Chemical poisoning is a major public health concern. Approximately 95% of all accidental or intentional poisonings are due to chemicals. Nearly 90% of these cases occur at home. Infants, toddlers, and small children are at the greatest risk for accidental (acute) poisoning. In 2016, poison control centers received about 2.2 million calls about poison exposures, more than a million of which involved children younger than age six. Chronic exposure is chemical poisoning that occurs slowly and insidiously over a prolonged period of time. Many chronic, degenerative diseases have been linked to environmental pollution or poisoning. The list may include cancer, memory loss, allergies, multiple chemical sensitivity, chronic fatigue syndrome, infertility in adults, learning and behavioral disorders, developmental abnormalities, and birth defects.
Of the millions of natural and synthetic chemicals in existence, approximately 3,000 are known to cause significant health problems. In many cases, the type and severity of danger posed by a chemical is a matter of dispute among experts. Accidental acute chemical poisoning involving common household or garden products is easy to diagnose and treat, as long as it is recognized early enough. By contrast, chronic poisoning due to daily exposure to chemicals is more difficult to diagnose and the extent of damage is more difficult to assess. Toxic chemicals can be found anywhere—in homes, around homes on private property, at work, on the playground—even in foods and drinking water. Some result from illegal dumping. However, many chemical poisonings occur insidiously by the supposedly harmless chemicals that people bring into their homes or office to make their lives more comfortable.
Because of the huge amounts of toxic chemicals that can be found inside homes, scientists have come to believe the home—not the office or the freeway—is the most contaminated place of all. Any chemicals found inside the house can be accidentally ingested by small children. Daily exposure to chemicals indoors may also cause significant health risks. Major chemical poisons inside homes include volatile organic compounds, lead, radon, carbon monoxide, and the various substances in household cleaners and carpet.
LEAD AND OTHER HEAVY METALS. Lead is a very toxic chemical, especially to small children. Lead poisoning can cause learning disabilities and behavioral problems in children. Lead poisoning in pregnant women can cause fetal abnormalities, brain damage, and impaired motor skills in their babies. Lead is found in leaded paint (in old houses) and is sometimes present in pesticides, pottery and china, artists' paint, and products used for hobbies and crafts. Also harmful are other heavy metals, such as mercury and cadmium.
CARBON MONOXIDE. In closed areas, carbon monoxide (CO) is the most lethal gas produced by a burning heat source. Sources of CO are gas heat, fireplaces, or idling cars. A CO detector is needed in all homes because this gas is odorless, colorless, and deadly.
CHEMICALS TRAPPED INSIDE CARPETS. Carpets contain many chemicals capable of causing nerve damage. These neurotoxic chemicals include acetone, benzene, toluene, phenol, xylene, decane, and hexane.
HOUSEHOLD CLEANERS. The following are neurotoxic chemicals commonly found in household cleaners:
MEDICINES. Medicines are one of the most common causes of accidental and intentional (suicide) poisonings. Drugs most commonly involved are aspirin, acetaminophen, sedatives; any psychoactive drug if the patient is prone to impulsive, suicidal action (e.g., antidepressants); antiseizure drugs; iron pills; vitamins/mineral supplements containing iron; and cardiac drugs, such as digoxin and quinidine.
Yard materials that can be toxic to humans and pets include:
Workers are often exposed to toxic effects of various chemicals in their working environment:
Highly processed or prepackaged foods use various chemical additives to make these foods look more attractive, taste better, or store for longer periods of time. Harmful substances that can be found in foods include:
Air pollution can cause or worsen lung or heart diseases and increase risk of cancer. Chemicals that most often cause pollution in the air and water supply are fine particles, ozone, asbestos, carbon monoxide, lead, nitrogen oxides, halogenated hydrocarbons, and pesticides.
According to the National Capital Poison Center, chemical poisoning is common and the second leading cause of injury and death in the United States. In 2008, over 41,000 people died as a result of poisoning, and poisoning became the leading cause of injury death for the first time since at least 1980. The poisoning death rate nearly tripled between 1980 and 2010 and the percentage of poisoning deaths that were caused by drugs increased from about 60% to about 90%. Nearly 9 out of 10 poisoning deaths are caused by drugs, and opioid pain medications were involved in more than 40% of all 2008 drug and chemical poisoning deaths, up from about 25% in 1999. According to the CDC, about 76% of poisoning deaths were unintentional, 16% were suicides, and 8% were of undetermined intent.
The following events are possible causes for acute poisoning:
The following signs and symptoms indicate the possibility of acute chemical poisoning:
COMMON ROUTES OF EXPOSURE. Individuals may accumulate toxic amounts of a chemical in their body through daily exposure to the chemical. Common routes of exposure include:
EFFECTS OF TOXIC CHEMICALS ON THE YOUNG. Toxic chemicals can have devastating effects on developing fetuses and children. The following diseases and conditions are linked to chronic exposure to home and environmental pollution:
The following chronic diseases and conditions may occur in adults as a result of cumulative chemical poisoning:
In many cases, the identity of the poison is known to the patient or the parents of the affected child. The role of the physician is to determine what treatment (if any) is necessary based on the type and amount of toxic substance exposure, the identity of the chemical, and patient's signs and symptoms.
When an emergency poisoning occurs, especially in children, parents are encouraged to call a toll-free hotline that is staffed 24 hours a day at 1-800-222-1222.
For acute poisoning, individuals should call 911, a local poison control center, or 1-800-222-1222 immediately. The toll-free number is a national hotline begun in 2002 by the American Association of Poison Control Centers to provide 24-hour poison treatment and prevention services. If a child is suspected of eating or drinking hazardous chemicals, parents should look for the container and call for instructions. Patients or parents of the poisoned child should wait for instructions before administering syrup of ipecac, activated charcoal, or anything else by mouth. Treatment of a particular poison depends on the identity of the poison and how the poison is absorbed by the body.
INHALED POISONS. Treatment of inhaled poison includes bringing the patient out and away from the area contaminated with poisonous gas. The patient should be given oxygen and other respiratory support as necessary.
SKIN AND EYE CONTAMINATION. If a person's skin comes into contact with toxic chemicals, the contaminated clothing should be removed, the chemical carefully brushed off the skin, and the body flushed with running water to dilute the poison. The wounds, if any, should be covered with sterile gauze or cloth and the patient transferred to the hospital for treatment of chemical burn. If toxic or caustic chemicals get in the eyes, the affected person should remove glasses or any contact lenses immediately, rinse the eyes well with clean water or normal saline solution, and go to the emergency room for further treatment or observation.
INGESTED POISONS. Depending on the specific type of ingested poisons, syrup of ipecac, activated charcoal, and/or gastric lavage (stomach pumping) can be used.
In many cases of accidental poisoning, syrup of ipecac can be used effectively. When swallowed, it irritates the stomach and induces vomiting. As of 2012, syrup of ipecac was considered the safest drug for treating poisoning and was often the most effective. Syrup of ipecac can be used for most ingested poisons. However, syrup of ipecac should not be used if the suspected poison is strychnine, a corrosive substance (strong acids or lye), petroleum products (gasoline, kerosene, paint thinner, or cleaning fluids), or certain prescription drugs, such as antidepressants or sustained-release theophylline. In addition, it should not be used in patients who are unconscious or seizing.
Activated charcoal is also an effective treatment for many chemical poisons. It absorbs poisons quickly and in large amounts. In addition, it is nontoxic, may be stored for a long time, and can be conveniently administered at home. Charcoal works by absorbing irritating or toxic substances in the stomach and intestines. This action prevents the toxic drug or chemical from spreading throughout the body. The toxic drug or chemical and the activated charcoal are excreted in the stools without harming the body.
If both syrup of ipecac and charcoal are recommended for treatment of the poison, ipecac should be given first. Charcoal should not be given for at least 30 minutes after ipecac or when vomiting from ipecac stops. Activated charcoal is often mixed with a liquid before being swallowed or put into the tube leading to the stomach. Activated charcoal is available in liquid form in 30 g bottles. It is also available in 15 g container sizes, and as slurry of charcoal premixed in water or as a container to which water or soda pop is added.
Charcoal should not be used to treat poisoning caused by corrosive products, such as lye or other strong acids or petroleum products such as gasoline, kerosene, or cleaning fluids. Charcoal may make the condition worse and delay the diagnosis and treatment. In addition, charcoal is not effective if the poison is lithium, cyanide, iron, ethanol, or methanol.
Gastric lavage may also be used to treat chemical poisoning. This procedure is performed by medical professionals in emergency rooms only. Lavage fluids (saline water or water) are given through a large tube down the patient's throat and the stomach contents are pumped out. This procedure is repeated until most of the toxic substance is removed. Then a specific antidote for the chemical or activated charcoal is given to absorb the rest.
Sometimes, antidotes are available to neutralize poison and render it harmless. The following are common antidotes:
Treatment of chronic chemical poisoning involves identifying and eliminating the source of poison from the patient's environment, followed by symptomatic treatment of the condition. Chelation therapy can be used to remove heavy metals, such as lead, iron, mercury, copper, nickel, zinc, cadmium, beryllium, and arsenic. This treatment uses chelating agents, such as ethylenediamine tetraacetic acid (EDTA) and dimethylsuccinate (DMSA) to bind and precipitate metals and remove them from the body.
Naturopaths sometimes recommend patients suspected of chronic chemical poisoning to follow a detoxification (detox) diet for at least several months. Pregnant women, small children, or very frail people should avoid taking this diet. Medical experts see little harm in these diets but find little evidence that they are effective. A detox diet has the following characteristics:
Exercise to the point of perspiration helps eliminate toxins from the body. Daily walking for 30 minutes is helpful and appropriate for most people.
Milk thistle (Silybum mariannum) is a powerful antioxidant that protects the liver and assists in the detoxification process by increasing glutathione supply in the liver. Glutathione is the enzyme primarily involved in the detoxification of many toxic chemicals in the environment, such as solvents, pesticides, and heavy metals.
Depending on a patient's specific condition, an expert Chinese herbalist may prescribe herbal remedies that can help remove toxins from the body and improve liver function.
For homeopathic therapy, patients should consult a homeopathic physician who can prescribe specific remedies based on knowledge of the underlying cause.
Depending on the severity of the poisoning, the affected person may have total or partial recovery. If the rescue effort comes too late, a patient may die of acute chemical or drug poisoning. For those affected by chronic exposure to environmental poisoning, recovery depends on the severity of the poisoning, the ability to stay away from the offending agent, and appropriate diagnosis and treatment. Total recovery can occur in many patients.
Some strategies for avoiding poisoning are:
The World Health Organization has established poison centers to deal with outbreaks of chemical poisoning. They are specialized units that advise on, and assist with, the prevention, diagnosis and management of poisoning. The structure and function of poison centers varies around the world; however, at a minimum a poison center is an information service. Some poison centers may also include a toxicology laboratory and/or a clinical treatment unit.
A poison center answers enquiries about exposure to chemical agents, including products, pharmaceuticals, natural toxins, pesticides and industrial chemicals. It provides an assessment of whether a particular exposure is hazardous and information on the need for treatment and the kind of treatment that should be given. Poison centers aim to promote the evidence-based, cost-effective management of poisoning and to ensure that unnecessary or ineffective treatment is avoided.
Poison centers offer a service to health professionals and also, in many countries, to the general public. Other users include the emergency services, government bodies, regulatory agencies and education services. They are uniquely centralized repositories of data about human exposures to chemicals, including information about the agents involved, the circumstances giving rise to exposure, and the health effects of exposure. These data can be used to help reduce the incidence of poisoning by identifying emerging toxicological hazards (a process known as toxicovigilance), stimulating preventive measures by manufacturers and regulators, and assessing the efficacy of such measures. Poison center data also contribute to improving knowledge about the human health effects of chemicals.
See also Acetone ; Air pollution ; Asbestos ; Benzene ; Bioterrorism ; Cadmium ; Cadmium poisoning ; Lead ; Lead poisoning ; Mercury ; Multiple chemical sensitivity ; Ozone ; Radiation ; Radiation exposure ; Smoking ; Toxicology .
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Agency for Toxic Substances and Disease, 1825 Century Blvd., Atlanta, GA, 30345, (800) 232-4636, http://www.atsdr.cdc.gov .
American Academy of Environmental Medicine, 6505 E Central Ave., No. 296, Wichita, KS, 67206, (316) 684-5500, http://www.aaemonline.org .
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Environmental Protection Agency, Ariel Rios Bldg., 1200 Pennsylvania Ave. NW, Washington, DC, 20460, (202) 260-7751, http://www.epa.gov .
Teresa G. Odle
Revised by Karl Finley