Mar 18th 2017 by salad-daze • 39 Questions • 44 Points
Hello Reddit! We are pharmacist, nurse and physician toxicologists and poison specialists at the National Capital Poison Center in Washington DC. It’s hard to imagine what people swallow, splash, or inhale by mistake, but collectively we’ve responded to more than million phone calls over the years about….you name it!
National Poison Prevention Week (March 19-25) is approaching. Take a few minutes to learn how to prevent and respond to a poison emergency. Be safe. AMA!
There are two ways to get free, confidential, expert help if a poisoning occurs:
1) Call 1-800-222-1222, or
You don’t have to memorize that contact info. Text “poison” to 484848 (don’t type the quotes) to save the contact info directly to your smart phone. Or download our vcard.
The National Capital Poison Center is a not-for-profit organization and accredited poison center. Free, expert guidance for poison emergencies – whether by telephone or online – is provided 24/7. Our services focus on the DC metro area, with a national scope for our National Battery Ingestion Hotline (202-625-3333), the webPOISONCONTROL online tool, and The Poison Post®. We are not a government agency. We depend on donations from the public.
Now for a bit of negative advertising: We hope you never need our service! So please keep your home poison safe.
Hey Redditors, thank you for all your amazing questions. We won't be taking any new questions, but will try to get to as many of the questions already asked that we can.
I guess... What's the weirdest [request/person/event/police encounter/bug infestation]?
What is the wildest / Funniest call you guys have gotten?
Fortunately no police encounters or bug infestations, but I've seen some lizards sneak in on plants that have come in and worked in a shop with a mold issue and rats in the basement. Might not sound weird but I've had a lot of people ask if the flowers the flowers are organic/edible. They definitely aren't. Had a guy who was stalking his ex order like $800 worth of flowers (including delivery) to send flowers everyday of the week. She rejected them on the first day and with out no refund policy he ended up buying $800 worth of gardening supplies for his yard.
A family called us after attending a funeral where the corpse spontaneously exploded. They were worried that they might explode too. Jess Benson, Pharm.D., DABAT
Has anyone ever wanted something so explicit written on the card that you couldn't do it?
Have you ever had someone call in trying to inquire which home substance would make the best poison for criminal intentions?
I've definitely seen some weird ones but nothing super offensive. More awkward to read like "I love you. Xx your monkey butt". We've had a few where the message it myself isn't creepy, but we get a call from the recipient to asking us to take the flowers back because they're from a stalker. My favorite was a card that said, "We still think your face is the prettiest. Love Mom and Dad" I took the order and the flowers were to cheer her up after a bike accident.
Yes. Tony Hillerman's son (Tony Hillerman is a famous mystery author) once called to run a few poisons by us. He was helping his dad at the time. I was also asked to give a talk to a group of aspiring authors about qualities of the perfect poison. If you are interested in this topic I recommend a book called "Criminal Poisoning: Investigational Guide for Law Enforcement, Toxicologists, Forensic Scientists, and Attorneys (2nd ed.)" by John Trestrail III. Jess Benson, Pharm.D.
What's the best flower to buy for a significant other? I ask for potential future reference
if Poison ever reunites how will you respond?
There are so many options! I feel like I'd just be giving you my top picks. I'd say pretty much anyone would be impressed by a peony or tulip, but there are plenty more unusual options. Ranunculus, dahlias, and anemones are gorgeous and a little less traditional but still somewhat easy to find. Then again plenty of people appreciate something traditional like a red rose. But again so many options and most people would be touched by the thought put into picking out any flower.
"Life Goes On", We'll Have "Nothin' But a Good Time"! By the way, if you inhale too much hairspray, call Poison Control. P Soto, PharmD
Ingestion, or eating something is probably the most common, but people can be poisoned through the skin, by inhaling fumes, and eye injuries can occur from chemicals being splashed in the eye. Poisoning can occur from injecting drugs in the vein. The most common poisonings are due to medications found in the home.
Do I really need to call poison control if my kid swallows toothpaste? Why can't we come up with a toothpaste that is edible?
Absolutely, it's always prudent to call Poison Control if your child swallows toothpaste (or anything else that he/she wasn't supposed to), but in general small amounts of fluoride-containing toothpastes (ex: less than a mouthful) in children are typically well tolerated. In these cases we usually only see some mild stomach upset or an episode of vomiting. Obviously, larger amounts of toothpaste ingested (especially Rx strength) can be problematic in children. However, there are toothpastes out there that are “safer to swallow”, that do not contain fluoride. They typically contain sorbitol, which may only cause some loose stools.
RP, PharmD, MPH, CSPI
So I was on my bed last night getting tired and downs comes the biggest spider in my life a couple feet away from me. My first instinct is oh shit, then I try and look for my Guinness world records book to kill it as it's rappeling down. Long story short, I couldn't find the book and I just stared at it while it made its way down to the side of my bed, where I lost it and still can't find it. I found some Raid bug spray and sprayed it under my bed andon the sides of it. The window was wide open.
Question: How much Raid would be needed to end up in the ER or to be on the phone with you guys?
That is a common scenario. Folks get scared by something and in their panic they use a chemical to try to kill the insect (bees are common as well as spiders). You can certainly try to look it up on webPOISONCONTROL, but if you don't feel comfortable please call us and we'll help you sort it out. You don't have to think you are seriously poisoned to make the phone call. And some people are surprised that many accidental exposures often don't cause serious injury. Sometimes when you are in panic mode it's best to talk to a specialist at poison control, because we are great at calming our callers down.
Don't know whether it's good or bad that we aren't a government agency, but we are not. We're a 501(c)(3) charitable organization. Sadly, the National Capital Poison Center is projecting a budget deficit of $2.2 million - of a total cost of just over $5 million/year. About half of our funding is from state government grants. The rest is philanthropy.
Mr. Yuk, with his green scowly face, was first introduced in 1971 by the Pittsburgh Poison Center and was used in parts of the US. There was some concern that the application of Yuk stickers to products attracted children to the products. In about 2002 there was a move to a single phone number for all 55 U.S. poison centers (1-800-222-1222) and with it a national logo was introduced - Poison Help.
Times have changed! Poison Help commercial has replaced that one!
Besides calling, is there a way people can text or chat poison control?
There are 55 poison centers covering the U.S., each with a designated service area. Some have chat capabilities, but most don't - yet. Throughout the U.S. (or internationally), if you prefer to get your poison help online, you can use the webPOISONCONTROL tool. There you enter age, substance, and amount swallowed and get case-specific automated recommendations, including a determination of whether it's safe to stay home, you need to go to the ER, or you need to call Poison Control. In most cases (73%), it's OK to stay home. We never discourage calls, but if that's not the way you like to get help, feel free to go online. Toby Litovitz, MD
Do you agree with the Bell Biv DeVoe assertion about that girl?
Yes, that girl is poison. P Soto, PharmD
I recently had an experience where someone had ingested kerosene from an unmarked container in the garage, it was mistaken for water. When I called the poison control line, they didn't offer any advice, only asked me questions like, "How do you know that it wasn't windshield wiper fluid?" (It smelled like kerosene and wasn't blue). It also seemed like they were stalling for time. I ended up hanging up and looking up information online instead (don't induce vomiting!).
Was this just an inexperienced operator? Does the phone number get traced in case of an emergency that requires authorities?
I'm sorry that you had an unsatisfactory experience calling Poison Control. I can't really speak to what the specific specialist might have been thinking or what their level of experience might be. In general, Specialists in Poison Information are registered nurses with at least 2 years of experience in the hospital, or pharmacists with a clinical background. Once you are hired by a poison center, you have to train for at least a year, and pass a national exam to become a Certified Specialist in Poison Information.
Our Poison Center utilizes a system similar to 911 to obtain phone numbers and location and we do confirm this information with the caller at the beginning of the call in case the connection drops or the patient becomes incapacitated while on the phone with us. The Poison Centers do have the capability to mobilize EMS to the patient's location if necessary.
And just to be clear, all of this personal information is kept strictly confidential by the Poison Center. N. Reid RN/BSN, DABAT
Most of us were drawn to the medical profession because we had an interest in helping people. I worked at a suicide prevention telephone service while in pharmacy school. Most of the calls were about possible poisonings. During my clinical rotations I saw many poisonings in the emergency room and admitted to the ICU. It seemed like I was drawn to clinical toxicology. Over the years I have seen many changes in poison control. One thing that has remained the same is the poison centers' ability to help people quickly and compassionately. Jess Benson
What was the hardest part of putting the app together and how do you keep track of the "logic" for all the different possible scenarios?
If you ask the toxicologists (as opposed to the software developers), we'd say the hardest part is developing the algorithms, product database and logic. Each of the 1325+ ingredient algorithms is matched to the corresponding ingredients in 49,000 products - so we have to be able to handle products with multiple ingredients, too. Each algorithm has age- or weight-based thresholds for the ingredient, a list of expected minor symptoms which may develop, a list of symptoms that require further medical evaluation, specific home treatment where appropriate, the expected onset and duration of symptoms and a risk window beyond which significant toxicity is unlikely if symptoms have not already developed. Since algorithms are also used in traditional poison centers, they also outline the justification for the threshold and provide references.
On the other hand, the developers might tell you that the greatest challenge was the overall scope and complexity of the code and the many little nuances required to accommodate variations. Specific logic is incorporated in the software to handle each formulation type, multi-ingredient products, unknown amounts, unknown weight, and the minimum possible weight for age.
It may be difficult to imagine the complexity of the engine driving this app. There are more than 50 administrative interfaces that enable tracking, linking and manipulation of products, images, barcodes (yes, you can scan the barcode of the product your kid swallowed to enter the product name), algorithms, and case data. It also includes tools for quality assurance and data analysis.
Toby Litovitz, MD
How do you account for new products that enter the market place? Do they need to disclose the ingredients to you before being allowed to be on a shelf?
Companies introducing new products are not required to disclose their ingredients. Many do voluntarily, which is a big help. But many companies are also fearful their proprietary blend of ingredients will be stolen. In these cases previous experience of the specialist at the poison center can be very helpful in determining likely ingredients and possible concerns.
What are some common poisons that often get overlooked as safe?
In children we worry about imidazoline-containing nasal sprays (contain oxymetazoline or tetrahydrozoline). Most people will not think of them as poisonous because they are over-the-counter and generally viewed as safe. Unfortunately, small amounts can produce loss of consciousness, slowed heart rate and loss of breathing. Button batteries are another example. See our reply at https://www.reddit.com/r/IAmA/comments/5zrfrq/we_are_the_national_capital_poison_center_ready/df0etyz/ We also worry about laundry pods. Jess Benson, Pharm.D., DABAT
Hi NCPC! I read a book on poison response and the vast majority of treatments seem to be ingesting medical grade activated charcoal. In a pinch, if I cut open a water filter filled with activated charcoal and took the same amount, could it be used as a somewhat effective treatment? (This is not an endorsement for people eating Brita filter charcoal instead of going to the hospital, just in a case where you're in the wilderness a few hundred miles away from civilization and just so happen to have a Brita)
Hi! Yes, that is true. People are often worried about getting their stomachs "pumped", but that isn't done very often at all anymore. Activated charcoal is still a method of decontamination that we recommend when an ingestion is recent. You're right - we don't recommend doing home treatments of activated charcoal, because if it is serious enough to require activated charcoal, we will likely want you to go into the ER. Unfortunately, the activated charcoal sold over the counter, and in water filters are probably not as "activated" as the ones available in the emergency room. Also, there are some things that charcoal cannot absorb. Some people get nauseated and vomit after drinking charcoal, which can make some situations much worse (aspiration). Overall, I would not recommend using it. P Soto, PharmD.
Tell the truth: What do you really think of parents that have to call multiple times a year for the same child that seems to have taste tested half the house?
I think children explore their environments with their mouths. This is totally normal behavior. They are quick and curious and parents are often just one step behind them when things go in the mouth. We don't judge, we want people to call -- even if it is something that seems silly. Call to be sure, don't guess. And if you are too embarrassed to call, use the webPOISONCONTROL app or online tool. N. Reid, RN/BSN, DABAT
What has been done to raise awareness of Dihydrogen Monoxide?
Dihydrogen monoxide a.k.a water is necessary for human life. However keep in mind, the poison is in the dose. If someone were to drink excessive amounts of water, it can cause electrolyte disturbances leading to vomiting, seizures, mental confusion, and yes even death. Oh, plus you can drown in it. N. Reid, RN/BSN, DABAT
Is alcohol poisoning within your purview? Secondly, if so, what kind of data do you have about alcohol poisoning (and is it made available to the public)?
Yes. You can call or use the webPOISONCONTROL site anytime about possible alcohol poisoning. The previous year's national poisoning experience is published yearly in a medical journal called Clinical Toxicology (http://dx.doi.org/10.1080/15563650.2016.1245421). This report contains statistics for all kinds of poisoning including ethanol (alcohol) poisoning. The report will under-represent the true number of people who suffer from alcohol poisoning because many people will not call their poison center when it happens. It will give you a rough idea however of how frequent these exposures are. For instance in 2015, there were 6761 calls to all U.S. poison control centers regarding possible ethanol beverage exposures. Jess Benson, Pharm.D., DABAT
I called because my cat had eaten something, but I pretended that it was my child. Did you know that I was actually calling about my cat?
So we want to stress that it’s always important to be upfront when calling Poison Center since our pets (dogs, cats, etc.) have different metabolisms than humans, and some things that are completely safe for humans can be very toxic to dogs and cats. For example, certain foods that humans can safely enjoy such as: grapes, raisins, onions, shallots, garlic, coffee, and even chocolate can be toxic even in small amounts to our pets!
RP, PharmD, MPH, Certified Specialist in Poison Information