the situation. We’ll ask you a series questions and we’ll help determine how to manage the situation.

Chris: And if you listened to our first episode, you’ll know that 90 percent of the time we manage them on the spot.

Carolyn: So you don’t have to go to the emergency room. That’s what we’re hoping to be able to prevent, we’re hoping to be able to give you the information that you need to know at home.

Chris: And potentially will follow up with you if you still have concerns. You can certainly request that if you want to talk to us. That is what we’re here for.

All agree

Chris: So what is it that kiddos get into, what do we get calls on?

Carolyn: Oh my gosh… A lot of our calls are on medicines, and not just children’s medicines but that’s a lot of it, over-the-counter as well as prescription. Some of the more common over-the-counter meds are things like pain relievers, like you’d take for a headache, or cough and cold meds, or multivitamins. And anything can be a problem depending on how much you take and the size of the person, so we will ask things like what does it say on the label, what is the exact name of the active ingredients, and the amount.

Chris: Might even ask how much your child weighs and get some background health information for them.

Carolyn: Yes, absolutely right.

Karlee: That’s usually really important too. A lot of medications that we deal with aren’t necessarily going to cause symptoms even if it is a toxic amount, so those weight based calculations are really important and we’re trained to do those to make sure it is in a safe range to stay home.

All agree

Carolyn: Exactly, and some of those medications, like cough and cold, have several different active ingredients so we’ll do a calculation for each ingredient in there, so we can make sure all of it is safe or not to stay home.

Chris: We are conservative, if we don’t know how much the child got we’ll go by worst-case scenario was, how much they could’ve gotten at maximum.

Carolyn: I always feel like we’re part detective.

Chris and Karlee agree and laugh

Carolyn: You know we’ll help you figure it out. Some people will say, “I have no idea how much the child got,” and then we can ask those questions. We can’t tell you exactly what happened and we don’t try to, but we can maybe help you figure out the most possible.

Chris: That being said, there are certain medications where even a very small amount can be a concern.

Karlee: Ones we typically worry about would be prescription pain medications—opioids, medications for heart health, and medications for diabetes. There’s ways that anything can be a problem, but those specific categories are ones that small amounts may be even fatal, so just some of the ones that we specifically ask about…

Chris: We’re trained on a drug-by-drug basis to assess the corresponding toxicity.

Carolyn: And it is just as important for you to know that some meds can be very dangerous in children in a short period of time so again, don’t wait to call.

Chris: Maybe a category of calls that is a little less scary than when your kiddo gets into medication: personal care products, right? What do we get calls on?

Carolyn: Things like diaper rash cream, lotion, shampoos and soaps, toothpaste—stuff that kids use or you use on kids. I remember when I first started working here, the first call I got where a 7-month-old or somebody about that age bit into a tube of diaper rash cream, and I thought, “How does a 7 month old get a diaper rash cream?” and the parent said, “Oh I gave it to them while I was changing the diaper,” and I thought, “Why would a parent do that?!” And then, I had children!

Chris and Karlee laugh

Carolyn: And I realized if you don’t give them something, you can’t change the diaper. But just remember there will always be that time where they going to be able to bite into it, or get into it or open it, or whatever it might be. So, just be careful with those products.

Chris: And again, we know a range of commercially available products. We know what the concerns for toothpaste would be versus hair conditioner, and we can go into detail on that sort of thing with you.

All agree

Chris: Cleaners, huh? Do we get calls on cleaners?

Laughs

Karlee: Cleaners are a very common call. It could be disinfectants, dish soaps, laundry detergent. Kind of a really popular—not popular, but sort of well-known exposure right now is laundry pods.

Chris: The Tide Pod Challenge!

Karlee groans

Karlee: Yeah…why, just why?

Chris and Karlee laugh

Karlee: Yeah, or bleach and other products out there—you never know if there is going to be an exposure. And similar to the personal care products, there is just a large range. Some things are a little less toxic versus other things are very, very toxic and dangerous, and we’re trained on that.

Chris: We know all sorts of weird chemical names that would be weird for you to know otherwise, outside of this job.

Karlee laughs

Chris: So if you can bring that bottle with you and read the label, it’s very helpful. We’re usually pretty good at narrowing it down.

Carolyn: That is so important—the exact name of the product if at all possible, is really, really helpful. We don’t just help with ingestions, we can help if it gets in the eyes or on the skin. Sometimes you know, another sibling will, the baby doesn’t smell good because they have a full diaper and they spray deodorizer on them.

Karlee laughs

Carolyn: You know they think they’re being helpful! I am not making this up. Really these things happen…

Karlee: Yeah

Carolyn: We can help, we can tell you how to flush an eye or wash the skin appropriately, or whatever it might be.

Chris: Sure, sure.

Karlee: Speaking of how important it is to have the packaging available, Chris do you want to talk about the actual laws regarding packaging?

Carolyn: Yeah, great!

Chris: Yes. So, The Poison Prevention Packaging Act has been around since 1970, and what that is relevant to is child resistant packaging for prescription drugs, over the counter drugs, these household chemicals we’re talking about, and any other hazardous materials that kiddos can get into. In particular we find it can be a concern when kids get into medication. You know when you buy a bottle from the store it’s pesky, and you can’t get the lid off, it’s frustrating, maybe embarrassing?

Karlee laughs

Carolyn: Hurts your hands…

Chris: That’s by design. Basically the standard is, the agency that regulates this sort of stuff, they want children under the age of 5, they want at least 80 percent of children to not be able to open it within 5 minutes of coming into contact. And important to note that 80 percent is not 100 percent. There are clever kids out there.

All agree

Carolyn: I swear there’s more than 20 percent that can open them. They’re not childproof, they’re resistant, and resistant at best.

Karlee: Common misconception too, people will call all the time and say, “It was child resistant or childproof!” And it’s not. It just sometimes slows them down, but they can sometimes still get into it.

Carolyn: Yes, you can’t rely on that.

Chris: Going along with the Poison Prevention Packaging Act, why don’t we talk about some prevention tips?

Carolyn: Sure! The first one of course, and you’ve heard this before—keep everything up and out of sight, and away. And that’s great! But, there is the day that that 2-and-a-half-year-old learns to climb!

Chris: A valuable life skill, just not in this context.

Karlee laughs

Carolyn: That’s right, or they know, they figure out, because they’re so smart they’ll move the chair over to climb on the chair. So just remember that and try to think about where they can’t get into, maybe a cabinet you can lock.

Karlee: A lot of the times they’ll watch you if they know they’re not supposed to have it they’ll try even harder to get it.

Karlee laughs

Chris: I think all the parents already know that one!

All laugh

Chris: We get a lot of calls on kiddos who get into substances stored underneath the kitchen or bathroom sink. That is another situation where locks may come in handy, up and away or locked.

All agree

Karlee: Even when you’re using it, just remembering to put it away as soon as you can every time is important. It seems like a simple concept but in the moment when there’s so much going on it can be easy to forget or even delay it. We get a lot of calls where, someone was doing laundry for example, and they just took out a laundry pod to do the laundry and you look back and suddenly the kiddo is in the laundry pod container.

Carolyn: Same thing with meds you know, you go to dose one child with something you know, a multivitamin or an antibiotic and then the other child grabs it while you’re turned with the other one!

Chris: Filling up the weekly pill minder, that’s a really common one too.

Karlee: Oh yeah, really common.

Chris: One thing we can do is, depending on the child’s age, teaching them about what exactly what medicine is for. Right? Because what kind of situations do we encounter where children misinterpret what the medication does?

Karlee: If you were to put medication and pictures of candy in a lineup it would be really hard to pick out which is which, even for an adult.

Chris laughs

Karlee: It is one of those things where it is so close to looking like something that a kid would be happy to eat, we just want to make sure we teach them that medicine is not candy.

Carolyn: Some people actually use that, if the child won’t take the medicine they’ll call it candy, and that sort of sets up for them potentially getting into something later on when they find they have access to it, so just be careful of that.

Chris: What else do kiddos love besides candy? Toys. Right, we encounter situations where children will be allowed to play with a bottle because it shakes and sounds like a rattle or a maraca? Also not recommended because again the lid can pop right off, it’s not completely childproof. Do we have any other good prevention tips we’ve learned over the years?

Carolyn: Keeping products in their original containers, that’s a huge one.

Karlee: Yeah, for sure.

Carolyn: Don’t put medicines in baggies, which are not child resistant at all and we often don’t know how many are in there, or sometimes what’s in there.

Chris agrees

Karlee: How many times what we gotten a call where someone, say, accidentally drank something that they put in a different container, like a Gatorade bottle. I’ve had a lot of people drink gas, or hydrogen peroxide by accident.

Carolyn: And some of you are thinking, “These people did what?” and others are saying, “Oh yeah I’ve done that before.”

Karlee laughs

Chris: I had a guy put antifreeze in his Gatorade bottle and it looks blue…

Carolyn: Yeah, so he drank it, or a child might drink it…

Karlee: …and it is very toxic and dangerous…

Chris: We can get into that in the future. Carolyn, I know you had brought up a story where a patient who, what did they do while they were driving?

Carolyn: This person was driving down the road and a cleaner was in a water bottle, they were transporting and they forgot. They were so thirsty that they drank a huge mouthful, pulled into a stranger’s driveway and started throwing up. The call actually came from the stranger, the person who was the homeowner.

Karlee laughs

Chris: Good Samaritan!

Carolyn: Yeah, very strange case.

Karlee: Hmm, something is going on in my driveway…

Karlee laughs

Carolyn: Yeah, exactly. That person was very calm actually. Luckily we were able to figure out what happened, and luckily everybody was okay, but can you imagine? It’s bad enough if you do it sitting in your garage, like Chris was just talking about with the Gatorade, but imagine driving down the road and you do that? What if they were on the highway? That could’ve been…

All agree

Chris: And, these are all, they may come off as common sense when you’re listening but there’s a lot that goes into it when a situation occurs. Having a young child is arguably the most stressful thing in the world.

Karlee: So stressful, lack of sleep, multitasking…

Laughs

Chris: Right! So just a few pointers we have. The CDC actually online has a couple more points you can look into at CDC.gov/medicationsafety, there are some other resources for you if you’d like to keep reading into what you can do to keep kiddos safe. And again, this is a brief overview of some of the substances kids get into. We could have an hour-long discussion on pretty much any one of these categories…

All agree

Chris: And we hope to down the line!

Carolyn: We have a lot to talk about!

Chris and Karlee laugh

Chris: Yes, we do. And we have plenty more anecdotes.

Karlee laughs

Chris: That’s about all we’re looking to cover today. We want to thank you again for listening to this episode of Poison Center Pointers. You can like, share and subscribe to us on Facebook and Twitter. If you want more information you can visit our website at nnepc.org. But, remember if there is an actual poisoning emergency, scenario or even just a question, you can contact the Northern New England Poison Center at 1-800-222-1222, you can text the word POISON to 85511, or you can chat with us online at nnepc.org. Thanks again for joining us, guys.

Carolyn: Thanks, everybody!

Karlee: Bye!

Chris: Next episode we’re going to get into some seasonal items.

Karlee: Stay tuned.

Upbeat music

Posted in Medication Safety, Poison Center Pointers Podcast, Poison Prevention | Comments Off on Poison Center Pointers: Childhood Poisonings

Poison Center Pointers: Ivermectin

Experts from the NNEPC poison help line address ivermectin, the drug that’s been in the news quite a bit lately, in this month’s episode of our Poison Center Pointers podcast. What is ivermectin used for? What problems are associated with improper use? Are people poisoning themselves with ivermectin?

Subscribe to Poison Center Pointers on Podbean, Amazon Music, Apple Podcasts, Google Podcasts or Spotify.

TRANSCRIPT

Disclaimer: Poison Center Pointers is brought to you by the Northern New England Poison Center. This podcast is not to replace timely advice or recommendations. If you have an actual poisoning emergency, scenario, or question, contact the Northern New England Poison Center by calling 1-800-222-1222, text the word “poison” to 85511, or chat online at nnepc.org.

Welcome to Poison Center Pointers, a podcast presented to you by the Northern New England Poison Center.

Chris: Hello, and welcome back to Poison Center Pointers. We appreciate everyone out there who’s been listening, and we appreciate all your feedback as well. My name is Chris. Again joined by Carolyn and Karlee.

Carolyn: Hi Chris. Hey, wait a minute. No old joke?

Chris: I was going to give you the week off.

Carolyn: Think I’m too old to take it?

Chris: Let me think of something.

Karlee: Stay tuned to next episode.

Chris: No, just give me a few minutes here. So, just a quick spiel as to what we do here. Again, we’re here to share our knowledge and experience dealing with everyday situations we help manage at the poison center. Our goal is to keep the community safe by preventing a poisoning or to make sure you know what to do if one occurs. And today’s topic… We’re hoping to prevent a few poisonings, right? We’re talking about something that’s all over the news. All over the internet. Ivermectin and its use in treating COVID. We want to talk about what you need to know from our perspective. So, why are we talking about it? What’s going on?

Carolyn: Well, we’re talking about it, basically, because of what you just said. It is all over the internet, in the news, and people are using it inappropriately. They’re using it in ways that can be poisonous.

Chris: How so?

Karlee: Essentially trying to either prevent or even treat COVID-19.

Chris: So there’s some data that came out across the country that suggesting that we have a 9-fold increase in cases that have been managed in the month of August. So, that’s just cases. That’s not even called or questions. So let’s talk about what exactly ivermectin is.

Carolyn: Yeah. Ivermectin is something that is used in people. It’s used for things like scabies and head lice. It’s used for parasites. It’s used in pets for things like heartworm. That’s probably where you’ve most likely seen it, if you have a dog. And it’s also used for parasites in livestock. It is not used for viruses.

Karlee: Yeah. I think parasite and virus are the keywords here. So, COVID-19 is a virus, and Ivermectin is approved for use for parasites.

Chris: So what are our concerns then from the Poison Center’s perspective? If someone is using something inappropriately for a virus?

Carolyn: Yeah, there’s so many concerns. And starting with the formulation that people are using is the one that is formulated for animals typically, because that’s what’s easiest for people to find at a store. A formulation that is used for a horse for example or a cow. And, as you can imagine, that is not the right dose for a person.

Karlee: Yeah, think about a 1200 pound horse versus a regular human. It’s just the big that comes into play is incorrect dosing, and humans essentially getting way overdosed.

Chris: And what else we worry about what these formulations?

Karlee: Yeah. With animal formulations, not just the active ingredient of ivermectin, there’s also inactive ingredients which are not approved for human use or known to be safe. So, it’s just generally recommended that any veterinary medicine is not used in humans for that reason also.

Chris: And we are the Poison Center. So what’s another big concern that we address here?

Carolyn:  Yeah, well that would be the toxicity. Or how poisonous something is. That’s kind of our thing. And people are taking it a couple different ways. The first way is there taking one large dose.

Chris: Yeah and there could be quite a few symptoms that could come from that. Including, obviously dependent on that amount taken, nausea, vomiting, diarrhea, dizziness, loss of coordination. And then in extreme situations where someone takes way too much, it can lead to confusion hallucinations rapid breathing and even seizures. So we’ve got a lot of concerns here.

Carolyn: Right, we’re not talking about a little stomach upset. We’re talking about things that can really affect yet. And this one large dose is just what we’re talking about with these animals formulations. Way too much for a person.

Chris: What about chronic situations? Which is another thing we’re worrying about here.

Karlee: Taking it chronically is not without risks either. A big thing I wanted to mention was that there are potential for drug interactions. So, you know, the way that ivermectin is, the way that your body gets rid of it. There’s other medications that go through this pathway that can be affected. So, it can have effects on your daily medications. Like heart medications. There’s a long list. Um, Warfarin, if you’re taking that to prevent a blood clot. Just things that it can interrupt and mess with.

Chris: She’s a pharmacist. You should probably trust her on this.

Carolyn: She knows that stuff. And the thing about chronically, you know, when people take it, they may take it chronically which just means they take it for several days or several times in a row. But, we’re seeing people take it for weeks and months. And we have a definite increase in toxic or poisonous symptoms.

Chris: Yeah, let’s talk about the science behind it too. Because, you know, a lot of this is stemming from the fact that people read online or they hear from a friend that this could be effective. What’s the evidence behind this?

Carolyn: Well, that’s the question isn’t it? The science is not good science. They’re being done in a way that doesn’t really prove that it works.

Karlee: And some of the information that we have, too, is being done in a way that some people can call “test tube” studies. So, good to just think of it like that. Just, in a test tube, or something outside of the human body. Just in a lab sort of situation.

Carolyn: Right. Not actually in people/

Karlee: Yeah, it doesn’t translate to a human. So it doesn’t really prove anything, and it’s just not good science that we can use.

Carolyn: And the amounts they’ve been talking about have been really large. Like we talked about that large dose. Doses that are not safe in people.

Chris: Yeah, and for this reason for this reason the FDA and the CDC have still determined that there is not enough evidence to suggest it be used for treatment or prevention of COVID.

Carolyn: Exactly.

Chris: Do we have anything that is effective and safe and proven for the prevention of COVID?

Carolyn: Well, I can think of one thing. Something we’ve all done here.

Karlee: Yeah.

Chris: What’s that?

Karlee: Getting vaccinated. That is good science.

Chris: And, important to note, if you have questions on the vaccines we are also here for you. We’re trained to know about these sort of things. You can always call us with questions, whether it’s about Ivermectin or it’s about the vaccine. We will still help you.

Carolyn: Or anything else for that matter.

Chris: If you are looking for more information about Ivermectin, you can go to our website. That’s nnepc.org. A new blog was just posted entitled “Answering Questions about Ivermectin”. It might have a little more helpful information for you. I believe that’s about all we wanted to cover, but we felt this was a really important topic, and we should just discuss this one thing today.

Carolyn: Right.

Chris: So. Thanks again for listening in to this episode of Poison Center Pointers.  Like, share, and subscribe to us on Facebook and Twitter and visit our website at nnepc.org. Remember, if you have an actual poisoning emergency, scenario, or even just a question, contact the Northern New England Poison Center by calling 1-800-222-1222, texting the word POISON to 85511, or chatting online.

Posted in COVID-19, National News, Poison Center Pointers Podcast, Poison Prevention, Regional News | Comments Off on Poison Center Pointers: Ivermectin

Answering questions about ivermectin

What is ivermectin?

Ivermectin has been in the news quite a bit lately, but what exactly is it?

Ivermectin is a drug that is used to treat infections from parasites. It is found in a variety of medications approved for treating certain infections in humans or animals. Human medications may be taken by mouth or applied to the skin, and are used to treat such conditions as roundworms, head lice, scabies and rosacea. Ivermectin is found in some heartworm medications for pets, and may be used for a variety of parasite infections in livestock.

Can ivermectin be used to treat COVID-19?

While some studies have looked at ivermectin as a potential treatment for COVID-19, at this time both the FDA and the CDC have determined that there is not enough evidence to suggest it should be used for this purpose.

Is ivermectin dangerous?

Like any medication, ivermectin is safe when used appropriately. That means using it as recommended by your doctor or pharmacist to treat a specific health condition.

Taking large doses or taking drugs formulated for animals can be harmful. Symptoms can include nausea, vomiting, diarrhea, abdominal pain, drowsiness, dizziness and loss of coordination. A handful of cases involving large doses have resulted in very serious symptoms, including confusion, hallucinations, rapid breathing, tremors and even seizures.

Ivermectin also may interact with the common heart medication warfarin to increase the risk of bleeding.

Are people poisoning themselves with ivermectin?

Nationally, poison centers have seen a significant increase in cases involving ivermectin since late July, with about nine times as many cases in August as typical, suggesting that some number of people are using ivermectin inappropriately. While this is concerning, these cases account for just a tiny fraction of overall poison center cases, and most patients did not experience significant effects from their inappropriate use of ivermectin. However, about 1 in 10 patients in these cases did experience more severe symptoms.

At the NNEPC, we typically manage about 15-20 human exposures and 5-10 animal exposures involving ivermectin each year. Most of these are common types of poison center cases: young children or dogs getting into medications that have been left out, people accidentally taking a second dose of their prescribed medication, people getting animal medication in their mouth or eyes while dosing livestock, etc. As of this writing, the NNEPC has managed 14 human exposures to ivermectin in 2021, with four of them stemming from attempts to treat or prevent COVID-19, mostly in the past two weeks. None of these patients experienced significant effects from the ivermectin.

How should I treat or prevent COVID-19?

Any treatment for COVID-19 should be coordinated with your doctor. Ivermectin is not approved for COVID-19 treatment, but there are many other options available.

Even better is to take steps to prevent COVID-19 infection: Get vaccinated, wear masks where recommended and practice social distancing where appropriate.

Posted in Medication Safety, National News, Poison Prevention | Comments Off on Answering questions about ivermectin

Poison Center Pointers: Insects and Repellents

In the second episode of Poison Center Pointers, our poison experts discuss three of our most common arthropod pests: ticks, mosquitos and brown-tail moth caterpillars. What are the risks from these critters and what are some ways you can safely deal with them?

Subscribe to Poison Center Pointers on Podbean, Amazon Music, Apple Podcasts, Google Podcasts or Spotify.

TRANSCRIPT

Disclaimer: Poison Center Pointers is brought to you by the Northern New England Poison Center. This podcast is not to replace timely advice or recommendations. If you have an actual poisoning emergency, scenario, or question, contact the Northern New England Poison Center by calling 1-800-222-1222, text the word ‘POISON’ to 85511, or chat online at nnepc.org.

Chris: Welcome to Poison Center Pointers, a podcast presented to you by the Northern New England Poison Center.

♪Upbeat music♪

Chris: Hello to all our listeners out there and welcome to Poison Center Pointers. Today is Episode 2and we’re keeping this summer themed today. We’re talking about insects and repellents.

Karlee: Boo insects!

Carolyn: Yay summer!

[Laughter]

Chris: Boo insects, I second that. My name is Chris and I’m joined by two of my co-hosts and colleagues. Karlee, welcome back!

Karlee: Thanks for having me!

Chris: And Carolyn, thank you for being here.

Carolyn: Thanks Chris, thanks for having me.

Chris: Carolyn’s been here since insects were invented, so she has plenty of expertise, once again.

Carolyn: Thanks, Chris… yes, I invented them, thank you.

Karlee: Thanks for that…

[Laughter]

Chris: So, just to get into again what exactly we’re doing here. We’re looking to share our knowledge and experience dealing with everyday situations that we manage at the poison center. Our goal is to keep our community safe and by preventing a poisoning, or making sure you know what to do if a poisoning does occur. Hopefully this episode is a little bit more entertaining than last week when we just talked about um, ourselves!

[Laughter]

Chris: So, insects and repellents… I think we should probably start with everyone’s least favorite insect or so I would think, in northern New England, ticks!

Carolyn: Yes, we do not like ticks, ick. Ticks are an insect that are found in the woods, in the tall grass, sometimes in your yard, but usually it’s more like the woods or the grass, where they’re found. They crawl around, they don’t fly, they don’t jump, but, if you walk through the grass where they found, they will attach themselves to you.

Chris: Yes they will.

Carolyn: They feed on the blood of animals and unfortunately we are animals too, so… yuck!

Karlee: That is why they grab on. One of the reasons we worry about them is because they are a vector for disease.

Carolyn: Lots of different kinds of disease. You’ve heard about Lyme disease, that’s the more common one but there are others too. We’re not going to get too detailed, basically it is way more common for it to be Lyme disease.

Chris: In this region of the country, anyway.

[Karlee and Carolyn agree]

Chris: How about a little bit more about ticks…

Carolyn: Sure!

[Laughter]

Carolyn: Once they feed they fall off. They don’t stay attached, they don’t crawl inside, they don’t burrow and stay. They just put their head in, and they feed. And once they finish feeding, they fall off. In certain stages their life they can be really small, like, nearly impossible to see, the size of a poppy seed or the tip of a pencil. And they can be active year round even here in northern New England, ‘cause sometimes we don’t get that long hard frost or lots of snow, like last winter. So even though they’re more common in the warmer months they actually can be found year round.

Chris: Do you guys have any of your own horror stories about encounters with ticks?

[Carolyn laughs]

Carolyn: Well! My first, and only encounter actually happened here at the poison center.

Karlee: Oh?

Carolyn: Yeah, thanks Karlee!

Karlee: What?!

[Laughter]

Carolyn: Well, Karlee has dogs and we share a seat here at the poison center.  Not at the same time, but we share the same desk…

[Karlee laughing]

Carolyn: …when she’s not here, we share, and I think that she probably brought it in from her dogs. So, I found one here for the first time ever about a month ago.

Chris: Good point, right! We don’t usually find ticks inside a building.

Karlee: But dogs can bring them in…

Carolyn: …or people!

Chris: Any sort of animal.

Carolyn: And Karlee!

[Laughter]

Chris: So just a little bit of background. Why don’t we talk about some good prevention techniques? I think that’s probably what people would want to know most about.

Karlee: Yeah, so first off, we can try to avoid areas where we know ticks are prevalent which would be in the woods, grassy areas, bushes, that sort of thing. But, in northern New England, pretty hard to avoid those areas, especially when we want to get out in the summer.

Carolyn: But, if you’re hiking you can stay in the middle of the path.

Karlee: Exactly!

Carolyn: Even things as simple as that can make a difference.

Karlee: But, if you’re unable to do that there are other things, as far as you know, using clothing. You can wear long clothing to, you are obviously going to be wearing clothing…

[Laughter]

Carolyn: That’s why I was laughing…

Karlee: But long sleeves…

Carolyn: Long pants…

Chris: Long socks….

Karlee: Long pants, tuck your pants into your socks, things like that.  And also you can you use preventative sprays. So, DEET, there is picaridin…

Chris: Natural products, quite a few products available.

Carolyn: Light-colored clothing can be helpful ‘cause you can see the ticks crawling up. They don’t generally attach right away. They want to crawl up and find a spot like your under arms, behind your ears…

Karlee: Crevices…

Carolyn: Crevices. 

Chris: Back of the knee…

Carolyn: Belly button, ick.

Karlee: Hairline…

Carolyn: But, they crawl up, so they crawl up first. They generally don’t attach to your ankles or feet. So, if you have light-colored clothing, and you’ve tucked your pants into your socks like Karlee was mentioning, then you can maybe see them crawling up before they attach.

Chris: How about a theoretical, here? Say you took all those proper preventative techniques, and you come home after a nice hike in summer, and you find a tick on yourself. What do we do?

Carolyn: Well, actually even before that, no matter what you do, when you get home do a tick check.

[Chris and Karlee agree]

Carolyn: But, if you do have one, then you want to grab tweezers or tick removal tool, a lot of stores sell them… If you have tweezers you just grab it close to the skin, at the tip of the body right before the head, grab it, not too hard, you don’t want to rupture it. Just pull very slowly so that the head comes out.

Karlee: Try to not jerk or twist it. I want you to remove it as fast as you can, but also make sure you’re getting the head because of the head is retained in, there is just a greater chance to get diseases from it, or infections, things like that.

Carolyn: Or, you can do what I did when I found it here at work. I screamed, and then I grabbed it, and threw it to the ground.

[Laughter]

Carolyn: Luckily it had literally just attached, because it came right out.

Chris: But in all seriousness don’t throw it on the ground.

[Laughter]

Carolyn: No, I didn’t keep it there. You want to put it in rubbing alcohol. That will kill it, and it will preserve it. Don’t flush, you’re not killing it if you flush it. You want to put it in rubbing alcohol or crush it.

Chris: And important to note actually, if you do put it in the rubbing alcohol which will kill it, it will actually preserve it, if you’re concerned it could be harboring a disease. There are sources we have available in northern New England to have it identified. For more information you can certainly call us, chat us, text us, and we’re happy to assist. How about some common pitfalls or kind of, old school methods for how we remove ticks? We should probably bring those up.

[Carolyn and Karlee laugh]

Carolyn: Thanks for looking at me for that Chris.

[Laughter]

Carolyn: Sometimes people will call, and say they’ve used the match method. That means you light a match, blow it out, put it on the back of the tick. That is actually never a good idea. It might get the tick to remove its’ head, but he’s more likely to regurgitate the virus or bacteria, because that’s found in the salivary glands. You are more likely to get sick if it has one of these diseases.

Chris: Also, putting a burning match to your skin, you know…

Carolyn: That’s true, that’s not a good idea. I agree Chris.

[Laughter]

Carolyn: The other one is Vaseline, covering it in Vaseline, because people think it will smother it. They actually only breathe 1-2 times an hour, so you’re going to be sitting there a long time, and then you’ll have to grab the tweezers!

[Laughter]

Karlee: And those things are really just delaying the actual removal and so…

[Chris and Carolyn agree]

Chris: And there are situations where people worry, “Could I have been exposed to one of those tick-borne illnesses?” When will we recommend reaching out to your doctor or your primary care provider?

Karlee: Yeah, so, after the removal it’s important to do typical first aid. So washing really well with soap and water to the area, and if you have found it is imbedded, follow up with your primary care provider and just see if there’s any further evaluation or management. Or, certainly if you feel symptomatic at all follow up with them as well.

Carolyn: You don’t, you know, it’s not emergent. If you find the tick in the middle of the night, you don’t need to call the doctor’s office in the middle of the night, you can wait ‘til the next day. It doesn’t happen that fast.

Chris: Another important resource that we should probably refer you also is the federal CDC’s website, cdc.gov. They do have a web page dedicated to ticks, and they have all sorts of helpful hints and tips that we went over so you might also find that to be a good resource

Carolyn: Yes, absolutely.

Karlee: Just to elaborate on symptoms, if you feel that you are having fever, muscle aches, you notice that classic bullseye rash, you could ‘Google’ photos of that, that’s pretty typical for Lyme disease… but anything like that as far as symptoms go, I’d want you to follow up with your primary care provider.

Carolyn: Absolutely.

Chris: Yes. I think the next type of insect that unfortunately we encounter way too much this time of year: mosquitoes.

[Karlee and Carolyn agree]

Carolyn: Ew, yeah, not my fav.

Chris: You all might be familiar.

[Laughter]

Carolyn: Probably, if you live here.

Chris: Any pointers you all have about where you are most likely to encounter mosquitoes, and just ways to prevent exposure?

Carolyn: Sure, mosquitoes are, they like water. That’s where they reproduce and that’s where they tend to hang out. So, morning when there’s dew on the grass and in the evening, you have to be careful. You want to cover up, you can use some repellents, we’ll talk about repellents later… the other thing is, they tend to, as I mentioned, reproduce in water, so if you have any open water like standing buckets, your wheelbarrow is turned over and gets filled up in a rainfall, empty it, because that’s where the larvae are and you’ll increase the amount of insects in your yard if you have those things.

Chris: But say, you do want to spend some time outside, and you don’t want to be covered in big red bumps for the next 2 to 3 days, what do we usually encounter that people like to use here?

Karlee: Yeah you can prevent bites by some different methods. One would be using a spray that contains DEET. That would kind of be your two for one, to cover you for ticks and mosquitoes. There’s also some natural products like lemongrass, citronella, and there’s mosquito dunks…

Chris: That’s a product you can put in a standing pool of water and it’ll help get rid of any of the insect larvae that are there.

Carolyn: And remember mosquitoes, they’re annoying and we don’t like to get bit by them, but they also, they can carry diseases. We don’t generally see a lot of that in northern New England, but you know, like with anything we just want to prevent exposure.

Chris: Sure, sure. The next group of insects – something where we actually worry occasionally about medical emergencies so we should probably talk about that – and that is stinging insects. Bees, hornets, ants can bite you, pretty irritating so, do you guys have any helpful hints for our listeners out there?

Carolyn: Sure, so the first thing you want to do is get rid of the stinger if it’s still in there. They don’t all leave the stinger in there, but instead of inspecting it carefully just grab a credit card or a license, scrape across the bite site. That’ll remove the stinger if there’s one there. Don’t use tweezers or squeeze because if there’s a venom sac, it’ll hurt way more.

Karlee: And just squeeze the venom further in, rather than just removing it all together.

Carolyn: Exactly, and like with everything else, wash with soap and water, that’s the first thing you’re going to want to do. And if there’s a little swelling then apply ice. A little bit of swelling, a little bit of pain, normal, it’ll go away in a pretty short period of time. That’s nothing to worry about. But, sometimes you do have to worry.

Karlee: Yeah, that would be anaphylaxis. So you can be allergic when you get stung by any of these insects that we’re talking about right now. Usually if you’re going to see signs of anaphylaxis it’ll be within the first 15 minutes of the exposure, sometimes it can be delayed an hour or two, but most commonly you’ll see it pretty soon. And that would be, you know, difficulty breathing, swelling in your neck, hives, anything like that – if you have any symptoms you need to call 911 because it is a medical emergency.

Carolyn: Right.

Chris: So, you step into a big nest of hornets, which hopefully that never happens to anyone out there…

Carolyn: Eesh, yeah… run screaming, ouch. If you get stung by, the number they say is 50 or more, that you can actually get poisoned from the venom. Fifty is a rough number, and obviously you’re not counting when you’re getting chased by a nest…

[Chris and Karlee laugh]

Chris: That would be pretty impressive.

Carolyn: … or a swarm of bees. If you get multiple stings, just call us. You still want to do the same stuff, you want to scrape the sites, you want to wash, but there might, even if you’re not allergic, there might be another thing to worry about there, so be careful.

Chris: Yeah. I think probably my least favorite group of insects that we unfortunately do encounter this time of year would be caterpillars.

Carolyn: Caterpillars? You know you can outrun them Chris? Why caterpillars?

[Karlee laughs]

Chris: Because they look terrifying!

[Laughter]

Carolyn: Have you seen a tick?!

[Laughter]

Chris: Okay. To our listeners out there, feel free to ‘Google’ what these species look like. But…

Carolyn: They’re pretty!

[Chris laughs]

Chris: There are a couple species that we worry about particularly in northern New England: tussock caterpillars, gypsy moths, and of course the brown tail moth.

Carolyn: The dreaded brown tail moth…

Chris: Now for our listeners in New Hampshire and Vermont, don’t fret too much, they’re not really in that area.

Carolyn: That’s brown tail moths.

Chris: Yes, what did I say?

Carolyn: Specifically the brown tail moth.

Chris: Yes, brown tail moths are located more in coastal Maine and Cape Cod.

Carolyn: Lucky us…

[Laughter]

Chris: Yes, lucky us. So this might be a little bit more relevant to those in in coastal Maine, but really the same recommendations go for most of these caterpillars so, what do we worry about?

Carolyn: Yeah, go ahead Karlee.

Karlee: Yeah, as a general rule of thumb, we typically just say don’t touch the hairy ones because really the issue with these is the hairs.

Carolyn: Right.

Karlee: The hairs are very irritating when they get on your skin. They can float in the air and you can breathe them in, and it can be very irritating to your airway and cause breathing difficulty which is one of the things we do worry about and would have you watch out for. The hairs can also stay active in the environment even if they’re not on the actual caterpillar for months.

Carolyn: Months!

Karlee: Yeah, so, really important as far as prevention goes.

Chris: And what are some of those prevention techniques?

Carolyn: Yeah, you don’t want to leave your clothes hanging outside if you’re in an area where these caterpillars are found. You want to wash clothes inside, and dry them inside, use hot water, just to make sure that you get rid of the hairs and you render them inactive. And just understand that some people are just more allergic to them. Some people just have, some people don’t have any reaction at all, some have a little bit, and some are just miserable for weeks.

[All agree]

Chris: You’ll be aware if you’re sensitive to it.

Carolyn: Absolutely.

Chris: And we do have treatment remedies. I don’t know if you want to expand on that, Karlee? As a pharmacist she might know about some of that.

Karlee: Yeah, so some things that we have recommended to people could be poison ivy wipes, you could use calamine lotion, if it’s itchy you could use an antihistamine like Benadryl, over the counter things. And actually, if you go to your local pharmacy you can ask them, in this area they’ll probably be aware of some of the things that can be used. And one thing that is common is half a tube of hydrocortisone, half a tube of diphenhydramine, and witch-hazel that you would apply topically.

Carolyn: They call that the magic potion or magic lotion.

Chris: Yes, something to talk to your pharmacist about or the staff in the pharmacy because they might have it available already. One small piece I’d like to talk about with caterpillars that we do encounter occasionally, obviously because we deal with a lot of exposures in little kids – what are we worried about if a child swallows a caterpillar?

Carolyn: Oh, that can be a problem with the hairs in the mouth and the throat. It can cause breathing difficulty…

Karlee: Swelling…

Chris: It can be a medical emergency. If something like that happens we do urge you to get in contact with us.

Carolyn: Right, and again we’re talking about the hairy caterpillars.

Chris: Yes.

Carolyn: Kids eat lots of bugs…

[Chris laughs]

Chris: Which you can always feel free to call us about regardless.

[Karlee laughs]

Chris: So we should probably talk about some of the defense, the repellents, some of the commercially available products we have to prevent against this sort of thing.

Carolyn: Yeah, before we talk about the exact products, the most important thing is to read the label. I know that sounds silly, but they’re very highly regulated, pesticides are, and they’ll tell you exactly how to use them. Do not apply them more often than it states, and if it says don’t use on children it’s because they have a high level of the pesticide. So, just be very careful. You don’t want to saturate clothing for example, while it’s on your child or your body ‘cause then you’re being exposed to it constantly. You just want to be careful there.

Karlee: There are different percentages of pesticides depending on the product that you have. Some are just meant to spray on clothes, and you let them dry before you put them on. You’re not supposed to apply them to your skin. There can be pretreated tents, or things like, but yeah, read the label.

Chris: We got a lot of calls this time of year and that exact thing. So what kind of products are available? I know we touch kind of briefly on it but, what do we most commonly encounter?

Karlee: There are permethrin products that can certainly be irritating to the skin. If you do use that product incorrectly just call us and we can talk through all of the concerns for toxicity. There is DEET, which definitely can be a concern, especially when ingested it can be very toxic. There’s also natural products like eucalyptus, lemongrass oil, citronella candles, and picaridin is another option as well.

Carolyn: And even the natural products can be a problem if they’re ingested. They’re all pretty safe to use when used correctly, but it sometimes even if you use as instructed you know, you put it on the child and they lick their arm. I mean, we see that all the time.

[Karlee laughs]

Chris: Happens all the time.

Carolyn: Yeah, so just call us, we can help with those things.

Chris: And not to be total bummers and make summer seem like it’s a dangerous time, we all love summer here…

[Carolyn and Karlee laugh]

Carolyn: We do!

Chris: But frankly we get a lot of calls on all these subjects. If you have any questions, please feel free to always call us, chat us or text us. In conclusion we just wanted to thank you all again for listening to this episode of Poison Center Pointers. You can always like, share, and subscribe to us on Facebook and Twitter, or you can visit our website at nnepc.org. Remember if you have an actual poisoning emergency, a scenario, or even just a question you can contact the Northern New England Poison Center by calling 1 800-222-1222, you can text the word ‘POISON’ to 85511, and you can chat online at nnepc.org. Org thanks again for joining us today. See you next time.

♪Upbeat music♪

Chris: Hey guys, it’s Chris still here with you. I actually have some additional information and clarification from one of our specialists here who reviewed our podcast. We’ll go ahead and call this the ‘fact check’ section of the podcast. As I said one of our specialists in poison information, also the public health educator for the state of Maine, Victoria is here with us. Thanks for joining!

Victoria: Sure Chris, thanks so much for letting me criticize your work!

[Chris laughs]

Chris: The internet was going to do that anyway so, might as well keep it in house. A couple, or a few points we want to go over for the last episode. What have we got?

Victoria: Yeah, not too much. But first, I did want to mention, not to get into semantics, but…

[Chris laughs]

Victoria: …ticks are not insects, they are arachnids!

Chris: Yeah, yeah.

Victoria: They are both arthropods, insects and arachnids, and some repellants can be used for both, but they’re not in the same class. And, you know we do take our arachnids pretty seriously here at the poison center so…

[Victoria laughs]

Chris: Yeah, so we won’t get into the full differences, just know that insects and arachnids are not the same thing. What else did you want to go over?

Victoria: So you had all mentioned the CDC as a great resource to learn more about the different diseases that arthropods can carry and transmit to people. I just wanted to mention that if our listeners want more information about repellants, epa.gov is a great resource for that.

Chris: We went over a couple brief products, and if you go on EPA’s website they have information on registered repellants, versus non-registered, and it really is a great resource. We did do a bit of reviewing on our end. I think there was one last point that we wanted to go over?

Victoria: Yeah, lastly, if any of our listeners do find themselves in need of any of the over the counter remedies that we had talked about, we do encourage folks to reach out to their providers if they’re feeling unwell. And, if you do find yourself in the pharmacy and have questions about products, the pharmacist there is also a great resource. But, of course, people can call us as well if they have other questions.

Chris: Is that all we had as far as criticisms, so far?

[Victoria laughs]

Victoria: Yes, that is all I had.

Chris: Yeah? Okay, well again stay tuned for episode 3, should be coming out in a couple weeks. Again, you can always call us at 1-800-222-1222, you can chat with us at nnepc.org, and text ‘POISON’ to 85511. Thanks for joining us Victoria.

Posted in Poison Center Pointers Podcast, Poison Prevention | Comments Off on Poison Center Pointers: Insects and Repellents

Introducing Poison Center Pointers, a podcast from the NNEPC’s poison specialists

We are pleased to announce the launch of Poison Center Pointers, a podcast brought to you by the specially trained professionals who answer your calls on the poison help line at the NNEPC.

What is it like working for a poison control center? What types of calls do we get? Get insights straight from the experts themselves while learning about ways you can avoid poisonings, and what to do in cases of possible poisoning.

Our first episode provides an introduction to poison centers and your local center, the NNEPC. Visit our podcast home page on Podbean to subscribe, or find Poison Center Pointers on Amazon Music, Apple Podcasts, Google Podcasts or Spotify.

TRANSCRIPT

Disclaimer: Poison Center Pointers is brought to you by the Northern New England Poison Center. This podcast is NOT to replace timely advice or recommendations. If you have an actual poisoning emergency, scenario or question, contact the Northern New England Poison Center by calling 1-800-222-1222, texting the word POISON to 85511, or chatting online at nnepc.org

Welcome to Poison Center Pointers, a podcast presented to you by the Northern New England Poison Center. ♪upbeat music♪

Chris: Hello to all our listeners, and welcome to the first ever episode of Poison Center Pointers, a podcast presented to you by the Northern New England Poison Center. My name is Chris, I am one of the specialists in poison information, and I am joined by two of my co-hosts and colleagues, Karlee and Carolyn. Thanks for being here, guys.

Karlee: Yeah, hi everybody!

Carolyn: Yeah, thanks for having us.

Chris: In this room we have a couple decades of experience here. A couple of those decades do come from Carolyn…

Carolyn: Thanks, Chris…

[laughter]

Chris: We decided to start a podcast here to share our knowledge and experience dealing with everyday situations we help manage at the poison center. Our goal is to keep the community safe by preventing a poisoning, but also making sure that you know what to do if a poisoning occurs. We’re hoping with the podcast we can provide some entertainment value along the way.

Carolyn: Maybe…

Karlee: We think we’re pretty funny!

Chris: That may be a judgement… [laughter] With our inaugural episode we figured we should probably start with the basics, and go over a few kind of key points here. Namely, I wanted to cover who works at the Northern New England Poison Center, what exactly is it that a poison center does, why should you call the poison center, and how do you get in contact with a poison center. So without further ado, Carolyn would you like to take it away and talk about who works here?

Carolyn: Sure, Chris. Most of the people who work here are nurses and pharmacists. Everybody is pretty much trained in health care, but more importantly we are specialists and uniquely trained in poison information and poison emergencies.

Karlee: Yes, and we are here all the time, 24/7…

Chris: 365…

Karlee: Yes, exactly. And, we take calls from the general public and various healthcare professionals, whether it be an emergency department or primary care office. We cover Maine, Vermont and New Hampshire.

Chris: Thus, Northern New England Poison Center. We’re one of 55 accredited poison centers across the United States. So, that’s just kind of a brief overview of who works is here, but we do want to cover what exactly the Northern New England Poison Center does. So Carolyn, do you want to expand on that?

Carolyn: Sure, before I talk about what a poison center does, let’s talk a little bit about what is a poison. Most people don’t really realize what the poison is, or what does it mean when you work at a poison center. A poison isn’t just a referring to a poisonous snake or a poisonous spider, ‘cause luckily we don’t really have many of those around here, if any.

Karlee: Yeah, that’s why I live here.

[laughter]

Carolyn: We appreciate that! But, a poison is anything that can cause harm. Whether it means it gets on your skin and causes a rash, or because you inhale it, or swallow it, or get it in the eye.

So, we deal with all of those, we don’t just deal with things that people swallow that they’re not supposed to, although that’s more common. We can tell you, for example, how to flush an eye over the phone. And we deal with poisons whether they are from around the home, or whether they’re in the workplace, or a medication error, or whether it’s something from the environment—any of those things! And you know, people often think that we just deal with children. We really don’t, we deal with anybody. You know, if you double dose your med by accident we’re going to be able to help you with that, or any of that kind of information.

Chris: If you are wondering if we can help, just call and we will always try our best to. You know, Karlee I think we should bring up, does it have to be an emergency for the public to reach out to us?

Karlee: No, good point. It doesn’t have to be an emergency and it doesn’t even have to be an exposure. We like to promote prevention here obviously, so you know if you’re thinking about maybe bringing something into an environment where there’s an individual who could be exposed. For example, you know you’re buying a new house plant and you have kiddos around. We can give you some toxicity information in general about the plant, and you can kind of use that to make decisions.

Chris: I think a lot of familiarity with poison centers just extends from getting a product and looking on the back and seeing that label that says “If swallowed, call the poison center, or 1-800-222-1222.” There isn’t as much familiarity with what exactly it’s like to call a poison center so, do we kind of want to go into what that experience is like?

Karlee: Yeah! It’s not just you know, you call us and we say and “That’s probably poisonous. Bye!”

[Laughter]

Carolyn: That would make our job a lot easier!

[Laughter]

Karlee: No, we really do a lot more for you than that. We will assess the situation, that’s what we’re trained for. We’ll triage to determine if you can be managed at home or if you do need to go into a health care facility.

Chris: Yeah, going along with that we should probably get into why we feel it’s important the community is aware of us, and why exactly they should call us. So do we kind of want to go into that as well?

Carolyn: Sure, so first of all, when you call the poison center, the person you are speaking with, the person who answers the phone, is the person who can help you. You don’t have to wait, it’s very quick. It’s one-on-one service and we’re not managing five other calls at the same time.

We’re talking to you and we’re going to deal with your emergency or your question. So it’s one-on-one, it’s quick, it’s confidential, judgement-free—we really are there to help.

Karlee: Yep, and aside from just good quality care, other perks are that we can save you time and money. So the time aspect, I mean that we get a lot of calls from people who say that they’ve been researching something for upwards of 30 minutes to an hour online and can’t really find anything. Well, we do have evidenced-based sources to kind of give you accurate and timely information.

Carolyn: Right. A lot of times when you look on the internet you see the worst case scenario. It doesn’t take into account how much, how old is the person, you know what exactly happened, and we can access all that, and we can do it very quickly.

Chris: Along with time we even have situations where people are worried that they need to run into the emergency department for something that’s, you know, not as much of an issue from our perspective. And we’re happy to let you know that, so—saves time, saves money.

Carolyn: Right, absolutely.

Chris: A fun fact that we like to say here is that for every dollar invested in a poison center saves $13 on the healthcare system. So, pretty good return on investment.

Carolyn: It’s pretty significant.

Chris: Carolyn also brought up one-on-one personalized care. We will follow up with you on the phone. We handle about 30,000 calls here yearly at the Northern New England Poison Center, and 9 out of 10 are just managed over the phone.

Carolyn: Right! We can save you that trip to the doctor or the emergency room. And we can let you—we will tell you if you need to go.

Karlee: Yep.

Chris: Right. I think the most important thing we could go over in this introductory episode however, is how exactly the communities we serve can get in contact with us. So, what’s the most common way?

Karlee: The most common is right over the phone, people calling us. So get out your pens, and write it down. The number is 1-800-222-1222. That is the national number but if you are in Maine, Vermont, or New Hampshire you’ll be routed to us. And you know if you call us, we will send you a magnet—stick it on your fridge.

Chris: We have pill reminder boxes too.

Carolyn: Lots of good stuff!

Chris: How about for the more tech savvy members of our community?

Carolyn: Sure, let me just mention that if you call we do have an interpreter service available as well, just so you know that. But you know, if you’d rather chat, you can chat through our website at nnepc.org, as in Northern New England Poison Center.org. Or, you can text POISON to 85511.

Chris: Well that’s the majority of, really, what we wanted to cover here in this introductory episode. But you know we do plan to have a lot in store, and we’re hoping to release episodes regularly. Any ideas on those topics we should be covering soon?

Karlee: Yeah we’re excited to expand on lots of different things. I think, you know, seasonal—sort of summer or fall, or even around the holidays, just certain things you should be aware of.

Carolyn: Yeah I mean we can do things like—we could do a whole podcast on mushrooms and berries, or carbon monoxide, or what children tend to get into and how to deal with that, so, we have a lot of ideas.

Chris: Yeah, so, plenty of material to work from, but we do want to say thanks again for listening to the first episode of Poison Center Pointers.

Carolyn: Yeah, thanks everybody!

Karlee: Thanks!

Chris: You can like, share, and subscribe to us on Facebook and Twitter, and again visit our website at nnepc.org, and if you have feedback or topics you’d like us to cover you can certainly send it to us.

Carolyn: Yeah, that’d be great.

Chris: But remember if you have an actual poisoning emergency, scenario, or even just a question contact the Northern New England Poison Center by calling 1-800-222-1222, text the word POISON to 85511, or chat online at nnepc.org. So, on behalf of Karlee, Carolyn and I, thank you so much for joining us today.

♪upbeat music♪

Posted in Poison Center Pointers Podcast, Poison Prevention, Regional News | Comments Off on Introducing Poison Center Pointers, a podcast from the NNEPC’s poison specialists

NNEPC notes increase in self-harm cases among young teens

The NNEPC has noted a significant increase in self-harm-related poisonings among children 16 years old and younger over the past several months in Maine, New Hampshire and Vermont.

From October 2020 to May 2021, the center managed 560 cases of self-harm among patients in this age range, more than 50% more cases than average for an eight-month span. The increase comes after self-harm cases in this age group fell slightly during the first few months of the COVID-19 pandemic.

The increase has been most significant among patients 13 and 14 years old, with the average number of cases per month during this period (30) nearly double the monthly average from 2017 to 2019 (16).

Graph showing increase in self-harm among 13-14-year-oldsMonthly cases among patients younger than 13 also nearly doubled, though the number of cases remained small (7 per month), while the number of cases involving 15- and 16-year-olds increased by a third (33 cases per month from October to May versus 25 per month from 2017-2019).

Graph showing increase in self-harm among 15-16-year-oldsThe increase in self-harm cases was mostly due to attempts by girls.

  • Girls accounted for 85% of the patients during this eight-month period.
  • The average number of cases per month involving girls during this period was 65% higher (59) than the average from 2017-2019 (36). The number of cases involving boys rose only slightly (11 vs 9 per month).

NNEPC self-harm-related poisonings have fallen overall since the beginning of the pandemic, and within most age groups the number of cases has remained well below 2017-2019 levels in recent months, making this increase among young people even more notable.

Young patients attempting self-harm are most likely to take medications that are easily accessible, such as their own medications for depression and over-the-counter medications found in the family medicine cabinet. Some over-the-counter medications can be dangerous in overdose. Parents and caregivers of youth in these age groups should consider keeping their medications locked up or otherwise inaccessible.

In addition, parents, teachers and others who work with youth in these age groups should be familiar with the risk factors and warning signs for self-harm and resources available for help.

The National Suicide Prevention Lifeline is available 24 hours a day to provide free and confidential support for people in distress, as well as prevention resources for those close to them. Call 1-800-273-8255 or visit suicidepreventionlifeline.org to chat online or get more information. Other resources include:

The NNEPC is available 24/7 at 1-800-222-1222 to provide fast, expert advice in cases of possible poisoning, and to answer questions about medications and other potential poisons.

Further reading: Similar national trends were noted in a June issue of the CDC’s Morbidity and Mortality Report.

 

 

 

Posted in Data, Poison Prevention, Regional News | Comments Off on NNEPC notes increase in self-harm cases among young teens

Preparing for a new baby: Steps for avoiding accidental poisonings

If you are expecting a new baby or have young children in your home, taking steps to prevent accidental poisonings is a crucial part of home safety. Many common items in and around your home may be poisonous, presenting risks for newly crawling or walking babies, who explore the world by touching things and putting them in their mouth.

The most common things babies get into while exploring like this are medications, vitamins and supplements, cleaning products, personal care products such as hand sanitizer and deodorant, toys and foreign objects, plants and mushrooms, and pesticides like ant traps and bug spray.

Some of the most serious poisonings involve prescription pain medications, marijuana, ADHD medications, cough and cold medications, and certain foreign objects like batteries, magnets and ammunition.

Following the safety tips below can help prevent many poisonings. Kids act fast, though, and sometimes despite our best efforts they will get into something, or we’ll make a mistake when giving them medication. That’s why it’s important to have the poison center number saved in your phone: 1-800-222-1222. The poison center is staffed by specially trained nurses and pharmacists who provide fast, expert help at no cost to you. With help from the poison center, 95% of poisonings involving young children can be treated at home. You can also reach us by text message by sending the word POISON to 85511 or by chatting live with our poison experts here on our website.

Making your home safer

Tips for home safety and medication safety:

  • Store all potential poisons up high, out of reach of children, in a locked cabinet if possible. Keep purses, luggage and diaper bags out of reach of children as well.
  • Store products in their original containers, and keep all nonfood items separate from food and drink.
  • Put the cap back on immediately and put products away as soon as you are finished using them.
    Be sure to replace the safety cap tightly right after using a product

    Image from the Up and Away campaign. Visit their site for more resources related to safe storage.

  • Read the label on medications, cleaners and other products, and carefully follow the instructions each time you use them.
  • When giving medication to a child, use the measuring tool provided with the medication or another marked measuring tool like a teaspoon or tablespoon. Do not use silverware or serving spoons.
  • Do not call medication “candy.”
  • Get rid of products you no longer need, such as expired medications or old pesticides, safely and promptly. Call your town office for guidance on disposal.
  • Be prepared for poison emergencies: store the poison center’s number, 1-800-222-1222, in your phone contacts and put a magnet on your refrigerator. Request a magnet online or by calling the hotline.

The NNEPC was pleased to assist Safe Kids VT with its Preparing for Baby booklet, which featured a modified version of this post. Download the booklet from the UVM Medical Center Safe Kids page.

 

Posted in Medication Safety, Poison Prevention | Comments Off on Preparing for a new baby: Steps for avoiding accidental poisonings