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Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: You may have seen the pictures or heard about the algae bloom at Utah Lake. I've read in a couple of articles that if you were in Utah Lake that you should contact Poison Control so we did. We're going to talk to Barbara Crouch right now, she a director of the Utah Poison Control Center.

Interviewer: What questions are people asking and what are you telling?

Barbara: So I guess the most common call that we've gotten are people that have been recreating in Utah Lake initially and then are concerned because they've heard about the bloom. And so they're concerned about their exposure, whether it's been boating or swimming or kayaking or sailing in there. And so that's probably the most common call to date.

People have complaints of adverse effects. We certainly don't know, at this point, whether they're related or not. But at this point, we have, again, a healthy degree of caution with that. And we do know that from previous information about these toxins that they produce some nonspecific effects. So they're not totally characteristic, which makes this difficult. But most commonly, abdominal pain, vomiting, diarrhea, as well as headache, skin irritation, and eye irritation are the most common complaints that we've heard about to date.

Interviewer: Skin irritation, eye irritation probably because you got water on you. These other ones, do you have to actually have ingested some water to have those or could it just be on the lake and breathing the fumes?

Barbara: It's aerosolized water so it's spraying and you inhale that. Certainly, that's a risk factor.

Interviewer: So that's enough?

Barbara: As well as swallowing it. And also aerosolized, so if you think about the water being used in your sprinkler system that you can inhale those droplets of water and so that is also a significant concern.

Interviewer: What are you telling a caller if they call in if they have some of these nonspecific symptoms that may or may not be related?

Barbara: So we're monitoring those and these are nonspecific symptoms that we can generally manage on site, but we're monitoring those. So if it's diarrhea, we want to make sure that that diarrhea is resolving. And in most situations, it is resolving within a reasonable timeframe. But if it's at all persistent and it's lingering for several days or it's more severe in nature, then we are referring folks to see their doctor for evaluation. And to date, most of the situations, 95% of them, are managed on site and are resolving in a reasonable period of time.

Interviewer: And the same would apply for if you're vomiting as well or a skin irritation? Just kind of keep an eye on it. If it goes away in a couple of days, then you're probably all right. Otherwise, go see your doctor.

Barbara: That's right. And feel free to call the poison center We're there 24 hours a day. When you call the poison center, you're talking to a pharmacist or a nurse with additional training in clinical toxicology. So they're the experts. They're there, it's free, it's confidential. And they'll provide you some guidance immediately on the situation. And then, we're also being able to catalog these and be able to share it with the health department so we can be able to help to describe the extent of this issue, this public health problem in Utah.

Interviewer: So you really want people to call?

Barbara: We do.

Interviewer: Even if they're not completely concerned. Just because it would help gather more information.

Barbara: That's right. Anybody that's been exposed and is concerned, we do welcome their call. And that number is 800-222-1222 and, again, we're there 24 hours a day.

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Interviewer: You get bitten by some sort of animal, whether it's a dog or a wild animal, the first thing you probably are starting to worry about is, "Did I get rabies?" We're going to find out more about that next on The Scope.

Dr. Troy Madsen's an emergency room physician at University of Utah Health Care. You get bit by an animal, I think the first thing a lot of people think after, "Ouch," is, "Ooh, do I have rabies?" Is that a real threat?

Dr. Madsen: It's a real concern. So, primarily, you're thinking about this with dog bites, cat bites, raccoons, foxes, and bats. And one of the really interesting about bats is, and this is something I've found kind of fascinating, the Centers for Disease Control, the CDC, actually recommends if you wake up and you look at the ceiling and there's a bat there, they actually recommend getting the rabies vaccine in that situation. The idea being that you may have been bitten by the bat during the night, you may not know you've been bitten, the bite marks are usually so small you can't see them. So the concern is that great.

There are certain animals that you may get bitten by and you may wonder about the concern about rabies, animals like rabbits, rats, mice. Those are not really concerns. The big thing I think about in my mind, typically, the animals that are going to transmit rabies are animals that are not necessarily vegetarian-type animals. So rabbits, those things, they don't really transmit rabies. It's more things like foxes, skunks, raccoons, these kinds of scavenger animals that may be eating some meat here and there. Those kinds of animals are sometimes those that carry rabies and those are the ones we get concerned about in saying, "Hey, if you've been bitten by one of these animals, we probably need to think about rabies."

In terms of dogs and cats, if it's an animal where you don't know the dog or you can't observe it, you don't know if it's had its shots, those are also animals where absolutely we worried about rabies and we treat you potentially to prevent a rabies infection.

Interviewer: So if it's a neighborhood dog, good idea to go talk to that neighbor, get that information and save yourself from the rabies shots, I suppose?

Dr. Madsen: Exactly.

Interviewer: If you find out, no, they haven't had their vaccinations, but they don't seem to be showing any symptoms, or you've been bitten by another animal where you're unsure, what would the next steps be?

Dr. Madsen: Then, that's a situation where you need to get the rabies vaccine. And what that involves, first of all, is giving them a medication at the site of the bite wound to prevent rabies infection. It's not necessarily the vaccine, but it's something that kind of neutralizes the virus if it is there. And then I start them on a series of basically four shots, where they'll come in, they'll get the shot that day, they'll come back in a few more days, get another shot. These are all vaccines to prevent a rabies infection.

And that's a precaution I'm going to take on anyone who comes in after a bite from any animal that could be carrying rabies. And the reason we're very, very cautious in that situation is because there's not much you can do if someone gets rabies. It's something you really want to prevent. You don't want somebody to catch it because if someone catches rabies and they actually develop the disease, it's almost universally fatal.

Interviewer: Really? So it's bad news, it's serious stuff.

Dr. Madsen: It's bad news if you get it, yeah. It's one of those things you can try and treat it and try and get them through it, but it's a horrible thing to get. So really, the treatment for rabies is prevention.

Interviewer: Gotcha. And these shots, they used to be in the stomach, right? And I heard they used to be really painful and there are a lot of them, but you're saying there's one at the site and then four more after that. Where are those four more?

Dr. Madsen: They're just in your arm or your leg. It's not in the stomach. I remember hearing that as a kid as well.

Interviewer: Has that ever been true?

Dr. Madsen: I don't know. That's . . .

Interviewer: Oh. Not since you've been in medicine.

Dr. Madsen: Not in the last 15 years that I've been in the medical profession.

Interviewer: Okay. All right.

Dr. Madsen: I don't know. I heard that too. I remember always hearing that you had to get a shot in the stomach and I thought, "Wow, if I got bitten by a dog, no way would I want to go get the rabies shot because that sounds miserable." But no, these are shots, you give them the same place you'd give a tetanus shot or something like that. They hurt a little bit, kind of like a tetanus shot would, but it's not something, like some really crazy shot that you're getting in your stomach.

Interviewer: Yeah. And better than the alternative.

Dr. Madsen: It's much better than the alternative. Exactly. You don't want to get rabies.

Interviewer: And is this an ER-only thing or could you do an Urgent Care for this?

Dr. Madsen: I think Urgent Cares can do this. I can't say I've looked into it specifically to see if they offer the rabies vaccine in most Urgent Cares, but it's a pretty straightforward thing. If you went there and they just said, "Hey, we don't have the vaccine here," then they're going to send you to the ER, but I think it's a reasonable place to start.

Interviewer: All right. And is there a time limit? After I get bit, is it a day? Six hours? Three hours?

Dr. Madsen: I would want to get in within the first 24 hours. Really, as soon as you can. I would not put it off, especially, like I said, because one of the vaccines, one of the injections we're giving, at the site of the wound is essentially neutralizing that virus if it's there, so the sooner, the better.

updated: March 10, 2021
originally published: July 22, 2016

Interviewer: You get bitten by a non-poisonous snake, ER or not? That's next on The Scope.

Announcer: Is it bad enough to go to the emergency room? Or isn't it? You're listening to "ER or Not" on The Scope.

Interviewer: It's the game where you get to decide whether or not you would go to the ER and then we find out the correct answer from Dr. Troy Madsen, emergency room physician at University of Utah Health Care. ER or not today, you are bitten by a non-poisonous snake. Is that a reason to go to the ER?

Dr. Madsen: Non-poisonous snakes, first of all, you want to know that it is a non-poisonous snake. So in Utah, we're thinking primarily about rattlesnakes being the poisonous snake here of concern. So if you know it's not a rattlesnake, if it's a little garden snake that was in your yard, you picked it up, it bit your finger, not necessarily a reason to go to the ER.

Interviewer: Okay.

Dr. Madsen: But there is kind of one little caveat here, with this. With any bite, and we always think about it with snakebites, you have to think about tetanus. Something we have to think about with any laceration, anything like that. So if you can tell yourself, "Okay. I know I had a tetanus booster. It's been within the last 10 years. I'm covered there." In terms of the bite itself, everything's moving okay, it's not like it affected any tendons, nerves, nothing like that, it's not a real deep bite, it's probably something you can just wash out at home and not go to the ER.

Interviewer: What about infection? Is that a worry in a snakebite as well? I know it's a worry with a lot of other bites.

Dr. Madsen: It is for a lot of other bites. And again, certainly, infection is something that you think about with snakebites. But if someone comes to the ER, they've got a couple little fang marks on their finger from a snakebite, and it looks clean, it's not like a real dirty wound where they were working in the garden and their hands were real dirty and then the snakebite pushed a bunch of dirt into their finger, I'm not really going to start that person on an antibiotic for that.

Interviewer: Fascinating. So like getting bit by a dog, more worry of infection than getting bitten by a snake?

Dr. Madsen: It is. And for me, it is just because the dog bites are usually deeper. There's usually more tissue involved. I don't know. I can't say I have ever looked to see what the germ content of a dog's mouth versus a snake's mouth is.

Interviewer: There's somebody out there that probably knows.

Dr. Madsen: There probably is, but for me, it's more just the fact that the dog bites are usually a much larger area, usually deeper, usually a lot more tissue involved.

Interviewer: Okay.

Dr. Madsen: That's why with dog bites, I am usually thinking more starting antibiotics to prevent an infection where with snakebites, typically, not such a concern, but something you have to watch out for to make sure nothing develops.

Interviewer: All right. So a non-poisonous snake bite, no need to go to the ER as long as you are sure you've had that tetanus booster within the past 10 years.

Dr. Madsen: Exactly.

Interviewer: Wash it out and just watch it, at that point.

Dr. Madsen: Yeah, wash it out. You can use some antibiotic ointment on it, keep an eye on it, make sure it doesn't develop an infection.

Interviewer: And if you have not had that tetanus shot, urgent care? Can they give you...

Dr. Madsen: Urgent care is fine, yep. You get in to see your doctor within the next day or two, that's fine as well.

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Interviewer: Poison lookalikes. You might have some lurking around your house. We're going to tell you how to find them next, on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Sherrie Pace is a health educator with the Utah Poison Control Center. And some poisonings happen just because kids mistake one thing for another thing. They're called poison lookalikes and we're going to talk about that today and help you maybe create an ability for you to see those around your house in a way that you haven't seen them before. The first thing, though, if you ever suspect a poisoning regardless, don't go on the Internet. Don't try to figure it out yourself. Call Poison Control immediately.

Sherrie: Yes. That's absolutely right. It's important to do that as your first step. You don't want to go searching. You could find information on the Internet that could be actually harmful.

Interviewer: All right. So call Poison Control. They want to hear your call. What's the phone number?

Sherrie: It's 1-800-222-1222

Interviewer: So poison lookalikes. Well, explain what poison lookalikes are. You do this.

Sherrie : Okay. Yes. So poison lookalikes are things that look really similar. So one of them would be something that's okay to eat, like candy. And one would be something that would be possibly dangerous, like medication. So that sort of one of our examples of lookalikes

Interviewer: So when you go out to schools are health fair events like that, you take these and then it's kind of like a little quiz. So you're going to quiz me here.

Sherrie: Right. I'm going to quiz you. We take these to these events, usually pictures because we don't want anyone actually getting some of these products, but I brought you the real deal today.

Interviewer: All right. I'll keep my hands off. I'm a pretty smart guy. I've been around for a while. I'm not like a four-year-old. I think this is going to be pretty easy.

Sherrie: We'll find out.

Interviewer: Okay. Let's go ahead and see the first poison lookalike. Oh, my. You're kidding. What? All right. I'm looking at two jars here. Okay. They both have red pill-like objects in them. They look like Skittles. Both of them look like Skittles. And when I initially saw them, I couldn't tell them apart. When I started looking little closer, I see the letter "S" on the Skittles and I notice that these pills are a little bit smaller and not quite as round. A little bit more uniform. But there, again, I'm a grown adult.

Sherrie: Right. And you know what to look for. If you were a small child or even just a young child, you would have a hard time telling the difference

Interviewer: Wow. So before we do some more of these, is this a pretty common way? I mean, what do we know about lookalikes and the danger it really poses?

Sherrie: Yes, this is very common for our kids under six years old. Lookalikes are very problematic. They just can't tell the difference at their young age. They don't know the dangers. They just can't process that.

Interviewer: Yeah. So if I've had Skittles before, I come across these, which are not the Skittles?

Sherrie: They're going in the mouth.

Interviewer: By the way, what are these?

Sherrie: Those are like a flu and cold medication, over the counter medicine.

Interviewer: Oh, there's actually some letters on those too. They say, "CF." All right. What's next? Wow, that was eye-opening because initially, I had a hard time so I could only imagine a kid that doesn't have as much experience.

Sherrie: Okay. Here we go.

Interviewer: The second thing. You've got two containers of blue liquid.

Sherrie: Yes.

Interviewer: So . . .

Sherrie: You shook it.

Interviewer: I shook it, but . . .

Sherrie: You can't shake it. Actually, they're both bubbling up pretty good.

Interviewer: They are. They bubble differently. So I can only imagine that one of them is a glass cleaner.

Sherrie: Right. Yep.

Interviewer: I'm at a little bit of a struggle as to what would be blue that I would drink. Because it's not like blueberry juice. It's not that color blue.

Sherrie: No. It's a Powerade or a Gatorade type thing. Sports drink.

Interviewer: So that kind of . . . I don't know. Whatever kind of blue that is. Yeah. You can't tell the difference.

Sherrie: It looks identical. One of the problems we've had is people pouring cleaners into a different container, maybe even a glass or a cup to put a rag in or a toothbrush to do their deep cleaning, and it's sitting there on the counter. And along comes a child, even an older child, and they might take a swig.

Interviewer: Yeah. Sure. And even if it was in the container that it's supposed to be in, kids that age might not be able to read.

Sherrie: Exactly. The little ones.

Interviewer: At some point, they would be able to recognize, I suppose. So what about the smell? When I put the glass cleaner, I could definitely smell the difference. Do kids make the differentiation?

Sherrie: They really don't. And one thing I've noticed with the cleaners these days is they actually smell pretty good. They do. They have fruity smells, flowery smells so that you are more likely to use their product.

Interviewer: I don't know what this has to add, other than the fact that I'm smelling the Gatorade or the Powerade or whatever it is.

Sherrie: And does it smell?

Interviewer: No. If you were to give this to me and say, "I want you to just make a decision whether this is safe to drink or not," what would I do? I'd smell it. I'd look at it. I might go, "Well, that could be Powerade," but I smell it and I don't necessarily . . . I wouldn't be able to confidently say this isn't something that's bad for me.

Sherrie: Right. That's true. That's true.

Interviewer: Because it doesn't really have the smell I would expect of it. Wow. Poison lookalikes. Got another one, huh?

Sherrie: Yeah, I've got another one for you.

Interviewer: Oh, it's another liquid. This time, it's clear liquid. You're covering them up so I can't see. Okay.

Sherrie: Okay. So one of these is water and one is rubbing alcohol.

Interviewer: Is rubbing alcohol pretty poisonous?

Sherrie: It can be dangerous.

Interviewer: All right. So, once again, I'm not going to shake these. Last time, I shook them, but they both bubbled up. One of them does have bubbles forming on the bottom of the container and it also has a label that says what it is. So now I know.

Sherrie: You looked.

Interviewer: Well, I didn't know that there was a label on the bottom that said what.

Sherrie: I had to put the label because I can't tell the difference once I pour them in these jars.

Interviewer: Yeah. So it is the water that has some bubbles, but other than that, you can't tell the difference.

Sherrie: You can't. If you smell it, obviously, you can tell.

Interviewer: Yeah, there's no smell to the water, obviously. You know, this is kind of weird for me too. When it's in the container, I can almost before I smell it, think about what it smells like. But because it's not in its normal container, that sense isn't working in my brain.

Sherrie: That's interesting.

Interviewer: Oh, yeah.

Sherrie: You can tell that's the rubbing alcohol. Yeah.

Interviewer: Yeah. So kids would drink that, huh?

Sherrie: They would. I mean, if it's sitting out within reach and they see it sitting there, it looks like water and they'll drink it.

Interviewer: So the question on alcohol, do they normally take a swig and it's so powerful, they're like, "Ew, no more"?

Sherrie: Sometimes that happens with some of the stronger chemicals and things. But, occasionally, they do drink a little bit too much.

Interviewer: So regardless of the amount, you should call Poison Control?

Sherrie: Absolutely.

Interviewer: "Thank God that was just a little bit. I'm not worried about it."

Sherrie: Always call us because if it's not a big deal, we'll tell you that and you can have peace of mind and not have to be worrying about it.

Interviewer: All right. Do you have one more?

Sherrie: I have one more.

Interviewer: One more. This is fun. Oh.

Sherrie: Okay. One of these is a popular candy that kids like. Little candy. And the other is a fertilizer.

Interviewer: They both sound the same.

Sherrie: Yeah. They do sound the same.

Interviewer: That one makes a little bit more noise. All right. So I'm looking at two containers and the fertilizer and the candy are both white. One tends to have a little bit more of a shiny coat on it. What I believe to be the fertilizer is this one.

Sherrie: Yeah. That's a little simpler one.

Interviewer: Yeah. That was the easiest of the bunch, but for a kid, I'd imagine these are Nerds?

Sherrie: Yeah. Those are Nerds.

Interviewer: White Nerds. They look a lot like fertilizer.

Sherrie: Kids, of course, they love those little candies.

Interviewer: And go out in the garage and, "Oh, look."

Sherrie: "It's a whole bucket."

Interviewer: "That's a king-sized bag. I've never seen such a thing. I'd better get in there."

Sherrie: Exactly.

Interviewer: Poison lookalikes. So let's talk about, quickly, a couple tips people can do to go through their home to make sure they don't have more of these lurking around. What are things to look for?

Sherrie: Okay. The first thing to do would be to think about keeping things in their original container. That is number one. So don't pour things into smaller containers for ease of use. Keep them in original containers. It's not really worth it to buy those huge warehouse buckets and bottles of things that are sitting around with lots of chemicals in the home, in the garage. Just buy what you need and keep it out of reach of kids.

Interviewer: So original containers. What are some other tips? Some containers of something good and something bad look alike.

Sherrie: They do. They really do. And some of the cleaners even have pictures of fruit on the labels, which is really problematic. Certainly, keeping those out of reach of kids, especially the little ones.

Interviewer: Are there other lookalike things to look for, other than the fact they look alike?

Sherrie: Other typical lookalikes that we get calls on are things like fingernail polish and juice drinks, even when you're talking about tubes of things, like toothpaste, it also looks like frosting tubes that we use in the kitchen to frost the cookies. So kids are interested in that. So that's just a couple of ideas of other lookalikes we get calls on.

Interviewer: So think like a three-year-old would think?

Sherrie: Yes. Absolutely.

Interviewer: You can't read, you can't tell one bottle from another, would this be something you might consume if it was left out? Any other thoughts? Anything we should leave thinking about?

Sherrie: One other tip would be to keep things stored where they should go so that the cleaners should probably not be sitting on the kitchen counter. We've had poisonings where people have accidentally put a cleaner in the refrigerator or like a windshield washer fluid in the refrigerator and then it gets poured out as a drink.

Interviewer: Yeah, sure.

Sherrie: I mean, obviously, you wouldn't do that if you were thinking, but you never know. If the groceries are getting unloaded there on the countertop and things are not getting put away where they should go, there could be a problem.

Interviewer: Or even in a cabinet, maybe don't store food and chemicals in the same place. And that way, you could educate the child, to some extent, that this is not where we go. This is okay.

Sherrie: This is where the cleaners are. This is where the food is.

Interviewer: This was very eye opening. Thank you very much.

Sherrie: You're welcome. Thanks for having me today.

Interviewer: I'm glad I asked, but it was a little bit more difficult than I thought it was going to be.

Sherrie: You did great.

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Interviewer: Poison prevention strategies for parents whose kids just started crawling, walking or climbing.

Sherrie Pace is a health educator for the Utah Poison Control Center.

Interviewer: You broke out these three segments. Why?

Sherrie: I did because development kind of changes through those three areas. With the crawlers, they're super excited to get moving. They've been looking around and seeing all these things that they want to explore for a long time and all of a sudden, they can move.

Interviewer: Yes. So before they can move, do you really have to worry that much as far as poison?

Sherrie: Well, it's always good to make sure older sibling aren't getting anything in their way. And making sure you're correctly dosing if there's medication to be given. Those are typically the infant top poisonings.

Interviewer: What should you do to protect crawlers?

Sherrie: They can reach things on low shelves, low cupboards, low drawers, anything that's left on the floor. Kind of think of it from a child's point of view as you look around your home. And then, you'll want to make sure that you put things up and out of reach of those little crawlers and then use child resistant closures because when they get a hold of medicine bottles, believe it or not, even little, tiny people can sometimes get those open.

Interviewer: And they're persistent. And I think if nothing else, that's in their favor. They will sit there and work on it for hours.

Sherrie: Putting locks on the cupboards and below cupboards. Keeping things out of their little reach.

Interviewer: Are locks are pretty effective? I've gone to other people's houses and those locks sometimes, I feel like I didn't realize it was there. I pull the door and I get it open pretty easily.

Sherrie: It's a deterrent, but nothing is childproof. It's child-resistant so it gives you a little more time to catch them in the act.

Interviewer: I even thought, like if you're cleaning around the house and you leave your cleaners out on the floor, you might not think of that. But, quickly, somebody could get into that, a little crawler.

Sherrie: It just takes a couple of seconds. and that's one of the biggest problems with the kids getting into the things, is it happens a lot at times and when things are out and in use. Even if we're good about putting things up high, when we're actually cleaning the floor and we've got that cleaner out and we're distracted for a split second, it can happen.

Interviewer: So think like a crawler. Get down on your hand and knees and crawl around and see what you see. Let's talk about walkers.

Sherrie: Walkers. The peak age for poisoning is 18 months. And that's usually new little walkers. They can reach higher. They actually on their tippy toes can reach pretty deep onto a counter top. And that's something where we see some difficulty. They can certainly get to higher cupboards, higher drawers than crawlers. So you have to think of it from their perspective as well. But they have a little more breach than those crawlers did.

Interviewer: The stuff on the bathroom counter, for example, nail polishes. Is toothpaste bad?

Sherrie: Toothpaste, we get a lot of calls on toothpaste. Certainly, call us if that happens because you never know what's in that. If there's fluoride in it, there could be more problems. It's just something to call us about.

Interviewer: For walkers, you've got to not only think like a crawler but like a walker and a reacher.

Sherrie: A reacher, absolutely.

Interviewer: Are there any other tips you have for the walkers?

Sherrie: Yes. Definitely with older siblings, that can be a problem too. I've definitely heard stories where an older sibling leaves something on the counter, doesn't think their little toddler sibling can get it and they do.

Interviewer: The next one: climbers and, obviously, extending the reach a little bit.

Sherrie: Right. So nothing's off limits at this age.

Interviewer: How old is a climber, generally?

Sherrie: Honestly, that depends. Some kids never really are big climbers and others, they are just so motivated to get whatever they can see. So they are scrambling up drawers, stepping drawer to drawer like stairs, getting up on counter tops in high cupboards. And if you have the climber, it's very challenging.

Interviewer: What do you do what are some tips for that?

Sherrie: I would recommend keeping especially medications locked up. Under kind of lock and key.

Interviewer: That sounds really extreme. Do people really do that?

Sherrie: It's an extreme, but it's not a bad idea, especially with your medications.

Interviewer: Especially, if you have some of those powerful painkillers. Those can be deadly.

Sherrie: They can be particularly problematic. But definitely using the child-resistant closures that can slow them down and the child protective locks that can slow them down. All those things help a little bit to catch them in the act. And obviously, adult supervision, you can't ever say enough about that.

Interviewer: It sounds like a lot of these strategies are more about slowing somebody down than really maybe getting something completely out of reach. Or is it a little bit of both?

Sherrie: Well, it's a little bit of both. When things are out of sight too, that's something where the kids aren't as enticed to get something. So a really high shelf and a cupboard with the door closed, they're less likely to be going for something that they can't see.

Interviewer: All right. When does it get better? At what point do you not have to worry quite so much that your child might get into something particularly bad?

Sherrie: Our statistics show that the majority of our calls are for kids under age six. We really recommend a lot of these strategies for under age six just because cognitively, their functioning, they can't read yet. It's difficult for them to maybe distinguish between things that are safe and things that aren't. And everything goes in the mouth when you're a little kid. It's how they explore. It's always a good idea to keep things up and out of reach.

Interviewer: After six, not quite as bad, but still probably, you need to keep an eye on things.

Sherrie: You still need to be cautious.

Sherrie: Give us a call if you need us. That's what we're there for. We know that things happen. We don't judge you. We understand things can go wrong and that's why we're there. The number is 800-222-1212.

updated: December 9, 2021
originally published: March 20, 2016

Dr. Gellner: Hand sanitizers are poisoning more kids, but how? I'm Dr. Cindy Gellner and I will explain on today's edition of The Scope.

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Dr. Gellner: Poison control centers are warning parents and school officials about a troubling trend: small children becoming drunk after drinking alcohol-based hand sanitizer. Kids as young as five or six are showing up in emergency rooms stumbling, slurring their words, and falling down. When the doctors ask about the possibility that the kids have gotten into anything poisonous, they learn that the kids are eating hand sanitizer. Ew. A lot of sanitizers can be made to smell good, like strawberries or other fruit, and little kids, being the curious explorers they are, often taste things that smell yummy. In these cases, though, the kids wind up with blood alcohol levels above the legal limit for an adult.

This seems to be part of a trend that we are only just now recognizing. In 2010, the US Poison Control Centers got more than 3600 calls about kids under the age of 12 eating hand sanitizer. By 2013 that number had jumped to over 16,000 calls. That's a 400% increase.

Hand sanitizers come in brightly colored bottles. They can be laced with glitter, and they can smell like bubble gum, lemonade, vanilla, and the packaging makes them very enticing to young children. The trouble with these products is that they can be 40% to 95% alcohol. Drinking even just a little bit can make kids drunk. It's like drinking a shot or two of hard liquor, and I don't know of any parent who would give their kids that.

Some hand sanitizers are twice as strong as vodka. Because of their small size, kids are more vulnerable to alcohol poisoning than adults are. They may stagger, seem sleepy, or vomit. Their heart rate, blood pressure, and breathing may slow down. Alcohol can also cause a child's blood sugar to drop rapidly, leading to seizures and even put them in a coma.

Hand sanitizers are often included in the list of school supplies parents should send to school. I know I've sent my kids to school with them, but we often don't realize how much alcohol is really in them. We just want our kids to avoid germs. Parents and teachers should be aware of this. Hand sanitizers should be kept out of reach and kids should only be allowed to use them with adult supervision.

These products do have a role in decreasing germs, but they need to be used wisely. Washing hands works, too, don't forget. And if you're going to send hand sanitizer to school, consider sending your child with hand wipes instead. Those usually don't get eaten.

If you think your child has eaten hand sanitizer, call your local poison control center right away at 1-800-222-1222. That's a national hotline. If your child shows any signs of intoxication, take them to the closest children's hospital for age appropriate treatment. Remember, kids are not little adults and need to be treated as kids when it comes to emergencies.

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Interviewer: Bleach, Visine, or laundry pods. Which one of those three things is the most dangerous for your child to swallow? We'll answer that question next on The Scope.

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Interviewer: You're listening to this podcast. Go ahead, and this is the play along at home part. I'm going to give you three substances and I want you to think. Which one do you think is the most dangerous poison if you were to ingest it: bleach, Visine, or those little pods that you use in your laundry?

Barbara Crouch is with the Utah Poison Control Center. Out of those three items, give our audience a chance to think what that would be, I would say bleach. Is that the most dangerous?

Barbara: It's actually the least dangerous.

Interviewer: You're kidding me.

Barbara: No, no, it's not. Not that I recommend a diet of bleach or swallowing it, but it is upsetting to the stomach. It can make somebody throw up. But with the household bleach that's usually the worst thing that happens.

The Visine and products like that act chemically just like a blood pressure medication, so they can dangerously lower blood pressure. Children can have difficulty breathing with that medication.

Interviewer: How much would it take for that to start to happen?

Barbara: You know, nobody really knows, right? You have a Visine bottle that you keep in your pocket, so . . .

Interviewer: And they're not that big.

Barbara: They're not that big, so we don't really have a great idea of how much it takes. I couldn't tell you what the right amount is.

Interviewer: But there's enough in that little bottle in some instances to cause problems.

Barbara: Absolutely. Again, it acts just like a blood pressure medication. That's really on our list of things that are very dangerous in a dose.

Interviewer: Wow.

Barbara: So that's usually the most surprising thing in the household that's problematic. The laundry pods are new things and they're fairly dangerous as well. We're getting more information about those. They're very easy to squeeze so we've had a lot of problems with people getting it in their eye. It's very concentrated because you've got all of your laundry detergent right in one little teeny pod that's going to clean your entire laundry, so it's concentrated, it's irritating, and with children, when they've ingested them because they're extremely attractive, we've had children that have had effects that are far different than children swallowing a mouthful of regular laundry detergent. We've had children that have had difficulty breathing, that have had to have support for breathing with tubes and ventilator kind of things. Those are things that are relatively new the last couple years that we're watching, but we tend to see much more severe effects than what we typically expect with laundry detergent.
Interviewer: So out of those three things, you should always call Poison Control, even if it's bleach.
Barbara: Absolutely.

Interviewer: Make that phone call.

Barbara: 1-800-222-1222 is the Poison Center phone number.

Interviewer: And an expert can help you out.

Barbara: 24 hours a day, and it's free and confidential.

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Interviewer: Don't search the Internet first. The first thing you should do is call Poison Control and we'll tell you why next on the Scope.

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Interviewer: Your child swallowed some Drano or your husband got some gasoline in his eye. Or your grandma took too many of her pills. What's the first thing you should do? It's not search the Internet for an answer. And we're going to find out from Barbara Crouch. She's with the Utah Poison Control Center. The first thing you should do in any of those instances is what, Barbara?

Barbara: Call the Poison Control Center, 1-800-222-1222.

Interviewer: But it seems it would be easier and I wouldn't be a hassle if I just went on the Internet and found out what to do if my child swallowed Drano? Why shouldn't I do that?

Barbara: I mean, you can search and get many, many different answers, but how do you know when you have the right answer? So it is a click on your cell phone, right, to make that call, a 10-digit dial from you home phone number, and you get an expert, you get a pharmacist, a nurse who is a specialist in poison information that can rapidly assess the situation and provide first-aid instructions.

Interviewer: Action item number one, let's say that phone number again and make sure everybody puts it in their phone because it could be a phone number seconds count. It could be a phone number that could save somebody's life.

Barbara: Absolutely. 1-800-222-1222.

Interviewer: All right. So rewind this, put that in your phone because you know we can't put the magnets up on the fridge anymore that says Poison Control like when we were kids, right? This was interesting to me. What is a poison? Because I think we only tend to think of one type thing as a poison, but there are a lot of them out there.

Barbara: Sure. Most people think about a swallowed poison, right? My child puts something in their mouth and swallows it. But a poison is anything that gets in the mouth, in the eyes, on the skin, we breathe in that can be potentially harmful. So it's not just a medication or a household product that gets swallowed. It could be a fume or a vapor that we inhale, smell something in the environment, it could be a bite or a sting. It could be exposure to sap from a plant or it could be a chemical that we splash in our eye when we're cleaning. All of those things are things that we handle every day at the Poison Control Center.

Interviewer: If any of those things happen, you should call immediately. And what can the person on the other end of the phone do for me?

Barbara: So they're going to rapidly ask a series of questions to assess the situation and they're going to rapidly determine whether or not it's safe, that we can manage that either on site or whether or not that situation requires the trip to the emergency department. And that typically takes about three minutes to do that and to assess that situation. And in 80% of the time, we can manage that situation at home with telephone follow-up.

Interviewer: That's much faster than I could search Google and then try to figure out if something's accurate or not. And that inaccurate information can also cause more damage. For example, I understand inducing vomiting isn't necessarily always the way you want to handle a poison incident anymore.

Barbara: In fact, we never want to induce vomiting anymore. We found that it doesn't help, it doesn't help us out, and in many cases it could do more harm. So we never recommend inducing vomiting, but you can go on the Internet and you can search for what to do in a poisoning. It will tell you to induce vomiting, it will give you several ways to do. Many of them are potentially dangerous.

Interviewer: I hope we've made the case that it's just so much better to call Poison Control and talk to an expert because they can do it so much more quickly, they know the latest information, 80% of the time, you mentioned you don't have even to leave your house. It's something you can manage over the phone and it saves money too, from what I understand. Poison Control Center actually saves money because people don't have to go to the ER.

Barbara: That's right. And national studies have demonstrated for every dollar spent on a poison center, we avert almost $14 in healthcare costs. So huge savings to our payers, our state governments, our federal governments our insurance companies and to all of us who pay for our own way into the emergency department.

Interviewer: Is there a time where you would want to call 911 instead of Poison Control in suspected poisoning incidents?

Barbara: Absolutely. Anytime anybody is unconscious or having difficulty breathing or is seizing, you should always call 911 first. But, other than that, the experts at the Poison Control Center, those pharmacists, nurses, specialists in poison information are going to be there right at your fingertips and they're going walk you through the situation and make the right decisions.

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Interviewer: You've been stung by a scorpion. Should that bother you? Should you freak out or are things going to be okay? We're going to find out next on The Scope.

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Interviewer: Poison Expert Dr. Brad Dahl works at the Utah Poison Control Center and I guess I didn't realize there were a lot of scorpions here in Utah, but you get some calls from people that think that they're stung by scorpions. Let's talk about scorpions.

Dr. Dahl: Yeah, right now actually we're getting quite a few calls about scorpions. I don't know whether it's because of the recent wet weather or what's going on, but they will sting you.

Interviewer: So I guess Utah Poison Control Center covers the whole state so you are getting some of these reports. Scorpion stings, what should I do if I've been stung by a scorpion?

Dr. Dahl: Well, the first thing you want to do is wash it off, soap and water, because we don't want it to get infected. The next thing you want to do is call us and we'll help you work through this and make sure that you do okay with it.

Interviewer: Where is kind of the most common place people are getting stung? Bottom of the foot, like putting their shoe on?

Dr. Dahl: Well, usually, it's because they're walking around barefoot and they step on it. Sometimes it's in their clothes and so if you're putting on a shirt you'll get stung anywhere that the shirt is touching. We did have a guy who had a scorpion in his underwear.

Interviewer: No thank you.

Dr. Dahl: Yeah, the good news is it stung him on the butt. It could have been a lot worse.

Interviewer: So is it in clothes, normally? Or barefoot, generally? That's how people are getting them?

Dr. Dahl: I think the foot is the most common.

Interviewer: Okay.

Dr. Dahl: Because you're walking around your house and if you're somewhere where there are scorpions, you don't see them. A lot of them are very tiny so unless you're carrying a black light with you, you're not going to see them.

Interviewer: Really?

Dr. Dahl: Yeah. They all light up with a black light. It's pretty cool.

Interviewer: So do you usually know that it's a scorpion that bit you? I mean, I guess I envision the classic scorpion going across the ground and stinging you.

Dr. Dahl: Yeah no. They sting. They don't bite. I mean, you know because it hurts. The venom hurts. The good news is that

Interviewer: But most of the time, you might not even see that that's what it was?

Dr. Dahl: Pretty much everybody who calls me well, we get plenty of people who are stung by things that they don't know what it was, but most of the scorpions, they know, they see it. So they know what it is. They're not that fast.

Interviewer: And instantly it starts hurting?

Dr. Dahl: Oh, yeah. Yeah, the pain is instantaneous.

Interviewer: Okay. Dr. Dahl: The good news is the scorpions that live here in Utah are fairly benign. Usually, that pain, within an hour or so, it goes away and everything is fine. They rarely swell up much. Interviewer: Al. right. So call Poison Control just as a matter of probably caution, but generally not something that's going to be a major issue?

Dr. Dahl: That is correct. Yes.

Interviewer: All right. Anything else I need to know about scorpions?

Dr. Dahl: Well, there is a venomous scorpion in Arizona that can make you pretty sick and every so often we'll get somebody who's been visiting down there and brings it back in their suitcase.

Interviewer: Okay.

Dr. Dahl: Okay. So that's the other issue. I mean, if you're in the Salt Lake Valley and you get stung by a scorpion, we want to know where have you been? Have you had any visitors from Arizona? And we've had a few of those. They can make you pretty sick. They're not going to kill you, but it could make you pretty sick. Try to pay attention and call the Poison Center. 1-800-222-1222. We're there 24 hours a day, every day of the year.
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Interviewer: Snakes, ugh. Snake bites, double ugh. We are with poison expert, Brad Dahl. He's from the Utah Poison Control Center. I should say Dr. Brad Dahl. Let's talk about snakes for a minute here. Poisonous snakes here in Utah area, rattlesnakes, that's the only game, right?

Dr. Dahl: Yeah. The rattlesnake is the only venomous snake that lives in the wild in Utah.

Interviewer: All right. I'm out hiking and I get bite by one. What next?

Dr. Dahl: Well, the best thing to do, and this is a very difficult thing to do, is to not panic because I've got to be honest with you, even knowing what I know, I would probably come close to freaking out.

Interviewer: Sure.

Dr. Dahl: Because if you can keep your rate and everything else as calm as possible, you're going to do much better. Just know that we can help you. Okay. You're not going to die from this.

Interviewer: So rattlesnake bites... not lethal?

Dr. Dahl: Very rarely. It does happen every so often. The worst things that we see here in Utah is when people do things they shouldn't do.

Interviewer: Like try to kiss a snake?

Dr. Dahl: Well yeah. Yeah, yeah, that's not a good idea. We don't recommend kissing snakes. But, yeah, the number one thing is what used to be in the Boy Scout manual and that is put a tourniquet on. Number one, you're not going to stop the flow of venom through your body. Once it enters your body it's on its way.

Interviewer: And, no, that doesn't help at all? A tourniquet is just a waste of time?

Dr. Dahl: No. It doesn't help at all. It also inhibits your body's ability to attack the venom itself with your own immune system. So you want your body to let it do its thing. You want to stay calm and don't do that because otherwise, you can actually tissue at the bite site. Which, Utah typically is going to be the hand.

Interviewer: Oh, it is? The hand is the most likely to get bit?

Dr. Dahl: It's very unusual to see people bit in the foot here in Utah. In the last 20 years, we've had probably less than 10 bites on the foot. Yeah, in the entire state.

Interviewer: So snakes, snakes cannot penetrate if you're wearing sensible footwear?

Dr. Dahl: Yeah, that's true. So if you're out hiking where there could be snakes, you definitely want to wear some good boots and you want to wear jeans. There's actually been a study done on people wearing jeans and it's protecting them from being envenomated. That's the other thing too. Just because you're bit by a snake doesn't mean they injected venom in you. Although most of the time they do. So I always like to be an optimist. It's like, "Oh, I was bit by a rattlesnake. Hey! Maybe I wasn't envenomated."

Interviewer: But just imagine, treat it as though it did. What about those snake bite kits? I went and bought one of those things in the yellow tube, got the razor blade, you're supposed to suck them out. Does that work?

Dr. Dahl: No, but the interesting thing is I've never seen anybody who had a venom extraction kit get bit. So I think it is somewhat protective.

Interviewer: Really? That's interesting.

Dr. Dahl: Yeah, just, yeah.

Interviewer: But actually the kit itself and the act of cutting and trying to get the poison out, at that point it's too late.

Dr. Dahl: No. There have actually been studies done with injecting non-poisonous stuff into people and trying to extract it out with a venom extraction kit and they've not been able to get out anything, significant anyway. So it's pointless to do it. Usually, when you're out hiking you've got a knife there, it's not sterile. If you start cutting into things, start cutting into things. Yeah. We've had people cut and do some real damage with the knife, trying to cut and get the venom out. Yeah. We do not recommend doing that. So yeah, what Hollywood teaches us is not the right thing to do. Do not cut and suck. The Boy Scouts, they've changed their manual now. So no more tourniquets.

The other thing people think of doing is putting ice on it. And the one thing it does do that's kind of good is it numbs the pain. But the other thing it does that is not so good is it inhibits blood flow to the area. So, again, we do not recommend putting ice on it as well.

Interviewer: So they don't kill us, but what's that venom going to do to us? If I'm a couple, three miles out and I get bit, I've got to walk two or three miles to get cell phone reception. What am I dealing with at that point?

Dr. Dahl: Yeah. Well, certainly the sooner we can get you help, the better. Yeah, you're okay to walk. If you're not, if you don't feel you're okay to walk, then you can stay there if you're with somebody else. That's why it's always good not to hike alone, kids. You can send them out to call somebody and they can come in and get you. So getting you help is probably the best thing you can do as soon as possible. And not waiting to see if it's going to be a problem because if you wait for four or five hours and you come in and your arm is swollen all the way to your elbow or beyond, up to your shoulder, you're going to end up with some pretty good tissue damage.

Interviewer: I'm not doing more damage by trying to walk out, that's what you're telling me?

Dr. Dahl: No. That is correct. If you're bit on the hand, which is the classic thing, you can put your arm in a sling. You don't want to be aggressively swinging it around and things like that. So it's okay to do that and try to keep it immobile. And to not run out. Try to keep your heart rate as normal as possible. But hike out as calm as you can and as soon as you get a cell signal, call 9-1-1 to get somebody out there to get you. Interviewer: Okay. That's completely okay to do that?

Dr. Dahl: It's totally okay to do that.

Interviewer: That is a reason to call 9-1-1 and have somebody show up.

Dr. Dahl: Yeah. That's not a problem at all. We would encourage that. And obviously, if you get to the trail head and you've got your car there and the hospital is within an hour's drive, you're probably okay just to drive to the hospital.

So the worst thing you can do is think, "Oh, this snake is on the trail. That could hurt somebody. I'm going to move the snake off the trail," find a stick to go get it. And the next thing you know, you got bit on the hand. So leave the snake alone. It will move. Or, if it's on the trail, tell other hikers as you pass them. "Hey, guess what? There's a rattlesnake up there. So be careful. When you see it, go around it."

Interviewer: Trust me, Dr. Dahl, when I see a snake, the other hikers around me know. It sounds like I blew my knee out usually when I see a snake. All right.

Dr. Dahl: I'm with you there. They scare me too.

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updated: June 18, 2019
originally published: July 22, 2015

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: You're out in nature and you get distracted, the next thing you know you see the kid eating some berries. What now? Should you freak out? Is it a problem? Well, we're going to find out from poison expert Dr. Brad Dahl from Utah Poison Control Center. And you said that this is one of the more common things, that a mother or a father is distracted and the next thing they know they see their young child, usually what, two or three, eating some foreign substance, berries or whatever and that freaks them out. So what do you do at that point?

Dr. Dahl: Well, number one, don't freak out. Okay?

Interviewer: Okay.

Dr. Dahl: Yeah, relax. You've got time and the good news is that there are very few things out there that are that poisonous that we're going to run into real problems.

Interviewer: So here in Utah that's the case?

Dr. Dahl: Yes, here in Utah. And us being Utah Poison Control Center it's our job to know what grows here.

Interviewer: Yeah.

Dr. Dahl: And the next best thing to do is to call us before doing anything else.

Interviewer: All right. But the good news is regardless of what it is, there's not a lot that's going to immediately hurt somebody.

Dr. Dahl: That is true.

Interviewer: So we do have time.

Dr. Dahl: We have plenty of time.

Interviewer: Is there something that a parent can do if they're not in cell phone service and they see this happening to determine what the danger might be?

Dr. Dahl: No, not really. Not unless they know what kind of berry it is. But even then, I mean, if you determine it's a toxic plant or something that could hurt your child. I think the natural instinct is to make them throw up and we learned through experience that you just cannot get enough of it out of them to change the outcome. So we recommend not making them throw up. So if there's anything still in the mouth, it's always a good idea to kind of sweep with your finger and get that out.

Interviewer: Okay.

Dr. Dahl: Give them something to drink. Push any residue down in case it's something that's irritating. But, other than that, you get to where you can get some service and give us a call. Don't panic. I know that's difficult as a parent because most of us parents actually like our kids and so we get a little anxious when they do things like that. But if you can keep calm because that keeps the kid calm and then call us as soon as you can and we'll chat about it and take good care of you.

Interviewer: And keep the kid calm because you just don't want that heart rate elevated and that kind of stuff. What about . . . my natural inclination would be to give them some bread or some water, or something to help dilute that. Is that a smart plan or not?

Dr. Dahl: No, it's totally okay to do that.

Interviewer: Does it help?

Dr. Dahl: No, it probably doesn't help, but what it does is, as a parent that's concerned, you feel like you're doing something to help the child and that kind of brings down the anxiety level. And again, things go much better when people are not out of control or anxious about something. You can better watch the child and know if they're really having symptoms that are real symptoms. If you keep asking them if they have a stomach ache, they're going to eventually say yes because you can convince a two or three-year-old to say that.

Interviewer: Sure. Okay. So they eat something, you're saying 100% of the time take it seriously, call Poison Control. If you're out of cell phone range, get into cell phone range, I'd imagine?

Dr. Dahl: Yes. Yeah, don't wait for them to get sick.

Interviewer: Okay.

Dr. Dahl: Because if it something, and if you can bring some of the plant with you, that's always helpful too because most people have cell phones that can take pictures. And you can send us a picture of it and we'll take a look at it and say, "Oh, yeah, we know what that is." Or it's like, "Ooh, yeah, we're not sure what that is." But we'll still give you the best information to make sure your child does the best possible.

Interviewer: Okay. I guess I was hoping for some magic answer that you would say "most of the time you don't have to worry about it," or, "it's these kinds of berries you've got to watch out for," but there is no real universal, it doesn't sound like.

Dr. Dahl: Well, the problem with trying to figure it out without really knowing what you're dealing with is, what if you're wrong? We don't like being wrong. Okay. So we want to treat everything until we know for sure what we are dealing with, like it could be something that's a problem. And so we treat it that way until we're sure that everything is fine. But again, knowing what grows here and knowing how much kids really eat, we know that it's highly unlikely that they're going to get enough of anything that's going to hurt them.

Interviewer: So do all poisonous berries or foods present some sort of symptoms or do some of them present no symptoms? I would think if they're saying they have a stomach ache then I would worry, or if a fever kicks in, I would worry.

Dr. Dahl: That's a great question and I can't really think of any plants that would cause a fever. Most of them are going to be gastrointestinal, nausea, vomiting, possibly diarrhea. That would be the classic presentation.

Interviewer: And that's going to take a while to set in?

Dr. Dahl: Yeah. Usually an hour or so. Sometimes it can be a little bit sooner. But, again, it depends on if they have something in their stomach and exactly what it is they ate. But there are some that contain other toxins that can affect the nervous system and also the heart. And so those symptoms, you're probably not going to see right away either. And you're not even going to be able to tell if it's a cardiac situation. You can't tell if your child's heart is beating fast or slow unless you're actually measuring it.

Interviewer: All right. Did I miss anything here? I'm trying to think from a parent's perspective, questions they might have, things they'd want to know.

Dr. Dahl: No. I think that was pretty good. Yeah.

Interviewer: So we just . . . if we see them eat something then pause on your plans. It's worth taking a picture of it. I love that idea. And finding out for sure from some experts.

Dr. Dahl: Yeah. Give us a call. We're there 24 hours a day. It's a free service. It's confidential and we'd love to help you. We want your call.

Interviewer: Give me that number?

Dr. Dahl: 1-800-222-1222. It's a 1 surrounded by 2s.

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Aaron: Prescription drug monitoring, that's next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Aaron: I'm here with Peter Kreiner PhD, he's a senior scientist at the Institute of Behavioral Health of the Schneider Institutes for Health Policy, a researcher for the Heller School for Social Policy and Management and he's an expert in prescription drug monitoring. Welcome Dr. Kreiner.

Dr. Kreiner: Thanks, Aaron.

Aaron: Dr. Kreiner, here in Utah, deaths due to prescription overdose have been increasing since about 2001 and we have about 21 Utahans die from prescription overdose every month. Is this a nation wide problem?

Dr. Kreiner: It certainly is, Aaron. Probably from the early 2000's on, public health officials started recognizing opioid and prescription drug overdose death as a huge and increasing problem and recognition has just grown from there. So in the last few years, all federal agencies and national organizations, state governments have grown increasingly concerned with the problem and have started reaching out in a lot of different directions to look for solutions.

Aaron: Now what is a prescription drug monitoring program? I understand that's one of the solutions that they're looking at.

Dr. Kreiner: Prescription monitoring programs are essentially a data repository. Forty-nine states have now passed legislation authorizing such a program. Forty-eight states have actual operating programs. The hold outs are Missouri for legislation and New Hampshire is just about to have an operating program. They're repositories of filled or dispensed prescriptions for controlled substances that pharmacies are required to submit to each state program. So they are databases that are intended to serve multiple stake holders, typically prescribers and pharmacists and often other individuals can establish an account with a prescription monitoring program and log in and query it about a patient to inform their clinical decision making.
In many states law enforcement can access the data in relation to an active case investigation and increasingly the value of this data is being recognized and so monitoring programs are providing data to other entities like medical examiners, drug courts, to follow some of their clients. Treatment facilities are accessing the data to see if patients in treatment facilities might be obtaining prescriptions that their clinicians don't know about. So there's a lot of innovation going on now across the country about use of this data

Aaron: What sort of data is maintained by these monitoring programs?

Dr. Kreiner: It's a record of each prescription that's dispensed, includes information about the patient, the prescriber, and the pharmacy that dispensed it, including dates the prescription was written, the date it was dispensed and info about the specific drug prescribed, the dosage the, date of supply, often whether or not it was a refill or if refills are allowed. In many states it includes information about the payment source. So, kind of insurance, cash, that sort of thing.

Aaron: What's the value of the program overall for patient safety?

Dr. Kreiner: For patient safety, again if a patient presents a prescriber or their physician, could be an emergency room or could be their primary care physician, that physician may or may not know about the prescription history of that patient. Often physicians think this is a legitimate patient, have legitimate symptoms. I'm interested in prescribing a pain medication opioid analgesics and yet when they check the monitoring program, they find that person may have obtained half a dozen prescriptions from a number of different prescribers in the last month. That's a very different picture of that patient then they might have had.

Aaron: So ultimately this can help a health care provider help a patient stop an addiction or at least get help for an addiction before it goes too far. Is that safe to say?

Dr. Kreiner: Patients may be obtaining multiple prescriptions for lots of different reasons. So they may be misusing or abusing, they may be addicted, they may be diverting. And certainly the prescriber, it's intended that they might have a discussion with that patient and really try to help that patient to seek appropriate help. It's an ongoing issue about what treatment resources are available and that's an issue in every state.

Aaron: Utah has a prescription drug monitoring program. I don't know how familiar you are with Utah's particular program, but based on what you've seen nation wide in your experience, how do you think Utah could better use its prescription drug monitoring program to prevent overdosing?

Dr. Kreiner: Our center, so we have a prescription drug monitoring program center of excellence at Brandeis University, studies best and promising innovative practices that monitoring programs are doing nation wide. So we've identified 30 some odd practices that keep increasing all the time. Some of the more impactful ones that we've seen in other states that I believe Utah is not currently implementing include what's called unsolicited reporting where a monitoring program proactively analyzes this data and pushes out a report or sometimes an electronic alert to a prescriber or pharmacist for a patient to bring that information to their attention.
Several states have enacted mandates for prescribers and or pharmacists to register with the program and query it under specified conditions. For example recently New York, Kentucky, Tennessee and even though those programs are quite recent, it's already had an impact on the amount of use of that program. But also in certain indicators of doctor pharmacy shopping and opioid prescribing.

Some other practices that seem very valuable that we've been using in Massachusetts is use of de-identified prescription monitoring program for public health surveillance purposes in particular to provide it to counties and communities, we're working to prevent and reduce prescription overdoses, prescription drug related problems. I could go on, but those are some leading practices that I think Utahans could benefit from.

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Interviewer: You may think that e-cigarettes are safer than conventional cigarettes, but did you know that in 2014, poison control centers in the United States received up to 215 calls per month about e-cigarette poisoning? That's next on The Scope.

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Interviewer: I'm talking with Dr. Zane Horowitz today. He's the Medical Director of the University of Utah Poison Control Center. Dr. Horowitz, I read something from the Center for Disease Control recently about the rise in poison control center calls regarding poisoning from e-cigarettes. What's that all about?

Dr. Horowitz: Well it's not so much the cigarettes themselves but the refillable cartridge where you put the liquid that you vape, in. Right now the amount of nicotine that's in that can vary dramatically. The flavors are tasty flavors that are attractive to kids, bubble gum, cherry, and all these fruity flavors. A few sips of that will deliver sometimes as much as anywhere from on the low side 10 milligrams of nicotine all the way up to 200 to 400 milligrams of nicotine. To put that in perspective, when we smoke a single cigarette, that delivers about 1 milligram of nicotine.

So a child who accidentally takes the top off this and smells it and it smells nice and fruity, and tastes it and it tastes really delicious, and takes a gulp or two, he's getting the equivalent of maybe 200 or more cigarettes delivered all at once. And he's going to get quite sick. The poison centers nationwide and here in Utah have been receiving increasing number of calls as these products have grown on the market. People are having these out on the kitchen table and the coffee table in the living room, so children just reach over. A sip later, and all of a sudden they're vomiting and they're sick and they have to go into the emergency room to be treated.

Interviewer: I guess maybe we need to go back and talk a little bit about e-cigarettes to begin with. Tell me what an e-cigarette is and how a person uses it.

Dr. Horowitz: The "e" stands for electronic. They're made to look a lot of times like cigarettes or cigars, although sometimes they're made to look like other objects. There's a long chamber where you can put a liquid, and the liquid contains mostly nicotine, but it could be flavored and there could be other things in it as well. There's a little heater that warms that up and creates a vapor. You inhale it just like a cigarette and you just get the vapor of nicotine without all that other smoke, all that burning tobacco leaves stuff that makes you smell like an ashtray. So it's reasonably odorless, although they tend to have a fruity odor about them. When that portion gets burned up, you take a refill out of your pocket or wherever you have it and you fill up that little chamber again so you can keep on vaping, is the term.

Interviewer: Recently the CDC put out a report that stated that back in 2010, poison control centers were getting about one call per month on e-cigarettes. In 2014, they're getting as many as 215 calls per month. That's a pretty astounding jump, don't you think?

Dr. Horowitz: Right. It's been rising almost every month, month to month, as more and more of these products are sold and they're in people's homes and they're where children are. Currently because there isn't any regulation one way or the other, how much is in these liquids is unknown. There's no safety cap as there would be with a medicine bottle or an automotive product. Other consumer products that we have around the house that we know can be dangerous to children often have some sort of cap that the child can't take off easily. And it's usually the exploratory 1 or 2 year old child who's learning how to manipulate things and pulls it off that and it smells delicious and they stick in their mouth and it tastes delicious and they drink a gulp. It doesn't take much with this. That's probably the key point. One gulp can be quite toxic to children.

Interviewer: And you're talking specifically about the flavored liquid that goes inside of these e-cigarettes.

Dr. Horowitz: Right.

Interviewer: What do the containers look like?

Dr. Horowitz: They look like a little eye dropper bottle. So far there aren't giant companies making these yet, so a lot of these are home grown little stores. They buy a little plastic bottle with a little screw top on it and you pour that little screw top or an eye dropper full into your chamber of your e-cigarette and put the cap back on. It doesn't take more than a quarter turn twist to get the cap back off, and that's easy for a child of 1 or 2 years old to manipulate and they have access to it.

Interviewer: The CDC Director, Tom Frieden, actually mentioned that these e-cigarette liquids are not required to be childproof.

Dr. Horowitz: Right now there isn't any regulation about that. That's being considered. I think we have to take a very rational common-sense approach to it. The simplest thing is obviously make these things childproof like we've made medicine bottles, automotive products, and some household cleaners that are toxic. That's the first big thing. Then I think the number of exposures will go down.

The second thing is just educating parents and uncles and aunts and whoever else is going to be visiting with little children, use some common sense. Don't put this out on the table and have your 2-year-old watch you pull it out and spill it in your little chamber of the e-cigarette and sit there vaping. They'll all look at it and go, "Wow. That looks like a cool little toy that I can play with now." Then you put it back on the counter or the table and they're going to take it apart and try to figure it out for themselves because that's what kids do.

Interviewer: If a child ingests this, what do some of the symptoms look like?

Dr. Horowitz: Usually they have nausea and vomiting. Sometimes they vomit over and over and over again. They can get pretty dehydrated pretty quickly for a small child. But in large amounts, like I said those concentrations sometimes can be equal to 200 cigarettes, this could potentially be fatal. A child could die if he takes those really concentrated liquids, and some stores are selling those, the high concentration, meant to be diluted down by the person who's going to be vaping. If a child gets into a few gulps of that, they can have seizures. They can have heart arrhythmias, where their heart beats very irregularly, and in severe cases, if they took enough of that, they could die.

Most of the things we're seeing are the lower concentrations, but there's no labeling. We don't know how much is in any product, and the size of these can vary from a tiny little dropper size to something that looks like a soda bottle size.

Interviewer: How long does it take for some of these symptoms to appear?

Dr. Horowitz: Usually pretty quickly, usually within minutes. Usually within five or ten minutes we're going to see something. The child is going to start vomiting and sweating and feeling pretty miserable.

Interviewer: Let's say they get a really heavy dose, one of these that could be fatal. How long does the child have to get treatment before they die?

Dr. Horowitz: Well if someone accidentally drank one of these with a high concentration, we would probably advise parents to call 911 and have an ambulance drive them to the hospital.

Interviewer: With a lower dose poisoning, do you still recommend that parents take their children into the emergency room, or what do you suggest to them?

Dr. Horowitz: Well I think if there's an accidental little taste or a lick, they certainly can call the poison center 24 hours a day. We have nurses and pharmacists with training, we've briefed everybody on this, and they can talk through the particulars of each individual occurrence. So if it's a small amount and the child's not having immediate nausea and vomiting, we may not have to send you to the hospital or the doctor. We'll just sort of call you back and see how you're doing.

Interviewer: Can you just tell us the number to the Poison Control Center for parents that might be interested to know that?

Dr. Horowitz: Yes. It's a universal 800 number. In whatever state you are in it will get you to your state's poison center. It's 1-800-222-1222. 24 hours a day that phone will be answered live by our poison information specialists and they're very happy to talk to you. No question's too small, whether it's e-cigarettes or any other product that your child might get into at home.

Interviewer: All right. Thank you.

Interviewer: Let's say you accidentally swallow a mouthful of gasoline, how dangerous is that?

Today we're talking with Brad Dahl who's a poison specialist at the University of Utah Poison Control Center. Well, tell us what you think Brad, how dangerous is gasoline?

Brad Dahl: Well that's an excellent question because we see people accidentally swallowing gasoline all the time, I mean it's a daily occurrence here in Utah and the important thing to know is that if you swallow gasoline and it goes down to your stomach, it's really not that big of a deal, other than you're going to be burping gasoline for about 24 hours, that's not real tasty, but it will keep going, it's not absorbed very well in your gut. But most peoples initial instinct is I have to get it out and that's the wrong thing to do because where it is dangerous is if even a tiny drop gets into your lungs, that' can be very dangerous because it spreads out and it coats the lungs and it really hurts the tissue in there and it makes it difficult to breath, so we do not want it in your lungs.

Interviewer: So in the poison control center, what kind of scenarios do you hear from people when they call with a potential gasoline poisoning issue?

Brad Dahl: Well the most common thing is when somebody is siphoning gasoline and again with the price of gas being so expensive now, we have people, you know, it's easier to take it out of one vehicle to put it in another rather than go buy some more, so they'll be siphoning it and then as they're sucking on that tube some seems to get in their mouth, and then they accidentally swallow it after that.

Interviewer: And how much are they typically swallowing, is it just a mouthful or is it more than that?

Brad Dahl: It's usually just a mouth full and typically it's less than that. Some people try to spit it out but almost everybody I talk to says they swallow some of it.

Interviewer: So it's not that dangerous if you get a mouthful?

Brad Dahl: No, even two mouthfuls wouldn't be that dangerous as long as it goes down to your stomach and stays there or keeps going.

Interviewer: Now what about if you're filling up your lawn mower or something and the gasoline splashes up into your eye?

Brad Dahl: That really hurts, so you want to get it out of your eye as soon as possible and the best way to do it is with warm water, not cold water because cold water feels better in the eye because it numbs it but it won't move it along very well because gasoline doesn't like water and if it doesn't mix very well, so you want to, you know, just flush it nice and gentle through your eyes, as long as it takes to get it out, once your eyes are feeling better, you're done.

Interviewer: And what about fumes from gasoline, any danger from those?

Brad Dahl: Yeah, yeah, if you inhale enough fumes from gasoline, I mean certainly it can cause you to be a little bit impaired and not feeling good. It can cause headache and nausea and dizziness, those are the most common things, but as far as life threatening problems, usually not that big of a deal.

Interviewer: Brad, are there different considerations when it comes to kids, if they get some gasoline in their mouth or something?

Brad Dahl: Well it's the same risk so you want it to go down to the stomach and I know the initial feeling for a lot of parents is, I have to make them throw up and that's the absolute wrong thing to do because that's the easiest way to get it into the lungs. So if they've swallowed it you need it to keep going, so it's a good idea to give them something to drink, just a couple of sips of something that tastes good will do it and also, if it stays in contact with your skin or the tissue in your mouth or your throat for very long, it will make it very sore and will cause a chemical burn, so you want to get it off of there and again, it's okay to push it to the stomach, don't worry about getting it out.

Interviewer: So Brad are there any other risks with gasoline?

Brad Dahl: Yeah, one thing we see a lot is that people working on their cars in the garage and they're lying underneath here and they're messing around with hoses and that, that sometimes that gasoline will drip and sometimes it will go in their ears and boy when that gets inside your ear it is really, really painful and again the problem there now is how do I get it out of my ear safely, it's very difficult to do. You want to do it with warm water and it's okay to use a little bit of detergent but you don't want to use any pressure, so you don't want to be flushing it aggressively. Most of the time the best thing to do is to have a doctor do that and rinse it out, so that way you don't hurt your ear, but you do need to get it out because that can cause some real significant damage inside your ear.

Interviewer: So where would you go to get this out? Let's say you get gasoline in your ear or you swallow it.

Brad Dahl: Well any doctors office can deal with something like that or any kind of clinic that does emergency type services is fine. I would save the emergency room for a last resort, everything else is closed kind of situation, but I would definitely try to rinse it with warm water at home, maybe like I said, with a little mild soap but, again, you want to be very careful rinsing it, you don't want to put any pressure into the ears.

Interviewer: With just swallowing or a kid getting it all over themselves, if there's any worries is it okay for the parents to just go ahead and call the Poison Control Center?

Brad Dahl: Well they should do that first. You should always call the Utah Poison Center when your child gets into something and we'll help you with it right away. We'll answer the phone, we'll talk to you, we'll ask you some quick questions and a lot of the time it's the quickness that really makes things better. So if you call us first, we can help you right away, we can make sure you do things appropriately, rather than trying to fix things that you did wrong. And that number is 1-800-222-1222 and that's a nationwide number, you can call it anywhere in the United States or U.S. Territory and you'll get a poison control center.

updated: February 17, 2021
originally published: June 24, 2014