Accidental poisoning

In most cases of poisoning, the victims, especially children, are not aware of the danger posed by the commonly available substances in their home. This is termed accidental poisoning.

Children tend to explore everywhere and investigate their environment. What they find frequently goes into their mouths. They do not understand danger and possibly cannot read warning labels.

The extent of accidental poisoning was evaluated in a survey conducted by the American Association of Poison Control Centre in 1989. In this survey, nearly 1.6 million poisoning cases in humans were reported. Eighty-nine per cent of these cases were a result of accidental poisoning.

The survey also identified the main age group involved in accidental poisoning to be children less than three years (46%), followed by children in the age group of three to six (15%). Besides identifying the age group, most of these accidental poisonings involving children were noted to occur at home. Drugs or medications were found to be the principal causative agents, followed by household items such as cleaning and polishing agents.

How then can this data be correlated to the actual situation in Malaysia? As our National Poison Centre has only been recently set up and is now embarking on an epidemiology study of poisoning cases in Malaysia, the overall pattern with regard to the ages and substances taken may still be accepted based on similiar studies done in other countries such as South Africa, Australia and some European countries.

A study done in South Africa regarding circumstances leading to accidental poisonings among children are given in the table below.

There are several approaches that can be pursued in handling accidental poisonings. Knowing what to do upon suspecting that a poisoning case has occurred greatly reduces mortality and morbidity.

Formal legislation has also been associated with a subsequent decrease in childhood poisoning. For example, in 1976 , the introduction of child resistant containers in Britain through legislation has resulted in a declined of accidental ingestion of paracetamol and aspirin by children. Similarly, in the United States, the introduction of the Poison Prevention Packaging Act of 1970 has done a lot in preventing such poisonings.

In addition to child resistant caps, other measures introduced in some countries include the labelling requirement for household poisons. For instance, Australia introduced labelling requirements for dishwasher detergents. Accordingly, the regulation specifies that the labels of these products should clearly contain the words "WARNING", "BURNS SKIN AND THROAT" and "KEEP OUT OF REACH OF CHILDREN".

Accidental poisoning cases in children showed that the most common substances ingested initially were white solids and clear fluids. Lately, the trend has changed towards colourful tablets and sweetened liquids.

A reverse alteration can be done to poisonous agents to reduce the likelihood of accidental ingestion of these agents. For example, if the product is sweet-tasting and easy to swallow, a child has greater chance of ingesting a toxic dose. However, if the product is foul-tasting and difficult to swallow, there would be less chance of an accidental poisoning.

Education for safety is by far the most effective way of reducing the possibility of accidental poisoning. Although it has been said that children, the high risk population, are the least receptive to an educational approach, parents on the other hand, are motivated to it. They are concerned about safety and can be easily encouraged to adopt safety measures at home.

An important point to note is that in accidental poisoning involving both adults and children, most cases occur in the home. They are almost entirely the result of inadequate and improper supervision in an unsafe environment. Parents should be aware of the danger at home and take steps to make it poison-proof.

The writer is the head of Toxicology Laboratory at the National Poison Centre, USM, Penang.