Guest Blog: Dr. Mom on Poison Prevention

By Dr. Melissa Arca

Poison Prevention: Safety for Kids

Your age-by-age guide to keeping kids safe from medicines and household products

Unfortunately, more than 67,000 children are rushed to an emergency room annually for accidental ingestion or poisoning. As parents, we know the importance of keeping our kids away from potentially dangerous situations. But the reality is that kids are fast, curious, and impulsive. It truly is up to us as parents and healthcare providers to maintain vigilance, stay one step ahead, and continually educate our children on the importance of poison prevention.

Toddlers and preschoolers

Toddlers are a fast and curious bunch. We have all been through that infant to toddler stage where everything the child touches ends up in their mouths. They definitely taste first and ask questions later. That’s why it’s so important for parents of children under the age of 6 to remain vigilant and absolutely keep all medications and household chemicals up and out of reach.

Do not simply rely on the child-resistant containers that pills and vitamins come in. A recent study revealed that children as young as 3 had no problem opening these “child-resistant” caps. The best way to keep young children safe is to keep all medicines, vitamins, chemicals, and laundry detergents high and out of reach.

Contrary to popular belief, most of these young children are not climbing up to medicine cabinets and getting the medications there. They are finding them on floors, pillboxes left on countertops, and from Grandma’s or Mom’s purse.

A few practical tips for parents of toddlers:

·         Check floors daily for wayward pills or vitamins.

·         Never refer to medicine that your child has to take as “candy”.

·         Ask grandparents to keep their medicines high and out of reach when children are visiting.

·         Do not keep medications or vitamins in your purse. We all know how much toddlers love to “explore” them.

·         Be wary of detergent pods that can look like colorful candy to a young child.

·         Keep all medicines, vitamins, chemicals, and detergents locked and out of reach.

·         Do not let your child “play” with a medicine bottle or as a distraction while you’re doing something else.

·         Program the number for poison control into your phone and have it posted on the wall at home: 1-800-222-1222

School-age children

By now your child should have stopped putting everything in his/her mouth, but vigilance and education is still paramount. Talk to your child about never taking a pill, vitamin, or liquid without showing you and asking you first. Even a simple children’s multivitamin can be dangerous if a child takes too many. Tell your child that taking a medication when he/she doesn’t need it is not good for their bodies. No matter how good it tastes.

Continue to store medications and chemicals high and out of reach. Reinforce safety by talking to them about the dangers of ingesting an unknown substance.

Tweens and Teens

Just when you thought you were out of the woods once your toddler stopped putting everything in her mouth, well…your child becomes a teenager. And with that, comes some risk tasking and impulsivity. Parents of teens absolutely need to be in the know when it comes to dangerous teen trends and/or dares.

Take the cinnamon challenge for instance. Teens video tape themselves trying to swallow a heaping tablespoon of cinnamon without any liquid. This has resulted in numerous calls to poison control centers and a few teens having to be hospitalized for lung damage.

This is the age where we as parents and healthcare providers need to emphasize to teens that they should not use any household product or medication for anything other than its intended use. Teens may take cough medicine, parents’ prescription medication, or other prescription medications and abuse them.

This is not the time to let your guard down, parents. Know what medicines are in your home and keep them safely stored in a medicine cabinet or other designated place. Talk to your teens about the dangers of medication abuse, underage drinking, and things like the cinnamon challenge.

You are your child’s first defense against accidental poisoning.

And remember, if your child of any age has ingested any unknown/known medication, chemical, or detergent; do not hesitate to call poison control immediately. The experts on the other end of the line can tell you within seconds what to do and if you need to worry. Believe me; I’ve been on the other end of that line seeking their expertise and guidance both as a mother and as a pediatrician.

1-800-222-1222

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About Dr. Arca (from her blog Confessions of a Dr. Mom)

I am a board certified pediatrician, mom of two (ages 5 and 8), writer, blogger, and child advocate. I write and speak about all things parenting and children’s health and feel that being active in social media is an excellent way to educate parents, connect with them, and advocate for children. I strive to bridge the gap between the pediatrician in me and the concerns we all have as parents. My philosophy is simple: trust your instincts, advocate for your children, and enjoy (mostly anyway) this roller coaster that is parenting. Parenting is not an exact science, I’m right there in the trenches with you…learning as I go. So, you’ll often find my candid parenting moments along the way. This blog is truly the place where my two worlds of doctor and mom collide. I’m a practicing pediatrician who juggles work and family just like any other parent. I have the privilege of appearing regularly on KCRA the local NBC news affiliate, and author a weekly Dr.Mom column in The Sacramento Bee.

Education and Training

• Bachelor of Science from UCIrvine
• M.D. from USC Keck School of Medicine
• Pediatric Residency at Childrens Hospital Los Angeles
• Board Certified in Pediatrics
• Fellow of the American Academy of Pediatrics
• Member of the AAP Council on Communication and Media

The Over-The-Counter-High: A Story of OTC Medicine Abuse

Melanie Sawyer began abusing over-the-counter medicine at the age of 14. After suffering through the debilitating effects of OTC medicine addiction, she finally found redemption through rehabilitation. Now 22 years old, Melanie seeks to share her story in hopes that others can learn the devastating impact easily accessible, inconspicuous over-the-counter medicine can have on a young life.

The Over-The Counter-High: A Story of OTC Medicine Abuse

By Wafa Unus, AAPCC Media Fellow

“I didn’t realize that I was abusing it. I just liked the taste,” said Melanie Sawyer, a 22 year old Maryland resident whose over-the-counter medicine abuse led her through homelessness, prison and a mental institution.

Sawyer began abusing over-the-counter cough syrup around the age of 14. It went from taking a little bit extra to intentionally misusing it to get high.

Sawyer was an ordinary middle school kid. She took part in after-school clubs and activities and had a comfortable family life. Aside from struggling with a learning disability, Sawyer said her childhood wasn’t much different from her peers until she fell into the wrong crowd who offered her the life-altering information. “You can get high off of cough syrup,” they told her. She already liked the way it tasted and she knew exactly where she could find it, in her cabinet at home. For Sawyer, it was an easy good time that took the edge off of the turbulence of teen years.

OTC medicine abuse is a growing national concern.  Nearly 5 percent of teens admit to abusing cough medicine to get high, according to a 2012 National Institute on Drug Abuse (NIDA) survey.

“I would be in class, really high, feeling really good but not really knowing that I was doing something that was addictive and that it was going to cause problems down the road,” said Sawyer.

That road would prove to be littered with lies, deceit and personal tragedy. From middle school onward, Sawyer’s OTC drug abuse grew more serious as she switched from cough syrup to cough and cold tablets containing Dextromethorphan (DXM), a drug that chemically affects the part of the brain that controls coughing.

When abused, DXM causes effects akin to those of LSD or PCP, resulting in a high that includes hallucinations, hyper-excitability, lethargy, slurred speech and a rise in blood pressure.

During her freshman year in high school, Sawyer began to experiment with alcohol. It was only then that her behavior caught the attention of her parents, who began imposing the typical teenage restrictions: loss of privileges and groundings. As her behavior continued to spiral downward due to her continued use of over-the-counter medication, her parents turned to regular drug testing.

For Sawyer, who was now regularly stealing the tablets from local stores, drug tests were not a problem. DXM is not detected in most home drug tests and in any case, she often rigged the tests by obtaining urine samples from friends who were clean.

In retrospect she can’t understand her behavior. Her parents were trying the best they could, she said. She admitted her family wasn’t perfect and she felt an emotional void, but she knew they were struggling in their own way as well.

“They didn’t know how to handle some situations, and I don’t blame them,” said Sawyer.

OTC abuse raises a unique challenge for parents worried about their teen’s habits. Looking out for alcohol bottles and cigarette packets often distracts from seeing the inconspicuous pack of cough and cold medication.

“I was pretty much unaware [my addiction] was escalating. It was fun for the moment. Then, down the road something happened to me,” said Sawyer, a slight quiver in her voice.

Sawyer was sexually abused at the age of 16 and carried the secret with her for years before she felt she could share it with her parents. Her motivation for OTC drug abuse changed. No longer was she searching for a feeling of child-like euphoria. Sawyer began searching for a way to mask all feeling.

“It went from fun to just covering up my feelings, filling a void,” she said.

Filling that void meant sometimes taking about 30 cough and cold tablets over the course of a couple of days.

As her addiction escalated, Sawyer’s relationship with her family deteriorated. She was no longer living with her parents by the age of 18 and she found herself in between friends’ houses and stints in rehab. Meanwhile, she attended some college and worked. Finally, in 2010, Sawyer moved in with her sister who believed at the time that she had kicked her habit.

It was the day of her sister’s wedding that the effects of the cough and cold tablets took a nearly deadly turn. Sawyer fell into a coma and ended up missing the nuptials.

When she was discharged from the hospital, her sister refused to let her return to her home. Instead Sawyer found shelter with a friend. She continued to use and went from house to house, searching for the next friend who might lend her a couch to sleep on for a month or two.

After about four months, Sawyer’s mother, under the impression that Sawyer was no longer abusing OTC drugs, welcomed her daughter back into her home. Sawyer, still using but hiding it well, was eventually welcomed back into her sister’s home too.

Her charade only lasted a month or so and it wasn’t long before she found herself on the street again. Having exhausted the generosity of her friends and family Sawyer spent the week before her birthday homeless. Alone and disillusioned by the reality that she would spend her birthday homeless, Sawyer turned to hard liquor for comfort. The effects of the alcohol mixed with her OTC high. The events of the night are still a blur.

Sawyer recounted the pieces of that night. The rest, she said, was what the police had told her had happened.

She entered a house, assaulted a man in the home, destroyed over $1,000 worth of property and kicked the arresting police officers.

“I just wanted to go home. I wanted to go somewhere. I don’t remember that night. I just remember opening the door. I didn’t know what I was doing. I’ve never done anything like that in my life before,” she said.

Sawyer was incarcerated and spent the next 11 months in jail. That was when the withdrawal symptoms kicked in.

“I was hallucinating and hearing voices…I was out of my mind. I didn’t know what was happening,” she said. “At one point, I went under my bed and I felt like I had died there.”

Haunted by the images and voices of family members and loved ones, Sawyer felt trapped, forced to relive her past mistakes.

“I couldn’t get away from anything that I did. I was just going through my whole life story and having to hear it,” she said.

Still, Sawyer found comfort in the safety of her cell. The world that had consumed her was locked out and she was finally safe.

“I just knew from that moment that I was okay because I was away from everything negative.”

After 11 months in prison, Sawyer was moved to a mental hospital where she spent four months. Following that treatment she was admitted to a residential rehabilitation program in Maryland.

Currently in the program, Sawyer is no longer addicted to cough and cold tablets. She attends regular, mandatory substance abuse and mental health meetings, three times a week. In addition she works with a sponsor and attends consistent therapy sessions.

Sawyer admits that the desire to feel the high isn’t completely gone; it’s locked away so that she may remain free.

“I am always going to have [that] thought, to want to use, but as long as I don’t go forth with that thought, I’ll be okay,” said Sawyer. “The lucky ones break away…”

Sawyer is confident she’s a lucky one.

Many people are unaware of the dangers of over-the-counter medicine. If you or someone you know is struggling with OTC abuse, contact your local poison center.

The American Association of Poison Control Centers supports the nation’s 57 poison centers in their efforts to prevent and treat poison exposures. Poison centers offer free, private, confidential medical advice 24 hours a day, seven days a week. We take calls in more than 150 languages and from the hearing impaired. For questions about poison or if you think someone has been exposed to a poison, call 1-800-222-1222 to reach your local poison center. 

Poisons in the News: Anhydrous Ammonia

By Wafa Unus

Poisons in the News: Anhydrous Ammonia

Last night, an enormous explosion shook the small town of West, Texas when a fertilizer plant caught fire and exploded. At least 5 people were killed and an estimated 150 more were injured. The blast leveled nearby homes and businesses, with its impact visible within a five block radius of the blast site.

As emergency personal continue their search and recovery efforts, poison center experts are prepared to respond to the health impact of the release of anhydrous ammonia, a potentially poisonous gas released by the fertilizer plant. While the explosion was massive and uncommon, poison center experts don’t expect exposure to the gas to be the primary cause of injury, according to Henry Spiller, managing director of the Central Ohio Poison Center. “Most of the injuries were from the actual blast,” he said.

What is Anhydrous Ammonia?

Anhydrous ammonia is a gas used as a low-cost nitrogen-based fertilizer. Its effectiveness makes it a popular choice for industrial plants. However, exposure can cause serious danger in certain conditions.

Anhydrous means “without water.” When used as a fertilizer, it is injected into soil in a liquid form. When it makes contact with the moisture in the soil, the water combines with the ammonia rapidly and becomes a gas. This gas is then easily absorbed into the soil.

When the anhydrous ammonia mixes with water, it becomes the highly corrosive compound ammonium hydroxide. It’s the exposure to ammonium hydroxide that poses a potentially serious danger when inhaled.

Low levels of exposure are generally more an annoyance than anything else. Those exposed may feel irritation in their throat or eyes. However, high exposures to anhydrous ammonia can be fatal. The highly corrosive nature of ammonia can cause the body to physically close airways, ultimately leading to severe and potentially fatal respiratory distress.

Exposure Risks

A number of factors contribute to the danger of exposure to anhydrous ammonia. Distance and concentration are primarily responsible for severe reactions. Because of the nature of the anhydrous ammonia vapors to move closer to the ground, low-lying areas such as valleys can see a fatally high concentration of the gas in the event of a chemical release.

Exposure to high concentrations of the gas is also not highly likely in situations like the one in West, Texas where, the geography of the region is fairly flat. “[Anhydrous ammonia] is a highly reactant gas…It becomes another substance once it combines with water. It doesn’t stay at high concentrations,” said Dr. Cynthia Lewis-Younger, medical director at the Florida Poison Information Center in Tampa. “The main concern is [for] people who already have respiratory concerns.”

Those who have been exposed to anhydrous ammonia may begin to have difficulty breathing, irritation of the eyes, nose and throat as well as see burns and blisters.

“In very rare cases [the effects of exposure] can be long term. It can cause an asthma-like disease process. That’s pretty infrequent [and] is only if there was really severe exposure. Ninety-nine percent of [those exposed] will get better,” Spiller said.

Poison center experts encourage those in the affected regions to stay indoors with windows and doors closed to cut down on exposure and limit activity that would contribute to an increased respiratory rate such as running.

For more information about anhydrous ammonia or if you think you may have been exposed to anhydrous ammonia please contact your local poison center at 1-800-222-1222.

 

 

Poisons in the News: Ricin

By Wafa Unus

Two envelopes recently sent to federal elected officials, including the President, have tested positive for the deadly poison ricin.

According to news reports, preliminary tests have determined the identity of the poison but a full analysis takes between 24 to 48 hours.

This is not the first ricin poison attempt made on the Capitol. In 2004, a letter sent to then-Majority Leader Bill Frist’s office was found to be laced with the poison. As a result 16 employees were required to be decontaminated. Thankfully, no one became ill.

Ricin is a particularly concerning poison because of the ease by which it can be made and the potency of the toxin. An amount the size of a grain of salt can kill an adult.

Derived through the production of oil from castor beans, ricin is a waste product that, when purified, can be deadly.

Pure ricin, its most toxic form, is harder to produce. However, impure versions of the poison can easily be made. And, with more than 1 million tons of castor beans being processed per year, producing 5 to 10 percent ricin, the poison isn’t hard to come by.

How it Works

Ricin poisoning affects the body much like other poisons. When it enters the cells of the body by being inhaled, eaten or through skin and eye exposure, it blocks the body from making necessary proteins that the body needs to survive. As a result, the cells die, eventually causing the entire body to shut down.

It can take as little as four hours for symptoms to appear and 36 hours for fatality if the exposure is high enough.

Because there is no antidote for ricin poisoning, prevention is essential.

How Great is the Danger?

The toxin is most deadly if injected in its purified form. That’s what authorities say happened to Bulgarian journalist Georgi Markov in London in 1978. He died after being poked by a modified umbrella that housed an injector in its tip that contained ricin.

In the 1940s, the United States even considered using ricin as a biowarfare agent.

However, “home-brewed” ricin, the most commonly found version used in pervious poison attempts, is not particularly potent and has little potential to become a major threat, according Dr. Eric Toner of the Center for Biosecurity at the University of Pittsburgh Medical Center in an interview with NBC news.

Still, the United States government and many prominent entities have adopted strict screening procedures to prevent the delivery of toxic mail, following the 2001 anthrax attacks when anthrax-laced envelopes containing highly purified spores killed five and sickened 13 others.

For more information about ricin and its affects, watch this short video featuring Kansas University Hospital Poison Control Center Medical Director Dr. Stephen Thornton.
If you have questions about ricin, or any other toxic substance, contact your local poison center for free, expert information. 1-800-222-1222.

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