Overview

Introduction

Based on the data from the 2012 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 30th Annual Report, there are over 2 million* human exposures reported per year to participating poison centers. Of these reported exposures, over 80% were by ingestion.

It is interesting to note that over 90% of the reported poisonings occurred at home. Children under 6 accounted for nearly 50% of cases but less than 2% of the fatalities. In fact, the annual number of pediatric poisoning deaths in the US has generally numbered in the 20's over the last 10 years. This is due to the unintentional nature of the event coupled with the success of poison prevention campaigns, childproof packaging and limitations on numbers of pills per bottle of children's OTC pharmaceuticals. Approximately 70% of the cases are managed on site (usually at home) with about 27% treated in a healthcare facility.

Childhood medical exposures are on the rise. For an in-depth look at this problem, please read the following SAFE KIDS Worldwide™ report, "An In-Depth Look at Keeping Young Children Safe Around Medicine".

There are relatively few specific antidotes in the treatment of poisoning; in fact, many of these are toxic themselves. Most poisoning treatment consists of decontamination and general support/stabilization. In recent years there has been a major trend away from attempting to empty the stomach (by ipecac or stomach tube) since these measures are usually instituted too late to have much benefit and are associated with potential risk. Ipecac, once regarded as the poison treatment which  every family had in their medicine chest, is no longer recommended.  It does a poor job of emptying the stomach and has the additional disadvantage of leaving the patient nauseated so that the decontaminant of choice, activated charcoal, cannot be administered.

*Note: The NPDS represents only reported exposures. The actual number is unknown.

ACTIVATED CHARCOAL HAS EMERGED AS THE PREFERRED TREATMENT FOR MOST POISONINGS

Activated charcoal is recommended in the vast majority of toxic ingestions. The exceptions are poisoning due by hydrocarbons, caustics, cyanide and metals such as iron and lithium.

What has also become increasingly apparent in the last ten years is the more focused use of activated charcoal. In most cases, it is not recommended for ingestions over one hour old - the exception being ingestants that slow gi motility. This has raised the interest in activated charcoal for home use – and there are many advocates for this – if there were a palatable product.