Initial postmarketing experience with crotalidae polyvalent immune Fab for treatment of rattlesnake envenomation.

STUDY OBJECTIVE: We describe our postmarketing experience with patients receiving Crotalidae polyvalent immune Fab (CroFab; FabAV) antivenom for treatment of rattlesnake envenomation. METHODS: The charts of 28 patients admitted between March 1 and September 9, 2001, with rattlesnake envenomation and treated with FabAV were reviewed for demographic information, time until antivenom treatment, laboratory findings, evidence of hypersensitivity reaction, length of hospital stay, and readmission to the hospital. RESULTS: All patients had swelling, 20 patients had elevated prothrombin times (\u3e14 seconds), 12 patients had low fibrinogen levels (/dL), and 6 patients had thrombocytopenia (platelet count \u3c120,000/mm(3)) on presentation. The total dose of FabAV ranged from 10 to 47 vials per patient. Hypofibrinogenemia was resistant to FabAV in some patients. On follow-up, recurrence of coagulopathy was detected in 3 patients, and recurrence of thrombocytopenia was detected in 1 patient. Two patients demonstrated delayed-onset severe thrombocytopenia. Recurrence or delayed-onset toxicity might have been underestimated because of incomplete follow-up in some patients. No acute hypersensitivity reactions occurred. Two patients reported mild symptoms of possible serum sickness on follow-up. CONCLUSION: FabAV effectively controlled the effects of envenomation; however, initial control of coagulopathy was difficult to achieve in some cases, and recurrence or delayed-onset hematotoxicity was common. When initially managing hematotoxicity, a trend toward normalization of laboratory values might be a more reasonable end point for FabAV treatment than attainment of normal reference values in nonbleeding patients

Clinical Features of Reported Ethylene Glycol Exposures in the United States

BackgroundEthylene glycol is highly toxic and represents an important cause of poisonings worldwide. Toxicity can result in central nervous system dysfunction, cardiovascular compromise, elevated anion gap metabolic acidosis and acute kidney injury. Many states have passed laws requiring addition of the bittering agent, denatonium benzoate, to ethylene glycol solutions to reduce severity of exposures. The objectives of this study were to identify differences between unintentional and intentional exposures and to evaluate the utility of denatonium benzoate as a deterrent.Methods and FindingsUsing the National Poison Data System, we performed a retrospective analysis of reported cases of ethylene glycol exposures from January 2006 to December 2013. Outcome classification was summed for intentionality and used as a basis for comparison of effect groups. There were 45,097 cases of ethylene glycol exposures resulting in 154 deaths. Individuals more likely to experience major effects or death were older, male, and presented with more severe symptoms requiring higher levels of care. Latitude and season did not correlate with increased exposures; however, there were more exposures in rural areas. Denatonium benzoate use appeared to have no effect on exposure severity or number.ConclusionDeaths due to ethylene glycol exposure were uncommon; however, there were major clinical effects and more exposures in rural areas. Addition of denatonium benzoate was not associated with a reduction in exposures. Alternative means to deter ingestion are needed. These findings suggest the need to consider replacing ethylene glycol with alternative and less toxic agents

Poison Control Center Data in the NC DETECT Syndromic Surveillance System

ObjectiveTo describe Carolinas Poison Control Center (CPC) calls datacollected in the NC DETECT syndromic surveillance system.IntroductionCPC provides the 24/7/365 poison hotline for the entire state ofNorth Carolina and currently handles approximately 80,000 callsper year. CPC consultation services that assist callers with poisonexposure, diagnosis, optimal patient management, therapy, andpatient disposition guidance remain indispensable to the public andhealth care providers. Poison control center data have been used foryears in syndromic surveillance practice as a reliable data source forearly event detection. This information has been useful for a varietyof public health issues, including environmental exposures, foodbornediseases, overdoses, medication errors, drug identification, drug abusetrends and other information needs. The North Carolina Departmentof Health and Human Services started formal integration of CPCinformation into surveillance activities in 2004. CPC call data areuploaded in real time (hourly), 24/7/365, to the NC DETECT statedatabase.MethodsCPC calls collected by NC DETECT from 2009-2015 wereanalyzed in this descriptive study. Counts of CPC calls wereexamined by year to assess total volume and changes over time, bymonth to assess seasonality, by geographic location, and call sitefacility and call originator. CPC calls were also categorized by type ofcall – exposure calls versus information calls – in order to determinewhy people call CPC and to assess if any trends exist amongst thesecategories.ResultsThe majority of CPC calls originate from the caller’s own residence(53.40%). The age groups most represented are 0-1 years old,2-4 years old, and 25-44 years old. Calls to CPC were for male andfemale patients in approximately equal numbers. The region of NCthat has the highest number of calls, by a fairly wide margin, is theCharlotte Metro region. In 2009, the total number of CPC calls wasover 120,000. This number decreased monotonically every yearfollowing, with the total in 2015 being 80,000. This is a 1/3 reductionin the total number of calls over 7 years. When the calls were analyzedby type of call, an interesting trend emerged. The total number ofexposure calls remained relatively constant over the time period,ranging from 64,000 to 68,000 per year. However, the total number ofinformation calls decreased each year going from just over 40,000 toonly about 5,000. When examined by month to assess seasonality, thedata show an increase in the number of calls beginning in Februaryand peaking in May, and then a steady and slow decline throughoutthe rest of the year.ConclusionsOur study shows that CPC consultations from callers with exposureshave remained stable over time. However, in the absence of exposure,fewer people call CPC for information on various substances. Drugidentification calls saw a decrease each year during the study timeperiod. In 2009 there were 34,495 drug identification calls and in2015 there were 5,722. This dramatic decrease in information callsis most likely due to the increased use of the internet and searchengines. Because people have more access to the internet, especiallyvia mobile devices, they may not feel the need to call CPC to obtaininformation

Poison Control Center Data in the NC DETECT Syndromic Surveillance System

ObjectiveTo describe Carolinas Poison Control Center (CPC) calls datacollected in the NC DETECT syndromic surveillance system.IntroductionCPC provides the 24/7/365 poison hotline for the entire state ofNorth Carolina and currently handles approximately 80,000 callsper year. CPC consultation services that assist callers with poisonexposure, diagnosis, optimal patient management, therapy, andpatient disposition guidance remain indispensable to the public andhealth care providers. Poison control center data have been used foryears in syndromic surveillance practice as a reliable data source forearly event detection. This information has been useful for a varietyof public health issues, including environmental exposures, foodbornediseases, overdoses, medication errors, drug identification, drug abusetrends and other information needs. The North Carolina Departmentof Health and Human Services started formal integration of CPCinformation into surveillance activities in 2004. CPC call data areuploaded in real time (hourly), 24/7/365, to the NC DETECT statedatabase.MethodsCPC calls collected by NC DETECT from 2009-2015 wereanalyzed in this descriptive study. Counts of CPC calls wereexamined by year to assess total volume and changes over time, bymonth to assess seasonality, by geographic location, and call sitefacility and call originator. CPC calls were also categorized by type ofcall – exposure calls versus information calls – in order to determinewhy people call CPC and to assess if any trends exist amongst thesecategories.ResultsThe majority of CPC calls originate from the caller’s own residence(53.40%). The age groups most represented are 0-1 years old,2-4 years old, and 25-44 years old. Calls to CPC were for male andfemale patients in approximately equal numbers. The region of NCthat has the highest number of calls, by a fairly wide margin, is theCharlotte Metro region. In 2009, the total number of CPC calls wasover 120,000. This number decreased monotonically every yearfollowing, with the total in 2015 being 80,000. This is a 1/3 reductionin the total number of calls over 7 years. When the calls were analyzedby type of call, an interesting trend emerged. The total number ofexposure calls remained relatively constant over the time period,ranging from 64,000 to 68,000 per year. However, the total number ofinformation calls decreased each year going from just over 40,000 toonly about 5,000. When examined by month to assess seasonality, thedata show an increase in the number of calls beginning in Februaryand peaking in May, and then a steady and slow decline throughoutthe rest of the year.ConclusionsOur study shows that CPC consultations from callers with exposureshave remained stable over time. However, in the absence of exposure,fewer people call CPC for information on various substances. Drugidentification calls saw a decrease each year during the study timeperiod. In 2009 there were 34,495 drug identification calls and in2015 there were 5,722. This dramatic decrease in information callsis most likely due to the increased use of the internet and searchengines. Because people have more access to the internet, especiallyvia mobile devices, they may not feel the need to call CPC to obtaininformation