Allister Vale

Introduction Automatic dishwashing rinse aids are drying aids which contain non-ionic surfactants, usually ethoxylated alcohols, typically at concentrations of ≤30%. Objective To assess the reported toxicity of rinse aids. Methods Telephone enquiries to the UK National Poisons Information Service were analysed from January 2008 to June 2019. Res...

Introduction Detergents used in automatic dishwashing machines are of two main types: traditional tablets that require removal from an external wrapper and newer soluble film tablets. Objective To determine the toxicity of automatic dishwashing tablets. Methods Telephone enquiries to the UK National Poisons Information Service were analysed for t...

Poisoning is usually an acute, short-lived event which necessitates immediate care, though complications such as rhabdomyolysis may persist for a few days. Less commonly, symptoms may arise only after prolonged exposure, as occurs with many heavy metals. Rarely, sequelae may not occur until many years after exposure (e.g. with vinyl chloride). It m...

Introduction: Liquid laundry detergent capsules (also called single-use detergent sacs; laundry pods; laundry packets) have become an increasingly popular household product worldwide. Objectives: To review the composition and mechanisms of toxicity of liquid laundry detergent, capsules, and the circumstances, routes, clinical features (and impact o...

Introduction: Liquid laundry detergent capsules contain concentrated liquid laundry detergent in a water-soluble polyvinyl alcohol membrane. Objective: To review 4652 exposures reported to the United Kingdom National Poisons Information Service (NPIS) and to assess the impact of regulatory changes on potential toxicity. Methods: Telephone enquiries...

Introduction: Sodium hypochlorite is used as a bleaching and disinfecting agent and is commonly found in household bleach. Objective: The objective is to review critically the epidemiology, mechanisms of toxicity, clinical features, diagnosis, and management of hypochlorite poisoning. Methods: PubMed was searched from January 1950 to June 2018 usin...

Background: Accidental drug overdose is a common problem in young children. We examined the influence of formulation and dose in enquiries for different gastro-oesophageal reflux disease treatments in children under 5 years to the UK's National Poisons Information Service. Methods: Overdose characteristics with ranitidine, omeprazole or domperid...

This paper will review Winston Churchill's severe respiratory illness in March 1886 when he developed pneumonia of the right lung as an 11-year-old boy. Winston was treated supportively with ‘nourishment, stimulants [probably alcohol] and close watching’ at his school by the ‘celebrated’ family physician, Dr Robson Roose, with the assistance of Dr...

This paper reviews Churchill’s illnesses in February 1943 and August/ September 1944 when he developed pneumonia; on the first occasion this followed a cold and sore throat. Churchill was managed at home by Sir Charles Wilson (later Lord Moran) with the assistance of two nurses and the expert advice of Dr Geoffrey Marshall, Brigadier Lionel Whitby...

While staying in the White House over Christmas 1941, Churchill developed chest pain on trying to open a window in his bedroom. Sir Charles Wilson, his personal physician, diagnosed a 'heart attack' (myocardial infarction). Wilson, for political and personal reasons, decided not to inform his patient of the diagnosis or obtain assistance from US me...

Objective: To determine the toxicity of rinse aids which are used as drying aids to remove water from crockery. Methods: Enquiries to the UK National Poisons Information Service (NPIS) were analysed retrospectively for the period January 2008 to December 2016. Results: There were 855 enquiries relating to 828 patients; children aged 5 years or less...

This paper reviews Churchill’s illness in Carthage in December 1943. It was characterised by fever that lasted 6 days, left lower lobe pneumonia and two episodes of atrial fibrillation. He was managed in a private villa by Lord Moran, his personal physician, with the assistance of two nurses and the expert advice of colleagues. Sulphadiazine and di...

Organophosphorus (OP) insecticides are used widely in agriculture, horticulture, and veterinary medicine. These insecticides also are used domestically and in public hygiene to control vectors of disease. Some OP compounds (e.g., malathion) are used to treat human infestation with scabies, head lice, and crab lice. Some 200,000 people die annually...

Chlorophenoxy herbicides (phenoxycarboxylic acid herbicides) are weed killers that act as synthetic auxins (plant “hormones”) and cause plant death by disrupting nutrient transport and growth. Most cases of serious poisoning involve deliberate ingestion. The pathophysiology of toxic effects involves dose-dependent call membrane damage, uncoupling o...

This Chapter reviews the mechanisms of action, efficacy, dosing and adverse effects of the oximes, pralidoxime, obidoxime and HI-6, used to treat organophosphorus insecticide and nerve agent poisoning.

Introduction: Oven cleaning products contain corrosive substances, typically sodium or potassium hydroxide. Objective: To determine the reported toxicity from exposure to oven cleaning products. Methods: Telephone enquiries to the UK National Poisons Information Service regarding oven cleaning products were analysed retrospectively for the period J...

Context: Grout, tile and floor stone sealants contain a solvent, a water-repelling agent and in the case of aerosols a propellant. The water-repelling agent used is typically a fluoropolymer resin, a silicon-based resin, or a combination of both. Objective: To report the clinical course in patients exposed to fluoropolymer-containing sealants refer...

Background: Automotive screenwashes commonly contain ethylene glycol, methanol, and/or isopropanol; ethanol is also included in many formulations. The concentrations and combinations of each constituent vary considerably between the products. This study was undertaken to investigate the toxicity of automotive screenwashes as reported by telephone...

Introduction: Mexedrone, 3-methoxy-2-(methylamino)-1-(4-methylphenyl)propan-1-one, is the alpha-methoxy-derivative of mephedrone (4-methyl-N-methyl cathinone). Mexedrone inhibits the re-uptake of serotonin and dopamine in a dose-dependent manner and has affinity for serotonin and dopamine membrane transporters and receptors (5-HT2 and D2 receptors)...

Introduction: Although the majority of those exposed to liquid laundry detergent capsules remain asymptomatic or suffer only minor clinical features after exposure, a small proportion develop central nervous system depression, stridor, pulmonary aspiration and/or airway burns following ingestion or conjunctivitis and corneal ulceration following ey...

Introduction: Traditional automatic dishwashing tablets are contained within an external wrapper that requires removal prior to use. Objective: To determine the toxicity of traditional tablets and to compare this with our previously reported experience of soluble film dishwashing tablets. Methods: Telephone enquiries regarding traditional tablets w...

Context: Kinetic models could assist clinicians potentially in managing cases of lead poisoning. Several models exist that can simulate lead kinetics but none of them can predict the effect of chelation in lead poisoning. Our aim was to devise a model to predict the effect of succimer (dimercaptosuccinic acid; DMSA) chelation therapy on blood lead...

Aims: Case reports and small case series suggest increased Central Nervous System (CNS) toxicity especially convulsions, after overdose of mefenamic acid, compared with other NSAIDs, but comparative epidemiological studies have not been conducted. This study compared rates of CNS toxicity after overdose between mefenamic acid, ibuprofen, diclofena...

Context: No kinetic models presently exist which simulate the effect of chelation therapy on lead blood concentrations in lead poisoning. Objective: Our aim was to develop a kinetic model that describes the kinetics of dimercaptosuccinic acid (DMSA; succimer), a commonly used chelating agent, that could be used in developing a lead chelating model....

Introduction: Soluble film automatic dishwashing tablets, unlike their traditional counterparts, require no removal from an outer protective wrapper prior to use. Instead, the tablets are enclosed by a water-soluble polyvinyl alcohol film and are loaded straight into the dishwashing machine. They most commonly contain a source of hydrogen peroxide...

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Objective Accidental poisoning in young children is common, but severe or fatal events are rare. This study was performed to identify the number of such events occurring in the UK and the medications that were most commonly responsible. Design Analysis of national data sets containing information relating to severe and fatal poisoning in children i...

Background A 2010/2011 audit of the Royal College of Emergency Medicine (RCEM) National Poisons Information Service (NPIS) UK guidelines on antidote availability demonstrated variable stocking of antidotes for the management of poisoned patients; the guidelines were updated and republished in 2013. Aim To assess if antidote stocking has improved si...

Context: Toxicity from the use of synthetic cannabinoid receptor agonists (SCRAs) has been encountered increasingly frequent in many countries. Objective: To characterise presentation rates, demographic profiles and reported clinical features for users of SCRAs referred by health professionals in the United Kingdom to the National Poisons Inform...

Substantial ingestion of an anticoagulant can result in haemorrhage into any internal organ; severe blood loss can result in hypovolaemic shock, coma and death. If active major bleeding occurs, dried prothrombin complex 25-50 units/kg and phytomenadione 10-20 milligrams intravenously (250 micrograms/kg body weight for a child) should be given.

Generally, phenytoin and carbamazepine have greater toxicity in overdose than sodium valproate and the newer anticonvulsants, although case reports confirm that severe toxicity can uncommonly occur.

β-Adrenoceptor blocking drugs exert their toxic effects in overdose not only by blocking β1- and β2-adrenoreceptors, but also by their blockade of sodium channels. Patients severely poisoned with β-adrenoceptor blocking drugs develop hypotension, marked bradycardia, coma, convulsions and intraventricular conduction defects. Glucagon has been the tr...

Objective: The objective of this study is to review the reported toxicity of reed diffuser fragrance liquid which, in addition to essential oils, commonly contains glycol ethers but other ingredients and/or alternatives are 3-methoxy-3-methyl-1-butanol, petroleum distillates, ethanol and isopropanol. Methods: We analysed retrospectively enquirie...

Initial management involves the treatment of any potentially life-threatening conditions, such as airway compromise, breathing difficulties, haemodynamic instability and serious dysrhythmias. Thereafter, convulsions should be treated, fluid, acid–base and electrolyte abnormalities corrected, and measures taken to correct hypothermia or hyperthermia...

Household products are generally ingested accidentally by children. In developing countries more toxic agents are available in a domestic setting, but in the developed world serious toxicity is rare.

Sarin and VX were released on civilians in Japan on 11 occasions in the period 1994-1995. Clinicians must be prepared, therefore, to treat casualties from nerve agent exposure. This requires an understanding of the mechanisms of nerve agent toxicity and the factors that influence their clinical impact. Clinicians need to be able to make a rapid and...

Assessment of an acutely poisoned patient involves taking an appropriate history, assessing the level of consciousness, ventilation and circulation, undertaking a physical examination, and requesting appropriate toxicological and non-toxicological investigations. Diagnosis is based on the history, circumstantial evidence (if available), a cluster o...

Antidotes exert their beneficial effects by a variety of mechanisms, including forming an inert complex with the poison, accelerating detoxification of the poison, reducing the rate of conversion of the poison to a more toxic compound, competing with the poison for essential receptor sites, blocking essential receptors through which the toxic effec...

There is no evidence that the use of single-dose activated charcoal, gastric lavage, syrup of ipecacuanha, cathartics or whole-bowel irrigation improves the clinical outcome in poisoned patients. However, activated charcoal and gastric lavage can be considered in patients who have ingested life-threatening amounts of a toxic agent up to 1 hour prev...

Paracetamol poisoning is common. If untreated, liver and/or renal failure can develop. The administration of acetylcysteine within 8-10 hours of overdose will minimize or prevent hepatic damage and ensure survival irrespective of the magnitude of the ingestion. Important prognostic factors are the international normalized ratio, pH and plasma creat...

Both organophosphorus (OP) and carbamate insecticides inhibit acetylcholinesterase (AChE), which results in accumulation of acetylcholine (ACh) at autonomic and some central synapses and at autonomic postganglionic and neuromuscular junctions. As a consequence, ACh binds to, and stimulates, muscarinic and nicotinic receptors, thereby producing char...

Introduction: Acetylcholinesterase inhibition by organophosphorus insecticides can cause acute parasympathetic system dysfunction, muscle weakness, seizures, coma, and respiratory failure. Prognosis depends on the dose and relative toxicity of the specific compound, as well as pharmacokinetic factors. Methods and outcomes: We conducted a systema...

Background: Poisoning with methanol and ethylene glycol can cause serious morbidity and mortality. Specific treatment involves the use of antidotes (fomepizole or ethanol) with or without extracorporeal elimination techniques. Methods: A prospective audit of patients with methanol or ethylene glycol poisoning reported by telephone to the Nationa...

In 2012, of 675,800 pregnant women screened in England, 1,310 (0.19%) were HIV positive. Of all children born to HIV-infected women in the UK between 2005 and 2011, an estimated 2% became infected with HIV, although the transmission rate of HIV among children born to women with diagnosed HIV infection was under 1%. In order to prevent vertical tran...

Objective: To characterise the patterns of presentation and clinical features of toxicity following reported recreational use of benzofuran compounds ((2-aminopropyl)-2,3-dihydrobenzofurans) in the UK, as reported to the National Poisons Information Service (NPIS), and to compare clinical features of toxicity with those after reported mephedrone u...

Objective: 2,4-Dinitrophenol (DNP) increases energy consumption by uncoupling oxidative phosphorylation. Although not licensed as a medicine, it is sometimes used by 'body sculptors' and for weight loss as a 'fat burning' agent. This research was performed to characterise patterns of presentation, clinical features and outcomes of patients reporte...

This chapter deals with analgesics, the most frequent drugs ingested in self-harm episodes in the UK. This is because they are widely available for sale, both in pharmacies and other retail outlets, and are widely prescribed. Paracetamol is the commonest single cause of poisoning seen in the UK, and of acute liver failure in Europe and North Americ...

Household products are a common cause of telephone calls to poisons centres, and usually follow an accident involving young children who have been exposed to such material while playing at home. Occasionally, confused elderly patients may inadvertently ingest detergents or antiseptics. Considering how many such products are available serious toxici...