Journal of Pharmacy Practice

Prior to the 1950s, there existed no formal system for poison prevention or treatment in the United States. Estimates place the number of pediatric poisoning fatalities at over 400 per year at that time. After World War II, urbanization and modern technological methods brought forth over 250,000 different brand name products on the market. Health care professionals presented with cases of acute poisoning usually had little knowledge of what ingredients were contained in these new products making it difficult, if not impossible, to treat these patients. In the 1930s, decades before the creation of the Chicago Poisoning Control Program, pharmacist Louis Gdalman had already established a poison information service at St. Luke's Hospital. Because of Mr. Gdalman's training in pharmacy and chemistry, physicians throughout the city of Chicago and from around the United States called on him around the clock in search of his assistance. In the late 1940s, Mr. Gdalman began recording information on small cards and developed a standard data collection form. By the 1950s he had established an extensive library on the management of acute and chronic poisoning. The first poison control center in Chicago was described as nothing more than a desk, chair, and a telephone located in the inpatient pharmacy. Reluctance by hospital administrators to designate space, resources, and funds were problems confronted by the first poison control center. Poison centers of the 1990s still experience these same difficulties.

Poison centers are the source of expert treatment advice for all types of poison exposures. For this reason, health care providers and consumers are encouraged to call poison centers immediately in case of a possible poison exposure. This allows for rapid evaluation of potential toxicity, determination of the need for treatment, follow-up to the conclusion of a patient's clinical course, and data collection which can be useful in identifying unsuspected poisons, directing future research, and identifying subjects for poison prevention efforts.

In 1998, there were 2,241,082 human poison exposures reported by the American Association of Poison Control Centers. Approximately 52.7% of these exposures were in children under the age of six, however 91 % of the fatalities were in adults. The most common poison exposures reflected availability of substances in homes, where more than 91 % of poison exposures occurred. Evaluation of fatal exposures provides information about substances with the greatest inherent toxicity, as well as exposures that are difficult to recognize or treat when misused or taken in overdose.

More than half of all poison exposures occur in children under the age of six, and more than 90% of all poison exposures occur in a residence. Poison exposures in children are precipitated by normal growth and development and by availability of potentially toxic substances. Because young children cannot protect themselves from poisoning, parents and child-care providers must provide a safe environment. Programs and informational materials that are scientifically and educationally sound will assist health care professionals in providing effective poison prevention education programs.

Exposure to over-the-counter and prescription medications can pose significant therapeutic and health hazards to patients, and present health care professionals with scenarios that require proper assessment and treatment. Knowing when an exposure to or overdose of a drug requires emergency medical attention is equally as important as to knowing when such assistance is not necessary—that simple treatment measures performed at home will suffice. This current discussion is intended to highlight select principles and clinical information pertaining to common drug exposures and overdoses, but not replace the full spectrum of information that would be available to health care professionals (and the lay public) by contacting their nearest poison control center. Many of the basic principles and concerns that are encountered with exposures to chemicals (i.e., route of exposure, patient medical history, quantity of the substance involved, elapsed time since the initial exposure, etc.) apply equally well to drug exposures. Likewise, evaluating each of these variables will determine which type of treatment approaches are, and are not, considered in situations of drug (or chemical) exposure and overdose.

Poison information specialists use a wide variety of consultants in the process of fielding calls. One group with whom they may appear to have the least in common is the industrial safety and health specialists. By knowing more about their respective backgrounds, both these specialists can benefit, ultimately making better clinical decisions on any given patient exposure event that they may be responding to. In terms of training, there are some important differences to note with respect to the poison information specialist and industrial safety and health specialist.