THE ANTIDOTE
News & Notes from The Blue Ridge Poison Center November 2016 www.brpc.virginia.edu
Featured this issue Antifreeze: Why Bitter‐Tasting
Antifreeze Additives May Not Be Enough Food Poisoning to Prevent Ingestions. News and Notes
An freeze is a synthe c (man‐made) type may include nausea, vomi ng, inebria on, of alcohol added to the water in our car’s central nervous system dysfunc on, BRPC Staff: radiator to prevent freezing in cold breathing problems, dangerous changes in Director weather. Many an freeze products are heart rhythm, and injury to the kidneys Christopher Holstege, MD made with ethylene glycol ‐‐ a clear, and other organs. Some symptoms can be
Nursing Manager colorless, odorless liquid with a sweet delayed by many hours, which could lead Beth Mehring, MSN taste. Colored dyes (usually green but to a delay in treatment. Such delays could some mes blue or orange) are added to be fatal. Medical Toxicologists an freeze to help iden fy the liquid and to Andy Baer, MD Many cases of ethylene glycol poisoning Heather Borek, MD help trace the source of leaks. Nathan Charlton, MD are due to the accidental inges on of it by Josh King, MD Ethylene glycol is itself an alcohol, and can young children. Children, pets, and cause intoxica on. However, it is wildlife are a racted to the sweet taste. Medical Toxicology Fellow metabolized (changed) in the body into Alcoholics may mistakenly drink it as a Justin Rizer, MD several other highly toxic compounds. subs tute for ethanol, the type of alcohol Epidemiologist Symptoms of ethylene glycol poisoning Saumitra V. Rege, MS, PhD continued page 2
Poison Specialists Brenda Beech, RN, CSPI Focus on Food Poisoning Andre Berkin, BSN, CSPI Jennifer Horn, BSN, CSPI You spent hours on the turkey, mastered Sue Kell, Ph.D, M.Ed, CSPI your first homemade gravy, and TOXIC TRIVIA Teresa Kinzie, RN, CSPI successfully kept the pie crust from Christie Lee, RN, CSPI burning. Your holiday meal will be One teaspoon of this fragrant herbal Kathy Mayo, RN, CSPI Alicia Snyder, RN delicious! By taking a few extra steps, the product—which some believe Scott Wiley, BSN, CSPI only discomfort a erwards will be from full provides relief from muscle aches and Steven Yoder, RN, CSPI stomachs. pains—is the chemical equivalent of nearly 23 adult aspirin tablets...a Public Health Educator Improperly prepared, cooked, or stored potentially life‐threatening dose for a Kristin Wenger, MT, BS food can contain foodborne pathogens: small child. What is this product? disease‐causing bacteria, viruses, fungi, or Administrative Specialists Answer on pg. 3 Heather Collier Teresa Dorrier continued page 3 1 Antifreeze: Why Bitter‐Tasting Additives May Not Be Enough to Prevent Ingestions — continued from front
found in beverages such as beer, wine, or liquor. avoid or spit out any product that contains Bitrex®.” Ethylene glycol is also some mes swallowed inten onally by people who are trying to harm Researchers also examined whether the addi on of themselves. Bitrex® had an effect on those who inten onally drank it to harm themselves. A er Bitrex®‐containing In December 2012, the Humane Society Legisla ve products were introduced to U.S. markets, there was Fund and the Consumer Specialty Products no change in the number of people who a empted Associa on announced an agreement to voluntarily suicide by drinking an freeze. There was also no add a bi er‐tas ng chemical to an freeze difference in the amount that they swallowed, what manufactured for sale for the consumer market in all kinds of medical treatment they needed, or medical 50 states and the District of Columbia. The substance outcome. used is denatonium benzoate, commonly called Bitrex®. Bitrex® can also be found in many other In conclusion, Bitrex® does not seem to be a strong products; including some cosme cs, cleaning deterrent in cases of accidental or inten onal products, and pes cides; as a means to prevent inges on. It s ll may prevent some people from poisoning. The thinking behind its use is that if swallowing a product like an freeze (or swallowing someone tried to swallow a product containing large amounts), but alone it is not enough to prevent Bitrex®, they would spit it out because of the all poisonings. Addi onal precau ons should be taken extremely bi er taste. Unfortunately, this does not to protect others from an freeze, including: always happen and poisonings s ll occur. Clean up an freeze spills immediately. One 2015 study¹ compared the cases of children who Check the ground beneath your car's engine swallowed an freeze both before and a er the regularly for leaks. A green or blue liquid may Bitrex®‐containing products were introduced to U.S. indicate an freeze. markets. Researchers determined there was no difference in the frequency of childhood an freeze Store an freeze in clearly marked containers up inges ons, nor in the amount of product swallowed high, out the sight and reach of children. per case. There was also no difference in the medical outcome of the children who swallowed an freeze When you replace an freeze, or if you flush your with or without Bitrex®. radiator, remember to take the used an freeze to your local auto repair or radiator shop where it “Unfortunately, young children have unpredictable can be disposed of properly or recycled. Never reac ons to bad tastes or flush it down the drain or dump it into a driveway, smells,” says Kris n Wenger, roadside, or waterway. (Not only is that dangerous Educa on Coordinator for the to people, pets, and wildlife‐‐ it is illegal). Blue Ridge Poison Center. “Parents frequently share stories If you suspect that someone has ingested any amount with me of disgus ng things their of an freeze, contact the Blue Ridge Poison Center child ate. Some of these stories immediately. Do not wait for symptoms to develop. are pre y funny, but some are Call 1‐800‐222‐1222, 24‐hours a day, any day of the frightening and have resulted in harm to the child. year. Bo om line: don’t assume that a child will naturally
¹ White NC, Litovitz T, White MK, Watson WA, Benson BE, Horowitz BA, Marr-Lyon L. The impact of bittering agents on suicidal ingestions of antifreeze. Clin Tox. 2008;46:6:507-514.
2 Focus on Food Poisoning — continued from front
parasites that can make you Keep food hot—at least 140 degrees F‐‐‐a er cooking sick. Symptoms can include and before ea ng. fever, headache, diarrhea, Chill: Keep your refrigerator at least 40 degrees F. abdominal pain and o en vomi ng. Foodborne Refrigerate or freeze food within 2 hours of cooking pathogens are sneaky. You or purchasing. cannot always detect them For more ps to keep that most unwelcome holiday by looking at or tas ng food. guest – food poisoning – from messing up your According to the U.S. Food perfect holiday meal, visit www.foodsafety.gov. and Drug Administra on (FDA), food poisoning sends more than 100,000 Americans to the hospital each year. There are four News and Notes basic steps to keeping your food safe: Clean, Separate,
Cook, and Chill. ATTENTION SENIORS and Clean: Wash hands for at least 20 seconds before and those who work with older a er handling food, and a er using the bathroom, adults: The Blue Ridge Poison Center wants to help seniors changing diapers, or handling pets. learn to take their medicines Wash cu ng boards, countertops, and utensils a er safely and to protect young they touch raw animal products (meat, poultry, eggs, children in their lives from or seafood). medicine poisoning. If your group of at least 10 senior adults would like to schedule a 1-hour Rinse fruits and vegetables under running tap water, presentation from our Health Educator, contact even if you plan to peel them. Kristin Wenger at 434-982-4386 or [email protected]. We will travel to your Separate: Separate raw animal products from other location. The presentation is free, and all foods in your grocery bags and refrigerator. participants will receive FREE materials including Don’t reuse marinades that touched raw animal a personal drug disposal kit. products, unless you boil them first. Consider having a separate cu ng board for raw DID YOU KNOW the Blue animal products. Ridge Poison Center will help you identify an unknown Cook: Always heat food to the correct internal pill? If you misplace an temperature. Use a food thermometer to be sure. original container, accidentally mix your medicines Turkey and other poultry should reach 165 degrees F. together, or find a loose pill somewhere, call our For a chart lis ng safe temperatures for other foods, hotline: 1-800-222-1222 any time of the day or visit www.foodsafety.gov. night for free and confidential assistance.
This free, quarterly newsletter is courtesy of the Blue Ridge Poison Center, serving Southwestern and Central Virginia and the Shenandoah Valley. We encourage you to print, post, forward, or share in any way. Please share it entirely; do not cut out portions without permission. If you have suggestions or comments, or want to sign up to receive new issues automatically, contact Kristin Wenger, Health Educator, Blue Ridge Poison Center, University of Virginia Health System:
434-982-4386 or [email protected].
Wintergreen of Oil Answer: Trivia
Poison Safety Tips & More! Follow us on Twi er @blueridgepoison Poison
3