Download 2004 Annual Report of the American Association of Poison Control

Toxicology
A special contribution from the American
Association of Poison Control Centers.
2004 Annual Report of the
American Association of Poison Control Centers
Toxic Exposure Surveillance System
William A. Watson PharmD, Toby L. Litovitz MD, George C. Rodgers Jr MD, PhD,
Wendy Klein-Schwartz PharmD, MPH, Nicole Reid MEd, Jessica Youniss MBA,
Anne Flanagan MS, Kathleen M. Wruk MHS
1. Introduction
Toxic Exposure Surveillance System (TESS) data are
compiled by the American Association of Poison Control
Centers (AAPCC) on behalf of the US poison centers.
These data are used to identify hazards early, focus
prevention education, guide clinical research, direct training, and detect chemical/bioterrorism incidents. TESS data
have prompted product reformulations, repackaging, recalls,
and bans; are used to support regulatory actions; and form
the basis of postmarketing surveillance of newly released
drugs and products.
The American Association of Poison Control Centers gratefully acknowledges the generous financial contribution of McNeil Consumer and Specialty
Pharmaceuticals in support of the compilation and production of this report. The compilation of these data was also supported, in part, by the US Centers for
Disease Control and Prevention, Cooperative Agreement U50/CCU323406-02.
US poison centers make possible the compilation and reporting of this comprehensive description of human exposures to potentially toxic substances
through their meticulous documentation of each case using standardized definitions and compatible computer systems. Participating centers include the
Regional Poison Control Center, Birmingham, AL; Alabama Poison Center, Tuscaloosa, AL; Arizona Poison and Drug Information Center, Tucson, AZ;
Banner Poison Control Center, Phoenix, AZ; Arkansas Poison and Drug Information Center, Little Rock, AK; California Poison Control System–Fresno/
Madera Division, CA; California Poison Control System–Sacramento Division, CA; California Poison Control System–San Diego Division, CA; California
Poison Control System–San Francisco Division, CA; Rocky Mountain Poison and Drug Center, Denver, CO; Connecticut Poison Control Center, Farmington,
CT; National Capital Poison Center, Washington, DC; Florida Poison Information Center, Tampa, FL; Florida Poison Information Center, Jacksonville, FL;
Florida Poison Information Center, Miami, FL; Georgia Poison Center, Atlanta, GA; Illinois Poison Center, Chicago, IL; Indiana Poison Center, Indianapolis, IN; Iowa Statewide Poison Control Center, Sioux City, IA; Mid-America Poison Control Center, Kansas City, KA; Kentucky Regional Poison Center,
Louisville, KY; Louisiana Drug and Poison Information Center, Monroe, LA; Northern New England Poison Center, Portland, ME; Maryland Poison Center,
Baltimore, MD; Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA; Children’s Hospital of Michigan
Regional Poison Control Center, Detroit, MI; DeVos Children’s Hospital Regional Poison Center, Grand Rapids, MI; Hennepin Regional Poison Center,
Minneapolis, MN; Mississippi Regional Poison Control Center, Jackson, MS; Missouri Regional Poison Center, St Louis, MO; Nebraska Regional Poison
Center, Omaha, NE; New Hampshire Poison Information Center, Lebanon, NH; New Jersey Poison Information and Education System, Newark, NJ; New
Mexico Poison and Drug Information Center, Albuquerque, NM; New York City Poison Control Center, New York, NY; Long Island Regional Poison and
Drug Information Center, Mineola, NY; Finger Lakes Regional Poison and Drug Information Center, Rochester, NY; Central New York Poison Center,
Syracuse, NY; Western New York Poison Center, Buffalo, NY; Carolinas Poison Center, Charlotte, NC; Cincinnati Drug and Poison Information
Center, Cincinnati, OH; Central Ohio Poison Center, Columbus, OH; Greater Cleveland Poison Control Center, Cleveland, OH; Oklahoma Poison Control
Center, Oklahoma City, OK; Oregon Poison Center, Portland, OR; Pittsburgh Poison Center, Pittsburgh, PA; The Poison Control Center, Philadelphia, PA;
Palmetto Poison Center, Columbia, SC; Tennessee Poison Center, Nashville, Tenn; Southern Poison Center, Memphis, TN; Central Texas Poison Center,
Temple, TX; North Texas Poison Center, Dallas, TX; Southeast Texas Poison Center, Galveston, TX; Texas Panhandle Poison Center, Amarillo, TX; West
Texas Regional Poison Center, El Paso, TX; South Texas Poison Center, San Antonio, TX; Utah Poison Control Center, Salt Lake City, UT; Virginia Poison
Center, Richmond, VA; Blue Ridge Poison Center, Charlottesville, VA; Washington Poison Center, Seattle, WA; West Virginia Poison Center, Charleston, WV;
and Children’s Hospital of Wisconsin Poison Center, Milwaukee, WI.
Reprints are available at a cost of $10 each. Address requests to AAPCC, 3201 New Mexico Ave, Suite 330, Washington, DC 20016.
0735-6757/$ – see front matter D 2005 American Association of Poison Control Centers. Published by Elsevier Inc. All rights reserved.
doi:10.1016/j.ajem.2005.05.001
590
Table 1A
W.A. Watson et al.
2. Characterization of participating centers
Growth of the AAPCC TESS
Year
No. of
participating
centers
Population
served
(in millions)
Human
exposures
reported
Exposures
per thousand
population
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Total
16
47
56
57
63
64
70
72
73
68
64
65
67
67
66
65
64
63
64
64
64
62
43.1
99.8
113.6
132.1
137.5
155.7
182.4
191.7
200.7
196.7
181.3
215.9
218.5
232.3
250.1
257.5
260.9
270.6
281.3
291.6
294.7
293.7
251 012
730 224
900 513
1 098 894
1166 940
1 368 748
1 581 540
1 713 462
1 837 939
1 864 188
1 751 476
1 926 438
2 023 089
2 155 952
2 192 088
2 241 082
2 201156
2 168 248
2 267 979
2 380 028
2 395 582
2 438 644
38 655 222
5.8
7.3
7.9
8.3
8.5
8.8
8.7
8.9
9.2
9.5
9.7
8.9
9.3
9.3
8.8
8.7
8.4
8.0
8.1
8.2
8.1
8.3
From its inception in 1983, TESS has grown dramatically,
with increases in the number of participating poison centers,
population served by those centers, and reported human
exposures (Table 1A) [1- 21].
The cumulative AAPCC database now contains
38.7 million human poison exposure cases. This report
includes 2 438 644 human exposure cases reported by
62 participating poison centers during 2004, an increase of
1.8% compared to 2003. The data do not directly identify a
trend in the overall incidence of poisonings in the United
States because the percentage of poisonings reported to
poison centers is unknown (Fig. 1).
Of the 62 reporting centers, 60 submitted data for the
entire year. Fifty-two of the 62 participating centers were
certified as regional poison centers by the AAPCC at the
end of 2004. The annual human exposure case volume by
center ranged from 12 124 to 111 242 (mean 40 521) for
centers participating for the entire year. The number of
human poison exposure cases reported per 1000 population
per year was calculated by state and ranged from 5.5 to 18.1
(mean 8.3) reported exposures per 1000 population.
The entire population of the 50 states and the District of
Columbia (293.7 million) was served by the participating
centers. Extrapolations from the number of reported poison
exposures to the number of actual poisonings occurring
annually in the United States cannot be made from these data
alone, as considerable variations in poison center penetrance
were noted. Indeed, assuming all centers reached the
penetrance level of 18.1 poison exposures per 1000 population reported for 1 state, 5.3 million poison exposures
would have been reported to poison centers in 2004.
Although this report focuses on the human exposure cases
reported to TESS in 2004, the database also contains data (not
presented here) on animal poison exposures (139 769 cases,
primarily companion animals), human confirmed nonexposures (7797), animal confirmed nonexposures (407), and
information calls (1 278 649). An additional 4009 duplicate
reports (reported to more than 1 participating poison center)
were excluded. This total of 3 865 266 cases and information
calls reported to TESS in 2004 does not reflect the full extent
of poison center effort. In addition, nearly 2.8 million followup calls were placed by poison centers during the year to provide further patient guidance, confirm compliance with
recommendations, and gather final outcome data. Followups were done in 44.8% of human exposure cases. One
Human Exposures, Animal Exposures, and Information Calls Reported to TESS, 2000-2004
8000
Cases or Calls per Day
7000
Human Exposures
6000
5000
4000
3000
Information Calls
2000
1000
Animal Exposures
1/
1/
20
4/ 00
1/
20
7/ 00
1/
20
10 00
/1
/2
0
1/ 00
1/
20
4/ 01
1/
20
7/ 01
1/
20
10 01
/1
/2
0
1/ 01
1/
20
4/ 02
1/
20
7/ 02
1/
20
10 02
/1
/2
0
1/ 02
1/
20
4/ 03
1/
20
7/ 03
1/
20
10 03
/1
/2
0
1/ 03
1/
20
4/ 04
1/
20
7/ 04
1/
20
10 04
/1
/2
0
1/ 04
1/
20
05
0
Date
Fig. 1 Daily count of human poison exposures, animal poison exposures, and information calls reported to US poison control centers, 2000
to 2004.
2004 AAPCC Annual Report
Table 1B
591
Distribution of information calls
Information call type
No. of calls %
Drug identification
Public inquiry: drug sometimes involved in abuse
279 703
Public inquiry: drug not known to be abused
180 210
Public inquiry: unknown abuse potential
12 567
Public inquiry: unable to identify
80 697
Health professional inquiry: drug sometimes involved
19 768
in abuse
Health professional inquiry: drug not known to
36 652
be abused
Health professional inquiry: unknown abuse potential
2822
Health professional inquiry: unable to identify
16 655
Law enforcement inquiry: drug sometimes involved
47 149
in abuse
Law enforcement inquiry: drug not known to be abused
28 068
Law enforcement inquiry: unknown abuse potential
1678
Law enforcement inquiry: unable to identify
11 558
Other drug identification
5733
Subtotal
723 260
Drug information
Adverse effects (no known exposure)
18 814
Brand/generic name clarifications
5117
Calculations
384
Compatibility of parenteral medications
365
Compounding
1129
Contraindications
2257
Dietary supplement, herbal, and homeopathic
1904
Dosage
15 438
Dosage form/formulation
4440
Drug use during breast-feeding
8078
Drug-drug interactions
33 721
Drug-food interactions
1970
Foreign drug
2808
Generic substitution
722
Indications/therapeutic use
27 178
Medication administration
3425
Medication availability
3127
Medication disposal
808
Pharmacokinetics
4166
Pharmacology
2873
Regulatory
2115
Stability/storage
3354
Therapeutic drug monitoring
1169
Other drug information
34 312
Subtotal
179 674
Environmental information
32 914
Medical information
33 699
Occupational information
1860
Poison information
106 863
Substance abuse
12 423
Teratogenicity information
5921
Other information
44 090
Administrative (optional)
23 742
Caller referred (optional)
60 709
Prevention/safety/education (optional)
53 494
Total
1 278 649
21.87
14.09
0.98
6.31
1.55
2.87
0.22
1.30
3.69
2.20
0.13
0.90
0.45
56.56
1.47
0.40
0.03
0.03
0.09
0.18
0.15
1.21
0.35
0.63
2.64
0.15
0.22
0.06
2.13
0.27
0.24
0.06
0.33
0.22
0.17
0.26
0.09
2.68
14.05
2.57
2.64
0.15
8.36
0.97
0.46
3.45
1.86
4.75
4.18
100.00
Overall, the volume of information calls handled by US
poison centers increased 9.5% from 2003 to 2004.
The most frequent information call was for drug identification, comprising 723 260 calls to poison centers during
the year. Of these, 108 910 (15.1%) could not be identified
over the telephone. Of the drug identification calls, 76.5%
were received from the public, 10.5% from health professionals, and 12.2% from law enforcement. Forty-eight
percent of drug identification requests involved drugs
sometimes involved in abuse; however, these cases were
categorized based on the abuse potential, generally without
knowledge of whether abuse was actually intended.
Drug information calls (179 674 calls) comprised 14.1%
of all information calls. Of these, 18.8% were questions
about drug-drug interactions, 15.1% were questions about
therapeutic use and indications, and 10.5% were questions
about adverse effects. Environmental inquiries comprised
2.6% of all information calls. Of these, 20.3% related to
cleanup of mercury thermometers, and 11.3% involved
pesticides. Poison information comprised 8.4% of information calls, with 11.9% of these involving food poisoning or food preparation practices and 10.0% involving
plant toxicity.
3. Review of the data
No changes to the data collection format were implemented in 2004. Prior revisions occurred in 1984, 1985,
1993, 2000, 2001, and 2002. Data reported after January 1,
2000, allow an unlimited number of substances for each
case, a factor that should be considered when comparing
substance data with prior years.
Of the 2 438 644 human exposures reported in 2004,
92.7% occurred at a residence (Table 2). Exposures occurred
in the workplace in 2.0% of cases, in schools (1.4%), health
care facilities (0.3%), and restaurants or food services
(0.4%). Poison center peak call volumes were from 4 to
11 pm, although call frequency remained consistently high
between 8 am and midnight, with 89.8% of calls logged
during this 16-hour period. The average number of human
poison exposure consultations handled per day by all
participating US poison centers was 6663. Higher volumes
Table 2
follow-up call was made in 22.2% of human exposure cases,
and multiple follow-up calls (range 2-111) were placed in
22.6% of cases.
A total of 1 278 649 information calls were reported to
TESS in 2004, including 137 945 calls coded in optional
reporting categories such as administrative, immediate
referral, and prevention/safety/education (Table 1B). These
latter call types were reported inconsistently as they were not
required to be reported by participating poison centers.
Site of caller and site of exposure, human exposure cases
Residence
Own
Other
Health care facility
Workplace
School
Public area
Restaurant/food service
Other
Unknown
Site of caller (%)
Site of exposure (%)
75.6
2.4
14.3
1.4
0.6
0.4
0.0
4.9
0.3
89.7
3.0
0.3
2.0
1.4
1.1
0.4
0.9
1.1
592
Table 3
W.A. Watson et al.
Age and sex distribution of human exposure cases
Age (y)
Male
b1
1
2
3
4
5
Unknown child V 5
6-12
13-19
Unknown child
Total children (b 20)
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90-99
Unknown adult
Total adults
Unknown age
Total
Female
Unknown
Cumulative total
Row %
No.
Row %
No.
Row %
No.
Col %
No.
Col %
72 230
208 082
209 872
96 696
46 934
26 892
2278
89 276
78 372
2869
833 501
87 592
71128
60 668
36 469
18 899
12 922
6885
1025
45 821
341 409
4578
1179 488
51.6
52.0
52.6
55.0
56.2
56.6
47.6
57.5
44.5
40.5
52.5
45.0
42.3
41.4
38.7
36.2
34.5
31.5
27.8
39.1
40.9
33.0
48.4
67 182
191 606
188 167
78 812
36 426
20 417
1956
65 056
96 985
2480
749 087
106 772
96 809
85 759
57 637
33 251
24 529
14 990
2661
67 425
489 833
5856
1 244 776
48.0
47.9
47.2
44.8
43.6
43.0
40.9
41.9
55.1
35.0
47.1
54.9
57.6
58.5
61.2
63.7
65.5
68.5
72.1
57.5
58.6
42.2
51.0
522
559
654
333
187
178
553
906
730
1738
6360
252
151
105
62
30
18
17
5
3950
4590
3430
14 380
0.4
0.1
0.2
0.2
0.2
0.4
11.6
0.6
0.4
24.5
0.4
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
3.4
0.6
24.7
0.6
139 934
400 247
398 693
175 841
83 547
47 487
4787
155 238
176 087
7087
1 588 948
194 616
168 088
146 532
94 168
52 180
37 469
21 892
3691
117 196
835 832
13 864
2 438 644
5.7
16.4
16.4
7.2
3.4
2.0
0.2
6.4
7.2
0.3
65.2
8.0
6.9
6.0
3.9
2.1
1.5
0.9
0.2
4.8
34.3
0.6
100.0
139 934
540 181
938 874
1114 715
1198 262
1 245 749
1 250 536
1 405 774
1 581 861
1 588 948
1 588 948
1 783 564
1 951 652
2 098 184
2 192 352
2 244 532
2 282 001
2 303 893
2 307 584
2 424 780
2 424 780
2 438 644
2 438 644
5.7
22.2
38.5
45.7
49.1
51.1
51.3
57.7
64.9
65.2
65.2
73.1
80.0
86.0
89.9
92.0
93.6
94.5
94.6
99.4
99.4
100.0
100.0
were observed in the warmer months, with a mean of 7007
consultations per day in July compared with 6184 per day in
December. On average, ignoring time of day and seasonal
fluctuations, US poison centers handled 1 poison exposure
every 13 seconds.
The age and sex distribution of human poison exposure
victims is outlined in Table 3. Children younger than 3 years
were involved in 38.5% of cases, and 51.3% occurred in
children younger than 6 years. A male predominance is found
among poison exposure victims younger than 13 years,
but the sex distribution is reversed in teenagers and adults.
Of all poison exposures captured, 8431 occurred in pregnant women. Of those with known pregnancy duration,
32.0% occurred in the first trimester, 37.6% in the second
Table 4
Total
No.
trimester, and 30.5% in the third trimester. In 5.3% of cases
(130 056 cases), multiple patients were implicated in the
poison exposure episode (eg, siblings bsharedQ a household
product, or multiple patients inhaled vapors at a hazardous
material spill).
Fatalities differed from the total exposure data set in
several ways. Table 4 presents the age and sex distribution
for the 1183 reported fatalities. Although responsible for the
majority of poisoning reports, children younger than 6 years
comprised just 2.3% (27) of the fatalities. Fifty-six percent
of poisoning fatalities occurred in 20- to 49-year-old
individuals. A single substance was implicated in 91.4% of
reports, and 2.9% of patients were exposed to more than 2
possibly poisonous drugs or products (Table 5). In contrast,
Distribution of age and sex for 1183 fatalities
Age (y)
Male
Female
b1
1
2
3
4
5
Unknown child (b6)
6-12
13-19
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90-99
Unknown adult
Unknown
Total
2
7
4
2
1
1
0
5
49
116
106
124
102
31
26
11
0
21
4
612
2
2
2
0
0
2
0
11
41
79
103
140
80
35
33
15
5
11
2
563
Unknown
Total (%)
1
0
0
0
0
0
1
0
0
0
0
0
0
1
0
0
0
0
5
8
5 (0.4)
9 (0.8)
6 (0.5)
2 (0.2)
1 (0.1)
3 (0.3)
1 (0.1)
16 (1.4)
90 (7.6)
195 (16.5)
209 (17.7)
264 (22.3)
182 (15.4)
67 (5.7)
59 (5.0)
26 (2.2)
5 (0.4)
32 (2.7)
11 (0.9)
1183 (100.0)
Cumulative total (%)
5 (0.4)
14 (1.2)
20 (1.7)
22 (1.9)
23 (1.9)
26 (2.2)
27 (2.3)
43 (3.6)
133 (11.2)
328 (27.7)
537 (45.4)
801 (67.7)
983 (83.1)
1050 (88.8)
1109 (93.7)
1135 (95.9)
1140 (96.4)
1172 (99.1)
1183 (100.0)
1183 (100.0)
2004 AAPCC Annual Report
Table 5
593
Number of substances involved in human exposure cases
No. of substances
No. of cases
% Of cases
1
2
3
4
5
6
7
8
z9
Total
2 229 172
139 122
40 995
15 960
6656
3018
1662
828
1231
2 438 644
91.4
5.7
1.7
0.7
0.3
0.1
0.1
0.0
0.1
100.0
50.6% of fatal cases involved 2 or more drugs or products.
The overwhelming majority of human exposures were acute
(91.9%) compared with 55.9% of poison-related fatal exposures. Chronic exposures comprised 1.8% of all poison exposure reports, and acute-on-chronic exposures comprised 5.5%.
(Chronic exposures were defined as continuous or repeated
exposures occurring over a period exceeding 8 hours.)
Reason for exposure was coded according to the
following definitions:
Unintentional general: All unintentional exposures not
otherwise defined below. Most unintentional exposures
in children are reported here.
Environmental: Any passive, nonoccupational exposure
that results from contamination of air, water, or soil.
Environmental exposures are usually caused by manmade contaminants.
Occupational: An exposure that occurs as a direct result
of the person being on the job or in the workplace.
Therapeutic error: An unintentional deviation from a
proper therapeutic regimen that results in the wrong dose,
incorrect route of administration, administration to the
wrong person, or administration of the wrong substance.
Only exposures to medications or products used as
medications are included. Drug interactions resulting
from unintentional administration of drugs or foods
which are known to interact are also included.
Unintentional misuse: Unintentional improper or incorrect use of a nonpharmaceutical substance. Unintentional
misuse differs from intentional misuse in that the
exposure was unplanned or not foreseen by the patient.
Bite/sting: All animal bites and stings, with or without
envenomation, are included.
Food poisoning: Suspected or confirmed food poisoning;
ingestion of food contaminated with microorganisms
is included.
Unintentional unknown: An exposure determined to be
unintentional, but the exact reason is unknown.
Suspected suicidal: An exposure resulting from the
inappropriate use of a substance for reasons that are
suspected to be self-destructive or manipulative.
Intentional misuse: An exposure resulting from the intentional improper or incorrect use of a substance for reasons
other than the pursuit of a psychotropic or euphoric effect.
Intentional abuse: An exposure resulting from the
intentional improper or incorrect use of a substance
where the victim was likely attempting to achieve a
euphoric or psychotropic effect. All recreational use of
substances for any effect is included.
Intentional unknown: An exposure that is determined to
be intentional, but the specific motive is unknown.
Contaminant/tampering: The patient is an unintentional
victim of a substance that has been adulterated (either
maliciously or unintentionally) by the introduction of an
undesirable substance.
Malicious: This category is used to capture patients who
are victims of another person’s intent to harm them.
Withdrawal: Effect related to decline in blood concentration of a pharmaceutical or other substance after
discontinuing therapeutic use or abuse of that substance.
Adverse reaction: An adverse event occurring with
normal, prescribed, labeled, or recommended use of the
product, as opposed to overdose, misuse, or abuse.
Included are cases with an unwanted effect because of an
allergic, hypersensitive, or idiosyncratic response to the
active ingredients, inactive ingredients, or excipients.
Concomitant use of a contraindicated medication or food
is excluded and coded instead as a therapeutic error.
The vast majority (84.1%) of poison exposures were
unintentional; suicidal intent was present in 8.0% of cases
(Table 6A). Therapeutic errors comprised 9.1% of exposures
(222 644 cases), with unintentional nonpharmaceutical
product misuse comprising another 3.9% of exposures.
Table 6A
Reason for human exposure cases
Reason
Unintentional
General
Therapeutic error
Misuse
Bite/sting
Environmental
Food poisoning
Occupational
Unknown
Subtotal
Intentional
Suspected suicidal
Abuse
Misuse
Unknown
Subtotal
Other
Malicious
Contamination/tampering
Withdrawal
Subtotal
Adverse reaction
Drug
Food
Other
Subtotal
Unknown
Total
No.
%
1 511 748
222 644
96 124
89 562
55 725
36 851
34 452
3496
2 050 602
62.0
9.1
3.9
3.7
2.3
1.5
1.4
0.1
84.1
196 164
45 562
43 514
16 014
301 254
8.0
1.9
1.8
0.7
12.4
9291
4592
1022
14 905
0.4
0.2
0.0
0.6
42 812
5319
13 123
61 254
10 629
2 438 644
1.8
0.2
0.5
2.5
0.4
100.0
594
W.A. Watson et al.
Table 6B
Scenarios for therapeutic errors
Inadvertently took/given medication twice
Other incorrect dose
Wrong medication taken/given
Inadvertently took/given someone else’s medication
Medication doses given/taken too close together
Other/unknown therapeutic error
Confused units of measure
Incorrect dosing route
Incorrect formulation or concentration given
More than 1 product containing same ingredient
Dispensing cup error
Health professional/iatrogenic error
Incorrect formulation or concentration dispensed
10-Fold dosing error
Drug interaction
Exposure through breast milk
No. of cases
b6 y
(Row %)
6-12 y
(Row %)
13-19 y
(Row %)
N19 y
(Row %)
Unknown
(row %)
74 028
31159
29 245
23 034
18 194
13 277
9146
7043
6988
5928
5120
4053
1816
1301
976
145
25.4
38.0
18.5
21.1
25.6
24.8
61.0
15.4
53.0
33.4
64.2
31.1
45.6
65.0
11.0
93.8
12.8
12.6
12.6
18.8
10.5
11.2
14.6
6.6
16.8
15.4
17.3
9.5
15.1
3.7
7.3
0.0
5.9
7.4
6.8
7.1
7.5
7.8
5.1
4.8
4.8
12.3
4.4
5.8
6.6
3.8
8.7
0.0
55.5
41.6
61.6
52.7
56.1
55.3
19.0
72.2
25.0
38.7
13.9
51.9
31.8
27.1
72.0
2.8
0.3
0.4
0.4
0.2
0.3
0.8
0.3
1.0
0.4
0.1
0.2
1.7
0.8
0.4
1.0
3.4
treated in a health care facility varied considerably with age.
Only 10.2% of children younger than 6 years and only 13.4%
of children between 6 and 12 years were managed in a health
care facility compared with 48.5% of teenagers (13-19 years)
and 36.7% of adults (N19 years). Of cases managed in a health
care facility, 51.9% were treated and released without
admission, 14.7% were admitted for critical care, and 7.7%
were admitted for noncritical care. Where treatment was
provided in a health care facility, 32.2% of the patients were
referred in by the poison center, and 67.8% were already in or
en route to the health care facility when the poison center was
contacted. Health care facilities included acute care hospitals
(83.8%), physician offices or clinics (8.4%), and freestanding
emergency centers (3.0%).
Table 11 displays the medical outcome of the human
poison exposure cases distributed by age, showing a greater
rate of severe outcomes in the older age groups. Table 12
compares medical outcome and reason for exposure and
shows a greater frequency of serious outcomes in intentional
exposures. Table 13 demonstrates an increasing duration of
the clinical effects observed with more severe outcomes.
Medical outcome categories were as follows:
The types of therapeutic errors observed in each age group
are delineated in Table 6B. Thirty-three percent of therapeutic errors involved double-dosing. Dispensing cup errors
were seen in 5120 cases, 10-fold dosing errors in 1301
cases, iatrogenic or dispensing errors in 5869 cases, and
errors resulting from exposure to multiple products with
common ingredients in 5928 cases.
Unintentional poisonings outnumbered intentional poisonings in all age groups (Table 7). In contrast, of the
1183 human poisoning fatalities reported, 87.8% of adolescent deaths and 80.2% of adult deaths (older than 19 years)
were intentional (Table 8).
Ingestion was the route of exposure in 76.8% of cases
(Table 9), followed in frequency by dermal, inhalation, and
ocular routes. For the 1183 fatalities, ingestion, inhalation,
and parenteral were the predominant exposure routes.
Clinical effects (signs, symptoms, or laboratory abnormalities) were coded in 30.2% of cases (16.1% had 1 effect,
7.9% had 2 effects, 4.0% had 3 effects, 1.4% had 4 effects,
0.4% had 5 effects, and 0.4% had N5 effects). Of 1 645 092
clinical effects coded, 80.5% were deemed related, 8.6%
were considered not related, and 11.0% were coded as
bunknown if related.Q
The majority of cases reported to poison centers were
managed in a non–health care facility (77%), usually at the
site of exposure, the patient’s own residence (Table 10). This
includes the 2% of cases that were referred to a health care
facility but refused to go. Treatment in a health care facility
was rendered in 22.4% of cases. The percentage of patients
Table 7
Distribution of reason for exposure by age
Reason
b6 y
No.
Unintentional
Intentional
Other
Adverse reaction
Unknown
Total
1 242 735
1116
1099
4960
626
1 250 536
6-12 y
Row %
60.6
0.4
7.4
8.1
5.9
51.3
* Includes unknown child and unknown age.
No effect: The patient developed no signs or symptoms
as a result of the exposure.
Minor effect: The patient developed some signs or
symptoms as a result of the exposure, but they were
minimally bothersome and generally resolved rapidly
with no residual disability or disfigurement. A minor
13-19 y
N19 y
Unknown*
Total
No.
Row %
No.
Row %
No.
Row %
No.
Row %
No.
Col %
140 758
8474
1989
3303
714
155 238
6.9
2.8
13.3
5.4
6.7
6.4
85 176
81 937
2361
4975
1638
176 087
4.2
27.2
15.8
8.1
15.4
7.2
567 362
205 427
9108
47 142
6793
835 832
27.7
68.2
61.1
77.0
63.9
34.3
14 571
4300
348
874
858
20 951
0.7
1.4
2.3
1.4
8.1
0.9
2 050 602
301 254
14 905
61 254
10 629
2 438 644
84.1
12.4
0.6
2.5
0.4
100.0
2004 AAPCC Annual Report
Table 8
595
Table 10
Distribution of reason for exposure and age for 1183 fatalities
Reason
b6 y
Unintentional
General
Therapeutic error
Bite/sting
Misuse
Environmental
Food poisoning
Occupational
Unknown
Subtotal
Intentional
Suicide
Abuse
Misuse
Unknown
Subtotal
Other
Contamination/
tampering
Malicious
Withdrawal
Subtotal
Adverse reaction
Unknown
Total
6-12 y
13-19 y
N 19 y
Unknown
Total
10
3
1
0
6
0
0
0
20
1
0
0
0
7
0
0
2
10
0
0
0
0
6
0
0
0
6
5
38
4
4
41
0
11
6
109
0
0
0
0
0
0
0
0
0
16
41
5
4
60
0
11
8
145
0
0
0
0
0
0
1
0
0
1
46
24
2
7
79
591
123
41
78
833
2
3
1
0
6
639
151
44
85
919
0
0
0
0
0
0
2
0
2
1
4
27
0
0
0
4
1
16
0
0
0
0
5
90
6
0
6
20
71
1039
0
0
0
0
5
11
8
0
8
25
86
1183
effect is often limited to the skin or mucus membranes
(eg, self-limited gastrointestinal symptoms, drowsiness,
skin irritation, first-degree dermal burn, sinus tachycardia
without hypotension, and transient cough).
Moderate effect: The patient exhibited signs or symptoms
as a result of the exposure that were more pronounced,
more prolonged, or more systemic in nature than minor
symptoms. Usually, some form of treatment is indicated.
Symptoms were not life-threatening, and the patient had
no residual disability or disfigurement (eg, corneal
abrasion, acid-base disturbance, high fever, disorientation,
hypotension that is rapidly responsive to treatment, and
isolated brief seizures that respond readily to treatment).
Major effect: The patient exhibited signs or symptoms as
a result of the exposure that were life-threatening or
Table 9
fatalities
Distribution of route of exposure for human exposure cases and 1183
Route
Ingestion
Dermal
Inhalation
Ocular
Bites and stings
Parenteral
Otic
Aspiration
Rectal
Vaginal
Other
Unknown
Total
All exposure cases
Fatal exposure cases
No.
%
No.
%
1 964 500
190 762
150 336
133 370
89 609
12 837
2734
1449
929
866
2575
8839
2 558 806
76.8
7.5
5.9
5.2
3.5
0.5
0.1
0.1
0.0
0.0
0.1
0.3
100.0
996
12
135
3
5
52
0
21
2
0
4
102
1332
74.8
0.9
10.1
0.2
0.4
3.9
0.0
1.6
0.2
0.0
0.3
7.7
100.0
Multiple routes of exposure were observed in many poison exposure victims. Percentage is
calculated on the total number of exposure routes (2 558 806 for all patients; 1332 for fatal
cases) rather than the total number of human exposures (2 438 644) or fatalities (1183).
Management site of human exposure cases
Site
Managed on-site, nonhealth care facility
Managed in health care facility
Treated and released
Admitted to critical care
Admitted to noncritical care
Admitted to psychiatry
Lost to follow-up; left AMA
Subtotal
Other
Refused referral
Unknown
Total
No.
%
1 801 037
73.9
283 620
80 326
42 226
44 397
95 659
546 228
27 567
49 362
14 450
2 438 644
11.6
3.3
1.7
1.8
3.9
22.4
1.1
2.0
0.6
100.0
AMA indicates against medical advice.
resulted in significant residual disability or disfigurement
(eg, repeated seizures or status epilepticus, respiratory
compromise requiring intubation, ventricular tachycardia
with hypotension, cardiac or respiratory arrest, esophageal
stricture, and disseminated intravascular coagulation).
Death: The patient died as a result of the exposure or as a
direct complication of the exposure. Only those deaths
that were probably or undoubtedly related to the
exposure are coded here.
Not followed, judged as nontoxic exposure: No followup calls were made to determine the outcome of the
exposure because the substance implicated was nontoxic,
the amount implicated was insignificant, or the route of
exposure was unlikely to result in a clinical effect.
Not followed, minimal clinical effects possible: No
follow-up calls were made to determine the patient’s
outcome because the exposure was likely to result in only
minimal toxicity of a trivial nature. (The patient was
expected to experience no more than a minor effect.).
Unable to follow, judged as a potentially toxic exposure:
The patient was lost to follow-up, refused follow-up, or
was not followed, but the exposure was significant and
may have resulted in a moderate, major, or fatal outcome.
Unrelated effect: The exposure was probably not
responsible for the effect.
Confirmed nonexposure: This outcome option was coded
to designate cases where there was reliable and objective
evidence that an exposure initially believed to have
occurred actually never occurred (eg, all missing pills are
later located). All cases coded as confirmed nonexposure
are excluded from this report.
Tables 14 and 15 outline the use of decontamination
procedures, specific antidotes, and measures to enhance
elimination in the treatment for patients reported in this
database. These must be interpreted as minimum frequencies because of the limitations of telephone data gathering.
Table 16 demonstrates the continuing decline in the use of
ipecac-induced emesis in the treatment of poisoning. Ipecac
was administered in only 4701 human poison exposures in
2004. A 49.4% decrease in ipecac syrup use in 2004
compared with 2003 was observed, likely as a result of
596
W.A. Watson et al.
Table 11
Medical outcome of human exposure cases by patient age
Outcome
b6 y
No.
No effect
Minor effect
Moderate effect
Major effect
Death
No follow-up, nontoxic
No follow-up,
minimal toxicity
No follow-up,
potentially toxic
Unrelated effect
Total
6-12 y
13-19 y
N19 y
Unknown*
Total
Col %
No.
Col %
No.
Col %
No.
Col %
No.
Col %
No.
Col %
321 862
108 105
9699
686
27
266 593
505 506
25.7
8.6
0.8
0.1
0.0
21.3
40.4
25 772
26 594
4058
254
16
24 321
66 306
16.6
17.1
2.6
0.2
0.0
15.7
42.7
27 874
45 583
18 951
1974
90
9846
49 591
15.8
25.9
10.8
1.1
0.1
5.6
28.2
94 482
193 374
84 490
12 997
1039
53 099
288 823
11.3
23.1
10.1
1.6
0.1
6.4
34.6
3192
2568
711
51
11
2382
6077
15.2
12.3
3.4
0.2
0.1
11.4
29.0
473 182
376 224
117 909
15 962
1183
356 241
916 303
19.4
15.4
4.8
0.7
0.1
14.6
37.6
19 781
1.6
4050
2.6
17 683
10.0
71130
8.5
5390
25.7
118 034
4.8
18 277
1 250 536
1.5
51.3
3867
155 238
2.5
6.4
4495
176 087
2.6
7.2
36 398
835 832
4.4
34.3
569
20 951
2.7
0.9
63 606
2 438 644
2.6
100.0
* Includes unknown child and unknown age.
breakdown of plant exposures is provided for those most
commonly implicated (Table 20).
A summary of the 1183 fatal exposures is presented in
Table 21. Each fatality reported to TESS was verified and
abstracted by the reporting poison center. After extensive
review, those exposures determined to be either
bprobablyQ or bundoubtedlyQ responsible for the fatality
were included in Table 21. Abstracts of selected interesting or unusual cases, including most incidents with
multiple fatalities, are included in Appendix B. Table 21
also reports the highest blood concentrations for the
responsible agents, where that information is known. In
addition, Table 21 identifies those cases reported indirectly
to the poison center (5.8% of cases) and those cases in
which a prehospital cardiac and/or respiratory arrest occurred (39.5% of cases). Deaths are categorized in Table 21
according to the agent deemed most responsible for the
death, by agreement of the medical director of the reporting
center and at least 2 additional toxicologist reviewers.
Single agents were considered responsible for 49% of
deaths. Additional agents implicated (up to a maximum of
3 total agents) are listed below the primary agent. Cases in
which more than 3 agents were involved are also identified.
The age distribution of reported fatalities is similar to that in
the past years, with the overwhelming majority of fatal cases
occurring in adults.
ipecac use guidelines issued in late 2003. A joint Guidelines
Consensus Panel formed by the American Association of
Poison Control Centers, American College of Medical
Toxicology, and American Academy of Clinical Toxicology
issued a guideline which concluded that the circumstances
in which ipecac syrup is the appropriate or desired method
of gastric decontamination are rare [22]. The American
Academy of Pediatrics went a step further, concluding not
only that bipecac should no longer be used routinely as a
home treatment strategy,Q but also recommending disposal
of ipecac currently in homes [23].
Table 17A presents the most common substance categories involved in human exposures, listed by frequency of
exposure. Tables 17B and 17C present similar data for
children and adults, respectively, and show the considerable
differences between pediatric and adult poison exposures.
Table 18 lists the substance categories with the largest
number of reported deaths; analgesics and sedative/hypnotics/antipsychotics lead this list. Although analgesics are
the most frequently involved substance category for both
deaths and nonlethal human exposures, there is otherwise
little correlation between the frequency of exposures to a
substance and the number of deaths. Table 19 shows little
variation over the past 2 decades in the percentage of cases
reported to TESS that are fatal poisonings and in the
percentage of reported fatalities as a result of suicide. A
Table 12
Distribution of medical outcome by reason for exposure in human exposure cases
Outcome
No effect
Minor effect
Moderate effect
Major effect
Death
No follow-up, nontoxic
No follow-up,
minimal toxicity
No follow-up,
potentially toxic
Unrelated effect
Total
Unintentional
Intentional
Other
Adverse Reaction
Unknown
Total
No.
Col %
No.
Col %
No.
Col %
No.
Col %
No.
Col %
No.
416 342
272 266
50 893
2929
145
349 891
855 266
20.3
13.3
2.5
0.1
0.0
17.1
41.7
53 055
83 626
56 187
11 518
919
4199
32 448
17.6
27.8
18.7
3.8
0.3
1.4
10.8
1651
3366
1115
108
8
811
5047
11.1
22.6
7.5
0.7
0.1
5.4
33.9
1220
15 466
8026
743
25
1100
21 934
2.0
25.2
13.1
1.2
0.0
1.8
35.8
914
1500
1688
664
86
240
1608
8.6
14.1
15.9
6.2
0.8
2.3
15.1
473 182
376 224
117 909
15 962
1183
356 241
916 303
Col %
19.4
15.4
4.8
0.7
0.1
14.6
37.6
55 337
2.7
54 103
18.0
1767
11.9
4077
6.7
2750
25.9
118 034
4.8
47 533
2 050 602
2.3
84.1
5199
301 254
1.7
12.4
1032
14 905
6.9
0.6
8663
61 254
14.1
2.5
1179
10 629
11.1
0.4
63 606
2 438 644
2.6
100.0
2004 AAPCC Annual Report
Table 13
597
Table 15
Duration of clinical effects by medical outcome
Duration of effect
V2 h
N2 h, V 8 h
N8 h, V 24 h
N24 h, V 3 d
N3 d, V 1 wk
N1 wk, V 1 mo
N1 mo
Anticipated permanent
Unknown
Minor effect
Moderate effect
Major effect
Col %
Col %
Col %
39.1
25.6
16.8
5.4
1.7
0.5
0.2
0.2
10.6
6.5
21.8
30.2
17.9
6.7
1.9
0.6
0.4
14.2
2.5
7.7
25.6
30.4
15.7
5.5
1.2
2.6
8.8
There were 27 fatalities reported in children younger than
6 years, similar to numbers reported over the last decade and
less than the aberrant 34 cases reported in 2003 (Table 19).
As a percentage of total reported fatalities, the pediatric
cases represent 2.3%, similar to percentages reported over
most of the last 6 years. The percentage of pediatric fatalities
related to total pediatric calls was 0.0022%. By comparison,
0.12% of all adult exposures reported resulted in death. Of
the reported deaths in children younger than 6 years, 20
were known to be unintentional. Of these, 6 were from
carbon monoxide, and 3 were therapeutic errors. There were
2 deaths in children younger than 6 years resulting from
malicious intent, and there was 1 death from an adverse
drug reaction. Of the 19 medication-associated deaths,
5 were from nonprescription medications, and 14 were
associated with prescription medications. Of the prescription
medications, 9 contained opioids, including 4 from methadone. Compared with previous years, this represents a
worrisome increase in opioid-related deaths in this age
range. There was only a single fatality related to a household
product, a decrease from previous years. Interestingly, there
were no pediatric fatalities from iron or antidepressants,
agents which have been problems in some past years.
In the age range 6 to 12 years, there were 16 reported
fatalities, including 3 from adverse drug reactions and no
suspected suicides. Of these cases, 10 were unintentional,
including 7 from carbon monoxide. The number of deaths in
this age range is higher than in the previous 5 years (mean
7.8 deaths per year), although there is no clear pattern in
terms of agents.
In the age range 13 to 19 years, there were 90 reported
fatalities. This number is the largest reported in any prior
year (mean 67 deaths per year over the last 5 years).
Looking at the reasons for the adolescent fatalities, 51.1%
were presumed suicides, and 26.7% were caused by
Table 14
Decontamination and therapeutic interventions
Therapy
No. of patients
%
Decontamination only
Observation only
No therapy provided
Decontamination and other therapy
Other therapy only (no decontamination)
Unknown if therapy was provided/patient refused
1 208 961
300 836
227 639
185 821
135 641
357 563
49.6
12.3
9.3
7.6
5.6
14.7
Therapy provided in human exposure cases
Therapy
Decontamination
Dilution/irrigation
Activated charcoal, single dose
Cathartic
Gastric lavage
Other emetic
Ipecac syrup
Whole bowel irrigation
Measures to enhance elimination
Activated charcoal, multidose
Hemodialysis
Other extracorporeal procedure
Hemoperfusion
Specific antidote administration
Benzodiazepine
N-acetylcysteine (oral)
Naloxone
Calcium
N-acetylcysteine (IV)
Flumazenil
Fomepizole
Antivenom (Fab)
Atropine
Glucagon
Insulin
Phytonadione
Folate
Fab fragments
Ethanol
Hyperbaric oxygen
Antivenom (excluding Fab)
Pyridoxine
Succimer
Octreotide
Cardiac pacing
Physostigmine
Pralidoxime (2-PAM)
Methylene blue
Deferoxamine
EDTA
Dimercaprol (BAL)
Sodium thiosulfate
Sodium nitrite
Amyl nitrite
Penicillamine
Other interventions
Alkalinization
Organ transplantation
ECMO
No.
1127 564
130 938
44 664
16 179
8420
4701
2961
5031
1726
33
29
16 685
15 333
12 618
7039
3807
2148
1099
1001
964
830
690
629
608
515
466
449
446
418
206
185
180
157
98
97
74
71
59
55
25
11
6
8654
29
9
intentional abuse. These numbers are similar to those in
most recent years except for 2003 when abuse was the most
common reason. As in the past years, only a small number
(6.7%) of adolescent fatalities are unintentional; most of
these were related to carbon monoxide.
The most common classes of substances involved as
primary substance in fatalities were analgesics, antidepressants, stimulants and street drugs, sedative/hypnotics/antipsychotics, and cardiovascular agents. This relative order is
similar to that seen in recent years. Of the 419 fatalities
where an analgesic was felt to be the primary responsible
agent, 67 were associated with acetaminophen as a single
agent, 43 with acetaminophen plus 1 or 2 other drugs and
108 with acetaminophen in a combination product, usually
containing an opioid. There were 22 fatalities where
598
W.A. Watson et al.
Table 16
Year
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Decontamination trends
Human
exposures
reported
% of
Exposures
involving
children b6 y
Ipecac
administered
(% of exposures)
Activated
charcoal
administered
(% of exposures)
251 012
730 224
900 513
1 098 894
1166 940
1 368 748
1 581 540
1 713 462
1 837 939
1 864 188
1 751 476
1 926 438
2 023 089
2 155 952
2 192 088
2 241 082
2 201156
2 168 248
2 267 979
2 380 028
2 395 582
2 438 644
64.0
64.1
63.4
63.0
62.3
61.8
61.1
60.8
59.9
58.8
56.0
54.1
52.9
52.8
52.5
52.7
50.5
52.7
51.6
51.6
52.0
51.3
13.4
12.9
15.0
13.3
10.1
8.4
7.0
6.1
5.2
4.3
3.7
2.7
2.3
1.8
1.5
1.2
1.0
0.8
0.7
0.6
0.4
0.2
4.0
4.0
4.6
5.2
5.2
6.5
6.4
6.7
7.0
7.3
7.3
6.8
7.7
7.3
7.1
6.8
6.6
6.7
6.6
6.3
5.9
5.6
Table 17B
Substances most frequently involved in pediatric exposures
(children younger than 6 years)
Substance
Cosmetics and personal care products
Cleaning substances
Analgesics
Topicals
Foreign bodies
Cough and cold preparations
Plants
Pesticides
Vitamins
Antihistamines
Antimicrobials
Gastrointestinal preparations
Arts/crafts/office supplies
Electrolytes and minerals
Hormones and hormone antagonists
Analgesics
Cleaning substances
Cosmetics and personal care products
Sedatives/hypnotics/antipsychotics
Foreign bodies
Topicals
Cough and cold preparations
Antidepressants
Pesticides
Bites/envenomations
Plants
Alcohols
Cardiovascular drugs
Antihistamines
Food products, food poisoning
Antimicrobials
Vitamins
Hydrocarbons
Hormones and hormone antagonists
168 021
124 962
98 237
92 482
91101
67 494
55 078
52 174
48 989
34 401
33 528
30 289
29 798
24 886
22 877
13.4
10.0
7.9
7.4
7.3
5.4
4.4
4.2
3.9
2.8
2.7
2.4
2.4
2.0
1.8
(controlled release or transdermal) other than methadone
were felt to be the primary responsible agent (33 deaths
in 2004).
The second most common class of drugs primarily
responsible for fatalities was antidepressants, accounting
for 119 deaths, similar to other recent years. Amitriptyline,
either alone or in combination, is the single most common
agent, as in the past years. Newer agents continue to
produce numerous deaths, although no one agent appears
disproportionately responsible. There were, however, significantly more deaths related to bupropion (26 vs 8 deaths
in 2003) and venlafaxine (16 vs 11 deaths in 2003).
The third most common class of drugs associated with
fatalities was stimulants and street drugs. The number (40)
of deaths related to cocaine as the primary agent was the
Table 17C
Substances most frequently involved in human exposures
Substance
%*
Despite a high frequency of involvement, these substances are not necessarily the most
toxic, but rather may be the most readily accessible.
* Percentages are based on the total number of exposures in children younger than
6 years (1 250 536) rather than the total number of substances.
salicylate as a single agent was felt to be responsible. Once
again, excluding the chronic ingestion cases, only half of
these cases ever had salicylate concentrations measured that
exceeded 100 mg/dL. Most of these cases did not receive
dialysis in a useful time frame. These data suggest that more
aggressive and earlier use of dialysis may be indicated in the
treatment of large salicylate ingestions. There were marked
increases in the numbers of deaths attributed primarily to
either methadone (76 vs 38 cases in 2003) or oxycodone
(31 vs 22 cases in 2003). There continued to be a large
number of cases where long-acting opioid preparations
Table 17A
No.
Substances most frequently involved in adult exposures (N19 years)
Substance
No.
%*
279 955
229 040
224 792
129 885
122 011
113 489
108 814
103 155
102 754
97 263
74 811
74 268
74 145
72 762
69 915
64 768
62 562
54 766
48 359
11.5
9.4
9.2
5.3
5.0
4.7
4.5
4.2
4.2
4.0
3.1
3.0
3.0
3.0
2.9
2.7
2.6
2.2
2.0
Despite a high frequency of involvement, these substances are not necessarily the most
toxic, but rather may be the most readily accessible.
* Percentages are based on the total number of human exposures (2 438 644) rather
than the total number of substances.
Analgesics
Sedatives/hypnotics/antipsychotics
Cleaning substances
Antidepressants
Bites/envenomations
Cardiovascular drugs
Alcohols
Pesticides
Food products, food poisoning
Cosmetics and personal care products
Chemicals
Hydrocarbons
Fumes/gases/vapors
Anticonvulsants
Antihistamines
Stimulants and street drugs
Antimicrobials
Hormones and hormone antagonists
Cough and cold preparations
Muscle relaxants
No.
%*
124 186
97 714
82 854
67 479
62 027
46 470
44 809
40 328
39 327
38 081
27 743
27 589
26 968
26 555
24 079
23 265
22 479
21102
18 673
17 526
14.9
11.7
9.9
8.1
7.4
5.6
5.4
4.8
4.7
4.6
3.3
3.3
3.2
3.2
2.9
2.8
2.7
2.5
2.2
2.1
Despite a high frequency of involvement, these substances are not necessarily the most
toxic, but rather may be the most readily accessible.
* Percentages are based on the total number of exposures in adults older than
19 years (835 832) rather than the total number of substances.
2004 AAPCC Annual Report
Table 18
599
Table 20
Categories with largest numbers of deaths
Category
No.
Analgesics
Sedative/hypnotics/antipsychotics
Antidepressants
Stimulants and street drugs
Cardiovascular drugs
Alcohols
Gases and fumes
Anticonvulsants
Chemicals
Muscle relaxants
Antihistamines
Hormones and hormone antagonists
Cough and cold preparations
Automotive products
Cleaning substances
% of all
exposures
in category
658
371
299
214
162
114
83
81
62
61
55
46
30
27
25
0.235
0.286
0.290
0.472
0.218
0.153
0.206
0.202
0.133
0.261
0.076
0.095
0.028
0.185
0.011
This table and Tables 22A and 22B are based on all substances coded per exposure,
whereas Table 21 only includes up to 3 substances per case. Unknown drug category is
excluded from this table.
fewest reported since 2000, whereas the number (22 cases)
of heroin-related fatalities remained virtually identical to the
23 deaths reported in 2003. There was modest increase in
deaths primarily related to methamphetamine (26 vs 23
cases in 2003) and a significant decrease in the number of
MDMA-related fatalities (3 deaths in 2004 and 12 deaths in
2003). For the second year in a row, there were no reported
deaths involving c-hydroxybutyrate or related compounds.
The vast majority (77.7%) of reported fatalities in 2004,
as in the past years, were the result of intentional actions.
The percentage of fatalities attributable to other reasons
remained little changed from previous years (Table 10). A
disturbing number of deaths continue to occur because of
therapeutic errors, although the 41 cases reported in 2004
Table 19
22-Year comparisons of fatality data
Year
Total fatalities
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Suicides
No.
% of
cases
No.
% of
deaths
95
293
328
406
397
545
590
612
764
705
626
766
724
726
786
775
873
920
1074
1153
1106
1183
0.038
0.040
0.036
0.037
0.034
0.040
0.037
0.036
0.042
0.038
0.036
0.040
0.036
0.034
0.036
0.035
0.040
0.042
0.047
0.048
0.046
0.049
60
165
178
223
226
297
323
350
408
395
338
410
405
358
418
421
472
476
552
629
592
639
63.2
56.3
54.3
54.9
56.9
54.5
54.7
57.2
53.4
56.0
54.0
53.5
55.9
49.3
53.2
54.3
54.1
51.7
51.4
54.6
53.5
54.0
Pediatric deaths (b6 y)
No. (% of deaths)
10
21
20
15
22
28
24
25
44
29
27
26
20
29
25
16
24
20
26
23
34
27
(10.5)
(7.2)
(6.1)
(3.7)
(5.5)
(5.1)
(4.1)
(4.1)
(5.8)
(4.1)
(4.3)
(3.4)
(2.8)
(4.0)
(3.2)
(2.1)
(2.7)
(2.2)
(2.4)
(2.0)
(3.1)
(2.3)
Frequency of plant exposures by plant type
Botanical name
Common name
Frequency
Spathiphyllum spp
Ilex spp
Philodendron spp
Euphorbia pulcherrima
Phytolacca americana
Toxicodendron radicans
Ficus spp
Solanum spp
Malus spp
Schlumbergera bridgesii
Crassula spp
Nerium oleander
Epipremnum aureum
Chrysanthemum spp
Caladium spp
Dieffenbachia spp
Hedera helix
Cactus spp
Taraxacum officinale
Liriope muscari
Peace lily
Holly
Philodendron
Poinsettia
Pokeweed, inkberry
Poison ivy
Rubber tree, weeping fig
Nightshade, Jerusalem cherry
Apple, crabapple (plant parts)
Christmas cactus
Jade plant
Oleander
Pothos, devil’s ivy
Chrysanthemum
Caladium
Dumbcane
English ivy
Cactus
Dandelion
Lilyturf
2972
2597
2421
2206
1697
1490
1136
1046
920
918
817
785
725
716
711
707
705
700
668
634
This table provides the frequency of involvement of plants in exposures reported to
poison centers with no correlation with severity of toxicity. Several of the plants on the
list pose little, if any, ingestion hazard.
are less than the numbers in the 2 previous years (48 cases
in 2003 and 54 in 2002). Adverse drug reactions also
accounted for 24 deaths. There were fewer deaths reported
in 2004 related to occupational exposures (11 cases) than in
any year since 1999. As in the prior 3 years, there were no
reported fatalities from either food poisoning or tampering.
Tables 22A and 22B provide comprehensive demographic data on patient age, reason for exposure, medical
outcome, and use of a health care facility for all 2 438 644
exposures, presented by substance categories. Table 22A
focuses on nonpharmaceuticals; Table 22B presents drugs.
Of the 2 776 925 substances logged in Tables 22A and 22B,
50.0% were nonpharmaceuticals, and 50.0% were pharmaceuticals. The reason for the exposure was intentional for
29.5% of pharmaceutical substances implicated compared
with 5.4% of nonpharmaceutical substances. Correspondingly, treatment in a health care facility was provided in a
higher percentage of exposures to pharmaceutical substances (38.7%) compared with nonpharmaceutical substances
(16.6%). Pharmaceutical exposures also had more severe
outcomes. Of substances implicated in fatal cases, 85.2%
were pharmaceuticals, compared with 50.0% of substances
reported in nonfatal cases. Similarly, 85.4% of substances
implicated in major outcomes were pharmaceuticals.
In 2004, real-time monitoring of cases submitted to TESS
was expanded to include GIS mapping, new surveillance
case definitions, and enhanced toxicosurveillance at the local
level. Monitoring results were reviewed at least daily. The
core approach included monitoring increased individual
poison center activity, increased reporting of clinical effects,
and cases that met surveillance case definitions as described
in the 2003 AAPCC TESS Annual Report.
Sixty US poison centers (all except Puerto Rico)
continue to submit data to TESS in near real time, with
600
W.A. Watson et al.
most centers submitting every 4 to 10 minutes. Surveillance
query results are automatically sent to clinical toxicologists
at the AAPCC when outliers are identified. Additional
information is obtained by e-mail or telephone from
reporting poison control centers when reports of potential
importance are detected. Public health issues are brought to
the attention of the National Center for Environmental
Health/Agency for Toxic Substances Disease Registry at the
Centers for Disease Control and Prevention. Affected state
or local health departments are also alerted.
Data on outlier clinical effects are provided daily to
43 individual poison centers, covering all or parts of 39
states. In a few cases, results are also sent directly to state or
local health departments; in most states, results are interpreted by poison control center staff before the communications of significant outliers to the appropriate health
authorities. Individual poison control centers have developed surveillance case definitions, and new monitors
identify cases that meet these definitions. Current surveillance case definitions identify cases that have clinical
effects suggestive of nerve agents, cyanide, arsenic,
botulism, ricin, anthrax (systemic and dermal), irritant
gases, smallpox, arenavirus, radiation, and puffer fish
Table 21
Case
ingestions with neurological effects. These monitors have
been implemented in response to public health issues or
concerns and are run at 1- to 12-hour intervals. Previous
case definitions included both early and late paraquat/
diquat toxicity and anticoagulant rodenticides. Cases
coded as specific substances, for example, arsenic, ricin,
carbon monoxide, and food poisoning/food products, are
also monitored. Surveillance processes continue to be
developed, refined, and evaluated.
Preliminary projects to assess the utility of TESS to
provide dose-response data show promising results [24,25].
TESS substance, amount, and patient weight data were used
to determine dose-response for acute pediatric exposures to
clonidine and amlodipine. Additional evaluations and
development of approaches to enhance the methodology
are underway.
In closing, we gratefully acknowledge the extensive contributions of each participating poison center and the
assistance of the many health care providers who provided
comprehensive data to the poison centers for inclusion in
this database. We especially acknowledge the dedicated
efforts of the Specialists in Poison Information who
meticulously coded 2.4 million poison exposures in 2004.
Summary of fatal exposures reported to TESS in 2004
Age
Substances
NONPHARMACEUTICALS
Alcohols
1i
33 y
Ethanol
2p
42 y
Ethanol
3p
42 y
Ethanol
4
44 y
Ethanol
5p
44 y
Ethanol
6
46 y
Ethanol
7
55 y
Ethanol
8p
52 y
Ethanol
Acetaminophen/propoxyphene
9p
55 y
Ethanol
Acetaminophen/propoxyphene
10 p
34 y
Ethanol
Benzodiazepine
Opioid
11 a
76 y
Ethanol
Lead
12
39 y
Ethanol
Oxycodone (long-acting)
Cyclobenzaprine
13
46 y
Ethanol (denatured)/ethyl acetate/
methanol/heptane
14 a
45 y
Ethanol /isopropyl alcohol hand sanitizer
15
28 y
Ethanol/methanol/methyl isobutyl ketone
16 p
50 y
Isopropyl alcohol
17
63 y
Isopropyl alcohol
18
90 y
Isopropyl alcohol
Iodine
19
39 y
Isopropyl alcohol
Mouthwash (ethanol)
Acetaminophen
20 p
60s y
Methanol
21 i
22 y
Methanol
Fluoxetine
Quetiapine
Chronicity Route
Reason
A/C
A/C
A
A
A/C
A/C
A
A
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Int
Int
Int
Int
Int
Int
Int
Int
A
Ing
Int suicide
U
Ing/unk
Int unk
C
Ing
Int abuse
A/C
Ing
Int abuse
A
Ing
Unk
A
A
A
U
A
Ing
Ing
Ing
Ing
Ing
Int
Int
Int
Int
Int
U
Ing
Int abuse
A
A
Ing
Ing
Int suicide
Int suicide
abuse
abuse
suicide
abuse
abuse
abuse
abuse
suicide
abuse
abuse
suicide
abuse
suicide
Blood
Concentrations
607 mg/dL§
537 mg/dL
218 mg/dL
358 mg/dL
500 mg/dL
164.2 mg/dL
171 lg/mLw
490 mg/dL
78 lg/mLw
115
250
170
0.19
Methanol 570
lg/dL
mg/dL
ng/mL
lg/mL
mg/dL§
Ethanol 32.5 mg/dL
Methanol 520 mg/dL
43.8 lg/mL
4 mg/dL
234 mg/dL
Interval after
Exposure
2004 AAPCC Annual Report
601
Table 21 continued
Case
Age
Substances
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
NONPHARMACEUTICALS
Alcohol
22 p
39 y
Methanol
U
Ing
Int abuse
Chlorofluorocarbon
23
61 y
Methanol
A
Ing
Int unk
740 mg/dL
Pine oil/isopropyl alcohol cleaner
See also cases 88, 91, 98, 102, 104, 135, 210, 332 to 337, 357, 379, 432, 435, 437, 456, 493, 494, 503, 510, 516, 517, 578 to 586, 611, 617, 641, 645, 646, 655, 676, 683,
721, 727, 728, 755, 762, 776, 783 to 785, 793, 828, 876, 914 to 916, 920, 934, 969, 974, 978, 985, 994, 1002, 1004, 1059, 1080, 1085, 1115, 1122, 1164, 1165, 1182,
and 1183 (ethanol); 104, 494, and 575 (isopropyl alcohol).
Automotive/aircraft/boat products
24
19 y
Antifreeze (ethylene glycol)
25 p
27 y
Antifreeze (ethylene glycol)
26
31 y
Antifreeze (ethylene glycol)
27
34 y
Antifreeze (ethylene glycol)
28 i/p
36 y
Antifreeze (ethylene glycol)
29
41 y
Antifreeze (ethylene glycol)
30 p
42 y
Antifreeze (ethylene glycol)
31 p
45 y
Antifreeze (ethylene glycol)
32 p
46 y
Antifreeze (ethylene glycol)
33
47 y
Antifreeze (ethylene glycol)
34
47 y
Antifreeze (ethylene glycol)
35
48 y
Antifreeze (ethylene glycol)
36
50 y
Antifreeze (ethylene glycol)
37
63 y
Antifreeze (ethylene glycol)
38
78 y
Antifreeze (ethylene glycol)
39
84 y
Antifreeze (ethylene glycol)
40 p
N19 y
Antifreeze (ethylene glycol)
41 a
43 y
Antifreeze (ethylene glycol)
Cocaine
42
24 y
Antifreeze (ethylene glycol)
Diphenhydramine
43 p
43 y
Antifreeze (ethylene glycol)
Drain opener (sodium hydroxide)
44
54 y
Antifreeze (ethylene glycol)
Mouthwash (ethanol/methyl salicylate)
45
47 y
Antifreeze (ethylene glycol)
Sertraline
Boric acid
46 a/p
33 y
Carburetor cleaner
47
48
49
See also case
Batteries
50
38 y
Carburetor cleaner (acetone/methanol/xylene)
27 y
Carburetor cleaner (methanol/hydrocarbons)
36 y
Windshield washer fluid (methanol)
378 (antifreeze [ethylene glycol]).
46 y
battery acid (sulfuric acid)
A
A
A
A
A
A
A
A
A
A
A
A
A/C
A
A
A
A
A
Ing
Ing
Ing
Ing
Ing
Ing
Ing/unk
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing/unk
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
A
Ing
Int suicide
A
Ing
Int unk
A
Ing
Int abuse
A
Ing
Int unk
A/C
Inh
Int abuse
A
A
A
Inh
Inh
Asp/ing
Int abuse
Int abuse
Int suicide
A
Ing
Int suicide
A
A
Bite/sting
Bite/sting
Bite/sting
Bite/sting
Bite/sting
Int suicide
Env
Int misuse
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Occ
Bites and envenomations
51
44 y
Bothrops alternatus
52 a
50 y
Crotalidae, unk
Fentanyl
53 a
55 y
Crotalus horridus horridus
54
44 y
Hymenoptera
55 a
5y
Loxosceles reclusa (brown recluse)
A
A
A
Bite/sting
Bite/sting/
Paren
Bite/sting
Bite/sting
Bite/sting
Chemicals
56 a
57 p
58 a/p
59 p
60 a
61 a
62
63 p
64 a/p
65 p
A
U
A
A
A
A
A
A
A
A
Ing
Inh
Derm/inh
Inh
Ing
Ing
Ing
Ing
Unk
Derm/inh/ocu
25 y
23 y
Unk
23 y
26 y
37 y
40 y
40s y
50 y
38 y
Aluminum fluoride
Ammonia (anhydrous)
Ammonia (anhydrous)
Chloroform
Cyanide
Cyanide
Cyanide
Cyanide
Cyanide
Diphenylmethyl diisocyanate
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
unk
suicide
suicide
suicide
suicide
suicide
36.7 mg/dL
50
65
0.091
40
27
267
mg/dL
mg/dL
mg/dL§
mg/dL
mg/dL
mg/dL
256 mg/dL
183 mg/dL
17 h
9 mg/dL
138 mg/dL
Benzoylecgonine 0.562 lg/mL§
120 mg/dL
118 mg/dL
712.3 mg/dL
Dichloromethane 106 lg/mL§
Methanol 20 mg/dL§
Toluene 6.3 lg/mL§
460 mg/dL
N5 mmol/L
0.27 lg/mL§
0.3 lg/mL
(continued on next page)
602
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
Chronicity Route
Reason
glycol
glycol
glycol
glycol
glycol
glycol
glycol
glycol
glycol
glycol
U
A
A
A
A
A
U
A
A
A
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Int unk
Int suicide
Unk
Int unk
Int suicide
Int suicide
Unk
Unk
Int suicide
Int suicide
Ethylene glycol
Ethylene glycol
Ethylene glycol
Ethylene glycol
Ethylene glycol
Ethylene glycol
Ethylene glycol
Ethylene glycol
Ethylene glycol
Alprazolam
85
38 y
Ethylene glycol
Aspirin/carisoprodol
ParoxetineA
86
50 y
Ethylene glycol
Clonazepam
87 p
61 y
Ethylene glycol
Cyanide
88
52 y
Ethylene glycol
Ethanol
89
32 y
Ethylene glycol
Methylenedioxymethamphetamine
90
48 y
Ethylene glycol
Morphine
91 p
26 y
Ethylene glycol
Unknown substance
Ethanol
92
42 y
Hydrochloric acid
93
55 y
Hydrochloric acid
94 a
71 y
Hydrochloric acid
95 a
58 y
Hydrofluoric acid
96
60 y
Hydrofluoric acid
97
29 y
Industrial cleaner (acetone/
methyl ethyl ketone)
Acetaminophen/hydrocodone
98 a
47 y
Propylene glycol
Ethanol
99 a
58 y
Sodium hydroxide
Polyaluminum hydroxychlorosulfate
Corrosion inhibitor
100 p
N19 y
Strychnine
101
70 y
Sulfuric acid
102
35 y
Sulfuric acid
Ethanol
103
47 y
Unknown acid
104
41 y
Unknown alkali
Isopropyl alcohol
Ethanol
105
37 y
Unknown chemical
See also cases 45 (boric acid); 99 (corrosion inhibitor); 87, 208, and 209
213 (trihydroxytriazine); and 212 and 461 (unknown chemical).
A
A
U
U
A
A
A
A
A
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Unk
Int suicide
Unk
Unk
Unk
Int suicide
Int suicide
Int suicide
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
U
Ing
Int suicide
U
Ing
Unk
A
Ing
Int suicide
A
Ing
Int suicide
U
Ing/unk
Unk
A
A
A
A
A
A
Ing
Ing
Ing
Ing
Derm
Ing
Int suicide
Int suicide
Int suicide
Malicious
Occ
Int suicide
A
Ing
Unk
A
Asp/ing/inh
Occ
A
A
A
Ing
Ing
Ing
Int suicide
Unint misuse
Int suicide
A
U
Ing
Ing
Int suicide
Int abuse
NONPHARMACEUTICALS
Chemicals
66
22 y
Ethylene
67
26 y
Ethylene
68 p
26 y
Ethylene
69
31 y
Ethylene
70
33 y
Ethylene
71
39 y
Ethylene
72
42 y
Ethylene
73
43 y
Ethylene
74
48 y
Ethylene
75 a
49 y
Ethylene
76
77
78
79
80
81
82
83
84
50
51
51
52
56
71
82
N19
59
y
y
y
y
y
y
y
y
y
Cleaning substances (household)
106
87 y
Disinfectant (phenol/alkali)
107 p
73 y
Disinfectant (sodium hypochlorite, 12.5%)
Industrial cleaner (acid)
Dextromethorphan
Blood
Concentrations
Interval after
Exposure
45 mg/dL
65 mg/dL
77 mg/dL
2000 mg/dL
26
838
Glycolic acid 348
43.3
28
14
7
15
250
40
mg/dL
mg/dL
mg/dL
mg/dL
mg/dL
mg/dL
mg/dL
mg/dL
mg/dL
mg/dL
46 mg/dL
60 mg/dL
0.26 lg/mL
30 mg/dL
167 mg/dL
219 mg/dL
250 ng/mL§
N200 mg/dL
1171 lg/mL§
15 mg/dL
38 mg/dL
U
Unk
Unk
(cyanide); 99 (polyaluminum hydroxychlorosulfate); 347 (propylene glycol); 213 (sulfuric acid);
A
A
Ing
Ing/inh
Int suicide
Occ
0.367 lg/mL§
2004 AAPCC Annual Report
603
Table 21 continued
Case
Age
Substances
Chronicity Route
NONPHARMACEUTICALS
Cleaning substances (household)
108
55 y
Drain opener (alkali)
A
Ing
109
45 y
Drain opener (alkali)
A
Ing
Turpentine
Iodine
110
57 y
Drain opener (hydrochloric acid, 15%-25%)
A
Derm/ing/ocu
111
54 y
Drain opener (hydrochloric acid, 5-15%)
A
Ing
112
76 y
Drain opener (sodium hypochlorite
A
Ing
4.5%/sodium hydroxide, 2.3%)
113
65 y
Drain opener (potassium hydroxide)
A
Ing
114
43 y
Drain opener (sodium hydroxide, 54%)
A
Ing
115
40 y
Drain opener (sodium hydroxide, 50%-60%)
A
Ing
116
81 y
Drain opener (sulfuric acid)
A
Ing
Acetaminophen
Naproxen
117
65 y
Drain opener (sulfuric acid, 95%)
A
Ing
118
50s y
Laundry detergent (anionic/cationic)
A
Ing
119
49 y
Oven cleaner (sodium hydroxide, 5%-10%)
A
Ing
120 p
42 y
Pine oil/isopropyl alcohol cleaner
A
Asp/ing
121
52 y
Pine oil/isopropyl alcohol cleaner
A
Ing
122
61 y
Rust remover (phosphoric acid, 44.99%)
A
Ing
123 a
51 y
Toilet bowl cleaner (hydrochloric acid)
A
Ing
124
84 y
Toilet bowl cleaner (hydrochloric acid, 15%)
A
Ing
125
30 y
Toilet bowl cleaner (hydrochloric acid, 15%-25%) A
Ing
126
59 y
Toilet bowl cleaner (hydrochloric acid, 9.5%)
A
Ing
127 a
1y
Wheel cleaner (ammonium bifluoride)
A
Ing
See also cases 43 (drain opener [sodium hydroxide]) and 23 (pine oil/isopropyl alcohol cleaner).
Reason
Blood
Concentrations
Interval after
Exposure
Int suicide
Int suicide
Int suicide
Int suicide
Unint gen
Int
Int
Int
Int
suicide
suicide
suicide
suicide
153 lg/mL
Int suicide
Unint gen
Unint gen
Int unk
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Unint gen
Industrial cleaners
See also case 107 (industrial cleaner [acid]).
Cosmetics/personal care products
128
72 y
Aftershave
A
Ing
See also cases 19 (mouthwash [ethanol]) and 44 (mouthwash [ethanol/methyl salicylate]).
Int suicide
Deodorizers
129 a/p
130 i/p
11 y
16 y
Air freshener
Air freshener
U
A
Inh
Inh
Int abuse
Int abuse
Dyes
131
79 y
Fluorescein dye
Phenylephrine
A
Paren
Adv rxn
A
Ing
Adv rxn
A
Asp/ing
Ther err
Food products/food poisoning
132 p
N19 y
Cashew nuts
Foreign bodies/toys/miscellaneous
133 a
63 y
Activated charcoal
Acetaminophen/butalbital/caffeine
Zolpidem
134
12 y
Activated charcoal
Diphenhydramine
Citalopram
135
24 y
Activated charcoal
Ethanol
Quetiapine
See also cases 401 and 1012 (activated charcoal).
Fumes/gases/vapors
136 p
48 y
137 p
19 y
138 p
N19 y
139 i/p
3 mo
140
2y
141 p
5y
142 p
7y
Asphyxiant, unk
Butane
Carbon monoxide
Carbon monoxide
Carbon monoxide
Carbon monoxide
Carbon monoxide
73 lg/mLw
A
Asp/ing
Adv rxn
A
Asp/ing
Adv rxn
213 mg/dL
A
A
A
U
A
C
A
Inh/unk
Inh
Inh
Inh
Inh
Inh
Inh
Env
Int abuse
Occ
Env
Env
Env
Env
84%§
19%
53%
(continued on next page)
604
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
NONPHARMACEUTICALS
Fumes/gases/vapors
143 i
9y
Carbon monoxide
144
9y
Carbon monoxide
145 i/p
11 y
Carbon monoxide
146 p
14 y
Carbon monoxide
147 i/p
15 y
Carbon monoxide
148 p
15 y
Carbon monoxide
149 p
16 y
Carbon monoxide
150 i/p
16 y
Carbon monoxide
151 a/i/p 17 y
Carbon monoxide
152 a/i/p 17 y
Carbon monoxide
153 a/i/p 17 y
Carbon monoxide
154 i/p
21 y
Carbon monoxide
155 p
24 y
Carbon monoxide
156 p
25 y
Carbon monoxide
157 p
25 y
Carbon monoxide
158 i/p
26 y
Carbon monoxide
159 p
36 y
Carbon monoxide
160 i/p
36 y
Carbon monoxide
161 p
38 y
Carbon monoxide
162 i/p
40 y
Carbon monoxide
163 p
40 y
Carbon monoxide
164 p
40 y
Carbon monoxide
165 i/p
41 y
Carbon monoxide
166 i/p
42 y
Carbon monoxide
167 i/p
43 y
Carbon monoxide
168 i/p
45 y
Carbon monoxide
169 i/p
46 y
Carbon monoxide
170 p
46 y
Carbon monoxide
171
46 y
Carbon monoxide
172 i/p
50 y
Carbon monoxide
173
51 y
Carbon monoxide
174 p
51 y
Carbon monoxide
175 p
52 y
Carbon monoxide
176 i/p
53 y
Carbon monoxide
177 i/p
56 y
Carbon monoxide
178 i/p
57 y
Carbon monoxide
179 p
59 y
Carbon monoxide
180 p
60 y
Carbon monoxide
181 i/p
69 y
Carbon monoxide
182 i/p
70 y
Carbon monoxide
183 i/p
71 y
Carbon monoxide
184 a/p
72 y
Carbon monoxide
185 i/p
72 y
Carbon monoxide
186 i/p
83 y
Carbon monoxide
187 i/p N19 y
Carbon monoxide
188 i/p N19 y
Carbon monoxide
189 p
N19 y
Carbon monoxide
190 p
N19 y
Carbon monoxide
191 p
N19 y
Carbon monoxide
192 i/p N19 y
Carbon monoxide
193 p
49 y
Carbon monoxide
Acetaminophen/codeine
194 p
195 p
196
197
198
199
200
201
202
203
p
p
i/p
p
i/p
p
p
Bupropion (long-acting)A
Carbon monoxide
Bupropion (long-acting)
51 y
Carbon monoxide
Fluoxetine
Olanzapine
19 mo Carbon monoxide/smoke
3y
Carbon monoxide/smoke
6y
Carbon monoxide/smoke
6y
Carbon monoxide/smoke
7y
Carbon monoxide/smoke
30 y
Carbon monoxide/smoke
30s y
Carbon monoxide/smoke
35 y
Carbon monoxide/smoke
17 y
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
A
A
A
A
A
A
A
A
A
A
A
A
U
A
C
A
U
A
A
A
A/C
A
A
A
A
A
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Ing/inh
Env
Env
Env
Env
Env
Env
Int suicide
Int suicide
Env
Env
Env
Unk
Env
Int suicide
Env
Env
Env
Env
Int suicide
Env
Env
Env
Env
Env
Env
Unk
Unk
Env
Env
Env
Env
Occ
Env
Env
Env
Env
Int suicide
Env
Env
Int suicide
Env
Env
Int suicide
Int suicide
Env
Env
Int suicide
Env
Env
Int suicide
Int suicide
A
Ing/inh
Int suicide
A
Ing/inh
Int suicide
N80%§
A
A
A
A
A
A
A
A
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Inh
Env
Env
Env
Env
Env
Env
Env
Env
38%§
44.6%
44.3%
21%
39%
46%
42%
79.03%§
6%
44%§
21%
80%§
43.4%
80%§
55%§
23.1%
59.5%§
42 lg/mL§,w
Codeine 23.482 lg/mL§
711 ng/mL§
35.7%§
34%
38.9%
30.5%
2004 AAPCC Annual Report
605
Table 21 continued
Case
Age
Substances
NONPHARMACEUTICALS
Fumes/gases/vapors
204 p
39 y
Carbon monoxide/smoke
205 p
55 y
Carbon monoxide/smoke
206 p
76 y
Carbon monoxide/smoke
207
N19 y
Carbon monoxide/smoke
208 p
30s y
Carbon monoxide/smoke
Cyanide
209 p
76 y
Carbon monoxide/smoke
Cyanide
210 p
47 y
Carbon monoxide/smoke
Ethanol
211 p
4y
Carbon monoxide/smoke
Midazolam
212 p
74 y
Chlorine
Other swimming pool product
Unk chemical
213
38 y
Chlorine
Sulfuric acid
Trihydroxytriazine
214 p
43 y
Helium
215 a/p
22 y
Hydrogen sulfide
216 p
28 y
Hydrogen sulfide
217 p
32 y
Methane
See also case 948 (cyclopropane).
Heavy metals
218 a
42 y
219
64 y
220
67 y
221
25 y
See also case 11 (lead).
Hydrocarbons
222 p
16
223 p
18
224 p
20
225 a/i/p N19
226 p
20
Algaecide (copper)
Arsenic
Arsenic
Ricin
Copper
Chlorofluorocarbon
Chlorofluorocarbon
Chlorofluorocarbon
Chlorofluorocarbon
Gasoline
Chloral hydrate
See also cases 22 (chlorofluorocarbon), 233 (gasoline), and 109 and 377
Mushrooms
227 a
228 a/p
229 a
230 i
See also case
y
y
y
y
y
83 y
Amanita bisporigera
44 y
Amanita muscaria
70 y
Amanita phalloides
76 y
Unk mushroom
751 (Amanita muscaria).
Paints and stripping agents
231 p
40 y
Spray paint
Amphetamine
TrazodoneA
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
A/C
A
A
A
A
Inh
Inh
Inh
Inh
Inh
Env
Env
Malicious
Env
Env
A
Inh
Env
10%
A
Ing/inh
Env
A
Inh/paren
Env
33%
250 mg/dL
51.8%
A
Inh
Unint misuse
A
Inh
Env
A
A
A
A
Inh
Inh
Inh
Inh
Int abuse
Occ
Env
Occ
A
A
U
Ing
Ing
Unk
Int suicide
Int suicide
Malicious
C
Other
Env
A
A
A
A
A/C
Inh
Inh
Inh
Inh
Ing/inh
Int abuse
Int abuse
Int abuse
Occ
Int suicide
37.4%
62%
40%
50%
Copper 3.24 lg/mL
6h
16 h
Trichloroethanol 3.5 lg/mL§
(turpentine).
A
A
A
A
Ing
Ing
Ing
Ing
Unint misuse
Int misuse
Unint misuse
Int suicide
U
Ing/inh
Int unk
Pesticides: herbicides (including algaecides, defoliants, desiccants, and plant growth regulators)
232 a
34 y
2,4-Dichloro-phenoxyacetic acid
A
Ing
233
30 y
2,4-Dichloro-phenoxyacetic acid
A
Ing
Gasoline
234 a
75 y
Glyphosate
A
Ing
Pesticides: insecticides (including insert growth regulators, molluscicides, nematicides)
235
24 y
Cypermethrin/imiprothrin
A
Asp/ing
236
89 y
Diazinon
A
Ing
237
N19 y
Organophosphate
A
Ing/paren
238 a
38 y
Terbufos
A
Ing
Int suicide
Int suicide
Int suicide
Int
Int
Int
Int
suicide
suicide
suicide
suicide
Pesticides: rodenticides
See also case 457 (long-acting anticoagulant rodenticide).
(continued on next page)
606
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
NONPHARMACEUTICALS
Plants
239 a
19 y
Datura spp
See also case 220 (ricin).
Swimming pool/aquarium
240 a
56 y
Algaecide (benzylammonium chloride)
241
23 y
Chlorine
See also case 212 (other swimming pool product).
Other/unk nondrug substances
242 p
24 y
Unk substance
243 p
39 y
Unk substance
Unk drug
See also cases 91 and 1153 (unk substance).
PHARMACEUTICALS
Analgesics
244 a
2y
Acetaminophen
245 a
3y
Acetaminophen
246
15 y
Acetaminophen
247
18 y
Acetaminophen
248
18 y
Acetaminophen
249
19 y
Acetaminophen
250
19 y
Acetaminophen
251
21 y
Acetaminophen
252
22 y
Acetaminophen
253
22 y
Acetaminophen
254
24 y
Acetaminophen
255
27 y
Acetaminophen
256
29 y
Acetaminophen
257
29 y
Acetaminophen
258
29 y
Acetaminophen
259
33 y
Acetaminophen
260
33 y
Acetaminophen
261
34 y
Acetaminophen
262
36 y
Acetaminophen
263
36 y
Acetaminophen
264
37 y
Acetaminophen
265
38 y
Acetaminophen
266
38 y
Acetaminophen
267
38 y
Acetaminophen
268
39 y
Acetaminophen
269
39 y
Acetaminophen
270
39 y
Acetaminophen
271 p
39 y
Acetaminophen
272 p
40 y
Acetaminophen
273
40 y
Acetaminophen
274 a
40 y
Acetaminophen
275
40 y
Acetaminophen
276
42 y
Acetaminophen
277
43 y
Acetaminophen
278
43 y
Acetaminophen
279
43 y
Acetaminophen
280
45 y
Acetaminophen
281
45 y
Acetaminophen
282
45 y
Acetaminophen
283
46 y
Acetaminophen
284
46 y
Acetaminophen
285
47 y
Acetaminophen
286
50 y
Acetaminophen
287
51 y
Acetaminophen
288 a
51 y
Acetaminophen
289
51 y
Acetaminophen
290
52 y
Acetaminophen
291
52 y
Acetaminophen
292
53 y
Acetaminophen
293
53 y
Acetaminophen
294
54 y
Acetaminophen
295
55 y
Acetaminophen
Chronicity Route
Reason
A
Ing
Int abuse
A
A
Ing
Derm/inh/ocu
Int suicide
Unint gen
U
A
Unk
Ing
Unk
Unk
C
C
A
A
A/C
A
A
A
A
A
A
A
A
C
A
U
A
A
A
U
C
A
C
A
A
U
A/C
U
C
U
A
A
C
C
A/C
A
A
C
A/C
C
A
U
A
U
U
C
A
U
C
U
C
C
Ing/rectal
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ther err
Ther err
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int misuse
Int unk
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int misuse
Unk
Ther err
Int suicide
Int suicide
Int unk
Int suicide
Unk
Ther err
Unk
Malicious
Int suicide
Int misuse
Ther err
Int suicide
Int suicide
Int unk
Int misuse
Int suicide
Int misuse
Int suicide
Int unk
Int suicide
Int misuse
Int suicide
Int misuse
Int suicide
Int suicide
Int misuse
Unk
Int suicide
Int suicide
Blood
Concentrations
72 lg/mL
52 lg/mL
15 lg/mL
90 lg/mL
N210 lg/mL
650 lg/mL
35 lg/mL
144 lg/mL
41 lg/dL
158 lg/mL
21 lg/mL
66
32
117
129
68
41
24
29.8
78
lg/mL
lg/mL
lg/mL
lg/mL
lg/mL
lg/mL
lg/mL
lg/mL
lg/mL
74 lg/mL
13 lg/mL
198 lg/mL
20 lg/mL
43 lg/mL
50 lg/mL
101 lg/mL
48.3 lg/mL
23 lg/mL
28 lg/mL
42 lg/mL
116 lg/mL
64 lg/mL
8 lg/mL
82.3 lg/mL
381
N200
95
1180.6
lg/mL
lg/mL
lg/mL
lg/mL
328 lg/mL
289 lg/mL
12 lg/mL
469 lg/mL
681.5 lg/mL
Interval after
Exposure
8h
16 h
24 h
24 h
69 h
28 h
2d
24 h
l3 d
36 h
24 h
13 h
2004 AAPCC Annual Report
607
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
296
56 y
Acetaminophen
297
57 y
Acetaminophen
298 p
58 y
Acetaminophen
299
60 y
Acetaminophen
300
61 y
Acetaminophen
301
63 y
Acetaminophen
302
67 y
Acetaminophen
303 i
69 y
Acetaminophen
304
70 y
Acetaminophen
305
70 y
Acetaminophen
306
76 y
Acetaminophen
307
81 y
Acetaminophen
308
82 y
Acetaminophen
309
60 y
Acetaminophen
Acetaminophen/aspirin/caffeine
310
71 y
Acetaminophen
Acetaminophen/dextromethorphan/
doxylamine/pseudoephedrine
311
20 y
Acetaminophen
Acetaminophen/diphenhydramine
312
23 y
Acetaminophen
Acetaminophen/diphenhydramine
ClomipramineA
313 p
34 y
Acetaminophen
Acetaminophen/hydrocodone
314
34 y
Acetaminophen
Acetaminophen/hydrocodone
315
25 y
Acetaminophen
Alprazolam
Tricyclic antidepressantA
316 p
43 y
Acetaminophen
Amphetamine
Benzodiazepine
317
32 y
Acetaminophen
Aspirin
318 a
15 y
Acetaminophen
Buprenorphine
Codeine/guaifenesin
319
41 y
Acetaminophen
Carisoprodol
320
72 y
Acetaminophen
Chlordiazepoxide
Marijuana
321
56 y
Acetaminophen
Clonazepam
Paroxetine
322
18 y
Acetaminophen
Cocaine
323
40s y
Acetaminophen
Cocaine
324
47 y
Acetaminophen
Cocaine
325
67 y
Acetaminophen
Codeine
326 p
29 y
Acetaminophen
Diazepam
Alprazolam
327
54 y
Acetaminophen
Diphenhydramine
328 p
49 y
Acetaminophen
Diphenhydramine
Acetaminophen/codeine
329
28 y
Acetaminophen
Diphenhydramine
Cocaine
330
41 y
Acetaminophen
Ephedrine
MeprobamateA
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
A/C
A/C
U
U
A
U
A/C
C
C
C
A
A
U
C
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Int misuse
Int suicide
Int suicide
Int suicide
Int suicide
Int unk
Int suicide
Ther err
Ther err
Int misuse
Int suicide
Int suicide
Unk
Int misuse
C
Ing
Int misuse
223 lg/mL
96.6 lg/mL
10 lg/mL
13 mg/dLb
47 lg/mL
A
Ing
Int suicide
142 lg/mL
A
Ing
Int suicide
549 lg/mL
Diphenhydramine 2.3 lg/mL
A/C
Ing
Int misuse
171.5 lg/mL
C
Ing
Int misuse
29 lg/mL
A
Ing
Int suicide
88 lg/mL
U
Ing
Int abuse
5.4 lg/mL
A
Ing
Int suicide
A
Ing
Int suicide
33 lg/mL
12.2 mg/dL
155 lg/mL
A
Ing
Int suicide
A
Ing/inh
Int suicide
51 lg/mL
A/C
Ing
Int suicide
414 lg/mL
A
Ing/unk
Int suicide
210 lg/mL
U
Ing/unk
Int suicide
10 lg/mL
A
Ing/unk
Int suicide
A
Ing
Int suicide
154 lg/mL
A/C
Ing
Int suicide
648 lg/mL
A
Ing
Int suicide
U
Ing
Int suicide
316.3 lg/mL
1.114 lg/mL§
143 lg/mL
A
Ing/unk
Int abuse
342 lg/mL
U
Ing
Unk
22.3 lg/mL
136 lg/mL
68 lg/mL
N200 lg/mL
315
302
194
50
74
70
3d
lg/mL
lg/mL
lg/mL
lg/mL
lg/mL
lg/mL
24 h
24 h
24 h
12 h
24 h
(continued on next page)
608
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
331
76 y
Acetaminophen
Esomeprazole
Rabeprazole (long-acting)A
332
20 y
Acetaminophen
Ethanol
333
21 y
Acetaminophen
Ethanol
334
39 y
Acetaminophen
Ethanol
335
46 y
Acetaminophen
Ethanol
336
21 y
Acetaminophen
Ethanol
Aspirin
337
54 y
Acetaminophen
Ethanol
Marijuana
338
21 y
Acetaminophen
Fluoxetine
Amitriptyline
339
36 y
Acetaminophen
Gabapentin
TopiramateA
340
17 y
Acetaminophen
Hydroxyzine
341
36 y
Acetaminophen
Ibuprofen
342
36 y
Acetaminophen
Ibuprofen
343
26 y
Acetaminophen
Iron
344 p
40s y
Acetaminophen
Morphine
345
26 y
Acetaminophen
Multiple vitamins with iron
346
24 y
Acetaminophen
Phencyclidine
Marijuana
347
58 y
Acetaminophen
Propylene glycol
348 p
41 y
Acetaminophen
Tricyclic antidepressant
349
51 y
Acetaminophen
Unk drug
350
14 y
Acetaminophen
Zolpidem
RisperidoneA
351
21 y
Acetaminophen
Zolpidem
RisperidoneA
352
33 y
Acetaminophen (long-acting)
353
35 y
Acetaminophen (long-acting)
354
48 y
Acetaminophen/aspirin/caffeine
Acetaminophen/hydrocodone
355
34 y
Acetaminophen/codeine
356
55 y
Acetaminophen/codeine
Acetaminophen/hydrocodone
Escitalopram
357
59 y
Acetaminophen/codeine
Acetaminophen/hydrocodone
EthanolA
358
52 y
Acetaminophen/codeine
Carisoprodol
DiphenhydramineA
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
U
Ing
Int suicide
16.5 lg/mL
U
Ing
Int unk
300 lg/mL
A
Ing
Int suicide
73 lg/mL
12 h
A
Ing
Int suicide
27 lg/mL
21 h
C
Ing
Int suicide
63 lg/mL
A
Ing
Int suicide
36.9 lg/mL
U
Ing/inh
Int suicide
7.2 mg/dL
726.5 lg/mL
187 mg/dL
A
Ing
Int suicide
A/C
Ing
Int suicide
1780 lg/mL
930 ng/mL§
550 ng/mL§
44 lg/mL
A
Ing
Int suicide
120 lg/mL
26 h
A
Ing
Int suicide
7.6 lg/mL
2d
C
Ing
Int misuse
A
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
A
Ing/unk
Unk
U
Ing
Int unk
145 lg/mL
A
Ing
Int suicide
570 lg/mL
U
Ing
Unk
A
Ing
Int suicide
A
Ing
Int suicide
163 lg/mL
A
A
C
Ing
Ing
Ing
Int suicide
Int suicide
Ther err
196 lg/mL
2 lg/mL
92 lg/mLw
C
A/C
Ing
Ing
Ther err
Int suicide
A
Ing
Int suicide
67 lg/mLw
A/C
Ing
Int suicide
335 lg/mLw
Codeine 3 lg/mL§
Morphine 36 ng/mL§
8.3 lg/mL§
Meprobamate 75 lg/mL§
1 lg/mL§
3d
336 lg/dL
33 lg/mL
Iron 333 lg/dL
147 lg/mL
48 h
2004 AAPCC Annual Report
609
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
359
31 y
Acetaminophen/codeine
Chlordiazepoxide
360
66 y
Acetaminophen/codeine
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
C
Ing
Int unk
A
Ing
Int suicide
A/C
Ing
Int suicide
A/C
A
A
A
A
U
A
A
A
A
A
A
A
A
A/C
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Asp/ing
Ing
Ing
Ing
Ing
Ing
Ing
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
A
Ing
Int suicide
N300 lg/mLw
U
Ing
Int suicide
175 lg/mLw
97 mg/dL
A
Ing
Int suicide
U
Ing
Int suicide
12 mg/dL
173.3 lg/mLw
A
Ing
Int suicide
738 lg/mLw
A
Ing
Int suicide
770 lg/mLw
A
A
Ing
Ing
Unint gen
Int unk
27.3 lg/mLw
116 lg/mLw
Codeine 0.7 lg/mL§
4h
lg/mLw
lg/mLw
lg/mLw
lg/mLw
lg/mLw
lg/mLw
lg/mLw
lg/mLw
lg/mLw
lg/mLw
lg/mLw
24 h
361 p
74 y
362
363
364
365
366
367 p
368
369
370
371
372
373
374
375 p
376
20
20
24
25
25
28
29
29
33
39
39
45
46
51
25
377
23 y
378
18 y
379
33 y
380 i
51 y
381
32 y
382 p
49 y
383 p
384 p
2y
15 y
Naproxen
IbuprofenA
Acetaminophen/codeine
Thioridazine
LorazepamA
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen/diphenhydramine
Acetaminophen
Acetaminophen/diphenhydramine
Acetaminophen/aspirin
Turpentine
Acetaminophen/diphenhydramine
Antifreeze (ethylene glycol)
Acetaminophen/diphenhydramine
Ethanol
Acetaminophen/diphenhydramine
Naproxen
Acetaminophen/diphenhydramine
Quetiapine
LorazepamA
Acetaminophen/diphenhydramine
Zolpidem
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
385
386
387
388
389
390 p
391
392
393
394 p
19
21
26
29
37
39
39
42
44
48
y
y
y
y
y
y
y
y
y
y
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
A/C
A
C
A
A/C
A
A/C
A
A
U
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
suicide
suicide
misuse
suicide
suicide
suicide
suicide
suicide
suicide
suicide
395 p
396
397
398
399
48
62
63
N19
48
y
y
y
y
y
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/hydrocodone
Acetaminophen/antihistamine
Carisoprodol
Acetaminophen/hydrocodone
Acetaminophen/tramadol
AspirinA
Acetaminophen/hydrocodone
Activated charcoal
A/C
C
A
A/C
C
Ing
Ing
Ing
Ing
Ing
Int
Int
Int
Int
Int
unk
unk
suicide
misuse
misuse
A/C
Ing
Int abuse
7.3 lg/mLw
A
Asp/ing
Int suicide
7.9 mg/dL
1.2 lg/mLw
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
400
34 y
401
44 y
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
suicide
unk
88
500
449.2
69
50
507
93
63
589
467
194
405 lg/mLw
153 lg/mLw
52 lg/mLw
18 h
48 h
36 h
4.3 h
4h
3h
7.5 h
Hydrocodone 1200 ng/mL§
41.2 lg/mL§,w
Hydrocodone 260 ng/mL§
143 lg/mLw
31 lg/mLw
70.6 lg/mLw
73
183.7
169.5
36
lg/mLw
lg/mLw
lg/mLw
lg/mLw
157 lg/mLw
Hydrocodone 110 ng/mL
8h
320 lg/mLw
Hydrocodone 780 ng/mL§
47 lg/mLw
24 h
(continued on next page)
610
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
402 p
24 y
Acetaminophen/hydrocodone
Alprazolam
403 p
38 y
Acetaminophen/hydrocodone
404 p
74 y
405 p
20 y
Alprazolam
Acetaminophen/hydrocodone
Alprazolam
Acetaminophen/hydrocodone
Chronicity Route
Reason
A
Ing
Int suicide
A/C
Ing
Int suicide
U
Ing
Unk
A
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
88 lg/mLw
A/C
Ing
Int suicide
132 lg/mLw
A/C
Ing
Int misuse
66 lg/mLw
C
Ing
Int misuse
73 lg/mLw
A
Ing
Int suicide
A/C
Ing
Int misuse
50 lg/mLw
A/C
Ing
Int suicide
16 lg/mLw
A
Ing
Int suicide
C
Ing
Int abuse
A
Ing
Int unk
A/C
Ing
Int suicide
A/C
Ing
Int suicide
22.8 lg/mLw
A
Ing
Int suicide
16 lg/mLw
A/C
Ing
Int suicide
A/C
Ing
Int suicide
U
Ing
Int suicide
Alprazolam
CarisoprodolA
406
48 y
407
51 y
408 p
31 y
409
31 y
410
32 y
411
36 y
412
41 y
413
42 y
414
42 y
415
43 y
416
45 y
417
46 y
418
37 y
419
37 y
420 p
48 y
421 p
20 y
422
61 y
423
44 y
424
59 y
425 p
38 y
Acetaminophen/hydrocodone
Amitriptyline
Acetaminophen/hydrocodone
Atropine/hyoscyamine/
phenobarbital/scopolamine
Diazepam
Acetaminophen/hydrocodone
Buspirone
AlprazolamA
Acetaminophen/hydrocodone
Carisoprodol
Acetaminophen/hydrocodone
Carisoprodol
Acetaminophen/hydrocodone
Carisoprodol
Acetaminophen/hydrocodone
Carisoprodol
Acetaminophen/hydrocodone
Carisoprodol
Acetaminophen/hydrocodone
Carisoprodol
Acetaminophen/hydrocodone
Carisoprodol
Acetaminophen/hydrocodone
Carisoprodol
Acetaminophen/hydrocodone
Carisoprodol
Acetaminophen/hydrocodone
Carisoprodol
Alprazolam
Acetaminophen/hydrocodone
Carisoprodol
Alprazolam
Acetaminophen/hydrocodone
Carisoprodol
Alprazolam
Acetaminophen/hydrocodone
Carisoprodol
Baclofen
Acetaminophen/hydrocodone
Carisoprodol
DiazepamA
Acetaminophen/hydrocodone
Diazepam
Acetaminophen/hydrocodone
Diazepam
MethadoneA
Acetaminophen/hydrocodone
Escitalopram
Clonazepam
Blood
Concentrations
Interval after
Exposure
31.8 lg/mL§,w
Hydrocodone 160 ng/mL§
62 ng/mL§
12.8 lg/mLw
Hydrocodone 250 ng/mL
Hydromorphone 40 ng/mL
30 ng/mL
7.9 lg/mL
Meprobamate 10.7 lg/mL
192 lg/mLw
61 lg/mL§,b
Hydrocodone 250 ng/mL§
Dihydrocodone 47 ng/mL§
44 ng/mL§
65.48 lg/mL§,w
Hydrocodone 110 ng/mL§
2.44 lg/mL§
21 lg/mLw
190 lg/mLw
319 lg/mLw
24 h
2004 AAPCC Annual Report
611
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
426 p
31 y
Acetaminophen/hydrocodone
Methadone
427
47 y
Acetaminophen/hydrocodone
428
52 y
429
430
431
432
44
53
63
43
433
52 y
434
49 y
435
86 y
y
y
y
y
436 p
28 y
437 p
37 y
438
46 y
439 i/p
40 y
440
69 y
441 p
45 y
442 p
443 p
25 y
34 y
444 p
445
446
42 y
47 y
52 y
447 p
14 y
448 p
35 y
449
72 y
450
63 y
451
49 y
Temazepam
Acetaminophen/hydrocodone
Tiagabine
AmitriptylineA
Acetaminophen/oxycodone
Acetaminophen/oxycodone
Acetaminophen/oxycodone
Acetaminophen/oxycodone
Acetaminophen/butalbital/caffeine
Ethanol
Acetaminophen/oxycodone
Acetaminophen/codeine
DiazepamA
Acetaminophen/oxycodone
Acetaminophen/hydrocodone
MethocarbamolA
Acetaminophen/oxycodone
Aspirin
Ethanol
Acetaminophen/oxycodone
Carisoprodol
Acetaminophen/oxycodone
Ethanol
Acetaminophen/oxycodone
Fluoxetine
EletriptanA
Acetaminophen/oxycodone
Mirtazapine
CarisoprodolA
Acetaminophen/oxycodone
Phenytoin
ZolpidemA
Acetaminophen/oxycodone
Unk drug
Acetaminophen/propoxyphene
Acetaminophen/propoxyphene
Acetaminophen/propoxyphene
Acetaminophen/propoxyphene
Acetaminophen/propoxyphene
Acetaminophen
Acetaminophen/propoxyphene
Acetaminophen
Unk cough/cold medication
Acetaminophen/propoxyphene
Acetaminophen/hydrocodone
AlprazolamA
Acetaminophen/propoxyphene
Alprazolam
Cyclobenzaprine
Acetaminophen/propoxyphene
Alprazolam
ParoxetineA
Acetaminophen/propoxyphene
Amitriptyline
Oxycodone (long-acting)A
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
U
Ing
Unk
A
Ing
Int suicide
A/C
Ing
Int suicide
C
A/C
A/C
A
Ing
Ing
Ing
Ing
Ther err
Ther err
Int suicide
Int suicide
17
153
151
26
U
Ing
Int suicide
56 lg/mLw
Codeine 0.914 lg/mL§
Morphine 270 ng/mL§
A
Ing
Int suicide
5.1 lg/mLw
A
Ing
Int suicide
172 lg/mLw
43 mg/dL
0.6 lg/mL§
59.4 lg/mLw
Hydrocodone 119 ng/mL§
900 ng/mL
lg/mLw
lg/mLw
lg/mLw
lg/mLw
9h
36 h
19.4 lg/mLw
A
Ing
Int suicide
A
Ing
Int unk
A
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A
Inh
Int abuse
A
A
Ing
Ing
Int suicide
Int suicide
A
C
A
Ing
Ing
Ing
Int suicide
Int misuse
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
72 lg/mLw
A
Ing
Int suicide
A/C
Ing
Int suicide
53 lg/mLw
Propoxyphene 0.19 lg/mL
Norpropoxyphene 0.16 lg/mL
110 ng/mL
140 ng/mL
15 lg/mLw
48 lg/mLw
2h
120 lg/mLw
32 lg/mL§,w
Oxycodone 1300 ng/mL§
200 ng/mL§
12 lg/mL§
151
Propoxyphene 3.7
229
90
48.2
lg/mL§,w
lg/mL§
lg/mLw
lg/mLw
lg/mLw
160 lg/mL§,w
Propoxyphene N10 lg/mL§
(continued on next page)
612
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
452
55 y
Acetaminophen/propoxyphene
Bupropion (long-acting)
CyclobenzaprineA
453
37 y
Acetaminophen/propoxyphene
Carisoprodol
Unk drug
454
52 y
Acetaminophen/propoxyphene
Cyclobenzaprine
455
56 y
Acetaminophen/propoxyphene
Diphenoxylate/atropine
456
25 y
Acetaminophen/propoxyphene
Ethanol
Cocaine
457 p
38 y
Acetaminophen/propoxyphene
Long-acting anticoagulant rodenticide
458 p
28 y
Acetaminophen/propoxyphene
Methadone
Unk drug
459
43 y
Acetaminophen/propoxyphene
Chronicity Route
Reason
A/C
Ing
Int suicide
U
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
23.6 lg/mLw
A
Ing/unk
Int suicide
78 lg/mLw
112 mg/dL
A
Ing
Int suicide
Norpropoxyphene 0.69 lg/mL§
A
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
U
Derm/ing
Int suicide
C
A
A
A
A
C
A
A
A
A
A
A
A
A
A
A/C
A
U
A
A
C
U
A
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Adv rxn
Int suicide
Int suicide
Int suicide
Int suicide
Int misuse
Int suicide
Int unk
Int suicide
Int suicide
Int unk
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Unk
Unk
Int suicide
Unint gen
Unk
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing/unk
Int suicide
A
Ing
Int suicide
Mirtazapine
Carisoprodol
460
25 y
461
73 y
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
a
p
a
i
11 y
23 y
36 y
38 y
38 y
41 y
43 y
45 y
47 y
47 y
49 y
52 y
53 y
58 y
68 y
77 y
78 y
80 y
90 y
N19 y
97 y
Unk
21 y
485
51 y
486
56 y
487
66 y
488 i
25 y
489
47 y
Acetaminophen/propoxyphene
Morphine
Acetaminophen/propoxyphene
Quetiapine
Unk chemical
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Aspirin
Acetaminophen
Aspirin
Acetaminophen
Aspirin
Acetaminophen
Aspirin
Acetaminophen
Aspirin
Acetaminophen
CocaineA
Aspirin
Acetaminophen/hydrocodone
Acetaminophen/dextromethorphan/
doxylamine/pseudoephedrineA
Blood
Concentrations
Interval after
Exposure
336 lg/mLw
14 h
232 lg/mLw
Propoxyphene 3.8 lg/mL§
Norpropoxyphene 4.8 lg/mL§
2200 ng/mL§
17 lg/mL§
Meprobamate 44 lg/mL§
27 lg/mLw
66
73.9
141
105
97.7
82
mg/dL
mg/dL
mg/dL
mg/dL
mg/dL
mg/dL
96 mg/dL
91.7 mg/dL§
101 mg/dL
100 mg/dL
103 mg/dL
120 mg/dL
82.3 mg/dL
98.4 mg/dL
141.7 mg/dL
42.5 mg/dL
97 mg/dL
73 mg/dL
137 mg/dL
88.9 mg/dL
143 mg/dL
340 lg/mL
54 mg/dL
300 lg/mL
103 mg/dL
53 lg/mL
39 mg/dL
13.9 lg/mL
36.5 mg/dL
126 lg/mL
63 mg/dL
120 lg/mLw
Hydrocodone 70 ng/mL§
Pseudoephedrine 2.1 lg/mL§
Doxylamine 0.45 lg/mL§
Dextromethorphan 0.19 lg/mL§
23 h
11 h
22 h
2004 AAPCC Annual Report
613
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
490
38 y
Aspirin
Acetaminophen/propoxyphene
491
47 y
Aspirin
Benzodiazepine
Barbiturate (long-acting)
492
83 y
Aspirin
Diltiazem
AcetaminophenA
493
32 y
Aspirin
Ethanol
494
39 y
Aspirin
Isopropyl alcohol
Ethanol
495
55 y
Aspirin
Mirtazapine
TrazodoneA
496
51 y
Aspirin
Olanzapine
497
41 y
Aspirin
Quetiapine
498
14 y
Aspirin
Quetiapine
Acetaminophen/brompheniramine/
pseudoephedrineA
499
65 y
Aspirin
Valproic acid (long-acting)
Clonazepam
500 i
77 y
Aspirin/butalbital/caffeine
Acetaminophen/hydrocodone
501 p
42 y
Aspirin/codeine
502
54 y
Aspirin/oxycodone
503 i/p
30s y
504 p
505
78 y
52 y
506
507 a
508
509
33
51
84
57
y
y
y
y
510 p
24 y
511
512
513
514
515
516
44
25
19
42
48
31
p
p
p
p
a/p
p
y
y
y
y
y
y
517 p
34 y
518
29 y
519 p
29 y
520 p
22 y
521
34 y
522 p
37 y
Buprenorphine/naloxone
Ethanol
Codeine
Codeine
Acetaminophen
Colchicine
Colchicine
Colchicine
Colchicine
Acetaminophen/codeine
AllopurinolA
Etodolac
Unk drug
Ethanol
Fentanyl
Fentanyl lozenge
Fentanyl patch
Fentanyl patch
Fentanyl patch
Fentanyl patch
Ethanol
Fentanyl patch
Ethanol
Fentanyl patch
Flurazepam
Fentanyl patch
Ma huang
Fentanyl patch
Morphine
Fentanyl patch
Sertraline
Acetaminophen
Fentanyl patch
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
A
Ing
Int suicide
A
Ing
Int suicide
94.6 mg/dL
191 lg/mLw
92 mg/dL
A
Ing
Int suicide
N300 mg/dL
A
Ing
Int suicide
248 lg/mL
136.8 mg/dL
A
Ing
Int suicide
51.5 mg/dL
U
Ing
Int suicide
263 mg/dL
75 mg/dL
A
Ing
Int suicide
73 mg/dL
A
Ing
Int suicide
69 mg/dL
A
Ing
Int suicide
69 mg/dL
34 lg/mLw
A
Ing
Int suicide
U
Ing
Int suicide
A
A/C
Ing
Ing
Int suicide
Int misuse
A/C
Ing
Int abuse
A
A/C
Ing
Ing
Int suicide
Int suicide
C
A
C
A/C
Ing
Ing
Ing
Ing
Ther err
Int suicide
Ther err
Int suicide
104 mg/dL
50 lg/mL
50 ng/mL§
24 mg/dLb
44.4 mg/dLb
Oxycodone 210 ng/mL
14.6 lg/mL
229.2 lg/mLw
U
Ing
Unk
A
A
A
A
A/C
U
Ing
Ing
Derm
Ing/paren
Derm
Derm/ing
Int
Int
Int
Int
Int
Int
A
Ing
Int abuse
A/C
Ing
Int abuse
A
Ing
Int suicide
A/C
Ing/unk
Int suicide
A
Derm/ing
Int suicide
U
Ing
Int suicide
abuse
abuse
abuse
abuse
abuse
unk
16 h
4h
5h
10 h
29.7 ng/mL§
(continued on next page)
614
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
522 p
37 y
Fentanyl patch
Zonisamide
Trazodone
523 i
40 y
Hydromorphone
Alprazolam
524
N19 y
Meperidine
525 a/p
10 mo Methadone
526 a/i
15 mo Methadone
527 a
20 mo Methadone
528
b6 y
Methadone
529 i
14 y
Methadone
530 p
17 y
Methadone
531 p
17 y
Methadone
532 p
17 y
Methadone
533 p
18 y
Methadone
534 p
19 y
Methadone
535 p
19 y
Methadone
536 p
20 y
Methadone
537 p
20 y
Methadone
538 p
21 y
Methadone
539 i/p
23 y
Methadone
540
25 y
Methadone
541 p
26 y
Methadone
542 p
32 y
Methadone
543
33 y
Methadone
544 p
34 y
Methadone
545 p
39 y
Methadone
546 p
40 y
Methadone
547 p
41 y
Methadone
548 p
48 y
Methadone
549
51 y
Methadone
550 p
53 y
Methadone
551 p
54 y
Methadone
552 p
62 y
Methadone
553 p
64 y
Methadone
554
74 y
Methadone
555 p
N19 y
Methadone
556 i/p Unk
Methadone
557 p
23 y
Methadone
Acetaminophen
558 p
27 y
Methadone
Acetaminophen/hydrocodone
559 p
45 y
Methadone
Acetaminophen/hydrocodone
Alprazolam
560 p
46 y
Methadone
Acetaminophen/hydrocodone
AlprazolamA
561 p
26 y
Methadone
Acetaminophen/hydrocodone
Sertraline
562
24 y
Methadone
Acetaminophen/pseudoephedrine
563 p
22 y
Methadone
Alprazolam
564 p
40 y
Methadone
Alprazolam
Methamphetamine
565
50 y
Methadone
Amitriptyline
Acetaminophen/hydrocodoneA
566 p
47 y
Methadone
Benzodiazepine
567 p
54 y
Methadone
Benzodiazepine
568 p
21 y
Methadone
Chronicity Route
Reason
U
Ing
Int suicide
U
Ing
Int unk
A
A
A
A
U
A
A
A
A
A
U
A
A
A
A/C
A/C
U
A/C
A/C
U
A
A/C
A/C
U
U
A
A
A
A/C
A/C
A/C
A
U
U
Ing
Ing
Ing
Ing
Unk
Unk
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Paren
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Unk
Ing
Int unk
Malicious
Unint gen
Unint gen
Unk
Unk
Int unk
Int abuse
Int abuse
Int suicide
Int unk
Int unk
Int abuse
Int abuse
Int suicide
Int unk
Int suicide
Int abuse
Int suicide
Int suicide
Int unk
Int unk
Int suicide
Unk
Int abuse
Int suicide
Int abuse
Unk
Int suicide
Int suicide
Int suicide
Unk
Unk
Int unk
U
Ing
Int unk
U
Ing
Unk
U
Ing
Int suicide
U
Ing
Int abuse
A
Ing
Int suicide
U
Ing
Int suicide
U
Ing/paren
Int abuse
A/C
Ing
Int unk
Blood
Concentrations
0.67 lg/mL§
0.4 lg/mL§
0.1 lg/mL
4.2 lg/mL
0.13 lg/mL§
0.2 lg/mL§
16.302 lg/mL
0.7 lg/mL§
Hydrocodone 60 ng/mL§
0.3 lg/mL§
Hydrocodone 50 ng/mL§
20 ng/mL§
0.65 lg/mL§
Hydrocodone 100 ng/mL§
0.19 lg/mL
50 ng/mL
Norsertraline 10 ng/mL
1.9 lg/mL§
40 ng/mL§
0.7 lg/mL§
91 ng/mL
0.912 lg/mL
U
Ing
Int suicide
A
Ing
Int suicide
1.36 lg/mL§
A
Ing
Int suicide
0.17 lg/mL§
Interval after
Exposure
2004 AAPCC Annual Report
615
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
568 p
21 y
Methadone
Carisoprodol
569 i/p
6y
Methadone
Chloral hydrate
Hydroxyzine
570 p
32 y
Methadone
Clonazepam
571 p
18 y
Methadone
572
29 y
573
33 y
574 p
40 y
575 p
20 y
576 p
62 y
577 p
28 y
578 p
21 y
579 p
21 y
580 p
22 y
581 p
30 y
582 p
34 y
583
47 y
584 p
55 y
585 p
16 y
586 p
56 y
587 p
22 y
588 p
20 y
589 p
24 y
590
23 y
591 p
21 y
592
35 y
593 p
19 y
594 p
38 y
Cocaine
Methadone
Cocaine
Methadone
Cocaine
BenzodiazepineA
Methadone
Diazepam
BaclofenA
Methadone
Diazepam
Isopropyl alcohol
Methadone
Diazepam
Zolpidem
Methadone
Doxylamine
Methadone
Ethanol
Methadone
Ethanol
Methadone
Ethanol
Methadone
Ethanol
Methadone
Ethanol
Methadone
Ethanol
Methadone
Ethanol
Methadone
Ethanol
Marijuana
Methadone
Ethanol
Metoprolol (long-acting)A
Methadone
Fluoxetine
BupropionA
Methadone
Gabapentin
Methadone
Lysergic acid diethylamide
Citalopram
Methadone
Meprobamate
Diazepam
Methadone
Methylenedioxymethamphetamine
Methadone
Opioid
BenzodiazepineA
Methadone
Oxycodone
Alprazolam
Methadone
Chronicity Route
Reason
A
Ing
Int suicide
A
Ing
Unk
A/C
Asp/ing
Int suicide
A/C
Ing/inh
Int abuse
A
Ing/unk
Int unk
U
Ing/unk
Int abuse
U
Ing
Int suicide
A
Ing
Int abuse
A/C
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int abuse
U
Ing
Int unk
A
Ing
Int misuse
U
Ing
Unk
U
Ing
Unk
A/C
Ing
Int abuse
A
Ing
Int suicide
U
Ing/inh
Int abuse
Blood
Concentrations
Interval after
Exposure
0.17 lg/mL§
0.51 lg/mL§
2,2,2-Trichloroethanol 8.3 lg/mL§
0.54 lg/mL§
0.06 lg/mL§
EDDP 0.002 lg/mL§
0.96 lg/mL
480 ng/mL#
0.112 lg/mL§
0.4 lg/mL§
100 mg/dL§
0.2 lg/mL§
350 mg/dL§
2.834 lg/mL
18 h
0.4 lg/mL§
280 mg/dL§
180 mg/dL
U
Ing
Int unk
0.3 lg/mL§
140 mg/dL§
U
Ing
Unk
0.3 lg/mL§
A/C
Ing
Int unk
A
Ing
Int abuse
U
Ing
Int abuse
U
Ing
Int abuse
A
Ing
Int abuse
U
Unk
Int unk
0.1 lg/mL§
A
Ing
Int abuse
20 ng/mL§
0.7 lg/mL§
0.52 lg/mL§
0.17 lg/mL§
432 ng/mL§
690 ng/mL§
0.37 lg/mL
2.171 lg/mL
59 ng/mL§
Nordiazepam 292 ng/mL§
(continued on next page)
616
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
594 p
38 y
Methadone
Promethazine
595 p
42 y
Methadone
Quetiapine
AlprazolamA
596
43 y
Methadone
Quetiapine
CitalopramA
597
42 y
Methadone
Tramadol
Escitalopram
598 p
26 y
Methadone
Venlafaxine
599
19 y
Methadone
Venlafaxine (long-acting)
Unk drug
600 p
46 y
Methadone
Zolpidem
QuetiapineA
601 p
50 y
Morphine
602
Unk
Morphine
603 p
45 y
Morphine
Acetaminophen/aspirin/caffeine
VenlafaxineA
604 p
38 y
Morphine
Benzodiazepine
Phenytoin
605 p
57 y
Morphine
Bupropion (long-acting)
AlprazolamA
606 p
14 y
Morphine (long-acting)
607 p
39 y
Morphine (long-acting)
608 p
56 y
Morphine (long-acting)
Chlordiazepoxide
DiazepamA
609 p
37 y
Morphine (long-acting)
Diazepam
CitalopramA
610 p
60 y
Morphine (long-acting)
Diphenhydramine
SertralineA
611 p
47 y
Morphine (long-acting)
Gabapentin
EthanolA
612 a/p
42 y
Nalbuphine
Propofol
613 a/i/p 10 mo Naproxen
614 p
65 y
Opioid
615
40 y
Opioid
Acetaminophen
616 p
48 y
Opioid
Benzodiazepine
Unk drug
617 p
24 y
Opioid
Marijuana
Ethanol
618 p
20 y
Opioid
Phencyclidine
Marijuana
619 p
49 y
Opioid
Unk drug
620 p
1y
Oxycodone
621 p
57 y
Oxycodone
622
N19 y
Oxycodone
623 a/p
14 mo Oxycodone
Acetaminophen
Chronicity Route
Reason
A
Ing
Int abuse
U
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int unk
C
Ing
Int unk
A
Ing
Int suicide
A
Ing
Int unk
A/C
U
U
Ing
Ing
Ing
Unk
Unk
Int unk
U
Ing
Unk
U
Ing
Unk
A
A/C
A/C
Ing
Ing
Ing
Int abuse
Int unk
Unk
Blood
Concentrations
Interval after
Exposure
0.7 lg/mL§
150 ng/mL§
0.8
100
0.162
310
lg/mL§
ng/mL§
lg/mL
ng/mL
1.7 lg/mL§
1600 ng/mL§
436 ng/mL§
1600 ng/mL§
1300 ng/mL§
530 ng/mL§
200 ng/mL§
U
Ing/unk
Unk
C
Ing
Int unk
A/C
Ing
Int unk
A
Paren
Adv rxn
A
U
A
Asp/ing
Unk
Ing
Unint gen
Unk
Int abuse
U
Unk
Int abuse
A/C
Inh/unk
Int unk
A
Unk
Int abuse
A
Ing/unk
Int unk
A
A
U
U
Ing
Ing
Ing
Ing
Unk
Int suicide
Unk
Unk
500 ng/mL§
40 ng/mL§
0.2 lg/mL§
400 ng/mL§,#
240 ng/mL§
Free morphine 90 ng/mL§
5 lg/mL§
290 mg/dL§
46 ng/mL§
130 lg/mL§
1200 ng/mL
2600 ng/mL§
220 ng/mL
12 lg/mL
2004 AAPCC Annual Report
617
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
624
37 y
Oxycodone
Acetaminophen/hydrocodone
ClonazepamA
625 p
24 y
Oxycodone
Acetaminophen/propoxyphene
626 p
28 y
627
19 y
628 p
17 y
629 p
24 y
630 p
26 y
631
53 y
632
53 y
633 p
21 y
634
9y
635 a/p
2y
636 p
637
638 p
14 y
Unk
23 y
639
39 y
640 p
53 y
641 p
33 y
642 p
25 y
643 p
42 y
644
35 y
645 p
19 y
646 p
23 y
647
54 y
648 p
31 y
649 p
40 y
650 p
40 y
Oxycodone
Cocaine
Oxycodone
Cocaine
DiazepamA
Oxycodone
Marijuana
Oxycodone
Methadone
Oxycodone
Methadone
Alprazolam
Oxycodone
Primidone
AlprazolamA
Oxycodone
Risperidone
MirtazapineA
Oxycodone
Trazodone
ZolpidemA
Oxycodone (long acting)
Morphine
Oxycodone (long-acting)
Oxycodone (long-acting)
Oxycodone (long-acting)
Oxycodone (long-acting)
Acetaminophen/hydrocodone
Alprazolam
Oxycodone (long-acting)
Acetaminophen/hydrocodone
DiazepamA
Oxycodone (long-acting)
Alprazolam
Oxycodone (long-acting)
Benzodiazepine
Ethanol
Oxycodone (long-acting)
Cocaine
Oxycodone (long-acting)
Cocaine
Marijuana
Oxycodone (long-acting)
Diazepam
Acetaminophen/oxycodoneA
Oxycodone (long-acting)
Ethanol
Oxycodone (long-acting)
Ethanol
Oxycodone (long-acting)
Hydromorphone
Oxycodone (long-acting)
Quetiapine
Oxycodone (long-acting)
Quetiapine
Clonazepam
Oxycodone (long-acting)
Valproic acid
BuspironeA
Chronicity Route
Reason
A/C
Ing
Int suicide
A
Ing
Int abuse
U
Ing/unk
Int unk
U
Ing/unk
Int abuse
A
Ing/unk
Int abuse
A
Ing
Int suicide
U
Ing
Unk
A/C
Ing
Int suicide
Blood
Concentrations
Interval after
Exposure
1009 ng/mL§
Propoxyphene 0.26 lg/mL§
Norpropoxyphene 0.702 lg/mL§
200 ng/mL§
0.1 lg/mL§
800 ng/mL§
100 ng/mL§
0.08 lg/mL§
50 ng/mL§
35.6 lg/mL
Phenobarbital 10.8 lg/mL
U
Ing
Unk
A/C
Ing
Int abuse
A
Ing
Unint gen
A
Ing
Unint gen
A
U
A/C
Ing
Ing
Ing
Int abuse
Unk
Int unk
A/C
Ing
Int unk
A/C
Ing
Int suicide
A/C
Ing
Int abuse
U
Ing/unk
Int abuse
A/C
Ing/inh
Int suicide
U
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int abuse
A/C
Ing
Int suicide
A
Ing
Int abuse
U
Ing/unk
Int abuse
A
Ing
Int suicide
4h
3d
570 ng/mL§
410 ng/mL§
90 ng/mL§
560 ng/mL§
Oxymorphone 260 ng/mL§
160 ng/mL§
250 ng/mL§
110 mg/dL
410 ng/mL§
420 ng/mL§
37 lg/mL
(continued on next page)
618
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Analgesics
651 p
28 y
Phenazopyridine
Unk drug
652 a
29 y
Phenylbutazone
653 p
654
50 y
46 y
655
59 y
Propoxyphene
Propoxyphene
Aspirin
Propoxyphene
Chronicity Route
Reason
U
Ing
Unk
C
Ing
Int misuse
A/C
A
Ing
Ing
Int suicide
Int suicide
A/C
Ing
Int suicide
Blood
Concentrations
Interval after
Exposure
13 lg/mL§
Oxyphenbutazone 3.4 lg/mL§
35 mg/dL
1.5 lg/mL
Norpropoxyphene 1.5 lg/mL
171 mg/dL
Ethanol
Propoxyphene
A
Ing
Unk
Unk opioid
657 p
39 y
Tramadol
U
Ing
Int suicide
658 p
43 y
Tramadol
A/C
Ing
Int unk
7.15 lg/mL§
Amitriptyline
260 ng/mL§
Meprobamate
1.04 lg/mL§
659
39 y
Tramadol
A/C
Ing
Int suicide
Diazepam
Acetaminophen/oxycodoneA
660 p
23 y
Tramadol
A/C
Ing/unk
Int suicide
Mirtazapine
Clonazepam
661
52 y
Tramadol
A/C
Ing
Int unk
Oxycodone
Benzodiazepine
662 p
41 y
Unk analgesic
A/C
Ing
Int unk
See also cases 19, 116, 376, 446, 447, 484 to 488, 492, 505, 521, 557, 615, 623, 664, 672, 712, 713, 737, 757, 782, 876, 895, 925, 932, 953, 969, 1008, and 1152
(acetaminophen); 377 (acetaminophen/aspirin); 309 and 603 (acetaminophen/aspirin/caffeine); 133 and 432 (acetaminophen/butalbital/caffeine); 193, 328, 433, and 509
(acetaminophen/codeine); 311 and 312 (acetaminophen/diphenhydramine); 97, 313, 314, 354, 356, 357, 434, 448, 489, 500, 558 to 561, 565, 624, 638, 639, 758, 792, 873,
879, 923, 925, 942, 970, 982, 983, 1011, 1079, and 1147 (acetaminophen/hydrocodone); 644 and 659 (acetaminophen/oxycodone); 8, 9, 490, 625, 714, 809, 871, 884, 898,
and 954 (acetaminophen/propoxyphene); 400 (acetaminophen/tramadol); 317, 336, 400, 435, 654, 668, 814, 884, 892, and 1046 (aspirin); 85 (aspirin/carisoprodol); 714
(aspirin/oxycodone); 318 (buprenorphine); 325 (codeine); 318 (codeine/guaifenesin); 1040 (diclofenac); 52 (fentanyl); 976 (fentanyl patch); 973, 974, and 1160
(hydrocodone); 647 (hydromorphone); 341, 342, 360, 829, and 1038 (ibuprofen); 987 and 1094 (meperidine); 424, 426, 458, 629, 630, 722, 724, 729, 766, 767, 813, 830,
947, 976, 986, 987, 1000, 1023, 1095, and 1096 (methadone); 90, 344, 460, 520, 634, 977, and 1030 (morphine); 116, 360, 380, and 829 (naproxen); 10, 592, 731, 785, 801,
978, 1060, 1158 (opioid); 593, 661, 781, and 1124 (oxycodone); 12, 451, 1001, 1036, and 1183 (oxycodone [long-acting]); 831 (propoxyphene); 597 and 816 (tramadol);
and 656 and 1152 (unk opioid).
656 p
Anesthetics
663 p
37 y
23 y
Ether
Heroin
PhenobarbitalA
664
48 y
Halothane-like substance
Acetaminophen
665 a/p
17 y
Sevoflurane
See also case 612 (propofol).
Anticholinergic drugs
666
39 y
Benztropine
Doxepin
FluoxetineA
667
49 y
Benztropine
Ziprasidone
Memantine
See also cases 790, 806, and 1009 (benztropine); 698 (trihexyphenidyl).
Anticoagulants
668
50 y
669
670
671
60 y
71 y
41 y
Anticonvulsants
672
8y
673
40 y
Clopidogrel
Aspirin
ClonidineA
Warfarin
Warfarin
Carbamazepine
Carbamazepine
Acetaminophen
Carbamazepine
Phenytoin
A
Inh/unk
Int abuse
C
Ing/inh
Occ
A
Inh
Int abuse
U
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
14 mg/dL
C
C
A/C
Ing
Ing
Ing
Ther err
Ther err
Int suicide
C
Ing
Unk
A/C
Ing
Int suicide
39.7 lg/mL
30 lg/mL
43.9 lg/mL#
2004 AAPCC Annual Report
619
Table 21 continued
Case
Age
Substances
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
PHARMACEUTICALS
Anticonvulsants
674
51 y
Carbamazepine (long-acting)
A/C
Ing
Ther err
37.4 lg/mL
675 a
18 mo Fosphenytoin
A
Paren
Ther err
676
62 y
Gabapentin
A
Ing
Int suicide
Isosorbide dinitrate
EthanolA
250 mg/dL
677 p
41 y
Lamotrigine
U
Ing
Int suicide
678 p
27 y
Lamotrigine
A
Ing
Int suicide
Quetiapine
679
30 y
Lamotrigine
A/C
Ing
Int suicide
Quetiapine
OxcarbazepineA
680
49 y
Lamotrigine
A
Ing
Int suicide
Venlafaxine (long-acting)
QuetiapineA
681 p
19 y
Oxcarbazepine
U
Ing
Unk
682 a
46 y
Oxcarbazepine
A/C
Ing
Int suicide
683
46 y
Oxcarbazepine
A
Ing
Int suicide
188.8 lg/mL
18 h
Ethanol
131 mg/dL
Benzodiazepine
684 p
16 y
Topiramate
A
Ing
Int suicide
685 p
18 y
Topiramate
A/C
Ing
Int suicide
Bupropion (long-acting)
AripiprazoleA
686
23 y
Valproic acid
U
Ing
Int suicide
390 lg/mL
687
26 y
Valproic acid
A/C
Ing
Int suicide
1272 lg/mL
688
30 y
Valproic acid
A/C
Ing
Int suicide
927 lg/mL
689
41 y
Valproic acid
A/C
Ing
Int suicide
909 lg/mL
690 p
47 y
Valproic acid
A
Ing
Int suicide
720 lg/mL
691 a
49 y
Valproic acid
A
Ing
Int suicide
1855 lg/mL
1d
692
55 y
Valproic acid
A/C
Ing
Int suicide
N150 lg/mL
693
35 y
Valproic acid
U
Ing
Int suicide
44 lg/mL
Bupropion
300 ng/mL§
Metformin
694
58 y
Valproic acid
A
Ing
Int suicide
586.8 lg/mL
Escitalopram
Lorazepam
695
30 y
Valproic acid
C
Ing
Adv rxn
43 lg/mL
Lamotrigine
696
39 y
Valproic acid
A
Ing
Int suicide
N300 lg/mL
Paroxetine
A
Trazodone
697 p
45 y
Valproic acid
A
Ing
Int suicide
500 lg/mL§
Phenobarbital
23 lg/mL§
ClonazepamA
698 p
45 y
Valproic acid
U
Ing
Unk
Trihexyphenidyl
See also cases 339, 588, 611, 732, 1000, 1019, 1037, 1098, and 1102 (gabapentin); 695 and 1084 (lamotrigine); 679, 737, 754, 759, and 899 (oxcarbazepine); 440, 604, 673,
790, 858, and 1023 (phenytoin); 631 (primidone); 428 and 1006 (tiagabine); 339, 741, 744, and 794 (topiramate); 650, 907, 1041, 1051, and 1052 (valproic acid); 499
(valproic acid [long-acting]); and 522 and 809 (zonisamide).
Antidepressants
699 p
16 y
700
701
702
703
704
705
706
707
708
709
710
711
712
24 y
p
p
p
p
p
36
36
40
42
45
47
50
61
83
N19
N19
45
y
y
y
y
y
y
y
y
y
y
y
y
Amitriptyline
A
Ing
Int unk
Amitriptyline
A
Ing
Int suicide
Amitriptyline
Amitriptyline
Amitriptyline
Amitriptyline
Amitriptyline
Amitriptyline
Amitriptyline
Amitriptyline
Amitriptyline
Amitriptyline
Amitriptyline
Amitriptyline
Acetaminophen
A
A/C
A/C
A
A
A
A
A/C
A
A/C
U
A
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
Unk
Int suicide
1700 ng/mL§
Nortriptyline 450 ng/mL§
160 ng/mL
Nortriptyline 80 ng/mL
2100 ng/mL§
374.3 lg/mL§
(continued on next page)
620
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Antidepressants
713
37 y
Amitriptyline
Acetaminophen
Chlorpromazine
714 p
55 y
Amitriptyline
Acetaminophen/propoxyphene
Aspirin/oxycodoneA
715 p
N19 y
Amitriptyline
Alprazolam
716 p
25 y
Amitriptyline
Alprazolam
EscitalopramA
717 p
49 y
Amitriptyline
Amitriptyline/chlordiazepoxide
718 p
39 y
Amitriptyline
Aripiprazole
VenlafaxineA
719
74 y
Amitriptyline
Chronicity Route
Reason
C
Ing
Int suicide
A
Ing
Int unk
U
Ing
Int suicide
A
Ing
Int unk
A/C
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing/unk
Int suicide
A/C
Ing
Int suicide
A/C
Ing/unk
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing/unk
Int suicide
A/C
Ing/unk
Unk
A
Ing
Int suicide
A/C
Ing
Int suicide
C
Ing
Unk
Blood
Concentrations
213 ng/mL
45 h
Nortriptyline 221 ng/mL
45 h
231 ng/mL
45 h
600 ng/mL§,#
400 ng/mL§
0.17 lg/mL§
720 p
62 y
721
49 y
722 p
29 y
723
19 y
724 p
42 y
725
46 y
726
24 y
727
49 y
728
57 y
729 p
43 y
Chlorpromazine
Amitriptyline
Citalopram
Methamphetamine
Amitriptyline
Clonazepam
Ethanol
Amitriptyline
Clonazepam
MethadoneA
Amitriptyline
Clonazepam
Quetiapine
Amitriptyline
Clonidine
MethadoneA
Amitriptyline
Cocaine
Amitriptyline
Escitalopram
ChlorpromazineA
Amitriptyline
Ethanol
Amitriptyline
Ethanol
Amitriptyline
48 y
Methadone
Acetaminophen/dextromethorphan/
doxylamine/pseudoephedrine
Amitriptyline
A
Ing
Int suicide
Pseudoephedrine 0.86 lg/mL§
1600 ng/mL
Nortriptyline 400 ng/mL
731
44 y
Olanzapine
Diazepam
Amitriptyline
A
Ing
Int suicide
4400 ng/mL
964 ng/mL§
Nortriptyline 607 ng/mL§
732
48 y
A/C
Ing
Int suicide
733 p
54 y
A/C
Ing
Int suicide
734
43 y
A/C
Ing
Int suicide
735 a
55 y
A
Ing/paren
Int suicide
736 p
32 y
A/C
Ing
Int suicide
737 p
19 y
U
Ing/unk
Int suicide
730
Opioid
Amitriptyline
Potassium chloride
GabapentinA
Amitriptyline
Unk drug
Amitriptyline
Verapamil (long-acting)
Amitriptyline
Insulin
Amoxapine
Trifluoperazine
Bupropion
Acetaminophen
OxcarbazepineA
Interval after
Exposure
258 mg/dL
0.48 lg/mL#
150 mg/dL
460 ng/mL§
Nortriptyline 430 ng/mL§
0.5 lg/mL§
620 ng/mL
107 lg/mL
22 h
9h
2004 AAPCC Annual Report
621
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Antidepressants
738
17 y
Bupropion
Acetaminophen/chlorpheniramine/
dextromethorphan
739 p
29 y
Bupropion
Citalopram
740
52 y
Bupropion
Escitalopram
Paroxetine
741
39 y
Bupropion
742
Unk
743
34 y
744 p
21 y
745 p
59 y
746
747
748 p
749
750
751 p
20
24
33
43
N19
20
y
y
y
y
y
y
752 p
23 y
753
41 y
754
30 y
755
39 y
756 p
44 y
757
35 y
758
55 y
759
21 y
760
42 y
761
45 y
762
41 y
763
19 y
764
57 y
Escitalopram
TopiramateA
Bupropion
Olanzapine
Nortriptyline
Bupropion
Phenobarbital
Bupropion
Topiramate
Bupropion
Trifluoperazine
Bupropion (long-acting)
Bupropion (long-acting)
Bupropion (long-acting)
Bupropion (long-acting)
Bupropion (long-acting)
Bupropion (long-acting)
Buspirone
Amanita muscaria A
Bupropion (long-acting)
Citalopram
Bupropion (long-acting)
Clonazepam
Bupropion (long-acting)
Escitalopram
OxcarbazepineA
Bupropion (long-acting)
Ethanol
Bupropion (long-acting)
Lithium
PropranololA
Bupropion (long-acting)
Metaxalone
AcetaminophenA
Bupropion (long-acting)
Metoprolol (long-acting)
Acetaminophen/hydrocodoneA
Bupropion (long-acting)
Oxcarbazepine
Bupropion (long-acting)
Venlafaxine
ClonazepamA
Bupropion (long-acting)
Venlafaxine (long-acting)
ZopicloneA
Bupropion (long-acting)
Ethanol
Citalopram
Phenobarbital
Quetiapine
Doxepin
Chronicity Route
Reason
A/C
Ing
Int suicide
U
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
U
Ing
Int suicide
U
Ing
Int suicide
A
A/C
A/C
A
A
A
Ing
Ing
Ing
Ing
Ing
Ing
Int
Int
Int
Int
Int
Int
A
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Unk
A/C
Ing
Int suicide
Blood
Concentrations
Interval after
Exposure
7000 ng/mL§
4000 ng/mL§
1000 ng/mL
Metabolites 20 300 ng/mL
700 ng/mL
4.4 lg/mL§
11 000 ng/mL§
1d
1d
1d
103.4 lg/mL
suicide
suicide
suicide
suicide
suicide
abuse
4100 ng/mL
14 000 ng/mL
445 ng/mL§
3h
1300 ng/mL§
333 mg/dL
600 ng/mL§
Metabolites 2540 ng/mL§
3h
57 lg/mL
9300 ng/mL§
10 000 ng/mL§
880 ng/mL§,#
2100 ng/mL§
Norvenlafaxine 570 ng/mL§
46 mg/dL
1410 ng/mL
13.1 lg/mL§
1520 ng/mL§
Nordoxepin 1640 ng/mL§
Benzodiazepine
Hydrochlorothiazide/valsartanA
(continued on next page)
622
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Antidepressants
765
57 y
Doxepin
Enalapril
Risperidone
766 p
48 y
Doxepin
Methadone
767 p
55 y
Doxepin
Methadone
768
19 y
Doxepin
Quetiapine
769
40 y
Doxepin
Quetiapine
Clonazepam
770
16 y
Escitalopram
Amphetamine/dextroamphetamine
771
50 y
Escitalopram
Doxepin
MetoprololA
772 p
41 y
Escitalopram
Zolpidem
AtenololA
773
37 y
Fluoxetine
774
27 y
Imipramine
775 p
776
28 y
37 y
777
778
779
780
781 p
42
43
53
83
26
782 p
49 y
783 p
25 y
784
47 y
785 p
24 y
786
787
788
42 y
58 y
33 y
789
37 y
790
38 y
791
47 y
792 p
19 y
793 p
54 y
y
y
y
y
y
794 p
30s y
795
796 p
797
47 y
53 y
54 y
Imipramine
Imipramine
Ethanol
Lithium
Lithium
Lithium
Lithium
Mirtazapine
Fluoxetine
OxycodoneA
Nortriptyline
Acetaminophen
Nortriptyline
Ethanol
Nortriptyline
Ethanol
Paroxetine
Ethanol
OpioidA
Sertraline
Sertraline
Sertraline
Cyclobenzaprine
DiltiazemA
Sertraline
Diphenhydramine
Sertraline
Phenytoin
BenztropineA
Tranylcypromine
Acrivastine/pseudoephedrine
Amlodipine/benazeprilA
Trazodone
Acetaminophen/hydrocodone
Trazodone
Ethanol
AlprazolamA
Trazodone
Topiramate
Cyclobenzaprine
Tricyclic antidepressant
Tricyclic antidepressant
Tricyclic antidepressant
Chronicity Route
Reason
A/C
Ing
Int suicide
A/C
Ing
Int suicide
U
Ing
Int unk
A
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
A/C
A/C
Ing
Ing
Int suicide
Int suicide
A
A
Ing
Ing
Int suicide
Int suicide
C
C
C
C
U
Ing
Ing
Ing
Ing
Ing
Ther
Ther
Ther
Ther
Ther
U
Ing
Unk
U
Ing
Int suicide
A
Ing
Int suicide
U
Ing
Int suicide
A
U
A
Ing
Ing
Ing
Adv rxn
Int suicide
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int unk
err
err
err
err
err
Blood
Concentrations
Interval after
Exposure
1010 ng/mL#
1550 ng/mL§
1.95 lg/mL§
Citalopram 1900 ng/mL§
990 ng/mL§
18.7 lg/mL§
4500 ng/mL§
3920 ng/mL§
Desipramine 1820 ng/mL§
5.2 mEq/L
2.9 mEq/L
5.1 mEq/L
87 ng/mL§
N2000 ng/mL§,#
343 ng/mL§
5200
20
390
191
ng/mL§
mg/dL§
ng/mL§
mg/dL
62 lg/mLw
234 mg/dL
13 000 ng/mL§
A/C
Ing
Int suicide
A
A/C
A
Ing
Ing
Ing
Int suicide
Int suicide
Int suicide
1300 ng/mL#
900 ng/mL
14 h
2004 AAPCC Annual Report
623
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Antidepressants
798
35 y
Tricyclic antidepressant
Amphetamine
799
41 y
Tricyclic antidepressant
Bupropion (long-acting)
Trazodone A
800 p
49 y
Tricyclic antidepressant
Marijuana
Benzodiazepine
801
43 y
Tricyclic antidepressant
Opioid
CocaineA
802 p
54 y
Venlafaxine
803
28 y
Venlafaxine
Glipizide
804 a
39 y
Venlafaxine
Lorazepam
Diphenoxylate/atropineA
805
43 y
Venlafaxine
Methocarbamol
806 p
40 y
Venlafaxine
Quetiapine
BenztropineA
807 p
19 y
Venlafaxine
Chronicity Route
Reason
A
Ing
Int suicide
A
Ing
Int suicide
A
Ing/unk
Int suicide
A
Ing/unk
Int suicide
U
A
Ing
Ing
Int suicide
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
Blood
Concentrations
Interval after
Exposure
7300 ng/mL§
1500 ng/mL
61 lg/mL
24 h
24 h
100 000 ng/mL§
Nor metabolites 19 900 ng/mL§
140 ng/mL§
8.3 lg/mL§
Ziprasidone
AtomoxetineA
808
43 y
Venlafaxine
A/C
Ing
Int suicide
Ziprasidone
A
Trazodone
809
40 y
Venlafaxine
A
Ing
Adv rxn
Zonisamide
Acetaminophen/propoxyphene
810 p
19 y
Venlafaxine (long-acting)
A/C
Ing
Int suicide
811
38 y
Venlafaxine (long-acting)
A
Ing
Int suicide
812
56 y
Venlafaxine (long-acting)
A
Ing
Int suicide
123 000 ng/mL
813 p
21 y
Venlafaxine (long-acting)
A
Ing
Int suicide
Diazepam
Methadone
814
33 y
Venlafaxine (long-acting)
A
Ing
Int suicide
Diphenhydramine
A
15 mg/dL
Aspirin
815
50 y
Venlafaxine (long-acting)
U
Ing
Int suicide
Olanzapine
ClomipramineA
816
17 y
Venlafaxine (long-acting)
U
Ing
Int suicide
Tramadol
Methamphetamine
817
23 y
Venlafaxine (long-acting)
A/C
Ing/unk
Int suicide
Zolpidem
A
Lorazepam
See also cases 338, 406, 428, 451, 565, 658, 826, 888, 914, 972, 997, and 1056 (amitriptyline); 717 (amitriptyline/chlordiazepoxide); 854 (amitriptyline/perphenazine); 587,
693, 931, 962, and 1127 (bupropion); 193, 194, 452, 605, 685, 799, 853, 885, 945, 1036, 1050, 1084, and 1104 (bupropion [long-acting]); 134, 589, 596, 609, 720, 739,
752, 827, 849, 955, 972, and 1117 (citalopram); 312 and 815 (clomipramine); 666 and 771 (doxepin); 1049 (duloxetine); 356, 425, 597, 694, 716, 726, 740, 741, 754, and
1031 (escitalopram); 21, 195, 338, 438, 587, 666, 781, 1018, and 1020 (fluoxetine); 756 and1032 (lithium); 439, 459, 495, 632, 660, 918, and 943 (mirtazapine); 742, 899,
and 977 (nortriptyline); 85, 321, 450, 696, 740, 953, 1037, and 1038 (paroxetine); 45, 521, 561, 610, 960, 1006, 1041, and 1062 (sertraline); 231, 495, 522, 633, 696, 799,
808, and 905 (trazodone); 315, 348, and 1061 (tricyclic antidepressant); 598, 603, 718, 760, 879, 886, and 909 (venlafaxine); and 599, 680, 761, 853, and 943 (venlafaxine
[long-acting]).
Antihistamines
818 a/i/p
819 p
820 p
821
822
823 p
5y
17 y
25 y
35 y
37 y
44 y
Diphenhydramine
Diphenhydramine
Diphenhydramine
Diphenhydramine
Diphenhydramine
Diphenhydramine
A
A
A
A
A
A
Ing
Ing
Ing
Ing
Ing
Ing
Malicious
Int suicide
Int suicide
Int suicide
Int suicide
Int suicide
N10 lg/mL§
20.3 lg/mL§
(continued on next page)
624
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Antihistamines
824 p
48 y
Diphenhydramine
825 p
79 y
Diphenhydramine
826
51 y
Diphenhydramine
Amitriptyline
827
15 y
Diphenhydramine
Citalopram
828 p
32 y
829
14 y
830
57 y
831 p
33 y
Diphenhydramine
Ethanol
Diphenhydramine
Ibuprofen
Naproxen
Diphenhydramine
Methadone
Diphenhydramine
Propoxyphene
Chronicity Route
Reason
A/C
A
A
Ing
Ing
Ing
Int suicide
Int suicide
Int suicide
A
Ing
Int suicide
A
Ing
Unk
A
Ing
Int suicide
A
Ing
Int suicide
U
Ing
Int suicide
Blood
Concentrations
Interval after
Exposure
0.87 lg/mL§
17.24 lg/mL§
4610 ng/mL§
Norcitalopram 130 ng/mL§
0.2
6.8
1.36
Norpropoxyphene 1
0.16
lg/mL§
lg/mL§
lg/mL§
lg/mL§
lg/mL§
PhentermineA
Diphenhydramine
A
Ing
Int suicide
Unk drug
See also cases 857 (cetirizine); 42, 134, 327, 328, 358, 610, 789, 814, 897, 933, and 956 (diphenhydramine); 340, 569, 850, and 877 (hydroxyzine); and 594, 885, 1011,
and 1054 (promethazine).
832 p
17 y
Antimicrobials
833 a/i/p
7y
834 i
2y
835 a
68 y
Hydroxychloroquine
Isoniazid
Isoniazid
Rifampin
836
34 y
Itraconazole
Atorvastatin
837
45 y
Lamivudine
Stavudine
GlipizideA
838
42 y
Lincomycin
839 p
33 y
Quinine
Lisinopril
OlanzapineA
840 a
40 y
Tilmicosin
See also cases 835 (rifampin) and 837 (stavudine).
Antineoplastics
841
54 y
Capecitabine
842
68 y
Methotrexate
See also case 857 (methotrexate).
Asthma therapies
843
53 y
Theophylline
Terbutaline
844
68 y
Theophylline (long-acting)
845
74 y
Theophylline (long-acting)
See also case 843 (terbutaline).
Cardiovascular
846
847
848
drugs
55 y
71 y
55 y
849
49 y
850
51 y
851
59 y
Amiodarone
Amiodarone
Amlodipine
Amlodipine/benazepril
Acetaminophen/dextromethorphan/
doxylamine/pseudoephedrine
Amlodipine
Citalopram
Amlodipine
Clonidine
HydroxyzineA
Amlodipine
Metoprolol (long-acting)
A
U
C
Ing
Ing
Ing
Unk
Unk
Adv rxn
C
Ing
Adv rxn
A
Ing
Adv rxn
A
A
Paren
Ing
Int misuse
Int suicide
A
Paren
Occ
C
A
Ing
Paren
Adv rxn
Adv rxn
C
Ing
Ther err
A/C
C
Ing
Ing
Ther err
Int misuse
C
C
A
Ing
Ing
Ing
Ther err
Adv rxn
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
70 lg/mL§
22 lg/mL
83 lg/mL
78.9 lg/mL
840 ng/mL§
2004 AAPCC Annual Report
625
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Cardiovascular drugs
852
50 y
Amlodipine
Nifedipine (long-acting)
Potassium chloride (long-acting)A
853
63 y
Amlodipine
Venlafaxine (long-acting)
Bupropion (long-acting)A
854
78 y
Amlodipine/benazepril
Amitriptyline/perphenazine
LevothyroxineA
855
61 y
Atenolol
Amlodipine
856 p
61 y
Calcium-channel blocker
Atenolol
857
73 y
Clonidine
Methotrexate
CetirizineA
858 p
60 y
Clonidine
Potassium chloride
Phenytoin
859
64 y
Digoxin
860 i/p
65 y
Digoxin
861
66 y
Digoxin
862
68 y
Digoxin
863 p
69 y
Digoxin
864
70 y
Digoxin
865 p
72 y
Digoxin
866
74 y
Digoxin
867
87 y
Digoxin
868
88 y
Digoxin
869
92 y
Digoxin
870
56 y
Digoxin
Atenolol
FurosemideA
871
81 y
Digoxin
Diltiazem (long-acting)
Acetaminophen/propoxypheneA
872
51 y
Digoxin
Insulin
873
78 y
Digoxin
Lorazepam
Acetaminophen/hydrocodoneA
874
73 y
Digoxin
Metformin
Verapamil
875
58 y
Diltiazem
876
52 y
Diltiazem
Acetaminophen
Ethanol
877
57 y
Diltiazem
Hydroxyzine
Hydrochlorothiazide
878 p
36 y
Diltiazem
Metoprolol
ClonidineA
879 p
62 y
Diltiazem
Venlafaxine
Acetaminophen/hydrocodoneA
880
54 y
Diltiazem (long acting)
Hydrochlorothiazide/triamterene
LisinoprilA
881 a
10 mo Diltiazem (long-acting)
882
31 y
Diltiazem (long-acting)
883
92 y
Diltiazem (long-acting)
884 p
83 y
Diltiazem (long-acting)
Acetaminophen/propoxyphene
AspirinA
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
A/C
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
7.1 ng/mL
6.3 mEq/L
C
A
C
C
C
C
A/C
C
C
C
C
A/C
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ing
Ther err
Int suicide
Ther err
Ther err
Ther err
Unk
Ther err
Ther err
Ther err
Ther err
Unk
Ther err
3.2 ng/mL
160 ng/mL
5.7 ng/mL
2.3 ng/mL
2.9 ng/mL
2.94 ng/mL
3.8 ng/mL
6 ng/mL
3.59 ng/mL
2.5 ng/mL
3.9 ng/mL
2.5 ng/mL
A/C
Ing
Int suicide
N6 ng/mL
A/C
Ing/paren
Int suicide
N5 ng/mL
A
Ing
Int suicide
29 ng/mL
C
Ing
Ther err
3.1 ng/mL
A
A
Ing
Ing
Int suicide
Int suicide
8.9 mEq/L
36 h
14 lg/mL
A/C
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A
A
A
U
Ing
Ing
Ing
Ing
Unint gen
Int suicide
Ther err
Int suicide
444 lg/mLw
5h
(continued on next page)
626
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Cardiovascular drugs
885
46 y
Diltiazem (long-acting)
Bupropion (long-acting)
PromethazineA
886
57 y
Diltiazem (long-acting)
Clonidine
VenlafaxineA
887
49 y
Diltiazem (long-acting)
Diazepam
888
54 y
Diltiazem (long-acting)
Lisinopril
AmitriptylineA
889
37 y
Disopyramide
890 a/p
15 mo Flecainide
891
48 y
Flecainide
Amisulpride
892
23 y
Flecainide
Diltiazem (long-acting)
Aspirin
893 i
77 y
Labetalol
894
52 y
Lisinopril
Diltiazem (long-acting)
Metoprolol (long-acting)
895
41 y
Metoprolol
Acetaminophen
896
54 y
Metoprolol
Cocaine
897
43 y
Nifedipine
Diphenhydramine
898
37 y
Propranolol
Acetaminophen/propoxyphene
QuetiapineA
899
31 y
Propranolol
Nortriptyline
OxcarbazepineA
900 p
54 y
Sildenafil
Atenolol
901
53 y
Verapamil
902
55 y
Verapamil
903
64 y
Verapamil
904
52 y
Verapamil
Atenolol
Hydrochlorothiazide
905
48 y
Verapamil
Clonidine
Trazodone
906
89 y
Verapamil
Fluvastatin
Tolterodine
907
38 y
Verapamil
Quetiapine
Valproic acidA
908
64 y
Verapamil (long acting)
Chlorpromazine
909
29 y
Verapamil (long acting)
Venlafaxine
910
42 y
Verapamil (long-acting)
911
44 y
Verapamil (long-acting)
912
81 y
Verapamil (long-acting)
913 p
28 y
Verapamil (long-acting)
Acetaminophen/chlorpheniramine
Benzodiazepine
914
62 y
Verapamil (long-acting)
Amitriptyline
915
43 y
EthanolA
Verapamil (long-acting)
Clonidine
Ethanol
Chronicity Route
Reason
A/C
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
A/C
A/C
A
Ing
Ing
Ing
Int suicide
Unint gen
Int suicide
A
Ing
Int suicide
A
A/C
Ing
Ing
Int suicide
Int suicide
A
U
Ing
Int suicide
A
Inh/paren
Adv rxn
A/C
Ing
Int suicide
A
Ing
Int suicide
U
Ing
Int suicide
A/C
Ing
Adv rxn
A/C
A
A/C
A/C
Ing
Ing
Ing
Ing
Int
Int
Int
Int
A
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
A
A/C
C
A
Ing
Ing
Ing
Ing
Int suicide
Int suicide
Ther err
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
suicide
suicide
suicide
suicide
Blood
Concentrations
Interval after
Exposure
6.87 lg/mL
9.5 lg/mL§
0.83 lg/mL§
1.1 lg/mL§
2.12 lg/mL§
345 ng/mL§
Nortriptyline 247 ng/mL§
116 mg/dL
0.77 lg/mL§
Norverapamil 0.4 lg/mL§
190 mg/dL
5h
2004 AAPCC Annual Report
627
Table 21 continued
Case
Age
Substances
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
PHARMACEUTICALS
Cardiovascular drugs
916 i
36 y
Verapamil (long-acting)
A/C
Ing
Int suicide
Ethanol
917
71 y
Verapamil (long-acting)
A
Ing
Int suicide
Metoprolol
LisinoprilA
918
60 y
Verapamil (long-acting)
A/C
Ing
Int suicide
Mirtazapine
A
Pravastatin
919
37 y
Verapamil/trandolapril (long-acting)
A/C
Ing
Int suicide
920
32 y
Verapamil/trandolapril (long-acting)
A
Ing
Int suicide
Ethanol
See also cases 855, 984, and 1027 (amlodipine); 791 and 848 (amlodipine/benazepril); 772, 856, 870, 900, 904, and 991 (atenolol); 836 (atorvastatin); 668, 724, 850, 878, 886,
905, and 915 (clonidine); 492 and 788 (diltiazem); 871, 892, 894, 945, and 1086 (diltiazem [long-acting]); 765 and 956 (enalapril); 906 (fluvastatin); 764
(hydrochlorothiazide/valsartan); 676 (isosorbide dinitrate); 839, 880, 888, 917, 984, and 1012 (lisinopril); 959 (losartan); 771, 878, and 917 (metoprolol); 586, 758, 851,
and 894 (metoprolol [long-acting]); 1086 (nifedipine); 852 (nifedipine (long-acting)); 918 (pravastatin); 960 (propafenone); 756 (propranolol); 1039 and1040 (simvastatin);
874 (verapamil); and 734 (verapamil [long-acting]).
Cold and cough preparations
921 p
29 y
Acetaminophen/chlorpheniramine
922 p
18 y
Acetaminophen/chlorpheniramine/
dextromethorphan
923
39 y
Acetaminophen/pseudoephedrine
Acetaminophen/hydrocodone
924 a/p
2y
Benzonatate
925
36 y
Brompheniramine/pseudoephedrine
Acetaminophen
Acetaminophen/hydrocodoneA
926 p
23 y
Chlorpheniramine/dextromethorphan
Unk drug
927
4 mo Chlorpheniramine/guaifenesin/phenylephrine
A/C
A
Ing
Ing
Int suicide
Int suicide
C
Ing
Int suicide
A
A
Ing
Ing
Unint gen
Int suicide
29 lg/mLw
64 lg/mL
A
Ing
Int abuse
A
Ing
Adv rxn
Chlorpheniramine 0.081 lg/mL§
12 mo Chlorpheniramine/hydrocodone
A
Ing
Unint gen
50 y
Dextromethorphan/guaifenesin
U
Ing
Int suicide
60 y
Dextromethorphan/guaifenesin
A
Ing
Int suicide
Metformin
AlprazolamA
931 p
24 y
Fexofenadine/pseudoephedrine
U
Ing
Int suicide
Pseudoephedrine 14 lg/mL
Bupropion
2000 ng/mL
932
30 y
Ibuprofen/pseudoephedrine
A
Ing
Int suicide
Acetaminophen
933 p
32 y
Pseudoephedrine (long-acting)
A
Ing
Int suicide
Diphenhydramine
See also cases 399 (acetaminophen/antihistamine); 498 (acetaminophen/brompheniramine/pseudoephedrine); 913 (acetaminophen/chlorpheniramine); 738 (acetaminophen/
chlorpheniramine/dextromethorphan); 310, 489, 729, and 848 (acetaminophen/dextromethorphan/doxylamine/pseudoephedrine); 562 (acetaminophen/pseudoephedrine);
791 (acrivastine/pseudoephedrine); 107 (dextromethorphan); 1005 (pseudoephedrine); and 447 (unk cough/cold medication).
928 a/p
929
930 p
Dietary supplements/herbals/homeopathic
934 a/p
33 y
Caffeine/ephedra
Ethanol
935
34 y
Ephedra
936 a
50s y
Laetrile
See also cases 1058 and 1118 (ephedra) and 519 (ma huang).
C
Ing
Int misuse
A
A
Ing
Ing
Int unk
Int misuse
Cyanide 5.1 lg/mL
Diuretics
See also cases 870 (furosemide); 877, 904, and 958 (hydrochlorothiazide); and 880 (hydrochlorothiazide/triamterene).
Electrolytes and minerals
937
71 y
Magnesium hydroxide
C
Ing
Ther err
938 p
56 y
Potassium chloride
A
Ing
Int suicide
See also cases 343 (iron); 732 and 858 (potassium chloride); and 852 (potassium chloride [long-acting]).
Eye/ear/nose/throat preparations
939
20s y
Propylhexedrine
See also case 131 (phenylephrine).
A
Paren
Magnesium 15.4 mEq/L
Int abuse
Gastrointestinal preparations
940 a/i
19 y
Diphenoxylate
A
Inh
Unk
40 mg/mL
12 h
Diazepam
941 a
44 y
Loperamide
A
Ing
Int suicide
See also cases 407 (atropine/hyoscyamine/phenobarbital/scopolamine); 455, 804, and 1121 (diphenoxylate/atropine); 331 (esomeprazole); 331 (rabeprazole [long-acting]);
and 906 (tolterodine).
(continued on next page)
628
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Hormones and hormone antagonists
942
79 y
Glimepiride
Acetaminophen/hydrocodone
943
33 y
Glyburide
Venlafaxine (long-acting)
MirtazapineA
944 i
60 y
Insulin
945 p
46 y
Insulin
Diltiazem (long-acting)
Bupropion (long-acting)
946
61 y
Insulin
Glyburide
947
52 y
Insulin
Methadone
948 a
54 y
insulin
Tiletamine/zolazepam
Cyclopropane
949
37 y
Metformin
950
47 y
Metformin
951
57 y
Metformin
952
82 y
Metformin
953
56 y
Metformin
Acetaminophen
ParoxetineA
954 a
77 y
Metformin
Acetaminophen/propoxyphene
955
71 y
Metformin
Clonazepam
Chronicity Route
Reason
C
Ing
Int suicide
A/C
Ing
Int suicide
A
A
Paren
Ing/paren
Malicious
Int suicide
A
A
Ing/paren
Int suicide
A/C
Ing/paren
Int suicide
A
Inh/paren
Int suicide
A
A/C
C
C
A/C
Ing
Ing
Ing
Ing
Ing
Int suicide
Int suicide
Adv rxn
Int misuse
Int suicide
Blood
Concentrations
44.1 lg/mLw
105 lg/mL
A/C
Ing
Int suicide
A
Ing
Int suicide
64 lg/mL§
33 lg/mLw
110 lg/mL§
84 ng/mL§
7-Aminoclonazepam 170 ng/mL§
66 ng/mL§
CitalopramA
Metformin
A
Ing
Int suicide
Diphenhydramine
EnalaprilA
957
33 y
Metformin
A
Ing
Int suicide
Glipizide
958
N19 y
Metformin
C
Ing
Adv rxn
Hydrochlorothiazide
A
Glipizide
959
45 y
Metformin
A
Ing
Int suicide
Losartan
960 p
88 y
Metformin
A/C
Ing
Int misuse
120 lg/mL
Propafenone
Sertraline
961
79 y
Metformin
A/C
Ing
Int suicide
unk drug
962
38 y
Metformin/rosiglitazone
A
Ing
Int suicide
Bupropion
See also cases 803, 837, 957, and 958 (glipizide); 946 (glyburide); 735, 872, and 1003 (insulin); 854 (levothyroxine); and 693, 874, and 930 (metformin).
956
15 y
Miscellaneous drugs
963 a
74 y
Lepirudin
C
Paren
Ther err
964 i/p N19 y
Nicotine patch (long-acting)
U
Derm
Unk
965 a/p
46 y
Succinylcholine
A
Paren
Int suicide
See also cases 509 (allopurinol); 807 and 1062 (atomoxetine); 1181 (berberine); 438 (eletriptan); 998 (flumazenil); and 667 (memantine).
Muscle relaxants
966 a
12
967 p
68
968 p
17
969 p
45
y
y
y
y
970 p
50s y
971 p
53 y
Baclofen
Baclofen
Carisoprodol
Carisoprodol
Acetaminophen
Ethanol
Carisoprodol
Acetaminophen/hydrocodone
Diazepam
Carisoprodol
Alprazolam
Interval after
Exposure
A
A/C
A
A/C
Other
Ing/oth
Ing
Ing
Adv rxn
Ther err
Int suicide
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
9.3 lg/mL§
Meprobamate 40 lg/mL§
97 lg/mL§
4h
2004 AAPCC Annual Report
629
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Muscle relaxants
972
38 y
Carisoprodol
Citalopram
Amitriptyline
973 p
25 y
Carisoprodol
Chronicity Route
Reason
Blood
Concentrations
A
Ing
Int suicide
Meprobamate 6.8 lg/mL
U
Ing
Int suicide
10 lg/mL§
Meprobamate 41 lg/mL§
100 ng/mL§
200 ng/mL§
Nordiazepam 300 ng/mL§
Hydrocodone
DiazepamA
974
Interval after
Exposure
16 y
Carisoprodol
A
Ing
Int suicide
Hydrocodone
EthanolA
975 i
N19 y
Cyclobenzaprine
C
Ing
Unk
0.256 lg/mL§
976 i
N19 y
Cyclobenzaprine
U
Derm/ing
Unk
0.42 lg/mL§
Methadone
0.33 lg/mL§
Fentanyl patch
6 ng/mL§
977
39 y
Cyclobenzaprine
A/C
Ing
Int suicide
Nortriptyline
Morphine
978
58 y
Tizanidine
A/C
Ing
Int suicide
Ethanol
Opioid
979 p
32 y
Tizanidine
A/C
Ing
Int suicide
Zolpidem
DiazepamA
See also cases 421 and 574 (baclofen); 319, 358, 399, 405, 409 to 422, 436, 439, 453, 459, 568, and 983 (carisoprodol); 12, 449, 452, 454, 788, 794, 1039, 1054, and 1120
(cyclobenzaprine); 757 (metaxalone); and 434 and 805 (methocarbamol).
Narcotic antagonists
See also case 1119 (naltrexone).
Sedative/hypnotics/antipsychotics
980
48 y
Alprazolam
981
Unk
Alprazolam
982
17 y
Alprazolam
Acetaminophen/hydrocodone
983 p
64 y
Alprazolam
Acetaminophen/hydrocodone
Carisoprodol
984
44 y
Alprazolam
Amlodipine
Lisinopril
985 p
63 y
Alprazolam
Ethanol
986 p
25 y
Alprazolam
Methadone
987 p
25 y
Alprazolam
Methadone
MeperidineA
988 p
24 y
Alprazolam
Phentermine
MethamphetamineA
989 p
33 y
Alprazolam
Unk drug
990
38 y
Alprazolam
Zolpidem
991
56 y
Alprazolam
Zolpidem
Atenolol
992 a
83 y
Amobarbital/secobarbital
993
39 y
Barbiturate (long-acting)
Benzodiazepine
MarijuanaA
994 p
27 y
Benzodiazepine
Ethanol
Cocaine
995 p
39 y
Benzodiazepine
Unk drug
Marijuana
A/C
A
U
Ing
Ing
Ing
Int suicide
Unk
Int suicide
A/C
Ing
Int suicide
Hydrocodone 470 ng/mL
A/C
Ing
Unk
A
Ing
Int suicide
A/C
Ing
Int suicide
U
Ing
Int suicide
U
Ing/unk
Int unk
A/C
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
A
A/C
Ing
Ing/inh
Int suicide
Int suicide
U
Ing/unk
Int unk
35 ng/mL§
0.514 lg/mL§
20 ng/mL
0.08 lg/mL
Normeperidine 0.3 lg/mL§
38 mg/dL
U
Unk
Unk
(continued on next page)
630
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Sedative/hypnotics/antipsychotics
996
48 y
Chlordiazepoxide
997 p
50 y
Clonazepam
Amitriptyline
Heroin
998
47 y
Clonazepam
Flumazenil
MethamphetamineA
999 p
30 y
Clonazepam
Heroin
AlprazolamA
1000 p
44 y
Clonazepam
Methadone
Gabapentin
1001 p
21 y
Clonazepam
Oxycodone (long-acting)
1002 p
41 y
Diazepam
Ethanol
1003
57 y
Diazepam
Insulin
1004
27 y
Diazepam
Methamphetamine
EthanolA
1005 p
17 y
Diazepam
Pseudoephedrine
1006 p
24 y
Diazepam
Tiagabine
SertralineA
1007
21 y
Doxylamine
Cocaine
AmphetamineA
1008
28 y
Haloperidol
Acetaminophen
Clonazepam
1009
59 y
Haloperidol
Ziprasidone
BenztropineA
1010 p
48 y
Lorazepam
1011
44 y
Lorazepam
Acetaminophen/hydrocodone
PromethazineA
1012
52 y
Lorazepam
Activated charcoal
LisinoprilA
1013
27 y
Lorazepam
Dextroamphetamine
Marijuana
1014
75 y
Meprobamate
1015 p
34 y
Olanzapine
1016 p
54 y
Olanzapine
Clonazepam
1017 p
33 y
Olanzapine
Clonazepam
Unk drug
1018 p
37 y
Olanzapine
Fluoxetine
1019 p
40 y
Olanzapine
Gabapentin
1020
14 y
Olanzapine
Risperidone
FluoxetineA
1021 p
1022
1023
50 y
73 y
58 y
1024 p
1025
19 y
41 y
Phenobarbital
Phenobarbital
Phenobarbital
Methadone
PhenytoinA
Quetiapine
Quetiapine
Chronicity Route
Reason
A/C
A/C
Ing
Ing/inh
Int suicide
Int suicide
A
Ing
Int suicide
A
Ing/unk
Int abuse
A/C
Ing
Int suicide
U
Ing
Int unk
A
Ing
Int suicide
A
Ing/paren
Int suicide
A
Ing
Int unk
U
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing/unk
Int suicide
A
Ing
Int suicide
Blood
Concentrations
Interval after
Exposure
63.6 ng/mL§,e
100 ng/mL§
365 mg/dL
500.3 lg/mL
A/C
Ing
Adv rxn
A/C
A
Ing
Ing
Int suicide
Int suicide
A
Asp/ing
Int suicide
A/C
Ing/inh
Int abuse
A/C
A
A
Ing
Ing
Ing
Unk
Int suicide
Int suicide
U
Ing
Unk
A/C
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
600 ng/mL§
2500 ng/mL§
Norfluoxetine 600 ng/mL§
277 lg/mL
169 lg/mL
120 lg/mL
A
A
A
Ing
Ing
Ing
Int suicide
Int suicide
Int suicide
U
A
Ing
Ing
Int suicide
Int suicide
26 740 ng/mL§
38 h
2004 AAPCC Annual Report
631
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Sedative/hypnotics/antipsychotics
1026
56 y
Quetiapine
1027 p
76 y
Quetiapine
Amlodipine
1028
62 y
Quetiapine
Clonazepam
1029
64 y
Quetiapine
Clonazepam
1030
43 y
Quetiapine
Cocaine
MorphineA
1031 p
40 y
Quetiapine
Escitalopram
ClonazepamA
1032
47 y
Quetiapine
Lithium
ThiothixeneA
1033 p
45 y
Quetiapine
Methamphetamine
1034
32 y
Quetiapine
Olanzapine
1035 p
38 y
Quetiapine
Olanzapine
ZolpidemA
1036 p
21 y
Quetiapine
Oxycodone (long-acting)
Bupropion (long-acting)
1037
45 y
Quetiapine
Paroxetine
GabapentinA
1038
24 y
Quetiapine
Paroxetine
IbuprofenA
1039 i/p 46 y
Quetiapine
Propranolol
CyclobenzaprineA
1040 p
60 y
Quetiapine
Simvastatin
DiclofenacA
1041 p N19 y
Quetiapine
Valproic acid
Sertraline
1042
32 y
Quetiapine
ZiprasidoneA
Risperidone
1043 p
32 y
Risperidone
1044
47 y
Risperidone
1045
77 y
Risperidone
Clorazepate
1046
86 y
Risperidone
Lorazepam
AspirinA
1047
77 y
Temazepam
1048 a/p 19 y
Trimethobenzamide
1049 p
20 y
Ziprasidone
Duloxetine
1050
41 y
Ziprasidone
Lorazepam
Bupropion (long-acting)
1051
45 y
Ziprasidone
Valproic acid
Fluphenazine
1052
31 y
Ziprasidone
Valproic acid
HaloperidolA
1053 p N19 y
Zolpidem
Chronicity Route
Reason
A/C
A
Ing
Ing
Int suicide
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A
Ing/unk
Int suicide
U
Asp/ing
Unk
A
Ing
Int suicide
Blood
Concentrations
Interval after
Exposure
5.2 mEq/L
C
Ing
Int suicide
A/C
Ing
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A/C
Ing/unk
Int suicide
A/C
Ing
Int suicide
A
Ing
Int suicide
A
Ing
Int suicide
U
Ing
Int suicide
C
Ing/paren
Adv rxn
A
A/C
A/C
Ing
Ing
Ing
Int suicide
Adv rxn
Int suicide
U
Ing
Int suicide
A
A
A
Ing
Ing
Ing
Int suicide
Int suicide
Int suicide
A/C
Ing
Int suicide
A
A/C
Ing
Unk
0.09 lg/mL§
43.8 ng/mL§,#
45 mg/dL
12 lg/mL
400 ng/mL§
A/C
Ing
Int suicide
U
Ing
Int suicide
(continued on next page)
632
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
PHARMACEUTICALS
Sedative/hypnotics/antipsychotics
1054 p
51 y
Zolpidem
U
Ing/unk
Int abuse
1962 ng/mL§
Promethazine
792 ng/mL§
CyclobenzaprineA
0.042 lg/mL§
See also cases 84, 315, 326, 402 to 405, 408, 418 to 420, 448 to 450, 523, 559, 560, 563, 564, 593, 595, 605, 630, 631, 638, 640, 715, 716, 793, 930, 971, 999, 1080, 1096, and
1147 (alprazolam); 891 (amisulpride); 685 and 718 (aripiprazole); 491 (barbiturate [long-acting]); 10, 316, 491, 566, 567, 573, 592, 604, 616, 641, 661, 683, 764, 800, 913,
993, 1060, 1083, 1114, 1115, and 1148 (benzodiazepine); 408, 650, and 751 (buspirone); 226 and 569 (chloral hydrate); 320, 359, and 608 (chlordiazepoxide); 713, 719, 726,
and 908 (chlorpromazine); 86, 321, 425, 499, 570, 624, 649, 660, 697, 721 to 723, 753, 760, 769, 955, 1008, 1016, 1017, 1028, 1029, 1031, and 1116 (clonazepam); 1045
(clorazepate); 326, 407, 422 to 424, 433, 574 to 576, 590, 608, 609, 627, 639, 644, 659, 730, 813, 887, 940, 970, 973, 979, and 1085 (diazepam); 329 (diphenhydramine);
577 (doxylamine); 1051 (fluphenazine); 518 (flurazepam); 1052 (haloperidol); 361, 381, 694, 804, 817, 873, 1046, 1050, and 1092 (lorazepam); 330, 590, and 658
(meprobamate); 211 (midazolam); 195, 496, 730, 742, 815, 839, 1034, 1035, and 1091 (olanzapine); 663, 697, 743, and 763 (phenobarbital); 21, 135, 381, 461, 497, 498,
595, 596, 600, 648, 649, 678 to 680, 723, 763, 768, 769, 806, 898, 907, 1102, and 1125 (quetiapine); 350, 351, 632, 765, 1020, 1042, and 1098 (risperidone); 427
(temazepam); 361 (thioridazine); 1032 (thiothixene); 736 and 745 (trifluoperazine); 667, 807, 808, 1009, and 1042 (ziprasidone); 133, 350, 351, 382, 440, 576, 600, 633,
772, 817, 979, 990, 991, and 1035 (zolpidem); and 761 (zopiclone).
Stimulants and street drugs
1055 p
39 y
Amphetamine
1056
42 y
Amphetamine
Amitriptyline
Marijuana
1057 p
50 y
Amphetamine
Cocaine
Heroin
1058
52 y
Amphetamine
Ephedra
1059 p
40 y
Amphetamine
Ethanol
1060
40 y
Amphetamine
Opioid
Benzodiazepine
1061
26 y
Amphetamine
Tricyclic antidepressant
1062 p
14 y
Amphetamine/dextroamphetamine
Atomoxetine
Sertraline
1063
17 y
Cocaine
1064 p
23 y
Cocaine
1065 i/p 25 y
Cocaine
1066 a/p 25 y
Cocaine
1067 a
26 y
Cocaine
1068
30 y
Cocaine
1069
30s y
Cocaine
1070
31 y
Cocaine
1071 a/p 40 y
Cocaine
1072 p
41 y
Cocaine
1073
43 y
Cocaine
1074 p
48 y
Cocaine
1075
52 y
Cocaine
1076 i/p N19 y
Cocaine
1077 p N19 y
Cocaine
1078
Unk
Cocaine
1079
42 y
Cocaine
Acetaminophen/hydrocodone
1080 p Unk
Cocaine
Alprazolam
Ethanol
1081
33 y
Cocaine
Amphetamine
1082 p
18 y
Cocaine
Amphetamine
MarijuanaA
1083 p
27 y
Cocaine
Benzodiazepine
Marijuana
1084
19 y
Cocaine
Bupropion (long-acting)
LamotrigineA
A
A
Unk
Ing/unk
Int abuse
Int abuse
A
Ing/unk
Int abuse
U
Ing
Int abuse
U
Ing/unk
Unk
A
Ing
Int abuse
U
Unk
Unk
U
Ing
Unk
A
A
A/C
A
A
A
A
C
A
A
U
U
U
A
A
U
A/C
Ing
Unk
Paren
Ing
Ing
Ing
Paren
Inh
Inh
Ing
Unk
Unk
Unk
Ing
Ing
Unk
Ing/unk
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
A
Ing/unk
Int abuse
A
Ing
Int misuse
A
Ing/inh/paren
Int abuse
A
Ing/inh/unk
Int abuse
A
Ing/unk
Int suicide
misuse
unk
abuse
misuse
misuse
misuse
abuse
abuse
abuse
abuse
unk
abuse
unk
abuse
misuse
suicide
unk
1.2 lg/mL
N5 lg/mL§
15 lg/mLw
Benzoylecgonine 0.144 lg/mL§
151 ng/mL§
291 mg/dL§
2004 AAPCC Annual Report
633
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Sedative/hypnotics/antipsychotics
1085
39 y
Cocaine
Diazepam
Ethanol
1086
47 y
Cocaine
1087 p
19 y
1088
27 y
1089
52 y
1090 p
N19 y
1091 p
43 y
1092
27 y
1093 p
47 y
1094
20 y
1095
54 y
1096 p
30 y
1097 i/p
35 y
1098 p
30 y
1099
28 y
1100 i/p
1101
1102 p
48 y
55 y
48 y
1103
1104
46 y
42 y
1105
1106 p
1107 p
1108 p
1109 p
1110 p
1111 p
21
23
24
25
47
48
51
1112 p
54 y
y
y
y
y
y
y
y
Diltiazem (long-acting)
NifedipineA
Cocaine
Heroin
Cocaine
Heroin
Cocaine
Heroin
Cocaine
Heroin
Cocaine
Heroin
Olanzapine
Cocaine
Lorazepam
Cocaine
Marijuana
Cocaine
Meperidine
Cocaine
Methadone
Cocaine
Methadone
AlprazolamA
Cocaine
Methamphetamine
Cocaine
Risperidone
Gabapentin
Cocaine
Unk drug
Cocaine (crack)
Cocaine (crack)
Cocaine (crack)
Quetiapine
Gabapentin
Ephedrine
Ephedrine
Bupropion (long-acting)
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Heroin
Stimulants and street drugs
1113 p
56 y
Heroin
1114 p
39 y
Heroin
Amphetamine
BenzodiazepineA
1115
38 y
Heroin
Benzodiazepine
Ethanol
1116 p
29 y
Heroin
Clonazepam
1117 p
36 y
Heroin
Cocaine
CitalopramA
Chronicity Route
Reason
A
Ing
Int suicide
A
Ing/inh
Int abuse
A
Ing/paren
Int abuse
A/C
Inh/paren
Int abuse
A
Inh/paren
Int abuse
C
Paren
Int abuse
A
Ing/inh
Int abuse
A/C
Ing/unk
Int unk
A
Unk
Unk
A/C
Rectal/unk
Int unk
A/C
Ing/inh
Int abuse
A
Ing/unk
Int unk
Blood
Concentrations
Interval after
Exposure
Benzoylecgonine 4.07 lg/mL
Ecgonine 0.766 lg/mL
0.152 lg/mL
Benzoylecgonine 0.52 lg/mL§
Morphine 40 ng/mL§
Benzoylecgonine 0.013 lg/mL
370 ng/mL
Benzoylecgonine 2.279 lg/mL§
3h
3h
0.0876 lg/mL§
A/C
Unk
Unk
A
Ing
Int unk
C
Ing/inh/unk
Int unk
A
A
U
Inh
Inh
Ing/unk
Int abuse
Int abuse
Int abuse
C
A
Ing
Ing
Int abuse
Int suicide
C
U
U
A/C
A
A/C
A
Paren
Inh
Paren
Paren
Unk
Paren
Paren
Int unk
Int abuse
Int abuse
Int unk
Malicious
Int abuse
Int abuse
U
Paren
Int abuse
A
A
Paren
Unk
Int abuse
Unk
A/C
Ing/paren
Int unk
A/C
Ing/paren
Int abuse
A
Ing/paren
Int abuse
Benzoylecgonine 1.47 lg/mL§
Morphine 0.58 ng/mL
Free morphine 0.12 ng/mL
200 mg/dL
Morphine 70 ng/mL§
0.03 lg/mL§
(continued on next page)
634
W.A. Watson et al.
Table 21 continued
Case
Age
Substances
PHARMACEUTICALS
Stimulants and street drugs
1118 p
27 y
Heroin
Cocaine
EphedraA
1119 p
30 y
Heroin
Cocaine
1120 p
42 y
1121 p
52 y
1122 p
22 y
1123 p
22 y
1124 p
15 y
1125 p
51 y
1126
47 y
1127 a
18 y
1128
1129
1130
1131
1132
1133
1134
1135
1136
1137
1138
1139
1140
1141
1142
15
17
18
19
21
25
26
26
30
31
31
31
32
33
34
p
p
p
p
p
a
y
y
y
y
y
y
y
y
y
y
y
y
y
y
y
Naltrexone
Heroin
Cyclobenzaprine
Heroin
Diphenoxylate/atropine
Heroin
Ethanol
Heroin
Marijuana
Heroin
Oxycodone
Marijuana
Heroin
Quetiapine
Heroin
Unk drug
Lysergic acid diethylamide
Bupropion
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
Chronicity Route
Reason
U
Ing/inh/oth/unk Int unk
A
Ing/paren
Unk
A/C
Ing/paren
Int abuse
U
Ing/paren
Unk
A/C
Ing/paren/unk
Int abuse
A
Unk
Int abuse
U
Ing/inh/unk
Int abuse
A
Asp/ing/paren
Int suicide
A
Paren
Int abuse
A
Ing
Int abuse
A
U
A
A
A
A
A
A
A/C
A
A
U
C
A
A
Inh
Unk
Ing
Ing
Unk
Unk
Paren
Ing
Ing/paren
Ing
Unk
Unk
Unk
Ing
Ing
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
Int
abuse
abuse
abuse
misuse
suicide
abuse
abuse
misuse
misuse
abuse
abuse
suicide
unk
suicide
abuse
1143
35 y
Methamphetamine
A
Ing
Int abuse
1144 p
1145 p
1146
1147
38
45
62
22
Methamphetamine
Methamphetamine
Methamphetamine
Methamphetamine
A
A
U
U
Ing
Unk
Unk
Ing
Int
Int
Int
Int
A/C
Ing/inh/paren
Int abuse
A
Ing
Int abuse
A
Ing/inh
Int abuse
U
Inh
Int abuse
U
Ing/unk
Int abuse
y
y
y
y
1148 p
41 y
1149
29 y
1150
26 y
1151 p
37 y
1152 p
44 y
1153
32 y
1154 a
14 y
Acetaminophen/hydrocodone
Alprazolam
Methamphetamine
Amphetamine/dextroamphetamine
Benzodiazepine
Methamphetamine
Heroin
Methamphetamine
Marijuana
Methamphetamine
Marijuana
Methamphetamine
Unk opioid
Acetaminophen
Methamphetamine
Unk substance
Methylenedioxyamphetamine
1155 p
22 y
Methylenedioxymethamphetamine
misuse
abuse
abuse
abuse
Blood
Concentrations
Interval after
Exposure
Morphine 100 ng/mL§
0.24 lg/mL§
Benzoylecgonine 1 lg/mL§
Morphine 50 ng/mL§
6-Acetylmorphine 15 ng/mL§
60 mg/dL§
16 lg/mL
1.69 lg/mL§
21
Amphetamine 0.38
5.8
Amphetamine 0.31
11
lg/mL§
lg/mL§
lg/mL§
lg/mL§
lg/mL§
11 lg/mL§
Amphetamine 0.37 lg/mL§
62 ng/mL§
4.8 lg/mL§
11 lg/mL
A
Unk
Int abuse
A
Ing
Int abuse
U
Ing
Int abuse
0.41 lg/mL
d-Methamphetamine 0.04 lg/mL
2004 AAPCC Annual Report
635
Table 21 continued
Case
Age
Substances
Chronicity Route
Reason
Blood
Concentrations
Interval after
Exposure
PHARMACEUTICALS
Stimulants and street drugs
1156 a
29 y
Methylenedioxymethamphetamine
A
Unk
Int abuse
1157
22 y
Methylenedioxymethamphetamine
A
Ing/unk
Int abuse
Cocaine
1158
25 y
Phencyclidine
U
Unk
Int abuse
Opioid
Marijuana
1159 p
43 y
Phentermine
A/C
Ing
Int suicide
16 lg/mL§
1160 p
29 y
Phentermine
U
Unk
Unk
0.1 lg/mL§
Cocaine
HydrocodoneA
1161 a
22 y
Phenylethylamine
A
Ing
Int abuse
1162 p
21 y
Unk street drug
A
Unk
Int abuse
1163 p
23 y
Unk street drug
U
Unk
Int unk
1164 p
25 y
Unk street drug
U
Ing/unk
Unk
Ethanol
200 mg/dL
1165
46 y
Unk street drug
A
Ing/unk
Int unk
Ethanol
445 mg/dL
See also cases 231, 316, 798, 1007, 1081, 1082, and 1114 (amphetamine); 770, 1148 (amphetamine/dextroamphetamine); 41, 322 to 324, 329, 456, 488, 571 to 573, 626, 627,
642, 643, 725 ,801, 896, 994, 1007, 1030, 1057, 1117 to 1119, 1157, and 1160 (cocaine); 1013 (dextroamphetamine); 330 (ephedrine); 663, 997, 999, 1057, 1087 to 1091,
and 1149 (heroin); 589 (lysergic acid diethylamide); 320, 337, 346, 585, 617, 618, 628, 643, 800, 993, 995, 1013, 1056, 1082, 1083, 1093, 1123, 1124, 1150, 1151, and
1158 (marijuana); 564, 720, 816, 988, 998, 1004, 1033, and 1097 (methamphetamine); 89 and 591 (methylenedioxymethamphetamine); 233 (methylphenidate
[long-acting]); 346 and 618 (phencyclidine); and 831 and 988 (phentermine).
Topical preparations
See also cases 18 and 109 (iodine).
Veterinary drugs
See also case 948 (tiletamine/zolazepam).
Vitamins
See also case 345 (multiple vitamin with iron).
Unknown drugs
1166 p
10 y
1167 p
19 y
1168 i/p 19 y
1169
28 y
1170
34 y
1171
40s y
1172
42 y
1173 i/p 44 y
1174
49 y
1175 p
50 y
1176
52 y
1177
54 y
1178
57 y
1179 p Unk
1180 p Unk
1181
57 y
Unk drug
A
Unk drug
U
Unk drug
A/C
Unk drug
U
Unk drug
U
Unk drug
U
Unk drug
A/C
Unk drug
A
Unk drug
A
Unk drug
U
Unk drug
U
Unk drug
A
Unk drug
A
Unk drug
A
Unk drug
A
Unk drug
A
Berberine
1182
39 y
Unk drug
A
Ethanol
1183 p
17 y
Unk drug
A
Ethanol
Oxycodone (long-acting)
See also cases 243, 349, 441, 453, 458, 510, 599, 616, 619, 651, 733, 832, 926, 961,
Paren
Ing
Ing
Ing
Unk
Ing
Ing
Ing
Ing
Ing
Unk
Ing
Ing
Unk
Unk
Ing
Adv rxn
Int unk
Int suicide
Int suicide
Int abuse
Int suicide
Int suicide
Int suicide
Int unk
Unk
Int abuse
Int suicide
Int suicide
Int abuse
Int abuse
Unk
Unk
Unk
Ing/inh
Int abuse
84 mg/dL
989, 995, 1017, 1099, and 1126 (unk drug).
The term blong-actingQ is used throughout for all sustained-release, extended-release, delayed-release, or long-acting formulations.
p Indicates prehospital (cardiac and/or respiratory) arrest; i, reported to poison center indirectly (by coroner, medical examiner, or from other source) after the fatality occurred; m, reported by
medical examiner to poison center; C, chronic exposure; A, acute exposure; A/C, acute on chronic; derm, dermal; U, unknown; Ocu, ocular; Inh, inhalation; Ing, ingestion; Adv rxn, adverse
reaction; Env, environmental; Int, intentional; Occ, occupational; Paren, parenteral; Ther err, therapeutic error; Unint gen, unintentional general.
§ Concentration obtained postmortem.
w Acetaminophen concentration.
A
Additional substances not listed; abstract provided in Appendix B.
b Salicylate concentration.
# Concentration includes metabolite and parent compound.
636
Table 22A
W.A. Watson et al.
Demographic profile of exposure cases by generic category of substances and products: nonpharmaceuticals
No. of
Exposures
Adhesives/glues
Cyanoacrylate
Epoxy
Toluene/xylene
Nontoxic
Unknown
Category total
Age
Reason
6-19
b6
Unint
N19
10 308
767
822
1869
4581
18 347
3869
325
501
1265
2143
8103
1938
50
82
432
672
3174
4384
388
236
156
1686
6850
45 370
8264
219
7803
979
1382
6340
91
4558
265
6412
721
30
676
126
37 034
1170
96
2525
578
12
11
1
0
12
280
194
18
68
355
251
24
79
3371
6601
548
466
74 268
2272
4029
413
105
19 911
224
534
48
65
8879
868
2015
84
292
44 809
Arts/crafts/office supplies
Artist paint, nonwater color
Chalk
Clay
Crayon
Glaze
Office supplies: miscellaneous
Pencil
Pen/ink
Typewriter correction fluid
Water color
Other
Unknown
Category total
2843
1862
2482
2416
170
500
3099
19 356
2290
1411
5862
296
42 587
2019
1685
2181
2160
61
331
1618
12 238
1612
1223
4473
197
29 798
361
123
190
163
59
39
1235
6317
469
114
635
72
9777
Automotive/aircraft/boat products
Brake fluid
Ethylene glycol
Glycol: other
Glycol and methanol
Hydrocarbon
Methanol
Nontoxic
Other
Unknown
Category total
1431
5562
412
249
3186
1521
8
2009
219
14 597
365
672
221
59
1254
320
3
610
63
3567
1338
136
158
6
6
43
105
16
3041
5695
77
198
10 819
Alcohols
Ethanol: beverage
Ethanol: other
Higher alcohol
Isopropanol
Methanol
Rubbing alcohol
Ethanol with methyl
salicylate
Ethanol without
methyl salicylate
Isopropanol with
methyl salicylate
Isopropanol without
methyl salicylate
Unknown rubbing alcohol
Other
Unknown
Category total
Batteries
Automotive battery
Disc batteries
Alkaline (MnO2)
Lithium
Mercuric oxide
Nickel cadmium
Silver oxide
Zinc air
Other
Unknown
Dry cell battery
Other
Unknown
Category total
9981
737
786
1791
4319
17 614
Int
Other
Adv
Rxn
Treated
in Health
Care
Facility
Outcome
None
Minor
Moderate Major Death
194
14
23
54
125
410
62
0
3
10
50
125
52
15
7
13
79
166
2180
202
142
70
805
3399
1228
166
189
203
810
2596
2109
160
142
105
897
3413
369
50
19
10
167
615
2
0
1
0
2
5
0
0
0
0
0
0
5662 37 895
7927
274
202
5
6623
1069
828
121
399
36
3
57
8
743
19
9
18
4
34 191
522
49
1698
495
4411
2266
48
2086
248
14 117
866
52
1409
225
9772
76
8
387
63
1810
7
3
56
44
97
5
0
5
4
0
0
0
1
3
1
0
0
0
257
18
1
4
40
82
25
7
1
0
330
24
1
0
65
137
54
13
2
0
3140
214
5676
828
532
10
217
212
31 406 40 670
12
55
0
4
576
2
17
4
14
834
457
1236
44
245
39 043
684
1596
160
64
11 785
447
1159
54
127
18 536
76
230
7
84
10 723
7
27
1
22
1980
0
2
0
1
114
455
46
97
73
50
126
221
703
195
73
720
26
2785
2766
1840
2461
2403
163
489
2957
18 767
2165
1395
5649
278
41 333
54
18
14
12
2
10
82
503
104
12
147
15
973
7
2
2
0
1
0
44
33
18
0
26
0
133
13
2
3
0
3
1
3
42
0
4
34
2
107
108
42
68
35
20
42
123
389
156
16
258
16
1273
458
267
265
234
26
101
297
2637
571
217
783
45
5901
175
53
96
26
24
37
286
556
182
43
300
18
1796
25
4
3
6
3
10
15
33
24
0
53
2
178
0
0
1
0
0
0
0
0
0
0
1
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
135
678
49
50
443
228
1
346
18
1948
922
4157
136
135
1461
957
4
1030
136
8938
1343
4679
398
234
2935
1298
8
1917
206
13 018
73
751
9
14
192
197
0
49
8
1293
9
61
4
1
33
17
0
9
0
134
4
20
1
0
17
3
0
28
1
74
525
2109
87
71
865
684
2
591
97
5031
269
1024
88
58
791
393
1
368
35
3027
483
1012
130
80
897
409
0
744
64
3819
95
422
6
6
150
86
0
125
18
908
7
195
1
0
17
25
0
8
3
256
0
23
0
0
2
2
0
0
0
27
82
140
1096
1317
11
2
6
372
101
481
107
2
1
87
72
2
3
24
40
6
1894
3003
32
60
5305
29
30
1
0
3
16
5
859
1231
13
38
2365
19
55
3
3
16
49
5
263
1421
31
98
3059
131
152
6
6
41
101
15
2963
5395
75
185
10 387
3
4
0
0
2
3
1
57
243
1
10
335
0
0
0
0
0
0
0
17
19
0
3
41
0
0
0
0
0
0
0
1
26
1
0
34
88
76
5
1
32
68
8
1935
820
15
21
3441
79
57
5
0
29
63
8
1447
1338
16
40
3183
8
18
1
1
2
4
4
123
984
14
51
1691
5
9
0
0
0
0
0
36
158
4
19
338
2
2
0
0
0
0
0
2
6
0
0
14
0
0
0
0
0
0
0
0
0
0
0
1
2004 AAPCC Annual Report
637
Table 22A continued
No. of
Exposures
Bites and envenomations
Aquatic
Coelenterate
Fish
Other/unknown
Insects
Ant/fire ant
Bee/wasp/hornet
Caterpillar
Centipede/millipede
Mosquito
Scorpion
Tick
Other
Mammals
Bat
Cat
Dog
Fox
Human
Raccoon
Rodent/lagomorph
Skunk
Other
Reptile: other/unknown
Snakes
Copperhead
Coral
Cottonmouth
Crotaline: unknown
Rattlesnake
Exotic snakes
Poisonous
Nonpoisonous
Unknown if poisonous
Nonpoisonous snake
Unknown snake
Spiders
Black widow
Brown recluse
Necrotizing spider: other
Tarantula
Other spider
Unknown insect or spider
Other/unknown bite/
envenomation
Category total
6-19
Reason
N19
Unint
Int
Other
Adv
Rxn
Treated
in Health
Care
Facility
Outcome
None
Minor
Moderate Major Death
1015
1283
516
127
24
239
499
237
92
378
1012
175
1012
1281
494
1
1
15
1
0
5
1
1
2
132
375
59
3
10
71
300
331
108
75
158
19
1
5
1
0
0
0
2323
12 424
1961
2004
694
14 950
2159
17 197
880
2367
460
333
180
1232
477
3501
309
2352
501
366
126
2913
433
2869
1120
7610
974
1284
376
10 737
1227
10 640
2309
12 407
1934
1998
692
14 944
2153
17 032
6
8
19
5
0
5
1
46
7
2
1
0
0
0
1
66
0
4
7
1
1
0
0
36
220
1210
158
131
108
907
375
2676
46
90
42
49
6
66
72
351
571
4040
670
725
147
2718
326
3755
143
632
86
44
38
398
65
1006
7
29
0
0
1
13
2
20
0
1
0
0
0
0
0
0
420
892
1920
23
88
120
1843
262
1085
1101
53
97
371
0
10
7
427
24
173
371
88
170
750
8
15
28
631
54
309
419
268
603
772
15
50
83
740
180
573
287
413
891
1918
23
71
119
1827
256
1071
1063
0
0
1
0
1
0
1
0
3
15
0
0
1
0
14
0
6
3
1
1
1
1
0
0
0
1
5
0
2
20
252
474
1310
13
38
69
424
29
463
177
83
11
31
2
2
11
70
25
61
69
63
223
580
6
18
28
424
65
206
346
8
76
157
0
8
5
21
7
30
39
0
0
4
0
0
0
0
0
2
3
0
0
0
0
0
0
0
0
0
0
1098
99
192
431
1178
64
5
7
25
49
213
26
43
118
165
816
64
140
284
957
1096
99
191
429
1170
1
0
1
0
4
0
0
0
1
1
0
0
0
1
2
988
91
164
382
1034
22
8
3
14
33
381
40
87
139
253
482
26
59
186
549
38
6
6
22
79
0
0
0
1
1
131
131
2
1803
2147
3
16
0
179
149
16
46
0
709
627
107
67
2
897
1347
125
131
1
1801
2146
5
0
0
1
1
0
0
0
0
0
1
0
0
1
0
113
44
2
482
1343
3
2
0
64
75
41
44
2
731
947
45
6
0
57
344
10
0
0
1
22
1
0
0
0
0
2720
2859
325
240
13 205
5959
463
231
206
39
14
1477
828
73
404
381
61
77
2353
1052
82
2069
2240
221
144
9262
4006
300
2715
2853
323
233
13 160
5956
460
3
2
0
2
15
0
0
1
0
0
0
6
0
0
0
2
1
5
14
0
0
860
1058
105
56
2102
740
116
137
49
5
5
188
27
5
762
625
82
62
2971
647
145
380
639
61
8
894
183
43
13
34
1
0
16
2
2
0
1
0
0
0
0
0
97 263
14 718
19 542
62 027
96 797
163
118
110
19 280
1811
23 609
6977
340
5
1842
458
192
144
586
1198
2581
1762
30
19
3
4
23
22
204
671
528
189
202
398
32
355
2
14
0
0
82
635
52
68
36
133
1486
26
4818
101
257
11
13
11
37
251
13
1030
547
619
42
77
31
162
1074
94
4430
724
1493
109
156
77
322
2772
129
10 125
2
11
0
0
1
4
32
1
100
2
3
0
0
0
1
3
0
16
13
20
0
2
0
4
25
4
113
127
183
11
21
11
110
507
43
1888
114
127
14
17
11
55
503
21
1579
54
318
17
24
10
84
440
39
1586
21
42
9
3
6
37
146
11
662
0
2
0
0
0
1
11
3
33
0
0
0
0
0
0
0
0
0
1188
299
142
726
1067
82
20
10
380
188
303
71
9
1
3078
996
5413
443
161
43
522
29
508
49
904
61
2358
897
3901
348
2938
965
5179
417
76
10
117
8
22
5
31
14
25
10
69
1
1149
765
2077
186
218
76
455
30
1057
356
1869
128
437
277
754
62
18
18
38
0
3
2
4
1
Building and construction products
Caulking compound and putty
2641
Cement, concrete
1810
Insulation
Asbestos
747
Fiberglass
1529
Urea/formaldehyde
109
Other
158
Unknown
78
Soldering flux
333
Other
2836
Unknown
136
Category total
10 377
Chemicals
Acetone
Acids
Hydrochloric
Hydrofluoric
Other
Unknown
Age
b6
(continued on next page)
638
W.A. Watson et al.
Table 22A continued
No. of
Exposures
Alkali
Ammonia
Borate/boric acid
Chlorate
Cyanide
Dioxin
Ethylene glycol
Formaldehyde/formalin
Glycol: other
Ketone
Methylene chloride
Nitrate and nitrite
Phenol/creosote
Strychnine
Toluene diisocyanate
Other/unknown
Category total
Cleaning substances (household)
Ammonia cleaner
Automatic dishwasher detergents
Granular
Liquid or gel
Tablet
Rinse agent
Other/unknown
Bleaches
Borate
Hypochlorite
Nonhypochlorite
Other/unknown
Carpet/upholstery cleaner
Cleansers
Anionic/nonionic
Other/unknown
Disinfectants
Hypochlorite
Phenol
Pine oil
Other/unknown
Drain openers
Acid: hydrochloric
Acid: sulfuric
Acid: other/unknown
Alkali
Other/unknown
Fabric softeners/antistatic agents
Aerosol/spray
Dry/powder
Liquid
Solid/sheet
Other/unknown
Glass cleaners
Ammonia
Anionic/nonionic
Isopropanol
Other/unknown
Hand dishwashing
Anionic/nonionic
Other/unknown
Laundry additives
Bluing/brightening agent
Detergent booster
Enzyme/microbiologic
additive
Water softener
Other/unknown
Age
6-19
b6
Reason
N19
Unint
Int
Other
Adv
Rxn
Treated
in Health
Care
Facility
Outcome
None
Minor
Moderate Major Death
4860
4698
2443
81
257
15
808
1142
920
772
450
1366
602
60
686
16 458
46 736
880
1104
1106
19
12
0
84
121
339
265
90
354
46
14
128
5285
10 901
803
566
275
25
23
3
73
319
139
42
63
496
57
6
89
2689
7332
3122
2960
1041
35
213
9
637
690
432
455
293
497
490
39
459
8141
27 743
4618
4396
2244
67
194
11
471
1016
827
750
434
1229
570
28
663
14 826
42 910
97
173
140
2
32
0
281
97
49
7
7
110
11
16
15
545
1875
64
45
27
12
17
1
11
13
17
5
0
14
3
12
1
541
875
61
53
21
0
2
2
5
13
16
8
7
7
17
2
7
414
750
2246
1499
460
28
163
8
522
457
345
340
179
279
271
32
185
4621
16 192
501
533
559
12
39
2
116
185
177
138
56
268
63
13
59
2672
6360
1486
1470
256
26
52
3
103
343
210
252
157
238
168
10
159
3383
12 029
847
500
57
6
30
2
114
80
65
79
45
44
96
3
44
1069
4682
57
35
5
0
10
0
150
7
10
1
2
7
3
1
1
79
451
4
2
1
0
8
0
26
0
2
0
0
0
0
1
1
6
62
1963
673
173
1090
1831
99
12
20
388
292
528
121
1
0
4480
4943
1738
1400
1094
3765
4275
1635
1287
875
138
129
25
21
47
559
534
77
90
168
4446
4895
1731
1391
1078
14
22
4
6
4
16
18
3
2
11
3
8
0
1
1
187
239
53
96
62
1461
1663
610
335
253
588
772
241
189
152
30
50
10
19
16
1
2
0
1
2
0
0
0
0
0
596
57 137
821
479
5268
294
21 259
306
193
3809
45
5819
86
56
294
250
29 430
414
221
1140
557
53 263
742
430
5088
18
2637
40
30
67
4
485
4
12
22
17
615
31
2
87
99
10 751
176
126
590
101
8511
118
72
1109
165
17 469
254
134
918
31
2529
44
39
132
1
64
6
0
3
0
0
0
0
0
3578
2340
2775
1379
197
201
594
744
3490
2183
59
81
3
38
22
32
290
437
924
546
448
516
50
110
1
3
0
0
3018
1636
4496
5275
1479
1082
2451
3411
274
183
371
502
1236
360
1629
1318
2889
1525
4026
4976
67
76
345
157
40
16
45
54
20
14
63
79
700
201
968
627
491
293
1194
1197
733
365
1197
1147
204
33
99
152
3
3
14
4
1
1
2
0
573
319
45
3913
794
55
28
6
572
129
78
16
4
313
59
420
271
35
2971
586
507
302
42
3541
723
29
10
0
282
52
1
0
2
22
9
34
6
1
45
6
92
105
12
1231
212
173
29
4
513
119
262
111
14
1229
223
33
48
7
488
92
1
0
0
54
4
1
2
0
7
0
212
0
1182
458
10
169
0
943
380
9
12
0
61
24
1
29
0
173
54
0
198
0
1135
446
10
6
0
32
8
0
6
0
3
0
0
2
0
11
4
0
14
0
125
14
1
40
0
305
95
2
26
0
150
31
1
6
0
15
2
1
1
0
0
0
0
0
0
0
0
0
7339
171
2241
1209
5810
112
1676
843
580
21
182
138
911
38
362
221
6944
155
2113
1120
308
13
101
73
59
2
15
9
16
0
9
5
593
26
223
155
1675
44
611
262
1058
35
388
210
83
3
39
17
5
0
2
2
0
0
0
0
5623
1968
3650
1208
498
187
1441
562
5362
1855
118
46
79
38
56
28
443
137
758
261
1169
369
76
27
4
2
0
0
51
35
107
22
20
64
7
1
10
22
14
31
48
34
105
2
0
1
1
1
0
0
0
0
8
8
22
9
5
20
9
9
14
6
1
5
0
0
0
0
0
0
62
962
21
786
11
54
30
114
52
908
2
20
2
6
6
26
13
93
10
248
21
164
2
17
1
0
0
0
2004 AAPCC Annual Report
639
Table 22A continued
No. of
Exposures
Laundry detergents
Granular
5066
Liquid
4687
Soap
62
Other/unknown
179
Laundry prewash/stain removers
Dry solvent-based
3
Liquid solvent-based
934
Spray solvent-based
390
Other/unknown
79
solvent-based
Dry surfactant-based
121
Liquid surfactant-based
2267
Spray surfactant-based
622
Other/unknown
80
surfactant-based
Other/unknown
3616
Miscellaneous cleaners
Acid
952
Alkali
7620
Anionic/nonionic
6422
Cationic
2021
Ethanol
289
Glycols
1329
Isopropanol
1778
Methanol
41
Phenol
17
Other/unknown
3993
Oven cleaners
Acid
17
Alkali
2561
Detergent
17
Other/unknown
271
Rust removers
Alkali
10
Anionic/nonionic
1
Hydrofluoric acid
458
Other acid
514
Other/unknown
320
Spot removers/dry cleaning agents
Anionic/nonionic
340
Glycol
356
Perchloroethylene
31
Isopropanol
57
Other halogenated
46
hydrocarbon
Other nonhalogenated
812
hydrocarbon
Other/unknown
200
Starch/fabric finish/sizing
695
Toilet bowl cleaners
Acid
3772
Alkali
2024
Other/unknown
2930
Wall/floor/tile cleaners
Acid
5672
Alkali
9708
Anionic/nonionic
7222
Cationic
2662
Ethanol
117
Glycol
2064
Isopropanol
922
Methanol
1
Other/unknown
1628
Wheel cleaner: HF/bifluoride
98
Category total
215 630
Age
b6
6-19
Reason
N19
Unint
Int
Other
Adv
Rxn
Treated
in Health
Care
Facility
Outcome
None
Minor
Moderate Major Death
4093
3303
38
111
268
304
7
7
689
1058
16
60
4911
4487
55
170
93
136
3
3
12
19
1
1
46
40
1
5
550
577
7
29
1076
779
7
29
1196
1135
8
42
102
99
1
6
2
5
1
1
0
1
0
0
3
740
344
68
0
43
11
2
0
149
33
9
3
915
383
78
0
9
5
1
0
1
1
0
0
7
1
0
0
125
64
10
1
302
79
22
0
159
93
12
0
16
13
2
0
2
0
0
0
0
0
0
110
2004
559
73
3
76
21
3
7
177
41
3
121
2245
612
79
0
15
3
1
0
4
5
0
0
2
1
0
6
276
132
5
22
449
123
9
7
405
150
7
2
60
33
1
0
0
1
0
0
0
0
0
2452
217
925
3545
31
13
24
326
804
719
59
1
0
394
4716
4349
964
151
883
996
17
3
2015
61
572
465
198
83
176
542
5
1
483
482
2303
1557
845
55
266
229
19
12
1460
877
7259
6126
1893
275
1268
1682
36
16
3646
25
243
180
95
9
37
63
4
1
180
9
49
39
13
4
9
27
0
0
70
40
61
68
13
1
13
4
1
0
86
218
1611
862
554
37
166
166
15
10
872
236
1611
1330
392
57
271
397
10
2
809
252
1687
1281
496
65
287
413
14
6
1094
77
366
171
112
3
29
18
2
3
186
0
14
7
2
0
4
0
0
0
6
0
0
0
0
0
0
0
0
0
0
13
536
8
58
1
302
2
34
3
1677
7
179
17
2454
16
252
0
43
0
7
0
32
1
9
0
29
0
3
3
925
2
99
5
269
2
29
2
751
3
90
0
348
1
29
0
18
0
1
0
1
0
0
2
1
73
200
49
2
0
25
25
31
6
0
354
285
239
10
1
423
494
294
0
0
11
18
7
0
0
7
0
1
0
0
12
1
17
3
1
190
124
70
2
1
121
114
41
3
0
196
152
124
1
0
45
37
32
0
0
6
3
1
0
0
0
1
0
283
224
17
37
16
13
22
2
6
3
42
110
12
14
27
338
343
31
51
44
0
5
0
2
0
0
3
0
4
1
1
4
0
0
1
32
54
4
5
15
75
73
8
9
4
49
84
9
7
14
6
10
1
2
5
0
1
0
0
0
0
0
0
0
0
354
85
364
766
22
8
14
219
138
238
46
0
0
145
593
15
38
40
60
195
683
1
9
2
1
2
2
32
29
39
150
45
64
5
6
1
0
0
0
1201
1234
2125
394
88
111
2125
688
667
3458
1962
2844
234
52
57
7
1
6
71
7
23
874
339
353
785
539
778
1615
457
400
290
102
82
18
6
2
5
0
0
3022
5909
4377
1687
92
1518
642
0
913
31
121197
371
762
595
232
6
124
53
0
105
13
17 826
2236
2947
2178
723
19
418
207
1
584
54
74 800
5426
9240
6773
2534
116
1975
856
1
1534
94
204 048
150
297
335
94
1
70
26
0
58
3
7468
13
52
47
19
0
8
13
0
5
1
1558
79
104
48
9
0
8
23
0
28
0
2170
968
1906
1252
403
9
231
89
1
283
64
34 714
1219
2170
1571
529
36
457
279
0
426
17
43 056
1734
2535
1489
539
10
381
185
0
454
35
52 502
274
488
191
76
1
40
16
1
71
18
8222
7
15
7
2
0
3
5
0
0
1
328
0
0
1
0
0
0
0
0
0
1
24
(continued on next page)
640
W.A. Watson et al.
Table 22A continued
No. of
Exposures
Industrial cleaners
Acid
Alkali
Anionic/nonionic
Cationic
Disinfectant
Other/unknown
Category total
2216
3544
1136
475
3942
2097
13 410
Cosmetics/personal care products
Baby oil
3143
Bath oil/bubble bath
5609
Cream/lotion/makeup
25 065
Dental care products
Denture cleaner
1440
Toothpaste with fluoride
24 180
Toothpaste without fluoride
1616
Other
2212
Deodorant
17 566
Depilatory
1959
Douche
136
Eye product
1290
Hair care products
Coloring agent
2347
Curl activator
59
Oil
266
Permanent wave solution
397
Relaxer: sodium hydroxide
768
Relaxer: other alkaline
847
Relaxer: other nonalkaline
66
Rinse/conditioner/relaxer
2688
Shampoo
6175
Spray
2165
Other
3125
Lipstick/balm: with camphor
1192
Lipstick/balm: without camphor
4467
Mouthwash
Ethanol
15 727
Nonethanol
823
Fluoride
4004
Unknown
122
Nail products
Acrylic nail adhesive
1558
Acrylic nail primer
319
Acrylic nail remover
50
Polish
10 786
Polish remover: acetone
2742
Polish remover: other
2114
Polish remover: unknown
8178
Other
1692
Perfume/cologne/aftershave
17 627
Peroxide
16 550
Powder: talc
2917
Powder: without talc
2532
Soap
17 476
Suntan/sunscreen
10 797
Category total
224 792
Deodorizers
Air fresheners
Aerosol
Liquid
Solid
Other/unknown
Diaper pail deodorizer
Toilet bowl deodorizer
Other
Unknown
Category total
3443
6063
5187
1549
20
784
5612
74
22 732
Age
b6
6-19
Reason
N19
Unint
Int
Other
Adv
Rxn
Treated
in Health
Care
Facility
Outcome
None
Minor
Moderate Major Death
707
1070
545
124
572
747
3765
150
448
115
63
444
253
1473
1339
1995
466
280
2894
1080
8054
2086
3337
1049
422
3666
1969
12 529
90
122
60
44
205
62
583
13
52
9
4
46
29
153
24
23
14
5
19
33
118
571
1571
276
210
1159
709
4496
401
476
188
75
375
303
1818
564
1208
316
173
1306
674
4241
163
475
51
43
405
198
1335
10
32
0
2
12
10
66
1
0
0
0
0
0
1
2960
5210
21 262
73
203
1223
102
182
2502
3112
5554
24 325
14
30
292
4
5
45
11
18
391
206
203
876
974
1180
4309
224
560
1497
16
22
124
2
0
3
0
0
0
288
21 890
1398
838
15 277
541
107
1125
80
1026
56
406
1129
386
9
49
1064
1213
154
955
1115
1021
20
113
1392
23 484
1540
1766
16 707
1333
128
1263
39
282
16
35
239
89
5
10
2
44
4
6
94
13
0
1
5
361
56
401
523
521
2
15
88
440
30
194
490
384
14
57
298
5187
312
315
2723
179
27
211
113
1272
93
351
1467
582
11
76
12
42
5
37
92
170
0
10
0
0
0
0
1
4
0
1
0
0
0
0
0
0
0
0
847
39
233
180
530
637
48
2206
4827
1328
2194
1089
4189
244
7
10
31
43
47
5
200
523
288
247
55
170
1231
12
23
183
188
163
12
273
801
535
661
43
94
1918
54
258
359
738
818
61
2573
5855
1814
2935
1173
4413
33
4
4
2
4
6
0
83
230
324
75
9
22
2
0
0
2
0
2
0
11
14
13
7
2
2
392
1
4
33
26
21
5
21
67
8
104
6
29
447
12
45
129
364
328
18
222
430
416
411
22
71
355
19
57
68
151
215
14
625
959
493
593
256
617
585
11
37
117
268
267
12
307
1039
478
527
63
127
135
1
8
52
96
84
3
46
64
75
90
2
7
2
0
0
0
1
1
0
2
2
9
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4442
349
2892
36
2586
165
910
30
8614
305
198
54
14 222
755
3961
109
1386
56
33
9
47
0
1
0
37
10
7
2
1422
75
50
11
2802
182
871
20
1172
88
90
13
268
9
5
1
35
0
0
0
2
0
0
0
569
252
27
9775
2065
1585
5902
985
14 917
6967
2513
2342
13 411
9749
168 021
481
25
4
499
242
200
896
64
1468
1515
180
82
1411
573
17 841
497
41
19
472
427
326
1340
629
1184
7951
219
98
2593
454
38 081
1515
314
47
10 650
2652
2049
7888
1659
16 919
15 771
2850
2499
16 653
10 555
214 641
21
2
1
95
66
46
223
14
540
390
44
24
370
51
5218
8
0
0
18
10
10
43
1
111
66
10
4
122
8
732
13
3
2
16
10
9
18
15
39
290
11
3
311
182
3999
558
95
4
556
268
175
843
412
1183
1159
272
126
867
361
14 334
163
63
7
2096
803
653
1785
335
4107
2706
637
463
2689
1636
42 155
476
99
10
1464
487
344
1315
351
3701
2773
626
478
2155
1584
27 310
107
23
1
66
20
14
87
87
110
251
49
20
127
47
2485
3
0
0
0
1
2
5
0
11
7
2
1
5
2
106
0
0
0
0
0
0
0
0
1
0
0
0
0
0
3
2490
5347
4725
1144
18
691
4233
49
18 697
556
323
177
192
0
29
395
9
1681
384
380
274
204
2
60
965
16
2285
3239
5981
5153
1483
20
767
5434
69
22 146
147
57
17
35
0
10
94
4
364
33
15
4
4
0
2
39
1
98
16
9
13
23
0
4
44
0
109
326
454
233
154
0
84
640
12
1903
595
1462
1148
377
5
239
1326
23
5175
873
1164
654
327
1
57
926
16
4018
56
54
22
27
1
9
97
0
266
5
2
0
1
0
0
3
0
11
2
0
0
0
0
0
0
0
2
2004 AAPCC Annual Report
641
Table 22A continued
No. of
Exposures
Age
b6
6-19
Reason
N19
Unint
Int
Other
Adv
Rxn
Treated
in Health
Care
Facility
Outcome
None
Minor
Moderate Major Death
Dyes
Fabric
Food
Leather
Other
Unknown
Category total
418
1242
122
587
77
2446
310
1047
101
290
47
1795
38
123
12
187
6
366
70
67
9
103
24
273
406
1193
118
535
68
2320
3
22
1
21
4
51
0
15
0
2
0
17
5
11
3
28
5
52
21
33
5
68
14
141
89
207
14
113
18
441
19
46
5
49
8
127
2
4
1
12
1
20
0
1
0
2
0
3
0
0
0
1
0
1
Essential oils
Clove oil
Cinnamon oil
Eucalyptus oil
Pennyroyal oil
Tea tree oil
Other/unknown
Category total
444
534
489
29
832
3797
6125
277
329
336
3
523
2950
4418
26
108
24
6
62
287
513
137
78
129
20
239
540
1143
420
444
466
18
772
3688
5808
9
54
10
10
29
48
160
0
0
0
0
0
10
10
15
34
12
1
30
48
140
68
61
99
15
88
347
678
103
41
137
5
228
881
1395
106
263
84
9
144
851
1457
8
7
12
0
8
61
96
0
0
2
1
0
2
5
0
0
0
0
0
1
1
Fertilizers
Household plant food
Outdoor fertilizer
Plant hormone
Other
Unknown
Category total
2742
4319
44
2149
167
9421
1692
2794
17
1381
90
5974
333
426
5
231
32
1027
705
1066
22
511
44
2348
2697
4215
43
2104
161
9220
21
35
0
16
1
73
19
27
0
6
0
52
5
40
0
22
5
72
71
238
12
182
20
523
499
974
9
452
41
1975
109
274
4
174
28
589
4
45
1
24
3
77
0
1
0
0
0
1
0
0
0
0
0
0
Fire extinguishers
3715
317
955
2305
3322
144
208
21
876
521
1065
218
2
0
69 915
18 342
11 325
39 327
63 527
925
958
4331
5725
5672
12 537
2517
82
1
486
4595
457
723
3179
40 015
5286
810
5790
217
2265
20
240
45
60
600
2795
336
258
4177
17
130
64
94
115
132
114
1543
789
1208
313
22
189
566
4899
575
915
3821
44 155
6260
2169
10 226
258
2563
5
23
32
1
70
328
58
26
100
3
19
2
13
4
1
8
90
117
95
31
0
6
1
4
18
2
1
8
14
7
5
0
3
30
128
46
50
1173
1217
148
238
498
22
89
77
613
126
195
1021
5934
928
377
1224
51
389
44
1019
59
64
384
262
245
196
2383
28
135
5
23
19
2
39
15
15
32
46
7
12
1
0
2
0
3
4
1
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
3180
820
5
9660
13 116
497
91101
2023
502
5
3725
3341
107
18 381
2298
532
7
352
3733
105
11 610
7564
1864
17
13 605
19 623
669
119 749
55
19
0
120
346
21
1226
4
3
0
39
177
19
609
9
4
0
23
192
8
299
458
66
4
650
1784
62
6663
1370
408
4
1777
3314
135
17 943
89
79
1
1804
1385
52
8229
5
1
0
36
181
4
442
0
0
0
2
5
0
18
0
0
0
0
0
0
5
661
17 115
785
1208
55
2137
39
55
256
2759
78
120
342
11 678
664
1030
591
16 523
769
1171
56
458
15
34
2
11
1
2
11
64
0
1
125
6427
191
326
49
2514
55
88
181
4823
284
578
38
1599
117
250
3
203
3
0
0
74
0
0
6031
1980
5514
19
3222
1766
1937
40 238
481
149
906
7
304
209
146
4488
1227
495
873
1
690
251
197
6947
4206
1040
3070
11
2128
1273
1526
26 968
5803
1976
5435
18
2893
1662
1852
38 693
124
0
45
0
271
56
21
1080
10
0
7
0
21
11
31
96
88
4
15
0
23
32
13
251
1794
375
1066
2
952
423
399
12 080
260
750
1250
9
427
261
246
5909
2508
407
1086
2
841
478
502
11 690
914
119
195
0
279
143
125
3779
17
9
15
0
27
7
5
289
2
2
1
0
4
0
0
83
Food products/food poisoning
Foreign bodies/toys/miscellaneous
Ash
574
Bubble blowing solution
4939
Charcoal
630
Christmas ornament
920
Coin
3905
Desiccant
44 604
Feces/urine
6457
Glass
2302
Glow product
10 368
Incense, punk
261
Soil
2591
Thermometers
Mercury
7651
Other
1895
Unknown
17
Toy
13 796
Other
20 382
Unknown
719
Category total
122 011
Fumes/gases/vapors
Carbon dioxide
Carbon monoxide
Chloramine
Chlorine: acid mixed with
hypochlorite
Chlorine: other
Hydrogen sulfide
Methane and natural gas
Polymer fume fever
Propane/simple asphyxiant
Other
Unknown
Category total
(continued on next page)
642
W.A. Watson et al.
Table 22A continued
No. of
Exposures
Age
b6
6-19
Reason
N19
Unint
Int
Other
Adv
Rxn
Treated
in Health
Care
Facility
Outcome
None
Minor
Moderate Major Death
Heavy metals
Aluminum
Arsenic (excluding pesticide)
Barium
Cadmium
Copper
Fireplace flame colors
Gold
Lead
Manganese
Mercury: elemental
Mercury: other/unknown
Metal fume fever
Selenium
Thallium
Other
Unknown
Category total
1000
989
26
70
1002
27
1
3154
85
2818
211
729
135
20
2657
44
12 968
518
172
2
3
184
20
0
1505
6
344
70
20
47
2
859
8
3760
102
77
14
3
332
3
0
477
14
655
12
57
10
0
318
8
2082
367
720
10
64
480
4
1
1110
65
1425
126
644
77
17
1426
28
6564
941
688
22
53
926
27
1
2975
74
2582
181
721
111
7
2286
33
11 628
14
19
2
1
39
0
0
47
2
89
7
1
5
2
175
1
404
28
137
0
3
11
0
0
60
2
36
6
1
1
2
36
5
328
9
19
1
1
19
0
0
13
5
58
10
6
15
6
141
3
306
109
479
9
41
296
2
0
1168
45
582
65
224
38
11
738
18
3825
126
138
3
11
123
7
0
690
5
705
47
26
26
1
517
5
2430
71
85
9
3
338
4
0
244
15
108
20
208
21
1
325
3
1455
25
59
2
9
58
0
0
83
8
33
9
96
7
2
139
1
531
0
7
0
2
4
0
0
11
1
5
0
0
1
1
17
0
49
0
2
0
0
2
0
0
1
0
0
0
0
0
0
1
0
6
Hydrocarbons
Benzene
Carbon tetrachloride
Diesel fuel
Fluorochlorocarbon/propellant
Gasoline
Halogenated hydrocarbon: other
Kerosene
Lamp oil
Lighter fluid/naphtha
Lubricating oil/motor oil
Mineral seal oil
Mineral spirits/varsol
Toluene/xylene
Turpentine
Other
Unknown
Category total
107
36
1949
6868
20 103
640
2040
2907
3421
6119
64
2835
1620
710
4454
893
54 766
6
6
346
506
5002
135
1039
2397
1705
3874
42
983
260
217
2212
353
19 083
5
1
194
1419
3428
84
233
119
362
485
6
318
143
118
504
117
7536
91
29
1391
4851
11 503
416
748
375
1331
1723
16
1504
1160
372
1669
410
27 589
105
35
1875
6103
18 828
593
1952
2844
3170
5921
63
2635
1500
595
4180
794
51193
0
0
55
647
1095
20
61
45
179
106
1
130
87
90
149
74
2739
1
1
13
53
96
13
14
14
48
58
0
28
6
12
49
16
422
0
0
3
42
39
10
11
2
19
19
0
31
23
6
69
6
280
63
18
410
1574
3069
233
608
950
1040
964
12
858
707
197
1262
304
12 269
26
13
263
1218
2973
71
421
900
800
2027
22
498
208
133
1008
187
10 768
20
3
610
1463
7505
230
569
728
943
1044
11
845
532
171
968
244
15 886
12
1
87
456
605
57
133
273
199
138
1
186
147
31
306
75
2707
2
1
3
23
21
3
3
24
15
6
0
7
18
9
13
7
155
0
0
0
5
2
0
0
0
0
0
0
0
0
2
0
0
9
Lacrimators
Capsicum defense spray
Lacrimator: CN
Lacrimator: CS
Other
Unknown
Category total
5072
1444
64
95
214
6889
873
242
14
13
24
1166
1674
480
15
5
59
2233
2431
682
30
76
101
3320
4099
1037
56
95
142
5429
189
78
3
0
8
278
582
261
4
0
33
880
93
19
0
0
1
113
980
295
22
27
81
1405
107
36
4
4
1
152
2493
680
27
22
103
3325
201
94
6
7
4
312
4
1
0
0
2
7
0
0
0
0
0
0
Matches/Fireworks/Explosives
Explosive
Firework
Match
Other
Unknown
Category total
377
594
1044
28
5
2048
204
473
968
17
1
1663
99
77
29
2
2
209
68
41
41
8
2
160
344
576
1027
27
4
1978
23
9
12
0
1
45
8
4
2
0
0
14
0
2
0
0
0
2
83
64
26
5
2
180
102
179
237
5
0
523
55
45
15
4
4
123
16
10
3
2
0
31
0
1
0
0
0
1
0
0
0
0
0
0
Mushrooms
Coprine
Cyclopeptide
Gastrointestinal irritant
Hallucinogenic
Ibotenic acid
Miscellaneous, nontoxic
Monomethylhydrazine
Muscarine
Orellanine
Other potentially toxic
Unknown
Category total
12
50
158
994
44
228
52
36
3
25
6999
8601
6
4
74
48
4
94
2
8
0
10
4697
4947
1
8
35
563
9
25
4
5
1
7
1159
1817
5
38
49
365
31
108
45
23
2
7
1106
1779
11
31
131
158
32
193
43
23
2
14
6068
6706
0
18
20
816
11
7
4
6
1
8
834
1725
0
0
0
10
0
2
0
0
0
1
6
19
1
1
7
2
1
26
5
7
0
2
75
127
4
45
70
730
25
61
24
18
3
15
2494
3489
5
7
52
70
9
57
14
5
0
9
3541
3769
2
7
54
162
12
53
21
7
0
5
771
1094
3
18
15
420
17
12
7
4
2
4
346
848
0
6
0
22
1
0
0
1
0
0
29
59
0
3
0
0
1
0
0
0
0
0
1
5
2004 AAPCC Annual Report
643
Table 22A continued
No. of
Exposures
Paints and stripping agents
Paints
Antialgae
Anticorrosion
Oil-based
Water-based
Stains
Stripping agents
Methylene chloride
Other
Unknown
Varnish, lacquer
Other paint/varnish/lacquer
Unknown paint/varnish/lacquer
Category total
Age
b6
6-19
Reason
N19
Unint
Int
Other
Adv
Rxn
Treated
in Health
Care
Facility
Outcome
None
Minor
Moderate Major Death
37
61
3642
6966
935
3
9
1024
5330
359
6
6
662
445
81
27
45
1909
1157
483
37
57
3403
6850
905
0
2
167
42
9
0
0
9
15
1
0
2
59
56
20
9
18
646
457
127
9
6
481
1120
168
8
18
904
499
173
4
5
168
60
33
0
1
12
5
1
0
0
1
0
0
1097
912
125
1777
778
7354
23 684
156
177
16
510
304
4505
12 393
111
57
13
178
62
586
2207
826
669
93
1064
391
2204
8868
1046
879
120
1707
729
7110
22 843
21
14
3
34
17
118
427
2
4
0
5
4
25
65
26
12
2
25
26
87
315
363
401
67
352
160
910
3510
71
80
6
239
106
1205
3491
369
254
40
424
141
730
3560
122
118
19
102
60
146
837
7
5
0
4
4
9
48
0
0
0
0
0
0
1
4
0
0
0
0
1
11
2
0
0
0
1
0
2
6
1
0
0
0
3
17
61
13
0
1
8
64
166
26
16
2
1
18
36
147
39
9
0
3
7
54
148
10
3
0
0
4
7
42
1
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
1
0
2
0
0
0
4
0
1
1
0
0
2
1
0
60
2
10
49
20
16
15
0
0
35
7
9
23
0
9
47
18
13
23
1
1
5
3
6
0
0
0
0
1
0
0
0
0
0
0
0
0
1
39
5
59
4
1
4
5
15
8
0
1
16
0
18
0
0
2
0
6
12
0
3
68
8
193
1
0
17
0
42
20
5
17
453
54
788
36
1
100
20
442
112
3
17
453
76
1024
5
0
67
14
234
47
1
14
491
49
1154
13
1
101
16
356
89
2
4
93
13
91
10
0
16
3
79
24
0
0
3
0
6
2
0
0
0
2
1
0
0
2
0
1
0
0
0
0
0
0
4
43
94
23
1
17
26
8
0
10
37
6
24
267
604
92
111
952
533
95
6
126
435
152
1
22
127
17
1
1
11
2
0
0
0
0
36
7
5
1
61
12
302
42
227
63
161
75
43
10
6
3
0
0
0
4
0
178
2
0
1
6
0
35
2
0
3
1
0
149
1
0
14
46
1
1525
13
3
19
57
0
1229
20
1
6
29
3
1250
19
2
5
3
1
297
8
1
0
0
0
56
0
0
0
0
0
3
0
0
20
6
20
212
190
291
51
0
0
0
0
0
0
0
0
0
0
0
0
7
0
0
0
2
0
23
0
0
74
11
1
30
10
0
103
19
0
22
3
0
0
1
0
0
0
Pesticides
Fungicides (nonmedicinal)
Carbamate
170
45
11
111
158
Copper compound
60
8
6
46
59
Mercurial
2
1
1
0
2
Nonmercurial
8
2
0
6
8
Phthalimide
96
52
13
30
95
Wood preservative
312
56
14
237
307
Other/unknown
753
173
57
514
723
Fumigants
Aluminum phosphide
95
2
8
84
94
Metam sodium
2
0
0
2
2
Methyl bromide
12
0
0
12
12
Sulfuryl fluoride
330
59
48
221
323
Other
61
8
7
44
60
Unknown
79
11
8
59
76
Herbicides (includes algicides, defoliants, desiccants, and plant growth regulators)
Carbamate
11
2
2
6
11
2,4-D or 2,4,5-T
89
33
3
51
84
Chlorophenoxy
2339
669
212
1421
2214
Diquat
263
73
27
160
250
Glyphosate
4425
1162
360
2872
4146
Paraquat
57
2
3
51
50
Paraquat/diquat
2
0
0
2
1
Triazine
474
101
37
333
451
Urea
75
25
9
40
70
Other
1567
366
140
1027
1499
Unknown
421
110
51
252
378
Insecticides (includes insect growth regulators, molluscicides, and nematicides)
Arsenic pesticide
344
251
14
76
339
Borate/boric acid
3592
2980
122
474
3520
Carbamate only
2935
1233
282
1389
2768
Carbamate with other
697
152
69
470
659
insecticide
Chlorinated hydrocarbon only
897
350
128
414
795
Chlorinated hydrocarbon
331
147
34
146
311
with other insecticide
Insect growth regulator
100
49
16
34
96
Metaldehyde
255
105
15
132
244
Nicotine
7
4
0
3
7
Organophosphate
5874
1746
566
3491
5484
Organophosphate/carbamate
112
33
9
69
107
Organophosphate/
6
1
1
4
6
chlorinated hydrocarbon
Organophosphate/other
1186
221
111
840
1140
insecticide
Organophosphate/carbamate/
3
0
0
3
3
chlorinated hydrocarbon
Piperonyl butoxide only
1
0
0
1
1
Piperonyl butoxide/pyrethrin
321
110
33
175
290
Pyrethrins only
122
31
6
85
120
(continued on next page)
644
W.A. Watson et al.
Table 22A continued
No. of
Exposures
Insecticides (includes insect growth regulators,
Pyrethrin
5512
Pyrethroid
18 214
Rotenone
103
Veterinary insecticide
234
Other
9246
Unknown
3886
Repellents
Bird, dog, deer, or other
492
mammal repellent
Insect repellent with DEET
10 917
Insect repellent without
2064
DEET
Insect repellent: unknown
120
Naphthalene
1678
Paradichlorobenzene
143
Other moth repellent
4
Unknown moth repellent
2223
Rodenticides
a-Naphthylthiourea
2
Anticoagulant: warfarin type
337
Anticoagulant: long-acting,
16 054
superwarfarin
Bromethalin
643
Cholecalciferol
6
Monofluoroacetate
2
Strychnine
121
Vacor
5
Zinc phosphide
94
Other
772
Unknown
1396
Category total
102 754
Photographic products
Developer/fixing/stop bath
Photographic coating fluid
Other
Unknown
Category total
Plants
Amygdalin/cyanogenic glycoside
Anticholinergic
Cardiac glycoside
Colchicine
Depressant
Dermatitis
Gastrointestinal irritant
Hallucinogenic
Nicotine
Nontoxic
Oxalate
Solanine
Stimulant
Toxalbumin
Other toxic
Unknown toxic or unknown
if toxic
Category total
Polishes and waxes
Radioisotopes
Age
6-19
b6
Reason
N19
Unint
molluscicides, and nematicides)
1936
663
2857
5076
5310
1951 10 760
16 869
21
10
69
96
71
27
135
224
4863
791
3487
8897
1059
406
2343
3494
Int
Other
Adv
Rxn
Treated
in Health
Care
Facility
Outcome
None
Minor
Moderate Major Death
144
495
1
3
114
135
22
122
0
0
30
108
260
696
6
7
188
123
947
3094
16
31
926
987
934
2925
13
39
1957
540
1240
4308
31
51
998
728
237
747
9
9
153
214
6
30
2
0
10
15
1
0
0
0
0
0
168
99
222
473
6
3
10
44
91
122
7
0
0
7485
1598
1742
201
1632
246
10 342
1990
96
27
73
2
399
44
821
131
1741
388
3365
343
184
21
12
0
0
0
72
1231
113
3
1335
9
113
7
0
167
36
314
23
1
695
112
1651
143
4
2134
1
21
0
0
54
1
0
0
0
12
6
4
0
0
17
12
377
13
0
372
16
675
51
0
627
28
117
12
1
209
5
20
1
0
29
0
1
0
0
2
0
0
0
0
0
0
292
14 229
2
12
434
0
25
1313
1
319
15 334
1
16
570
0
0
89
0
0
23
0
102
4576
0
124
5087
1
2
204
0
2
96
0
0
23
0
0
1
510
6
0
6
3
30
569
891
52 174
23
0
1
13
1
5
69
76
9.245
96
0
1
97
1
54
127
407
40 328
596
6
1
49
5
81
745
1134
96 739
37
0
1
28
0
13
16
165
2522
6
0
0
29
0
0
3
76
751
2
0
0
0
0
0
5
2
2498
188
3
1
65
4
33
77
620
19 168
225
1
0
11
2
24
215
389
21 865
12
0
0
11
1
16
40
65
17 237
7
0
1
13
0
4
7
36
2853
3
0
0
6
0
1
4
6
219
0
0
0
0
0
0
0
0
8
394
6
857
13
1270
30
5
472
6
513
139
0
88
4
231
220
1
292
3
516
386
6
835
13
1240
0
0
21
0
21
2
0
0
0
2
6
0
1
0
7
122
1
110
6
239
33
0
156
2
191
149
2
162
4
317
37
0
64
1
102
0
0
0
0
0
0
0
0
0
0
2842
1058
1461
22
353
9610
13 037
436
126
13 559
10 258
1255
137
254
5008
15 395
1851
407
849
16
215
5400
10 092
144
50
10 932
8767
936
42
91
3634
11 652
522
436
253
0
42
1345
1260
169
31
1300
894
124
36
34
723
1904
444
206
349
6
92
2799
1600
114
43
1211
573
189
58
119
619
1721
2703
583
1356
21
265
9030
12 419
238
117
12 963
10 047
1189
115
198
4736
14 826
68
456
87
0
70
191
343
184
5
178
171
33
18
22
141
310
4
8
4
0
3
13
22
5
0
29
10
4
0
22
5
21
65
4
7
1
10
356
243
8
4
367
23
27
4
3
115
223
124
537
243
1
64
747
920
172
57
453
364
159
38
95
446
1008
636
203
440
5
60
1267
2772
76
31
1718
2576
418
34
78
1226
3442
112
97
113
3
33
1078
1015
60
32
657
1299
105
26
44
359
1245
14
320
23
0
18
307
199
86
18
103
61
16
7
11
93
166
1
29
1
0
4
6
8
3
2
5
1
4
0
0
6
10
0
1
0
0
0
0
0
2
0
1
0
0
0
1
0
0
74 811
55 078
9073
10 143
70 806
2277
150
1460
5428
14 982
6278
1442
80
5
9601
7823
507
1237
9358
149
29
56
1050
3055
1451
138
12
0
333
19
59
247
302
4
6
17
91
37
46
23
0
0
2004 AAPCC Annual Report
645
Table 22A continued
No. of
Exposures
Sporting equipment
Fishing bait
Fishing product: other
Golf ball
Gun bluing
Hunting product: other
Other
Unknown
Category total
Swimming pool/aquarium
Tobacco products
Weapons of mass destruction
Anthrax
Other biologic weapon
Nerve gas
Other chemical weapon
Suspicious powder in
envelope/package
Other suspicious powder
Other suspicious substance
Category total
Other/unknown nondrug
substances
Total no. of
nonpharmaceuticals
% of nonpharmaceuticals
% of all substances
Table 22B
Age
Reason
6-19
b6
N19
Unint
Int
Other
Treated
in Health
Care
Facility
Adv
Rxn
Outcome
None
Minor
Moderate Major Death
65
21
22
70
369
40
2
589
41
13
4
42
176
29
2
307
17
4
9
7
88
6
0
131
7
4
9
21
101
5
0
147
61
18
17
68
324
38
2
528
3
1
5
1
25
0
0
35
1
1
0
1
8
1
0
12
0
1
0
0
6
1
0
8
5
3
5
35
122
5
0
175
18
8
3
26
100
14
1
170
4
0
6
15
37
5
1
68
0
0
3
6
7
1
0
17
0
0
0
0
2
0
0
2
0
0
0
0
0
0
0
0
11 572
4667
2142
4659
11 036
141
29
357
2070
1800
3514
718
14
3
7671
6656
230
770
7238
306
43
63
1532
2693
1596
201
9
0
31
54
3
119
123
1
16
0
0
3
1
9
0
4
2
29
29
3
110
115
15
49
2
113
22
0
0
0
2
0
14
2
1
2
97
1
2
0
0
1
13
13
1
68
18
4
9
0
29
71
5
4
0
31
13
0
1
0
20
1
0
0
0
0
0
0
0
0
0
0
43
11
384
2
0
22
2
2
20
37
9
332
16
0
217
1
0
3
17
7
140
0
0
4
15
3
131
7
9
129
3
2
58
0
0
22
1
0
1
0
0
0
24 399
10 469
3937
9496
20 139
623
2023
949
4580
3776
3784
1082
86
5
1 387 769
715 976
174 041 483 990 1 276 973 74 810 11 422 20 312
230 822
232 133 250 036
56 404
4734
372
50.0%
51.6%
25.8%
4.1%
2.0%
0.3%
0.2%
0.0%
0.0%
12.5%
6.3%
34.9%
17.4%
92.0%
46.0%
5.4%
2.7%
0.8%
0.4%
1.5%
0.7%
16.6%
8.3%
16.7%
8.4%
18.0%
9.0%
Demographic profile of exposure cases by generic category of substances and products: pharmaceuticals
No. of
Exposures
Analgesics
Acetaminophen only
Adult formulation
32 395
Pediatric formulation
21 538
Unknown formulation
8609
Acetaminophen in combination with:
Aspirin with other
6525
ingredient
Aspirin without other
397
ingredient
Codeine
5496
Hydrocodone
22 594
Oxycodone
6949
Propoxyphene
6089
Other opioid
456
Other drug: adult
22 032
formulation
Other drug: pediatric
45
formulation
Aspirin alone
Adult formulation
7031
Pediatric formulation
1039
Unknown formulation
10 111
Age
Reason
Other
Treated
in Health
Care
Facility
Adv
Rxn
Outcome
6-19
N19
Unint
Int
7734
19 590
2035
10 263
1629
2360
14 177
267
4117
15 852
21 058
3514
15 930
353
4817
20
5
8
409
100
103
18 762
2809
5699
8819
5128
2073
4906
350
1454
2559
93
1132
624
18
382
70
2
78
2070
1827
2586
3338
2907
0
255
3272
1605
1328
486
25
4
127
77
191
220
155
1
16
166
81
60
40
9
0
1018
2035
805
689
45
3121
1155
3285
808
816
61
5162
3273
16 862
5169
4505
348
13 528
2235
7517
2513
2229
128
7289
2746
13 341
3724
3494
299
13 886
6
13
5
3
0
7
443
1330
539
278
19
680
3164
13 622
3598
3811
313
14 321
1233
4200
1428
1327
63
4582
1385
5312
1459
1520
138
5476
559
2868
833
792
64
3025
111
751
228
198
14
530
12
86
16
32
0
27
38
6
1
45
0
0
0
6
11
2
2
0
0
2209
715
2051
1834
148
2941
2941
175
5020
3623
887
3722
3190
120
6020
6
2
8
175
26
215
3895
302
7043
1955
413
2270
1147
65
2084
926
29
1850
88
1
310
17
0
37
b6
None
Minor
Moderate
Major
Death
(continued on next page)
646
W.A. Watson et al.
Table 22B continued
No. of
Exposures
Age
Reason
6-19
b6
Analgesics
Aspirin in combination with:
Carisoprodol
397
18
Codeine
243
32
Oxycodone
144
11
Propoxyphene
39
5
Other opioid
73
7
Other drug: adult
1447
308
formulation
Other drug: pediatric
2
2
formulation
Nonaspirin salicylate
952
508
Opioids
Codeine
1281
467
Meperidine
444
43
Methadone
3965
260
Morphine
3097
270
Oxycodone
5510
494
Pentazocine
175
18
Propoxyphene
417
37
Tramadol
3769
439
Other/unknown
6974
964
Other nonsteroidal anti-inflammatory drugs
Colchicine
310
78
Cox-2 inhibitor
5834
2184
Other nonsteroidal anti-inflammatory drugs
Ibuprofen
70 916 41 498
Ibuprofen with
60
5
hydrocodone
Indomethacin
709
173
Ketoprofen
377
163
Naproxen
14 273
3247
Other
5133
1453
Unknown
13
7
Phenacetin
1
0
Phenazopyridine
1597
1113
Salicylamide
14
9
Other
237
120
Unknown
246
22
Category total
279 955 98 237
Unint
N19
Int
Other
Treated
in Health
Care
Facility
Adv
Rxn
Outcome
None
Minor
Moderate
Major
Death
39
34
17
7
6
224
334
172
111
27
57
906
81
70
45
20
21
674
299
156
85
14
40
678
0
0
0
0
0
0
5
10
12
5
12
73
326
164
83
19
46
792
49
45
18
6
10
321
126
57
28
7
15
313
83
45
23
3
8
178
23
11
5
3
4
33
1
1
2
0
0
2
0
0
2
0
0
0
2
1
0
0
0
0
121
316
727
184
0
35
296
244
136
57
7
0
291
56
404
297
641
29
45
449
758
506
335
3209
2463
4254
125
330
2843
5178
802
170
1045
1216
1951
62
116
1295
2580
370
210
2437
1483
3007
92
261
2071
3253
0
1
15
9
14
0
0
2
18
98
58
244
288
327
16
27
324
897
468
248
2817
1732
3269
102
291
2463
4071
282
54
398
459
863
30
54
805
983
215
97
798
536
1200
53
84
840
1425
87
75
967
572
853
21
92
629
1312
11
17
425
173
313
1
31
161
534
4
5
96
18
43
0
8
6
43
22
572
209
3048
217
3921
47
1437
1
2
42
438
159
2101
80
1595
52
666
36
436
10
83
4
6
13 949
9
15 110
44
51169
26
18 297
28
31
0
1219
6
20 043
24
17 900
8
6484
19
2216
5
292
0
13
0
449
363
139
259
7310
7105
2989
3259
3
8
0
1
325
1330
5
12
86
183
143
46
124 186 152 946
251
102
6148
1532
4
0
157
1
34
181
113 841
0
87
0
15
6
934
1
297
0
1
0
0
3
101
0
1
0
17
0
14
187 10 191
325
108
6377
1977
7
0
442
4
54
175
129 768
163
102
3508
1268
4
0
577
2
65
32
65 114
141
46
2479
744
3
0
195
2
28
72
43 547
58
13
890
371
0
0
58
1
14
32
24 393
11
3
137
85
0
0
19
0
1
3
5685
3
1
10
8
0
0
2
0
0
1
658
78
71
3592
658
3
1
156
0
28
75
55 004
Anesthetics
Inhalation anesthetics
Nitrous oxide
Other
Ketamine and analogs
Local/topical anesthetics
Dibucaine
Lidocaine
Other/unknown
Other
Unknown
Category total
199
140
180
30
10
14
63
18
45
105
110
119
90
109
39
75
21
109
1
4
12
32
5
11
85
65
138
13
11
14
43
45
41
23
16
59
6
2
15
0
3
0
49
1903
6714
25
10
9220
38
844
4801
11
2
5750
2
282
536
1
0
947
9
762
1355
13
7
2480
48
1615
6192
17
4
8114
1
121
163
2
0
492
0
10
22
0
0
49
0
148
317
6
6
525
7
479
880
11
4
1669
22
434
2171
9
2
2676
0
284
714
2
1
1130
1
124
139
3
1
366
0
16
23
2
0
64
0
0
0
1
0
4
Anticholinergic drugs
3970
415
340
3181
2656
1026
3
228
1593
826
550
546
115
10
14
0
0
13
10
0
0
4
12
5
2
1
1
0
198
2732
26
828
7
104
162
1785
124
2145
29
400
1
4
41
154
111
1071
42
691
12
162
42
276
7
68
0
2
1842
38
22
4846
453
14
12
1333
40
1
1
153
1345
22
7
3334
1557
30
15
3881
187
3
4
623
1
0
1
7
89
5
1
294
554
23
10
1781
570
12
5
1325
131
2
2
311
115
4
2
440
20
0
0
96
4
0
0
6
Anticoagulants
Glycoprotein IIb/IIIa
inhibitor
Heparin
Warfarin (excluding
rodenticide)
Other antiplatelet
Other
Unknown
Category total
2004 AAPCC Annual Report
647
Table 22B continued
No. of
Exposures
Anticonvulsants
Carbamazepine
Phenytoin
Primidone
Succinimide
Valproic acid
Other
Unknown
Category total
Antidepressants
Cyclic antidepressants
Amitriptyline
Amoxapine
Desipramine
Doxepin
Imipramine
Maprotiline
Nortriptyline
Protriptyline
Other cyclic antidepressant
Unknown cyclic
antidepressant
Cyclic antidepressant
formulated with a
benzodiazepine
Cyclic antidepressant
formulated with a
phenothiazine
Lithium
MAO inhibitor
SSRI
Trazodone
Other
Unknown
Category total
Antihistamines
Diphenhydramine:
unknown if OTC or Rx
Diphenhydramine: Rx
Diphenhydramine: OTC
H-2 receptor antagonist
Other
Category total
Antimicrobials
Antibiotics
Systemic
Topical
Unknown
Antifungals
Systemic
Topical
Unknown
Anthelmintics
Diethylcarbamazine
Piperazine
Other
Unknown
Antiparasitics
Antimalarial
Metronidazole
Other
Age
Reason
6-19
b6
N19
Unint
Int
Other
Treated
in Health
Care
Facility
Adv
Rxn
Outcome
None
Minor
Moderate
Major
Death
4845
4059
323
80
9069
21 629
16
40 021
1157
542
37
46
922
2985
2
5691
846
250
25
19
2045
4353
2
7540
2820
3236
261
15
6039
14 172
12
26 555
2918
2032
216
74
3685
9533
4
18 462
1602
1477
80
4
4742
10 663
12
18 580
0
2
0
0
10
8
0
20
243
434
20
2
478
1167
0
2344
2961
2721
146
21
6018
13 618
13
25 498
920
807
60
25
1975
4417
3
8207
1226
948
64
10
2162
5346
5
9761
860
751
41
0
1519
3581
2
6754
232
119
4
0
366
1000
1
1722
4
7
1
0
24
45
0
81
7430
22
185
1288
819
14
1152
26
1117
35
823
2
40
77
191
2
119
5
71
2
857
4
17
122
230
0
174
3
163
7
5683
16
127
1082
393
12
845
18
871
26
2186
5
89
335
420
5
417
9
360
3
4865
15
81
885
344
9
647
15
660
25
8
0
0
0
1
0
2
0
1
0
219
0
12
46
43
0
64
2
32
1
5792
16
124
1021
527
9
826
20
850
34
960
4
43
145
199
4
221
6
137
2
1700
6
28
334
161
1
217
1
239
9
2065
5
40
328
142
3
245
5
318
10
803
4
15
158
41
3
82
3
169
4
51
1
1
8
3
0
6
0
11
3
64
5
8
51
22
39
0
1
47
7
21
16
2
1
118
18
8
92
40
74
0
2
83
17
31
25
8
1
5474
260
48 204
12 227
24 635
85
103 155
304
32
8187
711
3404
5
13 998
936
5
11 680
1906
4658
17
20 795
4185
220
27 954
9468
16 378
58
67 479
1800
153
18 567
2827
9498
13
36 749
2772
64
27 222
8951
13 816
64
60 548
3
0
36
10
12
1
74
724
39
1917
328
1032
5
4467
4283
145
31181
9567
17 247
56
71 828
897
66
12 460
2178
5406
10
22 762
1278
33
10 922
3941
5587
14
24 523
1482
60
6761
2334
4748
12
18 599
286
12
1426
436
1467
1
4920
9
1
103
14
86
0
299
28 100
12 052
5119
10 755
17 347
9872
20
719
11 297
5535
5029
3262
431
28
10
1391
8659
34 602
72 762
3
413
5750
16 183
34 401
1
222
705
7883
13 930
6
750
2181
10 387
24 079
5
624
7379
25 525
50 880
3
735
1023
7717
19 350
0
0
2
17
39
2
29
232
1150
2132
8
744
1724
10 725
24 498
1
247
2468
8821
17 072
4
290
630
4419
10 372
2
199
291
2391
6145
0
23
53
397
904
0
2
3
22
55
38 536
7344
516
17 478
5460
147
6306
470
99
14 512
1378
266
28 346
7093
274
4791
62
132
24
3
0
5218
177
106
7775
250
162
6816
1259
57
4080
425
102
1543
50
38
216
4
3
9
0
0
1524
8979
13
747
6890
6
206
372
0
562
1678
7
1192
8651
13
124
73
0
0
8
0
202
236
0
340
495
3
341
1567
3
136
641
1
64
55
1
11
1
0
1
0
0
73
449
1266
12
38
332
782
7
6
47
120
2
27
68
353
3
67
427
1196
11
4
18
28
1
1
2
1
0
0
1
40
0
6
61
125
1
17
161
349
1
3
18
99
0
0
7
11
0
0
0
3
0
0
0
0
0
971
1637
33
258
401
13
98
189
5
611
1038
15
678
991
25
186
304
3
1
0
0
98
334
5
446
411
12
254
251
12
138
254
4
122
71
1
25
9
0
2
1
0
(continued on next page)
648
W.A. Watson et al.
Table 22B continued
No. of
Exposures
Antimicrobials
Antituberculars
Isoniazid
Rifampin
Other
Unknown
Antivirals
Amantadine
Anti-influenza agent:
other
Antiretroviral
Systemic
Topical
Unknown
Other
Unknown
Category total
Antineoplastics
Asthma therapies
Albuterol
Aminophylline/
theophylline
Terbutaline and other b 2
agonist
Other b agonist
Leukotriene antagonist/
inhibitor
Other
Unknown
Category total
Cardiovascular drugs
ACE inhibitor
a-blocker
Angiotensin receptor
blocker
Antiarrhythmic: other
Antihyperlipidemic
Antihypertensive
b-blocker
Calcium antagonist
Cardiac glycoside
Clonidine
Hydralazine
Long-acting nitrate
Nitroglycerin
Nitroprusside
Vasodilator: other/
unknown
Vasopressor
Other
Unknown
Category total
Cold and cough
preparations
Diagnostic agents
Age
6-19
b6
Reason
N19
Unint
Int
Other
Adv
Rxn
Treated
in Health
Care
Facility
Outcome
None
Minor
Moderate
Major
Death
401
82
25
1
60
27
4
0
147
15
4
0
192
39
17
1
165
61
14
0
188
9
2
1
0
0
0
0
43
12
9
0
289
25
10
1
85
17
3
1
40
10
3
0
68
3
5
0
92
3
2
0
2
1
0
0
272
93
77
30
36
14
157
49
176
65
62
21
0
0
27
7
135
33
62
24
41
13
40
7
12
1
0
0
832
1232
192
170
99
16
64 768
151
411
86
49
74
0
33 528
41
150
18
19
3
3
8370
633
654
84
100
22
13
22 479
432
907
176
112
91
8
51171
337
191
5
35
2
5
6584
0
1
1
0
0
0
42
58
123
10
21
6
3
6736
464
306
10
52
13
7
11 432
227
295
25
38
26
3
11 894
117
123
24
19
7
4
6302
86
62
0
12
2
3
2251
18
8
0
1
0
0
409
2
0
0
0
0
0
18
1459
324
111
999
1119
98
1
230
562
349
154
119
36
3
7239
757
5384
106
997
61
829
588
6496
516
391
152
16
0
315
72
1182
413
1879
164
890
114
393
158
10
28
3
3
3254
1361
559
1322
3002
107
2
138
354
746
227
95
4
1
773
11 929
132
9283
262
1739
372
876
714
11 336
27
477
0
1
30
97
304
1367
81
3188
327
373
96
96
0
26
0
1
359
10
24 321
124
1
16 391
38
3
3659
196
5
4188
285
5
22 354
47
4
1205
1
0
20
23
0
675
98
3
3721
78
0
6136
48
0
1979
32
3
873
3
0
71
0
0
8
12 021
1657
5475
3896
377
1533
659
64
263
7421
1209
3665
9609
1319
4593
1978
227
712
8
3
1
386
99
158
4409
686
1915
4088
511
1991
916
187
434
1046
204
362
210
23
68
17
2
3
1199
9831
1544
17 057
10 513
2891
5802
245
1293
1570
37
1402
216
3672
555
4077
2378
677
1888
59
284
921
7
445
33
507
422
1161
483
93
1695
16
33
79
1
116
943
5611
561
11 754
7613
2112
2195
169
975
563
29
829
1041
8209
1262
12 853
8284
2245
3970
208
1115
1277
15
962
91
1094
228
3595
1874
240
1599
30
138
251
0
274
1
3
1
3
3
2
10
0
0
3
0
21
63
481
46
509
305
338
164
7
36
31
22
131
453
2589
717
8186
5202
1464
3659
109
482
558
34
540
450
2655
564
6216
3853
847
1295
78
472
703
8
433
78
659
214
1408
893
190
1284
31
123
117
2
152
90
517
143
1986
1243
524
1308
25
134
105
13
132
28
112
17
481
356
147
210
0
24
13
2
15
7
11
0
25
62
17
12
0
3
1
0
2
1502
34
72
74 145
205
4
22
21 216
546
0
2
6173
743
30
48
46 470
1439
27
43
58 471
34
3
23
12 391
0
0
0
59
23
4
4
2807
762
18
45
31 828
85
8
17
24 274
692
5
4
7389
209
4
10
8055
5
2
0
1713
0
0
0
162
108 814
67 494
22 302
18 673
88 595
16 655
74
3144
25 042
24 924
15 323
5376
387
30
662
122
51
475
520
13
2
123
292
128
122
54
9
0
63
316
53
73
101
212
112
431
39
71
3
1
58
91
92
151
25
134
27
62
26
27
4
9
0
0
Dietary supplements/herbals/homeopathic
Amino acids
Creatine
217
Other amino acid
607
dietary supplement
2004 AAPCC Annual Report
649
Table 22B continued
No. of
Exposures
Cultural medicines
Ayurvedic
Asian
Hispanic
Other
Botanical products
Blue cohosh
Ginkgo biloba
Echinacea
Ginseng
Kava kava
Ma huang/ephedra
(single ingredient)
Citrus aurantium
(single ingredient)
St John’s wort
Valerian
Yohimbe
Multibotanical with
ma huang
Multibotanical without
ma huang or Citrus
aurantium
Multibotanical with
Citrus aurantium
Other single-ingredient
botanical
Homeopathic
Hormonal products
Androgen/precursor
(dietary supplement)
Phytoestrogen
Glandular
Melatonin
Other dietary supplements
Blue-green algae
Glucosamine (with or
without chondroitin)
Other single-ingredient
nonbotanical
Unknown supplement/
homeopathic
Category total
Diuretics
Furosemide
Thiazide
Other
Unknown
Category total
Electrolytes and minerals
Calcium
Chromium, trivalent
Colloidal silver
Fluoride
Iron
Magnesium
Potassium
Selenium
Sodium
Vanadium
Zinc
Multimineral dietary
supplement
Age
Reason
6-19
b6
Unint
N19
Int
Other
Treated
in Health
Care
Facility
Adv
Rxn
Outcome
None
Minor
Moderate
Major
Death
10
111
11
29
5
44
5
12
1
16
2
1
4
51
4
16
7
77
5
15
2
15
2
3
0
0
2
1
0
18
2
10
3
58
11
15
1
17
1
5
1
26
4
5
0
10
0
6
1
6
0
0
0
0
0
0
2
209
573
295
82
1293
1
98
392
153
19
408
1
24
87
42
9
246
0
87
90
100
54
621
1
143
481
196
33
586
1
27
37
53
39
496
0
0
1
3
2
2
0
34
45
41
8
182
2
60
74
90
48
728
1
36
158
75
16
288
0
33
23
46
9
235
0
13
8
27
10
222
0
1
2
0
2
26
0
0
0
0
0
5
22
6
3
13
11
3
0
8
15
0
2
6
0
0
226
288
191
3934
106
64
34
1201
27
44
15
1080
90
176
142
1629
143
136
72
1782
49
118
47
1612
2
0
3
7
31
31
67
504
80
150
113
2233
49
58
26
842
33
54
32
902
18
31
40
638
1
3
9
51
0
0
0
2
2535
1091
374
1058
1468
486
7
556
1020
560
527
249
20
0
489
114
141
227
189
211
0
84
305
79
151
77
4
0
2192
1156
200
817
1651
196
2
331
545
456
270
112
13
2
6403
5784
197
403
6063
159
5
170
489
1725
218
52
5
0
148
72
21
54
92
27
0
26
58
26
16
15
1
0
134
53
1705
60
32
934
6
5
361
68
15
401
96
42
1242
13
5
407
0
0
5
25
6
48
31
6
415
25
13
439
15
2
223
10
1
39
1
0
4
0
0
0
85
811
31
526
21
45
32
237
71
717
0
30
2
1
9
63
13
108
14
199
12
42
3
16
0
0
0
1
724
427
50
246
567
49
2
102
142
149
64
22
3
0
1463
603
240
614
875
269
4
293
615
285
208
157
10
0
24 842
13 757
3385
7562
17 304
4466
55
2843
7670
5702
3242
1835
176
10
3126
4345
1835
87
9393
1035
1425
633
33
3126
155
288
113
6
562
1923
2616
1083
48
5670
2592
3375
1456
53
7476
405
775
260
28
1468
0
5
0
0
5
114
163
104
6
387
1182
1556
627
46
3411
903
1313
549
20
2785
375
421
171
12
979
280
363
143
11
797
67
65
34
3
169
3
12
2
0
17
17 168
690
81
3571
3651
1260
1415
4
3119
2
1022
203
15 420
347
37
3157
2017
438
449
1
1782
2
640
144
731
55
13
300
410
157
64
0
560
0
79
18
982
280
31
110
1190
656
897
3
753
0
296
41
16 774
621
62
3507
2890
968
1188
4
2810
2
921
186
255
29
1
24
586
161
167
0
198
0
34
7
5
3
0
2
5
19
1
0
34
0
0
1
126
33
17
36
160
105
50
0
63
0
65
8
731
139
28
135
1207
220
469
3
428
0
93
38
2979
130
10
774
1015
223
439
1
592
2
184
50
328
51
3
223
449
156
124
1
550
0
101
10
72
32
1
9
142
39
83
1
65
0
9
5
9
3
1
0
15
5
22
0
5
0
2
1
0
0
0
0
1
1
7
0
0
0
0
0
(continued on next page)
650
W.A. Watson et al.
Table 22B continued
No. of
Exposures
Multimineral, multiherbal
dietary supplement
Other
Unknown
Category total
Eye/ear/nose/throat preparations
Nasal preparations
Tetrahydrozoline
Other decongestant
Other
Unknown
Ophthalmic preparations
Contact lens product
Glaucoma therapy
Tetrahydrozoline
Other sympathomimetic
Other
Unknown
Otic preparations
Combination product
Other
Unknown
Steroid, topical for eye/
nose/throat
Throat preparations
Lozenge without
local anesthetic
Lozenge with local
anesthetic
Other
Unknown
Category total
Gastrointestinal preparations
Antacids
Salicylate-containing
Proton pump inhibitor
Other
Antidiarrheals
Diphenoxylate/atropine
Loperamide
Non-opioid
Paregoric
Antispasmodics
Anticholinergic
Other
Laxative
Other
Unknown
Category total
Age
b6
6-19
Reason
Unint
N19
Int
Other
Adv
Rxn
Treated
in Health
Care
Facility
Outcome
None
Minor
Moderate
Major
Death
730
432
78
218
546
118
2
61
210
185
94
31
5
0
51
11
32 978
15
5
24 886
13
0
2478
23
4
5484
42
8
30 529
0
3
1583
0
0
72
8
0
732
13
5
3719
11
2
6597
9
1
2100
1
0
490
0
1
69
0
0
9
59
2216
579
13
41
1039
396
3
5
234
22
3
13
935
160
7
56
2029
561
8
0
51
5
1
1
6
0
3
2
128
13
1
19
273
30
2
24
593
108
4
8
305
77
1
3
37
3
1
0
2
0
0
0
1
0
0
3400
244
1520
799
1335
32
1562
71
962
370
660
8
360
10
191
119
154
3
1461
160
354
301
509
21
3338
207
1296
638
1224
27
25
8
81
48
28
1
8
0
104
45
5
3
29
29
32
59
77
1
628
54
371
179
114
12
363
55
659
258
171
6
841
27
139
89
139
7
154
14
41
16
31
2
1
1
2
2
2
0
0
0
0
1
0
0
2438
2134
51
2575
1172
816
23
1466
279
205
6
455
970
1095
21
646
2401
2110
48
2290
7
9
1
84
1
0
0
13
28
15
2
182
268
258
8
158
456
249
7
471
782
678
25
286
38
57
1
44
1
2
0
0
0
0
0
0
943
759
88
90
891
22
1
29
35
168
38
10
0
0
222
107
47
67
179
23
1
18
23
65
20
4
0
0
405
2
18 967
194
0
9649
87
0
2268
121
2
6933
345
1
17 649
45
1
440
2
0
193
12
0
657
86
0
2518
113
0
3770
58
0
3520
7
0
463
0
0
13
0
0
2
2734
8005
5608
2114
3350
4982
260
623
229
355
3997
386
2433
6358
5430
139
1217
100
2
3
6
151
389
65
281
2086
206
734
2021
991
149
692
116
26
437
19
5
92
3
0
9
0
519
1125
236
27
213
629
170
15
57
110
23
2
245
382
43
10
341
876
205
15
149
167
9
5
0
3
2
1
22
74
20
4
360
369
24
10
177
431
43
9
97
113
13
5
73
53
2
1
18
7
0
1
4
1
0
0
3740
86
13 535
10 416
21
46 052
1383
20
9255
8149
9
30 289
487
9
1287
486
1
3574
1845
56
2923
1736
11
11 989
2626
49
12 069
9391
11
39 804
852
25
802
611
5
4081
6
0
242
15
1
281
223
9
395
362
4
1718
1613
37
1598
1488
9
8081
1080
21
2271
2243
5
10 026
591
15
1653
586
3
4033
402
14
261
324
1
1613
56
4
23
45
1
255
4
0
2
1
0
21
130
4263
1286
130
7257
62
1017
133
170
848
232
3417
851
3018
785
261
7199
1924
2697
8203
116
649
226
548
514
2
3
2
14
12
48
861
116
90
173
174
1276
461
1380
746
73
1407
542
1096
1652
73
587
140
197
288
35
282
80
612
37
6
49
30
69
6
1
1
1
8
0
1003
1486
642
202
670
210
359
218
101
31
132
34
2860
2423
1130
239
419
384
3216
3236
1513
393
1031
573
861
745
296
66
74
40
2
1
0
0
2
0
133
135
67
15
118
16
1751
2677
895
269
198
140
1461
1669
839
207
249
190
394
316
183
31
78
31
399
872
180
74
35
18
93
104
25
8
7
2
19
9
3
0
1
0
5140
776
4704
9472
953
3
187
2264
2407
510
346
99
3
Hormones and hormone antagonists
Androgen
434
Corticosteroid
8747
Estrogen
2278
Insulin
3366
Oral contraceptive
8915
Oral hypoglycemics
Biguanide
4246
Sulfonylurea
4148
Thiazolidinedione
1882
Other/unknown
476
Progestin
1230
Selective estrogen
631
receptor modulator
Thyroid preparation
10 647
2004 AAPCC Annual Report
651
Table 22B continued
No. of
Exposures
Other hormone
Other hormone antagonist
Unknown hormone or
antagonist
Category total
Miscellaneous drugs
Allopurinol
Disulfiram
l-dopa and related drug
Ergot alkaloid
Neuromuscular blocking
agent
Nicotine pharmaceutical
Other
Category total
Muscle relaxants
Carisoprodol (formulated
alone)
Cyclobenzaprine
Methocarbamol
Other
Unknown
Category total
Narcotic antagonists
Radiopharmaceuticals
Age
Reason
6-19
b6
Unint
N19
Int
Other
Treated
in Health
Care
Facility
Adv
Rxn
Outcome
None
Minor
Moderate
Major
Death
814
522
23
270
183
5
194
55
2
348
278
14
651
430
13
88
54
7
1
0
0
70
37
3
232
109
10
217
109
5
97
26
0
42
26
2
13
4
1
0
0
0
48 359
22 877
4132
21102
40 812
5237
42
2069
12 582
12 123
2951
3040
516
46
551
386
951
307
25
247
7
225
144
2
32
5
17
36
1
271
368
704
124
22
475
81
797
212
16
57
221
90
63
3
0
2
0
0
0
13
74
54
30
6
177
232
327
198
21
223
28
256
111
4
39
101
144
50
1
37
73
93
25
1
6
15
17
5
8
2
0
0
0
1
867
20 514
23 601
358
8154
9137
84
3594
3769
420
8667
10 576
618
16 646
18 845
79
2330
2843
2
49
53
160
1364
1701
183
5362
6500
194
4799
5615
176
3016
3527
48
1186
1463
3
186
240
1
11
15
8368
355
837
7063
1520
6510
6
165
6706
950
2851
1799
445
29
7330
1533
5944
171
23 346
1379
207
940
19
2900
936
191
690
15
2669
4961
1117
4256
129
17 526
2684
564
2391
35
7194
4350
886
3156
129
15 031
6
4
3
0
19
208
55
297
6
731
5110
965
3914
127
16 822
1464
327
1203
17
3961
1945
365
1371
41
6573
1364
201
1158
33
4555
323
40
302
4
1114
15
4
13
0
61
304
10
22
264
102
131
0
55
203
38
60
74
14
1
28
1
0
27
19
0
0
8
15
2
6
2
0
0
Sedative/hypnotics/antipsychotics
Atypical antipsychotic
38 315
Barbiturates
Long-acting
2728
Short/intermediate-acting
349
Unknown type
72
Benzodiazepine
65 998
Buspirone
2033
Chloral hydrate
212
Ethchlorvynol
3
Glutethimide
2
Meprobamate
81
Methaqualone
12
Phenothiazine
4518
Sleep aid (OTC)
927
Other
14 345
Unknown
290
Category total
129 885
3154
8109
26 774
11 538
24 577
40
1638
29 260
6198
11 002
8892
2098
94
524
17
3
6431
233
40
0
0
5
1
685
102
1048
8
12 251
208
48
13
7020
273
24
1
0
10
4
564
136
2070
45
18 525
1974
280
54
51 657
1516
146
2
2
66
6
3237
679
11 093
228
97 714
1530
128
8
15 805
792
78
0
0
21
2
2032
215
3704
29
35 882
1081
193
61
47 476
1132
108
3
2
52
10
2009
688
9849
245
87 486
6
1
0
327
2
3
0
0
0
0
9
3
13
8
412
60
14
0
1327
84
16
0
0
4
0
407
17
565
4
4136
1472
241
66
49 553
1294
158
2
2
61
12
2959
661
10 425
231
96 397
530
46
7
10 099
412
23
0
0
12
2
858
141
1849
21
20 198
546
93
19
21 467
500
64
1
0
18
3
1027
249
4944
72
40 005
406
66
25
11 489
317
60
1
2
20
4
971
200
2624
63
25 140
168
20
6
2954
65
13
0
0
8
1
185
20
485
9
6032
10
1
0
202
4
2
0
0
5
0
19
3
30
1
371
2321
529
255
1484
1686
12
4
612
692
205
528
105
7
0
10 507
57
4605
7698
2742
5
901
134
4140
4
1779
857
3529
47
1889
6593
6279
19
1863
636
3615
37
2299
6802
45
0
17
64
397
1
379
36
5610
35
2031
6910
2338
5
563
858
2024
11
1263
1713
1662
12
711
2441
297
1
22
729
26
0
0
73
42
11
17
4
4
3
21
4
29
5
10
2
0
0
3
3
19
7
12
1
7
1
8
4
0
0
0
0
245
131
105
1412
715
1631
1730
79
47
27
378
6
25
13
49
19
23
210
99
578
151
115
63
53
814
591
985
1533
123
80
37
571
77
195
159
80
38
49
734
395
1311
1475
1
0
0
4
186
93
13
41
13
18
88
18
5
17
122
67
75
822
565
1274
1553
58
32
23
278
26
71
154
37
24
22
291
129
317
334
34
15
17
284
257
538
530
1
2
0
18
116
106
242
0
0
0
3
0
5
34
Serums, toxoids, and vaccines
Stimulants and street drugs
Amphetamine
Amyl/butyl nitrite
Caffeine
Cocaine
Diet aids
Phenylpropanolamine
Phenylpropanolamine
and caffeine
Other: OTC
Other: Rx
Unknown
Ephedrine
GHB and analog/precursor
Hallucinogenic amphetamine
Heroin
(continued on next page)
652
W.A. Watson et al.
Table 22B continued
No. of
Exposures
LSD
Marijuana
Mescaline/peyote
Methamphetamine
Methylphenidate
Phencyclidine
Phenylpropanolamine
look-alike drug
Other stimulant
Other hallucinogen
Unknown hallucinogen
Other stimulant/street drug
Unknown stimulant/street
drug
Category total
Topical preparations
Acne preparation
Boric acid/borate
Calamine
Camphor
Camphor/methyl salicylate
Diaper care/rash product
Hexachlorophene antiseptic
Hydrogen peroxide
Iodine or iodide antiseptic
Mercury antiseptic
Methyl salicylate
Minoxidil
Podophyllin
Silver nitrate
Topical steroid
Wart preparation
Topical steroid with
antibiotic
Other liniment
Other topical antiseptic
Category total
Veterinary drugs
Age
Reason
6-19
b6
Unint
N19
Int
Other
Treated
in Health
Care
Facility
Adv
Rxn
Outcome
None
Minor
Moderate
Major
Death
221
3799
118
3025
8336
511
3
6
139
25
109
1593
8
0
107
1554
34
511
4814
136
2
103
2061
56
2337
1878
358
1
27
467
67
404
6035
75
1
173
3132
46
2427
1992
391
2
17
56
1
70
8
20
0
1
58
3
41
245
5
0
165
3099
55
2420
3224
443
2
14
334
3
171
2160
27
1
41
1074
27
575
1331
110
1
75
1082
24
933
940
187
0
9
255
2
177
73
61
0
2
24
0
37
3
3
0
59
75
13
28
217
17
0
0
0
11
16
30
5
7
66
26
44
8
21
135
29
8
0
4
33
22
64
9
19
145
1
0
3
1
21
7
0
0
3
9
38
68
8
23
158
10
3
0
0
10
19
11
2
11
45
8
32
3
9
55
1
15
1
1
11
0
0
0
0
4
45 294
6286
15 198
23 265
17 223
25 269
621
1391
28 793
7152
9420
9861
2140
214
3225
100
3347
10 303
2015
53 626
41
7190
1507
213
9990
141
39
314
9401
1592
1564
1927
51
2488
8140
1764
51 769
19
2790
462
150
7832
73
8
67
6871
994
1022
608
6
156
570
78
707
6
621
261
17
693
8
6
110
580
236
138
679
41
700
1571
166
1016
16
3745
761
43
1435
60
25
135
1919
352
392
3001
99
3304
10 049
1982
53 559
33
7044
1243
194
9827
128
25
272
9242
1518
1518
78
0
32
159
3
34
4
112
174
10
62
2
7
26
41
15
11
1
0
1
16
0
9
0
10
13
0
16
0
0
1
6
8
1
141
1
9
70
30
22
4
19
64
9
78
11
7
15
107
50
33
222
7
155
896
180
538
8
318
357
22
741
28
13
51
211
198
73
640
20
574
3101
701
7649
8
694
328
56
2377
45
6
38
1339
345
244
406
7
178
1315
286
824
10
802
282
8
1781
20
9
56
369
252
221
29
2
5
72
12
21
3
40
63
3
64
3
3
23
21
33
16
3
0
0
8
2
0
0
1
6
0
3
0
0
1
1
0
2
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
2484
6397
113 489
1245
4810
92 482
189
653
5643
1041
2160
914
6174
15 011 111 372
25
129
924
4
51
137
292
38
1000
161
392
4571
346
1459
19 970
616
690
8132
38
47
498
1
2
30
0
0
2
16
73
389
3314
1284
Vitamins
Multiple-vitamin tablets: adult formulations
No iron, no fluoride
2656
1708
With iron, no fluoride
7330
5051
With iron carbonyl
249
191
(no fluoride)
With iron, with fluoride
72
50
No iron, with fluoride
42
36
Multiple-vitamin tablets: pediatric formulations
No iron, no fluoride
12 995 10 997
With iron, no fluoride
19 032 17 290
With iron carbonyl
79
69
(no fluoride)
With iron, with fluoride
176
166
No iron, with fluoride
1756
1682
Multiple-vitamin liquids: adult formulations
No iron, no fluoride
173
103
With iron, no fluoride
202
109
With iron, with fluoride
6
2
No iron, with fluoride
3
3
Multiple-vitamin liquids: pediatric formulations
No iron, no fluoride
453
422
With iron, no fluoride
763
729
With iron, with fluoride
43
43
No iron, with fluoride
515
499
265
1741
3150
71
829
559
89
13
1
269
534
16
674
1725
42
2268
6551
233
231
595
13
2
1
0
146
167
3
444
1066
34
623
1999
71
180
410
20
69
90
4
3
10
0
0
1
0
5
2
17
3
67
41
4
0
0
0
1
1
9
2
18
6
4
0
0
0
0
0
0
0
1894
1583
7
87
134
3
12 763
18 765
75
202
230
4
7
4
0
14
28
0
389
1422
16
2701
4759
29
231
672
3
6
34
0
0
0
0
0
0
0
9
63
0
9
174
1744
1
10
0
0
1
2
10
54
33
387
9
14
1
2
0
0
0
0
15
19
0
0
55
74
4
0
143
172
5
3
16
23
0
0
0
0
0
0
13
7
1
0
37
30
1
0
43
40
3
0
15
16
1
0
6
1
0
0
0
1
0
0
0
0
0
0
24
30
0
16
5
3
0
0
439
740
40
512
3
4
0
1
1
1
0
0
10
18
3
2
20
37
2
13
75
150
6
78
20
33
3
17
2
3
0
1
0
0
0
0
0
0
0
0
2004 AAPCC Annual Report
653
Table 22B continued
No. of
Exposures
Age
b6
Multiple vitamins, unspecified adult formulations
No iron, no fluoride
64
42
With iron, no fluoride
2285
1555
With iron, with fluoride
13
7
No iron, with fluoride
8
6
Multiple vitamins, unspecified pediatric formulations
No iron, no fluoride
242
176
With iron, no fluoride
205
185
With iron, with fluoride
10
6
No iron, with fluoride
65
63
Other vitamins
Vitamin A
623
448
Niacin (B3)
3048
670
394
255
Pyridoxine (B6)
Other B complex
3100
2201
vitamins
Vitamin C
2316
1750
Vitamin D
284
139
Vitamin E
1726
1306
Other
646
381
Unknown
988
649
Category total
62 562 48 989
Unknown drug
Total no. of
pharmaceuticals
% of pharmaceuticals
% of all substances
6-19
Reason
Unint
N19
Int
Other
Treated
in Health
Care
Facility
Adv
Rxn
Outcome
None
Minor
Moderate
Major
Death
4
225
1
0
18
499
5
2
51
2024
11
8
7
218
2
0
0
0
0
0
6
41
0
0
14
397
6
0
15
624
6
0
4
132
1
0
3
44
0
0
0
4
0
0
0
0
0
0
64
20
3
2
2
0
1
0
235
203
9
64
4
1
0
1
0
0
0
0
3
1
1
0
7
17
3
0
48
50
3
5
1
11
0
1
1
1
0
0
0
0
0
0
0
0
0
0
29
458
42
130
144
1888
93
754
560
1512
316
2717
33
401
56
234
2
4
0
4
26
1122
21
133
63
508
88
512
113
210
104
673
37
1068
26
181
5
109
9
76
2
3
9
15
0
0
0
0
221
21
97
63
142
6008
337
123
318
198
177
7394
2119
243
1589
507
813
57 716
129
16
64
53
115
2671
1
1
1
1
1
31
63
21
58
85
49
2047
208
47
197
123
197
5973
485
67
354
134
287
14 199
108
22
85
59
69
3453
28
6
26
16
23
566
3
0
1
0
2
53
0
1
1
0
0
3
4135
3619
8084
7028
6326
1024
885
10 385
2921
2561
2299
631
41
1 389 156 581 488
211 747
586 404 909 709
409 445
538 233 301 780
213 112
126 861
27 603
2148
41.9%
20.9%
15.2%
7.6%
15.3%
7.7%
9.1%
4.6%
2.0%
1.0%
0.2%
0.1%
16 323
50.0%
42.2%
21.1%
65.5%
32.8%
29.5%
14.7%
3542 54 941
0.3%
0.1%
4.0%
2.0%
38.7%
19.4%
21.7%
10.9%
MAO indicates monoamine oxidase; SSRI, selective serotonin reuptake inhibitors; OTC, over-the-counter; ACE, angiotensin-converting enzyme; GHB, c-hydroxybutyrate; LSD, lysergic
acid diethylamide.
Appendix A
AAPCC’s 2004 fatality verification process involved the preparation and review of abstracts on 1513 fatalities reported to
poison centers, some of which were eventually determined to be unrelated to a poison exposure. The review process requires
the dedication and commitment of hundreds of poison center staff members. . .more than could possibly be listed here. The
following fatality abstract authors were identified by their poison centers as having made a major contribution to this effort.
These individuals are acknowledged for their commitment to toxicosurveillance through the careful verification and
preparation of clinical abstracts of poisoning cases. Without the dedicated contributions of these individuals, this report would
not be possible.
Abbott-Teter, Cynthia L.
Akhtar, Jawaid
Albertson, Timothy E.
Alsop, Judith A.
Anderson, Deborah L.
Arnold, Thomas C.
Artalejo III, Leopoldo
Baker, David S.
Ballou, Dawn
Banner, William
Barker, Kim
Benitez, John G.
Bernstein, Jeffrey N.
Beuhler, Michael C.
Bilden, Elisabeth F.
Bond, Randall G.
Borys, Douglas J.
Bosse, George M.
Bottei, Edward M.
Boyer, Leslie V.
Bronstein, Alvin C.
Brooks, Daniel E.
Burns Ewald,
California Poison
Control System
San Diego
Division Fellows
Cantor, Richard
Cantrell, Lee
Caraccio, Thomas R.
Caravati, E. Martin
Casavant, Marcel J
Clancy, Cathleen
Cleary, Jean
Cobb, Douglas B.
Connecticut Poison
Control Center
Toxicology Fellows
Cox, Robert
Cumpston, Kirk
Dorough, Lois I.
Doyon, Suzanne
654
W.A. Watson et al.
Durback-Morris, Lynn F.
Eisenga, Bernard H.
Eldridge, David L.
Enders Shelly
Fernández, Miguel C.
Fisher III, John G.
Foster, Howell
Furbee, R. Brent
Gaar, Gregory G.
Garrison, James
Geib, Anne-Jeanette
Geller, Richard J.
Geller, Robert J.
Gracia, Rebecca
Gummin, David
Hantsch, Christina E.
Haynes, Jr, John F.
Henretig, Fred M.
Hesse, Carol L.
Hoffman, Robert S.
Holmes, Becky L.
Holstege, Christopher P.
Horowitz, Zane B.
Hughes, Michael P.
Jaramillo, Jeanie
Joshi, Prashant
Kay, Tama
Kemmerer, David A.
Kerns, William
Kirk, Mark A.
Kostic, Mark A.
Kunisaki, Thomas A.
Lai, Melisa W.
Lawrence, Ruth A.
Liebelt, Erica
Ling, Louis J.
Lopez, Gaylord
LoVecchio, Frank
Lovely, Perry L.
Marraffa, Jeanna M.
McGoodwin, Lee
McGuigan, Michael A.
McKay, Charles
McNally, Jude T.
Maloney, Gerald
Mercurio-Zappala, Maria
Michels, Jill E.
Morgan, Brent
Morgan, David L.
Mowry, James B.
Mrvos, Rita
Muller, Allison A.
Nester, Mary Lou
Nichols, Michele
Oller, Lisa
Olson, Kent R.
Omslaer, Judith C.
Patton, Jill B.
Quang, Lawrence
Quershi, Shaima
Reed, Michael
Richardson, William H.
Appendix B
Drug and chemical concentrations provided
in these abstracts were measured in blood,
serum, or plasma unless otherwise indicated
Case 11. A 76-year-old disoriented man was admitted to
the psychiatric unit with delirium tremens. His blood
pressure increased, and he was transferred to the intensive
care unit (ICU). Vital signs on admission to the ICU were
normal except for tachycardia with a heart rate of 115 beats
per minute. The patient was reclusive and had a history of
ethanol abuse, with his beverage of choice being
bmoonshine.Q Initial laboratory values were unremarkable
except for sodium, 122 mEq/L; and blood lead, 115 lg/dL.
He was encephalopathic. British Anti-Lewisite (BAL) was
instituted intramuscularly, followed by a continuous infusion of calcium EDTA. BAL was administered every 4 hours
for 3 additional doses. The patient remained on intravenous
(IV) calcium EDTA for 5 days with a blood lead
concentration of 66 lg/dL after 48 hours of treatment. An
erythrocyte protoporphyrin concentration was 12 lg/dL.
The encephalopathy persisted. Over the next 2 weeks, he
became febrile with presumed sepsis, became hypotensive,
and expired.
Rivera, Hector L.
Rivera, Wilfredo
Robertson, William O.
Rose, Rutherfoord S.
Rossi, Pamala R.
Ryan, Mark L.
Sangalli, Bernard
Scalzo, Anthony J.
Schultz, Debora
Scruton, Susan
Seger, Donna
Seifert, Steven A.
Serafin, David
Shum, Shu
Simmons, Henry F.
Simone, Karen E.
Smolinske, Susan C.
Snodgrass, Wayne
Spiller, Henry A.
Stremski, Ernest
Stork, Christine M.
Sweeney, Rachel
Tharratt, R. Steven
Thompson, Jon
Tomassoni, Anthony J.
Wahl, Michael
Waszolek,Kathleen
Weisman, Richard S.
White, Suzanne R.
Whitlow, K. Scott
Wittler, Mary
Case 14. A 45-year-old man presented to the ED
unresponsive, acidotic, and in acute renal failure. He had
been found agitated and tachycardic by a park ranger, with
blood glucose 20 to 30 mg/dL. He was believed to have
consumed an ethanol/isopropyl alcohol–containing hand
sanitizer as an alcohol substitute. Initial workup revealed a
wide anion-gap acidosis with partial respiratory compensation. His blood ethanol concentration was 32.5 mg/dL.
Fomepizole was ordered, and hemodialysis was initiated.
Subsequently, ethylene glycol and methanol assays were
negative. There was also no evidence of salicylate or iron
poisoning. The acidosis did not resolve with supportive
care, and he expired 24 hours after admission.
Case 41. A 43-year-old man ingested antifreeze
(ethylene glycol). At the time of the call to the poison
center, he was unresponsive with bradycardia (heart rate 30
beats per minute), acidosis (pH 6.8), and hyperkalemia. He
was mechanically ventilated, and hemodialysis and fomepizole were begun. His initial osmolality was 364 mOsm/kg
with a serum creatinine of 4.8 mg/dL. Despite hemodialysis
and fomepizole, he died on hospital day 2. Postmortem
analysis revealed ethylene glycol, 138 mg/dL (antemortem
sample); and the cocaine metabolite, benzoylecgonine,
0.562 lg/mL. Marked hyperhydration was noted on
2004 AAPCC Annual Report
postmortem. His weight at autopsy was 69 lb greater than
his hospital admission weight.
Case 46. A 33-year-old man with a history of carburetor
cleaner huffing over several months was found in cardiopulmonary arrest. He was last seen huffing several hours
earlier. The patient could not be resuscitated in the field and
was declared dead on arrival in the ED. He had first- and
second-degree burns on his bilateral upper extremities and
nonlinear second-degree burns/erythema on his chest wall.
Autopsy revealed pulmonary congestion and cardiomegaly.
Postmortem vena cava samples showed dichloromethane,
106 lg/mL; methanol, 20 mg/dL; and toluene, 6.3 lg/mL.
Postmortem samples from the aorta showed toluene,
11 lg/mL; and dichloromethane, 38 lg/mL.
Case 52. A 50-year-old man was bitten on his left second
finger by a snake; the snake was never positively identified
but was presumed to be a copperhead (Crotalidae). He
received polyvalent immune ovine Fab antivenin and
underwent a dermotomy of his finger and a fasciotomy of
his arm. He developed thrombocytopenia (platelet nadir,
51 000/lL) and was transfused. History revealed that he had
hepatitis C, cirrhosis, and a bchronic low platelet count.Q The
patient subsequently went into ethanol withdrawal and was
started on lorazepam. He became increasingly agitated and
also had diazepam, haloperidol, and fentanyl administered.
He then had a respiratory arrest which responded to
naloxone. He was intubated and placed on a ventilator. He
was later extubated and taken back to the operating room for
debridement of his arm wound. During surgery, he had
another respiratory arrest and was reintubated. He appears to
have aspirated during this episode and developed adult
respiratory distress syndrome. His platelets never increased
greater than 72 000/lL, and he developed myoglobinuria.
Medical care was withdrawn, and he died.
Case 53. A 55-year-old man was bitten while feeding a
captive canebrake rattlesnake (Crotalus horridus horridus). Within seconds of the bite, the patient became dizzy. He
then drove himself to a nearby ED. On arrival, he was noted to
have 1 puncture mark on his hand that appeared to have
entered a vein, and he immediately became hypotensive and
unresponsive. The patient was intubated while IV access was
being established, and vasopressors were begun. Because the
facility had no antivenom, he was transported to a regional
referral center. The patient remained hypotensive for most of
the 2 hours from the time of the bite until arrival at the tertiary
hospital. He received 14 vials of antivenom (Crotalidae
polyvalent immune Fab) and aggressive resuscitation. The
patient developed renal failure, disseminated intravascular
coagulation (DIC) and circulatory collapse. He died 7 hours
after the envenomation.
Case 55. A 5-year-old girl presented to the ED in
apparent septic shock and DIC. She reportedly had been
bitten on the foot by a brown recluse spider. Her laboratory
values were prothrombin time (PT) more than 200 seconds,
partial thromboplastin time more than 200 seconds,
fibrinogen 89 mg/dL, d-dimer more than 55 mg/dL, and
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platelets 45 000/lL. Her blood pressure was 100/50 mm Hg
while on an epinephrine infusion. She was intubated and
mechanically ventilated and expired on the second hospital
day. The reported findings from the autopsy were septic
shock with DIC and a skin lesion on the right foot
described as an ulcerated lesion 7/8 inch with a central
ulcerated area (1/8 inch) surrounded by contusions. A
sample from the lesion was negative for brown recluse
spider venom. The postmortem report concluded that
death was caused by septic shock and that ba possible
spider or insect bite cannot be excluded as the cause of the
foot lesion.Q
Case 56. A 25-year-old man presented to a remote clinic.
Oral ethanol was begun for possible intoxication from
ethylene glycol. Further inquiry found that the patient
operated a water treatment facility. Search of his home
revealed empty packets of aluminum fluoride. The
patient’s breathing had become more labored, and he was
transported to an ED where he was intubated. His vital signs
were temperature, 31.18C; blood pressure, 140/80 mm Hg;
and heart rate, 110 beats per minute with atrial fibrillation.
Laboratory analysis showed potassium, 7.1 mEq/L; and
serum calcium, 6.7 mg/dL. The patient was treated with
calcium gluconate, insulin and glucose, and bicarbonate. He
died while being resuscitated and awaiting transport to a
tertiary medical center.
Case 58. A man was riding in a vehicle with a container
of anhydrous ammonia for a suspected portable methamphetamine laboratory. The container ruptured. The patient
exited the vehicle and ran away from the scene. He was
found in cardiac arrest when emergency medical service
(EMS) arrived. He was also noted to have second- and thirddegree burns. Despite cardiopulmonary resuscitation (CPR),
the patient expired shortly after arrival at the ED.
Case 60. A 26-year-old man fell in his room. He had a
history of depression and a previous attempt to harm
himself. His mother heard the fall, found him groggy,
assumed his symptoms were related to recent sinus
problems, and helped him back to bed. A few hours later,
he was unresponsive and was brought to the ED with a
reported ingestion of cyanide. He was treated with a
cyanide antidote kit but remained unresponsive, hypotensive, and acidotic. He was intubated, ventilated, and given
dopamine. By 12 hours after arrival, he had no response to
stimuli but spontaneously moved and opened his eyes. At
24 hours after admission, he had decorticate posturing. The
acidosis resolved, and he was maintaining his blood
pressure without vasopressors. The electroencephalogram
(EEG) showed general slowing. He died on the second
hospital day. Blood cyanide levels were 0.18 lg/mL at
about 16 hours after arrival at the ED and 0.13 lg/mL
10 hours later. Postmortem examination showed bilateral
hemorrhagic infarcts of the caudate and putamen of the
brain, hypoxic-ischemic encephalopathy, and acute pulmonary thromboemboli. The postmortem heart blood cyanide
concentration was 0.27 lg/mL.
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Case 61. A 37-year-old man with a psychiatric history
ingested approximately 2 gulps of a cyanide-containing
gold-plating solution in front of his girlfriend. She
immediately called 911. EMS arrived within 15 minutes
and described the patient as alert but cool, pale, and
diaphoretic. Initial vital signs were blood pressure,
120/60 mm Hg; heart rate, 122 beats per minute; and
respiratory rate, 16 breaths per minute. The paramedics had
amyl nitrite ampules available, and the poison center
recommended immediate inhalation of 1 ampule en route
to the hospital. Activated charcoal and sodium thiosulfate
were given on arrival at the ED. Approximately 1 hour after
ingestion, the patient’s mental status appeared to be
declining, and he was given a second round of nitrite and
thiosulfate. Two hours after ingestion, he was awake and
talking; however, his mean arterial blood pressure was 47 to
50 mm Hg. An additional dose of sodium thiosulfate was
given. Three hours after ingestion, his arterial blood gas
values were pH 7.12; Pco2, 37 mm Hg; and Po2, 139 mm
Hg. A methemoglobin concentration was not available. He
was on high doses of phenylephrine and dopamine, and his
systolic blood pressure remained 78 to 80 mm Hg. By
5 hours after ingestion, his mean arterial pressure was in the
40s mm Hg despite the addition of vasopressin and
epinephrine. He had received several doses of IV bicarbonate and an additional dose of thiosulfate. Shortly after that,
he had a bradycardic arrest and expired. Autopsy revealed
marked pulmonary edema, acute gastritis, and edema of the
intestinal tract and airways. His blood cyanide concentration
was 0.3 lg/mL (time and location of sample not recorded).
An ethanol concentration was 100 mg/dL.
Case 64. A 50-year-old chemist was found unresponsive
and in respiratory distress at home after attempting suicide
with cyanide. Shortly after EMS arrival, she developed
apnea and was intubated en route to the ED. Initial
electrocardiogram (ECG) was suggestive of acute cardiac
injury. Other findings included tachycardia followed by
bradycardia, marked ectopy, then sinus arrest. No cyanide
antidote kit was available at the receiving hospital, and the
patient expired shortly after arrival.
Case 75. A 49-year-old man was found unresponsive and
blue in a hotel room. He had a history of an ethylene glycol
ingestion 6 weeks previously, for which he had received
dialysis. In the ED, he was noted to be comatose. He was
intubated and started on an IV ethanol infusion. He also had
hypotension and bradycardia and arrested twice in the ED.
He was treated with dopamine, thiamine, pyridoxine, sodium
bicarbonate, and atropine. Treatment also included continuous venovenous hemodiafiltration (CVVHD) because his
blood pressure was too low to perform hemodialysis. On the
second hospital day, he developed hyperthermia and
tachycardia and remained hypotensive. He continued to
receive CVVHD but did not show any improvement and
died the following day. Blood collected while he was in the
ED revealed an ethylene glycol concentration of 838 mg/dL
and a glycolic acid concentration of 348 mg/dL.
W.A. Watson et al.
Case 94. A 71-year-old man presented to the ED
approximately 5 hours after ingesting an unknown quantity
of brick cleaner later identified by police as hydrochloric
acid. The patient initially appeared lethargic and required
intubation. A nasogastric tube, placed postintubation,
returned dark blood. Less than 1 hour after arrival in the
ED, the patient sustained a cardiac arrest. Despite aggressive
attempts at resuscitation, the patient expired. An antemortem
arterial blood gas included a pH of 6.89. An autopsy revealed
severe transmural hemorrhagic necrosis of the esophagus
and stomach despite the absence of oropharyngeal burns.
Case 95. A 58-year-old man with a medical history of
diabetes arrived in the ED with oral burning. He had been at
a friend’s home where he mixed scotch with the contents of
a soda bottle that he believed contained soda and drank. The
patient said that the liquid tasted like bacid.Q In the ED, the
pH of the bottle’s content was tested and found to be less
than 5. Vital signs were heart rate, 78 beats per minute;
respiratory rate, 17 breaths per minute; blood pressure,
103/84 mm Hg; and oxygen saturation 93% on room air. An
arterial blood gas on a 100% nonrebreather mask showed
pH 7.27; Po2, 209 mm Hg; and Pco2, 40 mm Hg. The
patient had coffee-ground emesis and developed stridor and
respiratory distress; oral burns were noted in the mouth. He
was intubated, sedated, and started on IV fluids. No
abnormalities were seen in the initial ECG and chest xray. Laboratory values on admission were sodium, 140
mEq/L; potassium, 5.2 mEq/L; bicarbonate, 21 mEq/L;
blood urea nitrogen (BUN), 18 mg/dL; creatinine, 1.8 mg/
dL; glucose, 320 mg/dL; and calcium, 4.2 mg/dL. Approximately 3 hours after presentation, a dysrhythmia was noted
on the cardiac monitor. An ECG revealed absent P waves;
diffuse T wave inversions; QRS, 168 milliseconds; and
QTc, 505 milliseconds. The patient had already been given
1 ampule of calcium gluconate for hypocalcemia. He
developed hypotension (74/43 mm Hg) and tachycardia
(115 beats per minute). Repeat chemistries showed a total
calcium of 3.0 mg/dL with an ionized calcium of 0.5 mg/dL.
At 5 hours after presentation, blood pressure was 96/50 mm
Hg on norepinephrine. He had received a total of 3 ampules
of calcium gluconate, was on a bicarbonate drip, and had
received 2 g of magnesium. The patient then became
asystolic and died despite CPR. Autopsy revealed sloughing
of the esophageal mucosa, hemorrhage of the gastric
mucosa, and 300 mL of blood in the stomach. There were
no perforations. Hepatic fluoride concentrations were
elevated consistent with hydrofluoric acid poisoning.
Further history revealed that grout cleaner containing
hydrofluoric acid was stored in the soda bottle.
Case 98. A 47-year-old woman called EMS because she
was short of breath. On arrival, EMS noted that she was
next to an empty bottle of scotch and a marijuana bbong.Q
She had bradycardia, hypotension, and poor mentation. She
was given atropine which resulted in a heart rate of 50 beats
per minute, and she was intubated. In the ED, she was
noted to be in third-degree heart block which was
2004 AAPCC Annual Report
effectively treated with external cardiac pacing. Her
hospital evaluation revealed a severe metabolic and
respiratory acidosis, and an ECG revealed a wide QRS
complex of 122 milliseconds and the presence of a terminal
40-millisecond axis deviation in lead aVR. Her lactic acid
concentration was 25 mmol/L. Based on the cardiogram,
the physician initiated bicarbonate therapy, and based on
the elevated lactic acid concentration, sodium thiosulfate
was given. In addition, she was given fomepizole and was
hemodialyzed. Despite the aggressive therapy, the patient
died less than 24 hours after presentation. Postmortem
toxicological analysis revealed a propylene glycol concentration of 1171 lg/mL.
Case 99. A 58-year-old man was driving a coal truck.
The brakes failed, and the truck went into a sludge pond
where he aspirated the sludge. Prior analysis of the sludge
pond contents had shown microbes and other debris,
sodium hydroxide, polyaluminum hydroxychlorosulfate,
and an alkaline corrosion inhibitor. His chest x-ray showed
aspiration pneumonia, and he was intubated and ventilated.
He was treated with antibiotics and respiratory supportive
care. He expired from respiratory complications 17 days
after the crash.
Case 123. A 51-year-old woman drank approximately
120 mL of a toilet bowl cleaner containing hydrochloric
acid in a suspected suicide attempt. Her family gave her
water and milk, after which she vomited. In the ED, she was
made NPO and received IV fluids. Endoscopy revealed a
normal esophagus and a necrotic perforated stomach. The
patient underwent total gastrectomy. Postoperatively, she
became septic, and multisystem organ failure developed.
She died 4 days after ingestion.
Case 127. A 1-year-old boy reportedly ingested about
300 mL of a wheel cleaner containing ammonium
bifluoride. He was transported to the nearest hospital by
EMS. Plans were made to transfer him to a regional center
with a pediatric ICU (PICU), but he arrested and died before
transport could occur. He received 1 ampule of calcium
during resuscitation.
Case 129. An 11-year-old girl was found by her mother
collapsed on the bathroom floor near an aerosol air
freshener. She had a white residue around her mouth.
EMS found the patient in ventricular fibrillation and
started CPR. On arrival to the ED, she was in asystole with
a pH of 6.9. Resuscitative efforts were unsuccessful. On
postmortem examination, the gross pathology was normal,
and toxicology analysis was negative. The medical examiner ruled the cause of death to be cardiac arrest as a result
of hydrocarbon inhalation.
Case 133. A 63-year-old man was admitted to the
hospital after a presumed overdose. He was found with pill
bottles around him and had a decreased level of consciousness that required intubation. The time of ingestion was
unknown. His medications included acetaminophen/butalbital/caffeine, zolpidem, and clonazepam. He was started
on dopamine. A nasogastric tube was placed, and activated
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charcoal was administered through the tube before tube
placement was verified. The nasogastric tube was then noted
to be in his lung. The patient received an additional dose of
charcoal when a second nasogastric tube was placed into the
stomach. He was started on IV N-acetylcysteine. His initial
acetaminophen concentration was 73 lg/mL, with normal
liver enzyme levels. A second acetaminophen concentration
was 29 lg/mL. On hospital day 2, his liver enzymes
remained normal. Both N-acetylcysteine and dopamine
were discontinued. He was on propofol and fentanyl for
sedation, and attempts to wean these drugs were unsuccessful. On hospital day 4, attempts to wean him from the
ventilator caused tachycardia and hypertension. Charcoal
was still being suctioned from his lungs. On hospital day
7, an EEG was consistent with anoxic brain injury. On
hospital day 8, life support measures were withdrawn, and
the patient died. An autopsy showed an activated charcoal–
induced pneumonitis.
Case 151, 152, and 153. Two 17-year-old boys and a
17-year-old girl were found in cardiopulmonary arrest in a
cave which they had been exploring with 2 other teenagers
of similar age. All 3 died. One of the surviving teenagers
was able to stumble out of the cave and call EMS. The
children were burning a fire and were reported to have
symptoms before their death consistent with carbon
monoxide poisoning.
Case 184. A 72-year-old man was found dead in his
apartment. The patient’s carbon monoxide detector had gone
off the night before, but he had apparently disabled it.
Firefighters confirmed high concentrations of carbon
monoxide in his apartment from a furnace malfunction.
Case 215. A 22-year-old man was transported by
helicopter from a naval ship after being found unresponsive
in a confined area where there was a large waste storage tank.
The initial concern was that he had fallen and sustained
injuries. He arrived in cardiac arrest and could not be
resuscitated. Shortly after arriving at the trauma center, the
staff was informed that the confined area was filled with
hydrogen sulfide gas. At autopsy, significant pathological
findings included marked edema/congestion of the lungs and
acute brain swelling without herniation. Urine creatinine and
thiosulfate concentrations were 3959 and 21 lg/mL, respectively. A carboxyhemoglobin concentration was 1%, and
methemoglobin and sulfhemoglobin were undetectable.
Case 218. A 42-year-old woman ingested one half of a
tall glass of an algaecide containing 9% elemental copper
in a suspected suicide attempt. She complained of nausea
and vomiting. She was taken to a local ED and was
immediately transferred to a second hospital where she
was found to have renal and hepatic failure. The patient’s
clinical status declined, and she was transferred to a
tertiary care hospital. Upon arrival at the third facility, she
was having dry heaves. Initial laboratory results included
BUN, 24 mg/dL; creatinine, 2.0 mg/dL; aspartate aminotransferase (AST), 25 457 U/L; and alanine aminotransferase (ALT), 6791 U/L. On day 2, the patient’s BUN
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increased to 34 mg/dL and creatinine to 2.5 mg/dL.
A serum copper concentration was 3.24 lg/mL (reference
range 0.75-1.45 lg/mL). The patient received BAL, which
was not tolerated. On day 2, the patient experienced
sloughing of her esophagus. Hemodialysis was performed,
and calcium disodium EDTA was initiated. Repeat
laboratory analyses showed BUN, 38 mg/dL; creatinine,
3.2 mg/dL; AST, 18 345 U/L; ALT, 3375 U/L; and serum
copper, 1.51 lg/mL. On days 4 and 5, the patient had
gastrointestinal hemorrhage. She continued to receive
hemodialysis. On day 5, the patient was intubated before
upper gastrointestinal endoscopy. After intubation, the
patient’s respiratory and cardiac status declined, and she
developed bradycardia with pulseless electrical activity.
She could not be resuscitated.
Case 225. An adult man was found dead in the hold of an
offshore fishing vessel. A leak in the chlorofluorocarbon
refrigeration system was found. Three other crew members
were taken for treatment of hypothermia, fasciculations,
incontinence, and tachycardia.
Case 227. An 83-year-old man presented to the ED with
gastrointestinal symptoms about 8 to 12 hours after
ingesting 3 or 4 mushrooms he identified and picked
himself. Initial liver transaminases were elevated. Laboratory values on hospital day 4 were AST, 460 U/L; ALT,
689 U/L; serum creatinine, 6.2 mg/dL; total bilirubin,
9.6 mg/dL; and lactic acid, 4 mg/dL. His hemoglobin
dropped from 16 to 12 g/dL, and he developed abdominal
pain and gastrointestinal bleeding. He received sodium
bicarbonate for a metabolic acidosis, norepinephrine for
blood pressure support, and IV N-acetylcysteine. The
bicarbonate was stopped, and hemodialysis was started.
By hospital day 5, the patient had developed DIC. He
was given fresh frozen plasma (FFP) and platelets. Laboratory values were hemoglobin, 9.5 g/dL; platelet count,
28 000/lL; serum creatinine, 2.4 mg/dL; total bilirubin,
9.5 mg/dL; alkaline phosphatase, 83 U/L; AST, 640 U/L;
ALT, 824 U/L; international normalized ratio (INR), 1.81;
d-dimer, 6554 lg/L; and fibrinogen, 240 mg/dL. On
hospital day 6, the patient died. The mushrooms were
identified by a mycologist as Amanita bisporigera.
Case 228. A 44-year-old man ate 6 to 10 Amanita
muscaria mushrooms purchased freeze dried from an
internet site by a friend. After a prolonged period of
unresponsiveness and possible seizure activity, EMS was
contacted. He was in cardiorespiratory arrest when EMS
arrived. After a lengthy resuscitation in the ED, the patient
was admitted to the ICU. He was hypotensive and receiving
vasopressors. On the first hospital day, an EEG showed
constant subclinical seizure activity. He had a mildly
elevated AST but normal ALT. A head computed tomography (CT) was consistent with anoxic brain injury. The
patient expired on day 10.
Case 229. A 70-year-old woman developed vomiting and
diarrhea after eating wild mushrooms picked in a local park.
The time of onset of symptoms was unclear. The patient
W.A. Watson et al.
presented 2 days after the ingestion with blood pressure,
90/60 mm Hg; and heart rate, 130 beats per minute. Initial
laboratory results showed AST, 4699 U/L; ALT, 2907 U/L;
INR, 2.7; and serum creatinine 1.2 mg/dL. The patient was
given IV fluids, high-dose penicillin, and multiple doses of
activated charcoal. On the next day, her AST was 7005 U/L;
ALT, 4083 U/L; and INR, 4. She became drowsy then
hypotensive requiring vasopressors. Her case was discussed
with the regional liver transplant service, but she was felt to
be too unstable, and she died on the fourth hospital day. A
mycologist identified the mushrooms as Amanita phalloides.
Case 232. A 34-year-old man ingested 2,4-dichlorophenoxyacetic acid in a suicide attempt. Upon presentation,
the patient had altered mental status, miosis, increased oral
secretions, and tachycardia. He was initially treated with
atropine and pralidoxime for a presumed organophosphate
exposure until the product container was found. Bicarbonate
therapy was then instituted in an attempt to increase
elimination via urinary alkalinization. The patient died on
hospital day 2 after developing ventricular tachycardia,
pulmonary edema, and renal insufficiency.
Case 234. A 75-year-old man with a history of Parkinson
disease and a cardiac pacemaker was found unresponsive
approximately 20 minutes after ingestion of an unknown
amount of glyphosate concentrate. The patient was intubated in the field secondary to mental status depression and
hypoventilation. He received 1 dose of activated charcoal en
route to the ED. In the ED, he had central nervous system
depression, but his vital signs and baseline laboratory values
were all normal. He was treated with a propofol infusion for
agitation. The patient developed hypotension requiring
pressor support with dopamine, aspiration pneumonitis,
and nonoliguric renal failure with a peak serum creatinine of
4.3 mg/dL. The hypotension resolved over the next 48 hours
and the renal failure within a week. However, the patient’s
hospital course was complicated by hospital-acquired
pneumonia, and he expired on hospital day 11.
Case 238. A 38-year-old man was brought to an ED after
ingesting an unknown amount of concentrated terbufos
(15%) granules in a suicide attempt. The patient reportedly
mixed the granules with food and ate it. In the ED, he was
initially alert but subsequently developed weakness and
drooling. He was given 4 mg of atropine and intubated
when he developed copious secretions. Before pralidoxime
could be administered, he became asystolic. He could not be
resuscitated and expired about 2 hours after the ingestion.
Case 239. A 19-year-old man was brought to the ED by
the police. After initial evaluation in the ED, the patient was
transferred to the trauma center because of visible evidence
of traumatic injuries. On initial presentation, he had
hyperthermia (41.18C) with a heart rate of 200 beats per
minute, dilated pupils, and absence of sweating. The patient
then rapidly progressed to DIC, hypotension, and cardiac
arrest. It was subsequently revealed by observers that the
patient had crushed up angel’s trumpet (Datura species)
and drank it in the form of a tea.
2004 AAPCC Annual Report
Case 240. A 56-year-old man unintentionally ingested
about 60 mL of a pool clarifier concentrate containing
n-alkyldimethyl benzylammonium chloride. He went to
the ED complaining of throat and abdominal pain. The
patient had an emergent endoscopy and was noted to have
necrotic burns of the stomach and esophagus. He was
transferred to a tertiary care center and underwent exploratory laparotomy. No surgical repair was attempted because
of the amount of necrosis present. The patient was provided
with comfort measures only and expired less than 24 hours
after his initial presentation.
Case 244. A 2-year-old girl with a fever for 5 days
had been given acetaminophen in doses appropriate for a
6-year old, both orally and rectally. She was seen in an
ambulatory clinic for vomiting and had an acetaminophen
concentration of 72 lg/mL, approximately 8 hours after
the last dose. The patient was admitted to the hospital.
N-acetylcysteine was not administered. On the next day,
the acetaminophen concentration was 44 lg/mL; AST,
9842 U/L; ALT, 6486 U/L; alkaline phosphatase, 970 U/L;
ammonia, 320 lmol/L; bilirubin, 3.7 mg/dL; INR, 4.4;
glucose, 23 mg/dL; pH 7.2; BUN, 33 mg/dL; and creatinine,
1.8 mg/dL. At this point, the patient had a blood pressure of
45/20 mm Hg, was obtunded, and had oral bleeding. She
was intubated and given fluids, and IV N-acetylcysteine was
started. Additional measures included dextrose, dopamine,
bicarbonate, oral lactulose, and antibiotics. She continued to
deteriorate with bleeding and was given vitamin K, packed
red cells, and FFP. Prostaglandin E1 was also started on the
advice of the transplant center. The patient was not able to
be transported to the pediatric liver transplant center and
continued to deteriorate. After coding several times, the
patient died.
Case 245. A 3-year-old boy was administered adult
doses of acetaminophen for 5 days for an upper respiratory
tract infection. The patient presented with hypotension, liver
failure, and an acetaminophen concentration of 52 lg/mL,
16 hours after his last dose. He was transferred to a tertiary
care hospital. On arrival, his initial laboratory values
showed AST, 14 000 U/L; ALT, 40 000 U/L; and INR, 6.
IV N-acetylcysteine was administered, and the patient was
maintained on vasopressors. He developed a gastrointestinal
tract bleed, renal failure, and sepsis. The patient died 8 days
after being transferred to the tertiary care hospital.
Case 274. A 40-year-old man with a previous head
injury was living in a group home. At an unknown time, his
roommate allegedly forced him to take an overdose of
acetaminophen. In the hospital, his laboratory values were
acetaminophen concentration, 101 lg/mL; AST, 833 U/L;
ALT, 1008 U/L; and ammonia, 213 lmol/L. The timing of
these values relative to the ingestion is unknown. The
patient was sedated and required mechanical ventilation. He
was also started on N-acetylcysteine therapy, and supportive
care was instituted. Despite this, he continued to deteriorate
until he died 7 days after presentation. Postmortem
examination revealed liver necrosis and signs of acute
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tubular necrosis and multiorgan failure. The death was ruled
a homicide.
Case 288. A 51-year-old woman presented to an ED
after being found unresponsive and surrounded by vomit,
stool, and pills. Acetaminophen was the suspected drug
of ingestion; the time of ingestion was unknown. The
patient was also suspected to have aspirated. In the ED,
she was acidotic and hypothermic and required intubation.
Her initial laboratory values showed an acetaminophen
concentration of 1121 lg/mL and a pH of 6.9. IV
N-acetylcysteine therapy was initiated. On day 2, the
patient remained unresponsive, intubated, and ventilated
and did not require sedation. She then developed
hypotension and tachycardia and was placed on dopamine,
norepinephrine, and phenylephrine infusions. Subsequent
acetaminophen levels were 936 and 1180.6 lg/mL at
about 6 and 8 hours after the first level. Other laboratory
results revealed AST, 125 U/L; PT, 21.5 seconds; and
INR, 3.5. The patient was administered vitamin K. On
day 3, the patient’s status remained unchanged. Laboratory
results included AST, 4465 U/L; ALT, 2337 U/L; PT,
50.8 seconds; INR, 18.9; calcium, 7.0 mg/dL; ammonia,
63 lmol/L; creatine kinase, 3047 U/L; and creatine kinase–
myocardial band, 47.2 ng/mL. A screen for drugs of
abuse was negative. The initial IV N-acetylcysteine regimen
was completed, and a second 20-hour infusion was initiated.
On day 4, the patient expired.
Case 318. A 15-year-old boy with a history of drug
abuse presented to an outlying hospital 12 hours after
ingesting unknown amounts of acetaminophen (500 mg),
buprenorphine, and a cough/cold product containing
codeine and guaifenesin. An acetaminophen concentration
was 155 lg/mL at presentation, and IV N-acetylcysteine
was started. Initial laboratory values were AST, 174 U/L;
ALT, 208 U/L; total bilirubin, 1.4 mg/dL; and bicarbonate,
23 mEq/L. An ECG was noted to be normal. Fourteen hours
later, his blood pressure was 160/70 mm Hg, and pulse rate
was 90 beats per minute. Laboratory values at that time were
AST, 779 U/L; ALT, 1469 U/L; PT, 40.9 seconds; INR,
4.05; PTT, 29.5 seconds; total bilirubin, 4.5 mg/dL; and
total CO2, 19 mmol/L. Twelve hours later, he was
transferred to a tertiary care hospital with worsening liver
function. The N-acetylcysteine was continued, and he
received 2 U of FFP and vitamin K1, but his INR increased
to 7.0. He was alert and oriented with no signs of
encephalopathy. Over the next 2 days, his AST and ALT
were 462 and 4746 U/L, respectively. He showed increasing
signs of encephalopathy as his ammonia increased to
366 lmol/L and his creatinine to 8.3 mg/dL. On the fifth
hospital day, he received a liver transplant after a biopsy
showed 70% necrosis. After transplant, he was noted to be
unresponsive with nonreactive pupils. A head CT showed
diffuse cerebral edema with transtentorial herniation,
whereas a brain flow study showed global nonperfusion of
the brain, consistent with brain death. He was removed from
life support measures 7 days after presentation.
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Case 462. An 11-year-old boy being treated for acute
rheumatic fever with high-dose aspirin presented with
altered mental status and a salicylate concentration of
66 mg/dL. IV bicarbonate was started, and additional
laboratory tests revealed the patient to have elevated transaminases with an ALT of more than 1000 U/L and an INR of
2.9. An ammonia concentration subsequently returned at
457 lmol/L. The patient was treated with vitamin K and
hemodialysis but developed cerebral edema and papilledema. IV N-acetylcysteine was given for elevated liver
functions and lactulose for the elevated ammonia concentration. The patient continued to deteriorate neurologically in
deep coma. A liver biopsy confirmed the diagnosis of Reye
syndrome. Transaminases slowly declined as did the
ammonia and salicylate concentrations. An EEG showed
no brain activity, and after 2 weeks of supportive care
without change in neurological status, the patient expired.
Case 466. A 38-year-old man presented to the ED 10.5
hours after the reported ingestion of 300 enteric coated
regular-strength aspirin tablets. He was alert and oriented.
His medical history was significant for a self-inflicted
gunshot wound to the abdomen 3 months previously. On
physical examination, he was diaphoretic and complained of
abdominal pain. His heart rate was 113 beats per minute
with a normal blood pressure. Laboratory values included a
serum pH of 7.37 and a serum salicylate concentration of
97.7 mg/dL. IV fluids with sodium bicarbonate were begun.
Within an hour of arrival, he was noted to have an altered
mental status. He was sedated with lorazepam for agitation
before having a CT of his abdomen, as there was concern
over possible peritoneal signs and his history of abdominal
injury. Hemodialysis was then started. The salicylate
concentration dropped to 58.4 mg/dL after 6 hours, and
hemodialysis was stopped. His salicylate concentration then
rose to 90 mg/dL. He had a cardiopulmonary arrest 18 hours
after arrival and died.
Case 507. A 51-year-old woman presented to the ED
5.5 hours after ingesting 150 colchicine tablets in a
suspected suicide attempt. Her initial complaint was nausea
and vomiting. Vital signs on presentation included blood
pressure, 187/100 mm Hg; and heart rate, 115 beats per
minute. Initial laboratory examinations included white
blood cells, 16 600/lL; potassium, 3.3 mEq/L; bicarbonate,
25 mEq/L; and creatinine, 1.5 mg/dL. The patient was
treated with antiemetics, crystalloid fluids, potassium
supplementation, activated charcoal, gastric lavage, and
antihypertensives. She was admitted to the ICU. Sixteen
hours after ingestion, she developed hypotension, increased
respiratory distress, and decreased urinary output. She
remained alert and oriented with systolic blood pressure,
70 mm Hg; heart rate, 120 beats per minute; and respiratory
rate, 40 breaths per minute. She was started on vasopressors.
Twenty hours after ingestion, she developed cardiogenic
shock, metabolic acidosis, and anuria. A repeat arterial
blood gas showed a pH of 7.25. Her white blood cell count
increased to 28 600/lL. The patient was treated with
W.A. Watson et al.
maximum vasopressor support and a balloon pump;
evidence of vasospasm was seen during cardiac catheterization. Resuscitation was withheld, and the patient expired
31 hours after ingestion.
Case 515. A 48-year-old man with a medical history
of nonspecific heart problems and drug abuse was found
dead at home with 2 fentanyl patches on his shoulder.
The autopsy revealed no evidence of trauma. Analysis
of femoral blood revealed a fentanyl concentration of
29.7 ng/mL.
Case 525. A 10-month-old girl was brought to the ED
after being found in cardiopulmonary arrest at home. Rigor
mortis was apparent on presentation. A postmortem
subclavian blood sample showed a methadone concentration of 0.67 lg/mL. The child’s mother was on methadone.
The mother and her companion were prosecuted for giving
methadone to the child.
Case 526. A 15-month-old boy’s mother was taking
methadone and left it in a child’s decorated cup in a kitchen
cabinet. Another woman in the home thought it was juice
and gave it to the child. According to the mother, she
realized what had happened an hour later but did not do
anything because the child looked fine. Approximately
2 hours after the ingestion, the other woman in the
household noted that the child was not breathing and began
CPR. The child was transported to the ED by EMS but died
approximately 6 hours later. A postmortem blood methadone concentration was 0.4 lg/mL.
Case 527. A 20-month-old boy became sleepy and was
put down for his usual afternoon nap. Eight hours later,
the toddler was unarousable, and EMS was called. Upon
EMS arrival, the patient was unresponsive with pinpoint
pupils, decreased respirations, and eyes deviated to the
right. Responsiveness improved slightly with naloxone.
Medications available in the home were diazepam, liquid
methadone, gabapentin, and amitriptyline. The patient’s
urine drug screen was positive for methadone. Multiple
neurological investigations revealed marked hypoxic
injury with brain stem herniation. The child died on the
24th hospital day.
Case 612. A 42-year-old man was administered nalbuphine and propofol in a dental office before a dental
procedure. He developed respiratory insufficiency, and EMS
was called. The patient was intubated and transferred to an
ED. An arterial blood gas on arrival showed pH 7.06; Pco2,
79.3 mm Hg; Po2, 35.3 mm Hg; and oxygen saturation,
53.1%. His condition deteriorated in the ED, and he died
despite resuscitative measures. An autopsy showed severe
hemorrhagic pulmonary edema. Postmortem toxicology
results for blood were reported as alprazolam 6 ng/ml and
nalbuphine 46 ng/mL; propofol was not detected.
Case 613. A 10-month-old boy had apparently been
given a bottle of naproxen tablets to use as a rattle. The
child reportedly choked on the pills when the bottle opened.
Attempts at resuscitation both at the scene and in the ED
were unsuccessful. A naproxen blood concentration from an
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unspecified site obtained approximately 2 days postmortem
was 130 lg/mL. Anatomic examination revealed no
identifiable pills or fragments, and additional extensive
testing was all negative. The final cause of death was
determined to be asphyxiation as a result of the aspiration of
medication tablets.
Case 623. A 14-month-old boy was found by his mother
to be unarousable and was brought to an ED. In the ED, he
was in cardiopulmonary arrest and very acidemic. After
40 minutes of CPR, a pulse was returned. After 5 days with
no return of function, he was declared brain-dead. Blood
analysis showed an acetaminophen concentration of
12 lg/mL, and urine toxicology screen was positive for
opiates, confirmed in blood as oxycodone with a concentration of 220 ng/mL.
Case 635. A 2-year-old boy was found unarousable by his
father. Thirteen tablets of controlled-release oxycodone
80 mg were missing from the father’s prescription bottle.
Paramedics found the boy unresponsive, pulseless, and warm
with circumoral cyanosis. He was lying supine with vomitus
in his airway. The cardiac monitor showed ventricular
fibrillation rapidly followed by asystole. CPR was started,
and the child was intubated. There was no response to
naloxone, atropine, or epinephrine via an intraosseous line. In
the ED, additional doses of naloxone and epinephrine were
administered without response, and the child was declared
dead. Postmortem analysis of peripheral blood showed
oxycodone, 560 ng/mL; and oxymorphone, 260 ng/mL.
Case 652. A 29-year-old woman was admitted to the
ICU with a history of ingesting a veterinary analgesic,
phenylbutazone. No further information was available
regarding the time frame or amount ingested, although it
was believed that she may have taken repeated doses for a
headache. She had renal failure and liver failure and was
bleeding secondary to DIC. Her vital signs on phenylephrine and dopamine infusions were heart rate, 120 beats per
minute; and blood pressure, 117/51 mm Hg. On the
following day, she remained in DIC and was intubated
and on a ventilator. She was receiving infusions of propofol,
insulin, sodium bicarbonate, dopamine, phenylephrine,
furosemide, and total parenteral nutrition. She was bleeding
from multiple sites, and further blood products were
administered. On hospital day 3, supportive measures were
discontinued, and the patient expired. Autopsy showed
anasarca with bilateral pleural effusions, ascites, multiple
areas of hemorrhage, and evidence of diffuse organ
damage. Postmortem analysis showed serum phenylbutazone, 13 lg/mL; and oxyphenbutazone, 3.4 lg/mL.
Case 665. A 17-year-old man was found in respiratory
and cardiac arrest next to an empty 250-mL bottle of
sevoflurane. He was cardioverted and intubated in the field,
then transported to the ED. At the ED, the patient was
completely unresponsive with fixed dilated pupils. His
systolic blood pressure was 180 mm Hg with a heart rate of
114 beats per minute while receiving sodium bicarbonate,
calcium, epinephrine, and amiodarone. His initial serum pH
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was 6.86; serum calcium, 5.6 mg/dL, and his rectal
temperature was 36.28C. The patient was transferred and
admitted to an ICU 2.5 hours after his arrival to the ED and
was developing pulmonary edema. His clinical condition
continued to decline, and he expired about 24 hours after
the exposure.
Case 675. An 18-month-old boy weighing 11 kg was
inadvertently administered 2000 mg of IV fosphenytoin. He
developed bradycardia, then asystole. Despite aggressive
resuscitative measures over the next 3 hours, including
prolonged CPR, epinephrine, atropine, magnesium, albumin, and exchange transfusion, spontaneous circulation was
not restored.
Case 682. A 46-year-old man presented to the ED after
ingesting an estimated 75 oxcarbazepine 150-mg tablets.
The patient was decontaminated with activated charcoal.
One half hour after ED arrival and within 6 hours of
the ingestion, the patient became hypotensive and required
6 L of IV fluid for resuscitation. The patient then
developed asystole after a period of bradycardia and could
not be resuscitated. A urine screen for drugs of abuse
was negative.
Case 691. A 49-year-old woman reportedly ingested
400 valproic acid 500-mg tablets. She was ataxic and
drowsy when evaluated by EMS. During transport, the
patient became comatose and was intubated. The patient
was rapidly stabilized in the ED and admitted to the ICU.
Her initial valproic acid concentration was 980 lg/mL.
Eight hours after admission to the ICU, the patient remained
comatose. Her ammonia concentration had increased to
134 lmol/L, and her pH had decreased to 7.27. She
continued to deteriorate. Four hours later, she was neurologically unresponsive with no corneal reflexes, no doll’s
eyes, and with pupils fixed and dilated. Her pH had dropped
to 7.01, and 8 ampules of sodium bicarbonate were
administered to get the pH back to 7.38. She became
hypotensive with no response to dopamine. l-Carnitine was
administered. The patient developed an ileus and was
unable to hold down activated charcoal or polyethylene
glycol electrolyte solution. Laboratory values from the
morning of the second hospital day included ammonia,
more than 300 lmol/L; and valproic acid, 1855 lg/mL. Her
blood pressure continued to fall, and norepinephrine was
added. In addition, there was evidence that the patient had
aspirated activated charcoal, and an ileus had developed.
Despite 100% oxygen, her Po2 dropped to 40 mm Hg. She
continued to deteriorate and expired later that day.
Case 735. A 55-year-old man ingested amitriptyline
and injected NPH insulin. He was intubated and had a
prolonged QTc but did not have a prolonged QRS. He was
started on bicarbonate and a 10% dextrose in water
infusion. The ECG had normalized by day 2. On hospital
day 5, the patient collapsed on his way to the bathroom
and died.
Case 804. A 39-year-old man admitted to an ingestion of
btoo many pills,Q including venlafaxine, lorazepam,
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diphenoxylate/atropine, and hydrocodone. Significant
numbers of venlafaxine and lorazepam tablets were missing.
He presented to the ED obtunded with pinpoint pupils and
poor respiratory effort. He awoke in response to the
administration of 2 mg of naloxone. He was observed for
2 hours and released. He was found dead later that day.
Case 818. A 5-year-old boy was found dead in an empty
home by a process server. The child had last been seen alive
by his mother 36 hours previously, and it was estimated by
the medical examiner that he had been dead for about
24 hours. A container of liquid beverage found at the scene
contained a large amount of suspended diphenhydramine.
A postmortem blood sample had a diphenhydramine
concentration of more than 10 lg/mL.
Case 833. A 7-year-old girl was found dead in bed. She
had complained of stomach cramps the afternoon before and
was otherwise in good health. She was not taking any
medications. The patient’s father was taking hydroxychloroquine for rheumatoid arthritis. At autopsy, the postmortem
blood concentration of hydroxychloroquine was 70 lg/mL,
indicative of ingestion of a large number of pills.
Case 835. A 68-year-old man developed liver injury
1 month after starting isoniazid and rifampin for tuberculosis. He was transferred to a liver treatment center for care.
At that time, his laboratory values were AST, 1150 U/L;
ALT, 1180 U/L; potassium, 6.0 mEq/L; and INR, N10; BUN
and serum creatinine were normal. Despite aggressive
supportive care, the patient died 4 days after presentation.
Case 840. A 40-year-old man developed respiratory
distress after unintentionally injecting himself with the
veterinary antibiotic, tilmicosin, as he injected cattle.
Treatment included 125 mg of methylprednisolone sodium
succinate. The patient developed cardiac manifestations
including bradycardia and died within 4 hours of arriving at
the health care facility.
Case 881. A 10-month-old boy was found face down,
shaking, and vomiting. He was thought to have possibly
ingested extended-release diltiazem. In the ED, he was
crying and had a heart rate of 80 beats per minute and a blood
glucose greater than 300 mg/dL. An IV line was placed with
no response from the infant, and calcium chloride and
glucagon boluses were given without response. Hypotension and bradycardia progressively worsened despite
continued boluses of calcium gluconate and glucagon and
a dopamine infusion. The child vomited and had seizurelike activity leading to intubation and transfer to the PICU.
In the PICU, the child received activated charcoal with
whole bowel irrigation, an epinephrine infusion, and
an insulin/glucose infusion. The child continued to deteriorate, requiring multiple doses of atropine and chest
compressions for bradycardia. He expired about 7 hours
after initial presentation.
Case 890. A 15-month-old girl with a history of supraventricular tachycardia was found with her bottle of
flecainide liquid. She may have ingested a large swallow of
the flecainide. The child had a prehospital cardiac arrest while
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en route to the ED in a private vehicle. Despite resuscitation
efforts in the ED, the patient died within a few hours of the
ingestion. The patient’s antemortem blood flecainide level, at
an unknown time after ingestion, was 6.87 lg/mL.
Case 924. A 2-year-old girl ingested an unknown quantity
of benzonatate. A family member retrieved part of a perle
with a finger sweep of the mouth. Within 5 minutes, the
patient became unresponsive. On EMS arrival, the patient
had apnea and cyanosis. On ED arrival, the patient had a
seizure and asystole. A perfusing sinus rhythm developed
when CPR was administered. Postresuscitation vital signs
included blood pressure, 118/68 mm Hg; and heart rate, 145
beats per minute. A CT scan approximately 16 hours after the
event showed cerebral edema. The patient remained unresponsive with absent brainstem reflexes and no cerebral
blood flow. Autopsy results were consistent with anoxicischemic brain injury secondary to benzonatate ingestion.
Case 928. A 12-month-old boy ingested up to 20 mL of
a cough syrup containing chlorpheniramine and hydrocodone. EMS performed CPR at the scene. After arrival at
the tertiary care facility, the child was treated with naloxone
and dopamine and had a thready pulse (157 beats per
minute) and a blood pressure of 60/40 mm Hg. He was
admitted to the PICU on a ventilator with dilated pupils and
no spontaneous movement. He was also exhibiting diabetes
insipidus. The child was treated with dopamine, epinephrine, and vasopressin. With no change in the patient over
approximately 20 hours in the PICU and a poor prognosis,
testing was done for brain death, and the child was
pronounced dead about 27 hours after exposure.
Case 934. A 33-year-old woman had apparently been
drinking ethanol and taking a product containing ephedra
and caffeine for 3 days. She was found in asystole and was
cold and with evidence of livor mortis.
Case 936. An approximately 50-year-old man who was
receiving conventional treatments for lung cancer presented
to the local ED with respiratory distress. Supportive
resuscitation measures were begun, but the patient went
into cardiac arrest and died despite CPR. During the code,
the family of the patient produced a bottle of bAmygdalinaQ
(laetrile) tablets that the patient had reportedly purchased
via the internet. The family reported that the patient had
ingested approximately 20 of the 100-mg tablets the
previous evening in an attempt to speed his recovery from
cancer. The patient was pronounced dead before antidotal
therapy for cyanide exposure could be administered.
Thiocyanate levels returned within reference range, and
the serum cyanide concentration was 5.1 lg/mL.
Case 940. A 19-year-old man had a respiratory arrest and
died after inhaling powdered diphenoxylate and diazepam.
A diphenoxylate concentration of 40 mg/mL was measured
an estimated 12 hours after exposure. Powder consisting of
diphenoxylate and diphenhydramine was found with the
body. No atropine was detectable in the powder.
Case 941. A 44-year-old woman ingested up to 100 loperamide 2-mg tablets. She was found asleep approximately
2004 AAPCC Annual Report
1 hour later. When she was awakened, she was confused and
answered questions inappropriately. She was taken to the ED
where she was sleepy and had an altered level of
consciousness. Her heart rate was 96 beats per minute, and
she was breathing normally. She was given activated
charcoal. Her laboratory values were reported as normal,
and salicylate and acetaminophen assays were negative. She
was evaluated by psychiatry and discharged home after
approximately 6 hours of observation. At home, she was
more lethargic, and she was brought back to the ED shortly
after the first discharge. At that time, she had pinpoint pupils
and needed intubation. Four days later, she had flaccid
extremities and fixed and dilated pupils, and remained
intubated on pressor support. A CT scan of her head was
normal. After an EEG on day 11, she was taken off the
ventilator, and she died.
Case 948. A 54-year-old veterinarian with history of
bipolar disorder and a prior suicide attempt was found by
family unresponsive on an examination table at his office.
He had a bruise consistent with a needle mark on his right
thigh. Cyclopropane and nitrous oxide containers, an
empty 10-mL container of insulin, and 5 empty bottles
of a veterinary general anesthetic product containing
tiletamine 250 mg and zolazepam 250 mg were found in
close proximity. He was intubated en route to the hospital,
where he was given activated charcoal. Initial vital signs
were temperature, 33.58C; heart rate, 68 beats per minute;
respiratory rate, 14 breaths per minute; and blood pressure,
156/118 mm Hg. He was given naloxone. His blood glucose
was 20 to 30 mg/dL, and he was given 50% dextrose and
2 doses of glucagon. Shortly after arrival in the ED, he
developed hypotension and was started on a norepinephrine
drip. He developed posturing, which responded to sedation
with midazolam and propofol. His hospital course was
complicated by the development of rhabdomyolysis and
acute renal failure. Life support was withdrawn 1 week after
admission, and the patient expired.
Case 954. A 77-year-old man was brought to the ED
where he stated that he had taken 50 metformin tablets
(1000 mg) and an unknown number of acetaminophen/
propoxyphene tablets. Acetaminophen concentration,
thought to be 4 hours after ingestion, was 33 lg/mL, and
lactic acid concentration was 11 mg/dL. The patient was
drowsy with bradycardia and a normal blood glucose.
He later became more acidotic with pH 6.99; bicarbonate,
6 mEq/L; and lactic acid, 19.3 mg/dL. An osmolar gap was
28 mOsm/kg H2O. CVVHD was initiated. He received
bicarbonate as well as norepinephrine and dobutamine
for hypotension. He became unresponsive and was intubated and ventilated. His lactic acid concentration rose to
35 mg/dL, and he expired 48 hours after ingestion. The
postmortem metformin concentration was 64 lg/mL.
Case 963. A 74-year-old woman was started on
lepirudin postoperatively after developing heparin-induced
thrombocytopenia. Approximately 2 days later, the patient
was coagulopathic, bleeding from various sites, and had a
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PTT greater than 150 seconds. The lepirudin had been
discontinued. On the previous day, the patient’s laboratory
values had shown a new-onset renal insufficiency. The
lepirudin infusion had been decreased at that time, adjusting
for a creatinine clearance of 37 mL/min. Blood products
were already being ordered, including FFP, platelets, and
packed red blood cells. The patient underwent hemodialysis.
Norepinephrine was also started for hemodynamic support.
On the following day, she was reported to be unresponsive,
hypotensive, and anuric. Laboratory values were hemoglobin, 6.4 g/dL; hematocrit, 17.7%; platelet count, 88 000/lL;
PT, 19.4 seconds; PTT, 77 seconds; creatinine, 1.9 mg/dL;
fibrinogen, 145 mg/dL; AST, 2935 U/L; and ALT, 1174
U/L. Despite the above measures, she continued to show
signs of venous bleeding at various sites. Her clinical
condition gradually deteriorated, and she expired on the
third hospital day.
Case 965. A 46-year-old man was found in asystole by
EMS at his home. The patient had started an IV on himself
and injected approximately 600 mg of IV succinylcholine.
Resuscitation efforts were discontinued on transport.
Case 966. A 12-year-old boy arrived in the ED with
changes in mental status and a heart rate of 50 beats per
minute. Two days previously, he had received his first
intrathecal baclofen administration, presumably for spastic
paraplegia. The patient’s ECG showed third-degree heart
block with a junctional escape rate of 50 to 70 beats per
minute. The patient was not sedated or hypotensive but was
lethargic. Baclofen overdose was suspected. Later in the
evening, the patient went into ventricular fibrillation. By
early morning, the patient was more alert but was still
having heart block and premature ventricular contractions.
There were no significant laboratory abnormalities. Later in
the day, he was acting normally with stable vital signs. That
night, the patient was alert and awake with no further
episodes of ventricular fibrillation. He was in sinus rhythm,
with hemodynamics supported with isoproterenol, milrinone, dobutamine, and heparin. He was still experiencing
occasional premature ventricular contractions with no
definitive diagnosis. He had a recurrence of heart block
on hospital day 7. The dobutamine was discontinued,
and an idioventricular rhythm was noted looking like
ventricular tachycardia. The patient expired on the eighth
day of admission.
Case 992. An 83-year-old unconscious woman was
brought to the ED. She had last been seen the day before by
her family and was found with an empty bottle of hypnotic
capsules containing secobarbital (25 mg) and amobarbital
(25 mg). Her blood pressure was 90/49 mm Hg with pulse
of about 90 beats per minute. The patient appeared
dehydrated. Large blisters were present on the patient’s
skin, and her skin was described as bpeeling off in sheets.Q A
urine toxicology screen was positive for barbiturates. The
patient was mechanically ventilated and received aggressive
hydration and vasopressor support. She died about 36 hours
after presentation.
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Case 1048. A 19-year-old girl was found unresponsive in
the afternoon. She was suspected of having ingested a large
number of trimethobenzamide tablets the previous evening.
She arrived in the ED comatose, with seizures, followed by a
respiratory arrest. After initial resuscitation, she had 2 prolonged episodes of asystole requiring CPR. After restoration
of heart rate and blood pressure, she was transferred to a
tertiary care facility for the possibility of hemodialysis or
other enhanced elimination procedure. On arrival at the
second hospital, more than 36 hours after suspected
ingestion and 12 hours after cardiac arrest, the patient had
fixed and dilated pupils, no cranial nerve responses, and a
flat EEG. Dialysis and other procedures were deemed not to
be indicated, and the patient expired shortly after ICU
admission. Routine drug screens were negative.
Case 1066. A 25-year-old European man with an
unknown medical history had a seizure on a flight from
the Caribbean to Europe. He was given a total of 50 mg of
diazepam but continued to seize for about 1.5 hours. The
plane was diverted and landed on a Caribbean island. On
EMS arrival, the patient was noted to still be seizing. He
arrested en route and was found to be in pulseless electrical
activity on arrival at the hospital. He regained a pulse after
30 minutes of CPR and was then started on an epinephrine
drip. The patient had a wide complex bradycardia at 30 beats
per minute and was unresponsive to both transcutaneous
and transvenous pacing. He was hypotensive with a systolic
blood pressure of 50 to 70 mm Hg. On examination, he had
fixed and dilated pupils. Laboratory analysis revealed a
combined metabolic and respiratory acidosis with a pH
of 6.7 and a bicarbonate of 6.5 mEq/L. A urine toxicology
screen was positive for cocaine and tetrahydrocannabinol.
CTs of the head and chest were normal. CT of the abdomen
revealed that the stomach and intestines were filled with
packets. The patient subsequently passed 4 packets per
rectum. At least 1 packet was visibly leaking drug contents.
The patient was started on a bicarbonate drip but was too
hemodynamically unstable to be taken to the OR and died
about 5 hours after presentation.
Case 1067. A 26-year-old man celebrated his birthday
with a large amount of cocaine. He then ingested what
remained in his possession to avoid police arrest. He
presented to the ED with seizures, tachycardia, and a
temperature of 40.08C. He developed status epilepticus and
a temperature of 42.88C. Seizures could not be controlled
with intubation, ventilation, and benzodiazepine therapy. He
received vasopressors for hypotension. He subsequently
died. Postmortem analysis revealed a blood cocaine concentration of 1.2 lg/mL.
Case 1071. A 40-year-old man was found at home
banging his head against a wall. EMS was called to the
scene, but the patient had to be restrained with a stun gun.
He was a cocaine abuser. He was placed in a body bag
for restraint and transported. During transport, EMS noted
that he became unresponsive and asystolic. He received
CPR and had a pulse and blood pressure on arrival in the
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ED, where his core temperature was 39.78C. On evaluation, he was noted to have a wide complex rhythm
suspicious of hyperkalemia and treated as such. His laboratory evaluation revealed pH, 6.8; lactic acid, 13 mmol/L;
potassium, 7.9 mEq/L; and creatine kinase, 65 000 U/L.
He was unresponsive and stabilized. At some point
between ED presentation and admission to the ICU, the
patient died.
Case 1127. An 18-year-old woman was reported to have
taken about b8 hits of LSDQ earlier in the evening. She was a
college student and had a medical history of depression
treated with bupropion. No doses were missing by pill
count. She presented in the ED agitated, with hypertension
and tachycardia. In the ED, she had incomprehensible
speech, a heart rate of 200 beats per minute and possible
seizure activity. She was given 2 mg of lorazepam and had
decreased respiratory effort requiring intubation. Status
epilepticus developed, unresponsive to 2 mg of lorazepam
and a loading dose of phenytoin. While in the ED, her
temperature was 41.18C. She was admitted to the ICU with
intermittent seizure activity and started on a propofol drip.
She required intermittent vasopressor support for hypotension. Initially in the ICU, her seizures appeared controlled,
but continuous EEG showed return of seizure activity. No
further hyperthermia was noted. A lumbar puncture showed
no evidence of infection. The patient would irregularly have
spikes in blood pressure and was placed on esmolol, then
restarted on vasopressors when she was noted to be
hypotensive. On day 2, she had an extreme blood pressure
spike, and 1 pupil became fixed and dilated. No further EEG
activity was noted, although she was still having intermittent
autonomic instability. On day 3, she had bilateral fixed and
dilated pupils and no neurological responses and was
declared dead.
Case 1142. A 34-year-old man with a history of drug
abuse was arrested. While in police custody, he ingested a
bag which he said contained 0.25 oz of methamphetamine.
Three hours after the reported ingestion, he was taken to a
hospital. He was agitated and refused to cooperate with care.
He would not allow vital signs to be taken, although a heart
monitor revealed a pulse rate of about 140 beats per minute.
The patient was placed in 4-point restraints and sedated with
lorazepam and haloperidol. Activated charcoal and whole
bowel irrigation were administered via nasogastric tube.
IV fluid was given. A urine toxicology screen was positive
for amphetamines. Four hours after presentation, he had a
cardiac arrest and could not be resuscitated. Autopsy found
a plastic bag in the duodenum. Postmortem blood (heart)
contained methamphetamine at a concentration of 21 lg/mL
and amphetamine at a concentration of 0.38 lg/mL.
Case 1154. A previously healthy 14-year-old girl
reportedly ingested a single tablet of bdouble-stack valentineQ ecstasy with her friends at a sleepover. Approximately
1 hour later, she complained of a headache for which she
took 2 ibuprofen tablets. Over the next hour, her headache
continued, and she vomited. She was crying, and her friends
2004 AAPCC Annual Report
tried to calm her down by massaging her head and giving
her a bath. They also smoked some marijuana. They gave
her bread, milk, and water, but she vomited again. She
continued to vomit and bhad no control over her body,Q so
some older friends were called for advice. They arrived
about 4 hours after the ingestion and recommended giving
her water to drink. They tried to give her 10 to 15 cups of
water, but she kept vomiting and moaning. About 8 hours
after the ingestion, she had a convulsion, then began
moaning loudly and repeatedly. This awakened an adult
sleeping upstairs who entered the room and immediately
called 911. Paramedics found her unconscious, somewhat
combative, with minimal response to pain and incontinent
of urine. Vital signs were blood pressure, 160/120 mm Hg;
heart rate, 74 beats per minute; respiratory rate, 6 to
12 breaths per minute; and Glasgow Coma Scale, 6. Her
glucose was 164 mg/dL. She was taken to a local ED
where she was intubated without sedation. Initial laboratory
values were Na, 123 mEq/L; bicarbonate, 11 mEq/L; and
serum creatinine, 0.4 mg/dL. A head CT scan showed early
signs of cerebral edema. She was given dexamethasone and
mannitol and transferred to a tertiary care pediatric
hospital. On arrival at the second hospital, she remained
unresponsive with no spontaneous respirations. Her gag,
corneal, and cold caloric reflexes were all absent. A repeat
sodium value was 133 mEq/L. Hospital records do not
indicate her body temperature at the first hospital, but it
was 33.68C at the second hospital. She remained completely unresponsive over the next 2 days and was declared
brain-dead. Autopsy revealed cerebral swelling and herniation. Both hospital blood and urine samples were positive
for methamphetamine, amphetamine, and methylenedioxyamphetamine (MDA), but not MDMA. Her blood levels
of MDA and d-methamphetamine were 0.41 lg/mL and
0.04 lg/mL, respectively. One of the tablets was obtained
by the investigating police. It was described as pink and
shaped like a heart pierced by an arrow. It contained
only MDA.
Case 1156. A 29-year-old man came to the ED
complaining of neck and back pain. There was a questionable history of ecstasy use. Initial vital signs were blood
pressure, 145/90 mm Hg; heart rate, 120 beats per minute;
respiratory rate, 18 breaths per minute; and temperature,
36.58C. He was prescribed oral analgesics, then became
agitated and began screaming that the staff was trying to kill
him. He began convulsing and was treated with midazolam,
phenobarbital, and phenytoin. He was intubated and
admitted to the ICU, where he continued to seize despite
the anticonvulsants (including a midazolam infusion at
18 mg/h) and a propofol drip. His temperature climbed
steadily over the next several hours reaching 41.78C at
approximately 12 hours after admission. At this time, his
blood pressure was 98/33 mm Hg. A toxicology screen was
positive for benzodiazepines, amphetamines, and opiates. A
CT scan of his head and lumbar puncture were both normal.
He was transferred to a tertiary care hospital where he
665
continued to have seizure activity when the propofol drip
was reduced. His serum creatine kinase was 22 500 U/L. He
developed unstable temperatures (alternating hypothermia
and hyperthermia) and hypotension requiring vasopressors.
He expired 2 days after admission.
Case 1161. A 22-year-old quadriplegic man presented to
his local ED with a complaint of blurred vision almost
immediately after ingesting a small amount of b2C-T-21,Q
which he had recently purchased via the internet from a
chemical supply company. Later investigation revealed that
one third to three fourths of the contents from a vial
originally containing 1000 mg of phenylethylamine were
missing and presumably ingested. Initial vital signs were
heart rate, 132 beats per minute; blood pressure, 166/79 mm
Hg; temperature, 39.08C; and oxygen saturation, 98%. His
current medications included gabapentin, tizanidine, lansoprazole, melatonin, paroxetine, and oxybutynin. He quickly
developed frank hallucinations, seizures, and hyperthermia
to 42.28C. His pupils became fixed and dilated shortly
thereafter. A CT scan performed the next day revealed
cerebral edema and hemorrhage. Brain death was confirmed
on hospital day 2.
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