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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ESeveral common household items have been reported to cause serious effects when taken in excess. Clinicians mus learn to recognize the latest trends in toxicological emergencies, identify easily missed toxicological complications, and develop a rational emergency department approach to new sources of overdose.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EToxicology\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEmergency Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EToxicology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EMark B. Mycyk, MD, Cook County Health and Hospitals System, Chicago, Illinois, USA, advised that clinicians learn to recognize the latest trends in toxicological emergencies, identify easily missed toxicological complications, and develop a rational emergency department (ED) approach to new sources of overdose.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESeveral common household items have been reported to cause serious effects when taken in excess. For example, massive ingestion of soy sauce has been reported to cause hypernatremia [Carlberg DJ et al. \u003Cem\u003EJ Emerg Med.\u003C\/em\u003E 2013]. Excessive intake of Diet Coke led to seizures and hyponatremia [Mortelmans LJ et al. \u003Cem\u003EEur J Emerg Med.\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ELaundry detergent pods are among the newer household items that can cause potentially serious effects [Scharman EJ. \u003Cem\u003EClin Toxicol (Phila)\u003C\/em\u003E. 2012]. According to one study, when ingested, they can lead to gastrointestinal, neurologic, and metabolic toxicity [Smith E et al. \u003Cem\u003EJ Med Toxicol\u003C\/em\u003E. 2014]. Despite the absence of oral erythema, ulcers, or swelling, of the 3 patients who ingested laundry detergent pods, all developed some degree of esophageal injury. Another study showed that the most significant clinical characteristics of children aged \u2264 5 years exposed to laundry pods were vomiting and drowsiness\/lethargy (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001 for both; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Centers for Disease Control and Prevention (CDC). \u003Cem\u003EMMWR Morb Mortal Wkly Rep.\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15525\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15525\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15525\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EClinical Characteristics of Children Exposed to Laundry Pods\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EAnother newer item with potential for harming children is liquid nicotine. Following reports of children overdosing on this form of nicotine used in e-cigarettes [Chatham-Stephens K et al. \u003Cem\u003EMMWR Morb Mortal Wkly Rep.\u003C\/em\u003E 2014], pediatricians are calling for childproof packaging.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EIndeed, half of all poisonings occur in children aged \u2264 5 years. Buprenorphine, which is taken for the treatment of opioid dependency in adults, is involved in a disproportionate number of unsupervised ingestions by children, accounting for 9.5% of all pediatric overdose admissions [CDC. \u003Cem\u003EMMWR Morb Mortal Wkly Rep.\u003C\/em\u003E 2013]. Unintentional ingestion of buprenorphine can cause dose-dependent respiratory depression in children [Kim HK et al. \u003Cem\u003EPediatrics\u003C\/em\u003E. 2012].\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EOverall, the United States is experiencing a rising number of deaths due to overdoses of prescription opioid analgesics and cocaine [Okie S. \u003Cem\u003EN Engl Med.\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003ELevamisole, a veterinary antiparasitic drug, has been found in up to 70% of cocaine confiscated at the US border [CDC. \u003Cem\u003EMMWR Morb Mortal Wkly Rep.\u003C\/em\u003E 2009]. Side effects of levamisole include necrotizing vasculitis. This type of poisoning should be considered in cocaine users presenting with atypical symptoms. A thorough skin examination should be performed, and patients should be watched for development of neutropenia.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EIn high doses, energy supplements containing caffeine, taurine, or guarana can cause confusion, tremors, seizures, and a significant increase in blood pressure [Franks AM et al. \u003Cem\u003EAnn Pharmacother\u003C\/em\u003E. 2012]. Dr Mycyk presented a case report of intentional caffeine overdose that resulted in severe rhabdomyolysis and acute renal failure requiring hemodialysis [Campana C et al. \u003Cem\u003EAm J Emerg Med.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003ECannabinoid hyperemesis syndrome (CHS) is a type of cyclical vomiting that results from heavy marijuana use. Standard anti-emetic treatment often fails, but abstinence and hot showers (!) can be successful. Haloperidol has been shown to successfully treat CHS in a single case study [Hickey JL et al. \u003Cem\u003EAm J Emerg Med.\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EDr Mycyk recommends that clinicians caring for potential overdose patients pay close attention to collateral history, consider typical and atypical toxidromes, and not rely on standard \u201ctox screens.\u201d He recommends reading the Centers for Disease Control\u0027s \u003Cem\u003EMorbidity and Mortality Weekly Report\u003C\/em\u003E and a weekly blog called \u003Cem\u003EThe Poison Review\u003C\/em\u003E.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/46\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzogxp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzogxp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}