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ABSTRACT: Synthetic cannabinoid abuse is increasing in the United States. Synthetic cannabinoid exposures reported to Texas poison centers in 2010 were identified, and the distribution of exposures by selected factors was determined. There were 464 total cases. The number of exposures increased each month during January-July, then remained relatively constant for the next 5 months. The patients were 73.9% male and 57.3% were 20 years or older. Moderate or major effects or potentially toxic outcome occurred in 59.9% of the exposures. The most frequently reported clinical effects were tachycardia (37.3%), agitation (18.5%), drowsiness (18.5%), vomiting (15.7%), hallucinations (10.8%), and nausea (9.9%).
Journal of Addictive Diseases 10/2011; 30(4):351-8. · 1.46 Impact Factor
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Mathias B Forrester
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ABSTRACT: The combination of hydrocodone, carisoprodol, and alprazolam is subject to abuse. Ingestions of this drug combination reported to Texas poison centers during 1998-2009 were identified (totaling 1,295 cases) and the distribution of ingestions by selected factors was determined. The number of cases increased from 0 in 1998 to 200 in 2007, and then decreased to 132 in 2009. The counties in eastern and southeastern Texas accounted for 80.9% of the cases. Of the patients, 57.3% were women and 94.6% were age 20 or older. Suspected attempted suicide accounted for 59.3% of the cases and intentional misuse or abuse for 27.3%.
Journal of Addictive Diseases 04/2011; 30(2):110-5. · 1.46 Impact Factor
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Mathias B Forrester
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ABSTRACT: Triage guidelines for poison center management of atypical antipsychotic ingestions were published in December 2007. This investigation determined whether Texas poison centers already complied with a simplified version of these guidelines. All acute aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone ingestions reported to Texas poison centers during 2000-2007 were identified. Exclusion criteria were the presence of coingestants, patient already at or en route to a health-care facility when the poison center was contacted, and chronic ingestion. Each case was evaluated whether it was managed in compliance with the simplified triage guidelines and the compliance rate calculated. For 2,611 total cases, the compliance rate was 64.1%. The rate was 71.7% for aripiprazole, 43.6% for clozapine, 71.6% for olanzapine, 60.8% for quetiapine, 65.5% for risperidone, and 59.0% for ziprasidone. The majority of acute atypical antipsychotic ingestions reported to Texas poison centers were managed according to a simplified version of recommended triage algorithm.
Journal of medical toxicology: official journal of the American College of Medical Toxicology 12/2010; 6(4):403-7.
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Mathias B Forrester
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ABSTRACT: The objective of this study was to describe the pattern of pediatric carvedilol ingestions reported to poison centers.
Cases were all carvedilol ingestions by patients aged 0 to 5 years reported to Texas poison centers during 2000 to 2008. Multiple substance ingestions and patients not followed up to a final medical outcome were excluded. The distribution of cases by selected demographic and clinical factors was determined, and the mean dose (MD) in milligrams and milligrams per kilogram calculated for those cases where the dose ingested was reported.
Of a total 111 cases, the dose in mg was reported in 67 (mean, 18.2 mg; range, 0.3-200 mg) and in mg/kg was reported in 41 (mean, 1.5 mg/kg; range, 0.1-14.8 mg/kg). Of total cases, 63.1% were males and 36.9% females. The management site was as follows: 23.4% on site (MD, 7.8 mg and 0.6 mg/kg), 37.8% already at or en route to health care facility (MD, 22.7 mg and 2.6 mg/kg), and 38.7% referred to health care facility (MD, 22.1 mg and 1.6 mg/kg). The medical outcome as follows: 97.3% no effect (MD, 18.7 mg and 1.5 mg/kg), 1.8% minor effect (MD, 3.4 mg and 0.5 mg/kg), and 0.9% moderate effect. Adverse clinical effects were reported in 4 cases (3 drowsiness and 1 hypotension).
Pediatric ingestions of as much as 200 mg (14.8 mg/kg) reported to Texas poison centers might be expected to result in at most minor effects, although ingestions involving higher doses might be referred to health care facilities.
Pediatric emergency care 09/2010; 26(10):730-2. · 0.92 Impact Factor
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Mathias B Forrester
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ABSTRACT: Although thousands of iguanas are kept as pets in the United States, information on their bites is limited. The intent of this investigation was to describe the pattern of iguana bites reported to Texas poison centers. Iguana bites reported during 1998-2008 were identified. The distribution of cases by various factors was determined. Of 59 total bites, 71% were managed on-site, 17% of the patients were at or en route to a health care facility when the poison center was contacted, and 10% were referred to a health care facility. The medical outcome was no effect in 9% of the cases, minor effect in 24%, moderate effect in 2%, not followed but minimal effects possible in 64%, and unable to follow but potentially toxic in 2%. Most iguana bites reported to Texas poison centers did not result in serious effects and were managed on-site.
The American journal of emergency medicine 09/2010; 28(7):817-9. · 1.54 Impact Factor
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ABSTRACT: Poison control center data are used in research and surveillance. Due to the large volume of information, these efforts are dependent on data being recorded in machine readable format. However, poison center records include non-machine readable text fields and machine readable coded fields, some of which are duplicative. Duplicating this data increases the chance of inaccurate/incomplete coding. For surveillance efforts to be effective, coding should be complete and accurate. Investigators identified a convenience sample of 964 records and reviewed the substance code determining if it matched its text field. They also reviewed the coded clinical effects and treatments determining if they matched the notes text field. The substance code matched its text field for 91.4% of the substances. The clinical effects and treatments codes matched their text field for 72.6% and 82.4% of occurrences respectively. This under-reporting of clinical effects and treatments has surveillance and public health implications.
Journal of Medical Systems 08/2010; 34(4):499-507. · 1.13 Impact Factor
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ABSTRACT: Context. The utilization of poison center data for research and surveillance depends on the complete and accurate coding of the data. Objective. The intent of this study was to describe the coding that Texas poison centers used to identify calls relating to the recent H1N1 outbreak and the extent to which the coding accurately identified the calls. Methods. Cases were all H1N1 calls added to the six Texas poison centers' common database during April 28–September 30, 2009. Cases were selected by identifying all records that had the required H1N1 code or text in the FreeArea1, Substance Verbatim, or PoisIndex code fields or had the terms “swine” or “H1N1” anywhere within the Notes field. The proportion of fields that were coded correctly was determined for each field alone and all three combined and for each of the six poison centers and by 2-month period. Results. Of the 222 H1N1 calls identified, the FreeArea1 field was coded correctly in 67.1% cases, Substance Verbatim field in 73.9%, PoisIndex code field in 73.9%, all three fields together in 45.9%, and none of the three fields in 9.0%. Correct coding of all three fields ranged from 29.7 to 65.5% between the poison centers. All three fields were coded correctly in 49.7% of the April–May calls, 38.5% of June–July calls, and 29.6% of the August–September calls. Discussion. All three of the fields were coded correctly in less than half of the H1N1 calls; however, at least one of the fields was useful in identifying 91% of the calls. Correct coding rates varied widely between the poison centers and declined over time. Conclusions. Use of three different fields to code H1N1 calls identified the majority of such calls received. However, dependence on a single field would have missed a number of calls. This article has a commentary that should have been published alongside it: Poison center surveillance data: the good, the bad and … the flu. Karen E. Simone and Henry A. Spiller Clinical Toxicology, Vol. 48, No. 5: 415–417.
05/2010; 48(4):359-364.
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ABSTRACT: The utilization of poison center data for research and surveillance depends on the complete and accurate coding of the data.
The intent of this study was to describe the coding that Texas poison centers used to identify calls relating to the recent H1N1 outbreak and the extent to which the coding accurately identified the calls.
Cases were all H1N1 calls added to the six Texas poison centers' common database during April 28-September 30, 2009. Cases were selected by identifying all records that had the required H1N1 code or text in the FreeArea1, Substance Verbatim, or PoisIndex code fields or had the terms "swine" or "H1N1" anywhere within the Notes field. The proportion of fields that were coded correctly was determined for each field alone and all three combined and for each of the six poison centers and by 2-month period.
Of the 222 H1N1 calls identified, the FreeArea1 field was coded correctly in 67.1% cases, Substance Verbatim field in 73.9%, PoisIndex code field in 73.9%, all three fields together in 45.9%, and none of the three fields in 9.0%. Correct coding of all three fields ranged from 29.7 to 65.5% between the poison centers. All three fields were coded correctly in 49.7% of the April-May calls, 38.5% of June-July calls, and 29.6% of the August-September calls.
All three of the fields were coded correctly in less than half of the H1N1 calls; however, at least one of the fields was useful in identifying 91% of the calls. Correct coding rates varied widely between the poison centers and declined over time.
Use of three different fields to code H1N1 calls identified the majority of such calls received. However, dependence on a single field would have missed a number of calls.
Clinical Toxicology 05/2010; 48(4):359-64. · 2.22 Impact Factor
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Mathias B Forrester
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ABSTRACT: Although the multi-component weight loss supplement Redotex is banned in the United States, the supplement can be obtained in Mexico. The intent of this report was to describe the pattern of Redotex calls received by a statewide poison center system. Cases were all Redotex calls received by Texas poison centers during 2000-2008. The distribution of total calls and those involving ingestion of the supplement were determined for selected demographic and clinical factors. Of 34 total Redotex calls received, 55.9% came from the 14 Texas counties that border Mexico. Of the 22 reported Redotex ingestions, 77.3% of the patients were female and 45.5% 20 years or more. Of the 17 ingestions involving no co-ingestants, 52.9% were already at or en route to a health care facility, 41.2% were managed on site, and 5.9% was referred to a health care facility. The final medical outcome was no effect in 23.5% cases, minor effect in 5.9%, moderate effect in 11.8%, not followed but minimal clinical effects possible in 47.1%, and unable to follow but judged to be potentially toxic in 11.8%. Most Redotex calls to the Texas poison center system originated from counties bordering Mexico.
Human & Experimental Toxicology 02/2010; 29(9):789-91. · 1.31 Impact Factor
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Mathias B Forrester
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ABSTRACT: The purpose of this study was to describe the pattern of metaxalone ingestions by young children reported to poison control centers.
Cases were all metaxalone ingestions by patients aged 0 to 5 years reported to Texas poison control centers during 2000 to 2007. Cases with multiple substance ingestions and lack of follow-up were excluded. Cases were analyzed for selected demographic and clinical factors.
Of 148 total cases, 56.8% were boys. The distributions by management site were 56.1% on-site, 22.3% already at/en route to a health care facility, and 21.6% referred to a health care facility. Final medical outcomes were no effect for 90.5% cases, minor effect for 8.1%, moderate effect for 0.7%, and major effect for 0.7%. Specific clinical effects reported were drowsiness (11), vomiting (3), agitation (2), rash (1%), tachycardia (1), and ataxia (1).
Pediatric metaxalone ingestions reported to Texas poison control centers usually resulted in minor or no effect. Most ingestions did not require hospitalization.
Pediatric emergency care 01/2010; 26(1):15-8. · 0.92 Impact Factor
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Mathias B Forrester
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ABSTRACT: During serious influenza outbreaks, the number of oseltamivir exposures reported to poison centers might be expected to increase. This investigation describes the pattern of oseltamivir ingestions reported to Texas poison centers during 2000-2008. Of 298 total ingestions, 91.9% occurred in December-March, 76.8% involved patients aged 0-19 years, 72.5% resulted from therapeutic error, 90.0% were managed on-site, and 80.0% had no effect. The most frequently reported adverse clinical effects were vomiting (7.5%), nausea (3.8%), and abdominal pain (3.8%). Oseltamivir ingestions were reported to Texas poison centers primarily during periods of influenza outbreak. Most involved children, resulted from therapeutic error, and were managed on-site without serious outcome.
Human & Experimental Toxicology 12/2009; 29(2):137-40. · 1.31 Impact Factor
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Mathias B Forrester
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ABSTRACT: Few data exist on potentially adverse metaxalone (Skelaxin(R)) ingestions in adults. All metaxalone ingestions involving patients aged >or=20 years during 2000-2006 were retrieved from Texas poison control centers. Exclusion criteria were lack of follow-up or multiple substance ingestion. Cases were analyzed for selected demographic and clinical factors. Of the 142 patients, 66.2% were female. Dose ingested was reported for 61 patients. Of those cases with a reported dose, distribution by management site was 29.5% on-site, 59.0% already at/en route to health care facility, and 11.5% referred to health care facility. Final medical outcome was 'no effect' for 50.8% cases, 'minor effect' for 31.1%, and 'moderate effect' for 18.0%. The more common adverse clinical effects reported were drowsiness (27.9%), tachycardia (6.6%), agitation (6.6%), nausea (4.9%), dizziness (4.9%), slurred speech (4.9%), and tremor (4.9%). A moderate medical outcome occurred in 13.6% of ingestions of <or=2400 mg and 20.5% of ingestions of >2400 mg. Management involved a health care facility in 18.2% of ingestions of <or=2400 mg and 100.0% of ingestions of >2400 mg. This study found that adult ingestions of higher doses of metaxalone, particularly >2400 mg, were associated with more serious medical outcomes and were managed at health care facilities. This study also proposes triage guidelines for when ingestions can be safely managed at home.
Human & Experimental Toxicology 11/2009; 29(1):55-62. · 1.31 Impact Factor
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Mathias B Forrester
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ABSTRACT: On September 13, 2008, Hurricane Ike made landfall in Texas, resulting in the mandatory evacuation of 8 counties before landfall and the declaration of disaster areas in 29 counties afterward. This study evaluated whether Hurricane Ike affected the pattern of Texas poison center calls. Texas poison center calls received from the disaster area counties were identified for 3 time periods: August 12 to September 10, 2008 (preevacuation), September 11 to 13, 2008 (evacuation and hurricane landfall), and September 14 to 30, 2008 (postevacuation). For selected types of calls, the mean daily call volume during time periods 2 and 3 was compared with a baseline range (BR) derived from the mean daily call volume during time period 1. During the evacuation and landfall period, gasoline exposure calls were higher than expected (mean 3, BR -1 to 2). During the postevacuation period, higher than expected numbers of calls were observed for gasoline exposures (mean 5, BR -1 to 2) and carbon monoxide exposures (mean 3, BR -1-1). During an evacuation, certain calls such as those involving gasoline exposures may increase. After a hurricane, calls such as those involving carbon monoxide and gasoline exposures may increase.
Disaster Medicine and Public Health Preparedness 10/2009; 3(3):151-7. · 1.53 Impact Factor
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Mathias B Forrester
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ABSTRACT: Zolpidem is available in immediate-release (IR) and controlled-release (CR) formulations. This investigation examined whether there were differences in zolpidem IR and CR ingestions reported to poison control centers. Zolpidem ingestions that did not involve co-ingestants reported to Texas poison control centers during 2005-2008 were identified. The ingestions were grouped by IR and CR formulations and compared with respect to demographic and clinical factors. There were 734 IR and 163 CR ingestions. The mean dose ingested was 92.9 mg and 104.6 mg, respectively. IR and CR cases were, respectively, 56.9% and 58.3% male, 54.6% and 49.7% age >19 years, 65.0% and 65.0% already at or en route to a health care facility when the poison control center was contacted, and 30.1% and 39.3% involved no effect. The most frequently reported adverse clinical effects were, for IR and CR, respectively, drowsiness (54.4% vs 42.3%), tachycardia (10.6% vs 11.7%), ataxia (6.3% vs 11.7%), slurred speech (6.3% vs 6.7%), vomiting (5.0% vs 5.5%) and hallucinations/delusions (4.9% vs 3.1%). The distribution of zolpidem IR and CR ingestions reported to Texas poison control centers were similar. However, zolpidem CR ingestions appeared less likely to result in drowsiness and hallucinations but more likely to result in ataxia.
Human & Experimental Toxicology 09/2009; 28(8):505-9. · 1.31 Impact Factor
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ABSTRACT: Although 2% of exposures reported to U.S. poison control centers involve selective serotonin reuptake inhibitors (SSRI), many poison control centers do not have standardized guidelines for the management of these exposures. Recently, such guidelines were published, although the utility of these guidelines has not been evaluated. Cases evaluated in this study are all ingestions of SSRI alone reported to Texas poison control centers during 2000-2006. A simplified version of the published management guidelines triage algorithm was created, and the proportion of cases that were managed according to these guidelines was calculated. Of the total cases, 85% not already at/en route to a health care facility and 88% already at/en route to a health care facility were managed according to the simplified algorithm. The respective rate ranges were 82-89% and 83-90% among the 6 poison control centers and 77-86% and 80-90% among the 6 specific SSRI. The majority of ingestions of SSRI alone reported to Texas poison control centers during a recent 7-yr period were managed according to a simplified version of recommended triage algorithm. This was the case for all of the poison control centers and all of the specific SSRI.
Journal of Toxicology and Environmental Health Part A 02/2008; 71(5):304-9. · 1.83 Impact Factor
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Mathias B Forrester
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ABSTRACT: Little data exist on potentially adverse valsartan ingestions reported to poison control centers.
Using adult ingestions of valsartan reported to Texas poison control centers during 2000-2005, I determined the proportion of cases involving serious outcomes for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI).
Thirteen (7%) of 185 total cases involved serious outcomes. Serious outcomes were significantly more likely to occur with a maximum dose 320 mg (RR 9.06, CI 1.30-100.14) or 4 tablets (RR 9.00, CI 2.07-39.11) or where the circumstances of the exposures involved self-harm or malicious intent (RR 17.28, CI 4.98-67.13).
The severity of the medical outcome associated with adult valsartan ingestions depended on the dose and the circumstances of the ingestion. Such information is useful for creating triage guidelines for the management of adult valsartan ingestions.
Journal of medical toxicology: official journal of the American College of Medical Toxicology 01/2008; 3(4):157-63.
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Mathias B Forrester
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ABSTRACT: Review of the literature failed to identify any information on potentially adverse ingestions of the cholesterol-lowering drug gemfibrozil (GEM) reported to poison control centers. Data from Texas poison control centers were used to describe the pattern of isolated GEM ingestions reported during 2000-2005. A total of 118 cases were identified. The mean maximum dose ingested was 2407 mg (range 300-18,000 mg) or 3.3 tablets/capsules (range 1-30 tablets/capsules). The patient was male in 55% of the cases. The most common circumstances of the exposure were unintentional therapeutic error (49%), general unintentional (34%), and suspected attempted suicide (11%). The management site was on site (84%), already at/en route to a health care facility (10%), referred to a health care facility (5%), and other (2%). The ingestion considered potentially toxic in 3% of the cases and no deaths were reported. A specific adverse clinical effect was listed for 9% of the cases, being gastrointestinal (5%), neurological (3%), or cardiovascular (1%). A specific treatment was listed for 54% of the cases, most frequently decontamination by dilution (39%) or food (15%). Potentially adverse isolated GEM ingestions reported to poison control centers generally do not involve serious medical outcomes and are successfully managed at home with a favorable outcome.
Journal of Toxicology and Environmental Health Part A 01/2008; 70(24):2027-32. · 1.83 Impact Factor
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Mathias B Forrester
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ABSTRACT: Information on the management of potentially adverse exposures to clopidogrel is limited.
This study examined the distribution of 582 clopidogrel exposures reported to Texas poison control centers during 1998-2004.
Eighty-four percent of cases with a reported dose having a dose < or = 150 mg. Management of 65% of the exposures occurred on site. Of those exposures with a final medical outcome, 73% were classified as no effect. Of those exposures to clopidogrel alone, the most frequent adverse clinical effects were vomiting (2.4%) and dizziness (2.4%). The most frequent treatments were decontamination by dilution (30%), food (12%), and activated charcoal (7%).
In the majority of potentially adverse clopidogrel exposures reported to poison control centers the doses are twice the recommended dosage or less. The outcome of such exposures are generally favorable, with few adverse clinical effects occurring.
Clinical Toxicology 01/2008; 45(8):950-5. · 2.22 Impact Factor
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Mathias B Forrester
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ABSTRACT: Limited information exists on the toxicity of pediatric ingestions of the drug montelukast used in the treatment of chronic asthma. All ingestions of montelukast involving children age 0-5 yr reported to Texas poison control centers during 2000-2005 were retrieved. For a subset of cases where the final medical outcome and dose in milligrams or milligrams per kilogram were known, the pattern of exposures by final medical outcome and management site was evaluated. There was a total of 3698 cases. Of those cases with a known final medical outcome and dose, the mean dose in milligrams was 42.5 mg (range 0.4-536 mg) and the mean dose in milligrams per kilogram was 3.36 mg/kg (range 0.18-33.71 mg/kg). The final medical outcome was no observed effect in 95% of the cases and minor effect in the remainder of the cases. The patient was managed on site in 80% of the cases. The proportion of cases with a minor effect increased from 5% for ingested dose of < or = 100 mg to 10% for > 100 mg but was 5% for dose < or = 5 mg/kg and > 5 mg/kg. The proportion of cases managed with health care facility involvement increased from 15% for ingested dose of < or = 100 mg to 56% for > 100 mg and rose from 10% for dose < or = 5 mg/kg to 47% for dose > 5 mg/kg. Pediatric montelukast ingestions of doses up to 536 mg or 33.71 mg/kg do not appear likely to result in serious adverse effects and usually can be managed at home.
Journal of Toxicology and Environmental Health Part A 11/2007; 70(21):1792-7. · 1.83 Impact Factor
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Mathias B Forrester
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ABSTRACT: Eszopiclone is a nonbenzodiazepine hypnotic for the treatment of insomnia and classified as schedule IV controlled substance. Limited information exists on eszopiclone ingestions reported to poison control centers. The distribution of eszopiclone ingestions reported to Texas poison control centers during 2005-2006 was determined for various factors. In addition, triage guidelines for the management of such ingestions were drafted. Of 525 total eszopiclone ingestions, 259 involved coingestants. Of coingestant cases, 78.8% involved suspected attempted suicide and 90.7% were managed at a healthcare facility. Of 266 ingestions of eszopiclone alone, 40.2% were suspected attempted suicide and 62.0% were managed at a healthcare facility. A final medical outcome and dose ingested were known for 60 ingestions of eszopiclone alone. The mean dose was 28.3 mg (range 0.3-210 mg). Ingestions of eszopiclone alone of < or =6 and >6 mg differed with respect to the proportion involving suspected attempted suicide (0.0% versus 64.7%), final medical outcome of minor or moderate effect (38.5% versus 67.6%) and management at a healthcare facility (34.6% versus 91.2%). Using 6 mg as a threshold dose for referral to a healthcare facility, 78% of cases not already at/en route to a healthcare facility were managed according drafted triage guidelines.
Human & Experimental Toxicology 10/2007; 26(10):795-800. · 1.77 Impact Factor
