2014 Annual Report of the American Association of Poison Control

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Clinical Toxicology
ISSN: 1556-3650 (Print) 1556-9519 (Online) Journal homepage: http://www.tandfonline.com/loi/ictx20
2014 Annual Report of the American Association
of Poison Control Centers’ National Poison Data
System (NPDS): 32nd Annual Report
James B. Mowry PharmD, Daniel A. Spyker PhD, MD, Daniel E. Brooks MD,
Naya McMillan DrPH, MS & Jay L. Schauben PharmD
To cite this article: James B. Mowry PharmD, Daniel A. Spyker PhD, MD, Daniel E. Brooks
MD, Naya McMillan DrPH, MS & Jay L. Schauben PharmD (2015) 2014 Annual Report of the
American Association of Poison Control Centers’ National Poison Data System (NPDS): 32nd
Annual Report, Clinical Toxicology, 53:10, 962-1147, DOI: 10.3109/15563650.2015.1102927
To link to this article: http://dx.doi.org/10.3109/15563650.2015.1102927
Published online: 01 Dec 2015.
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Date: 01 December 2015, At: 12:54
Clinical Toxicology (2015) 53(10): 962–1146
Copyright ß Taylor & Francis
ISSN: 1556-3650 print / 1556-9519 online
DOI: 10.3109/15563650.2015.1102927
NPDS REPORT 2014
2014 Annual Report of the American Association of Poison
Control Centers’ National Poison Data System (NPDS):
32nd Annual Report
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JAMES B. MOWRY, PHARMD, DANIEL A. SPYKER, PHD, MD, DANIEL E. BROOKS, MD
NAYA MCMILLAN, DRPH, MS, and JAY L. SCHAUBEN, PHARMD
Address correspondence to: James B. Mowry, PharmD, DABAT,
FAACT, American Association of Poison Control Centers, 515 King
Street, Suite 510, Alexandria, VA 22314. E-mail: [email protected]
aapcc.org
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Table of Contents
Abstract ................................................................................................................................................................................... 968
Introduction............................................................................................................................................................................. 968
The NPDS Products Database ........................................................................................................................................... 968
Methods................................................................................................................................................................................... 969
Characterization of Participating Poison Centers and Population Served ....................................................................... 969
Call Management - Specialized Poison Exposure Emergency Providers ........................................................................ 970
NPDS - Near Real-time Data Capture .............................................................................................................................. 970
Annual Report Case Inclusion Criteria ............................................................................................................................. 970
Statistical Methods ............................................................................................................................................................. 970
NPDS Surveillance ............................................................................................................................................................. 970
Fatality Case Review and Abstract Selection ................................................................................................................... 971
Pediatric Fatality Case Review.......................................................................................................................................... 971
Results..................................................................................................................................................................................... 972
Information Calls to Poison Centers ................................................................................................................................. 972
Exposure Calls to Poison Centers...................................................................................................................................... 972
Age and Gender Distributions ........................................................................................................................................... 978
Caller Site and Exposure Site ............................................................................................................................................ 978
Exposures in Pregnancy ..................................................................................................................................................... 978
Chronicity ........................................................................................................................................................................... 978
Reason for Exposure .......................................................................................................................................................... 978
Scenarios ......................................................................................................................................................................... 979
Reason by Age ............................................................................................................................................................... 979
Route of Exposure.............................................................................................................................................................. 979
Clinical Effects ................................................................................................................................................................... 979
Case Management Site....................................................................................................................................................... 980
Medical Outcome ............................................................................................................................................................... 980
Decontamination Procedures and Specific Antidotes ....................................................................................................... 980
Top Substances in Human Exposures ............................................................................................................................... 981
Changes Over Time............................................................................................................................................................ 982
Distribution of Suicides...................................................................................................................................................... 983
Plant Exposures .................................................................................................................................................................. 983
Deaths and Exposure-related Fatalities ............................................................................................................................. 986
All fatalities – all ages ................................................................................................................................................... 987
Pediatric fatalities – age 5 years................................................................................................................................. 990
Pediatric fatalities – ages 6–12 years ............................................................................................................................ 992
Adolescent fatalities – ages 13–19 years ...................................................................................................................... 992
Pregnancy and Fatalities ................................................................................................................................................ 992
AAPCC Surveillance Results............................................................................................................................................. 992
Discussion ............................................................................................................................................................................... 995
Summary ................................................................................................................................................................................. 995
Disclaimer............................................................................................................................................................................... 995
References............................................................................................................................................................................... 996
APPENDIX A – Acknowledgments.................................................................................................................................... 1120
Poison Centers (PCs)........................................................................................................................................................ 1120
AAPCC Fatality Review Team ....................................................................................................................................... 1122
AAPCC Micromedex Joint Coding Group...................................................................................................................... 1123
AAPCC Rapid Coding Team........................................................................................................................................... 1123
AAPCC Surveillance Team ............................................................................................................................................. 1123
Regional Poison Center (PC) Fatality Awards ............................................................................................................... 1123
APPENDIX B – Data Definitions ....................................................................................................................................... 1124
Reason for Exposure ........................................................................................................................................................ 1124
Medical Outcome ............................................................................................................................................................. 1125
Relative Contribution to Fatality (RCF).......................................................................................................................... 1125
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APPENDIX C – Abstracts of Selected Cases..................................................................................................................... 1125
Selection of Abstracts for Publication............................................................................................................................. 1125
Abstracts ........................................................................................................................................................................... 1126
Abbreviations & Normal Ranges for Abstracts .............................................................................................................. 1144
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List of Figures and Tables
Figure 1. Human Exposure Cases, Information Calls and Animal Exposure Cases by Day since 1 January 2000 ......... 975
Figure 2. All Drug Identification and Law Enforcement Drug Identification Calls by Day since 1 January 2000.......... 976
Figure 3. Health Care Facility (HCF) Exposure Cases and HCF Information Calls by Day since 1 January 2000......... 976
Figure 4. Change in Encounters by Outcome from 2000 .................................................................................................... 984
Figure 5. Substance Categories with the Greatest Rate of Exposure Increase for More Severe Outcomes (Top 4) ........ 984
Figure 6a. NPDS Exposures and the CDC Fatalities for Heroin and Prescription Opioids ............................................... 994
Figure 6b. Best Prediction of CDC Heroin Mortality by NPDS Heroin and Opioid Exposures ....................................... 994
Table 1A. AAPCC Population Served and Reported Exposures (1983–2014) ................................................................... 972
Table 1B. Non-Human Exposures by Animal Type............................................................................................................. 972
Table 1C. Distribution of Information Calls......................................................................................................................... 973
Table 2. Site of Call and Site of Exposure, Human Exposure Cases.................................................................................. 977
Table 3A. Age and Gender Distribution of Human Exposures ........................................................................................... 977
Table 3B. Population-Adjusted Exposures by Age Group ................................................................................................... 977
Table 4. Distribution of Age and Gender for Fatalities ....................................................................................................... 978
Table 5. Number of Substances Involved in Human Exposure Cases ................................................................................ 978
Table 6A. Reason for Human Exposure Cases..................................................................................................................... 979
Table 6B. Scenarios for Therapeutic Errors by Age ............................................................................................................ 979
Table 7. Distribution of Reason for Exposure by Age......................................................................................................... 980
Table 8. Distribution of Reason for Exposure and Age for Fatalities................................................................................. 981
Table 9. Route of Exposure for Human Exposure Cases..................................................................................................... 981
Table 10. Management Site of Human Exposures ............................................................................................................... 982
Table 11. Medical Outcome of Human Exposure Cases by Patient Age............................................................................ 982
Table 12. Medical Outcome by Reason for Exposure in Human Exposures ...................................................................... 983
Table 13. Duration of Clinical Effects by Medical Outcome .............................................................................................. 983
Table 14. Decontamination and Therapeutic Interventions.................................................................................................. 983
Table 15. Therapy Provided in Human Exposures by Age.................................................................................................. 985
Table 16A. Decontamination Trends (1985–2014)............................................................................................................... 986
Table 16B. Decontamination Trends: Total Human and Pediatric Exposures 5=5 Years ................................................. 986
Table 17A. Substance Categories Most Frequently Involved in Human Exposures (Top 25)........................................... 987
Table 17B. Substance Categories with the Greatest Rate of Exposure Increase (Top 25) ................................................ 988
Table 17C. Substance Categories Most Frequently Involved in Pediatric (5 years) Exposures (Top 25)...................... 989
Table 17D. Substance Categories Most Frequently Involved in Adult (20 years) Exposures (Top 25)......................... 989
Table 17E. Substance Categories Most Frequently Involved in Pediatric (5 years) Deaths .............................................. 990
Table 17F. Substance Categories Most Frequently Identified in Drug Identification Calls (Top 25) ............................... 990
Table 17G. Substance Categories Most Frequently Involved in Pregnant Exposures (Top 25) ........................................ 991
Table 18. Categories Associated with Largest Number of Fatalities (Top 25)................................................................... 991
Table 19A. Comparisons of Death Data (1985–2014) ......................................................................................................... 992
Table 19B. Comparisons of Direct and Indirect Death Data (2000–2014) ......................................................................... 992
Table 20. Frequency of Plant Exposures (Top 25)............................................................................................................... 993
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures .................................................................. 997
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by
generic category ................................................................................................................................................................... 1077
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category ..... 1098
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Contents
Case 4. Acute methanol unknown: undoubtedly responsible............................................................................................. 1126
Case 20. Chronic methanol ingestion: undoubtedly responsible........................................................................................ 1126
Case 85. Acute envenomation (Crotalid) bite: undoubtedly responsible........................................................................... 1126
Case 89. Acute envenomation (Crotalid) bite: undoubtedly responsible........................................................................... 1127
Case 95. Acute cyanide ingestion: undoubtedly responsible. ............................................................................................ 1127
Case 99. Acute ethylene glycol and ethanol ingestion: undoubtedly responsible............................................................. 1127
Case 102. Acute cyanide ingestion: undoubtedly responsible. .......................................................................................... 1127
Case 113. Acute cyanide ingestion: undoubtedly responsible. .......................................................................................... 1127
Case 123. Chronic cobalt exposure: undoubtedly responsible. .......................................................................................... 1128
Case 130. Acute hydrofluoric acid ingestion and dermal: probably responsible. ............................................................. 1128
Case 133. Acute drain cleaner (alkali) ingestion: undoubtedly responsible...................................................................... 1128
Case 147. Acute laundry detergent (pod) ingestion and aspiration: probably responsible. .............................................. 1128
Case 148. Acute hypochlorite dermal: undoubtedly responsible. ...................................................................................... 1128
Case 154. Acute hydrogen peroxide ingestion: undoubtedly responsible. ........................................................................ 1129
Case 156. Acute peroxides ingestion: undoubtedly responsible. ....................................................................................... 1129
Case 180. Acute helium inhalation: undoubtedly responsible. .......................................................................................... 1129
Case 206. Acute hydrogen sulfide inhalation: probably responsible. ................................................................................ 1129
Case 216. Acute chlorine gas inhalation: probably responsible......................................................................................... 1130
Case 248. Acute lamp oil ingestion: undoubtedly responsible. ......................................................................................... 1130
Case 249. Acute-on-chronic freon inhalation and chlorpheniramine/dextromethorphan ingestion:
probably responsible............................................................................................................................................................. 1130
Case 263. Acute water ingestion: probably responsible..................................................................................................... 1130
Case 265. Acute Amanita phalloides ingestion: probably responsible. ............................................................................. 1131
Case 266. Acute mushroom (cyclopeptides) ingestion: probably responsible................................................................... 1131
Case 268. Acute mushroom (gastrointestinal), Coprinus comatus, Coprinus atrametarius ingestion:
undoubtedly responsible....................................................................................................................................................... 1131
Case 276. Acute dinitrophenol ingestion: undoubtedly responsible. ................................................................................. 1131
Case 279. Acute sulfuryl fluoride inhalation: probably responsible. ................................................................................. 1132
Case 280. Acute rodenticide (anticoagulant) ingestion: undoubtedly responsible. ........................................................... 1132
Case 281. Acute-on-chronic, brodifacoum ingestion: probably responsible...................................................................... 1132
Case 282. Acute glyphosate and cocaine ingestion: undoubtedly responsible.................................................................. 1132
Case 283. Acute sodium fluoroacetate ingestion: probably responsible............................................................................ 1133
Case 284. Acute organophosphate (chlorpyrifos) ingestion: undoubtedly responsible. .................................................... 1133
Case 285. Acute phosphine inhalation/nasal: probably responsible................................................................................... 1133
Case 287. Unknown, glyphosate ingestion: undoubtedly responsible. .............................................................................. 1133
Case 288. Acute carbofuran ingestion: contributory. ......................................................................................................... 1134
Case 289. Acute paraquat ingestion: undoubtedly responsible. ......................................................................................... 1134
Case 294. Acute rodenticide (aldicarb) ingestion: undoubtedly responsible. .................................................................... 1134
Case 296. Acute Aconitum napellus ingestion: probably responsible. .............................................................................. 1134
Case 304. Acute buprenorphine ingestion: undoubtedly responsible................................................................................. 1134
Case 305. Acute methadone ingestion: undoubtedly responsible. ..................................................................................... 1135
Case 394. Unknown, fentanyl inhalation/nasal: undoubtedly responsible. ........................................................................ 1135
Case 663. Acute tramadol ingestion: undoubtedly responsible.......................................................................................... 1135
Case 688. Acute acetaminophen ingestion: probably responsible. .................................................................................... 1135
Case 691. Acute morphine unknown: undoubtedly responsible. ....................................................................................... 1135
Case 692. Acute laundry (prewash), cleaner (anionic/nonionic), bath salts, oxycodone, carisoprodol,
clonazepam, alprazolam, ethanol, and cleaner (ammonia), ingestion: undoubtedly responsible...................................... 1136
Case 695. Acute lidocaine ingestion: undoubtedly responsible. ........................................................................................ 1136
Case 696. Acute methoxetamine: undoubtedly responsible. .............................................................................................. 1136
Case 699. Chronic fondaparinux ingestion: probably responsible. .................................................................................... 1136
Case 709. Unknown duration topiramate and ethanol ingestion: undoubtedly responsible.............................................. 1137
Case 754. Acute-on-chronic venlafaxine ingestion: probably responsible. ....................................................................... 1137
Case 823. Acute-on-chronic bupropion (extended release) ingestion: undoubtedly responsible...................................... 1137
Case 853. Acute rifampin ingestion: probably responsible. ............................................................................................... 1138
Case 858. Acute tilmicosin parenteral: undoubtedly responsible....................................................................................... 1138
Case 866. Acute (possibly chronic)flecainide ingestion: undoubtedly responsible........................................................... 1138
Case 928. Acute-on-chronic amlodipine ingestion: undoubtedly responsible. .................................................................. 1138
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Case 934. Acute amlodipine ingestion: undoubtedly responsible...................................................................................... 1138
Case 957. Acute propranolol ingestion: undoubtedly responsible. .................................................................................... 1139
Case 1008. Acute propafenone ingestion: undoubtedly responsible. ................................................................................. 1139
Case 1049. Acute benzonatate ingestion: undoubtedly responsible................................................................................... 1139
Case 1050. Acute benzonatate ingestion: undoubtedly responsible................................................................................... 1139
Case 1058. Acute energy product, other ingestion: undoubtedly responsible. .................................................................. 1140
Case 1060. Acute sodium ingestion: probably responsible. ............................................................................................... 1140
Case 1063. Acute on chronic loperamide ingestion: undoubtedly responsible. ................................................................ 1140
Case 1065. Unknown, loperamide ingestion: undoubtedly responsible............................................................................. 1140
Case 1071. Chronic androgen unknown: contributory. ...................................................................................................... 1141
Case 1094. Acute glycine transvaginal: undoubtedly responsible. .................................................................................... 1141
Case 1095. Acute succinylcholine parenteral: undoubtedly responsible. .......................................................................... 1141
Case 1111. Unknown, carisoprodol and paroxetine ingestion: undoubtedly responsible. ................................................ 1141
Case 1158. Acute propofol parenteral: undoubtedly responsible....................................................................................... 1142
Case 1200. Acute lysergic acid diethylamide (LSD) and methylenedioxymethamphetamine (MDMA) ingestion:
probably responsible............................................................................................................................................................. 1142
Case 1218. Acute-on-chronic, amphetamine (hallucinogenic) ingestion: undoubtedly responsible. ................................ 1142
Case 1223. Unknown, methamphetamine ingestion: undoubtedly responsible. ................................................................ 1142
Case 1224. Acute methylenedioxymethamphetamine (MDMA) ingestion: undoubtedly responsible.............................. 1143
Case 1238. Acute methamphetamine and marijuana exposure: undoubtedly responsible. ............................................... 1143
Case 1257. Acute amphetamine (hallucinogenic) ingestion: undoubtedly responsible..................................................... 1143
Case 1277. Acute amphetamine and benzodiazepine ingestion: undoubtedly responsible............................................... 1143
Case 1330. Acute methamphetamine ingestion: undoubtedly responsible. ....................................................................... 1144
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ABSTRACT
Background: This is the 32nd Annual Report of the American
Association of Poison Control Centers’ (AAPCC) National
Poison Data System (NPDS). As of 1 January 2014, 56 of the
nation’s poison centers (PCs) uploaded case data automatically to
NPDS. The upload interval was 7.82 [7.02, 11.17] (median [25%,
75%]) minutes, creating a near real-time national exposure and
information database and surveillance system.
Methodology: We analyzed the case data tabulating specific
indices from NPDS. The methodology was similar to that of
previous years. Where changes were introduced, the differences
are identified. Poison center cases with medical outcomes of death
were evaluated by a team of medical and clinical toxicologist
reviewers using an ordinal scale of 1–6 to assess the Relative
Contribution to Fatality (RCF) of the exposure to the death.
Results: In 2014, 2,890,909 closed encounters were logged by
NPDS: 2,165,142 human exposures, 56,265 animal exposures,
663,305 information calls, 6,085 human confirmed nonexposures,
and 112 animal confirmed nonexposures. US poison centers
(PCs) also made 2,617,346 follow-up calls in 2014. Total
encounters showed a 5.5% decline from 2013, while health
care facility human exposure cases increased by 3.3% from 2013.
All information calls decreased by 17.7% and health care facility
(HCF) information calls were essentially flat, decreasing by
0.04%, medication identification requests (Drug ID) decreased
29.8%, and human exposures reported to US PCs decreased
1.1%. Human exposures with less serious outcomes have
decreased 3.40% per year since 2008 while those with more
serious outcomes (moderate, major or death) have increased by
4.29% per year since 2000.
The top 5 substance classes most frequently involved in all
human exposures were analgesics (11.3%), cosmetics/personal
care products (7.7%), household cleaning substances (7.7%),
sedatives/hypnotics/antipsychotics (5.9%), and antidepressants
(4.4%). Sedative/Hypnotics/Antipsychotics exposures as a class
increased the most rapidly (2,368 calls (12.2%)/year) over the
last 13 years for cases showing more serious outcomes. The top
5 most common exposures in children age 5 years or less were
cosmetics/personal care products (14.0%), household cleaning
substances (11.0%), analgesics (9.3%), foreign bodies/toys/miscellaneous (6.7%), and topical preparations (5.8%). Drug identification requests comprised 43.3% of all information calls.
NPDS documented 1,835 human exposures resulting in
death with 1,408 human fatalities judged related (RCF of
1-Undoubtedly responsible, 2-Probably responsible, or
3-Contributory).
Conclusions: These data support the continued value of PC
expertise and need for specialized medical toxicology information to manage more serious exposures, despite a decrease in calls
involving less serious exposures. Unintentional and intentional
exposures continue to be a significant cause of morbidity and
mortality in the US. The near real-time, always current status of
NPDS represents a national public health resource to collect and
monitor US exposure cases and information calls. The continuing
mission of NPDS is to provide a nationwide infrastructure for
surveillance for all types of exposures (e.g., foreign body, viral,
bacterial, venomous, chemical agent, or commercial product), the
identification of events of public health significance, resilience,
response and situational awareness tracking. NPDS is a model
system for the real-time surveillance of national and global public
health.
NOTE: Comparison of exposure or outcome data from
previous AAPCC Annual Reports is problematic. In particular, the identification of fatalities (attribution of a death to the
exposure) differed from pre-2006 Annual Reports (see Fatality Case Review – Methods). Poison center death cases are
described as all cases resulting in death and those determined
to be exposure-related fatalities. Likewise, Table 22 (Exposure
Cases by Generic Category) since year 2006 restricts the
breakdown of included deaths to single-substance cases to
improve precision and avoid misinterpretation.
Introduction
This is the 32nd Annual Report of the American
Association of Poison Control Centers’ (AAPCC; http://
www.aapcc.org) National Poison Data System (NPDS).(1)
On 1 January 2014, fifty-six regional poison centers (PCs)
serving the entire population of the 50 United States,
American Samoa, District of Columbia, Federated States of
Micronesia, Guam, Puerto Rico, and the US Virgin Islands
submitted information and exposure case data collected
during the course of providing telephonic patient tailored
exposure management and poison information.
NPDS is the data warehouse for the nation’s PCs. Poison
centers place emphasis on exposure management, accurate
data collection and coding, and responding to the
continuing need for poison related public and professional
education. The PC’s health care professionals are available
free of charge to users, 24-hours a day, every day of the
year. Poison centers respond to questions from the public,
health care professionals, and public health agencies. The
continuous staff dedication at the PCs is manifest as the
number of exposure and information call encounters
averages 3.0 million annually. Poison center encounters
either involve an exposed human or animal (EXPOSURE
CALL) or a request for information with no person or
animal exposed to any foreign body, viral, bacterial,
venomous, or chemical agent or commercial product
(INFORMATION CALL). A unique feature of PC case
management is the use of follow-up calls to monitor case
progress and medical outcome.
The NPDS Products Database
The NPDS products database contains over 419,000
products ranging from viral and bacterial agents to
commercial chemical and drug products. The products
database is maintained and continuously updated by data
analysts at the Micromedex PoisindexÕ System
(Micromedex Healthcare Series [Internet database].
Greenwood Village, CO: Truven Health Analytics). A
robust generic coding system categorizes the product data
into 1,081 generic codes. These generic codes collapse into
Non-Pharmaceutical (562) and Pharmaceutical (519)
groups. These two groups are divided into Major (68)
and Minor (172) categories. The generic coding schema
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
undergoes continuous improvement through the work of
the AAPCC – Micromedex Joint Coding Group. The group
consists of AAPCC members and editorial and lexicon staff
working to meet best terminology practices. The generic
code system provides enhanced report granularity as
reflected in Table 22. The following 67 new generic
codes were introduced in 2014.
Table: Generic Codes Added in 2014
1
2
3
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4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
Acetaminophen and Acetylsalicylic Acid with Antihistamine
without Opioids
Acetaminophen and Acetylsalicylic Acid with Decongestant and
Antihistamine without Opioids
Acetaminophen and Acetylsalicylic Acid with Decongestant
without Opioids
Acetaminophen and Codeine with Antihistamine
Acetaminophen and Codeine with Decongestant
Acetaminophen and Codeine with Decongestant and
Antihistamine
Acetaminophen and Dextromethorphan with Antihistamine
Acetaminophen and Dextromethorphan with Decongestant
Acetaminophen and Dextromethorphan with Decongestant and
Antihistamine
Acetaminophen and Other Opioid with Antihistamine
Acetaminophen and Other Opioid with Decongestant
Acetaminophen and Other Opioid with Decongestant and
Antihistamine
Acetaminophen with Antihistamine without Opioids
Acetaminophen with Decongestant and Antihistamine without
Opioids
Acetaminophen with Decongestant without Opioids
Acetaminophen, Acetylsalicylic Acid, and Dextromethorphan
with Antihistamine
Acetaminophen, Acetylsalicylic Acid, and Dextromethorphan
with Decongestant
Acetaminophen, Acetylsalicylic Acid, and Dextromethorphan
with Decongestant and Antihistamine
Acetaminophen, Acetylsalicylic Acid, and Opioid with
Antihistamine
Acetaminophen, Acetylsalicylic Acid, and Opioid with
Decongestant
Acetaminophen, Acetylsalicylic Acid, and Opioid with
Decongestant and Antihistamine
Acetylsalicylic Acid and Codeine with Antihistamine
Acetylsalicylic Acid and Codeine with Decongestant
Acetylsalicylic Acid and Codeine with Decongestant and
Antihistamine
Acetylsalicylic Acid and Dextromethorphan with Antihistamine
Acetylsalicylic Acid and Dextromethorphan with Decongestant
Acetylsalicylic Acid and Dextromethorphan with Decongestant
and Antihistamine
Acetylsalicylic Acid and Other Opioid with Antihistamine
Acetylsalicylic Acid and Other Opioid with Decongestant
Acetylsalicylic Acid and Other Opioid with Decongestant and
Antihistamine
Acetylsalicylic Acid with Antihistamine without Opioids
Acetylsalicylic Acid with Decongestant and Antihistamine
without Opioids
Acetylsalicylic Acid with Decongestant without Opioids
Antihistamine and Decongestant with Codeine
Antihistamine and Decongestant with Dextromethorphan
Antihistamine and Decongestant with Other Opioid
Antihistamine and Decongestant without Opioid
Antihistamine with Codeine
Antihistamine with Dextromethorphan
(continued)
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Continued
Table: Generic Codes Added in 2014
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
Antihistamine with Other Opioid
Antihistamine without Opioid
Decongestant with Codeine
Decongestant with Dextromethorphan
Decongestant with Other Opioid
Decongestant without Opioid
Dextromethorphan With Expectorants
eCigarettes: Marijuana Device Flavor Unknown
eCigarettes: Marijuana Device With Added Flavors
eCigarettes: Marijuana Device Without Added Flavors
eCigarettes: Marijuana Liquid Flavor Unknown
eCigarettes: Marijuana Liquid With Added Flavors
eCigarettes: Marijuana Liquid Without Added Flavors
eCigarettes: Nicotine Device Flavor Unknown
eCigarettes: Nicotine Device With Added Flavors
eCigarettes: Nicotine Liquid Flavor Unknown
eCigarettes: Nicotine Liquid With Added Flavors
Expectorants Without Dextromethorphan
Non-Acetylsalicylic Acid Salicylates and Dextromethorphan
with Antihistamine
Non-Acetylsalicylic Acid Salicylates and Dextromethorphan
with Decongestant
Non-Acetylsalicylic Acid Salicylates and Dextromethorphan
with Decongestant and Antihistamine
Non-Acetylsalicylic Acid Salicylates and Opioid with
Antihistamine
Non-Acetylsalicylic Acid Salicylates and Opioid with
Decongestant
Non-Acetylsalicylic Acid Salicylates and Opioid with
Decongestant and Antihistamine
Non-Acetylsalicylic Acid Salicylates with Antihistamine without Opioid
Non-Acetylsalicylic Acid Salicylates with Decongestant and
Antihistamine without Opioid
Non-Acetylsalicylic Acid Salicylates with Decongestant without
Opioid
Non-Narcotic Antitussives Excluding Dextromethorphan
Because the new codes were added at different times
during the year, the numbers in Table 22 for these generic
codes do not reflect the entire year. For completeness,
certain categories require customized data retrieval until
these categories have been in place for a year or more.
Methods
Characterization of Participating Poison Centers and
Population Served
Fifty-six participating centers submitted data to AAPCC
through 29 July 2014, when one participating center closed
with its calls picked up by other poison centers in its state,
leaving 55 participating centers as of 31 December 2014.
Fifty-two centers (94.5%) were accredited by AAPCC as of
1 July 2014. The entire population of the 50 states,
American Samoa, the District of Columbia, Federated
States of Micronesia, Guam, Puerto Rico, and the US
Virgin Islands was served by the US PC network in
2014.(2,3,4)
The average number of human exposure cases managed
per day by all US PCs was 5,932. Similar to other years,
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J. B. Mowry et al.
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higher volumes were observed in the warmer months, with
a mean of 6,275 cases per day in August compared with
5,512 per day in December. On average, US PCs received a
call about an actual human exposure every 14.6 seconds.
Call Management – Specialized Poison Exposure
Emergency Providers
Poison center Managing Directors are primarily responsible for patient care/information service operations, clinical education, and staff instruction. Most are PharmDs or
RNs with American Board of Applied Toxicology (ABAT)
board certification in clinical toxicology. Medical direction
is provided by Medical Directors who are board-certified
physician medical toxicologists. At some PCs, the
Managing and Medical Director roles are held by the
same person.
Calls received at US PCs are managed by healthcare
professionals who have received specialized training in
toxicology to allow for assessment, triage, management
and monitoring of toxic exposure emergencies. These
providers include medical and clinical toxicologists, registered nurses, pharmacists (PharmD or BS), physicians and
physician assistants. Most commonly, registered nurses and
pharmacists (PharmD or BS) make up the contingent of
‘‘Specialists in Poison Information’’ (SPIs) or ‘‘Certified
Specialists in Poison Information’’ (CSPIs) in the US who
triage lay public calls to the most appropriate level of care
and provide health care professional callers with the most
up-to-date management recommendations to care for their
poisoned/overdosed patients. In order for a SPI to become
nationally certified as a CSPI, they must log a minimum of
2,000 calls and 2,000 hours in the PC as a care provider to
become eligible to take the national CSPI examination for
certification in poison information. ‘‘Poison Information
Providers’’ (PIPs) are allied healthcare professionals who
are allowed to manage information-type and low acuity
(non-hospital) calls while working under the supervision of
a CSPI. Of note, while the only individuals eligible to sit
for the CSPI examination are nurses, pharmacists, physicians and PA’s, there is a lack of an appropriate toxicology
core training within these health professional training
curriculums to allow for them to be prepared for PC patient
management operations. These SPIs must receive significant additional training above their degree programs to
become SPIs/CSPIs. Such training is only offered within
the PCs. Poison centers undergo a rigorous accreditation
process administered by the AAPCC and must be
reaccredited every 7 years.
NPDS – Near Real-time Data Capture
Launched on 12 April 2006, NPDS is the data repository
for all of the US PCs. In 2014, all 56 US PCs uploaded
case data automatically to NPDS. All PCs submitted data
in near real-time, making NPDS one of the few
operational systems of its kind. Poison center staff
record calls contemporaneously in 1 of 4 case data
management systems. Each PC uploads case data automatically. The average time to upload data for all PCs is
7.82 [7.02, 11.17] (median [25%, 75%]) minutes creating
a real-time national exposure database and surveillance
system.
The web-based NPDS software facilitates detection,
analysis, and reporting of NPDS surveillance anomalies.
System software offers a myriad of surveillance uses
allowing AAPCC, its member centers and public health
agencies to utilize NPDS exposure data. Users are able to
access local and regional data for their own areas and view
national aggregate data. Custom surveillance definitions
are available, along with ad hoc reporting tools.
Information in the NPDS database is dynamic. Each year
the database is locked prior to extraction of annual report
data to prevent inadvertent changes and ensure consistent,
reproducible reports. The 2014 database was locked on 10
July 2015 at 17:44 EDT.
Annual Report Case Inclusion Criteria
Note: In this year’s report, human and animal ‘‘exposure
calls’’ have been renamed to human and animal ‘‘exposure cases’’, since a single call may result in multiple cases
and the NPDS database contains information about
individual exposure cases. The information in this report
reflects only those cases that are not duplicates and
classified by the PC as CLOSED. A case is closed when
the PC has determined that no further follow-up/recommendations are required or no further information is
available. Exposure cases are followed to obtain the most
precise medical outcome possible. Depending on the case
specifics, most cases are ‘‘closed’’ within a few hours of
the initial call. Some cases regarding complex hospitalized patients or resulting in death may remain open for
weeks or months while data continues to be collected.
Follow-up calls provide a proven mechanism for monitoring the appropriateness of management recommendations, enabling continual updates of case information,
augmenting patient guidelines, and providing poison
prevention education, as well as obtaining final/known
medical outcome status to make the data collected as
accurate and complete as possible.
Statistical Methods
All tables except Tables 3B and 17B were generated
directly by the NPDS web-based application and can thus
be reproduced by each PC. The figures and statistics in
Tables 3B and 17B were created using SAS JMP version
9.0.0 (SAS Institute, Cary, NC) on summary counts
generated by the NPDS web-based application.
NPDS Surveillance
As previously noted, all of the active US PCs upload case
data automatically to NPDS. This unique near real-time
upload is the foundation of the NPDS surveillance system.
Clinical Toxicology 53(10) 2015
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AAPCC 2014 Annual Report of the NPDS
This makes possible both spatial and temporal case volume
and case based surveillance. NPDS software allows
creation of volume and case based definitions.
Definitions can be applied to national, regional, state, or
ZIP code coverage areas. Geocentric definitions can also be
created, which use cases reported from a geographic
location regardless of which poison center managed the
case. This functionality is available not only to the AAPCC
surveillance team, but to every PC. Poison centers also
have the ability to share NPDS real-time surveillance
technology with external organizations such as their state
and local health departments or other regulatory agencies.
Another NPDS feature is the ability to generate system
alerts on adverse drug events and other drug or commercial
products of public health interest like contaminated food or
product recalls. Thus, NPDS can provide real-time adverse
event monitoring, surveillance, resilience, response and
situational awareness.
Surveillance definitions can be created to monitor a
variety of parameters, i.e., volume; case based or on any
desired substance or commercial product in the
Micromedex Poisindex products database and/or set of
clinical effects or other parameters. The products database
contains over 419,000 entries ranging from viral and
bacterial agents to commercial chemical and drug products.
Surveillance definitions may be constructed using volume
or case based definitions with a variety of mathematical
options and historical baseline periods from 1 to 14 years.
NPDS surveillance tools include:
Volume Alert Surveillance Definitions
Total Call Volume
Human Exposure Call Volume
Animal Exposure Call Volume
Information Call Volume
Clinical Effects Volume (signs and symptoms, or
laboratory abnormalities)
Case Based Surveillance Definitions utilizing various
NPDS data fields linked in Boolean expressions
Substance
Clinical Effects
Species
Medical Outcome and others
Syndromic Surveillance Definitions allows Boolean
based definitions utilizing various NPDS data fields to
be run based on historical trends for user defined
periods of interest.
Incoming data is monitored continuously and anomalous signals generate an automated email alert to the
AAPCC’s surveillance team, designated PC or public
health agency staff. These anomaly alerts are reviewed
daily by the AAPCC surveillance team, the PC, or the
public health agency that created the surveillance definition. When reports of potential public health significance
are detected, additional information is obtained from
reporting PCs via the NPDS surveillance correspondence
system or phone as appropriate. The PC then alerts their
Copyright ß Taylor & Francis 2015
971
respective state or local health departments. Public health
issues are brought to the attention of the Health Studies
Branch, National Center for Environmental Health,
Centers for Disease Control and Prevention (HSB/
NCEH/CDC). This near real-time tracking ability is a
unique feature offered by NPDS and the PCs.
AAPCC Surveillance Team clinical and medical toxicologists review surveillance definitions on a regular basis
to fine-tune the queries. CDC, as well as state and local
health departments with NPDS access as granted by their
respective PCs, also have the ability to create surveillance
definitions for routine surveillance tasks or to respond to
emerging public health events.
Fatality Case Review and Abstract Selection
NPDS fatality cases can be recorded as DEATH or
DEATH (INDIRECT REPORT). Medical outcome of
death is by direct report. Deaths (indirect reports) are
deaths that the PC acquired from medical examiners or
media, but did not manage nor answer any questions
related specifically to that death.
Although PCs may report death as an outcome, the death
may not be the direct result of the exposure. We define
exposure-related fatality as a death judged by the AAPCC
Fatality Review Team to be at least contributory to the
exposure. The definitions used for the Relative
Contribution to Fatality (RCF) classification are defined
in Appendix B and the methods to select abstracts for
publications are described in Appendix C. For details of the
AAPCC fatality review process, see the 2008 annual
report.(1)
Pediatric Fatality Case Review
A focused Pediatric Fatality Review Team, comprised of
4 pediatric toxicologists, evaluated cases for patients
under 19 years of age. The panel reviewed the documentation of all such cases, with specific focus on the
conditions behind the poisoning exposure and on finding
commonality which might inform efforts at prevention.
The pediatric fatality cases reviewed exhibited a bimodal
age distribution. Exposures causing death in children 5
years of age were mostly coded as ‘‘UnintentionalGeneral’’, while those in ages over 12 years were mostly
‘‘Intentional’’. Often the Reason Code did not capture the
complexities of the case. For example, there were few
mentions of details such as the involvement of law
enforcement or child protective services. While there were
some complete and informative reports, in many narratives the circumstances which preceded the exposure
thought responsible for the death were unclear or absent.
In response to these findings, the Pediatric Fatality
Review Team developed and distributed Pediatric
Narrative Guidelines, with specific attention to the root
cause of these cases. Poison centers are requested to heed
these guidelines and the need for a more in-depth
investigation of ‘‘causality.’’
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RESULTS
Information Calls to Poison Centers
Data from 663,305 information calls to PCs in 2014
(Table 1C) was transmitted to NPDS, including calls in
optional reporting categories such as prevention/safety/
education (23,498), administrative (24,751) and caller
referral (50,071).
Figure 2 shows that All Drug ID calls have decreased
dramatically since mid-2009 through 2014. Law enforcement Drug ID Calls also showed a decline. The most
frequent information call was for Drug ID, comprising
287,038 calls to PCs during the year. Of these, 167,223
(58.3%) were identified as drugs with known abuse
potential; however, these cases were categorized based on
the drug’s abuse potential without knowledge of whether
abuse was actually intended.
While the number of Drug Information calls decreased
19.5% from 2013 (113,378 calls) to 2014 (91,306 calls),
the distribution of these call types remained steady at
13.8% of all information request calls. The most
common drug information requests were about drugdrug interactions, followed by other drug information,
questions about dosage, inquiries of adverse effects and
therapeutic use and indications. Environmental inquiries
comprised 2.6% of all information calls. Of these
environmental inquiries, specific questions related to
cleanup of mercury (thermometers and other) remained
the most common followed by questions involving
pesticides and air quality.
Of all the information calls, poison information
comprised 8.1% of the requests with inquiries involving
general toxicity the most common followed by questions
involving food preparation practices, safe use of household
products and plant toxicity.
Exposure Calls to Poison Centers
In 2014, the participating PCs logged 2,890,909 total
encounters including 2,165,142 closed human exposure
cases (Table 1A), 56,265 animal exposures (Table 1B),
663,305 information calls (Table 1C), 6,085 human
confirmed non-exposures, and 112 animal confirmed nonexposures. An additional 122 calls were still open at the
time the database was locked. The cumulative AAPCC
database now contains more than 62 million human
exposure case records (Table 1A). A total of 17,764,183
information calls have been logged into the AAPCC
database since the year 2000.
Figure 1 shows the human exposures, information calls
and animal exposures by day since January 1, 2001. Second
order (quadratic) least squares regression of these data
shows a statistically significant departure from linearity
(declining rate of calls since mid-2007) for Human
Exposure Cases. Information Calls are declining more
rapidly than a quadratic regression and are described by a
smoothing spline fit, and Animal Exposure Cases have
likewise been declining since mid-2005. The 2 May 2006
Table 1A. AAPCC Population Served and Reported Exposures (1983–2014).
Year
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Total
No. of
participating
centers
Population
served
(in millions)
16
47
56
57
63
64
70
72
73
68
64
65
67
67
66
65
64
63
64
64
64
62
61
61
61
61
60
60a
57c
57
57d
56d
43.1
99.8
113.6
132.1
137.5
155.7
182.4
191.7
200.7
196.7
181.3
215.9
218.5
232.3
250.1
257.5
260.9
270.6
281.3
291.6
294.7
293.7
296.4
299.4
305.6
308.5b
310.9b
313.3b
315.7b
318.0b
320.2e
322.9f
Human
exposures
Exposures per
thousand
population
251,012
730,224
900,513
1,098,894
1,166,940
1,368,748
1,581,540
1,713,462
1,837,939
1,864,188
1,751,476
1,926,438
2,023,089
2,155,952
2,192,088
2,241,082
2,201,156
2,168,248
2,267,979
2,380,028
2,395,582
2,438,643
2,424,180
2,403,539
2,482,041
2,491,049
2,479,355
2,384,825
2,334,004
2,275,141
2,188,013
2,165,142
62,282,510
5.8
7.3
7.9
8.3
8.5
8.8
8.7
8.9
9.2
9.5
9.7
8.9
9.3
9.3
8.8
8.7
8.4
8.0
8.1
8.2
8.1
8.3
8.2
8.0
8.1
8.1
8.0
7.6
7.4
7.2
6.8
6.7
a
As of 1 July 2010 there were 60 Participating Centers.
AAPCC Total as of 1 July Mid Year US Census (2012 data for 50 United
States, District of Columbia and Puerto Rico; 2011 data for Guam; 2010
data for American Samoa, Federated States of Micronesia, and the US
Virgin Islands)
c
As of 1 July 2011 there were 57 Participating Centers.
d
One Participating Center closed in September 2013. Its data is included in the
2013 totals but not in the 2014 data.
e
AAPCC Total as of 1 July Mid Year US Census (2013 data for 50 United
States, District of Columbia and Puerto Rico, Guam, American Samoa,
Federated States of Micronesia, and the US Virgin Islands)
f
AAPCC Total as of 1 July Mid Year US Census (2014 data for 50 United
States, District of Columbia and Puerto Rico, Guam, American Samoa,
Federated States of Micronesia, and the US Virgin Islands) (2,3)
b
Table 1B. Non-Human Exposures by Animal Type.
Animal
Dog
Cat
Bird
Rodent/lagomorph
Horse
Sheep/goat
Cow
Aquatic
Other
Total
N
%
50,696
4,809
188
141
115
63
41
22
190
56,265
90.10
8.55
0.33
0.25
0.20
0.11
0.07
0.04
0.34
100.00
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
Table 1C. Distribution of Information Calls.
Downloaded by [AAPCC] at 12:54 01 December 2015
Information call type
Drug identification
Public inquiry: Drug sometimes involved in abuse
Public inquiry: Drug not known to be abused
Public inquiry: Unknown abuse potential
Public inquiry: Unable to identify
HCP inquiry: Drug sometimes involved in abuse
HCP inquiry: Drug not known to be abused
HCP inquiry: Unknown abuse potential
HCP inquiry: Unable to identify
Law Enf. Inquiry: Drug sometimes involved in abuse
Law Enf. Inquiry: Drug not known to be abused
Law Enf. Inquiry: Unknown abuse potential
Law Enf. Inquiry: Unable to identify
Other drug ID
Subtotal
Drug information
Adverse effects (no known exposure)
Brand/generic name clarifications
Calculations
Compatibility of parenteral medications
Compounding
Contraindications
Dietary supplement, herbal, and homeopathic
Dosage
Dosage form/formulation
Drug use during breast-feeding
Drug-drug interactions
Drug-food interactions
Foreign drug
Generic substitution
Indications/therapeutic use
Medication administration
Medication availability
Medication disposal
Pharmacokinetics
Pharmacology
Regulatory
Stability/storage
Therapeutic drug monitoring
Other drug info
Subtotal
Environmental information
Air quality
Carbon monoxide – no known patient(s)
Carbon monoxide alarm use
Chem/bioterrorism/weapons (suspected or confirmed)
Clarification of media reports of environmental contamination
Clarification of substances involved in a HAZMAT incident – no known victim(s)
General questions about contamination of air and/or soil
HAZMAT planning
Lead – no known patient(s)
Mercury thermometer cleanup
Mercury (excluding thermometers) cleanup
Notification of a HAZMAT incident – no known patient(s)
Pesticide application by a professional pest control operator
Pesticides (other)
Potential toxicity of chemicals in the environment
Radiation
Safe disposal of chemicals
Water purity/contamination
Other environmental
Subtotal
Medical information
Dental questions
Diagnostic or treatment recommendations for diseases or conditions – non-toxicology
N
% of Info. calls
127,059
60,040
2,229
25,350
1,807
3,207
122
1,162
38,357
20,853
758
5,102
992
287,038
19.16
9.05
0.34
3.82
0.27
0.48
0.02
0.18
5.78
3.14
0.11
0.77
0.15
43.27
8,130
1,271
129
248
254
1,220
513
10,485
1,552
1,973
21,071
1,401
246
300
7,954
4,574
429
2,522
1,607
1,072
2,522
2,148
450
19,235
91,306
1.23
0.19
0.02
0.04
0.04
0.18
0.08
1.58
0.23
0.30
3.18
0.21
0.04
0.05
1.20
0.69
0.06
0.38
0.24
0.16
0.38
0.32
0.07
2.90
13.77
1,390
625
405
16
494
132
283
126
349
1,293
2,801
721
582
2,047
975
55
1,190
583
3,406
17,473
0.21
0.09
0.06
0.00
0.07
0.02
0.04
0.02
0.05
0.19
0.42
0.11
0.09
0.31
0.15
0.01
0.18
0.09
0.51
2.63
92
6,771
0.01
1.02
(continued)
Copyright ß Taylor & Francis 2015
973
974
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Table 1C. Continued
Downloaded by [AAPCC] at 12:54 01 December 2015
Information call type
Disease prevention
Explanation of disease states
General first-aid
Interpretation of non-toxicology laboratory reports
Medical terminology questions
Rabies – no known patient(s)
Sunburn management
Other medical
Subtotal
Occupational information
Occupational treatment/first-aid guidelines – no known patient(s)
Information on chemicals in the workplace
MSDS interpretation
Occupational MSDS requests
Routine toxicity monitoring
Safe handling of workplace chemicals
Other occupational
Subtotal
Poison information
Analytical toxicology
Carcinogenicity
Food poisoning – no known patient(s)
Food preparation/handling practices
General toxicity
Mutagenicity
Plant toxicity
Recalls of non-drug products (including food)
Safe use of household products
Toxicology information for legal use/litigation
Other poison
Subtotal
Prevention/Safety/Education
Confirmation of poison center number
General (non-poison) injury prevention requests
Media requests
Poison prevention material requests
Poison prevention week date inquiries
Professional education presentation requests
Public education presentation requests
Other prevention
Subtotal
Teratogenicity information
Teratogenicity
Subtotal
Other information
Other
Subtotal
Substance Abuse
Drug screen information
Effects of illicit substances – no known patient(s)
New trend information
Withdrawal from illicit substances – no known patient(s)
Other substance abuse
Subtotal
Administrative
Expert witness requests
Faculty activities
Funding
Personnel issues
Poison center record request
Product replacement/malfunction (issues intended for the manufacturer)
Scheduling of poison center rotations
Other administration
Subtotal
N
% of Info. calls
618
1,114
946
104
46
208
46
49,922
59,867
0.09
0.17
0.14
0.02
0.01
0.03
0.01
7.53
9.03
29
100
45
606
35
71
207
1,093
0.00
0.02
0.01
0.09
0.01
0.01
0.03
0.16
734
77
1,717
5,635
22,232
54
1,986
158
3,465
143
17,424
53,625
0.11
0.01
0.26
0.85
3.35
0.01
0.30
0.02
0.52
0.02
2.63
8.08
14,397
389
313
7,050
34
197
369
749
23,498
2.17
0.06
0.05
1.06
0.01
0.03
0.06
0.11
3.54
1,305
1,305
0.20
0.20
48,528
48,528
7.32
7.32
3,605
208
189
149
599
4,750
0.54
0.03
0.03
0.02
0.09
0.72
45
31
22
204
152
2,755
73
21,469
24,751
0.01
0.00
0.00
0.03
0.02
0.42
0.01
3.24
3.73
(continued)
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
975
Table 1C. Continued
Information call type
Caller Referred
Immediate referral
Immediate referral
Immediate referral
Immediate referral
Immediate referral
Immediate referral
Immediate referral
Immediate referral
Immediate referral
Immediate referral
Immediate referral
Immediate referral
Other call referral
Subtotal
Total
–
–
–
–
–
–
–
–
–
–
–
–
animal poison center or veterinarian
drug identification
drug information
health department
medical advice line
pediatric triage service
pesticide hotline
pharmacy
poison center
private physician
psychiatric crisis line
teratology information program
N
% of Info. calls
15,036
5,844
221
9,415
614
420
258
645
3,176
2,324
122
103
11,893
50,071
663,305
2.27
0.88
0.03
1.42
0.09
0.06
0.04
0.10
0.48
0.35
0.02
0.02
1.79
7.55
100.00
10000
Information Calls with Smoothing Spline Fit, lambda=1200
Animal Exposures with Smoothing Spline Fit, lambda=1200
Encounters Per Day
Downloaded by [AAPCC] at 12:54 01 December 2015
Human Exposures = 8246.8929 - 0.7402023*Year - 19.184451*(Year-2007.5)^2
8000
6000
4000
2000
0
2000
2002
2004
2006
2008
2010
2012
2014
Year
Both linear and second order (quadratic) terms were statistically significant for least-squares second
order regressions of Human Exposures (RSqr = 0.377). Smoothing spline fit with lambda=1200 was
used for Information Calls (RSqr = 0.768) and Animal Exposures (RSqr = 0.882).
Figure 1. Human Exposure Cases, Information Calls and Animal Exposure Cases by Day since 1 January 2000.
exposure data spike on the figure was the result of 602
children in a Midwest school reporting a noxious odor
which caused anxiety, but resolved without sequelae.
A hallmark of PC case management is the use of followup calls to monitor case progress and medical outcome. US
PCs made 2,617,346 follow-up calls in 2014. Follow-up
calls were done in 46.0% of human exposure cases. One
follow-up call was made in 21.8% of human exposure
cases, and multiple follow-up calls (range 2–172) were
placed in 24.3% of cases. For human exposure cases in
which follow up calls were documented, an average of 2.53
follow up calls per case were done.
Figure 3 shows a graphic summary and analyses of
Health Care Facility (HCF) Exposure and HCF Information
calls. HCF Exposure Cases slightly departed from linearity
but continued to increase at a steady rate, while the rate of
Copyright ß Taylor & Francis 2015
HCF Information Calls has been declining since
early 2005. This increasing use of the PCs for the more
serious exposures (HCF calls) is important in the face of
the overall decline in exposure and information encounters.
Tables 22A (Nonpharmaceuticals) and 22B
(Pharmaceuticals) provide summary demographic data
on patient age, reason for exposure, medical outcome, and
use of a health care facility for all 2,165,142 human
exposure cases, presented by substance categories. The
Pharmaceuticals category includes both licit and
illicit drugs.
Column 1: Name of the major, minor generic
categories and their associated generic substances
(Alternate Names). Note that for pharmaceuticals, the
generic category or generic substance listed is for the
976
J. B. Mowry et al.
All Drug Identification Calls with
Smoothing Spline Fit, lambda=630
Encounters Per Day
3000
Law Enforcement Drug ID Calls with
Smoothing Spline Fit, lambda=100
2000
1000
0
2000
2002
2004
2006
2008
2010
2012
2014
Year
Figure 2. All Drug Identification and Law Enforcement Drug Identification Calls by Day since 1 January 2000.
HCF Human Exposures = - 63292 + 32.1*Year - 0.344*(Year-2007.5)^2
1500
Encounters Per Day
Downloaded by [AAPCC] at 12:54 01 December 2015
Smoothing Spline Fits used lambda = 639 for All Drug Identification Calls (RSqr = 0.942) and
lambda = 100 for Law Enforcement Drug ID Calls (RSqr = 0.800).
HCF Information Calls = 4705 - 2.29*Year - 0.487*(Year-2007.5)^2
1000
500
0
2000
2002
2004
2006
2008
2010
2012
2014
Year
Regression lines show least-squares second order regressions for HCF Exposure (RSqr = 0.692) and HCF
Information Calls (RSqr = 0.281). All terms shown were statistically significant for each of the 2 regressions.
Figure 3. Health Care Facility (HCF) Exposure Cases and HCF Information Calls by Day since 1 January 2000.
initial FDA approved indication and may not reflect
current indications or uses for the pharmaceutical.
Column 2: No. of Case Mentions (all exposures) in
grey shading, displays the number of times the specific
generic code was reported in any human exposure case.
If a human exposure case has multiple instances of a
specific generic code it is only counted once.
Column 3: No. of Single Exposures displays the
number of human exposure cases that identified only
one substance (one case, one substance).
The succeeding columns (Age, Reason, Treatment
Site, and Outcome) show selected detail from these
single-substance exposure cases. Death cases include
both cases that have the outcome of Death or Death
(indirect report). These death cases are not limited by
the relative contribution to fatality.
Tables 22A and 22B restrict the breakdown columns to
single-substance cases. Prior to 2007, when multi-substance exposures were included, a relatively innocuous
substance could be mentioned in a death column when, for
example, the death was attributed to an antidepressant,
opioid, or cyanide. This subtlety was not always appreciated by the user of this table. The restriction of the
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
breakdowns to single-substance exposures should increase
precision and reduce misrepresentation of the results in
this unique by-substance table. Single substance cases
reflect the majority (75.9%) of all exposures. In contrast,
only 42.2% of fatalities are single substance exposures
(Table 5).
Tables 22A and 22B tabulate 2,557,756 substanceexposures, of which 1,925,657 were single-substance
exposures, including 999,812 (51.9%) nonpharmaceuticals
and 925,845 (48.1%) pharmaceuticals. In 20.5% of singlesubstance exposures that involved pharmaceutical substances, the reason for exposure was intentional, compared
to only 3.4% when the exposure involved a nonpharmaceutical substance. Correspondingly, treatment in an HCF
was provided in a higher percentage of exposures that
involved pharmaceutical substances (30.9%) compared
Table 2. Site of Call and Site of Exposure, Human Exposure Cases.
Downloaded by [AAPCC] at 12:54 01 December 2015
Site of caller
Site
Residence
Own
Other
Workplace
Health care facility
School
Restaurant/food service
Public area
Other
Unknown
Site of exposure
N
%
N
%
1,506,125
30,229
22,688
458,938
9,878
441
6,871
124,255
5,717
69.56
1.40
1.05
21.20
0.46
0.02
0.32
5.74
0.26
1,976,666
47,340
36,544
6,229
27,271
4,417
19,452
25,178
22,045
91.29
2.19
1.69
0.29
1.26
0.20
0.90
1.16
1.02
977
with nonpharmaceutical substances (16.2%). Exposures
to pharmaceuticals also had more severe outcomes.
Of single-substance exposure-related fatal cases, 620
Table 3B. Population-Adjusted Exposures by Age Group.
Exposures/100 k
population
Age Group
Children (520)
51
1
2
3
4
5
Child 6–12
Teen 13–19
Subgroup
Adults (20)
20–29
30–39
40–49
50–59
60–69
70–79
80–89
90+
Subgroup
Overall Total
Number of
Exposuresa
Populationb
2,834
8,327
8,085
3,575
1,758
1,056
453
530
1,595
113,209
333,811
323,772
144,879
71,255
42,815
132,067
158,468
1,326,789
3,994,930
4,008,864
4,004,608
4,052,400
4,052,349
4,053,999
29,145,160
29,879,841
83,192,151
402
350
291
265
235
255
291
266
344
671
182,868
146,847
122,322
118,056
80,552
49,075
28,220
6,295
825,009
2,165,142
45,460,063
41,964,029
42,001,257
44,595,465
34,332,733
19,279,568
9,712,705
2,365,351
239,711,171
322,903,322
a
Number of Exposures excludes UNKNOWN ages from the individual age
categories, but includes them in the Subtotals and Overall Total (see
Table 3A)
b
AAPCC Total as of 1 July 2014 322,903,322 (see Table 1A).(3,4,5)
Table 3A. Age and Gender Distribution of Human Exposures.
Male
Age (y)
N
Children (520)
51
59,033
1
173,775
2
168,968
3
79,566
4
39,945
5
24,305
Unknown 5
987
Child 6–12
75,605
Teen 13–19
63,211
Unknown Child
1,586
Subtotal
686,981
Adults (20)
20–29
85,207
30–39
63,305
40–49
50,130
50–59
47,197
60–69
30,712
70–79
17,747
80–89
9,715
90
1,932
Unknown adult
34,859
Subtotal
340,804
Other
Unknown age
4,365
Total
1,032,150
Copyright ß Taylor & Francis 2015
Female
% of age
group total
N
Unknown gender
Total
Cumulative total
% of age
group total
N
% of age
group total
N
% of total
exposures
N
%
52.15
52.06
52.19
54.92
56.06
56.77
45.15
57.25
39.89
36.65
51.78
53,823
159,529
154,261
65,005
31,101
18,340
870
55,504
94,620
1,509
634,562
47.54
47.79
47.64
44.87
43.65
42.84
39.80
42.03
59.71
34.87
47.83
353
507
543
308
209
170
329
958
637
1,232
5,246
0.31
0.15
0.17
0.21
0.29
0.40
15.05
0.73
0.40
28.47
0.40
113,209
333,811
323,772
144,879
71,255
42,815
2,186
132,067
158,468
4,327
1,326,789
5.23
15.42
14.95
6.69
3.29
1.98
0.10
6.10
7.32
0.20
61.28
113,209
447,020
770,792
915,671
986,926
1,029,741
1,031,927
1,163,994
1,322,462
1,326,789
1,326,789
5.23
20.65
35.60
42.29
45.58
47.56
47.66
53.76
61.08
61.28
61.28
46.59
43.11
40.98
39.98
38.13
36.16
34.43
30.69
38.40
41.31
97,461
83,407
72,096
70,785
49,788
31,310
18,494
4,360
52,853
480,554
53.30
56.80
58.94
59.96
61.81
63.80
65.54
69.26
58.22
58.25
200
135
96
74
52
18
11
3
3,062
3,651
0.11
0.09
0.08
0.06
0.06
0.04
0.04
0.05
3.37
0.44
182,868
146,847
122,322
118,056
80,552
49,075
28,220
6,295
90,774
825,009
8.45
6.78
5.65
5.45
3.72
2.27
1.30
0.29
4.19
38.10
1,509,657
1,656,504
1,778,826
1,896,882
1,977,434
2,026,509
2,054,729
2,061,024
2,151,798
2,151,798
69.73
76.51
82.16
87.61
91.33
93.60
94.90
95.19
99.38
99.38
32.71
47.67
6,018
1,121,134
45.10
51.78
2,961
11,858
22.19
0.55
13,344
2,165,142
0.62
100.00
2,165,142
2,165,142
100.00
100.00
978
J. B. Mowry et al.
Table 4. Distribution of Agea and Gender for Fatalitiesb.
Age (y)
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51 year
1 year
2 years
3 years
4 years
5 years
Child 6–12 years
Teen 13–19 years
Unknown Child
20–29 years
30–39 years
40–49 years
50–59 years
60–69 years
70–79 years
80–89 years
4¼ 90 years
Unknown adult
Unknown age
Total
Male
Female
Unknown
Total (%)
Cumulative total (%)
0
3
2
0
1
2
6
27
0
93
87
78
104
72
30
29
4
5
3
546
1
4
0
1
1
1
4
34
0
68
96
116
127
70
46
41
10
3
2
625
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
1
0
2
1 (0.1%)
7 (0.6%)
2 (0.2%)
1 (0.1%)
2 (0.2%)
3 (0.3%)
10 (0.9%)
61 (5.2%)
1 (0.1%)
161 (13.7%)
183 (15.6%)
194 (16.5%)
231 (19.7%)
142 (12.1%)
76 (6.5%)
70 (6.0%)
14 (1.2%)
9 (0.8%)
5 (0.4%)
1,173 (100.0%)
1 (0.1%)
8 (0.7%)
10 (0.9%)
11 (0.9%)
13 (1.1%)
16 (1.4%)
26 (2.2%)
87 (7.4%)
88 (7.5%)
249 (21.2%)
432 (36.8%)
626 (53.4%)
857 (73.1%)
999 (85.2%)
1,075 (91.7%)
1,145 (97.6%)
1,159 (98.8%)
1,168 (99.6%)
1,173 (100.0%)
1,173 (100.0%)
a
Age includes cases with both actual and estimated ages as shown in Table 21.
Includes cases with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory. This excludes
reports with outcome of Death INDIRECT.
b
Table 5. Number of Substances Involved in Human Exposure Cases.
Human exposures
No. of Substances
1
2
3
4
5
6
7
8
4¼ 9
Total
Fatal exposures
a
N
%
N
%
1,925,657
150,008
49,883
20,436
9,196
4,323
2,309
1,281
2,049
2,165,142
88.94
6.93
2.30
0.94
0.42
0.20
0.11
0.06
0.09
100.00
495
288
171
93
55
27
13
9
22
1,173
42.20
24.55
14.58
7.93
4.69
2.30
1.11
0.77
1.88
100.00
a
Includes cases with relative contribution to fatality of 1-Undoubtedly
responsible, 2-Probably responsible, or 3-Contributory. This excludes
reports with outcome of Death INDIRECT.
(70.3%) were pharmaceuticals compared with 262 (29.7%)
nonpharmaceuticals.
Age and Gender Distributions
The age and gender distribution of human exposures is
outlined in Table 3. Children younger than 3 years of age
were involved in 35.6% of exposures and children younger
than 6 years accounted for approximately half of all human
exposures (47.7%). A male predominance was found among
cases involving children younger than 13 years, but this
gender distribution was reversed in teenagers and adults,
with females comprising the majority of reported exposures.
Caller Site and Exposure Site
As shown in Table 2, of the 2,165,142 human exposures
reported, 71.0% of calls originated from a residence
(own or other) but 93.5% actually occurred at a residence
(own or other). Another 21.2% of calls were made from a
health care facility. Beyond residences, exposures occurred in
the workplace in 1.7% of cases, schools (1.3%), health care
facilities (0.3%), and restaurants or food services (0.2%).
Exposures in Pregnancy
Exposure during pregnancy occurred in 7,240 women
(0.3% of all human exposures). Of those with known
pregnancy duration (n ¼ 6,681), 30.1% occurred in the first
trimester, 37.8% in the second trimester, and 31.5% in the
third trimester. Most (74.7%) were unintentional exposures
and 19.0% were intentional exposures. There were two
deaths in pregnant females in 2014.
Chronicity
Most human exposures, 1,898,862 (87.7%), were acute
cases (single, repeated or continuous exposure occurring
over 8 hours or less) compared to 944 acute cases among the
1835 fatalities (51.4%). Chronic exposures (continuous or
repeated exposures occurring over48 hours) comprised
2.0% (44,088) of all human exposures. Acute-on-chronic
exposures (single exposure that was preceded by a continuous, repeated, or intermittent exposure occurring over a
period greater than 8 hours) numbered 192,428 (8.9%).
Reason for Exposure
The reason category for most human exposures was
unintentional (79.4%) with unintentional general (53.8%),
therapeutic error (12.6%) and unintentional misuse (5.8%)
of all exposures (Table 6A).
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
Scenarios
Of the total 271,737 therapeutic errors, the most common
scenarios for all ages included: inadvertent double-dosing
(29.2%), wrong medication taken or given (17.2%), other
incorrect dose (14.8%), doses given/taken too close
Table 6A. Reason for Human Exposure Cases.
Downloaded by [AAPCC] at 12:54 01 December 2015
Reason
Unintentional
Unintentional – General
Unintentional – Therapeutic error
Unintentional – Misuse
Unintentional – Environmental
Unintentional – Bite/sting
Unintentional – Occupational
Unintentional – Food poisoning
Unintentional – Unknown
Subtotal
Intentional
Intentional – Suspected suicide
Intentional – Misuse
Intentional – Abuse
Intentional – Unknown
Subtotal
Adverse Reaction
Adverse reaction – Drug
Adverse reaction – Other
Adverse reaction – Food
Subtotal
Unknown
Unknown reason
Subtotal
Other
Other – Contamination/tampering
Other – Malicious
Other – Withdrawal
Subtotal
Total
N
% Human
exposures
1,164,029
271,737
125,086
58,586
49,914
26,880
19,343
3,193
1,718,768
53.8
12.6
5.8
2.7
2.3
1.2
0.9
0.1
79.4
241,804
54,679
46,727
19,451
362,661
11.2
2.5
2.2
0.9
16.7
36,542
10,055
5,054
51,651
1.7
0.5
0.2
2.4
16,038
16,038
0.7
0.7
7,472
7,051
1,501
16,024
2,165,142
0.3
0.3
0.1
0.7
100.0
979
together (11.6%) and inadvertent exposure to someone
else’s medication (8.4%). The types of therapeutic errors
observed are different for each age group and are
summarized in Table 6B.
Reason by Age
Intentional exposures accounted for 16.7% of human
exposures. Suicidal intent was suspected in 11.2% of
cases, intentional misuse in 2.5% and intentional abuse in
2.2%. Unintentional exposures outnumbered intentional
exposures in all age groups with the exception of ages 13–
19 years (Table 7). Intentional exposures were more
frequently reported than unintentional exposures in patients
aged 13-19 years. In contrast, of the 1,173 reported
fatalities with RCF 1–3, the major reason reported for
children 5 years was unintentional while most fatalities
in adults (20 years) were intentional (Table 8).
Route of Exposure
Ingestion was the route of exposure in 83.7% of cases
(Table 9), followed in frequency by dermal (7.0%),
inhalation/nasal (6.1%), and ocular routes (4.3%). For the
1,173 exposure-related fatalities, ingestion (81.4%), inhalation/nasal (10.1%), unknown (7.8%) and parenteral
(5.2%) were the predominant exposure routes. Each
exposure case may have more than one route.
Clinical Effects
The NPDS database allows for the coding of up to 131
individual clinical effects (signs, symptoms, or laboratory
abnormalities) for each case. Each clinical effect can be
further defined as related, not related, or unknown if
related. Clinical effects were coded in 797,920 (36.9%)
Table 6B. Scenarios for Therapeutic Errorsa by Ageb.
Scenario
Inadvertently took/given medication twice
Wrong medication taken/given
Other incorrect dose
Medication doses given/taken too close together
Inadvertently took/given someone else’s
medication
Other/unknown therapeutic error
Incorrect dosing route
Confused units of measure
Dispensing cup error
Incorrect formulation or concentration given
Health professional/iatrogenic error
(pharmacist/nurse/physician)
More than 1 product containing same ingredient
Drug interaction
10-fold dosing error
Incorrect formulation or concentration dispensed
Exposure through breast milk
a
N
5¼ 5 y
6–12 y
13–19 y 4¼ 20 y
(Row %) (Row %) (Row %) (Row %)
Unknown Unknown Unknown
child
adult
age
(Row %) (Row %) (Row %)
79,248
46,864
40,302
31,523
22,946
16.39
15.10
31.54
16.12
15.91
12.69
12.07
12.15
10.18
21.19
6.05
6.32
6.66
6.28
7.38
58.64
60.36
45.61
59.91
50.81
0.05
0.09
0.08
0.09
0.06
5.87
5.71
3.70
7.13
4.44
0.30
0.35
0.25
0.30
0.21
16,339
14,789
9,744
5,863
5,592
5,541
19.63
7.62
56.24
64.17
46.16
26.84
10.97
3.94
19.64
20.81
17.24
10.83
6.55
2.96
4.40
3.14
4.74
6.15
55.03
72.65
18.10
10.80
29.29
50.39
0.15
0.08
0.09
0.05
0.05
0.25
6.95
11.93
1.35
0.96
2.36
4.60
0.72
0.82
0.16
0.09
0.16
0.94
4,695
2,185
1,145
1,142
134
12.06
6.50
65.33
43.26
90.30
15.02
7.96
8.47
17.78
0.75
14.23
7.92
2.10
5.87
0.00
51.54
63.62
22.01
28.98
5.97
0.02
0.09
0.00
0.00
0.00
6.75
13.50
1.92
3.33
2.99
0.38
0.41
0.17
0.79
0.00
All cases with a scenario category of therapeutic error regardless of reason
Of the human exposure cases reported to U.S. Poison Centers in 2014, 402,055 (18.6%) were coded to 1 or more of 54 scenarios.
b
Copyright ß Taylor & Francis 2015
1,718,768
362,661
51,651
16,038
16,024
2,165,142
0.22
0.08
0.22
0.52
1.45
0.21
58,533
92,664
3,725
1,854
1,692
158,468
Unintentional
Intentional
Adverse reaction
Unknown
Other
Total
1,026,055
325
3,384
766
1,397
1,031,927
62.40
0.09
7.40
5.20
10.15
49.85
115,526
11,390
2,616
882
1,653
132,067
7.03
3.24
5.72
5.99
12.01
6.38
3.56
26.36
8.15
12.59
12.29
7.66
435,926
244,031
35,166
10,427
8,685
734,235
26.51
69.42
76.94
70.79
63.09
35.47
3,678
271
102
76
200
4,327
70,792
10,847
5,843
1,233
2,059
90,774
4.31
3.09
12.78
8.37
14.96
4.39
8,258
3,133
815
800
338
13,344
0.50
0.89
1.78
5.43
2.46
0.64
Total
N
Row %
Unknown age
N
Row %
Unknown adult
N
Row %
Unknown child
N
Row %
4¼ 20 y
N
Row %
13–19 y
N
Row %
6–12 y
N
5¼ 5 y
Row %
N
Table 7. Distribution of Reason for Exposure by Age.
Reason
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79.38
16.75
2.39
0.74
0.74
100.00
J. B. Mowry et al.
%
980
cases (17.7% had 1 effect, 9.4% had 2 effects, 5.1% had 3
effects, 2.2% had 4 effects, 1.1% had 5 effects, and 1.4%
had 45 effects coded). Of clinical effects coded, 78.0%
were deemed related to the exposure, 9.8% were considered not related, and 12.2% were coded as unknown
if related.
Case Management Site
The majority of cases reported to PCs were managed in a
non–HCF (68.1%), usually at the site of exposure, primarily the patient’s own residence (Table 10). 1.5% of cases
were referred to an HCF but refused referral. Treatment in
an HCF was rendered in 28.3% of cases.
Of the 612,184 cases managed in an HCF, 290,219
(47.4%) were treated and released, 101,141 (16.5%) were
admitted for critical care, and 69,552 (11.4%) were
admitted to a noncritical unit.
The percentage of patients treated in an HCF varied
considerably with age. Only 12.7% of children 5 years
and only 16.5% of children between 6 and 12 years were
managed in an HCF compared to 61.1% of teenagers
(13–19 years) and 46.5% of adults (age 20 years).
Medical Outcome
Table 11 displays the medical outcome of human exposure
cases distributed by age. Older age groups exhibit a greater
number of serious medical outcomes. Table 12 compares
medical outcome and reason for exposure and shows a
greater frequency of serious outcomes in intentional
exposures.
The duration of effect is required for all cases which
report at least one clinical effect and have a medical
outcome of minor, moderate or major effect (n ¼ 503,864;
23.3% of exposures). Table 13 demonstrates an increasing
duration of the clinical effects observed with more serious
outcomes.
Decontamination Procedures and Specific Antidotes
Tables 14 and 15 outline the use of decontamination
procedures, specific physiological antagonists (antidotes),
and measures to enhance elimination in the treatment of
patients reported in the NPDS database. These should be
interpreted as minimum frequencies because of the limitations of telephone data gathering.
Ipecac-induced emesis for poisoning continues to
decline as shown in Tables 16A and 16B. Ipecac was
administered in only 41 (0.0%) pediatric exposures in
2014. The continued decrease in ipecac syrup use over the
last 2 decades was likely a result of ipecac use guidelines
issued in 1997 by the American Academy of Clinical
Toxicology and the European Association of Poisons
Centres and Clinical Toxicologists and updated in
2004.(5,6) In a separate report, the American Academy
of Pediatrics concluded not only that ipecac should no
longer be used routinely as a home treatment strategy, but
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
981
Table 8. Distribution of Reason for Exposure and Age for Fatalitiesa.
Downloaded by [AAPCC] at 12:54 01 December 2015
Reason
Unintentional
Unintentional–General
Unintentional–Environmental
Unintentional–Occupational
Unintentional–Therapeutic error
Unintentional–Misuse
Unintentional–Bite/sting
Unintentional–Food poisoning
Unintentional–Unknown
Subtotal
Intentional
Intentional–Suspected suicide
Intentional–Misuse
Intentional–Abuse
Intentional–Unknown
Subtotal
Other
Other–Contamination/tampering
Other–Malicious
Subtotal
Adverse reaction
Adverse reaction–Drug
Adverse reaction–Other
Subtotal
Unknown
Unknown reason
Subtotal
Total
Unknown
child
Unknown
adult
Unknown
age
14
30
8
22
17
3
1
3
98
0
0
0
0
1
0
0
0
1
1
0
1
0
0
0
0
0
2
0
1
2
0
0
0
0
0
3
22
41
12
23
18
4
1
4
125
31
1
19
3
54
606
32
112
69
819
0
0
0
0
0
4
0
2
0
6
1
0
1
0
2
644
33
135
72
884
0
0
0
0
0
0
0
3
3
0
0
0
0
0
0
0
0
0
1
4
5
0
0
0
0
0
0
1
0
1
42
3
45
0
0
0
0
0
0
0
0
0
43
3
46
4
4
16
0
0
10
2
2
61
106
106
1,071
0
0
1
1
1
9
0
0
5
113
113
1,173
5¼ 5 y
6–12 y
13–19 y
4
3
0
1
0
1
0
1
10
2
5
0
0
0
0
0
0
7
1
2
1
0
0
0
0
0
4
0
0
0
0
0
2
0
1
0
3
1
1
2
4¼ 20 y
Total
a
Includes cases with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory. This excludes reports with outcome
of Death INDIRECT.
Table 9. Route of Exposure for Human Exposure Cases.
Fatal exposuresa
Human exposures
Route
Ingestion
Dermal
Inhalation/nasal
Ocular
Bite/sting
Parenteral
Unknown
Other
Otic
Aspiration (with ingestion)
Vaginal
Rectal
Total Number of Routes
N
% of All
Routes
% of All
Cases
N
% of All
Routes
% of All
Cases
1,813,189
151,796
132,653
91,932
49,875
18,999
11,504
2,346
1,821
1,207
933
751
2,277,006
79.63
6.67
5.83
4.04
2.19
0.83
0.51
0.10
0.08
0.05
0.04
0.03
100.00
83.74
7.01
6.13
4.25
2.30
0.88
0.53
0.11
0.08
0.06
0.04
0.03
105.17
955
8
118
0
4
61
91
2
0
19
1
0
1,259
75.85
0.64
9.37
0.0
0.32
4.85
7.23
0.16
0.0
1.51
0.08
0.0
100.00
81.42
0.68
10.06
0
0.34
5.20
7.76
0.17
0
1.62
0.09
0
107.33b
a
Includes cases with relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory. This excludes reports with outcome
of Death INDIRECT.
b
Each exposure case may have more than one route.
also recommended disposal of home ipecac stocks.(7)
A decline was also observed since the early 1990s for
reported use of activated charcoal. While not as dramatic as
the decline in use of ipecac, reported use of activated
charcoal decreased from 3.7% of pediatric cases in 1993 to
just 0.8% in 2014.
Copyright ß Taylor & Francis 2015
Top Substances in Human Exposures
Table 17A presents the most common 25 substance
categories, listed by frequency of human exposure for
cases with more serious outcomes (moderate, severe and
death). This ranking provides an indication where
N
%
N
1,329
2,113
352
25
8
965
3,866
4,273
405
8
13,344
10.04
13.62
3.08
0.20
0.02
12.56
43.62
12.99
3.86
0.02
100.00
9,116
12,360
2,798
179
19
11,403
39,592
11,791
3,500
16
90,774
16.66
9.73
0.69
0.05
0.07
12.83
44.42
12.76
2.80
0.00
100.00
%
N
%
N
%
N
%
N
%
%
N
Unknown age
Unknown adult
Unknown child
4¼ 20 y
13–19 y
Total number of cases where Death was an outcome (1,559 + 276) is greater than the number of fatalities (1,173) judged to be exposure-related (relative contribution to fatality of 1-Undoubtedly responsible, 2-Probably
responsible, or 3-Contributory).
a
Changes Over Time
Total encounters peaked in 2008 at 4,333,012 calls with
2,491,049 human exposure cases and 1,703,762
6–12 y
prevention efforts might be focused, as well as the types of
serious exposures PCs regularly manage. It is relevant to
know whether exposures to these substances are increasing
or decreasing.
To better understand these relationships, we examined
exposures with more serious outcomes per year over the
last 14 years for the change over time for each of the 68
major generic categories via least squares linear regression.
The serious outcome exposure cases per year over this
period were increasing for 39 and decreasing for 29 of the
68 categories. The change over time for the 14 yearly values
was statistically significant (p50.05) for 47 of the 67
categories with data for the entire time period. Table 17B
shows the 25 categories which were increasing the most
rapidly. Statistical significance of the linear regressions can
be verified by noting the 95% confidence interval on the
rate of increase excludes zero for all but 1 of the 25
categories. Figure 5 shows the change over time and linear
regressions for the top 4 increasing categories in Table 17B.
Tables 17C and 17D present exposure results for
children and adults, respectively, and show the differences
between substance categories involved in pediatric and
adult exposures.
Table 17E reports the 25 categories of substances
most frequently involved in pediatric (5 years) fatalities
in 2014.
Table 17F reports the 25 Drug ID categories most
frequently queried in 2014, highlighting the value of Drug
ID information to the AAPCC, public health, public safety,
and regulatory agencies. Internet based resources do not
afford the caller the option to speak with a health care
professional if needed. Proper resources to continue this
vital public service are essential, especially since the top 10
substance categories include antibiotics as well as drugs
with widespread use and abuse potential such as opioids
and benzodiazepines.
Table 17G reports the 25 substance categories most
frequently reported in exposures involving pregnant
patients.
721
421
30
2
3
555
1,922
552
121
0
4,327
13.4
4.7
3.9
3.2
3.1
28.3
1.1
1.5
1.1
100.0
92,298 12.57
168,679 22.97
107,759 14.68
18,310
2.49
1,419
0.19
44,651
6.08
229,672 31.28
42,134
5.74
29,085
3.96
228
0.03
734,235 100.00
290,219
101,141
84,095
69,552
67,177
612,184
23,685
31,838
23,186
2,165,142
No effect
239,073 23.17 22,869 17.32 28,942 18.26
Minor effect
86,156
8.35 19,539 14.79 42,561 26.86
Moderate effect
10,263
0.99
4,037
3.06 24,670 15.57
Major effect
761
0.07
237
0.18
2,612
1.65
Death
23
0.00
11
0.01
76
0.05
No follow–up, nontoxic
190,756 18.49 19,291 14.61
7,465
4.71
No follow-up, minimal toxicity
473,223 45.86 60,138 45.54 37,424 23.62
No follow-up, potentially toxic
18,565
1.80
2,959
2.24 10,834
6.84
Unrelated effect
13,096
1.27
2,981
2.26
3,876
2.45
Death, indirect report
11
0.00
5
0.00
8
0.01
Total
1,031,927 100.00 132,067 100.0 158,468 100.00
68.1
N
1,474,249
Total
%
5¼ 5 y
Downloaded by [AAPCC] at 12:54 01 December 2015
Managed on site, nonhealth care facility
Managed in healthcare facility
Treated/evaluated and released
Admitted to critical care unit
Patient lost to follow-up/left AMA
Admitted to noncritical care unit
Admitted to psychiatric facility
Subtotal (managed in HCF)
Other
Refused referral
Unknown
Total
N
Table 11. Medical Outcome of Human Exposure Cases by Patient Agea.
Site of management
%
Table 10. Management Site of Human Exposures.
10.0
394,348 18.21
15.8
331,829 15.33
2.6
149,909
6.92
0.2
22,126
1.02
0.1
1,559
0.07
7.2
275,086 12.71
29.0
845,837 39.07
32.0
91,108
4.21
3.0
53,064
2.45
0.1
276
0.01
100.00 2,165,142 100.00
J. B. Mowry et al.
Outcome
982
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
983
Table 12. Medical Outcome by Reason for Exposure in Human Exposuresa.
Unintentional
Outcome
N
Intentional
%
N
%
Other
N
Adverse reaction
%
Death
158
0.01
1,064
0.29
10
0.06
Death, indirect report
27
0.00
213
0.06
6
0.04
Major effect
2,623
0.15 17,247
4.76
165
1.03
Minor effect
209,432 12.19 104,936 28.94 2,868 17.90
Moderate effect
42,570
2.48 94,810 26.14 1,185
7.40
No effect
328,561 19.12 61,323 16.91 1,750 10.92
No follow-up, nontoxic
268,396 15.62
4,178
1.15 1,190
7.43
No follow-up,
787,066 45.79 33,176
9.15 6,175 38.54
minimal toxicity
No follow-up,
45,067
2.62 37,928 10.46 1,549
9.67
potentially toxic
Unrelated effect
34,868
2.03
7,786
2.15 1,126
7.03
Total
1,718,768 100.00 362,661 100.00 16,024 100.00
Unknown
Total
N
%
N
%
N
%
81
3
776
12,024
7,452
1,445
1,039
17,511
0.16
0.01
1.50
23.28
14.43
2.80
2.01
33.90
246
27
1,315
2,569
3,892
1,269
283
1,909
1.53
0.17
8.20
16.02
24.27
7.91
1.76
11.90
1,559
276
22,126
331,829
149,909
394,348
275,086
845,837
0.07
0.01
1.02
15.33
6.92
18.21
12.71
39.07
3,526
6.83
3,038
18.94
91,108
4.21
7,794
51,651
15.09
100.00
1,490
9.29
53,064
2.45
16,038 100.00 2,165,142 100.00
a
Total number of cases where Death was an outcome (1,559 + 276) is greater than the number of fatalities (1,173) judged to be exposure-related (relative
contribution to fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).
Downloaded by [AAPCC] at 12:54 01 December 2015
Table 13. Duration of Clinical Effects by Medical Outcome.
Minor effect
Duration of effect
5¼ 2 hours
42 hours, 5¼ 8 hours
48 hours, 5¼ 24 hours
424 hours, 5¼ 3 days
43 days, 5¼ 1 week
41 week, 5¼ 1 month
41 month
Anticipated permanent
Unknown
Total
Moderate effect
N
%
N
%
N
%
108,722
90,401
62,139
22,083
3,829
1,143
364
480
42,668
331,829
32.76
27.24
18.73
6.65
1.15
0.34
0.11
0.14
12.86
100.00
7,262
29,864
54,498
30,460
7,454
1,571
312
228
18,260
149,909
4.84
19.92
36.35
20.32
4.97
1.05
0.21
0.15
12.18
100.00
439
1,084
4,996
7,555
4,141
1,264
133
468
2,046
22,126
1.98
4.90
22.58
34.15
18.72
5.71
0.60
2.12
9.25
100.00
information calls. Total encounters decreased 5.5% from
3,060,122 in 2013 to 2,890,909 in 2014. Information calls
decreased by 17.7% from 806,347 calls in 2013 to 663,305
in 2014, with a 29.8% decrease in drug identification calls
and a 0.04 % decrease in HCF information calls. Human
exposures decreased by 1.1% from 2,188,013 to 2,165,142
cases over the same time period.
Figure 4 shows the year-to-year change through 2000
as a percentage of year 2000 for human exposure cases
broken down into cases with more serious outcomes
(death, major effect and moderate effect) and less serious
outcomes (minor effect, no effect, not followed (nontoxic), not followed (minimal toxicity possible), unable to
follow (potentially toxic), and unrelated effect). Since
2000, cases with more serious outcomes have increased
by 4.29% (95% CI [3.87%, 4.72%]) per year from
108,148 cases in 2000 to 173,594 cases in 2014.
However, cases with less serious outcomes have consistently decreased since 2008 by 3.40% (95% CI [4.08%,
2.72%]) per year from 2,339,460 in 2008 to 1,991,272
cases in 2014. This has driven the overall decrease in
human exposures since 2008.
Thus we see a consistent increase in exposure cases
from HCFs (Figure 3) and for the more severe exposures
(Figure 4), despite a decrease in calls involving less severe
exposures.
Copyright ß Taylor & Francis 2015
Major effect
Table 14. Decontamination and Therapeutic Interventions.
Therapy
Decontamination Only
Therapeutic Intervention Only
Decontamination and Therapeutic Intervention
Not Coded
Total
N
%
1,051,515
249,621
138,078
725,928
2,165,142
48.6
11.5
6.4
33.5
100.0
Distribution of Suicides
Table 19A shows a modest variation in the distribution
of suicides and pediatric deaths over the past 2 decades
as reported to the NPDS national database. Within the
last decade, the percent of exposures determined to be
suspected suicides ranged from 30.3%% to 53.9% and the
percent of pediatric cases has ranged from 1.5% to 3.2%.
The relatively large change seen for 2011 and 2012 reflects
the large increase in indirect death reports in those years.
Analyses of suicides and pediatric deaths for Direct and
Indirect reports are shown in Table 19B.
Plant Exposures
Table 20 provides the number of times the specific plant
was reported to NPDS (N ¼ 44,731). The 25 most
commonly involved plant species and categories account
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984
J. B. Mowry et al.
The figure shows the percent change from baseline (year 2000) for Human Exposure Cases divided
among the 10 Medical Outcomes. The More Serious Exposures (major, moderate and death)
increased. The Less Serious Exposures (no effect, minor effect, not followed ((non-toxic), not
followed (minimal toxicity possible), unable to follow (potentially toxic) and unrelated effect)
decreased after 2008. Solid lines show least-squares linear regressions for the change in More
Serious Exposures per year () and Less Serious Exposures (). Broken lines show 95%
confidence intervaal on the regression.
Figure 4. Change in Encounters by Outcome from 2000.
Solid lines show least-squares linear regressions for the Human Exposure Cases per year for that category (). Broken lines show 95% confidence
interval on the regression.
Figure 5. Substance Categories with the Greatest Rate of Exposure Increase for More Serious Outcomes (Top 4).
for 39.5% of all plant exposures reported. The top 3
categories in the table are essentially synonymous for
unknown plant and comprise 12.2% (5,466/44,731) of all
plant exposures. For a variety of reasons it was not possible
to make a precise identification in these 3 groups. The top
most frequent plant exposures where positive plant
identification was made were (descending order): Cherry
(Species unspecified), Phytolacca americana (L.) (Botanic
name), Spathiphyllum species (Botanic name), Ilex species
(Botanic name), Philodendron (Species unspecified), Mold,
food-related, Zantedeschia aethiopica (Botanic name) and
Malus species (Botanical name).
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
985
Table 15. Therapy Provided in Human Exposures by Age.
Downloaded by [AAPCC] at 12:54 01 December 2015
Therapy
Decontamination
Cathartic
Charcoal, multiple doses
Charcoal, single dose
Dilute/irrigate/wash
Food/snack
Fresh air
Ipecac
Lavage
Other emetic
Whole bowel irrigation
Other Therapies
2-PAM
Alkalinization
Amyl nitrite
Antiarrhythmic
Antibiotics
Anticonvulsantsa
Antiemetics
Antihistamines
Antihypertensives
Antivenin (fab fragment)
Antivenin/antitoxinb
Atropine
BAL
Benzodiazepines
Bronchodilators
Calcium
Cardioversion
CPR
Deferoxamine
ECMO
EDTA
Ethanol
Extracorp. procedure (other)
Fab fragments
Fluids, IV
Flumazenil
Folate
Fomepizole
Glucagon
Glucose, 45%
Hemodialysis
Hemoperfusion
Hydroxocobalamin
Hyperbaric oxygen
Insulin
Intubation
Methylene blue
NAC, IV
NAC, PO
Nalmefene
Naloxone
Neuromuscular blocker
Octreotide
Other
Oxygen
Pacemaker
Penicillamine
Physostigmine
Phytonadione
Pyridoxine
Sedation (other)
Sodium nitrite
5¼ 5 y
6–12 y
13–19 y
4¼ 20 y
Unknown
child
Unknown
adult
Unknown
age
657
76
7,901
500,468
127,659
6,365
41
57
6,604
70
159
19
915
50,592
11,102
4,138
6
16
537
32
2,291
332
11,541
29,139
5,932
4,897
29
414
1,045
369
4,917
884
24,135
181,814
29,923
40,642
52
1,551
4,835
1,265
0
0
5
1,321
127
770
0
2
7
0
43
6
191
30,413
4,452
10,593
4
13
401
8
3
0
25
2,653
275
1,317
0
0
53
0
8,070
1,317
44,713
796,400
179,470
68,722
132
2,053
13,482
1,744
7
124
0
12
1,759
66
1,316
2,080
17
190
60
103
8
1,119
456
8,380
2
36
2
5
18
2
1
19
6,907
97
10
120
46
393
9
1
12
17
9
532
12
190
61
0
1,149
46
84
34,436
1,550
1
0
13
12
8
393
1
1
91
0
4
764
24
568
1,275
6
196
36
20
1
506
212
563
2
17
3
1
1
1
0
12
2,542
17
0
15
6
27
10
1
5
33
8
124
1
177
40
0
183
9
6
7,587
683
0
1
11
6
2
117
0
5
2,053
0
239
1,225
154
6,251
1,663
155
150
35
111
0
6,225
390
293
14
120
23
15
4
6
2
17
30,509
193
28
90
97
304
108
1
3
41
106
1,853
6
4,604
1,101
0
1,748
159
36
12,266
3,737
4
0
102
63
43
1,781
3
50
8,966
1
1,409
12,841
924
13,163
8,918
2,410
1,431
274
1,120
23
27,282
4,260
2,550
184
976
32
21
9
48
29
543
118,965
1,499
1,087
1,794
1,916
3,507
2,339
40
97
267
1,889
19,132
107
13,949
2,858
11
17,535
1,243
308
75,940
42,394
158
1
189
692
369
15,679
20
0
0
0
0
6
0
35
14
0
1
0
0
0
1
2
3
0
0
0
0
0
0
0
0
12
0
0
0
0
0
0
0
0
0
0
3
0
1
0
0
1
0
0
179
9
0
0
0
0
0
2
0
0
35
0
6
563
3
140
897
6
8
4
5
0
170
173
98
0
7
0
0
0
0
1
4
742
8
8
14
12
21
11
0
5
39
3
133
1
60
12
0
120
3
1
4,335
418
2
0
1
4
4
79
0
0
6
0
0
76
0
24
75
0
5
1
0
0
34
17
17
0
7
0
0
0
0
0
0
97
0
1
1
0
5
4
0
1
2
0
21
0
13
1
0
22
0
1
927
103
0
0
0
2
1
9
0
63
11,275
1
1,670
17,234
1,171
21,497
14,922
2,594
1,981
410
1,359
32
35,337
5,510
11,904
202
1,163
60
42
32
57
33
595
159,774
1,814
1,134
2,034
2,077
4,257
2,481
43
123
399
2,015
21,798
127
18,994
4,073
11
20,758
1,460
436
135,670
48,894
165
2
316
779
427
18,060
24
Total
(continued)
Copyright ß Taylor & Francis 2015
986
J. B. Mowry et al.
Table 15. Continued
5¼ 5 y
Therapy
Sodium thiosulfate
Steroids
Succimer
Transplantation
Vasopressors
Ventilator
3
728
75
0
92
487
6–12 y
13–19 y
4¼ 20 y
1
312
6
0
41
120
1
430
11
1
376
1,729
40
4,223
64
15
5,572
18,137
Unknown
child
0
6
0
0
0
3
Unknown
adult
1
302
0
0
22
119
Unknown
age
0
26
1
0
3
18
Total
46
6,027
157
16
6,106
20,613
a
Excludes benzodiazepines.
Excludes Fab fragments
b
Table 16A. Decontamination Trends (1985–2014).
Downloaded by [AAPCC] at 12:54 01 December 2015
Activated charcoal
Exposures involving
Activated charcoal
administered
children 5 y
Ipecac administered
Human
Ipecac administered administered
Year exposures (% of all exposures) (% of all exposures) (% of all exposures) (% of child exposures) (% of child exposures)
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
886,389
1,095,228
1,164,648
1,364,113
1,578,968
1,646,946
1,836,364
1,862,796
1,747,147
1,926,992
2,023,089
2,155,952
2,192,088
2,241,082
2,201,156
2,168,248
2,267,979
2,380,028
2,395,582
2,438,643
2,424,180
2,403,539
2,482,041
2,491,049
2,479,355
2,384,825
2,334,004
2,275,141
2,188,013
2,165,142
132,947
145,516
117,840
114,654
110,545
98,986
94,877
79,493
65,078
51,356
47,359
39,376
32,098
26,653
21,942
18,177
16,058
13,555
9,284
4,701
3,027
2,176
1,740
1,205
658
360
262
193
134
132
(14.999)
(13.286)
(10.118)
(8.4050)
(7.0011)
(6.0103)
(5.1666)
(4.2674)
(3.7248)
(2.6651)
(2.3409)
(1.8264)
(1.4643)
(1.1893)
(0.9968)
(0.8383)
(0.7080)
(0.5695)
(0.3875)
(0.1928)
(0.1249)
(0.0905)
(0.0701)
(0.0484)
(0.0265)
(0.0200)
(0.0100)
(0.0100)
(0.0100)
(0.0061)
41,063
56,481
60,310
88,876
101,368
108,341
129,092
135,625
127,893
138,247
155,880
157,331
156,213
152,134
145,853
145,911
149,442
149,527
140,412
135,969
123,263
111,351
106,010
97,297
84,805
74,431
66,770
57,888
50,459
46,030
(4.6)
(5.2)
(5.2)
(6.5)
(6.4)
(6.6)
(7.0)
(7.3)
(7.3)
(7.2)
(7.7)
(7.3)
(7.1)
(6.8)
(6.6)
(6.7)
(6.6)
(6.3)
(5.9)
(5.6)
(5.1)
(4.6)
(4.3)
(3.9)
(3.4)
(3.1)
(2.9)
(2.5)
(2.3)
(2.1)
568,691
690,137
730,228
843,106
963,924
999,751
1,099,179
1,094,256
978,560
1,042,651
1,070,472
1,137,263
1,150,931
1,180,989
1,154,799
1,142,796
1,169,478
1,227,381
1,245,584
1,250,536
1,233,695
1,223,815
1,271,595
1,292,754
1,290,784
1,207,575
1,144,729
1,102,307
1,049,475
1,031,927
(64.2)
(63.0)
(62.7)
(61.8)
(61.0)
(60.7)
(59.9)
(58.7)
(56.0)
(54.1)
(52.9)
(52.7)
(52.5)
(52.7)
(52.5)
(52.7)
(51.6)
(51.6)
(52.0)
(51.3)
(50.9)
(50.9)
(51.2)
(51.9)
(52.1)
(50.6)
(49.1)
(48.5)
(48.0)
(47.7)
94,919
99,688
83,443
80,749
79,192
73,469
73,069
63,486
50,834
41,489
38,372
32,622
26,536
22,247
18,326
15,239
13,389
11,163
7,310
3,366
1,999
1,337
1,052
641
330
163
98
83
42
41
(16.6908)
(14.4447)
(11.427)
(9.5776)
(8.2156)
(7.3487)
(6.6476)
(5.8018)
(5.1948)
(3.9792)
(3.5846)
(2.8685)
(2.3056)
(1.8838)
(1.5869)
(1.3335)
(1.1449)
(0.9095)
(0.5869)
(0.2692)
(0.1620)
(0.1092)
(0.0827)
(0.0496)
(0.0256)
(0.0100)
(0.0100)
(0.0100)
(0.0000)
(0.0040)
14,718
18,191
18,507
26,118
30,345
31,579
36,177
38,937
35,791
35,670
38,095
37,986
35,856
34,302
33,812
31,554
30,367
30,340
28,888
28,335
26,338
23,843
22,829
21,286
19,168
16,581
13,930
11,284
9,334
7,977
(2.59)
(2.64)
(2.53)
(3.10)
(3.15)
(3.16)
(3.29)
(3.56)
(3.66)
(3.42)
(3.56)
(3.34)
(3.12)
(2.90)
(2.93)
(2.76)
(2.60)
(2.47)
(2.32)
(2.27)
(2.13)
(1.95)
(1.80)
(1.65)
(1.48)
(1.37)
(1.22)
(1.02)
(0.89)
(0.77)
Table 16B. Decontamination Trends: Total Human and Pediatric Exposures
5¼ 5 Yearsa.
Human
exposures
Therapy
Activated charcoal
administered
Cathartic
Ipecac administered
Lavage
Other Emetic
Whole Bowel Irrigation
Total
a
Exposures
children 5¼ 5 y
N
%
N
%
46,030
2.13
7,977
0.77
8,070
132
2,053
13,482
1,744
71,511
0.37
0.01
0.09
0.62
0.08
3.30
657
41
57
6,604
70
15,406
0.06
0.00
0.01
0.64
0.01
1.49
Human exposures ¼ 2,165,142; Pediatric exposures ¼ 1,031,927
Deaths and Exposure-related Fatalities
A listing of cases (Table 21) and summary of cases
(Tables 4, 5, 8, 9, 18 and 22) are provided for fatal cases for
which there exists reasonable confidence that the death was
a result of that exposure (exposure-related fatalities).
Tables 11, 12, and 19 consider all deaths, irrespective of
the Relative Contribution to Fatality (RCF). Beginning in
2010, cases with outcome of Death, Indirect Report were
not further reviewed by the AAPCC Fatality Review Team
and the RCF was determined by the individual PC review
team.
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
Table
Fatalities Included
RCF
N
4
5
8
9
11
Death only
Death only
Death only
Death only
Death and Death (indirect
report)
Death and Death (indirect
report)
Pediatric Death and Death
(indirect report)
Death only
Death and Death (indirect
report)
Death and Death (indirect
report)
Death and Death (indirect
report)
Death and Death (indirect
report) – Single substance
deaths only
1,2,3
1,2,3
1,2,3
1,2,3
All
1,173
1,173
1,173
1,173
1,835
All
1,835
All
34
12
17E
18
19A
19B
21
Downloaded by [AAPCC] at 12:54 01 December 2015
22
1,2,3
All
1,173
1,835
All
1,835
1,2,3
1,408
All
882
There were 276 deaths, indirect and 1,559 deaths. Of
these 1,835 cases, 1,408 were judged exposure-related
fatalities (RCF ¼ 1-Undoubtedly responsible, 2-Probably
responsible, or 3-Contributory). The remaining 427 cases
were judged as follows: 111 as RCF ¼ 4-Probably not
responsible, 38 as 5 ¼ Clearly not responsible, and 278 as
6 ¼ Unknown.
Deaths are sorted in Table 21 according to the category,
then substance deemed most likely responsible for the
death (Cause Rank), and then by patient age. The Cause
Rank permits the PC to judge 2 or more substances as
indistinguishable in terms of cause, e.g., 2 substances
which appear equally likely to have caused the death could
have Substance Rank of 1,2 and Cause Rank of 1,1.
Additional agents implicated are listed below the primary
agent in the order of their contribution to the fatality.
As shown in Table 5, a single substance was implicated
in 75.9% of reported human exposures, and 24.1% of
patients were exposed to 2 or more drugs or products. The
exposure-related fatalities involved a single substance in
495 cases (42.2%), 2 substances in 288 cases (24.6%), 3
in 171 cases (14.6%) and 4 or more in the balance of
the cases.
In Table 21, the Annual Report ID number [bracketed]
indicates that the abstract for that case is included in
Appendix C. The letters following the Annual Report ID
number indicate: i ¼ Death, Indirect report (occurred in
235, 16.7% of cases), p ¼ prehospital cardiac and/or
respiratory arrest (occurred in 468 of 1,408, 33.2% of
cases), h ¼ hospital records reviewed (occurred in 647,
46.0% of cases), a ¼ autopsy report reviewed (occurred in
476, 33.8% of cases). The distribution of NPDS RCF was:
1 ¼ Undoubtedly responsible in 597 cases (42.4%),
2 ¼ Probably responsible in 629 cases (44.7%),
3 ¼ Contributory in 182 cases (12.9%). The denominator
for these Table 21 percentages is 1,408.
All fatalities – all ages
Table 4 presents the age and gender distribution for these
1,173 exposure-related fatalities (excluding death,
Table 17A. Substance Categories Most Frequently Involved in Human Exposures (Top 25).
Substance (Major Generic Category)
Analgesics
Cosmetics/Personal Care Products
Cleaning Substances (Household)
Sedative/Hypnotics/Antipsychotics
Antidepressants
Antihistamines
Cardiovascular Drugs
Foreign Bodies/Toys/Miscellaneous
Pesticides
Topical Preparations
Alcohols
Vitamins
Cold and Cough Preparations
Stimulants and Street Drugs
Anticonvulsants
Hormones and Hormone Antagonists
Antimicrobials
Bites and Envenomations
Gastrointestinal Preparations
Plants
Dietary Supplements/Herbals/Homeopathic
Chemicals
Fumes/Gases/Vapors
Other/Unknown Nondrug Substances
Hydrocarbons
a
All substances
%a
Single substance exposures
%b
291,062
199,291
198,018
150,715
112,412
103,327
102,170
99,835
83,005
82,819
68,648
66,058
61,288
59,869
56,832
56,775
56,726
55,017
48,501
44,731
42,535
38,975
33,944
32,001
31,903
11.29
7.73
7.68
5.85
4.36
4.01
3.96
3.87
3.22
3.21
2.66
2.56
2.38
2.32
2.20
2.20
2.20
2.13
1.88
1.74
1.65
1.51
1.32
1.24
1.24
187,329
192,552
178,973
55,653
46,517
72,989
45,466
96,748
77,480
80,746
22,277
56,938
43,645
34,660
23,314
38,651
46,358
54,298
36,440
42,351
34,569
33,138
31,238
28,688
29,907
9.73
10.00
9.29
2.89
2.42
3.79
2.36
5.02
4.02
4.19
1.16
2.96
2.27
1.80
1.21
2.01
2.41
2.82
1.89
2.20
1.80
1.72
1.62
1.49
1.55
Percentages are based on the total number of substances reported in all exposures (N ¼ 2,577,557)
Percentages are based on the total number of single substance exposures (N ¼ 1,925,657)
b
Copyright ß Taylor & Francis 2015
987
988
J. B. Mowry et al.
Table 17B. Substance Categories with the Greatest Rate of Exposure
Increase (Top 25).
Downloaded by [AAPCC] at 12:54 01 December 2015
Substance
(Major Generic
Category)
Sedative/Hypnotics/
Antipsychotics
Analgesics
Antidepressants
Cardiovascular Drugs
Alcohols
Stimulants and Street Drugs
Anticonvulsants
Antihistamines
Muscle Relaxants
Unknown Drug
Cold and Cough Preparations
Hormones and Hormone
Antagonists
Miscellaneous Drugs
Gastrointestinal Preparations
Diuretics
Anticoagulants
Electrolytes and Minerals
Other/Unknown Nondrug
Substances
Vitamins
Anticholinergic Drugs
Antimicrobials
Automotive/Aircraft/
Boat Products
Weapons of Mass
Destruction
Essential Oils
Narcotic Antagonists
Increase in serious
exposures per yeara
Mean
95% CIb
All
substances
in 2014
2,368
[1,987, 2,749]
48,650
2,060
1,200
988
925
693
635
533
483
309
277
249
[1,777, 2,344]
[1,069, 1,331]
[938, 1,038]
[837, 1,013]
[378, 1,007]
[584, 687]
[455, 610]
[418, 549]
[263, 355]
[210, 345]
[233, 266]
46,107
35,472
19,661
21,319
20,534
15,185
13,512
9,488
6,720
7,869
5,907
101
76
57
53
41
41
[66, 135]
[65, 88]
[47, 67]
[45, 60]
[34, 49]
[11, 72]
2,194
2,673
1,416
1,098
1,009
1,131
[32,
[30,
[6,
[2,
48]
49]
44]
28]
929
1,104
2,568
1,228
11
[3, 19]
251
10
8
[9, 12]
[6, 9]
203
168
40
39
19
15
major category section in Table 21 list all cases that
identify this substance as other than the primary substance.
This alternate name may not agree with the AAPCC
generic categories used in the summary tables (including
Table 22).
Table 18 lists the top 25 minor generic substance
categories associated with reported fatalities and the
number of single substance exposure fatalities for that
category – miscellaneous sedative/hypnotics/antipsychotics, miscellaneous cardiovascular drugs, opioids, and
miscellaneous stimulants and street drugs lead this list
followed by miscellaneous alcohols, acetaminophen alone,
acetaminophen combinations, selective serotonin reuptake
inhibitors (SSRIs) and miscellaneous fumes/gases/vapors.
Note that Table 18 is sorted by all substances to which a
patient was exposed (i.e., a patient exposed to an opioid
may have also been exposed to 1 or more other products)
and shows single substance exposures in the right hand
column.
The first ranked substance (Table 21) was a pharmaceutical in 1,105 (78.5%) of the 1,408 fatalities. These
1,105 first ranked pharmaceuticals included:
a
Serious exposures have outcomes of Moderate, Major or Death.
Increase and confidence intervals are based on least squares linear regression
of the number of calls per year for 2000–2014.
b
indirect). The age distribution of reported fatalities
showed a decrease in deaths among children (520 years
old) compared to 2013, with 88 cases representing 7.5%
of fatalities. This was an absolute decrease of 11 fatalities
and an 11.1% decrease in that age group, and possibly
due to a decrease in indirect death reports this year.
The age distribution of reported fatalities in adults
(age 20 years) is similar to prior years with 1,080 of
1,173 (92.1%) fatal cases occurring in that age group and
5 (0.4%) of fatalities occurring in Unknown Age patients.
While children 5 years old were involved in the
majority of exposures, the 16 deaths in this group
comprised just 1.4% of the exposure-related fatalities.
While most (65.6%) of the fatalities occurred in 20- to
59-year-old individuals, the percentage is slightly
decreased from prior years.
Table 21 lists each of the 1,408 human fatalities
(including death, indirect report) along with all of the
substances involved for each case. Please note: the
substance listed in column 3 of Table 21 (alternate name)
was chosen to be the most specific generic name based
upon the Micromedex Poisindex product name and generic
code selected for that substance. Alternate names are
maintained in the NPDS for each substance involved in
a fatality. The cross-references at the end of each
391 analgesics (112 acetaminophen, 47 acetaminophen/hydrocodone, 40 oxycodone, 35 methadone, 25
salicylate, 23 acetaminophen/oxycodone, 20 morphine,
18 fentanyl, 16 hydrocodone, 13 tramadol)
191 stimulants/street drugs (67 heroin, 48 methamphetamine, 30 cocaine, 10 amphetamines, 8 amphetamine (hallucinogenic))
188 cardiovascular drugs (34 amlodipine, 23 verapamil, 22 cardiac glycoside, 17 metoprolol, 10 propranolol, 9 carvedilol, 9 diltiazem (extended release), 8
diltiazem)
98 antidepressants (20 amitriptyline, 15 bupropion, 9
lithium, 9 venlafaxine, 8 doxepin, 7 citalopram, 6
bupropion (extended release))
77 sedative/hypnotic/antipsychotics (22 quetiapine, 14
alprazolam, 7 temazepam, 6 diazepam, 5 olanzapine, 4
clonazepam)
The exposure was acute in 774 (55.0%), A/C ¼ acute on
chronic in 289 (20.5%), C ¼ chronic in 108 (7.7%) and
U ¼ unknown in 237 (16.8%).
A total of 1,214 tissue concentrations for 1 or more
related analytes were reported in 555 cases. Most of these
(1,128) involved fatalities with RCF of 1–3, and are listed
in Table 21, while all tissue concentrations are available to
the PCs through the NPDS Enterprise Reports. These 123
analytes included: 196 acetaminophen, 97 ethanol, 58
salicylate, 33 carboxyhemoglobin, 31 alprazolam, 31
morphine, 27 oxycodone, 27 digoxin, 20 ethylene glycol,
20 benzoylecgonine, 19 methamphetamine, 17 amphetamine, 16 diphenhydramine, 16 quetiapine, 15 methanol,
15 diazepam.
Route of exposure was: Ingestion only in 996 cases
(70.7%), Inhalation/nasal in 116 cases (8.2%) and
Parenteral in 52 cases (3.7%). Most other routes were
combination routes or unknown.
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
989
Table 17C. Substance Categories Most Frequently Involved in Pediatric (5 years) Exposures (Top 25)a.
Downloaded by [AAPCC] at 12:54 01 December 2015
Substance (Major Generic Category)
Cosmetics/Personal Care Products
Cleaning Substances (Household)
Analgesics
Foreign Bodies/Toys/Miscellaneous
Topical Preparations
Vitamins
Antihistamines
Pesticides
Gastrointestinal Preparations
Plants
Dietary Supplements/Herbals/Homeopathic
Antimicrobials
Cold and Cough Preparations
Cardiovascular Drugs
Arts/Crafts/Office Supplies
Hormones and Hormone Antagonists
Electrolytes and Minerals
Deodorizers
Other/Unknown Nondrug Substances
Sedative/Hypnotics/Antipsychotics
Alcohols
Antidepressants
Tobacco/Nicotine/eCigarette Products
Chemicals
Hydrocarbons
All substances
%b
Single substance
exposures
%c
150,530
118,207
100,399
72,099
62,053
48,214
45,915
35,152
28,460
27,941
27,619
26,216
23,830
22,059
20,861
19,416
18,637
16,392
13,611
11,544
11,088
10,897
10,571
9,706
9,546
14.01
11.00
9.34
6.71
5.78
4.49
4.27
3.27
2.65
2.60
2.57
2.44
2.22
2.05
1.94
1.81
1.73
1.53
1.27
1.07
1.03
1.01
0.98
0.90
0.89
147,396
114,009
91,819
70,266
60,904
43,976
41,671
34,196
25,829
26,912
25,561
24,671
21,883
14,084
20,244
15,331
16,962
16,212
12,335
8,865
10,820
7,847
10,452
8,970
9,245
14.70
11.37
9.16
7.01
6.08
4.39
4.16
3.41
2.58
2.68
2.55
2.46
2.18
1.40
2.02
1.53
1.69
1.62
1.23
0.88
1.08
0.78
1.04
0.89
0.92
a
Includes all children with actual or estimated ages 5 years old. Results do not include ‘‘Unknown Child’’ or ‘‘Unknown Age’’.
Percentages are based on the total number of substances reported in pediatric exposures (N ¼ 1,074,395)
Percentages are based on the total number of single substance pediatric exposures (N ¼ 1,002,495)
b
c
Table 17D. Substance Categories Most Frequently Involved in Adult (20 years) Exposures (Top 25)a.
Substance (Major Generic Category)
Analgesics
Sedative/Hypnotics/Antipsychotics
Antidepressants
Cardiovascular Drugs
Cleaning Substances (Household)
Alcohols
Anticonvulsants
Pesticides
Bites and Envenomations
Antihistamines
Cosmetics/Personal Care Products
Stimulants and Street Drugs
Hormones and Hormone Antagonists
Fumes/Gases/Vapors
Chemicals
Antimicrobials
Muscle Relaxants
Cold and Cough Preparations
Hydrocarbons
Topical Preparations
Gastrointestinal Preparations
Other/Unknown Nondrug Substances
Foreign Bodies/Toys/Miscellaneous
Miscellaneous Drugs
Unknown Drug
a
All substances
%b
Single substance
exposures
%c
133,864
117,682
75,622
68,579
64,217
51,344
41,738
39,968
36,944
34,804
31,975
31,931
31,788
24,442
23,527
22,064
20,515
20,399
18,147
15,925
15,551
13,668
13,574
12,300
11,747
11.86
10.43
6.70
6.08
5.69
4.55
3.70
3.54
3.27
3.08
2.83
2.83
2.82
2.17
2.09
1.96
1.82
1.81
1.61
1.41
1.38
1.21
1.20
1.09
1.04
61,589
37,044
26,095
25,131
51,688
9,088
14,717
35,978
36,478
16,892
29,453
15,475
19,512
22,479
19,305
15,754
7,469
11,098
16,727
15,244
7,722
12,076
12,668
6,240
7,472
9.37
5.64
3.97
3.82
7.87
1.38
2.24
5.47
5.55
2.57
4.48
2.35
2.97
3.42
2.94
2.40
1.14
1.69
2.55
2.32
1.18
1.84
1.93
0.95
1.14
Includes all adults with actual or estimated ages 20 years old. Results also include ‘‘Unknown Adult’’ but do not include ‘‘Unknown Age’’.
Percentages are based on the total number of substances reported in adult exposures (N ¼ 1,128,313)
c
Percentages are based on the total number of single substance adult exposures (N ¼ 657,161)
b
Copyright ß Taylor & Francis 2015
990
J. B. Mowry et al.
Table 17E. Substance Categories Most Frequently Involved in Pediatric (5 years) Deathsa.
Downloaded by [AAPCC] at 12:54 01 December 2015
Substance (Major Generic Category)
All substances
%b
Single substance
exposures
%c
10
7
7
3
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
50
20.00
14.00
14.00
6.00
4.00
4.00
4.00
4.00
4.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
2.00
100.00
4
4
2
1
2
1
0
0
0
1
1
1
1
1
1
1
0
1
1
1
1
1
26
15.38
15.38
7.69
3.85
7.69
3.85
0.00
0.00
0.00
3.85
3.85
3.85
3.85
3.85
3.85
3.85
0.00
3.85
3.85
3.85
3.85
3.85
100.00
Fumes/Gases/Vapors
Analgesics
Cleaning Substances (Household)
Alcohols
Antihistamines
Cardiovascular Drugs
Cosmetics/Personal Care Products
Miscellaneous Drugs
Sedative/Hypnotics/Antipsychotics
Anesthetics
Batteries
Bites and Envenomations
Cold and Cough Preparations
Electrolytes and Minerals
Hydrocarbons
Information Calls
Muscle Relaxants
Other/Unknown Nondrug Substances
Serums, Toxoids, Vaccines
Stimulants and Street Drugs
Tobacco/Nicotine/eCigarette Products
Unknown Drug
Total
a
Includes all children with actual or estimated ages 5 years old. Results do not include ‘‘Unknown Child’’ or ‘‘Unknown Age’’. Includes death and death, indirect
regardless of Relative Contribution to Fatality.
Percentages are based on the total number of substances reported in pediatric fatalities (N ¼ 50)
c
Percentages are based on the total number of single substance pediatric fatalities (N ¼ 26)
b
Table 17F. Substance Categories Most Frequently Identified in Drug
Identification Calls (Top 25).
Substance (Major Generic Category)
Analgesics
Sedative/Hypnotics/Antipsychotics
Unknown Drug
Cardiovascular Drugs
Muscle Relaxants
Antidepressants
Antihistamines
Antimicrobials
Stimulants and Street Drugs
Anticonvulsants
Information Calls
Hormones and Hormone Antagonists
Gastrointestinal Preparations
Diuretics
Miscellaneous Drugs
Cold and Cough Preparations
Anticholinergic Drugs
Anticoagulants
Electrolytes and Minerals
Vitamins
Asthma Therapies
Other/Unknown Nondrug Substances
Dietary Supplements/Herbals/Homeopathic
Antineoplastics
Anesthetics
a
All
substances
%a
131,450
56,062
18,716
17,720
16,562
16,066
12,693
10,270
10,103
9,754
8,358
6,594
6,409
3,801
2,309
1,372
970
646
639
631
564
418
216
136
122
39.46
16.83
5.62
5.32
4.97
4.82
3.81
3.08
3.03
2.93
2.51
1.98
1.92
1.14
0.69
0.41
0.29
0.19
0.19
0.19
0.17
0.13
0.06
0.04
0.04
Percentages are based on the total number of substances reported in all drug
identification calls (N ¼ 333,110)
The Intentional exposure reason was: Abuse in 174
cases (12.4%), Suspected suicide in 672 cases (47.7%),
Unknown in 200 cases (14.2%) and Misuse in 35 cases
(2.5%). Unintentional exposure reason was: Environmental
in 53 cases (3.8%), Therapeutic error in 24 cases (1.7%),
and Misuse in 20 cases (1.4%). Adverse drug reaction was
the reason in 43 (3.1%).
Pediatric fatalities – age 5 years
Although children younger than 6 years were involved
in the majority of exposures, they comprised 34 of
1,835 (1.9%) of fatalities. These numbers are similar to
those reported since 1985 (Table 19A, all RCFs and
includes indirect deaths). Table 8 (RCF 1,2 or 3, excludes
indirect deaths) shows the percentage fatalities in children 5 years related to total pediatric exposures was
16/1,031,927 ¼ 0.00156%.
By
comparison,
1,080/
825,009 ¼ 0.13% of all adult exposures involved a fatality.
Of these 16 pediatric fatalities, 10 (62.5%) were reported as
unintentional, 4 (25.0%) were reported as unknown and 2
(12.5%) were coded as resulting from malicious intent
(Table 8).
The 25 fatalities in children 5 years old in Table 21
(includes death, indirect reports and RCF 1–3) included 10
pharmaceuticals and 15 nonpharmaceuticals. The first
ranked substances associated with these fatalities included:
fumes/gases/vapors (7), analgesics (6), cleaning substances
(household) (3), antihistamines (2) and 7 other substances
(1 each).
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
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Table 17G. Substance Categories Most Frequently Involved in Pregnant Exposuresa (Top 25).
Substance (Major Generic Category)
All
substances
%b
Single substance
exposures
%c
Analgesics
Cleaning Substances (Household)
Pesticides
Fumes/Gases/Vapors
Bites and Envenomations
Sedative/Hypnotics/Antipsychotics
Vitamins
Cosmetics/Personal Care Products
Foreign Bodies/Toys/Miscellaneous
Antihistamines
Antidepressants
Antimicrobials
Other/Unknown Nondrug Substances
Chemicals
Infectious and Toxin-Mediated Diseases
Hormones and Hormone Antagonists
Hydrocarbons
Stimulants and Street Drugs
Information Calls
Cold and Cough Preparations
Gastrointestinal Preparations
Paints and Stripping Agents
Cardiovascular Drugs
Alcohols
Plants
944
754
600
591
418
326
282
267
266
220
211
198
187
180
167
162
158
153
138
138
137
136
127
126
125
11.37
9.08
7.23
7.12
5.03
3.93
3.40
3.22
3.20
2.65
2.54
2.38
2.25
2.17
2.01
1.95
1.90
1.84
1.66
1.66
1.65
1.64
1.53
1.52
1.51
586
557
554
562
415
149
202
241
260
139
112
153
166
143
165
141
150
85
118
84
109
125
84
45
106
9.00
8.56
8.51
8.63
6.38
2.29
3.10
3.70
3.99
2.14
1.72
2.35
2.55
2.20
2.53
2.17
2.30
1.31
1.81
1.29
1.67
1.92
1.29
0.69
1.63
a
Includes all patient classified as pregnant and all female patients with a ‘duration of pregnancy’ greater than 0.
Percentages are based on the total number of substances reported in pregnant exposures (N ¼ 8,303)
Percentages are based on the total number of single substance pregnant exposures (N ¼ 6,509)
b
c
Table 18. Categories Associated with Largest Number of Fatalities (Top 25)a.
Substance (Minor Generic Category)
Miscellaneous Sedative/Hypnotics/Antipsychotics
Miscellaneous Cardiovascular Drugs
Opioids
Miscellaneous Stimulants and Street Drugs
Miscellaneous Alcohols
Acetaminophen Alone
Acetaminophen Combinations
Selective Serotonin Reuptake Inhibitors (SSRI)
Miscellaneous Fumes/Gases/Vapors
Miscellaneous Antidepressants
Miscellaneous Muscle Relaxants
Miscellaneous Anticonvulsants
Nonsteroidal Antiinflammatory Drugs
Acetylsalicylic Acid Alone
Miscellaneous Antihistamines
Miscellaneous Chemicals
Tricyclic Antidepressants (TCA)
Miscellaneous Unknown Drug
Oral Hypoglycemic
Anticonvulsants: Gamma Aminobutyric Acid and Analogs
Serotonin Norepinephrine Reuptake Inhibitors (SNRI)
Miscellaneous Hormones and Hormone Antagonists
Miscellaneous Anticoagulants
Cannabinoids and Analogs
Automotive Products
a
All
substances
%b
Single substance
exposures
%c
384
371
220
206
157
143
134
99
73
66
63
59
52
51
48
46
46
43
42
40
32
29
25
24
23
13.77
13.30
7.89
7.39
5.63
5.13
4.80
3.55
2.62
2.37
2.26
2.12
1.86
1.83
1.72
1.65
1.65
1.54
1.51
1.43
1.15
1.04
0.90
0.86
0.82
19
52
19
54
12
53
31
1
47
4
3
0
2
12
6
21
10
13
7
1
2
3
7
1
13
3.84
10.51
3.84
10.91
2.42
10.71
6.26
0.20
9.49
0.81
0.61
0.00
0.40
2.42
1.21
4.24
2.02
2.63
1.41
0.20
0.40
0.61
1.41
0.20
2.63
Numbers represent total exposures associated with 1,173 fatalities (with relative contribution to fatality of 1-Undoubtedly responsible,
2-Probably responsible, or 3-Contributory); each fatality may have had exposure to more than one substance.
b
Percentages are based on the total number of substances reported in fatal exposures (N ¼ 2,789)
c
Percentages are based on the total number of single substance fatal exposures (N ¼ 495)
Copyright ß Taylor & Francis 2015
991
992
J. B. Mowry et al.
Pediatric fatalities – ages 6–12 years
In the age range 6 to 12 years, there were 10 reported
fatalities, 5 of which were unintentional environmental, 2
were unintentional general, 2 were intentional suspected
suicide and 1 was intentional abuse (Table 8). The 15
fatalities listed in Table 21 (includes death, indirect reports
and RCF 1–3) included: 8 carbon monoxide, 2 smoke, 2
benzonatate, 1 nortriptyline, 1 ethanol, 1 butane.
Table 19A. Comparisons of Death Data (1985–2014)a.
Adolescent fatalities – ages 13–19 years
In the age range 13 to 19 years, there were 61 reported
fatalities, a decrease of 3 (4.68%) from 2013, and included
54 intentional, 4 unintentional, 1 adverse reaction and 2
unknown reason (Table 8). The 67 fatalities listed in
Table 21 (includes death, indirect reports and RCF 1–3)
included 53 pharmaceuticals and 14 nonpharmaceuticals.
The first ranked pharmaceuticals associated with these
fatalities included: heroin (4), diphenhydramine (3),
amphetamine (hallucinogenic) (3), methylenedioxymethamphetamine (MDMA) (3), methadone (2), salicylate
(2), amphetamine (hallucinogenic), 2C (2) and methamphetamine (2) and the remainder with 1 substance each. The
first ranked nonpharmaceutical associated with these fatalities included: ethanol (3), carbon monoxide (2), hydrogen
sulfide (2), methanol (1), chemical (inhalation), unknown
(1), cyanide (1), lysergic acid diethylamide (LSD) (1),
helium (1), hyperthermia (1) and dinitrophenol (1).
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Total fatalities
Suicides
Pediatric deaths
b
Year
N
% of
cases
N
% of
deaths
N
% of
deaths
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
328
406
398
544
590
553
764
705
626
766
724
726
786
775
873
921
1,085
1,170
1,109
1,190
1,438
1,515
1,597
1,756
1,544
1,730
2,765
2,937
2,477
1,835
0.036
0.037
0.034
0.040
0.037
0.032
0.042
0.038
0.036
0.040
0.036
0.034
0.036
0.035
0.040
0.042
0.048
0.049
0.046
0.049
0.059
0.063
0.064
0.070
0.062
0.072
0.118
0.129
0.113
0.085
174
223
227
296
323
320
408
395
338
410
405
358
418
421
472
477
553
635
592
642
674
705
737
797
779
779
865
890
785
790
53.0
54.9
57.0
54.4
54.7
57.9
53.4
56.0
54.0
53.5
55.9
49.3
53.2
54.3
54.1
51.8
51.0
54.3
53.4
53.9
46.9
46.5
46.1
45.4
50.5
45.0
31.3
30.3
31.7
43.1
20
15
22
30
24
21
44
29
27
26
20
29
25
16
24
20
27
27
35
27
32
39
47
39
37
55
42
46
51
34
6.1
3.7
5.5
5.5
4.1
3.8
5.8
4.1
4.3
3.4
2.8
4.0
3.2
2.1
2.7
2.2
2.5
2.3
3.2
2.3
2.2
2.6
2.9
2.2
2.4
3.2
1.5
1.6
2.1
1.9
a
Human exposures with medical outcome of death or death, indirect
regardless of Relative Contribution to Fatality.
b
Includes all children with actual or estimated ages 5 years old. Results do
not include ‘‘Unknown Child’’ or ‘‘Unknown Age’’. Includes death and
death, indirect regardless of Relative Contribution to Fatality.
Pregnancy and Fatalities
A total of 33 deaths of pregnant women have been reported
from the years 2000 through 2013. The majority (28 of 33)
were intentional exposures (misuse, abuse or suspected
suicide). There were 2 deaths in pregnant women reported
to NPDS in 2014.
AAPCC Surveillance Results
A key component of the NPDS surveillance system is the
variety of monitoring tools available to the NPDS user
community. In addition to AAPCC national surveillance
definitions, 28 PCs utilize NPDS as part of their surveillance programs. The Centers for Disease Control and
Table 19B. Comparisons of Direct and Indirect Death Data (2000–2014)a.
All deaths
Suicides
Pediatric deaths
Year
Total
Direct
Indirect
Total
% of
deaths
Direct
% of
direct
Indirect
Total
% of
deaths
Direct
% of
direct
Indirect
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
864
1,066
850
867
955
1,423
1,515
1,597
1,756
1,544
1,730
2,765
2,937
2,477
1,835
845
952
739
826
898
1,332
1,415
1,502
1,535
1,452
1,455
1,503
1,507
1,552
1,559
19
114
111
41
57
91
100
95
221
92
275
1,262
1,430
925
276
448
542
455
464
516
666
705
737
797
779
779
865
890
785
790
51.85
50.84
53.53
53.52
54.03
46.80
46.53
46.15
45.39
50.45
45.03
31.28
30.30
31.69
43.05
443
503
436
454
501
656
687
712
750
748
732
758
759
698
757
52.43
52.84
59.00
54.96
55.79
49.25
48.55
47.40
48.86
51.52
50.31
50.43
50.36
44.97
48.56
5
39
19
10
15
10
18
25
47
31
47
107
131
87
33
18
26
24
29
25
32
39
47
39
37
55
42
46
51
34
2.08
2.44
2.82
3.34
2.62
2.25
2.57
2.94
2.22
2.40
3.18
1.52
1.57
2.06
1.85
18
24
15
22
21
26
32
41
32
31
47
31
30
43
23
2.13
2.52
2.03
2.66
2.34
1.95
2.26
2.73
2.08
2.13
3.23
2.06
1.99
2.77
1.48
0
2
9
7
4
6
7
6
7
6
8
11
16
8
11
a
Human exposures with medical outcome of death or death, indirect regardless of Relative Contribution to Fatality.
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
993
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Table 20. Frequency of Plant Exposures (Top 25)a.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Botanical name or Category
AAPCC Generic Code Name
Plants-general-unknown
Unknown Botanical Name
BOTANICAL TERMS
Cherry (Species unspecified)
Phytolacca americana (L.)
Spathiphyllum spp.
Plants-toxicodendrol
Plants-cardiac glycosides
Ilex spp (not otherwise specified)
Philodendron spp.
Plants-pokeweed
Mold (not otherwise specified)
Zantedeschia aethiopica
Berry (not otherwise specified)
Malus spp.
Solanum dulcamara
Caladium spp.
Plants-oxalates
Solanum nigrum
Narcissus pseudonarcissus (L.)
Epipremnum areum
Solanum tuberosum
Euphorbia pulcherrima (Willd.)
Unknown Botanical Name
Nandina domestica (Thumb)
Unknown Toxic Types or Unknown if Toxic
Unknown Toxic Types or Unknown if Toxic
Unknown Toxic Types or Unknown if Toxic
Amygdalin and/or Cyanogenic Glycosides
Gastrointestinal Irritants (Excluding Oxalate Containing
Oxalates
Skin Irritants (Excluding Oxalate Containing Plants)
Cardiac Glycosides (Excluding Drugs)
Gastrointestinal Irritants (Excluding Oxalate Containing
Oxalates
Other Toxic Types
Unknown Toxic Types or Unknown if Toxic
Oxalates
Unknown Toxic Types or Unknown if Toxic
Amygdalin and/or Cyanogenic Glycosides
Solanine
Oxalates
Oxalates
Solanine
Gastrointestinal Irritants (Excluding Oxalate Containing
Oxalates
Solanine
Gastrointestinal Irritants (Excluding Oxalate Containing
Non-Toxic
Amygdalin and/or Cyanogenic Glycosides
N
Plants)
Plants)
Plants)
Plants)
2,257
1,756
1,453
1,158
1,135
902
873
677
637
621
551
512
500
482
463
457
429
399
368
354
352
350
343
321
310
a
Number of substances related to a human exposure with a Major Generic Category of Plant. Unknown Botanical Name represents
substances with a Major Generic Category of Plant and a NULL substance code. Total ¼ 44,731.
Prevention (CDC), six state health departments and one
state police department run surveillance definitions in
NPDS. Since Surveillance Anomaly 1, generated at 2:00
pm EDT on 17 September 2006, over 250,000 anomalies
have been detected. More than 1,700 were confirmed as
being of public health significance with PCs working
collaboratively with their local and state health departments and in some instances CDC on the public health
issues identified.
At the time of this report, 294 surveillance definitions
run continuously, monitoring case and clinical effects
volume and a variety of case based definitions from food
poisoning to nerve agents. These definitions represent the
surveillance work by many PCs, state health departments,
the AAPCC, and the Health Studies Branch, Division of
Environmental Hazards and Health Effects, National
Center for Environmental Health, Centers for Disease
Control and Prevention (CDC).
The underlying methodology of automated surveillance
continues to be improved in an effort to detect the index
case of a public health event. Uniform algorithms for the
identification of these index cases vary greatly by the agent
seeking to be identified and no one uniform algorithm is
without flaw.(8) However, the situational awareness that
NPDS provides is undoubtedly beneficial to public health
surveillance.(9) Typical NPDS surveillance data detects a
response to an event rather than event prediction. This aids
in situational awareness and resilience during and after a
public health event.
A current example of the involvement of the PC system
and NPDS can be seen in the following. Increasing
Copyright ß Taylor & Francis 2015
restrictions on the prescribing of opioids for chronic pain
have been associated with a decrease in opioid exposures
and an increase in heroin exposures.(10) We examined
NPDS single substance more serious exposures (outcomes ¼ moderate, major or death) to heroin and prescription opioids from 2000 to 2014 and compared them to
mortality data from the CDC’s National Center for Health
Statistics for 2000 to 2013.(11)
Figure 6a shows the change over time for these 4 data
sets and the sums (Total NPDS and Total CDC). The large
difference in absolute frequencies between the CDC and
NPDS data reflect voluntary reporting to NPDS compared
to CDC’s use of national death certificate data. Both NPDS
and CDC prescription opioid cases steadily increased until
2010, after which they plateaued and decreased in subsequent years. Heroin cases for both data sources show
relatively small increases, until after 2010, when the
frequency of reported cases showed sharp increases.
Opioids NPDS and Opioids CDC are strongly correlated
(r ¼ 0.976), as are Heroin NPDS and Heroin CDC
(r ¼ 0.989). The sums show a linear increase over time
for Total NPDS (r ¼ 0.986, increase of 8.33%/year) and for
Total CDC (r ¼ 0.996, increase of 8.85%/year). All of these
correlations are statistically significant, p50.0001. This
strong linear increase over time suggests that the decrease
in opioid morbidity and mortality is associated with a
corresponding increase in heroin morbidity and mortality.
We also examined the potential for these NPDS
exposure data to predict these CDC mortality data over
time. Figure 6b shows the best least squares prediction of
CDC Heroin Mortality by NPDS Heroin and Opioid
994
J. B. Mowry et al.
Downloaded by [AAPCC] at 12:54 01 December 2015
(a)
Solid lines show the frequencies for NPDS more serious (outcome = moderate, major and death) single substance human
exposure cases and are graphed on the left axis. Broken lines show the frequencies for CDC mortality data and are graphed
on the right axis. Total NPDS = Opioids NPDS + Heroin NPDS. Total CDC = Opioids CDC + Heroin CDC.
(b)
Top panel shows the scatter plot of predicted vs, observed CDC Heroin Deaths. The middle panel shows the
3 predictors sorted by their statistical contribution and associated p-values. The bottom panel shows a graphical
summary of each predictor’s contribution (leverage).
Figure 6. (a) NPDS Exposures and the CDC Fatalities for Heroin and Prescription Opioids. (b) Best Prediction of CDC Heroin Mortality by
NPDS Heroin and Opioid Exposures.
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
Exposures and Time (Year). The overall R-Squared was
0.989 (p50.0001) and the coefficients and associated
p-values for each predictor are shown in the middle panel
of Figure 6b. Prediction of CDC Opioid Mortality by
NPDS Heroin Exposures and Time showed an overall
R-Squared of 0.991 (p50.0001). These 2 statistical models
predict the 2014 mortality [95% confidence interval] to be
15,246 [13,915, 16,935] for opioids and 9,968 [9,186,
10,750] for heroin.
Downloaded by [AAPCC] at 12:54 01 December 2015
Discussion
The exposure cases and information requests reported by
PCs in 2014 do not reflect the full extent of PC efforts
which also include poison prevention activities and public
and health care professional education programs.
NPDS exposure data may be considered as providing
‘‘numerator data’’, in the absence of a true denominator,
that is, we do not know the number of actual exposures that
occur in the population. NPDS data covers only those
exposures which are reported to PCs since poison exposures and poisoning deaths are not currently required to be
reported to PCs.
NPDS 2000-2014 call volume data clearly demonstrate a
continuing decrease in exposure cases. This decline has
been apparent and increasing since mid-2007 and reflects
the decreasing use of the PC for less serious exposures.
However, in contrast, during this same period, exposures
with a more serious outcome (death, major, moderate) and
HCF cases have continued a consistent increase. Possible
contributors to the declining PC access include: declining
US birth (especially since exposure rates are much higher in
children 5 years of age), increasing use of text rather than
voice communication, and increasing use of and reliance on
internet search engines and web resources. To meet our
public health goals, PCs will need to understand and meet
the public’s 21st century communication preferences. We
are concerned that failure to respond to these changes may
result in a retro-shift with more people seeking medical care
for exposures that could have been managed at home by a
PC. Likewise, minor exposures may progress to more
serious morbidity and mortality because of incorrect
internet information or no telephone management. The net
effect could be more serious poisoning outcomes because
fewer people took advantage of PC services, with a resultant
increased burden on the national healthcare infrastructure as
may be reflected in the increased number of cases managed
in a healthcare facility this year.
NPDS statistical analyses indicate that all analgesic
exposures including opioids and sedatives are increasing
year over year. This trend is shown in Table 17B and
Figure 5. NPDS data mirrors CDC data that demonstrates
similar findings.(9) Thus NPDS provides a real-time view
of these public health issues without the need for data
source extrapolations.
One of the limitations of NPDS data has been the
perceived lack of fatality case volume compared to other
reporting sources. However, when change over time is
Copyright ß Taylor & Francis 2015
995
studied, NPDS is clearly consistent with other public health
fatality analyses. One of the issues leading to this concern
is the fact that medical record systems seldom have
common output streams. This is particularly apparent with
the various electronic medical record systems available. It
is important to build a federated approach similar to the one
modeled by NPDS to allow data sharing, for example,
between hospital emergency departments and other medical record systems including medical examiner offices
nationwide. Enhancements to NPDS can promote interoperability between NPDS and electronic medical records
systems to better trend poison-related morbidity and
mortality in the US and internationally.
Summary
Unintentional and intentional exposures continue to be a
significant cause of morbidity and mortality in the US. The
near real-time, always current status of NPDS represents a
national public health resource to collect and monitor US
exposure cases and information calls.
Changes in encounters in 2014 shown in Figures 1, 3
and 4 include:
Total encounters (all exposure and information calls)
decreased by 5.5%;
All information calls decreased 17.7%, Drug ID calls
decreased 29.8%, and human exposures decreased
1.1%;
Health care facility (HCF) information requests
decreased 0.04% and HCF exposure cases increased
3.3% in line with the steady increase since 2000;
Human exposures with less serious outcomes decreased
1.20% while those with more serious outcomes (moderate, major or death) increased 1.17% not withstanding
an overall 4.29% yearly increase since 2000;
The categories of substance exposures in cases with
more serious outcomes increasing most rapidly are:
sedative/hypnotics/antipsychotics, followed by analgesics, antidepressants, and cardiovascular drugs.
These data support the continued value of PC expertise
and need for specialized medical toxicology information to
manage the more severe exposures, despite a decrease in
cases involving less severe exposures. Poison centers must
consider newer communication approaches that match
current public communication patterns in addition to the
traditional telephone call.
The continuing mission of NPDS is to provide a
nationwide infrastructure for public health surveillance
for all types of exposures, public health event identification, resilience, response and situational awareness tracking. NPDS is a model system for the nation and global
public health.
Disclaimer
The American Association of Poison Control Centers
(AAPCC; http://www.aapcc.org) maintains the national
996
J. B. Mowry et al.
database of information logged by the country’s regional
Poison Centers (PCs) serving all 50 United States, Puerto
Rico and the District of Columbia. Case records in this
database are from self-reported calls: they reflect only
information provided when the public or healthcare
professionals report an actual or potential exposure to a
substance (e.g., an ingestion, inhalation, or topical exposure, etc.) or request information/educational materials.
Exposures do not necessarily represent a poisoning or
overdose. The AAPCC is not able to completely verify the
accuracy of every report made to member centers.
Additional exposures may go unreported to PCs and data
referenced from the AAPCC should not be construed to
represent the complete incidence of national exposures to
any substance(s).
Downloaded by [AAPCC] at 12:54 01 December 2015
References
1. National Poison Data System: Annual reports 1983-2013 [Internet].
Alexandria (VA): American Association of Poison Control Centers.
Available from: http://www.aapcc.org/annual-reports/
2. US Census Bureau. Table 1. Annual Estimates of the Resident
Population for the United States, Regions, States, and Puerto Rico:
April 1, 2010 to July 1, 2014 (NST-EST2014-01)[downloaded 2015
Aug
18]
http://www.census.gov/popest/data/state/totals/2014/
index.html
3. US Census Bureau: International Data Base (IDB) Demographic
Indicators for: American Samoa, Federated States of Micronesia,
Guam, Puerto Rico, Virgin Islands, [downloaded 2015 Aug 18]:
http://www.census.gov/population/international/data/idb/region.php
4. US Census Bureau: Annual Estimates of the Resident Population by
Single Year of Age and Sex for the United States, States, and Puerto
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Rico Commonwealth: April 1, 2010 to July 1, 2014, [downloaded
2015 Sep 1]: http://factfinder.census.gov/faces/tableservices/jsf/
pages/productview.xhtml?src¼bkmk
Position statement: ipecac syrup. American Academy of Clinical
Toxicology; European Association of Poisons Centres and Clinical
Toxicologists. J Toxicol Clin Toxicol. 1997;35:699–709.
American Academy of Clinical Toxicology European Association of
Poisons Centres and Clinical Toxicologists. Position Paper: Ipecac
Syrup. J Toxicol Clin Toxicol 2004; 42: 133–143.
American Academy of Pediatrics Policy Statement. Poison treatment
in the home. Pediatrics 2003; 112:1182–1185.
Savel TG, Bronstein A, Duck, M, Rhodes MB, Lee, B, Stinn J,
Worthen, K. Using Secure Web Services to Visualize Poison Center
Data for Nationwide Biosurveillance: A Case Study [Internet].
Online Journal of Public Health Informatics 2010; 2:1–9; [downloaded 2012 Oct 30] http://ojphi.org/htbin/cgiwrap/bin/ojs/
index.php/ojphi/article/view/2920/2505
Centers for Disease Control and Prevention. QuickStats: Number of
Poisoning Deaths* Involving Opioid Analgesics and Other Drugs or
Substances - United States, 1999—2007. MMWR Morb Mortal
Wkly Rep. 2010; 59:1026.
Unick GL, RosenblumD, Mars S, Ciccarone D. Intertwined
Epidemics: National Demographic Trends in Hospitalizations for
Heroin- and Opioid-Related Overdoses, 1993–2009. PLOS One
2013;8(2):1–8.
Hedegaard H, Chen L, Warner M. Drug-poisoning Deaths Involving
Heroin: United States, 2000–2013. NCHS data brief, no 190.
Hyattsville, MD: National Center for Health Statistics. 2015
McGraw-Hill’s AccessMedicine, Laboratory Values of Clinical
Importance (Appendix), Harrison’s Principles of Internal Medicine
17e. McGraw-Hill Professional, 2008[cited 2010 Nov 1]. Available
from: http://www.accessmedicine.com/.
Goldfrank’s Toxicologic Emergencies, Tenth Edition, McGraw-Hill
Companies, 2015.
Dart RC, editor. Medical Toxicology, Third Edition. Philadelphia,
Lippincott, Williams & Wilkins, 2004.
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
997
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
Substance
Rank
Cause
Rank
1
1
ethanol
salicylate
2
2
salicylate
ethanol
1
1
ethanol
ethanol
1
1
ethanol
ethanol
opioid
zolpidem
1
2
3
1
2
3
methanol
1
1
methanol
methanol
1
1
methanol
methanol
1
1
methanol
methanol
1
1
methanol
ethanol
1
1
ethanol
199 mg/dL In Blood
(unspecified)
@ Unknown
benzodiazepine
fluoxetine
sertraline
methadone
2
3
4
5
2
3
4
5
methadone
amphetamine
6
6
amphetamine
330 ng/mL In Blood
(unspecified)
@ Unknown
140 ng/mL In Blood
(unspecified)
@ Unknown
ethanol
nitrous oxide
1
2
1
2
ethanol
methamphetamine
1
2
1
2
ethanol
oxycodone
oxymorphone
1
2
3
1
2
3
methanol
1
1
Substances
Non-Pharmaceutical Exposures
Alcohols
1ph
6y M
ethanol
2p
3ph
Downloaded by [AAPCC] at 12:54 01 December 2015
[4h]
5pa
6ai
7ai
8ai
15 y F
19 y F
19 y F
22 y F
23 y M
25 y M
25 y M
11ai
26 y M
12 h
13 p
15ai
32 y M
17pai
1
2
1
2
ethanol
cocaine
hydrocodone
alprazolam
1
2
3
4
1
2
3
4
ethanol
1
1
nitrous oxide
2
2
isopropanol
1
1
32 y M
32 y M
16 h
ethanol
carisoprodol
26 y M
14ai
Reason
RCF
A
Ingst
Unt-G
3
ethanol
1
1
ethanol
1
1
33 y M
Ingst
Int-A
Ingst
Int-M
3
A
Unk
Int-U
1
Ingst
Unk
Analyte
A
Ingst + Inhal
Int-U
2
A
Ingst + Unk
Int-U
2
U
Ingst
Int-U
2
A
Ingst
Int-S
2
A
Ingst
Int-U
2
U
Unk
Int-U
2
A
Ingst + Inhal
Int-A
3
C
Ingst
Int-A
3
A
Ingst
Int-U
2
A
Ingst
Int-U
2
A
Ingst
Int-S
1
10 mg/dL In Blood
(unspecified)
@ 24 h (pe)
297 mg/dL In Blood
(unspecified)
@ 5 h (pe)
351 mg/dL In Blood
(unspecified)
@ 7 h (pe)
80 mg/dL In
Whole Blood
@ 13 h (pe)
methanol
methanol
1
1
methanol
methanol
1
1
methanol
methanol
1
1
methanol
2
2
1
1
A
Ingst + Unk
Int-A
10 mg/dL In Blood
(unspecified)
@ Unknown
130 mg/dL In Blood
(unspecified)
@ Unknown
29 mg/dL In Blood
(unspecified)
@ Unknown
65 mg/dL In Blood
(unspecified)
@ Unknown
268 mg/dL In Blood
(unspecified)
@ Unknown
1
ethanol
409 mg/dL In Blood
(unspecified)
@ Autopsy
467 mg/dL In Vitreous
@ Autopsy
ethanol
1
acetone
76 mg/dL In Blood
(unspecified)
@ Unknown
7.6 mg/dL In Blood
(unspecified)
@ Unknown
1
methanol
33 y F
Blood Concentration
@ Time
1
A
A
22 y M
10ai
Route
A
19 y M
9
Chronicity
1
ethanol
0.14 % In Blood
(unspecified)
@ Autopsy
(continued)
998
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
18ai
Downloaded by [AAPCC] at 12:54 01 December 2015
19ai
[20h]
21ai
22
23
24
25
Age
32ai
33ai
34ai
nordiazepam
diazepam
2
2
diazepam
alprazolam
3
3
alprazolam
acetaminophen/
oxycodone*
4
4
acetaminophen
acetaminophen/
oxycodone*
4
4
oxycodone
cyclobenzaprine*
tramadol
5
6
4
6
tramadol
0.53 mcg/mL In
Whole Blood
@ Autopsy
caffeine
temazepam
7
8
7
8
temazepam
25 ng/mL In
Whole Blood
@ Autopsy
ethanol
alprazolam
trazodone
1
2
3
1
2
3
ethanol
diphenhydramine
1
2
1
2
methanol
1
1
methanol
182 mg/dL In Blood
(unspecified)
@ Unknown
ethanol
1
1
ethanol
1
1
ethanol
430 mg/dL In Blood
(unspecified)
@ Unknown
methanol
1
1
methanol
323 mg/dL In Blood
(unspecified)
@ Unknown
ethanol
1
1
ethanol
225 mg/dL In Blood
(unspecified)
@ Unknown
hair spray
glycol/methanol
2
3
2
3
ethanol
1
1
ethanol
188 mg/dL In Blood
(unspecified)
@ 10 m (pe)
zolpidem
alprazolam
2
3
2
3
ethanol
1
1
ethanol
136 mg/dL In Blood
(unspecified)
@ Unknown
39 y M
40 y M
1
1
ethanol
hydrocodone
1
2
1
2
ethanol
hydrocodone
1
2
1
2
ethanol
carisoprodol
diazepam
amitriptyline
hydrocodone
1
2
3
4
5
1
2
3
4
5
ethanol (non-beverage)
1
1
drug, unknown
2
2
ethanol
diphenhydramine
1
2
1
2
ethanol
tramadol
1
2
1
2
ethanol
alprazolam
1
2
1
2
methanol
1
1
42 y M
43 y M
43 y F
43 y M
44 y M
44 y M
44 y M
45 y M
46 y F
ethanol
propylene glycol
1
2
1
2
ethanol (denatured)
1
1
47 y F
Reason
RCF
Ingst
Int-U
2
A
Ingst
Int-S
2
C
Ingst
Int-S
1
A
Ingst
Int-U
2
A
Ingst
Unk
2
A
ethanol
Route
A
U
42 y M
36 h
Chronicity
U
41 y F
35ha
37pi
2
36 y M
42 y F
31ph
2
34 y F
42 y F
30ai
diazepam
33 y F
27ha
29ai
Cause
Rank
33 y F
26 h
28ai
Substance
Rank
Substances
Ingst
Ingst
Ingst
Int-S
Int-S
Int-S
Analyte
Blood Concentration
@ Time
177 ng/mL In
Whole Blood
@ Autopsy
189 ng/mL In
Whole Blood
@ Autopsy
26 ng/mL In
Whole Blood
@ Autopsy
21 mcg/mL In
Whole Blood
@ Autopsy
471 ng/mL In
Whole Blood
@ Autopsy
1
3
3
C
Ingst
Int-A
3
A/C
Ingst
Int-S
3
A
Ingst
Int-U
2
U
Ingst
Int-U
2
U
Ingst
Unk
2
C
Ingst
Int-A
2
A
Ingst
Int-U
2
A
Ingst
Int-U
2
A
Ingst
Int-U
2
A
Ingst
Int-U
1
A
Ingst
Unk
3
U
Ingst
Int-U
1
(continued)
AAPCC 2014 Annual Report of the NPDS
999
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
38
47 y M
39ai
40ai
49 y M
49 y M
51 y F
45ai
51 y M
46ai
51 y F
Downloaded by [AAPCC] at 12:54 01 December 2015
56 y M
57 y M
53ai
54ai
55 a
56ai
ethanol
cyclobenzaprine
1
2
1
2
ethanol
fluoxetine
1
2
1
2
ethanol
1
1
ethanol
morphine
1
2
1
2
ethanol
hydrocodone
1
2
1
2
methanol
1
1
isopropanol
1
1
ethanol
1
1
methanol
1
1
pyrethroids
2
2
methanol
sertraline
ethylene glycol
(antifreeze)
1
2
3
1
2
3
ethanol
1
1
54 y F
50ai
52
1
2
53 y F
49 h
51
1
2
50 y M
44 h
48 h
ethanol
freon
48 y M
42ai
47
Cause
Rank
47 y M
41ai
43ai
Substance
Rank
Substances
ethanol
venlafaxine
midazolam
1
2
3
1
2
3
ethanol
1
1
A
Ingst + Inhal
Int-S
3
A
Ingst
Int-U
2
U
Ingst
Unt-U
2
A
Ingst
Int-S
2
A
Ingst + Unk
Int-U
2
A
Ingst
Int-U
2
U
Ingst
Unt-M
1
A
Ingst
Int-U
2
A
Ingst
Int-U
2
A
Ingst
Int-S
1
Ingst
Int-U
Analyte
74 mg/dL In Blood
(unspecified)
@ Unknown
ethanol
92 mg/dL In Blood
(unspecified)
@ Unknown
7.6 mg/dL In Blood
(unspecified)
@ Unknown
20.4 mg/dL In Blood
(unspecified)
@ Unknown
118 mg/dL In Blood
(unspecified)
@ Unknown
2
C
Ingst
Unk
3
A
Ingst
Int-S
2
U
Ingst
Int-U
2
2
2
1
methanol
isopropanol
2
2
isopropanol
ethanol
3
3
ethanol
ethanol
tramadol
morphine
amantadine
1
2
3
4
1
2
3
4
ethanol
carisoprodol
1
2
1
2
ethanol (non-beverage)
1
1
risperidone
alprazolam
2
3
2
3
ethanol
1
1
ethanol
1
1
A
60 y F
62 y M
Ingst
Unk
2
A
Ingst
Int-S
2
A
Ingst
Int-U
2
A
Ingst
Int-S
3
ethanol
A
Blood Concentration
@ Time
methanol
1
60 y M
63 y F
RCF
methanol
59 y F
78 y M
Reason
loratadine
59 y M
58 h
Route
A
58 y M
57phi
Chronicity
Ingst
Int-A
C
Ingst
Int-A
3
C
Ingst
Unk
2
361 mg/dL
In Blood
(unspecified)
@ Unknown
2
ethanol
1
1
See Also case 66, 69, 70, 74, 98, 99, 100, 118, 185, 186, 187, 195, 198, 202, 205, 260, 270, 271, 315, 318, 322, 327, 355, 359, 365, 367, 372, 374, 382, 385, 390, 395, 397, 400, 403, 404, 411, 413, 430, 442, 451, 458, 462,
492, 507, 526, 535, 547, 549, 581, 600, 607, 623, 624, 631, 635, 660, 669, 692, 693, 702, 709, 713, 715, 720, 722, 725, 752, 764, 765, 769, 771, 774, 776, 782, 797, 798, 801, 804, 806, 807, 810, 845, 848, 877, 891, 899,
901, 902, 915, 920, 921, 923, 924, 925, 930, 945, 949, 969, 976, 984, 986, 992, 1007, 1051, 1052, 1072, 1078, 1091, 1106, 1112, 1117, 1123, 1145, 1156, 1184, 1204, 1237, 1240, 1260, 1275, 1288, 1313, 1318, 1322, 1326,
1329, 1334, 1335, 1338, 1345, 1346, 1348, 1349, 1354, 1358, 1368, 1369, 1370, 1373, 1376, 1377, 1378, 1404
Automotive/Aircraft/Boat Products
59ha
33 y F
A
Ingst
Int-S
1
ethylene glycol
1
1
ethylene glycol
116 mg/dL In Blood
(antifreeze)
(unspecified)
@ Unknown
ethylene glycol
1
1
ethylene glycol
42 mg/dL In Blood
(antifreeze)
(unspecified)
@ Unknown
60
34 y M
U
Ingst
Int-S
2
ethylene glycol
1
1
(antifreeze)
61 h
38 y F
A
Ingst
Int-M
1
glycol/methanol
1
1
ethylene glycol
29 mg/dL In Blood
(unspecified)
@ Unknown
(continued)
1000
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
62i
63
64 h
65
66 h
67pi
68 h
Downloaded by [AAPCC] at 12:54 01 December 2015
69i
70ph
71 h
Age
78ha
79 a
80 h
81 a
82pa
1
ethylene glycol
(antifreeze)
1
1
ethylene glycol
(antifreeze)
1
1
methanol
1
1
methanol
ethanol (hand sanitizer)
1
2
1
2
ethylene glycol (antifreeze)
methamphetamine
1
2
1
2
ethylene glycol
(antifreeze)
1
1
ethylene glycol (antifreeze)
venlafaxine (extended
release)
clonazepam*
labetalol*
1
2
1
2
3
4
3
3
ethylene glycol (antifreeze)
ethanol
1
2
1
2
ethylene glycol (antifreeze)
ethanol
1
2
1
2
methanol
clonazepam
1
2
1
2
ethylene glycol (antifreeze)
1
1
42 y M
43 y M
44 y M
44 y F
46 y F
48 y M
50 y F
52 y F
77
1
41 y M
50 y M
76 h
glycol/methanol
38 y M
73 p
75
Cause
Rank
38 y F
72
74
Substance
Rank
Substances
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-A
1
A
Ingst
Int-S
2
A
Ingst
Int-M
2
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-S
2
C
Ingst
Int-S
2
C
Ingst
Int-S
3
U
Ingst
Int-U
1
A
Ingst + Inhal
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
methanol
210 mg/dL In Serum
@ Unknown
56 mg/dL In Serum
@ 6 h (pe)
61.4 mg/dL In Serum
@ 1 h (pe)
9 mg/dL In Serum
@ 14 h (pe)
35 mg/L In Serum
@ 1 h (pe)
1
ethylene glycol (antifreeze)
acetaminophen
1
2
1
2
ethylene glycol (antifreeze)
1
1
ethylene glycol (antifreeze)
1
1
ethylene glycol
ethylene glycol (antifreeze)
1
1
ethylene glycol
ethylene glycol (antifreeze)
1
1
ethylene glycol
acetaminophen/oxycodone
2
2
ethylene
glycol
(antifreeze)
1
1
ethylene glycol (antifreeze)
1
1
ethylene glycol (antifreeze)
1
1
methanol
1
1
disc battery, lithium
1
1
disc battery
1
1
envenomation (crotalid)
1
1
83 y M
30 + y M
acetaminophen
A
Ingst
Int-S
2
A
Ingst
Int-S
2
C
Ingst
Int-S
2
A
62 y M
Bites and Envenomations
[85]
4y M
74 y F
A
1
83 y F
69 y F
2
ethylene glycol (antifreeze)
71 y M
[89]
Int-S
690 mg/dL In Blood
(unspecified)
@ Unknown
1
2
3
4
62 y M
88
Ingst
envenomation (crotalid)
1
1
envenomation
(agkistrodon)
1
1
envenomation (crotalid)
1
1
envenomation (crotalid)
1
Ingst
Int-U
Blood Concentration
@ Time
methanol
1
2
3
4
61 y M
52 y M
A
Analyte
hydrocarbon
atenolol
alprazolam
methanol
59 y F
87pi
RCF
1
56 y M
42 y M
Reason
1
56 y F
86pi
Route
ethylene glycol (antifreeze)
See Also case 24, 985
Batteries
83i
4y F
84i
Chronicity
ethylene glycol
2000 mg/L In Blood
(unspecified)
@ Autopsy
methanol
109 mg/dL In Blood
(unspecified)
@ Unknown
1
A
Ingst
Unt-G
1
A
Ingst + Aspir
Unt-M
2
A
B-S
Unt-B
1
A
B-S
Unt-O
1
A
B-S
Unt-B
1
A
B-S
Unt-B
1
A
B-S
Unt-B
1
1
(continued)
AAPCC 2014 Annual Report of the NPDS
1001
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
90 p
78 y F
Chemicals
91 p
16 y F
92ph
17 y M
93ph
94 p
[95pa]
Downloaded by [AAPCC] at 12:54 01 December 2015
96 h
97
98
[99ha]
100 a
lysergic acid diethylamide
(LSD)
doxylamine
drug, unknown
trazodone
fluoxetine
1
1
2
3
4
5
2
3
4
5
chemical (inhalation),
unknown *
toluene-xylene *
1
1
2
1
cyanide
1
1
cyanide
1
1
ethylene glycol
(antifreeze)
1
ethylene glycol
(antifreeze)
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Inhal
Unt-O
2
A
Ingst
Int-S
1
A
Ingst
Int-S
1
2
1
ethylene glycol
mercaptobenzothiazole
2
2
hydrochloric acid
1
1
ethylene glycol
(antifreeze)
ethanol
1
1
2
2
Ingst
Unk
1
A
Ingst
Int-S
1
A
Ingst + Unk
Int-S
2
ethylene glycol
ethanol
A
Ingst
Int-U
1
1
ethylene glycol
ethanol
2
2
ethanol
acid, unknown
isopropanol
1
2
1
2
cyanide
1
1
cyanide
1
1
ethylene glycol (antifreeze)
1
1
ethylene glycol (antifreeze)
1
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
cyanide
1
1
hydrofluoric acid
1
1
ethylene glycol (antifreeze)
1
1
chemical (inhalation),
unknown
toluene-xylene
1
1
2
2
ethylene glycol (antifreeze)
1
1
ethylene glycol (antifreeze)
1
1
ethylene glycol (antifreeze)
1
1
ethylene glycol (antifreeze)
1
1
1
1
cyanide
1
1
Int-S
Ingst
Unk
1
A
Ingst
Unk
1
A
Ingst
Int-U
1
A
Ingst
Int-S
1
A
Inhal
Unt-O
2
A
Ingst
Int-S
2
A
Ingst
Unk
1
Ingst
Int-S
1394 mg/dL In Blood
(unspecified)
@ Autopsy
17 mg/dL In Blood
(unspecified)
@ Autopsy
cyanide
6.7 mcg/mL In Blood
(unspecified)
@ Unknown
ethylene glycol
228 mg/dL In Blood
(unspecified)
@ Unknown
ethylene glycol
98 mg/dL In Serum
@ Unknown
ethylene glycol
50.8 mg/dL In Blood
(unspecified)
@ Unknown
ethylene glycol
129 mg/dL In Blood
(unspecified)
@ Unknown
ethylene glycol
68 mg/dL In Blood
(unspecified)
@ Unknown
cyanide
6.4 mcg/mL In Blood
(unspecified)
@ Unknown
1
U
U
cyanide
Ingst
16.2 mg/dL In Serum
@ Unknown
161.5 mg/dL In Serum
@ Unknown
1
ethylene glycol (antifreeze)
54 y M
56 y F
Unt-B
Blood Concentration
@ Time
1
49 y F
52 y M
B-S
Analyte
33 mg/dL In Blood
(unspecified)
@ Unknown
49 mg/dL In Blood
(unspecified)
@ Unknown
48 y M
51 y M
RCF
ethylene glycol
46 y M
[113pa]
A
A
46 y M
112ph
Reason
1
37 y M
44 y F
Route
166 mcg/mL In Blood
(unspecified)
@ Autopsy
35 y F
107 a
Chronicity
cyanide
33 y F
42 y M
115ph
1
33 y M
106 h
114
1
26 y M
41 y M
111ha
cyanide
25 y M
105 p
110
1
24 y M
34 y F
109 h
1
23 y M
34 y M
108ph
sting (hymenoptera)
20 y M
[102ha]
104 h
Cause
Rank
19 y M
101ha
103 h
Substance
Rank
Substances
3
U
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
(continued)
1002
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
116
117 h
118
63 y M
121ph
64 y F
125 h
ethylene glycol (antifreeze)
1
1
ethylene glycol
(antifreeze)
benzodiazepine
1
1
2
2
alkali
1
1
ethylene glycol (antifreeze)
ethanol
1
2
1
2
alkali
1
1
62 y M
63 y F
124
Cause
Rank
61 y M
120
[123h]
Substance
Rank
Substances
59 y F
119 h
122 a
Downloaded by [AAPCC] at 12:54 01 December 2015
Age
Int-S
1
A
Ingst
Int-S
1
U
Ingst
Unk
1
A
Ingst
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Unt-E
3
A
Ingst
Int-S
1
ethylene glycol
160 mg/dL In Blood
(unspecified)
@ Unknown
ethylene glycol
97 mg/dL In
Whole Blood
@ Unknown
1
2
ethylene glycol (antifreeze)
1
1
cobalt
1
1
ethylene glycol (antifreeze)
1
1
ethylene glycol
764.5 mg/dL
In Serum
@ Unknown
amlodipine
clonazepam
acetaminophen
2
3
4
2
3
4
acetaminophen
75.6 mg/L In Plasma
@ Unknown
opioid
5
5
ethylene glycol (antifreeze)
1
1
ethylene glycol
487 mg/dL In Blood
(unspecified)
@ 2 h (pe)
metformin
2
2
acid
1
1
C
Oth
AR-O
1
A
Ingst
Int-S
1
A
1
Ingst
Oth-M
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
1
A
borate
1
1
A
Unknown adult
(4¼ 20 yrs)
F
sulfuric acid
1
1
[130ph]
Unknown age F
A
hydrofluoric acid
1
1
See Also case 16, 36, 48, 151, 187, 193, 198, 219, 220, 227, 231, 242, 295, 930, 1184, 1329
Cleaning Substances (Household)
131ph
1y F
A
disinfectant (isopropanol/
1
1
pine oil)
132 a
23 y F
A
hypochlorite
1
1
toilet bowl cleaner (acid)
2
2
[133ha]
25 y M
A
drain cleaner (alkali)
1
1
134 h
35 y F
A
hypochlorite
1
1
135 a
43 y F
A
laundry detergent (pod)
1
1
136ph
47 y F
A
hypochlorite
1
1
137
49 y M
A
toilet bowl cleaner (acid)
1
1
138
60 y F
A
drain cleaner, alkali
1
1
fluoxetine
2
2
acetaminophen
3
3
139 a
61 y F
A
cleaner, alkali
1
1
alprazolam
2
2
140
61 y M
A
drain cleaner (alkali)
1
1
141 h
65 y F
A
disinfectant (phenol)
1
1
142ai
67 y M
A
laundry detergent (pod)
1
1
143 h
72 y M
A
laundry detergent (pod)
1
1
144 h
80 y M
A
drain cleaner (alkali)
1
1
145
82 y M
A
cleaner (anionic/nonionic)
1
1
146
90 y M
A
toilet bowl cleaner (acid)
1
1
[147h]
100 y F
A
laundry detergent (pod)
1
1
[148ha]
17 m F
A
hypochlorite
1
1
129 p
87 y M
Ingst
Blood Concentration
@ Time
1
2
hydrochloric acid
128 h
A
Analyte
cyanide
carbon monoxide
76 y F
82 y M
RCF
1
67 y F
127 a
Reason
1
65 y F
77 y M
Route
sulfuric acid
65 y F
126 h
Chronicity
Ingst
Int-U
2
Inhal
Int-S
2
Ingst + Derm
Unt-E
2
Ingst + Inhal
Unt-G
3
Ingst
Int-S
1
Ingst
Int-S
1
Par
Int-S
3
Ingst
Unt-G
3
Ingst
Int-U
1
Ingst
Int-S
1
Ingst
Int-S
1
Ingst
Int-S
1
Ingst
Int-S
1
Ingst
Unk
1
Ingst
Unt-M
1
Ingst + Aspir
Unt-G
3
Ingst
Int-S
1
Ingst + Aspir
Int-S
3
Ingst
Int-S
1
Ingst + Aspir
Unt-G
2
Derm
Unt-G
1
(continued)
AAPCC 2014 Annual Report of the NPDS
1003
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
149i
17 m M
150 p
151 p
Substance
Rank
Cause
Rank
disinfectant (phenol)
perfume
1
2
1
2
cleaner (anionic/nonionic)
1
1
1
2
3
1
2
3
1
2
1
2
1
1
hydrogen peroxide
1
1
shampoo
1
1
Substances
80 + y F
Unknown
age F
toilet bowl cleaner (acid)
calcium polysulfide
hydrogen sulfide
See Also case 152, 290, 356, 692, 1352
Cosmetics/Personal Care Products
152i
39 y M
ethanol (hand sanitizer)
cleaner (cationic)
153 h
52 y M
ethanol (non-beverage)
[154h]
75 y M
155
76 y F
[156h]
81 y M
157
90 y F
Downloaded by [AAPCC] at 12:54 01 December 2015
peroxides
shampoo
See Also case 24, 65, 149, 692
Deodorizers
158 p
24 y M
hydrocarbon
159 h
39 y F
paradichorobenzene
Dyes
160ph
165pi
166pi
167pai
168ph
173pi
174 p
Par
Oth-M
3
A
Ingst
Unt-M
1
U
Inhal
Int-S
2
U
Ingst
Unk
3
A
Ingst
Int-A
3
A
Ingst
Unt-M
A
Ingst + Aspir
Int-M
1
A
Ingst
Unt-M
1
A
Ingst
Unt-G
3
U
Inhal
Int-A
1
U
Ingst
Int-M
2
A
Par
AR-D
1
U
Ingst
Int-A
1
A
Inhal + Derm
Unt-E
1
259 mg/dL
In Serum
@ Unknown
1 % In Blood
(unspecified)
@ Unknown
28.4 % In Blood
(unspecified)
@ Unknown
42 % In Blood
(unspecified)
@ 1 h (pe)
8.4 % In Blood
(unspecified)
@ Unknown
1
1
2
3
1
1
carboxyhemoglobin
carbon monoxide
1
1
carboxyhemoglobin
carbon monoxide
1
1
carboxyhemoglobin
carbon monoxide
1
1
carboxyhemoglobin
smoke
carbon monoxide
1
2
1
2
carbon monoxide
1
1
carbon monoxide
smoke
1
2
1
2
smoke
1
1
carbon monoxide
1
1
carbon monoxide
1
carbon monoxide
carbon monoxide
6y F
6y F
Blood Concentration
@ Time
ethanol
1
2
3
4y F
A
Inhal
Unt-E
1
A
Inhal
Oth-M
2
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-G
1
carboxyhemoglobin
60 % In Blood
(unspecified)
@ Autopsy
1
carboxyhemoglobin
1
1
carboxyhemoglobin
17 % In Blood
(unspecified)
@ 2 h (pe)
5 % In Blood
(unspecified)
@ 3 h (pe)
1
1
7y M
8y M
U
Analyte
1
3y F
7y M
RCF
1
3y M
170pi
172pa
1
79 y M
169 p
171pi
1
Reason
1
Foreign Bodies/Toys/Miscellaneous
161pha
41 y M
foreign body
cocaine
amphetamine
See Also case 747
Fumes/Gases/Vapors
162ph
2y M
carbon monoxide
164ai
1
1
Route
1
fluorescein
163pi
1
1
Chronicity
A
smoke
carbon monoxide
1
2
1
2
carbon monoxide
1
1
carbon monoxide
natural gas
1
2
1
2
carbon monoxide
1
1
butane
1
1
8y F
10 y F
11 y M
11 y M
Inhal
Unt-E
1
U
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Int-A
1
(continued)
1004
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
175 p
11 y F
176pa
12 y M
Substances
carbon monoxide
177ph
178pha
Downloaded by [AAPCC] at 12:54 01 December 2015
179pa
[180pa]
187pai
188pi
195pa
196 p
197
1
carbon monoxide
Route
Reason
RCF
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
Analyte
Blood Concentration
@ Time
60 % In Blood
(unspecified)
@ Autopsy
1
carboxyhemoglobin
1
1
carboxyhemoglobin
10 % In Blood
(unspecified)
@ 4 h (pe)
38 % In Blood
(unspecified)
@ 2 h (pe)
hydrogen sulfide
1
1
hydrogen sulfide
1
citalopram
A
A
Inhal
Inhal
Unt-E
Int-S
1
1
thiosulfate
2.2 mcg/mL In Blood
(unspecified)
@ Autopsy
1
thiosulfate
2
2
citralopram
benzodiazepine
3
3
nordiazepam
benzodiazepine
3
3
diazepam
19 mcg/mL In Plasma
@ Autopsy
0.18 mcg/mL
In Whole Blood
@ Autopsy
127 ng/mL In
Whole Blood
@ Autopsy
243 ng/mL In
Whole Blood
@ Autopsy
A
tramadol
4
4
helium
1
1
smoke
1
1
carbon monoxide
1
1
carbon monoxide
1
1
carbon monoxide
1
1
carbon monoxide
ethanol
1
2
1
2
carbon monoxide
1
ethanol (non-beverage)
Inhal
Int-S
1
A
Inhal
Int-S
1
A
Inhal
Unt-E
1
A
Inhal
Int-S
1
A
Inhal + Derm
Unt-E
1
carboxyhemoglobin
55 % In Blood
(unspecified)
@ Unknown
carboxyhemoglobin
46.5 % In
Whole Blood
@ 0.1 h (pe)
ethanol
260 mg/dL In Serum
@ Unknown
1
carboxyhemoglobin
2
2
ethanol
78 % In Blood
(unspecified)
@ Autopsy
0.22 % (wt/Vol)
In Vitreous
@ Unknown
carbon monoxide
1
1
ethanol*
sulfur*
guanidine
2
3
4
2
2
3
carbon monoxide
1
1
propane
1
1
C
A
28 y M
A
32 y F
U
33 y F
36 y F
194ai
carbon monoxide
Chronicity
carboxyhemoglobin
28 y F
35 y M
193pha
1
27 y F
190pa
192 ph
1
26 y M
189ai
191 p
carbon monoxide
19 y M
25 y M
186pha
1
19 y F
21 y M
185
1
16 y F
182pha
184ha
Cause
Rank
13 y F
181ph
183ph
Substance
Rank
Inhal
Inhal + Derm
Inhal
Unk
Int-S
Oth-M
Unk
Unk
Unt-E
1
2
1
1
A
Inhal
A
Inhal
Int-U
2
A
Inhal
Unt-E
1
carboxyhemoglobin
7.6 % In Blood
(unspecified)
@ Autopsy
carboxyhemoglobin
60 % In Blood
(unspecified)
@ Autopsy
carboxyhemoglobin
41.1 % In Blood
(unspecified)
@ 30 m (pe)
60 % In Whole Blood
@ Autopsy
150 mg/dL In Blood
(unspecified)
@ Autopsy
1
smoke
1
1
hydrogen sulfide
1
1
carbon monoxide
acetaminophen/
hydrocodone
1
2
1
2
smoke
1
1
cyanide
2
2
carbon monoxide
1
1
smoke
1
1
carboxyhemoglobin
ethanol
2
2
ethanol
carbon monoxide
1
1
carbon monoxide
benzodiazepine
1
2
1
2
36 y M
37 y M
38 y F
39 y F
39 y M
39 y M
40 y M
A
Inhal
Unt-O
1
A
Ingst + Inhal
Int-S
2
A
Inhal
Unt-E
1
A
Inhal
Int-S
2
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unk
1
(continued)
AAPCC 2014 Annual Report of the NPDS
1005
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
198 ph
41 y F
199 p
200 p
201 p
Downloaded by [AAPCC] at 12:54 01 December 2015
202pa
205 a
47 y M
[206ph]
47 y M
207 pi
49 y M
208 ph
50 y M
209 pi
51 y F
210 p
52 y M
211 p
53 y M
212 p
53 y F
hydrogen sulfide
1
1
carbon monoxide
1
1
carbon monoxide
1
1
smoke
1
ethanol
helium
55 y M
215 ha
56 y M
60 y M
218pa
61 y F
72 y F
A
Ingst + Inhal
Unk
1
A
Inhal
Unt-O
1
A
Inhal
Unt-E
1
Analyte
1
carboxyhemoglobin
2
2
ethanol
33 % In Blood
(unspecified)
@ Autopsy
300 mg/dL In Blood
(unspecified)
@ Autopsy
1
1
A
Inhal
Inhal
Int-S
Unt-E
2
1
A
Inhal
Int-S
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
carbon monoxide
1
1
smoke
1
1
carboxyhemoglobin
smoke
1
1
cyanide
smoke
1
1
carboxyhemoglobin
ethanol
2
2
ethanol
ethanol
2
2
ethanol
hydrogen sulfide
1
1
carbon monoxide
1
1
chlorine gas
bromine
chlorine dioxide
1
2
3
1
2
3
carbon monoxide
1
1
hydrogen sulfide
1
1
smoke
1
1
smoke
1
1
carbon monoxide
1
1
smoke
2
2
carbon monoxide
1
1
hydrogen sulfide
1
1
chlorine gas
1
1
hydrogen sulfide
1
1
A
Inhal
Unt-O
2
U
Inhal
Unt-E
1
A
Inhal
Unt-O
3
U
Inhal
Unt-E
1
A
Inhal
Unt-O
2
A
Inhal
Unt-E
2
A
Inhal
Unt-E
2
U
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-O
1
A
Inhal
Unt-O
A
Inhal
Int-S
1
A
Inhal
Unt-E
1
57 % In Whole Blood
@ 15 m (pe)
thiosulfate
7.4 mcg/mL In Blood
(unspecified)
@ Autopsy
carboxyhemoglobin
60 % In Blood
(unspecified)
@ Autopsy
29.6 % In Blood
(unspecified)
@ 1 h (pe)
48.5 % In Blood
(unspecified)
@ 5 m (pe)
2
1
1
carbon monoxide*
cyanide*
1
2
1
1
carbon monoxide
1
1
carboxyhemoglobin
carbon monoxide
1
1
carboxyhemoglobin
cyanide
2
2
propane
1
1
carbon monoxide
1
1
1
12.4 % In Blood
(unspecified)
@ 6 h (pe)
170 mcg/dL In Blood
(unspecified)
@ 1 h (pe)
62.1 % In Blood
(unspecified)
@ 1 h (pe)
238 mg/dL In Serum
@ 1 h (pe)
292 mg/dL In Blood
(unspecified)
@ 1 h (pe)
carboxyhemoglobin
smoke
smoke
Blood Concentration
@ Time
16.9 % In Blood
(unspecified)
@ Unknown
70 y F
70 y M
RCF
carboxyhemoglobin
64 y F
223 pi
Reason
A
63 y M
222 p
Route
47 % In Blood
(unspecified)
@ 1 h (pe)
58 y M
217 p
Chronicity
carboxyhemoglobin
54 y F
214 p
221 p
1
2
3
4
5
6
46 y F
47 y M
220 ph
1
2
3
4
5
6
42 y F
46 y M
219 h
carbon monoxide
cyanide
smoke
ethanol
cocaine
benzodiazepine
42 y F
204 pi
[216h]
Cause
Rank
41 y M
203 pi
213 ph
Substance
Rank
Substances
U
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Int-S
2
A
Inhal
Unt-E
3
A
Inhal
Unt-E
1
1
(continued)
1006
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
224 p
75 y M
225pa
75 y F
226 p
80 y F
227 ph
81 y M
229
85 y M
230 ph
85 y M
Downloaded by [AAPCC] at 12:54 01 December 2015
232pha
88 y M
90 y M
235pha
12 m M
236 pi
18 m F
237 ph
21 m F
238pa
Teen F
239 p
20 + y M
240pai
30 + y M
243 pi
244 p
245 p
246 p
2
2
carbon monoxide
1
1
chlorine gas
1
1
carbon monoxide
1
1
smoke
1
1
smoke
1
1
carbon monoxide
1
1
smoke
1
1
carbon monoxide
1
1
cyanide
2
2
smoke
1
1
carbon monoxide
1
1
carbon monoxide
1
1
smoke
1
1
smoke
carbon monoxide
1
2
1
2
carbon monoxide
1
1
carbon monoxide
1
1
propane
1
1
hydrogen sulfide
1
1
smoke
1
1
1
2
1
2
30 + y M
50 + y F
carbon monoxide
cyanide
Unknown adult
(4¼ 20 yrs)
M
carbon monoxide
Unknown adult
(4¼ 20 yrs)
U
carbon monoxide
Unknown age M
hydrogen sulfide
1
27 y M
252 ph
Inhal
Unt-E
2
A
Inhal
Unt-M
2
A
Inhal
Unt-E
1
A
Inhal
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
Inhal + Derm
Inhal
Unt-E
Unt-E
Analyte
Blood Concentration
@ Time
carboxyhemoglobin
14 % In Blood
(unspecified)
@ Unknown
carboxyhemoglobin
46 % In Blood
(unspecified)
@ Unknown
carboxyhemoglobin
27.7 % In Blood
(unspecified)
@ 15 m (pe)
carboxyhemoglobin
8 % In Blood
(unspecified)
@ Autopsy
carboxyhemoglobin
27 % In Blood
(unspecified)
@ Unknown
carboxyhemoglobin
49 % In Blood
(unspecified)
@ Unknown
thiosulfate
110 mcg/mL In Urine
(quantitative only)
@ Autopsy
1 Other (see abst)
In Serum
@ Unknown
1 Other (see abst)
In Serum
@ Unknown
1
3
1
A
Inhal
Unt-E
2
A
Ingst
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
2
U
Inhal + Unk
Unk
2
A
Inhal
Int-S
1
A
Inhal
Unt-E
1
A
Inhal
Unt-E
1
A
Inhal
Int-S
1
A
Inhal
Int-S
1
A
Inhal
Unt-O
1
1
1
1
fume-gas-vapor, unknown
2
2
hydrogen sulfide
1
1
cadmium
1
1
lamp oil
1
1
freon
chlorpheniramine/
dextromethorphan
1
2
1
2
chlorpheniramine
chlorpheniramine/
dextromethorphan
2
2
dextromethorphan
freon
1
1
20 y M
21 y F
A
Unt-E
RCF
1
See Also case 990, 1007
Hydrocarbons
[248]
5y M
251 p
Reason
1
Unknown age
M
250
Route
A
See Also case 121, 151, 274
Heavy Metals
247ai
67 y F
[249pha]
Chronicity
A
87 y F
234 h
242 ph
carbon monoxide
85 y F
233 h
241 p
Cause
Rank
81 y F
228 p
231 ha
Substance
Rank
Substances
A
Inhal
Unt-O
2
U
Unk
Unk
3
A
Ingst
Unt-G
1
Ingst + Inhal
Int-A
2
A/C
freon
1
1
freon
1
1
28 y M
A
Inhal
Int-A
1
A
Inhal
Int-A
2
U
Inhal
Int-A
1
(continued)
AAPCC 2014 Annual Report of the NPDS
1007
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
253ai
31 y M
254 h
34 y F
255 p
41 y M
256
43 y M
Substances
freon
257 ph
44 y M
258 h
46 y F
259 p
47 y M
260 p
50 y M
Substance
Rank
Cause
Rank
1
1
freon
1
1
gasoline
1
1
freon
1
1
freon
1
1
freon
1
1
freon
1
1
freon
ethanol
1
1
1
1
1
1
1
1
Amanita phalloides
1
1
mushroom
(cyclopeptides)
mushroom
(cyclopeptides)
1
1
1
1
1
1
1
1
2
3
2
3
1
1
Information Calls
[263ha]
3y F
water
Matches/Fireworks/Explosives
264 h
41 y F
matches
Mushrooms
[265h]
[266h]
267
31 y M
60 y M
71 y M
mushroom
(cyclopeptides)
[268ha]
Unknown adult
(4¼ 20 yrs) F
mushroom
(gastrointestinal)
Coprinus comatus
Coprinus atrametarius
See Also case 1192
Other/Unknown Nondrug Substances
269pa
18 y M
hyperthermia
270 ph
37 y F
substance
(non-drug),
unknown
ethanol
271
68 y M
substance
(non-drug),
unknown
ethanol
272i
86 y F
disinfectant
(perineal)
273pha
97 y F
nondrug,
unknown
274 pi
Unknown adult
(4= 20 yrs) M
substance
(non-drug),
unknown
hydrocarbon
propellant
See Also case 49, 298, 299
Paints and Stripping Agents
275 ph
68 y M
paint (aerosol)
Pesticides
[276h]
19 y M
277
22 y M
278 h
26 y M
[279ph]
30 y F
dinitrophenol
1
1
2
2
1
1
2
2
1
1
1
1
1
1
2
2
1
1
1
1
dinitrophenol
1
1
chlorpyrifos
1
1
sulfuryl fluoride
1
Route
Reason
RCF
A
Inhal
Int-U
2
A
Inhal
Int-A
1
A
Unk
Unt-U
2
C
Inhal
Int-A
2
A
Inhal
Int-A
1
A
Inhal
Int-A
1
C
Inhal
Int-A
1
A
Inhal
Int-A
2
1
2
261 p
Downloaded by [AAPCC] at 12:54 01 December 2015
Unknown adult
(4¼ 20 yrs)
M
freon
See Also case 38, 93, 108, 1287
Industrial Cleaners
262
71 y F
detergents (cationic)
1
2
Chronicity
Analyte
ethanol
A
Inhal
Unt-O
2
A
Ingst
Unt-G
1
A
Unk
Unk
2
A/C
Ingst
Unk
3
A
Ingst
Int-U
2
A
Ingst
Unt-M
2
A
Ingst
Unt-F
2
A
Ingst
Unt-G
1
A
Unk
Unk
1
U
Ingst
Unk
2
U
Ingst
Unk
1
A
Ingst
Unt-G
2
A
Ingst
Unt-G
3
A
Inhal
Unk
2
C
Inhal
Int-A
2
A
Ingst
Int-S
1
A
Ingst
Int-U
1
A
Ingst
Int-S
2
A
Inhal
Int-U
2
Blood Concentration
@ Time
167 mg/dL
In Serum
@ Unknown
1
(continued)
1008
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
[280]
45 y F
[281h]
[282a]
[283p]
58 y F
Downloaded by [AAPCC] at 12:54 01 December 2015
59 y F
[288a]
60 y F
[289]
65 y M
290 h
65 y M
[294h]
295 p
1
brodifacoum
1
1
glyphosate
cocaine
1
2
1
2
sodium fluoroacetate
1
1
organophosphate
1
1
phosphine
1
1
pesticide, unknown
phosmet
(organophosphate)
1
2
1
2
glyphosate
1
1
59 y M
[287h]
293 h
1
55 y M
57 y M
292
rodenticide
(antocoagulant)
50 y M
[285h]
291
Cause
Rank
48 y F
[284]
286 h
Substance
Rank
Substances
carbofuran
1
1
paraquat
1
1
acephate
atropine
hypochlorite
1
2
3
1
2
3
malathion
1
1
pyrethroids
pesticide, unknown
1
2
1
2
pyrethroids
oxycodone
1
2
1
2
rodenticide
1
1
1
2
1
2
1
1
1
1
67 y F
71 y M
82 y F
85 y M
50 + y M
pyrethroids
chemical, unknown
See Also case 47, 96, 410, 457, 943
Plants
[296h]
62 y M
Aconitum napellus
297 h
Unknown child
(5= 19 yrs) U
Manihot esculenta (cassava)
Chronicity
Route
Reason
RCF
A
Ingst
Oth-M
1
A/C
Ingst
Int-S
2
A
Ingst
Unt-M
1
Analyte
benzoylecognine
A
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Inhal
Unt-M
2
A
Ingst
Int-S
2
U
Ingst
Int-S
1
A
Ingst
Int-S
3
A
Ingst
Unt-M
1
A
Ingst
Int-S
3
A
Ingst
Int-S
1
A
Inhal
Unt-M
3
A
Ingst + Inhal
Int-S
1
A
Ingst
Int-S
1
A
Inhal
Int-M
2
A
Ingst
Unt-M
2
A
Ingst
Unt-M
2
Blood Concentration
@ Time
299 ng/mL In Urine
(quantitative only)
@ Unknown
Stimulants and Street Drugs
298 ha
26 y F
U
Unk
Unk
3
cocaine*
1
1
substance (non-drug),
2
1
unknown*
See Also case 5, 7, 11, 17, 66, 161, 198, 282, 308, 318, 324, 325, 328, 330, 339, 342, 344, 346, 347, 363, 364, 375, 387, 407, 425, 447, 452, 461, 463, 467, 479, 510, 521, 543, 547, 558, 572, 588, 591, 605, 625, 693,
734, 749, 770, 816, 819, 830, 869, 881, 895, 1030, 1074, 1122, 1123, 1130, 1136, 1191, 1392, 1396, 1399
Tobacco/Nicotine/eCigarette Products
299pa
31 y F
C
Inhal
AR-D
2
nicotine
1
1
nondrug, unknown
2
2
300 ph
12 m M
A
Ingst
Unt-G
2
nicotine
1
1
Weapons of Mass Destruction
301pha
23 y M
non-powder, unknown
302
34 y M
powder, unknown
303 pi
Unknown adult
(4= 20 yrs) M
non-powder, unknown
U
1
1
1
1
306 h
307 ph
308
2
A
Par
Int-M
3
U
Unk
Int-S
2
A
Ingst
Unk
1
A
Ingst
Unt-T
1
1
buprenorphine
1
1
methadone
1
1
methadone
methadone
1
1
methadone
acetaminophen
1
1
4y F
5y F
C
drug, unknown
2
2
methadone
oxycodone
(extended release)
1
2
1
2
15 y F
15 y F
Unk
1
Pharmaceutical Exposures
Analgesics
[304pha]
2y M
[305pha]
Unk
Ingst
Unk
16 ng/mL In Serum
@ 11 d (pe)
43 ng/mL In Serum
@ 4 d (pe)
2
acetaminophen
A
Ingst
Int-S
1
A
Ingst
Int-S
1
17.6 mcg/mL In Blood
(unspecified)
@ 8 h (pe)
(continued)
AAPCC 2014 Annual Report of the NPDS
1009
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
309 h
Downloaded by [AAPCC] at 12:54 01 December 2015
310 ph
Age
16 y F
16 y M
18 y M
315pha
20 y M
318pha
319 p
320 ha
321
322 ph
323 h
1
2
3
4
5
1
2
3
4
5
acetaminophen/
hydrocodone
1
1
acetaminophen
salicylate
2
2
salicylate
diazepam
ibuprofen
3
4
3
4
morphine (extended
release)
acetaminophen/
hydrocodone
escitaopram
cyclobenzaprine
aripiprazole
drug, unknown
1
1
2
2
3
4
5
6
3
4
5
6
oxycodone
1
1
methadone
1
1
trazodone
ondansetron
thyroid preparation
benzodiazepine
2
3
4
5
2
3
4
5
salicylate
1
1
tramadol
1
1
16 y F
314
317ai
salicylate
methylphenidate
acetaminophen
tramadol
diclofenac
16 y M
312 ha
316 h
Cause
Rank
15 y F
311ai
313
Substance
Rank
Substances
Chronicity
Route
Reason
A
Ingst
Int-S
Int-U
RCF
Analyte
2
A
Ingst
A
Ingst
Int-U
2
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Inhal
Int-A
2
A/C
Ingst
Int-S
1
methadone
856 ng/mL In Blood
(unspecified)
@ Unknown
0.09 mg/L In Blood
(unspecified)
@ Unknown
0.42 mg/L In Blood
(unspecified)
@ Unknown
0.45 mg/L In Blood
(unspecified)
@ Unknown
0.18 mg/L In Blood
(unspecified)
@ Unknown
1
1
oxymorphone (total)
oxycodone
1
1
oxycodone (free)
oxycodone
1
1
oxycodone (total)
alprazolam
2
2
alprazolam
carisoprodol
ethanol
3
4
3
4
A/C
Ingst
Int-S
ethanol
44 mg/dL In Serum
@ Unknown
acetaminophen
83 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
55.6 ng/mL In Blood
(unspecified)
@ Unknown
192 ng/mL In Blood
(unspecified)
@ Unknown
2
acetaminophen/
hydrocodone
1
1
oxycodone
1
1
morphine
1
1
morphine
methamphetamine
2
2
methamphetamine
ethanol
3
3
methadone
alprazolam
1
2
1
2
acetaminophen
1
1
20 y M
20 y M
20 y M
20 y M
20 y M
A
Unk
Int-U
2
U
Unk
Int-U
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
acetaminophen
41 mg/L In Plasma
@ 54 h (pe)
acetaminophen
383 mcg/mL In Serum
@ Unknown
196.6 mcg/mL
In Blood
(unspecified)
@ Unknown
2147 mcg/mL
In Blood
(unspecified)
@ Unknown
acetaminophen
1
1
benzodiazepine
2
2
fentanyl (transdermal)
ethanol
acetaminophen/
hydrocodone
alprazolam
1
2
3
1
2
3
4
4
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
lorazepam
2
2
21 y M
21 y F
229.6 mcg/mL
In Blood
(unspecified)
@ 4 h (pe)
54.7 mg/dL In Blood
(unspecified)
@ Unknown
1
oxycodone
20 y F
Blood Concentration
@ Time
A
Ingst
Int-A
1
A
Ingst
Int-S
2
(continued)
1010
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
324 h
325 ph
22 y F
22 y M
330 ha
331 a
332ai
333 ha
334 h
335 ha
336 h
337 ha
338ai
339 h
340pa
341 h
Cause
Rank
acetaminophen
cocaine
1
2
1
2
hydromorpinone
amphetamine
benzodiazepine
marijuana
1
2
3
4
1
2
3
4
acetaminophen
1
1
22 y M
327 p
329 ha
Substance
Rank
Substances
22 y
F-Pregnant
326 h
328 ph
Downloaded by [AAPCC] at 12:54 01 December 2015
Age
oxymorphone
ethanol
1
2
1
2
acetyl fentanyl
phencyclidine
1
2
1
2
morphine
1
1
23 y F
23 y F
Chronicity
Route
Reason
RCF
A
Ingst
Int-U
3
A/C
Ingst
Int-S
1
U
Ingst
Unk
2
A
Ingst + Unk
Int-U
2
A/C
Inhal
Int-A
1
U
Ingst
Int-U
3
Analyte
morphine
17 ng/mL In Blood
(unspecified)
@ Unknown
1400 ng/mL In Blood
(unspecified)
@ Autopsy
380 ng/mL In Blood
(unspecified)
@ Autopsy
5 ng/mL In Urine
(quantitative only)
@ Autopsy
340 ng/mL In Blood
(unspecified)
@ Autopsy
acetaminophen
2
2
oxycodone
1
1
oxycodone (free)
heroin
2
2
morphine
heroin
2
2
6-monoacetylmorphine
duloxetine
3
3
duloxetine
acetaminophen
1
1
23 y M
A/C
23 y
F-Pregnant
C
acetaminophen/oxycodone
2
2
fentanyl
1
1
acetaminophen
1
1
23 y M
23 y F
23 y F
Par
Ingst
Int-A
Unt-T
1
1
A
Unk
Int-U
2
C
Ingst
Unk
3
A
Ingst
Int-S
3
acetaminophen
68 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
21 mcg/mL In Serum
@ Unknown
acetaminophen
42 mcg/mL In Plasma
@ 15 m (pe)
1.1 ng/mL In Blood
(unspecified)
@ 2 d (pe)
14 mcg/mL In Blood
(unspecified)
@ 2 d (pe)
3.3 mcg/mL In Blood
(unspecified)
@ 2 d (pe)
acetaminophen
1
1
cyclic antidepressant,
unknown
tizanidine
2
2
3
3
fentanyl
1
1
fentanyl
levetiracetam
2
2
levetiracetam
phenytoin
3
3
phenytoin
acetaminophen
1
1
dextromethorphan/
guaifenesin
dextromethorphan
2
2
3
3
methadone
acetaminophen/
hydrocodone
1
2
1
2
amitriptyline
tramadol
quetiapine
oxcarbazepine
3
4
5
6
3
4
5
6
oxycodone
alprazolam
1
2
1
2
fentanyl
cocaine
1
2
1
2
methadone
alprazolam
1
2
1
2
sulindac
clonazepam
1
2
1
2
23 y F
U
24 y F
C
24 y F
A/C
24 y F
24 y M
24 y M
25 y F
Unk
Ingst
Ingst
Unk
Int-A
Int-S
Blood Concentration
@ Time
1
1
acetaminophen
25 mg/L In Blood
(unspecified)
@ 5 m (pe)
acetaminophen
187.4 mcg/mL
In Blood
(unspecified)
@ Unknown
10-hydroxy
carbazepine
14 mcg/mL In Blood
(unspecified)
@ Unknown
1
A
Ingst
Int-U
2
U
Inhal
Unk
2
A
Ingst
Int-A
1
A
Ingst
Int-S
2
(continued)
AAPCC 2014 Annual Report of the NPDS
1011
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
342 pi
25 y M
343
344 h
345 h
346 ph
Downloaded by [AAPCC] at 12:54 01 December 2015
347ai
348 p
349pa
350 ha
351 h
352 h
353
354 h
355 p
356 h
Cause
Rank
fentanyl
heroin
1
2
1
2
salicylate
1
1
salicylate
salicylate
1
1
salicylate
salicylate
1
1
salicylate
acetaminophen
1
1
acetaminophen
130 mcg/mL In Blood
(unspecified)
@ Unknown
cocaine
alprazolam
salicylate
2
3
4
2
3
4
salicylate
28 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
1
1
droperidol/fentanyl
cocaine
diazepam
1
2
3
1
2
3
oxycodone
cocaine
diazepam
1
2
3
1
2
3
fentanyl (transdermal)
alprazolam
1
2
1
2
fentanyl (transdermal)
1
1
fentanyl
76.9 Other (see abst)
In Liver
@ Autopsy
alprazolam
2
2
acetaminophen
1
1
acetaminophen
529 mcg/mL
In Serum
@ 4 h (pe)
ondansetron
citalopram
2
3
2
3
acetaminophen/opioid
benzodiazepine
1
2
1
2
acetaminophen
1
1
acetaminophen
56 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
1
1
acetaminophen
105 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
27 mcg/mL In Blood
(unspecified)
@ 18 h (pe)
41 mcg/mL In Blood
(unspecified)
@ 12 h (pe)
acetaminophen/
hydrocodone
2
2
methadone
ethanol
1
2
1
2
acetaminophen
1
1
cleaner (ammonia)
disinfectants (pine oil)
fabric softener
2
3
4
2
3
4
methadone
1
1
A/C
25 y F
U
25 y M
25 y M
26 y M
26 y M
26 y F
26 y F
26 y F
27 y M
27 y M
27 y F
Int-A
2
Ingst
Int-S
1
Unt-M
A
Ingst
Int-S
1
A
Unk
Int-U
2
A
Ingst
Int-U
2
Ingst + Aspir
Int-A
1
Ingst
Int-S
Ingst
Int-S
1
U
Ingst
Unt-G
2
Ingst
Int-S
Int-M
100 mg/dL In Blood
(unspecified)
@ 2 h (pe)
58 mg/dL In Blood
(unspecified)
@ Unknown
84 mg/dL In Blood
(unspecified)
@ 14 h (pe)
1
1
A/C
Ingst
Int-A
1
A/C
Ingst
Int-S
1
A
Ingst
Int-U
2
A
Ingst + Unk
Int-U
2
U
Ingst
Int-U
1
acetaminophen
50 mcg/mL In Serum
@ Unknown
0.063 mg/L In Blood
(unspecified)
@ 5 m (pe)
128 mcg/mL In Blood
(unspecified)
@ 5 m (pe)
60.6 mcg/mL In Blood
(unspecified)
@ 11 h (pe)
64 mg/dL In Blood
(unspecified)
@ 5 m (pe)
fentanyl
tramadol
1
2
1
2
acetaminophen/oxycodone
1
1
oxycodone
acetaminophen/oxycodone
1
1
acetaminophen
acetaminophen/oxycodone
1
1
acetaminophen
ethanol
2
2
ethanol
28 y F
Blood Concentration
@ Time
1
A
Ingst
Analyte
2
2
A/C
27 y M
Par
Ingst
RCF
Int-S
A
27 y M
Reason
Ingst
A
26 y M
Route
A
A/C
26 y F
358ai
Chronicity
U
25 y M
357ai
359pa
Substance
Rank
Substances
(continued)
1012
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
360pai
361 ph
362 ph
Downloaded by [AAPCC] at 12:54 01 December 2015
363pha
364pai
365 p
366
367 ha
368 h
369 h
370pha
371ai
Age
Substances
Substance
Rank
Cause
Rank
gabapentin
3
3
oxycodone
1
benzodiazepine
Chronicity
Route
Reason
RCF
Analyte
Blood Concentration
@ Time
gabapentin
10 mg/L In Blood
(unspecified)
@ 5 m (pe)
1
oxycodone
2
2
risperidone
benzodiazepine
2
2
pregabalin
benzodiazepine
2
2
diazepam
430 ng/mL
In Whole Blood
@ Autopsy
2.6 ng/mL
In Whole Blood
@ Autopsy
24 mcg/mL
In Whole Blood
@ Autopsy
250 ng/mL
In Whole Blood
@ Autopsy
pregabalin
skeletal muscle relaxant
3
4
3
4
acetaminophen/
hydrocodone
1
1
alprazolam
2
2
methadone
alprazolam
1
2
1
2
fentanyl (transdermal)
1
gabapentin
marijuana
28 y F
U
28 y M
A/C
Ingst
Ingst
Int-A
Int-S
1
2
acetaminophen
5.2 mg/dL In Blood
(unspecified)
@ Unknown
1
fentanyl
5.4 ng/mL In Blood
(unspecified)
@ Autopsy
2
3
2
3
delta-9-thc
marijuana
3
3
carboxy-thc
1.6 ng/mL In Blood
(unspecified)
@ Autopsy
54.8 ng/mL In Blood
(unspecified)
@ Autopsy
fentanyl
1
1
heroin
amphetamine
citalopram
2
3
4
2
3
4
acetaminophen/
hydrocodone
alprazolam
ethanol
ethanol
1
1
2
3
4
2
3
4
acetaminophen
1
1
acetaminophen
1
1
ethanol
2
2
acetaminophen/oxycodone
acetaminophen/butalbital/
caffeine
hydrocodone
alprazolam
1
2
1
2
3
4
3
4
oxymorphone (extended
release)
1
1
acetaminophen/
hydrocodone
1
acetaminophen/
hydrocodone
28 y M
29 y F
29 y M
C
Ingst
Int-A
2
A
Ingst
Int-A
1
A
Ingst + Par
Int-A
1
fentanyl
11.3 ng/mL In Blood
(unspecified)
@ Autopsy
acetaminophen
119 mcg/mL
In Blood
(unspecified)
@ 30 h (pe)
acetaminophen
31 mcg/mL
In Serum
@ 2 d (pe)
1
acetaminophen
1
1
hydrocodone
benzodiazepine
2
2
nordiazepam
benzodiazepine
2
2
diazepam
benzodiazepine
2
2
alprazolam
24 mg/L
In Serum
@ Unknown
310 ng/mL In Blood
(unspecified)
@ Unknown
110 ng/mL In Blood
(unspecified)
@ Unknown
75 ng/mL In Blood
(unspecified)
@ Unknown
76 ng/mL In Blood
(unspecified)
@ Unknown
methadone
hydrocodone
1
2
1
2
29 y M
29 y F
29 y F
U
Ingst
Int-U
2
A
Ingst
Int-S
1
A
29 y F
29 y M
30 y M
30 y M
Ingst
Int-S
1
A
Ingst
Int-S
1
C
Par
Int-A
2
A
Ingst
Int-S
1
A
Ingst
Int-U
2
(continued)
AAPCC 2014 Annual Report of the NPDS
1013
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
372
30 y M
373 ph
374
Downloaded by [AAPCC] at 12:54 01 December 2015
375 pi
376 h
377
378
379 ph
380 h
381 h
382
383 h
384 a
Substance
Rank
Cause
Rank
acetaminophen
1
1
acetaminophen
277 mcg/mL In Blood
(unspecified)
@ Unknown
ethanol
salicylate
2
3
2
3
salicylate
29 mg/dL In Blood
(unspecified)
@ Unknown
methadone
acetaminophen/
diphenhydramine
alprazolam
zolpidem
clonazepam
1
2
1
2
3
4
5
3
4
5
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
48 mcg/mL In Blood
(unspecified)
@ 24 h (pe)
64 mcg/mL In Blood
(unspecified)
@ 12 h (pe)
96 mcg/mL In Blood
(unspecified)
@ 10 m (pe)
ethanol
2
2
oxymorphone (extended
release)
cocaine
alprazolam
1
1
2
3
2
3
salicylate
1
1
methadone
acetaminophen/oxycodone
1
2
1
2
acetaminophen
1
1
buprenorphine
quetiapine
1
2
1
2
acetaminophen
1
1
vitamins
2
2
acetaminophen
1
1
acetaminophen/
diphenhydramine
ethanol
1
1
2
2
oxycodone
1
promethazine
venlafaxine
tizanidine
clonidine
phenazopyridine
alprazolam
chlorzoxazone
oxymorphone
zolpidem
Substances
30 y M
31 y F
31 y F
Chronicity
Route
Reason
A
Ingst
Int-S
Ingst
Int-U
2
A/C
Ingst
Int-M
2
A
Analyte
Blood Concentration
@ Time
2
A
A/C
31 y M
RCF
Ingst + Inhal
Int-U
2
Ingst
Int-S
2
salicylate
83.5 mg/dL In Serum
@ Unknown
acetaminophen
24 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
88 mg/L In Serum
@ Unknown
acetaminophen
119 mcg/mL In Blood
(unspecified)
@ Unknown
1
oxymorphone
0.05 mg/L In Blood
(unspecified)
@ Unknown
2
3
4
5
6
7
8
9
10
2
3
4
5
6
7
8
9
10
zolpidem
0.11 mg/L In Blood
(unspecified)
@ Unknown
fluoxetine
11
11
morphine
1
1
morphine
oxycodone
2
2
oxycodone
oxycodone
2
2
oxycodone
oxycodone
2
2
oxymorphone
acetaminophen/
hydrocodone
3
3
hydrocodone
acetaminophen/
hydrocodone
3
3
hydromorphone
1169 ng/mL In Urine
(quantitative only)
@ Unknown
25.7 ng/mL In Blood
(unspecified)
@ Unknown
7921 ng/mL In Urine
(quantitative only)
@ Unknown
901 ng/mL In Urine
(quantitative only)
@ Unknown
124 mg/mL In Urine
(quantitative only)
@ Unknown
179 ng/mL In Urine
(quantitative only)
@ Unknown
31 y M
31 y F
31 y F
31 y F
31 y F
C
Ingst
Int-U
2
A
Ingst
Int-S
1
A/C
Unk
Int-S
2
A
Ingst
Int-S
1
A/C
31 y F
32 y F
32 y M
Ingst
Int-M
2
C
Ingst
Int-M
2
A/C
Ingst
Int-S
1
U
Unk
Int-S
1
(continued)
1014
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Downloaded by [AAPCC] at 12:54 01 December 2015
385 a
386 h
387pa
388ai
389ai
390 ha
391 ph
Age
Cause
Rank
methadone
alprazolam
4
5
4
5
alpha-oh-alprazolam
alprazolam
5
5
alprazolam
alprazolam
5
5
alprazolam
clonazepam
6
6
7-aminoclonazepam
diazepam
7
7
nordiazepam
diazepam
7
7
temazepam
diazepam
7
7
oxazepam
metformin
quetiapine
fluoxetine
ibuprofen
levothyroxine
naproxen
8
9
10
11
12
13
8
9
10
11
12
13
acetaminophen
ethanol
1
2
1
2
acetaminophen
1
1
methadone
1
amphetamine
32 y F
Ingst
Int-S
1
U
Ingst
Int-U
3
Analyte
Blood Concentration
@ Time
1420 ng/mL In Urine
(quantitative only)
@ Unknown
27 ng/mL In Blood
(unspecified)
@ Unknown
532 ng/mL In Urine
(quantitative only)
@ Unknown
147 ng/mL In Urine
(quantitative only)
@ Unknown
170 ng/mL In Urine
(quantitative only)
@ Unknown
194 ng/mL In Urine
(quantitative only)
@ Unknown
69 ng/mL In Urine
(quantitative only)
@ Unknown
methadone
2
2
amphetamine
cocaine
3
3
benzoylecognine
promethazine
4
4
promethazine
0.6 mg/L In Blood
(unspecified)
@ Autopsy
0.1 mg/L In Blood
(unspecified)
@ Autopsy
1 mg/L In Blood
(unspecified)
@ Autopsy
0.1 mg/L In Blood
(unspecified)
@ Autopsy
morphine
hydrocodone
doxylamine
hydromorphone
sertraline
tramadol
1
2
3
4
5
6
1
2
3
4
5
6
hydrocodone
alprazolam
1
2
1
2
acetaminophen/
hydrocodone
1
1
acetaminophen
ethanol
2
2
ethanol
butalbital
3
3
butalbital
acetaminophen/
hydrocodone
labetalol
vilazodone
warfarin
1
1
2
3
4
2
3
4
morphine
1
1
32 y F
33 y M
RCF
A
A
32 y F
[394a]
Reason
1
32 y F
33 y F
Route
0 mcg/mL In Blood
(unspecified)
@ Unknown
32 y F
33 y M
Chronicity
acetaminophen
32 y M
393 p
396 ha
Substance
Rank
32 y M
392 p
395 a
Substances
opioid
1
1
fentanyl
1
1
salicylate
1
ethanol
acetaminophen
Ingst
Int-S
1
U
Ingst
Int-U
2
A
Ingst
Int-U
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-U
A
Ingst
Int-U
2
A
Par
Int-A
1
U
Inhal
Unk
1
67.9 mg/L In Blood
(unspecified)
@ Unknown
0.22 % In Blood
(unspecified)
@ Unknown
0.215 mg/L In Blood
(unspecified)
@ Unknown
3
fentanyl
3.64 ng/mL In Blood
(unspecified)
@ Unknown
1
salicylate
2
2
ethanol
54 mg/dL In Blood
(unspecified)
@ Unknown
0.184 % In Blood
(unspecified)
@ Unknown
1
1
33 y M
A
33 y F
C
Ingst
Ingst
Int-S
Int-U
1
1
acetaminophen
20.9 mcg/mL In Blood
(unspecified)
@ Unknown
(continued)
AAPCC 2014 Annual Report of the NPDS
1015
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
397 ha
33 y F
398pa
399 h
400 h
401ai
402pai
Downloaded by [AAPCC] at 12:54 01 December 2015
403 h
404pai
411pa
412
1
ibuprofen
ethanol
2
3
2
3
acetaminophen/oxycodone
1
1
acetaminophen/
hydrocodone
carisoprodol
levothyroxine
phenazopyridine
2
2
3
4
5
3
4
5
acetaminophen
1
1
acetaminophen
ethanol
1
2
1
2
methadone
1
1
fentanyl
1
1
acetaminophen
1
1
methanol
2
2
acetaminophen/oxycodone
1
acetaminophen/oxycodone
Route
Reason
A
Ingst
Int-S
RCF
Analyte
Blood Concentration
@ Time
1
102.4 mg/L In Serum
@ Unknown
acetaminophen
301 mcg/mL In Blood
(unspecified)
@ Unknown
fentanyl
10.2 ng/mL In Blood
(unspecified)
@ Autopsy
acetaminophen
5.6 mcg/mL In Blood
(unspecified)
@ Unknown
1
acetaminophen
1
1
oxycodone
ethanol
2
2
ethanol
diphenhydramine
3
3
diphenhydramine
19 mcg/mL In
Whole Blood
@ Autopsy
470 ng/mL In
Whole Blood
@ Autopsy
16 g/dL In Blood
(unspecified)
@ Autopsy
0.9 mcg/mL In Blood
(unspecified)
@ Autopsy
oxycodone
1
1
A/C
34 y F
34 y F
Ingst
Int-S
1
C
Ingst
Int-M
2
U
Ingst
Int-S
1
U
Ingst
Int-A
2
A
Par
Int-A
1
U
34 y M
A
Ingst
Ingst + Unk
Int-M
Int-A
2
1
A
Ingst
Int-U
2
U
Ingst
Int-U
1
oxycodone
1
1
oxycodone
oxymorphone
2
2
oxymorphone
oxymorphone
2
2
oxymorphone
oxymorphone
2
2
oxymorphone
alprazolam
3
3
alprazolam
alprazolam
3
3
alprazolam
gabapentin
escitalopram
trazodone
4
5
6
4
5
6
acetaminophen/oxycodone
1
1
tizanidine
trazodone
caffeine
2
3
4
2
3
4
acetaminophen
1
1
methadone
alprazolam
1
2
1
2
oxycodone
rodenticide, unknown
drug, unknown
1
2
3
1
2
3
fentanyl
1
ethanol
2
35 y M
A
Ingst + Aspir
Int-S
0.015 mg/L In Urine
(quantitative only)
@ Unknown
0.006 mg/kg In Blood
(unspecified)
@ 7 h (pe)
0.078 mg/L In Blood
(unspecified)
@ Unknown
1.2 mg/L In Urine
(quantitative only)
@ Unknown
0.03 mg/kg In Blood
(unspecified)
@ 7 h (pe)
0.039 mg/L In Blood
(unspecified)
@ Unknown
1
oxycodone
0.32 mg/L In Blood
(unspecified)
@ Unknown
acetaminophen
103.5 mcg/mL
In Serum
@ Unknown
1
fentanyl
2
ethanol
10 ng/mL In Blood
(unspecified)
@ Unknown
0.1 g/dL In Blood
(unspecified)
@ Unknown
35 y F
A
35 y M
35 y M
35 y M
36 y F
Chronicity
acetaminophen
34 y F
34 y M
410
1
33 y F
34 y M
409ai
acetaminophen
33 y F
406pha
408
Cause
Rank
33 y F
405ai
407pa
Substance
Rank
Substances
Ingst
Int-S
1
A
Ingst
Int-U
2
A
Ingst
Int-S
2
A
Ingst + Par + Unk
Int-U
2
A
Ingst
Int-S
1
(continued)
1016
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
413 ha
414 ph
Downloaded by [AAPCC] at 12:54 01 December 2015
415 ph
416 ha
417ai
418 ph
419
420ai
Age
427 h
1
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
lorazepam
ethanol
2
3
2
3
ethanol
47 mg/dL In Blood
(unspecified)
@ Unknown
acetaminophen*
2
1
acetaminophen
acetaminophen/
hydrocodone*
1
1
acetaminophen
31 mcg/mL In Serum
@ Unknown
31 mcg/mL In Serum
@ Unknown
methadone
1
1
acetaminophen/
hydrocodone
propranolol
buspirone
citalopram
clonazepam
2
2
3
4
5
6
3
4
5
6
acetaminophen
1
1
acetaminophen
1
1
Chronicity
U
A/C
A
37 y F
A/C
37 y M
hydrocodone
oxycodone
alprazolam
diazepam
1
2
3
4
1
2
3
4
acetaminophen/
hydrocodone
buspirone
1
1
2
2
opioid
acetaminophen
1
2
1
2
morphine
oxycodone
1
2
1
2
methadone
1
1
37 y F
37 y F
37 y F
37 y M
426 ph
1
acetaminophen
37 y M
37 y M
425 ph
acetaminophen
36 y M
422 p
424
Cause
Rank
36 y F
421ai
423 h
Substance
Rank
Substances
Route
Ingst
Ingst
Ingst
Ingst
Reason
Int-S
Int-S
Unk
Unt-U
RCF
Analyte
2
methadone
0.28 mg/L In Blood
(unspecified)
@ Unknown
acetaminophen
122 mcg/mL In Serum
@ 45 m (pe)
26 mcg/mL In Serum
@ 22 h (pe)
1
acetaminophen
Int-U
2
A
Ingst
Int-S
2
U
Ingst
Int-S
1
Unt-U
acetaminophen
52 mcg/mL In Plasma
@ Unknown
470 mcg/mL In Blood
(unspecified)
@ Autopsy
67.7 mg/dL In Blood
(unspecified)
@ 2 h (pe)
78.1 mg/dL In Blood
(unspecified)
@ 21.5 h (pe)
28 mcg/mL In Blood
(unspecified)
@ Autopsy
5 mcg/mL In Blood
(unspecified)
@ Autopsy
2
A
Ingst
Int-U
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
acetaminophen/
oxycodone
baclofen
meloxicam
zolpidem
clonazepam
1
1
2
3
4
5
2
3
4
5
salicylate
1
1
salicylate
salicylate
1
1
salicylate
salicylate
1
1
salicylate
oxcarbazepine
2
2
10-hydroxy
carbazepine
gabapentin
3
3
gabapentin
acetaminophen
1
1
salicylate
2
2
opioid
1
opioid
1
37 y F
37 y M
U
Ingst
Int-S
60 mcg/mL In Blood
(unspecified)
@ Unknown
88 mcg/mL In Blood
(unspecified)
@ 5 m (pe)
2
Ingst
Ingst
136 mcg/mL In Serum
@ 5 m (pe)
59.7 mcg/mL In Serum
@ 7 h (pe)
1
U
A
Blood Concentration
@ Time
1
acetaminophen
26 mcg/mL In Serum
@ 3 d (pe)
1
codeine
1
morphine
0.011 mg/L In Blood
(unspecified)
@ 1 h (pe)
0.1 mg/L In Blood
(unspecified)
@ 1 h (pe)
37 y M
U
amphetamine
2
2
fentanyl (transdermal)
1
1
acetaminophen
lamotrigine
topiramate
1
2
3
1
2
3
37 y F
37 y F
Par + Unk
Unk
1
U
Ingst + Derm
Int-U
1
A
Ingst
Int-S
1
(continued)
AAPCC 2014 Annual Report of the NPDS
1017
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
428
37 y F
429 ph
430
Downloaded by [AAPCC] at 12:54 01 December 2015
431pha
38 y F
437 ph
438 h
439pha
440 h
441 a
1
1
salicylate
acetaminophen
2
2
acetaminophen
oxycodone (extended
release)
1
1
acetaminophen
ethanol
1
2
1
2
acetaminophen
1
acetaminophen
Chronicity
Route
Reason
A
Ingst
Int-S
A/C
Ingst
Int-S
RCF
Analyte
Blood Concentration
@ Time
1
114 mg/dL In Serum
@ Unknown
343 mcg/mL In Serum
@ Unknown
2
oxycodone
0.019 mg/L In Blood
(unspecified)
@ 9 h (pe)
1
acetaminophen
1
1
acetaminophen
naproxen
2
2
naproxen
ibuprofen
3
3
260 mcg/mL In
@ Unknown
295 mcg/mL In
(unspecified)
@ Unknown
450 mcg/mL In
@ Unknown
221 mcg/mL In
@ Unknown
38 y M
433 ph
436 ph
salicylate
38 y F
38 y M
435 h
Cause
Rank
38 y F
432 a
434ai
Substance
Rank
Substances
A
Ingst
Int-S
1
A
Ingst
Int-S
3
ibuprofen
A
Ingst
Int-S
1
A/C
Ingst
Int-S
2
salicylate
1
1
tramadol
1
1
tramadol
tramadol
1
1
tramadol
trazodone
2
2
trazodone
hydrocodone
3
3
dihydrocodeine
hydrocodone
3
3
hydrocodone
hydrocodone
3
3
hydrocodone
hydrocodone
3
3
dihydrocodeine
diazepam
sertraline
4
5
4
5
sertraline
dextromethorphan
6
6
dextromethorphan
clonazepam
7
7
hydrocodone
1
1
38 y F
38 y F
A
Ingst
Int-U
2
A
Ingst
Int-S
1
acetaminophen/
diphenhydramine
1
1
diphenhydramine
acetaminophen/
diphenhydramine
1
1
acetaminophen
acetaminophen
1
1
38 y F
A
Ingst
Int-S
1
1
oxycodone
1
1
oxycodone (free)
alprazolam
2
2
alprazolam
acetaminophen/
hydrocodone
1
1
acetaminophen/
hydrocodone
1
1
hydromorphone
acetaminophen/
hydrocodone
1
1
dihydrocodeine/
hydrocodol (free)
acetaminophen/
hydrocodone
1
1
hydrocodone (free)
39 y M
40 y F
2.2 mg/L In Blood
(unspecified)
@ 10 m (pe)
240 mg/L In Blood
(unspecified)
@ 10 m (pe)
408 ng/mL In Blood
(unspecified)
@ Unknown
72 ng/mL In Blood
(unspecified)
@ Unknown
acetaminophen
A
Ingst
Int-S
2
A
Ingst
Int-S
1
Int-S
0.73 mg/L In Blood
(unspecified)
@ Autopsy
0.11 mg/L In Blood
(unspecified)
@ Autopsy
76 mcg/mL In Serum
@ 2 d (pe)
2
1
Ingst
15.5 mg/L In Blood
(unspecified)
@ Unknown
22.5 mg/L In Blood
(unspecified)
@ Autopsy
3.5 mcg/mL In Blood
(unspecified)
@ Unknown
12 mcg/L In Vitreous
@ Autopsy
131 mcg/L In Vitreous
@ Autopsy
192 mcg/L In Blood
(unspecified)
@ Autopsy
20 mcg/L In Blood
(unspecified)
@ Autopsy
acetaminophen
2
A/C
Serum
523.7 mg/L In Serum
@ Unknown
1
39 y F
Serum
acetaminophen
acetaminophen/
hydrocodone
39 y F
Blood
1
methadone
39 y F
Serum
1
A/C
Ingst
Int-S
1
U
Ingst
Int-S
1
4.7 ng/mL In Blood
(unspecified)
@ 1 h (pe)
50 ng/mL In Blood
(unspecified)
@ 1 h (pe)
730 ng/mL In Blood
(unspecified)
@ 1 h (pe)
(continued)
1018
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
442 h
443
444ai
Downloaded by [AAPCC] at 12:54 01 December 2015
445 h
Age
452 p
453 ph
454 ha
acetaminophen
lamotrigine
2
2
lamotrigine
citalopram
3
3
citalopram
zolpidem
4
4
zolpidem
ibuprofen
5
5
ibuprofen
acetaminophen
1
1
acetaminophen/
diphenhydramine
ethanol
2
2
3
3
A
acetaminophen/
diphenhydramine
1
1
methadone
1
1
acetaminophen
1
1
Ingst
Int-U
Int-S
RCF
Analyte
Ingst
Int-U
2
A/C
Ingst
Int-S
2
A
Ingst
Int-U
2
acetaminophen
72 mcg/mL In Serum
@ Unknown
ethanol
12 mg/dL In Unknown
@ Unknown
acetaminophen
608 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
36 mg/L In Serum
@ Unknown
A
Unk
Int-U
2
A
Ingst
Int-U
2
C
Ingst
Unt-M
1
acetaminophen
109 mcg/mL In Blood
(unspecified)
@ Unknown
22.2 mg/dL In Blood
(unspecified)
@ 1 d (pe)
40 mg/dL In Blood
(unspecified)
@ Unknown
50 mg/dL In Blood
(unspecified)
@ Unknown
61 mg/dL In Blood
(unspecified)
@ 0.5 d (pe)
1
1
1
2
oxycodone
oxymorphone
1
2
1
2
acetaminophen
1
1
caffeine/salicylamide/
salicylate
1
1
salicylate
caffeine/salicylamide/
salicylate
1
1
salicylate
caffeine/salicylamide/
salicylate
1
1
salicylate
caffeine/salicylamide/
salicylate
1
1
salicylate
oxycodone
oxymorphone
alprazolam
ethanol
1
2
3
4
1
2
3
4
acetaminophen/oxycodone
alprazolam
heroin
cocaine
1
2
3
4
1
2
3
4
oxycodone
trazodone
1
2
1
2
hydromorphone
1
1
hydromorphone
butalbital
2
2
butalbital
fentanyl
3
3
norfentanyl
acetaminophen
1
1
42 y F
42 y M
42 y F
methadone
amitriptyline
1
2
1
2
fluoxetine
3
3
salicylate
1
1
42 y F
Ingst
Int-S
3
A/C
Ingst
Unt-T
1
A/C
Ingst
Int-S
2
A
Ingst + Par + Unk
Int-S
2
C
Unk
Int-S
1
A
Ingst
Int-U
2
A/C
Ingst
Int-S
3
A
Ingst
Int-S
94 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
10 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
94 ng/mL In Blood
(unspecified)
@ 1 h (pe)
580 ng/mL In Blood
(unspecified)
@ 1 h (pe)
260 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
1
U
C
Blood Concentration
@ Time
2
1
2
41 y F
42 y F
Ingst
Reason
morphine
methamphetamine
41 y M
42 y F
Route
hydrocodone
41 y M
456 ph
Chronicity
U
40 y M
455ai
457 ph
1
40 y F
40 y F
451 p
1
40 y F
447ai
450
acetaminophen/
hydrocodone
40 y F
40 y F
449
Cause
Rank
40 y F
446ai
448ai
Substance
Rank
Substances
2.5 ng/mL In Blood
(unspecified)
@ Autopsy
570 ng/mL In
Whole Blood
@ Autopsy
1.1 ng/mL In
Whole Blood
@ Autopsy
amitriptyline
124 ng/mL In Blood
(unspecified)
@ Unknown
salicylate
100 mg/dL In Blood
(unspecified)
@ 4 h (pe)
1
(continued)
AAPCC 2014 Annual Report of the NPDS
1019
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
458 h
459 p
Downloaded by [AAPCC] at 12:54 01 December 2015
460 ha
461ha
462ai
463ai
464ai
465ai
466ai
467i
468pha
469
470
471 ha
472 p
Age
Substance
Rank
Cause
Rank
salicylate
1
1
salicylate
salicylate
1
1
salicylate
salicylate
1
1
salicylate
acetaminophen
2
2
acetaminophen
acetaminophen
2
2
acetaminophen
acetaminophen
2
2
acetaminophen
pyrethroids
3
3
acetaminophen
1
1
acetaminophen
ethanol
2
2
ethanol
acetaminophen
1
1
Substances
42 y F
Chronicity
C
43 y F
43 y F
Route
Ingst
Reason
Int-M
RCF
Analyte
A
Ingst
Int-S
1
U
Ingst
Int-U
1
506 mcg/mL In Serum
@ Unknown
acetaminophen
17 mcg/mL In Blood
(unspecified)
@ Unknown
150 mcg/L In Blood
(unspecified)
@ 1 m (pe)
277 mcg/L In Blood
(unspecified)
@ 1 m (pe)
1
methadone
heroin
1
2
1
2
morphine
alprazolam
3
3
alprazolam
Ingst + Par
Int-S
1
lorazepam
4
4
methadone
ethanol
1
2
1
2
fentanyl
methamphetamine
1
2
1
2
fentanyl
morphine
1
2
1
2
morphine
1
1
hydrocodone
cyclobenzaprine
citalopram
1
2
3
1
2
3
fentanyl
heroin
1
2
1
2
morphine
1
1
hydromorphone
morphine
1
1
morphine
alprazolam
2
2
alprazolam
alprazolam
2
2
alpha-oh-alprazolam
acetaminophen/
hydrocodone
3
3
hydrocodone
carisoprodol
4
4
meprobamate
colchicine
carvedilol
lisinopril
1
2
3
1
2
3
acetaminophen
1
1
acetaminophen
1
1
acetaminophen/caffeine/
salicylate
1
acetaminophen/caffeine/
salicylate
1
43 y F
43 y M
43 y F
43 y F
43 y F
43 y M
43 y F
44 y M
44 y F
56 mcg/mL In Serum
@ 0.25 h (pe)
33.4 mg/dL In Serum
@ 0.25 h (pe)
acetaminophen
1
A/C
114 mg/dL In Blood
(unspecified)
@ 1 h (pe)
17 mg/dL In Blood
(unspecified)
@ 2 d (pe)
25 mg/dL In Blood
(unspecified)
@ 15 h (pe)
192 mcg/mL In Blood
(unspecified)
@ 2 d (pe)
314 mcg/mL In Blood
(unspecified)
@ 15 h (pe)
400 mcg/mL In Blood
(unspecified)
@ 4 h (pe)
1
acetaminophen
43 y M
Blood Concentration
@ Time
A
Ingst
Int-U
2
A
Ingst + Unk
Int-U
2
A
Derm
Int-U
2
A
Unk
Int-U
2
A
Ingst
Int-S
2
U
Par
Int-A
2
U
Ingst
Int-S
1
A/C
Ingst
Int-S
1
U
Unk
Int-S
1
36 ng/mL In Blood
(unspecified)
@ Autopsy
730 ng/mL In Blood
(unspecified)
@ Autopsy
21 ng/mL In Blood
(unspecified)
@ Autopsy
22 ng/mL In Blood
(unspecified)
@ Autopsy
6.6 ng/mL In Blood
(unspecified)
@ Autopsy
6.6 ng/mL In Blood
(unspecified)
@ Autopsy
acetaminophen
119.2 mcg/mL In Blood
(unspecified)
@ Unknown
1
salicylate
1
acetaminophen
27 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
6 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
44 y F
44 y F
U
Unk
Unk
2
A/C
Ingst
Int-M
2
(continued)
1020
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
473 ph
474 ha
476
44 y F
479
480
481
482pha
483 ph
484ai
485
486ai
487 h
488 ha
489
490 h
491 h
492
493 h
Substance
Rank
Cause
Rank
valproic acid
2
2
methadone
1
1
acetaminophen
1
1
venlafaxine
2
2
44 y F
44 y F
478 h
Substances
44 y M
475 h
477pha
Downloaded by [AAPCC] at 12:54 01 December 2015
Age
acetaminophen
1
1
acetaminophen
ibuprofen
1
2
1
2
acetaminophen/
hydrocodone
1
1
oxycodone
1
1
acetaminophen/
hydrocodone
cocaine
1
1
2
2
acetaminophen/
hydrocodone
clonazepam
1
1
2
2
acetaminophen
1
1
diphenhydramine/
ibuprofen
2
2
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
zolpidem
1
1
1
1
2
2
alpha blocker
hydrochlorothiazide
naproxen
tetracycline
3
4
5
6
3
4
5
6
acetaminophen/
oxycodone
1
1
oxycodone
2
2
fentanyl
fluoxetine
1
2
1
2
acetaminophen/
diphenhydramine
1
1
morphine
1
1
acetaminophen
1
acetaminophen
45 y F
45 y M
45 y F
45 y F
45 y M
45 y M
Chronicity
Reason
RCF
A
Ingst
Int-A
2
C
Ingst
Int-S
1
Analyte
Ingst
Int-A
2
A
Ingst
Unk
2
A
Ingst
Int-S
1
A
Ingst
AR-D
3
A
Ingst
Int-S
2
A/C
Ingst
Int-S
3
A
Ingst
Int-S
1
26 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
acetaminophen
19 mcg/mL In Unknown
@ Unknown
890 ng/mL In Whole Blood
@ Autopsy
acetaminophen
Ingst
Int-S
Blood Concentration
@ Time
valproic acid
o-desmethyl
venlafaxine
A
A
45 y F
Route
19.7 mcg/mL In Blood
(unspecified)
@ Unknown
1
dihydrocodeine/hydro- 33 ng/mL In Serum
codol (free)
@ 10 m (pe)
hydrocodone (free)
347 ng/mL In Serum
@ 10 m (pe)
zolpidem
140 ng/mL In Serum
@ 10 m (pe)
U
Ingst
Int-S
3
acetaminophen
55 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
16 mcg/mL In Blood
(unspecified)
@ Unknown
1
acetaminophen
1
1
acetaminophen
278.6 mcg/mL In Blood
(unspecified)
@ Unknown
376.2 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
1
1
hydrocodone/ibuprofen
cyclobenzaprine
ibuprofen
1
2
3
1
2
3
acetaminophen
1
1
quetiapine
escitalopram
sertraline
buspirone
2
3
4
5
2
3
4
5
tramadol
amitriptyline
insulin
1
2
3
1
2
3
acetaminophen/
hydrocodone
ethanol
1
1
2
2
acetaminophen
acetaminophen/salicylate
ibuprofen
1
2
3
1
2
3
45 y F
45 y F
45 y M
45 y F
45 y M
A
Ingst + Derm
Int-U
2
A
Ingst
Int-S
1
A
Unk
Int-U
2
U
Ingst
Int-S
3
C
46 y M
46 y F
46 y F
46 y M
46 y M
Ingst
Unt-T
1
A/C
Ingst
Int-A
3
A
Ingst
Int-U
2
A/C
Ingst
Int-S
2
A
Ingst
Int-U
1
C
Ingst
Int-M
2
acetaminophen
115 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
acetaminophen
25 mcg/mL In Blood
(unspecified)
@ Unknown
(continued)
AAPCC 2014 Annual Report of the NPDS
1021
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
494
46 y M
495 ha
47 y M
Substances
acetaminophen
496 h
497 h
499ai
47 y M
Downloaded by [AAPCC] at 12:54 01 December 2015
acetaminophen
1
1
acetaminophen/
hydrocodone
carisoprodol
1
1
2
2
acetaminophen
1
1
48 y F
48 y F
504
48 y M
508 p
509 a
510ai
511 ha
512
513pa
514 h
Route
Reason
RCF
U
Ingst
Unk
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
C
Ingst
Int-M
3
A
Ingst
Int-U
2
A
Ingst
Int-U
2
A
Unk
Int-U
2
A
Ingst
Unt-M
1
Analyte
137 mg/L In Serum
@ Unknown
acetaminophen
98 mcg/mL In Serum
@ 16 h (pe)
0.12 mcg/mL In Blood
(unspecified)
@ Unknown
0.18 mcg/mL In Serum
@ Unknown
11 ng/mL In Blood
(unspecified)
@ Unknown
14 ng/mL In Serum
@ Unknown
64 mcg/mL In Blood
(unspecified)
@ Unknown
1
2
morphine
hydrocodone
alprazolam
diphenhydramine
1
2
3
4
1
2
3
4
oxycodone
oxymorphone
1
2
1
2
oxycodone
1
1
oxycodone
oxycodone
1
1
oxycodone
oxycodone
1
1
oxymorphone
oxycodone
1
1
oxymorphone
salicylate
2
2
salicylate
acetaminophen
1
1
1
A
Ingst + Aspir
Int-S
2
A
Ingst
Int-S
1
U
Ingst
Unk
3
1
acetaminophen
1
1
oxycodone
1
1
oxycodone
alprazolam
1
2
1
2
acetaminophen
1
1
ethanol
2
2
methadone
salicylate
1
2
1
2
48 y F
48 y M
48 y F
48 y F
49 y F
A
Ingst
Int-U
2
A
Ingst
Int-U
2
A
Ingst
Int-M
1
U
Ingst
Int-A
2
A/C
Ingst
Int-S
1
Blood Concentration
@ Time
acetaminophen
1
2
salicylate
507 h
Chronicity
hydrocodone
alprazolam
48 y M
503
506ai
1
47 y F
502 h
505ai
1
47 y M
47 y F
501 a
Cause
Rank
47 y F
498ai
500ai
Substance
Rank
salicylate
84 mg/dL In Unknown
@ Unknown
acetaminophen
66 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
30 mcg/mL In Serum
@ Unknown
salicylate
19.7 mg/dL In Serum
@ Unknown
trazodone
2.9 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
acetaminophen
126 mg/L In Blood
(unspecified)
@ Unknown
salicylate
58.7 mg/dL In Blood
(unspecified)
@ Unknown
oxycodone
trazodone
1
2
1
2
fentanyl
cocaine
diazepam
1
2
3
1
2
3
acetaminophen
1
1
salicylate
1
1
temazepam
diuretics, potassium sparing
ibuprofen
2
3
4
2
3
4
acetaminophen
1
1
acetaminophen
310 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen/codeine
salicylate
2
3
2
3
salicylate
17 mg/dL In Blood
(unspecified) @ Unknown
ibuprofen
lisinopril
pantoprazole
4
5
6
4
5
6
oxycodone
acetaminophen/oxycodone
gabapentin
clonazepam
zolpidem
1
2
3
4
5
1
2
3
4
5
49 y M
49 y F
49 y F
A
Ingst
Int-U
2
U
Ingst
Unt-G
1
A
49 y M
A/C
49 y F
A/C
Ingst
Ingst
Ingst
Int-S
Int-S
Unk
1
2
3
(continued)
1022
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
515 ha
49 y F
Substances
acetaminophen
516 pi
49 y F
517 ph
50 y M
518 h
50 y F
519
50 y F
520ai
50 y F
521ai
50 y M
522
50 y F
523
51 y F
Downloaded by [AAPCC] at 12:54 01 December 2015
524 ha
525
526 h
527
acetaminophen/
hydrocodone
1
1
acetaminophen/oxycodone
1
1
acetaminophen
1
1
acetaminophen
opioid
1
2
1
2
morphine
1
1
hydrocodone
alprazolam
diazepam
methamphetamine
1
2
3
4
1
2
3
4
salicylate
1
1
acetaminophen
1
1
methadone
1
1
530 ha
51 y F
tramadol
2
2
salicylate
1
1
acetaminophen/
hydrocodone
ethanol
1
1
2
2
acetaminophen
tramadol
opioid
1
2
3
1
2
3
morphine
1
1
salicylate
535ai
536 h
537pha
538 h
539
540
Chronicity
Route
Reason
A
Ingst
Unk
1
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
2
C
Ingst
Int-M
1
U
Ingst
Int-S
2
1
RCF
A
Unk
Int-U
2
A
Ingst + Unk
Int-U
2
A
Ingst
Int-S
1
U
Ingst
Int-S
1
U
51 y F
51 y M
534ai
1
51 y M
51 y M
533ai
1
51 y M
529
532ai
Cause
Rank
51 y F
528ai
531hai
Substance
Rank
Ingst + Par
Int-S
Analyte
acetaminophen
88 mg/L In Serum
@ Unknown
acetaminophen
400 mcg/mL In Blood
(unspecified) @ Unknown
methadone
0.1 mg/L In Blood
(unspecified)
@ 10 m (pe)
salicylate
55.8 mg/dL In Serum
@ Unknown
acetaminophen
335 mg/L In Serum
@ Unknown
acetaminophen
180 mcg/mL In Blood
(unspecified)
@ Unknown
salicylate
58.1 mg/dL In Blood
(unspecified) @ Unknown
180 ng/mL In Serum
@ 30 m (pe)
210 ng/mL In Serum
@ 30 m (pe)
68 ng/mL In Serum
@ 30 m (pe)
1100 ng/mL In Serum
@ 30 m (pe)
230 ng/mL In Serum
@ 30 m (pe)
1
A
Ingst
Int-S
2
A/C
Ingst
Unt-T
2
A
Ingst
Int-S
2
U
Unk
Int-U
2
C
Ingst
Int-A
2
A
Ingst
Int-S
1
1
acetaminophen
1
1
opioid
2
2
acetaminophen
1
1
oxycodone
fluoxetine
1
2
1
2
hydrocodone
fentanyl
1
2
1
2
hydrocodone
alprazolam
trazodone
diphenhydramine
1
2
3
4
1
2
3
4
hydrocodone
ethanol
1
2
1
2
salicylate
1
1
acetaminophen
2
2
tramadol
1
1
tramadol
tramadol
1
1
o-demethyl tramadol
alprazolam
2
2
alprazolam
citalopram
3
3
citralopram
citalopram
3
3
desmethyl
citalopram
acetaminophen/
hydrocodone
1
1
tramadol
amitriptyline
1
2
1
2
tramadol
pregabalin
zolpidem
carisoprodol
1
2
3
4
1
2
3
4
51 y F
C
51 y F
51 y M
51 y F
51 y M
51 y M
51 y M
51 y M
51 y F
Int-M
1
A
Ingst
Int-U
2
A
Ingst + Unk
Int-U
2
U
Ingst
Int-U
2
U
Ingst
Int-U
2
A/C
Ingst
Unk
2
A/C
51 y F
Ingst
Ingst
Int-S
Blood Concentration
@ Time
2
C
Ingst
Unk
3
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
2
(continued)
AAPCC 2014 Annual Report of the NPDS
1023
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
541
51 y M
Substances
acetaminophen
542pha
543
544ai
545 h
Downloaded by [AAPCC] at 12:54 01 December 2015
546 ha
547 ph
548
549 ha
550
559 ha
A
Ingst
Int-S
2
A
Ingst
Int-A
2
Analyte
133 mcg/mL In Serum
@ Unknown
oxycodone
0.78 mg/L In Blood
(unspecified)
@ Unknown
acetaminophen
149.4 mcg/mL In Blood
(unspecified)
@ Unknown
17 mcg/mL In Serum
@ 2 d (pe)
5 mcg/mL In Serum
@ 4 d (pe)
74 mcg/mL In Serum
@ 15 m (pe)
1
acetaminophen/oxycodone
2
2
methadone
heroin
1
2
1
2
fentanyl
morphine
1
2
1
2
acetaminophen/
hydrocodone
1
1
acetaminophen
2
2
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen/
hydrocodone
methamphetamine
drug, unknown
ethanol
1
1
2
3
4
2
3
4
acetaminophen
1
1
acetaminophen/
diphenhydramine
1
salicylate
A
Ingst
Int-S
2
A
Ingst + Derm
Int-U
2
Ingst
Int-U
1
A/C
A/C
Ingst
AR-D
Blood Concentration
@ Time
acetaminophen
1
1
A
Ingst
Unk
3
C
Ingst
Unk
2
acetaminophen
68 mcg/mL In Blood
(unspecified)
@ Unknown
1
acetaminophen
2
2
salicylate
ethanol
3
3
ethanol
quetiapine
4
4
quetiapine
32.6 mcg/mL In Blood
(unspecified)
@ Unknown
7.6 mg/dL In Blood
(unspecified)
@ Unknown
36 mg/dL In Blood
(unspecified)
@ Unknown
1200 ng/mL In Blood
(unspecified)
@ Autopsy
53 y F
U
lorazepam
5
5
acetaminophen/
hydrocodone
1
1
morphine
1
1
53 y F
53 y F
RCF
oxycodone
52 y M
53 y F
Reason
1
2
3
52 y F
554 ph
Route
1
2
3
52 y F
553 h
Chronicity
oxycodone
metoprolol
gabapentin
52 y F
53 y F
558 p
5
52 y F
53 y M
557 ph
5
52 y M
552 p
556 h
Cause
Rank
52 y F
551ai
555 ph
Substance
Rank
A
oxycodone
benzodiazepine
pregabalin
salicylate
1
2
3
4
1
2
3
4
acetaminophen
1
1
acetaminophen/
hydrocodone
1
1
acetaminophen/
hydrocodone
diphenhydramine
1
1
2
2
acetaminophen/
hydrocodone
lorazepam
1
1
2
2
acetaminophen/
hydrocodone
1
1
methadone
tizanidine
acetaminophen/
hydrocodone
salicylate
marijuana
1
2
3
1
2
3
4
5
4
5
acetaminophen
1
acetaminophen
1
54 y F
54 y F
54 y F
Ingst
Int-S
Ingst
Int-S
1
3
A
Unk
Int-U
2
A
Ingst
Int-S
3
U
Ingst
Unt-T
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Int-A
1
acetaminophen
38.9 mg/L In Serum
@ Unknown
1
acetaminophen
1
acetaminophen
100 mcg/mL In Blood
(unspecified)
@ 36 h (pe)
105 mcg/dL In Blood
(unspecified)
@ 50 h (pe)
54 y F
54 y M
A/C
Ingst
Int-S
2
U
Ingst
Unk
1
(continued)
1024
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
560ai
Downloaded by [AAPCC] at 12:54 01 December 2015
561ai
Age
54 y F
54 y M
564ai
54 y M
567
54 y M
570
55 y F
574 ph
575 ph
576 a
acetaminophen
carisoprodol
2
2
carisoprodol
carisoprodol
2
2
meprobamate
zolpidem
3
3
zolpidem
alprazolam
4
4
alpha-oh-alprazolam
alprazolam
4
4
alprazolam
hydrocodone
5
5
hydrocodone (free)
hydromorphone
6
6
hydromorphone
hydrocodone
alprazolam
1
2
1
2
oxycodone
1
1
methadone
1
1
A
Unk
Int-U
2
A
Ingst
Int-U
2
A
Ingst
Int-U
2
A
Ingst
Int-U
2
A
Ingst
Int-U
2
C
Unk
Unk
3
A
Ingst
Int-S
1
Analyte
1
2
1
2
ibuprofen
1
1
salicylate
1
1
salicylate
salicylate
1
1
salicylate
acetaminophen
1
1
morphine
1
1
C
Ingst
Int-M
Blood Concentration
@ Time
47 mcg/mL In Blood
(unspecified)
@ 68 h (pe)
30 mcg/mL In Blood
(unspecified)
@ 42.5 h (pe)
40 mcg/mL In Blood
(unspecified)
@ 42.5 h (pe)
920 ng/mL In Blood
(unspecified)
@ 42.5 h (pe)
35 ng/mL In Blood
(unspecified)
@ 36 h (pe)
44 ng/mL In Blood
(unspecified)
@ 36 h (pe)
190 ng/mL In Blood
(unspecified)
@ 36 h (pe)
12 ng/mL In Blood
(unspecified)
@ 36 h (pe)
135 mg/dL In Blood
(unspecified)
@ 27 h (pe)
95 mg/dL In Blood
(unspecified)
@ 24 h (pe)
3
U
Ingst
Int-S
3
A/C
Ingst
Int-U
2
A
Ingst + Par
Int-S
2
U
Unk
Unk
1
methadone
trazodone
1
2
1
2
morphine
oxycodone
zolpidem
1
2
3
1
2
3
methadone
1
1
methadone
0.28 mcg/mL In Blood
(unspecified)
@ 1 m (pe)
oxycodone
alprazolam
2
3
2
3
alprazolam
68 mcg/L In Blood
(unspecified)
@ 1 m (pe)
hydrocodone
oxycodone
methamphetamine
1
2
3
1
2
3
acetaminophen/oxycodone
1
1
acetaminophen
15 mg/L In Serum
@ Unknown
acetaminophen
112 mcg/mL In Serum
@ 1 h (pe)
salicylate
5.9 mg/dL In Serum
@ 1 h (pe)
acetaminophen
2
2
methadone
morphine
1
2
1
2
acetaminophen/
hydrocodone
tramadol
hydromorphone
benzodiazepine
1
1
2
3
4
2
3
4
acetaminophen/oxycodone
1
1
tramadol
phenothiazine
salicylate
2
3
4
2
3
4
55 y F
55 y F
56 y F
56 y F
RCF
morphine
oxycodone
55 y M
578ai
Reason
1
2
55 y F
56 y M
Route
1
2
55 y M
577ai
Chronicity
methadone
fluoxetine
54 y F
55 y M
573
1
54 y F
569 p
572ai
1
54 y F
568 h
571pha
acetaminophen
54 y F
563ai
566 h
Cause
Rank
54 y M
562ai
565 h
Substance
Rank
Substances
oxycodone
1
1
tramadol
venlafaxine
1
2
1
2
U
Ingst + Unk
Int-U
2
C
Ingst
Int-M
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-U
2
A
Ingst
Int-U
2
(continued)
AAPCC 2014 Annual Report of the NPDS
1025
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
579 h
56 y F
580 h
581 h
582
583 ha
Downloaded by [AAPCC] at 12:54 01 December 2015
584pha
585 h
586 ha
587 ph
588 ha
589
acetaminophen
1
1
opioid
warfarin
2
3
2
3
hydromorphone
1
1
acetaminophen
1
ethanol
2
acetaminophen
ethanol
165 mcg/mL In Serum
@ Unknown
53 mg/dL In Serum
@ Unknown
salicylate
3
3
acetaminophen
1
1
salicylate
2
2
A
Inhal
Int-A
1
C
Ingst
Int-U
1
A
acetaminophen/
hydrocodone
acetaminophen/butalbital/
caffeine
clonazepam
1
1
2
2
3
3
codeine
1
codeine
Ingst
Int-S
2
acetaminophen
salicylate
A
Ingst
Int-S
194 mcg/mL In Serum
@ Unknown
5.4 mg/dL In Serum
@ Unknown
1
acetaminophen
46 mg/L In Serum
@ Unknown
1
morphine
1
1
codeine
gabapentin
2
2
gabapentin
0.024 mg/L In Blood
(unspecified)
@ Autopsy
0.52 mg/L In Blood
(unspecified)
@ Autopsy
19 mg/L In Blood
(unspecified)
@ Autopsy
acetaminophen
1
1
U
Unk
Unk
2
A
Ingst
Int-S
2
A
Ingst
Int-S
2
acetaminophen
392 mcg/mL In Serum
@ Unknown
12.8 mg/L In Blood
(unspecified)
@ Autopsy
44 mg/L In Serum
@ Unknown
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
clonazepam
acetaminophen/
hydrocodone
2
3
2
3
hydrocodone
0.15 mg/L In Blood
(unspecified)
@ Autopsy
acetaminophen/
hydrocodone
antidepressant (SSRI)
benzodiazepine
1
1
2
3
2
3
acetaminophen
1
1
acetaminophen
330 mcg/mL
In Serum
@ Unknown
diphenhydramine
caffeine
valproic acid
ibuprofen
2
3
4
5
2
3
4
5
acetaminophen/
hydrocodone
diazepam
carisoprodol
codeine/pseudoephedrine/
guaifenesin
1
1
2
3
4
2
3
4
methadone
1
1
morphine (free)
0.56 mg/L In Whole Blood
@ Autopsy
acetaminophen
914 mcg/mL In Serum
@ 2 h (pe)
458 mg/mL In Serum
@ Unknown
9.06 mg/L In Blood
(unspecified)
@ Unknown
57 y F
57 y M
57 y F
57 y F
Blood Concentration
@ Time
2
57 y F
57 y F
Int-S
Analyte
2
57 y F
593 h
Unk
RCF
1
57 y F
592
Reason
55.1 mcg/mL In Blood
(unspecified)
@ Unknown
57 y F
57 y F
Route
acetaminophen
57 y F
57 y M
Chronicity
U
56 y F
591 a
595pha
Cause
Rank
56 y M
590 ph
594 h
Substance
Rank
Substances
A
Ingst
Int-S
1
A
Ingst
Int-U
1
A/C
morphine
1
1
methamphetamine
2
2
acetaminophen/codeine
1
1
Ingst
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Int-S
1
C
Ingst
Unk
2
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
tramadol
trazodone
acetaminophen/
hydrocodone
1
2
3
1
2
3
acetaminophen
1
1
propranolol
2
2
acetaminophen/oxycodone
1
1
acetaminophen
acetaminophen/oxycodone
1
1
oxycodone
58 y F
58 y F
A
Ingst
Int-S
1
(continued)
1026
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
596 h
58 y M
597 ha
598 h
58 y M
58 y F
Downloaded by [AAPCC] at 12:54 01 December 2015
603 h
604
605 a
606 h
607 ha
608 ph
609 h
oxycodone
fentanyl
alprazolam
1
2
3
1
2
3
ibuprofen
1
1
Chronicity
Route
Reason
RCF
A/C
Ingst
Int-S
3
A/C
Ingst
Int-M
3
U
Ingst
Int-S
3
C
Ingst
Int-S
2
U
Ingst
Int-S
2
Analyte
acetaminophen
1
1
ethanol
acetaminophen
1
1
acetaminophen
ethanol
2
2
acetaminophen/
hydrocodone
1
1
acetaminophen/
diphenhydramine
diphenhydramine/
ibuprofen
1
1
2
2
acetaminophen
1
1
acetaminophen/oxycodone
1
1
salicylate
1
U
Ingst
Unk
2
U
Ingst
Int-S
3
Blood Concentration
@ Time
23 mg/dL In Blood
(unspecified)
@ Unknown
73 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
62 mg/L In Plasma
@ Unknown
acetaminophen
71 mcg/mL In Blood
(unspecified)
@ Unknown
1
salicylate
salicylate
58.9 mg/dL In Serum
@ 3 h (pe)
83 mg/dL In Serum
@ 30 m (pe)
U
A/C
A
Ingst
Int-U
3
Ingst
Int-M
2
Ingst + Inhal
Int-S
1
salicylate
1
1
medicines, cultural*
phenmetrazine*
THC homolog
3
2
4
2
2
4
opioid
zolpidem
1
2
1
2
acetaminophen/
hydrocodone
1
1
hydrocodone
acetaminophen/
hydrocodone
1
1
acetaminophen
ethanol
60 y F
A/C
60 y F
A
ethanol
2
2
salicylate
3
3
acetaminophen/oxycodone
1
1
60 y F
60 y F
60 y F
618 ph
1
60 y M
612ai
617
1
59 y F
60 y F
616
methadone
59 y F
60 y F
615
1
59 y F
611ai
614
1
59 y F
610ai
613 h
acetaminophen/
hydrocodone
58 y M
600 p
602
Cause
Rank
58 y M
599 h
601 h
Substance
Rank
Substances
acetaminophen/
caffeine/salicylate
1
1
methadone
1
1
fentanyl
1
1
hydrocodone
oxycodone
carisoprodol
diazepam
1
2
3
4
1
2
3
4
acetaminophen
1
1
acetaminophen/
hydrocodone*
2
1
lorazepam*
naproxen
(extended release)
temazepam
1
3
1
3
4
4
salicylate
1
1
acetaminophen
1
1
60 y F
60 y F
61 y F
61 y M
acetaminophen
1
1
acetaminophen/
hydrocodone
1
1
61 y M
Int-S
2
Ingst + Unk
Int-S
1
A/C
Ingst
Int-A
1
A
Ingst
Int-S
2
A
Ingst
Int-U
2
A
Derm
Int-U
2
A
Ingst
Int-U
2
U
Ingst
Unk
2
A/C
Ingst
Int-S
2
C
61 y F
Ingst
Ingst
Unk
Ingst
Int-S
1
C
Ingst
Int-M
1
Ingst
Unk
acetaminophen
55 mcg/mL In Serum
@ Unknown
acetaminophen
22 mcg/mL In Blood
(unspecified)
@ Unknown
salicylate
93 mg/dL In Unknown
@ Unknown
acetaminophen
350.5 mcg/mL In Serum
@ Unknown
acetaminophen
47 mcg/mL In Blood
(unspecified)
@ 24 h (pe)
acetaminophen
36 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
2
U
C
0.14 mg/L In Blood
(unspecified)
@ 12 h (pe)
48 mg/L In Blood
(unspecified)
@ 12 h (pe)
77 mg/dL In Serum
@ 12 m (pe)
3
(continued)
AAPCC 2014 Annual Report of the NPDS
1027
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
619 ph
62 y M
621ai
62 y F
623 ha
624
625 h
626
633pha
634 h
635pa
2
metoprolol (extended
release)
amlopidipine
quetiapine
3
3
4
5
4
5
acetaminophen
1
benzodiazepine
opioid
oxazepam
Chronicity
Route
Reason
RCF
Analyte
Blood Concentration
@ Time
salicylate
18 mg/dL In Blood
(unspecified)
@ 1 h (pe)
1
acetaminophen
5.6 mg/L In Blood
(unspecified)
@ Unknown
2
3
4
2
3
4
oxazepam
temazepam
5
5
temazepam
1638 ng/mL In Urine
(quantitative only)
@ Unknown
18714 ng/mL In Urine
(quantitative only)
@ Unknown
morphine
6
6
oxycodone
1
1
A
Ingst
Int-S
2
A
Ingst
Int-U
2
U
Ingst
Int-A
2
A
Ingst
Int-S
2
C
Ingst
AR-D
3
hydrocodone
morphine
1
2
1
2
tramadol
trazodone
eszopiclone
diazepam
1
2
3
4
1
2
3
4
acetaminophen
1
1
acetaminophen
ethanol
2
2
ethanol
salicylate
ethanol (non-beverage)
1
2
1
2
acetaminophen/oxycodone
oxycodone
cocaine
1
2
3
1
2
3
acetaminophen/oxycodone
1
1
acetaminophen
1
1
63 y M
63 y M
63 y F
632 h
2
63 y M
63 y M
631 h
salicylate
62 y M
628ai
630
Cause
Rank
62 y F
627
629
Substance
Rank
Substances
62 y F
620ai
622 ph
Downloaded by [AAPCC] at 12:54 01 December 2015
Age
A
Ingst
Int-S
1
A
Ingst
Int-S
3
A/C
Ingst
Int-S
3
A
Ingst
Int-S
1
A
Ingst + Derm
Int-U
2
U
Ingst
Int-S
1
acetaminophen
141 mcg/mL In Serum
@ Unknown
acetaminophen
195.4 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
acetaminophen
121 mcg/mL In Blood
(unspecified)
@ 10 h (pe)
acetaminophen
385.5 mcg/mL In Blood
(unspecified)
@ Unknown
0 mg/mL In Blood
(unspecified)
@ Unknown
0 mg/mL In Blood
(unspecified)
@ Unknown
0 mg/mL In Blood
(unspecified)
@ Unknown
fentanyl
hydrocodone
temazepam
1
2
3
1
2
3
acetaminophen/
hydrocodone
1
1
acetaminophen/
hydrocodone
1
1
insulin
2
2
acetaminophen
1
1
ethanol
2
2
hydromorphone
1
1
hydromorphone
morphine (extended
release)
2
2
morphine
diazepam
3
3
diazepam
acetaminophen/
hydrocodone
1
1
acetaminophen
levetiracetam
1
2
1
2
oxycodone
1
1
oxycodone (free)
oxycodone
1
1
oxymorphone (total)
ethanol
2
2
ethanol
63 y M
63 y M
U
63 y M
A
63 y M
A/C
64 y F
64 y F
64 y F
Ingst
Ingst
Ingst
Int-S
Int-S
Unk
124 mcg/mL In Blood
(unspecified)
@ Unknown
39 mg/dL In Blood
(unspecified)
@ Unknown
3
1
3
U
Ingst
Int-S
1
A
Ingst
Int-S
3
U
Ingst
Int-S
1
1000 ng/mL In Blood
(unspecified)
@ Autopsy
8.7 ng/mL In Blood
(unspecified)
@ Autopsy
79 mg/dL In Blood
(unspecified)
@ Autopsy
(continued)
1028
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
636 ph
65 y M
638
65 y F
640
641 h
Substances
Substance
Rank
Cause
Rank
alprazolam
3
3
alprazolam
duloxetine
4
4
duloxetine
acetaminophen*
zolpidem*
1
2
1
1
acetaminophen
1
1
64 y M
637
639pa
Downloaded by [AAPCC] at 12:54 01 December 2015
Age
65 y F
644ai
66 y M
646 ha
647
648 ha
649pa
A
Ingst
Int-S
2
U
Ingst
Unk
2
C
Ingst
Int-M
1
A/C
Ingst
Int-S
2
Analyte
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
olanzapine
2
2
methadone
morphine
corticosteroids
1
2
3
1
2
3
salicylate
1
1
salicylate
salicylate
1
1
salicylate
oxycodone
1
1
acetaminophen/
hydrocodone
645 h
RCF
1
2
65 y F
65 y F
Reason
1
2
65 y M
643 h
Route
oxycodone
oxycodone
65 y F
642ai
Chronicity
1
U
Ingst
Unt-T
3
A
Ingst
Int-S
1
U
Ingst
Int-U
2
A
Ingst
Unk
3
U
Ingst
Int-U
2
U
Ingst
Unk
2
1
acetaminophen/
hydrocodone
acetaminophen/
hydrocodone
drug, unknown
1
1
acetaminophen
1
1
acetaminophen
2
2
acetaminophen/
oxycodone
1
1
acetaminophen
acetaminophen/
oxycodone
1
1
acetaminophen
salicylate
1
1
atorvastatin
2
2
acetaminophen/
oxycodone
1
1
oxycodone
1
oxycodone
66 y M
A
Ingst
Ingst
Int-M
Int-S
131.7 mg/dL In Blood
(unspecified)
@ 9 h (pe)
75.4 mg/dL In Blood
(unspecified)
@ 45 m (pe)
163 mcg/mL In Serum
@ 0.5 h (pe)
29 mcg/mL In Serum
@ 8 h (pe)
1
2
A
159 mcg/mL In Blood
(unspecified)
@ 24 h (pe)
304 mcg/mL In Blood
(unspecified)
@ 20 m (pe)
370 mcg/mL In Blood
(unspecified)
@ 47 h (pe)
441 mcg/mL In Blood
(unspecified)
@ 42 h (pe)
442 mcg/mL In Urine
(quantitative only)
@ Unknown
462.9 mcg/mL In Blood
(unspecified)
@ 40 h (pe)
80.5 mcg/mL In Blood
(unspecified)
@ 61 h (pe)
81.6 mcg/mL In Serum
@ Unknown
1
2
66 y F
15 mcg/mL In Blood
(unspecified)
@ Autopsy
50 ng/mL In Blood
(unspecified)
@ Autopsy
acetaminophen
tramadol
diphenhydramine
66 y F
Blood Concentration
@ Time
1
30.8 mg/L In Blood
(unspecified)
@ Unknown
52.5 mcg/mL In Blood
(unspecified)
@ Unknown
1
salicylate
129.9 mg/dL In Blood
(unspecified)
@ Unknown
1
oxycodone
1
1
oxymorphone
2503 ng/mL In Blood
(unspecified)
@ Unknown
50.9 ng/mL In Blood
(unspecified)
@ Unknown
zolpidem
hydrocodone
2
3
2
3
hydrocodone
lorazepam
4
4
lorazepam
66 y F
67 y F
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
63.3 ng/mL In Blood
(unspecified)
@ Unknown
39.2 ng/mL In Blood
(unspecified)
@ Unknown
(continued)
AAPCC 2014 Annual Report of the NPDS
1029
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
650
67 y F
651 h
652 h
653i
Substance
Rank
Cause
Rank
acetaminophen
1
1
tramadol
diclofenac
drug, unknown
opioid
1
2
3
4
1
2
3
4
acetaminophen/
oxycodone*
hydromorphone*
citalolpram
1
1
2
3
1
3
salicylate
1
1
acetaminophen
2
2
Substances
67 y M
67 y F
68 y M
654
68 y F
655ai
68 y M
acetaminophen
Downloaded by [AAPCC] at 12:54 01 December 2015
656 p
657
658 ha
659 h
660 p
661 h
662
[663ha]
664 p
665
666 h
1
C
Ingst
Unt-M
1
U
Ingst
Int-S
2
U
Ingst
Unk
2
U
Ingst
Unk
3
Analyte
229 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
salicylate
65 mg/dL In Serum
@ Unknown
13 mg/L In Serum
@ Unknown
acetaminophen
A
Ingst
Int-S
1
U
Ingst
Int-U
2
A/C
Ingst
Int-S
2
acetaminophen
319 mg/L In Plasma
@ Unknown
acetaminophen
118 mcg/mL In Blood
(unspecified)
@ 24 h (pe)
acetaminophen
50.9 mcg/mL In Serum
@ Unknown
0.86 mcg/mL In Whole Blood
@ Autopsy
5.3 mg/mL In Plasma
@ Unknown
acetaminophen
1
1
clonazepam
2
2
acetaminophen
1
1
oxycodone
1
1
oxycodone (free)
oxycodone
1
1
oxycodone (free)
diazepam
temazepam
2
3
2
3
U
A
A
Ingst
Ingst
Ingst
Int-S
Int-S
Unk
3
1
temazepam
2 mcg/mL In Plasma
@ Unknown
acetaminophen
14.4 mcg/mL In Serum
@ Unknown
120 mg/mL In Blood
(unspecified)
@ Unknown
92 mcg/mL In Blood
(unspecified)
@ Unknown
2
opioid
benzodiazepine
acetaminophen
1
2
3
1
2
3
cyclic antidepressant,
unknown
4
4
oxycodone
ethanol
1
2
1
2
ethanol
acetaminophen/
hydrocodone
3
3
acetaminophen
salicylate
1
1
fluoxetine
2
2
acetaminophen
1
1
quetiapine
alprazolam
acetaminophen/
hydrocodone
2
3
4
2
3
4
tramadol
1
tramadol
70 y F
A
70 y M
A/C
Ingst
Ingst
Int-S
Int-S
Blood Concentration
@ Time
acetaminophen
1
2
69 y F
1
1
salicylate
95.3 mg/dL In Serum
@ Unknown
acetaminophen
959 mcg/mL In Blood
(unspecified)
@ Unknown
1
tramadol
1
1
o-demethyl tramadol
18000 ng/mL In Blood
(unspecified)
@ 5 m (pe)
780 ng/mL In Blood
(unspecified)
@ 5 m (pe)
acetaminophen/
oxycodone
1
1
acetaminophen/
hydrocodone
1
1
acetaminophen
1
acetaminophen
oxycodone
71 y F
A
71 y M
A
71 y M
A
Ingst
Ingst
Ingst
Int-S
Int-S
Int-S
2
1
1
acetaminophen
96 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
82 mcg/mL In Blood
(unspecified)
@ Unknown
1
acetaminophen
1
1
acetaminophen
3.4 mcg/mL In Blood
(unspecified)
@ Unknown
5.6 mcg/mL In Blood
(unspecified)
@ Unknown
1
1
72 y F
A
72 y F
74 y F
RCF
1
2
69 y M
72 y F
Reason
hydrocodone
carisoprodol
68 y M
668
Route
1
68 y F
667 h
Chronicity
U
Ingst
Ingst
Int-S
Unk
2
2
A/C
Ingst
Int-S
3
U
Ingst
Int-S
3
(continued)
1030
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
669
670 ha
Downloaded by [AAPCC] at 12:54 01 December 2015
671ai
672 ha
673 h
674 p
675 ha
676
Age
Cause
Rank
acetaminophen
1
1
alprazolam
2
2
acetaminophen/
oxycodone
1
acetaminophen/
oxycodone
Reason
RCF
Analyte
Blood Concentration
@ Time
1
acetaminophen
1
1
acetaminophen
10 mcg/mL In Blood
(unspecified)
@ 2 d (pe)
18 mcg/mL In Blood
(unspecified)
@ Unknown
ethanol
2
2
acetaminophen/
hydrocodone
1
1
hydrocodone
acetaminophen/
hydrocodone
1
1
hydrocodone
temazepam
2
2
oxazepam
temazepam
2
2
temazepam
temazepam
2
2
temazepam
hydrocodone
1
1
acetaminophen/
hydrocodone
acetaminophen
1
1
2
2
acetaminophen
acetaminophen
2
2
acetaminophen
acetaminophen
2
2
acetaminophen
acetaminophen
2
2
acetaminophen
acetaminophen
2
2
acetaminophen
acetaminophen
2
2
acetaminophen
acetaminophen
2
2
acetaminophen
acetaminophen
2
2
acetaminophen
acetaminophen
2
2
acetaminophen
acetaminophen
2
2
acetaminophen
diazepam
3
3
diazepam
acetaminophen/butalbital/
caffeine
1
1
acetaminophen
1
1
acetaminophen/
oxycodone*
morphine*
2
1
1
1
oxycodone
zolpidem
1
2
1
2
oxycodone
1
1
C
A/C
76 y F
76 y F
77 y M
78 y F
1
1
acetaminophen/
hydrocodone
1
1
79 y F
80 y F
acetaminophen/
oxycodone
1
1
Ingst + Aspir
Unk
Int-S
3
2
Ingst
Int-U
2
A/C
Ingst
Int-S
1
A/C
Ingst
Int-U
2
A
Ingst
Int-S
3
A/C
acetaminophen
Ingst
A
A
79 y F
79 y F
Route
544 mcg/mL In Unknown
@ Unknown
75 y M
79 y M
Chronicity
acetaminophen
75 y F
678 h
680
Substance
Rank
74 y M
677
679 h
Substances
Ingst
Int-S
203 ng/mL In Blood
(unspecified)
@ Autopsy
60 ng/mL In Urine
(quantitative only)
@ Autopsy
104 ng/mL In Urine
(quantitative only)
@ Autopsy
2600 ng/mL In Urine
(quantitative only)
@ Autopsy
561 ng/mL In Blood
(unspecified)
@ Autopsy
11.2 mcg/mL In Blood
(unspecified)
@ 87 h (pe)
128.8 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
136.7 mcg/mL In Blood
(unspecified)
@ 50 h (pe)
161.6 mcg/mL In Blood
(unspecified)
@ 47 h (pe)
26.6 mcg/mL In Blood
(unspecified)
@ 81 h (pe)
41.6 mcg/mL In Blood
(unspecified)
@ 14 h (pe)
43.9 mcg/mL In Blood
(unspecified)
@ 70 h (pe)
47.4 mcg/mL In Blood
(unspecified)
@ 34 h (pe)
85.9 mcg/mL In Blood
(unspecified)
@ 5 h (pe)
95.5 mcg/mL In Blood
(unspecified)
@ 58 h (pe)
201 ng/mL In Blood
(unspecified)
@ 25 h (pe)
acetaminophen
27 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
acetaminophen
97.6 mg/mL In Serum
@ 4 h (pe)
acetaminophen
13 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
67 mcg/mL In Serum
@ 24 h (pe)
acetaminophen
79 mcg/mL In Serum
@ 7 h (pe)
1
Ingst
Int-S
3
A/C
Ingst
Int-S
3
C
Ingst
Unt-T
3
U
Ingst
Int-S
1
A/C
Ingst
Int-M
3
(continued)
AAPCC 2014 Annual Report of the NPDS
1031
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
681 ha
82 y F
682 h
683 a
684
685 h
Downloaded by [AAPCC] at 12:54 01 December 2015
686 p
687 ha
[688ha]
689
690 pi
[691pa]
[692pa]
Substance
Rank
Cause
Rank
salicylate
1
1
salicylate
salicylate
1
1
salicylate
warfarin
2
2
acetaminophen
1
1
Substances
83 y F
83 y M
Chronicity
Route
Reason
A
Ingst
Int-S
RCF
Analyte
1
U
Ingst
Int-U
1
A
Ingst
Int-S
1
285 mcg/mL In Serum
@ Unknown
130 mg/dL In Blood
(unspecified)
@ 3 h (pe)
900 mcg/mL In Blood
(unspecified)
@ Autopsy
1
1
salicylate
salicylate
1
1
salicylate
acetaminophen/
hydrocodone
1
1
tramadol
citalopram
1
2
1
2
acetaminophen/
hydrocodone
1
acetaminophen/
hydrocodone
A
Ingst
Int-S
640 mcg/mL In Blood
(unspecified)
@ Autopsy
82 mg/dL In Blood
(unspecified)
@ Unknown
acetaminophen
salicylate
84 y F
Blood Concentration
@ Time
2
acetaminophen
291 mcg/mL In Blood
(unspecified)
@ Unknown
1
acetaminophen
1
1
dihydrocodeine/
hydrocodol (free)
acetaminophen/
hydrocodone
1
1
hydromorphone
acetaminophen/
hydrocodone
1
1
hydrocodone (free)
acetaminophen/
hydrocodone
1
1
acetaminophen
130 mcg/mL In Blood
(unspecified)
@ Unknown
21 ng/mL In Blood
(unspecified)
@ Unknown
3.1 ng/mL In Blood
(unspecified)
@ Unknown
340 ng/mL In Blood
(unspecified)
@ Unknown
94 mcg/mL In Blood
(unspecified)
@ Unknown
acetaminophen
1
1
acetaminophen
acetaminophen
1
1
acetaminophen
diphenhydramine
naproxen
ibuprofen
2
3
4
2
3
4
acetaminophen
1
1
acetaminophen
1
1
salicylate
hydrochlorothiazide/
lisinopril
2
3
2
3
morphine
1
1
morphine
1
morphine
84 y M
86 y M
89 y F
C
Ingst
Unk
3
A
Ingst
Int-S
2
A
90 y F
A
Ingst
Ingst
Int-S
Int-S
1
146 mcg/mL In Serum
@ 7.5 h (pe)
504 mcg/mL In Serum
@ 15 m (pe)
2
acetaminophen
814 mcg/mL In Serum
@ 4 h (pe)
acetaminophen
50.8 mg/L In Plasma
@ Unknown
1
morphine
1
1
morphine
1300 ng/mL In
Whole Blood
@ Autopsy
2100 ng/mL In Gastric
(stomach content)
@ Autopsy
oxycodone
1
1
oxymorphone
oxycodone
1
1
oxymorphone
oxycodone
1
1
oxycodone
oxycodone
1
1
oxycodone
carisoprodol
2
2
meprobamate
carisoprodol
2
2
carisoprodol
carisoprodol
2
2
meprobamate
carisoprodol
2
2
carisoprodol
96 y F
C
18 m M
18 m F
23 m M
Ingst
Int-S
3
U
Ingst
Unk
2
A
Unk
Unk
1
A
Ingst
Unt-U
1
20.8 ng/mL In Blood
(unspecified)
@ Autopsy
2514 ng/mL In Urine
(quantitative only)
@ Autopsy
3518 ng/mL In Urine
(quantitative only)
@ Autopsy
838 ng/mL In Blood
(unspecified)
@ Autopsy
19.84 mcg/mL In Blood
(unspecified)
@ Autopsy
27.47 mcg/mL In Blood
(unspecified)
@ Autopsy
33149 ng/mL In Urine
(quantitative only)
@ Autopsy
4099 ng/mL In Urine
(quantitative only)
@ Autopsy
(continued)
1032
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Downloaded by [AAPCC] at 12:54 01 December 2015
693pai
Age
Substances
Substance
Rank
Cause
Rank
clonazepam
3
3
7-aminoclonazepam
clonazepam
3
3
7-aminoclonazepam
clonazepam
3
3
clonazepam
alprazolam
4
4
alprazolam
alprazolam
4
4
alpha-oh-alprazolam
alprazolam
4
4
alprazolam
ethanol
5
5
ethanol
cleaner (ammonia)
laundry (prewash)
laundry (prewash)
cleaner (anionic/nonionic)
bath salts
6
7
8
9
10
6
7
8
9
10
Unknown
adult
(4¼ 20 yrs)
M
fentanyl
heroin
ethanol
694 pi
Unknown age
M
1
2
3
Chronicity
Route
Reason
RCF
A
Par
Int-A
2
A
Unk
Unk
2
Analyte
Blood Concentration
@ Time
196 ng/mL In Urine
(quantitative only)
@ Autopsy
54.6 ng/mL In Blood
(unspecified)
@ Autopsy
9.2 ng/mL In Blood
(unspecified)
@ Autopsy
15.1 ng/mL In Blood
(unspecified)
@ Autopsy
343 ng/mL In Urine
(quantitative only)
@ Autopsy
73 ng/mL In Urine
(quantitative only)
@ Autopsy
0.062 % (wt/Vol) In Urine
(quantitative only)
@ Autopsy
1
2
3
opioid
1
1
See Also case 1, 3, 5, 8, 11, 17, 28, 29, 30, 33, 42, 43, 53, 76, 78, 124, 138, 179, 192, 293, 700, 702, 704, 710, 725, 728, 733, 738, 744, 752, 755, 757, 759, 760, 770, 776, 782, 784, 788, 805, 806, 808, 811, 812, 813,
815, 822, 826, 830, 835, 840, 841, 843, 849, 854, 855, 856, 863, 869, 870, 878, 885, 892, 896, 897, 899, 904, 931, 939, 948, 953, 966, 974, 976, 982, 983, 997, 999, 1004, 1006, 1011, 1028, 1030, 1048, 1052, 1053,
1055, 1056, 1061, 1062, 1067, 1068, 1070, 1077, 1087, 1098, 1104, 1105, 1106, 1107, 1108, 1109, 1110, 1113, 1114, 1116, 1119, 1120, 1122, 1124, 1128, 1129, 1130, 1133, 1139, 1144, 1151, 1154, 1157, 1160,
1165, 1177, 1181, 1182, 1185, 1186, 1191, 1194, 1209, 1210, 1214, 1226, 1237, 1241, 1244, 1258, 1259, 1261, 1275, 1282, 1286, 1287, 1298, 1299, 1300, 1309, 1311, 1314, 1315, 1318, 1320, 1328, 1334, 1343,
1345, 1347, 1351, 1356, 1358, 1360, 1363, 1377, 1382, 1385, 1392, 1397, 1406
Anesthetics
[695ph]
15 y F
A
Ingst
Int-S
1
lidocaine
1
1
[696h]
24 y M
A
Unk
Int-U
1
methoxetamine (MXE)
1
1
697 p
47 y F
A
Ingst
Int-S
2
lidocaine
1
1
See Also case 6, 12, 1129, 1261
Anticoagulants
698
57 y M
A/C
Ingst
Int-S
3
apixiban
1
1
zolpidem (extended
2
2
release)
[699h]
67 y M
C
Ingst
AR-D
2
fondaparinux
1
1
700 h
69 y F
A/C
Ingst
Unt-T
2
warfarin
1
1
acetaminophen
2
2
acetaminophen
116 mcg/mL In Blood
(unspecified)
@ Unknown
701 ph
70 y M
A/C
Ingst
AR-D
2
rivaroxaban
1
1
702 p
72 y F
A
Ingst
Int-S
2
warfarin
1
1
naproxen
2
2
acetaminophen
3
3
sertraline
4
4
antihyperlipidemic
5
5
ibuprofen
6
6
drug, unknown
7
7
ethanol
8
8
703 h
75 y F
C
Ingst
AR-D
2
factor Xa inhibitor
1
1
704
76 y F
C
Ingst
Int-S
1
dabigatran
1
1
acetaminophen/oxycodone
2
2
acetaminophen
128 mcg/mL In Serum
@ 10 m (pe)
705 h
79 y M
C
Ingst
AR-D
3
dabigatran
1
1
706 h
80 y M
C
Ingst
AR-D
2
factor Xa inhibitor
1
1
707 h
83 y F
A/C
Ingst
AR-D
3
rivaroxaban
1
1
708 h
85 y F
C
Ingst
Unk
1
thrombin inhibitor
1
1
See Also case 391, 579, 681, 730, 906, 917, 932, 981, 983, 987, 991, 1002, 1007, 1028
Anticonvulsants
[709ha]
20 y F
U
Ingst
Int-S
1
topiramate
1
1
topiramate
51000 ng/mL In Serum
@ Unknown
ethanol
2
2
710 ha
21 y F
A/C
Ingst
Int-S
1
(continued)
AAPCC 2014 Annual Report of the NPDS
1033
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
711 h
712 ha
713
714 ph
Downloaded by [AAPCC] at 12:54 01 December 2015
715
716
717
718 h
719
720 a
721 p
722 p
723 p
724 h
725 h
726 ph
Age
Substance
Rank
Cause
Rank
carbamazepine
1
1
carbamazepine
lamotrigine
2
2
lamotrigine
fluoxetine
3
3
fluoxetine
hydroxyzine
ibuprofen
4
5
4
5
lamotrigine
clonazepam
1
2
1
2
zonisamide
levetiracetam
1
2
1
2
gabapentin
ethanol
1
2
1
2
lamotrigine
venlafaxine
aripiprazole
bupropion
1
2
3
4
1
2
3
4
lamotrigine
clonidine
ethanol
1
2
3
1
2
3
zonisamide
benzodiazepine
1
2
1
2
lamotrigine
insulin
fluoxetine
eszopiclone
alprazolam
1
2
3
4
5
1
2
3
4
5
lamotrigine
trazodone
1
2
1
2
valproic acid
1
1
lamotrigine
paroxetine
citalopram
2
3
4
2
3
4
pregabalin
clonazepam
ethanol
1
2
3
1
2
3
carbamazepine
1
1
nortriptyline
diazepam
lorazepam
mirtazapine
gabapentin
2
3
4
5
6
2
3
4
5
6
gabapentin
ethanol
1
2
1
2
gabapentin
1
1
valproic acid
1
valproic acid
Substances
22 y F
35 y F
36 y F
Chronicity
Route
Reason
RCF
A/C
Ingst
Int-S
2
C
Ingst
AR-D
3
A
Ingst
Int-S
2
Analyte
Blood Concentration
@ Time
12 mcg/mL In Blood
(unspecified)
@ Autopsy
5.7 mcg/mL In Blood
(unspecified)
@ Autopsy
0.3 mcg/mL In Blood
(unspecified)
@ Autopsy
ethanol
15 mg/dL In Blood
(unspecified)
@ Unknown
ethanol
145 mg/dL In Blood
(unspecified)
@ Unknown
valproic acid
150 mcg/mL In Blood
(unspecified)
@ Unknown
carbamazepine
19.7 mg/L In Serum
@ Unknown
ethanol
53 mg/dL In Blood
(unspecified)
@ Unknown
1
valproic acid
1
1
valproic acid
valproic acid
1
1
valproic acid
199 mcg/mL In Blood
(unspecified)
@ 7 h (pe)
284 mcg/mL In Blood
(unspecified)
@ 4 h (pe)
330 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
quetiapine
2
2
lamotrigine
ethanol
1
2
1
2
opioid
3
3
lamotrigine
trazodone
1
2
1
2
42 y F
44 y F
44 y F
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A/C
47 y F
Ingst
Int-S
2
Ingst + Par
Int-S
2
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
2
A
48 y F
52 y F
53 y F
54 y F
55 y M
U
Ingst
Int-U
2
A
Ingst
Int-S
2
U
55 y M
56 y M
58 y F
Unk
2
U
Ingst
Unk
2
A/C
Ingst
Int-S
2
A
61 y M
Ingst
Ingst
Int-S
2
ethanol
A/C
Ingst
Int-S
148 mg/dL In Unknown
@ Unknown
1
(continued)
1034
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
727 a
67 y M
728
Downloaded by [AAPCC] at 12:54 01 December 2015
729 h
730 h
731 h
Substances
Substance
Rank
Cause
Rank
valproic acid
1
1
trazodone
olanzapine
amantadine
haloperidol
fenofibrate
fosinopril
tamulosin
2
3
4
5
6
7
8
2
3
4
5
6
7
8
gabapentin
acetaminophen
paroxetine
1
2
3
1
2
3
phenytoin
1
phenytoin
Chronicity
Route
Reason
A/C
Ingst
Int-S
RCF
Analyte
Blood Concentration
@ Time
1
valproic acid
129 mg/mL In Blood
(unspecified)
@ Unknown
1
phenytoin
1
1
phenytoin
phenytoin
1
1
phenytoin
phenytoin
1
1
phenytoin
phenytoin
1
1
phenytoin
phenytoin
1
1
phenytoin
35.1 mcg/mL In Blood
(unspecified)
@ 10 d (pe)
36 mcg/mL In Blood
(unspecified)
@ 8 d (pe)
42.5 mcg/mL In Blood
(unspecified)
@ 5 d (pe)
46.8 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
50.2 mcg/mL In Blood
(unspecified)
@ 2 d (pe)
51.5 mcg/mL In Blood
(unspecified)
@ 3 d (pe)
phenytoin
warfarin
1
2
1
2
69 y F
71 y F
73 y F
C
Ingst
Int-S
2
A/C
Ingst
AR-D
3
C
Ingst
Unt-T
3
75 y F
A
Ingst
Int-S
2
valproic acid (extended
1
1
release)
alprazolam
2
2
See Also case 335, 337, 359, 360, 363, 406, 423, 427, 441, 472, 514, 540, 541, 552, 584, 588, 634, 732, 734, 746, 749, 755, 760, 761, 764, 766, 769, 776, 777, 780, 786, 788, 793, 797, 814, 819, 821, 838, 843, 851,
867, 872, 877, 889, 892, 894, 899, 901, 904, 908, 917, 925, 929, 931, 935, 947, 956, 964, 999, 1024, 1042, 1052, 1067, 1073, 1078, 1115, 1116, 1131, 1132, 1137, 1140, 1144, 1146, 1152, 1176, 1259, 1298, 1314,
1320, 1337
Antidepressants
732pa
8y M
A
Ingst
Unt-G
3
nortriptyline
1
1
nortriptyline
3000 ng/mL In Whole Blood
@ Autopsy
trazodone
2
2
atomoxetine
3
3
valproic acid
4
4
valproic acid
12 mcg/mL In Whole Blood
@ Autopsy
lamotrigine
5
5
lamotrigine
1.5 mcg/mL In Whole Blood
@ Autopsy
733
15 y F
A
Ingst
Int-S
2
citalopram
1
1
morphine
2
2
acetaminophen/
3
3
hydrocodone
oxycodone
4
4
temazepam
5
5
734pa
16 y F
A
Ingst
Int-S
1
bupropion
1
1
bupropion
1400 ng/mL In Whole Blood
@ Unspecified
amphetamine
2
2
amphetamine
170 ng/mL In Whole Blood
@ Unspecified
caffeine/herbs/green tea
3
3
valproic acid
4
4
valproic acid
5 mcg/mL In Serum
@ 1 h (pe)
735 h
17 y M
C
Ingst
AR-D
3
lithium
1
1
736 h
18 y M
A
Ingst
Int-S
1
bupropion (extended
1
1
release)
737pa
19 y M
A/C
Ingst + Aspir
Int-S
1
doxepin
1
1
738 h
19 y F
A/C
Ingst
Int-S
1
venlafaxine
1
1
trazodone
2
2
acetaminophen/caffeine
3
3
739
20 y F
A
Ingst
Int-S
2
bupropion
1
1
740ai
20 y M
A
Ingst
Int-S
2
citalopram
1
1
741pha
21 y F
A
Ingst
Int-S
1
venlafaxine
1
1
venlafaxine
19.4 mg/L In Blood
(unspecified)
@ Autopsy
benzodiazepine
2
2
alprazolam
0.04 mg/L In Blood
(unspecified)
@ Autopsy
742 p
22 y F
A
Ingst
Int-S
2
escitaopram
1
1
diazepam
2
2
(continued)
AAPCC 2014 Annual Report of the NPDS
1035
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
743
22 y M
744pa
745 h
746 a
747 h
Downloaded by [AAPCC] at 12:54 01 December 2015
748 h
749 ha
750 ha
751 h
752
753pha
[754ha]
755 ha
Substances
Substance
Rank
Cause
Rank
bupropion
clonazepam
clonidine
1
2
3
1
2
3
bupropion
1
1
nonsteroidal
antiinflammatory
drug, unknown
2
2
3
3
citalolpram
alprazolam
1
2
1
2
bupropion (extended
release)
escitalopram
lamotrigine
clonazepam
1
1
2
3
4
2
3
4
amitriptyline
activated charcoal*
sertraline*
zolpidem
1
2
3
4
1
2
2
3
lithium
1
lithium
24 y F
Route
Reason
RCF
A/C
Ingst
Int-S
1
A
Ingst
Int-U
1
Analyte
Blood Concentration
@ Time
bupropion
1.2 mg/L In Blood
(unspecified)
@ Autopsy
1
lithium
1
1
lithium
2.8 mmol/L In Blood
(unspecified)
@ Unknown
6 mmol/L In Blood
(unspecified)
@ 30 m (pe)
amitriptyline
1
1
amitriptyline
amitriptyline
1
1
nortriptyline
amitriptyline
1
1
amitriptyline
chlorpromazine
2
2
chlorpromazine
citalopram
3
3
citalopram
gabapentin
4
4
gabapentin
zolpidem
5
5
zolpidem
cocaine
6
6
benzoylecognine
alprazolam
7
7
alprazolam
bupropion
1
1
bupropion
bupropion
1
1
hydroxybupropion
bupropion
1
1
hydroxybupropion
bupropion
1
1
bupropion
citalopram
1
1
sertraline
ibuprofen
ethanol
1
2
3
1
2
3
lithium
1
1
beta blocker
bupropion
benzodiazepine
metformin
2
3
4
5
2
3
4
5
venlafaxine
1
1
venlafaxine
1
1
25 y F
25 y M
25 y F
27 y M
A
Ingst + Aspir
Unk
2
A
Ingst + Aspir
Int-S
1
A/C
Ingst + Aspir
Int-S
2
Ingst
Unk
2
U
27 y F
A
29 y M
A
30 y F
30 y F
31 y F
31 y F
33 y M
Chronicity
Ingst
Ingst
Int-S
Int-S
1
1
U
Ingst
Int-S
2
A/C
Ingst
Int-S
3
A
Ingst
Int-S
1
A/C
Ingst
Int-S
Ingst
Int-S
1800 ng/mL In Blood
(unspecified)
@ 3 d (pe)
2300 ng/mL In Blood
(unspecified)
@ 2 h (pe)
5000 ng/mL In Blood
(unspecified)
@ 3 d (pe)
730 ng/mL In Blood
(unspecified)
@ 2 h (pe)
lithium
9.15 mEq/L In Serum
@ Unknown
venlafaxine
26 mg/L In Blood
(unspecified)
@ Unknown
80 mg/kg In Liver
@ Autopsy
2
venlafaxine
A/C
175 ng/mL In Blood
(unspecified)
@ Unknown
204 ng/mL In Blood
(unspecified)
@ Unknown
240 ng/mL In Blood
(unspecified)
@ Unknown
68 ng/mL In Blood
(unspecified)
@ Unknown
323 ng/mL In Blood
(unspecified)
@ Unknown
1.9 mcg/mL In Blood
(unspecified)
@ Unknown
398 ng/mL In Blood
(unspecified)
@ Unknown
2730 ng/mL In Urine
(quantitative only)
@ Unknown
4.3 ng/mL In Blood
(unspecified)
@ Unknown
1
(continued)
1036
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
756 ph
757 h
Downloaded by [AAPCC] at 12:54 01 December 2015
758ai
759 ha
760
761
762 ph
763 ha
764 h
765 ha
766 ha
Age
Substances
Substance
Rank
Cause
Rank
escitalopram
1
1
citralopram
dextromethorphan
2
2
dextromethorphan
cyclobenzaprine
3
3
cyclobenzaprine
topiramate
4
4
topiramate
chlorpheniramine
5
5
chlorpheniramine
meloxicam
trazodone
olanzapine
sumatriptan
benzonatate
buspirone
6
7
8
9
10
11
6
7
8
9
10
11
nortriptyline
propranolol
1
2
1
2
venlafaxine
tramadol
promethazine
1
2
3
1
2
3
doxepin
citalopram
1
2
1
2
amitriptyline
opioid
alprazolam
clonazepam
1
2
3
4
1
2
3
4
amitriptyline
pregabalin
acetaminophen/butalbital/
caffeine
1
2
3
1
2
3
trazodone
hydralazine
carbamazepine
1
2
3
1
2
3
lithium
1
1
lithium
1
1
lithium
lithium
1
1
lithium
quetiapine
sertraline
2
3
2
3
bupropion
lamotrigine
clonidine
haloperidol
ethanol
1
2
3
4
5
1
2
3
4
5
bupropion (extended
release)
1
bupropion (extended
release)
33 y M
33 y F
36 y M
37 y F
37 y F
37 y F
38 y M
38 y F
39 y M
Chronicity
Route
Reason
RCF
A/C
Ingst
Int-S
1
U
Ingst
Int-S
2
U
Ingst
Int-U
2
A/C
Ingst
Int-S
2
C
Ingst
Int-S
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
Ingst + Par
Int-S
Analyte
Blood Concentration
@ Time
2336 ng/mL In Blood
(unspecified)
@ Unknown
645 ng/mL In Blood
(unspecified)
@ Unknown
16.9 ng/mL In Blood
(unspecified)
@ Unknown
7 mcg/mL In Blood
(unspecified)
@ Unknown
104 ng/mL In Blood
(unspecified)
@ Unknown
10 mmol/L In Serum
@ 0 d (pe)
5.9 mmol/L In Serum
@ 2 d (pe)
3
ethanol
59 mg/dL In Blood
(unspecified)
@ Unknown
1
bupropion
1
1
hydroxybupropion
ethanol
2
2
ethanol
3700 ng/mL In Blood
(unspecified)
@ Unknown
980 ng/mL In Blood
(unspecified)
@ Unknown
252 mg/dL In Blood
(unspecified)
@ Unknown
bupropion
1
1
bupropion
bupropion
1
1
hydroxybupropion
topiramate
2
2
topiramate
clonazepam
3
3
clonazepam
clonazepam
3
3
7-aminoclonazepam
lorazepam
4
4
lorazepam
metoprolol
vortioxetine
meclizine
5
6
7
5
6
7
39 y M
A/C
39 y F
A/C
Ingst
Ingst
Int-S
Int-S
1
2
1900 ng/mL In Blood
(unspecified)
@ 1 h (pe)
5100 mg/mL In Blood
(unspecified)
@ 1 h (pe)
15000 ng/mL In Blood
(unspecified)
@ 1 h (pe)
42 ng/mL In Blood
(unspecified)
@ 1 h (pe)
91 ng/mL In Blood
(unspecified)
@ 1 h (pe)
11 ng/mL In Blood
(unspecified)
@ 1 h (pe)
(continued)
AAPCC 2014 Annual Report of the NPDS
1037
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
767 p
39 y F
768 h
40 y F
769pha
Downloaded by [AAPCC] at 12:54 01 December 2015
770 ph
771 a
772 ha
773 h
774
775
776 a
777 p
778 h
779 p
780 ph
781
782 p
Substances
Substance
Rank
Cause
Rank
amitriptyline
1
1
Chronicity
Route
Reason
RCF
U
Ingst
Int-S
1
A/C
Ingst
Unk
3
U
Ingst
Int-S
2
Analyte
amitriptyline
1
1
amitriptyline
1
1
nortriptyline
amitriptyline
1
1
amitriptyline
amlodipine
levetiracetam
2
3
2
3
levetiracetam
ethanol
4
4
ethanol
ethanol
4
4
ethanol
bupropion
buprenorphine/
naloxone (film)
aripiprazole
venlafaxine
amphetamine/
dextroamphetamine
quetiapine
1
2
1
2
3
4
5
3
4
5
41 y M
41 y F
A
Ingst
Int-S
2
A
Ingst
Int-S
2
6
6
citalopram
1
1
citalopram
verapamil
2
2
verapamil
promethazine
3
3
promethazine
ethanol
4
4
ethanol
bupropion
1
1
bupropion
bupropion
1
1
bupropion
trazodone
2
2
amitriptyline
carvedilol
1
2
1
2
bupropion
venlafaxine
clonazepam
fluoxetine
ethanol
1
2
3
4
5
1
2
3
4
5
bupropion (extended
release)
venlafaxine (extended
release)
1
1
2
2
citalopram
ethanol
oxycodone
lamotrigine
1
2
3
4
1
2
3
4
trazodone
gabapentin
cyclobenzaprine
1
2
3
1
2
3
amitriptyline
paroxetine
lorazepam
1
2
3
1
2
3
amitriptyline
metoprolol
clonazepam
cyclobenzaprine
1
2
3
4
1
2
3
4
amitriptyline
1
1
gabapentin
2
2
amitriptyline
1
1
cyclic antidepressant,
unknown
1
1
42 y M
42 y F
A
42 y M
44 y F
44 y M
44 y F
45 y F
45 y M
45 y F
46 y F
47 y M
Int-S
Ingst
Int-S
2
C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
1
U
Ingst
Int-S
3
A
Ingst
Int-S
2
U
Ingst
Int-S
2
A
Ingst
Int-S
3
U
378 ng/mL In Blood
(unspecified)
@ Unknown
489 ng/mL In Blood
(unspecified)
@ Unknown
11.7 mcg/mL In Blood
(unspecified)
@ Unknown
21 mg/dL In Blood
(unspecified)
@ Unknown
37 mg/dL In Vitreous
@ Unknown
0.46 mg/L In Blood
(unspecified)
@ Unknown
0.52 mg/L In Blood
(unspecified)
@ Unknown
0.18 mg/L In Blood
(unspecified)
@ Unknown
110 mg/dL In Blood
(unspecified)
@ Unknown
3
A
A/C
47 y M
Ingst
Blood Concentration
@ Time
Ingst
Int-S
2
Ingst + Unk
Int-S
2
358 ng/mL In Blood
(unspecified)
@ Unknown
6255 ng/mL In Blood
(unspecified)
@ Unknown
ethanol
159 mg/dL In Blood
(unspecified)
@ Unknown
amitriptyline
1864 ng/mL In Blood
(unspecified)
@ Unknown
(continued)
1038
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
783 p
47 y M
784
47 y F
Substance
Rank
Cause
Rank
opioid
ethanol
2
3
2
3
doxepin
1
1
Substances
amitriptyline
Downloaded by [AAPCC] at 12:54 01 December 2015
785 a
786 ph
787 h
788 h
789pha
790
791 h
792 h
793 h
794ai
795 ha
1
Chronicity
Route
Reason
RCF
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
1
Analyte
ethanol
79 mg/dL In Blood
(unspecified)
@ Unknown
amitriptyline
2514 ng/mL In Serum
@ Unknown
961 ng/mL In Serum
@ Unknown
187 ng/mL In Serum
@ Unknown
amitriptyline
1
1
nortriptyline
alprazolam
2
2
alprazolam
acetaminophen/
hydrocodone
metoprolol
3
3
4
4
paroxetine
5
5
48 y F
metoprolol
paroxetine
A/C
Ingst
Int-S
1
1
citalopram
quetiapine
2
2
quetiapine
metformin
diazepam
3
4
3
4
diazepam
diazepam
4
4
nordiazepam
benztropine
5
5
benztropine mesylate
venlafaxine
1
1
venlafaxine
venlafaxine
1
1
norvenlafaxine
lamotrigine
paroxetine
2
3
2
3
cyclic antidepressant,
unknown
benzodiazepine
1
1
2
2
bupropion
diazepam
baclofen
trazodone
ibuprofen
ranitidine
hydrochlorothiazide
valsartan
gabapentin
levothyroxine
simvastatin
omeprazole
melatonin
1
2
3
4
5
6
7
8
9
10
11
12
13
1
2
3
4
5
6
7
8
9
10
11
12
13
doxepin
1
1
desmethyldoxepin
doxepin
1
1
doxepin
aripiprazole*
3
2
aripiprazole
metoprolol*
sildenafil
2
4
2
4
duloxetine
alprazolam
1
2
1
2
venlafaxine
risperidone
1
2
1
2
doxepin
1
1
escitalopram
lamotrigine
atenolol
1
2
3
1
2
3
doxepin
sertraline
1
2
1
2
desipramine
1
1
A
49 y F
49 y F
50 y M
50 y F
51 y M
51 y F
52 y M
52 y F
53 y F
Ingst
Int-S
60.2 ng/mL In Serum
@ Unknown
426 ng/mL In Serum
@ Unknown
1
citalopram
48 y M
Blood Concentration
@ Time
685 ng/mL In Blood
(unspecified)
@ Autopsy
7864 ng/mL In Blood
(unspecified)
@ Autopsy
184 ng/mL In Blood
(unspecified)
@ Autopsy
278 ng/mL In Blood
(unspecified)
@ Autopsy
34.4 ng/mL In Blood
(unspecified)
@ Autopsy
1
U
Ingst
Int-S
2
A/C
Ingst
Int-S
2
U
Unk
Int-S
2
U
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
1
U
Ingst
Int-S
2
A
Ingst
Int-S
1
desipramine
1919 ng/mL In Blood
(unspecified)
@ 2 h (pe)
999 ng/mL In Blood
(unspecified)
@ 2 h (pe)
200 ng/mL In Blood
(unspecified)
@ Autopsy
46 ng/mL In Blood
(unspecified)
@ Autopsy
66 ng/mL In Blood
(unspecified)
@ Autopsy
10 mcg/mL In
Whole Blood
@ Autopsy
(continued)
AAPCC 2014 Annual Report of the NPDS
1039
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
796
797 ha
798 h
Downloaded by [AAPCC] at 12:54 01 December 2015
799 h
Age
806pha
807 a
808pha
1
1
sertraline
ziprasidone
bupropion
alprazolam
1
2
3
4
1
2
3
4
bupropion
1
fluoxetine
gabapentin
ethanol
Chronicity
Route
Reason
RCF
Analyte
Blood Concentration
@ Time
desipramine
15 mcg/mL In
Whole Blood
@ Autopsy
1
bupropion
2
2
fluoxetine
7.3 mcg/mL In Blood
(unspecified)
@ Autopsy
3.1 mcg/mL In Blood
(unspecified)
@ Autopsy
3
4
3
4
lithium
ethanol
drug, unknown
1
2
3
1
2
3
duloxetine
clonazepam
baclofen
escitalopram
thyroid preparation
1
2
3
4
5
1
2
3
4
5
amitriptyline
1
1
53 y F
55 y F
805ai
desipramine
53 y M
54 y F
804 p
Cause
Rank
53 y F
801 p
803 h
Substance
Rank
53 y F
800 p
802ai
Substances
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
U
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
Unk
Int-S
2
A
Ingst
Int-U
2
C
Ingst
AR-D
2
ethanol
110 mg/dL In Serum
@ Unknown
3.2 mmol/L In Blood
(unspecified)
@ Unknown
4.6 mmol/L In Blood
(unspecified)
@ Unknown
trazodone
clonazepam
ethanol
1
2
3
1
2
3
citalopram
mirtazapine
benztropine
donepezil
quetiapine
1
2
3
4
5
1
2
3
4
5
lithium
1
1
lithium
lithium
1
1
lithium
doxepin
ethanol
1
2
1
2
alprazolam
3
3
trazodone
butalbital
hydromorphone
alprazolam
1
2
3
4
1
2
3
4
amitriptyline
tramadol
ethanol
1
2
3
1
2
3
bupropion
1
bupropion
55 y F
55 y M
56 y F
A
Ingst
Int-S
1
ethanol
234 mg/dL In Blood
(unspecified)
@ Unknown
ethanol
141 mg/dL In Serum
@ Unknown
1
hydroxybupropion
1
1
bupropion
12000 ng/mL In Blood
(unspecified)
@ Autopsy
53000 ng/mL In Blood
(unspecified)
@ Autopsy
angiotensin receptor
blocker
ethanol
2
2
3
3
ethanol
calcium antagonist
4
4
diltiazem
lorazepam
5
5
lorazepam
fluoxetine
6
6
fluoxetine
fluoxetine
6
6
norfluoxetine
amitriptyline
acetaminophen/
oxycodone
1
2
1
2
56 y F
56 y M
58 y F
A
Ingst
Int-U
2
U
Ingst
Int-U
2
A/C
58 y M
U
Ingst
Ingst
Int-S
Int-S
1
30 mg/dL In Blood
(unspecified)
@ Autopsy
1200 ng/mL In Blood
(unspecified)
@ Autopsy
32 ng/mL In Blood
(unspecified)
@ Autopsy
680 ng/mL In Blood
(unspecified)
@ Autopsy
720 ng/mL In Blood
(unspecified)
@ Autopsy
1
oxycodone
27 mcg/L In Blood
(unspecified)
@ Unknown
(continued)
1040
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
809
Downloaded by [AAPCC] at 12:54 01 December 2015
810 p
811 h
812ai
813 h
814 p
815
816
817
818 h
Age
Substance
Rank
Cause
Rank
diazepam
3
3
nordiazepam
diazepam
3
3
diazepam
desipramine
clonazepam
pantoprazole
levothyroxine
1
2
3
4
1
2
3
4
amitriptyline
1
1
amitriptyline
amitriptyline
1
1
nortriptyline
fluoxetine
2
2
norfluoxetine
fluoxetine
2
2
fluoxetine
ethanol
3
3
ethanol
ethanol
3
3
ethanol
bupropion
1
1
hydroxybupropion
bupropion
1
1
bupropion
citalopram
2
2
citalopram
hydrocodone
3
3
hydrocodone (free)
acetaminophen
4
4
acetaminophen
acetaminophen
4
4
acetaminophen
glipizide
metformin
naproxen
tamsulosin
salicylate
5
6
7
8
9
5
6
7
8
9
salicylate
9 mg/dL In Blood
(unspecified)
@ Unknown
clonazepam
losartan
omeprazole
10
11
12
10
11
12
venlafaxine
hydrocodone
1
2
1
2
maprotiline
oxycodone
morphine
1
2
3
1
2
3
amitriptyline
metoprolol
duloxetine
gabapentin
lisinopril
prednisone
antibiotic, unknown
hydrochlorothiazide
atorvastatin
1
2
3
4
5
6
7
8
9
1
2
3
4
5
6
7
8
9
bupropion
metoprolol
acetaminophen/
hydrocodone
vortioxetine
drug, unknown
1
2
3
1
2
3
4
5
4
5
doxepin
clonidine
cocaine
1
2
3
1
2
3
escitalopram
amlodipine
1
2
1
2
lithium
1
1
lithium
1.7 mcg/mL In Blood
(unspecified)
@ 84 h (pe)
Substances
58 y F
59 y F
60 y M
Chronicity
61 y M
63 y M
64 y M
64 y M
64 y F
RCF
Ingst
Int-S
2
A/C
Ingst
Unk
1
A
60 y M
Reason
A
A/C
60 y M
Route
Ingst
Int-S
Analyte
Blood Concentration
@ Time
77 ng/mL In Blood
(unspecified)
@ Unknown
94 ng/mL In Blood
(unspecified)
@ Unknown
13031 ng/mL In Blood
(unspecified)
@ Autopsy
904 ng/mL In Blood
(unspecified)
@ Autopsy
1214 ng/mL In Blood
(unspecified)
@ Autopsy
1515 ng/mL In Blood
(unspecified)
@ Autopsy
0.092 % In Blood
(unspecified)
@ Autopsy
0.101 % In Vitreous
@ Autopsy
1
Ingst
Int-S
2
A/C
Ingst + Aspir
Int-S
3
A/C
Ingst
Int-S
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
3
A/C
Ingst
Int-S
2
130 ng/mL In Blood
(unspecified)
@ Unknown
80 ng/mL In Blood
(unspecified)
@ Unknown
1200 ng/mL In Blood
(unspecified)
@ Unknown
110 ng/mL In Blood
(unspecified)
@ Unknown
37 mcg/mL In Blood
(unspecified)
@ Unknown
80 mcg/mL In Blood
(unspecified)
@ Unknown
(continued)
AAPCC 2014 Annual Report of the NPDS
1041
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
819pa
66 y M
821 h
67 y F
[823ha]
824 ph
825 h
826 h
Cause
Rank
lithium
1
1
lithium
lithium
1
1
lithium
imipramine
levothyroxine
zolpidem
2
3
4
2
3
4
trazodone
1
1
cocaine
lamotrigine
sildenafil
2
3
4
2
3
4
amitriptyline
1
1
Int-U
RCF
Analyte
Blood Concentration
@ Time
4.87 mcg/mL In Blood
(unspecified)
@ 36 h (pe)
6 mcg/mL In Blood
(unspecified)
@ 24 h (pe)
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A/C
Ingst + Aspir
Int-S
2
A/C
Ingst
Int-S
1
trazodone
33 mg/L In Blood
(unspecified)
@ Autopsy
bupropion
0.285 mg/L In Blood
(unspecified)
@ Unknown
1
2
3
4
5
amitriptyline
oxycodone
tramadol
temazepam
clonazepam
furosemide
1
2
3
4
5
6
1
2
3
4
5
6
bupropion (extended
release)
1
1
cyclic antidepressant,
unknown
1
1
escitalopram
citalopram
1
2
1
2
lithium
1
1
lithium
3.3 mEq/L In Blood
(unspecified)
@ 7 h (pe)
zolpidem
salicylate
2
3
2
3
salicylate
salicylate
3
3
salicylate
salicylate
3
3
salicylate
50.7 mg/dL In Blood
(unspecified)
@ 15 m (pe)
72 mg/dL In Blood
(unspecified)
@ 7 h (pe)
85 mg/dL In Blood
(unspecified)
@ 10 h (pe)
ezetimibe/simvastatin
lisinopril
mirtazapine
lorazepam
4
5
6
7
4
5
6
7
venlafaxine
1
1
70 y F
81 y M
82 y F
Ingst
Reason
1
2
3
4
5
69 y M
82 y F
Route
venlafaxine
benzodiazepine
thyroid preparation
lamotrigine
antipsychotic (atypical)
68 y F
828 p
Chronicity
A
67 y F
827 h
829pha
Substance
Rank
Substances
64 y M
820
822 h
Downloaded by [AAPCC] at 12:54 01 December 2015
Age
U
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
2
U
Ingst
Int-S
2
A
Ingst
Int-S
2
A
Ingst
Int-U
1
desipramine
amitriptyline
alprazolam
1
2
3
1
2
3
bupropion (extended
release)
dextromethorphan
1
1
bupropion
2
2
chlorpheniramine
dextromethorphan
2
2
dextromethorphan
30 + y F
660 ng/mL In Whole Blood
@ Autopsy
1300 ng/mL In Whole Blood
@ Autopsy
4700 ng/mL In Whole Blood
@ Autopsy
chlorpheniramine
3
3
See Also case 5, 18, 30, 40, 48, 50, 68, 92, 138, 179, 310, 312, 330, 334, 337, 350, 364, 383, 384, 388, 391, 406, 407, 415, 433, 441, 453, 456, 466, 474, 484, 490, 491, 509, 532, 534, 537, 539, 563, 569, 578, 587,
593, 622, 635, 652, 659, 661, 685, 702, 710, 714, 717, 718, 719, 721, 726, 727, 728, 843, 847, 855, 862, 871, 876, 878, 882, 885, 888, 892, 895, 896, 897, 899, 901, 902, 912, 915, 924, 925, 929, 930, 931, 932, 933,
935, 947, 950, 961, 963, 980, 988, 992, 1007, 1011, 1016, 1035, 1048, 1068, 1070, 1111, 1115, 1117, 1126, 1128, 1131, 1132, 1133, 1136, 1137, 1144, 1148, 1152, 1153, 1154, 1174, 1178, 1180, 1185, 1186, 1189,
1214, 1221, 1263, 1314, 1320, 1337, 1345, 1361
Antihistamines
830 ph
16 y F
A
Ingst
Int-S
1
diphenhydramine
1
1
acetaminophen
2
2
THC homolog
3
3
831 h
16 y F
A
Ingst
Int-S
2
diphenhydramine
1
1
832 p
19 y F
A
Ingst
Int-U
2
diphenhydramine
1
1
833
20 y M
A
Ingst
Int-S
1
diphenhydramine
1
1
diphenhydramine
7.2 mg/L In Blood
(unspecified)
@ Unknown
834ai
29 y F
A
Ingst
Int-S
2
diphenhydramine
1
1
835 h
29 y F
A
Ingst
Int-S
2
(continued)
1042
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
836i
1m M
837 h
32 y F
838 p
35 y F
840ai
39 y F
842phi
843 h
844 h
845 p
846ai
847pha
848 ha
849 ha
850 a
851
Substance
Rank
Cause
Rank
diphenhydramine
diazepam
acetaminophen/
oxycodone
1
2
3
1
2
3
promethazine
1
1
Substances
diphenhydramine
1
1
hydroxyzine
drug, unknown
pregabalin
1
2
3
1
2
3
diphenhydramine
1
1
33 y F
839
841 ha
Downloaded by [AAPCC] at 12:54 01 December 2015
Age
Chronicity
Route
Reason
RCF
U
Ingst
Oth-M
1
A
Ingst
Int-S
2
U
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst + Unk
Int-U
2
A
Ingst
Unk
1
Analyte
Blood Concentration
@ Time
diphenhydramine
hydrocodone
fentanyl
1
2
3
1
2
3
diphenhydramine
1
1
diphenhydramine
diphenhydramine
1
1
diphenhydramine
diphenhydramine
1
1
diphenhydramine
salicylate
2
2
salicylate
salicylate
2
2
salicylate
salicylate
2
2
salicylate
diazepam
3
3
nordiazepam
diazepam
3
3
diazepam
diphenhydramine
1
1
diphenhydramine
1
1
diphenhydramine
gabapentin
2
2
gabapentin
gabapentin
2
2
gabapentin
doxepin
tramadol
3
4
3
4
hydroxyzine
benzodiazepine
1
2
1
2
diphenhydramine
ethanol
1
2
1
2
diphenhydramine
1
1
diphenhydramine
1
1
diphenhydramine
7.3 mg/L In Serum
@ Unknown
buspirone
ziprasidone
2
3
2
3
ziprasidone
0.09 mg/L In Serum
@ Unknown
sertraline
4
4
diphenhydramine
ethanol
1
2
1
2
diphenhydramine
1
1
diphenhydramine
alprazolam
2
2
alprazolam
fentanyl
3
3
fentanyl
lorazepam
4
4
lorazepam
520 ng/mL In Whole Blood
@ Autopsy
30 ng/mL In Whole Blood
@ Autopsy
1.1 ng/mL In Whole Blood
@ Autopsy
14 ng/mL In Whole Blood
@ Autopsy
diphenhydramine
1
1
diphenhydramine
gabapentin
1
2
1
2
42 y M
43 y F
45 y F
46 y M
47 y F
48 y M
51 y F
53 y F
56 y M
74 y F
A
Ingst
Int-S
1
A
Ingst
Int-S
3
A
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-U
2
A
Ingst
Int-S
1
A
Ingst
Int-S
2
U
Unk
Int-S
1
A
84 y F
Ingst
Int-S
Ingst
Int-S
0.13 mg/L In Blood
(unspecified)
@ Autopsy
1.14 mg/L In Blood
(unspecified)
@ Autopsy
14.94 mg/L In Blood
(unspecified)
@ Unknown
1
diphenhydramine
A
1.8 mcg/mL In Blood
(unspecified)
@ Unknown
41 Other (see abst) In Liver
@ Autopsy
7.5 mcg/mL In Blood
(unspecified)
@ Autopsy
16.2 mg/dL In Blood
(unspecified)
@ Unknown
26.2 mg/dL In Blood
(unspecified)
@ Unknown
37 mg/dL In Blood
(unspecified)
@ Unknown
0.067 mcg/mL In Blood
(unspecified)
@ Unknown
0.077 mcg/mL In Blood
(unspecified)
@ Unknown
650 ng/mL In Blood
(unspecified)
@ Autopsy
1
852ai
3m F
U
Ingst
Unk
2
diphenhydramine
1
1
See Also case 19, 32, 51, 383, 387, 404, 499, 534, 555, 588, 644, 687, 710, 755, 757, 771, 788, 829, 854, 903, 911, 980, 1007, 1011, 1098, 1115, 1116, 1126, 1127, 1131, 1153, 1190, 1198, 1259, 1263, 1376
(continued)
AAPCC 2014 Annual Report of the NPDS
1043
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
Substances
Substance
Rank
Cause
Rank
1
1
Antimicrobials
[853]
15 y F
rifampin
854
855
856i
857 h
17 y F
hydroxychloroquine
hydroxyzine
1
2
1
2
acetaminophen/butalbital/
caffeine
meloxicam
cetirizine
3
3
4
5
4
5
hydroxychloroquine
amitriptyline
cyclobenzaprine
acetaminophen/
diphenhydramine
tramadol
1
2
3
4
1
2
3
4
5
5
isoniazid
acetaminophen
1
2
1
2
1
1
48 y F
50 y M
acyclovir
Unknown adult
(4¼ 20 yrs)
F
tilmicosin
See Also case 53, 482, 727, 814, 863, 953, 1284
Asthma Therapies
859
70 y F
theophylline
860 h
83 y M
theophylline
(extended release)
Downloaded by [AAPCC] at 12:54 01 December 2015
1
1
1
1
1
1
propranolol
1
1
metoprolol
(extended release)
escitaopram
bupropion
1
1
2
3
2
3
diltiazem
(extended release)
1
1
metoprolol (extended
release)
hydrochlorothiazide/
irbesartan
furosemide
salicylate
ibuprofen
minocycline
2
2
3
3
4
5
6
7
4
5
6
7
verapamil
1
1
See Also case 955, 1004, 1035
Cardiovascular Drugs
861 p
14 y F
863
14 y M
17 y F
864 h
17 y M
865
17 y F
[866pha]
18 y F
867 ph
868 h
869 ha
870 h
carvedilol
nifedipine
1
2
1
2
flecainide
1
1
clonidine
valproic acid
quetiapine
1
2
3
1
2
3
angiotensin converting
enzyme inhibitor
angiotensin receptor
blockers
metformin
antihyperlipidemic
drug, unknown
1
1
19 y M
20 y F
Reason
RCF
A
Ingst
Int-S
2
Ingst
Int-S
1
C
83 y M
Route
U
C
[858pa]
862
Chronicity
Ingst
Ingst
Int-S
Unt-T
Analyte
hydroxyzine
960 ng/mL In Plasma
@ 20 m (pe)
acetaminophen
171 mcg/mL In Serum
@ Unknown
theophylline
51.4 mcg/mL In Blood
(unspecified)
@ Unknown
diltiazem
424 ng/mL In Blood
(unspecified)
@ Unknown
flecainide
2.6 mcg/mL In Blood
(unspecified)
@ Autopsy
17000 ng/mL In Whole Blood
@ Autopsy
9800 ng/mL In Whole Blood
@ Unknown
6.7 ng/mL In Whole Blood
@ Autopsy
13 ng/mL In Whole Blood
@ Autopsy
9.8 ng/mL In Whole Blood
@ Autopsy
1.5 ng/mL In Whole Blood
@ Autopsy
1
2
A
Ingst
Unt-T
3
A
Par
Int-S
1
C
Ingst
AR-D
1
C
Ingst
AR-D
3
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
A
Ingst
Int-S
1
U
Ingst
Int-S
1
A
Ingst
Int-S
1
U
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
2
2
3
4
5
3
4
5
diltiazem
(extended release)
diltiazem
(extended release)
oxycodone
1
1
diltiazem
1
1
diltiazem
2
2
oxycodone (free)
olanzapine
3
3
olanzapine
22 y F
lorazepam
4
4
lorazepam
marijuana
5
5
thc (tetrahydro
cannabinol)
propafenone
atenolol
amlodipine
1
2
3
1
2
3
23 y M
A/C
Ingst
Int-S
Blood Concentration
@ Time
1
(continued)
1044
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
871 ph
872 ph
873
874pha
875
Downloaded by [AAPCC] at 12:54 01 December 2015
876 ph
877 h
878
879 h
880 ha
881pa
882 a
883 ha
884ai
885 ph
Age
Substance
Rank
Cause
Rank
hydrochlorothiazide/
lisinopril
cardiac glycoside
4
4
5
5
metformin
glipizide
acetaminophen
omeprazole
6
7
8
9
6
7
8
9
propranolol
escitalopram
1
2
1
2
propranolol
temazepam
clonazepam
zolpidem
risperidone
lamotrigine
1
2
3
4
5
6
1
2
3
4
5
6
verapamil
1
1
calcium antagonist
1
1
Substances
25 y F
25 y F
30 y F
31 y M
Route
Reason
RCF
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
Analyte
Blood Concentration
@ Time
digoxin
4.2 ng/mL In Blood
(unspecified)
@ Unknown
diltiazem
3.3 mg/L In Blood
(unspecified)
@ Unknown
flecainide
16 mcg/mL In Blood
(unspecified)
@ Autopsy
lorazepam
98 ng/mL In Blood
(unspecified)
@ Unknown
hydrochlorothiazide
2
2
calcium antagonist
1
1
metoprolol (extended
release)
citalolpram
lithium
mirtazapine
clonazepam
1
1
2
3
4
5
2
3
4
5
amlodipine
gabapentin
ethanol
angiotensin converting
enzyme inhibitor
1
2
3
4
1
2
3
4
propranolol
fluoxetine
trazodone
quetiapine
metaxalone
acetaminophen
1
2
3
4
5
6
1
2
3
4
5
6
verapamil
propranolol
1
2
1
2
flecainide
1
1
angiotensin converting
enzyme inhibitor
2
2
propafenone
lisinopril
levothyroxine
caffeine
lorazepam
1
2
3
4
5
1
2
3
4
5
beta blocker
1
1
atenolol
4800 ng/mL In Blood
(unspecified)
@ Unknown
lisinopril
escitaopram
2
3
2
3
citalopram
260 ng/mL In Blood
(unspecified)
@ Unknown
clonazepam
trazodone
4
5
4
5
trazodone
1 mcg/mL In Blood
(unspecified)
@ Unknown
amlodipine
1
1
amlodipine
0.294 mg/L In Blood
(unspecified)
@ Unknown
verapamil
1
1
diphenhydramine
verapamil
1
1
verapamil
verapamil
1
1
naproxen
0.41 mg/L In Blood
(unspecified)
@ Unknown
1.5 mg/L In Blood
(unspecified)
@ Unknown
7.6 mg/L In Blood
(unspecified)
@ Unknown
beta blocker
2
2
32 y M
32 y F
32 y M
33 y F
U
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A
Ingst
Int-S
2
Ingst + Aspir
Int-S
1
U
Unk
Unk
2
A
Ingst
Int-S
1
A/C
34 y F
35 y M
37 y M
A/C
37 y F
A/C
37 y F
A/C
38 y M
38 y F
Chronicity
A
A
Ingst
Ingst
Ingst
Ingst
Ingst
Int-S
Int-S
Int-S
Int-S
Int-S
3
1
1
1
1
(continued)
AAPCC 2014 Annual Report of the NPDS
1045
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
886 h
39 y F
888hi
40 y F
41 y F
891 h
41 y M
893
894
895 h
896 h
897 ph
898 h
899 ha
Cause
Rank
amlodipine
losartan
benzodiazepine
barbiturate
cyclic antidepressant,
unknown
ibuprofen
1
2
3
4
5
1
2
3
4
5
6
6
cardiac glycoside
1
1
verapamil
1
1
amlodipine
citalopram
1
2
1
2
amlodipine
metoprolol
pregabalin
hydrochlorothiazide
metformin
1
2
3
4
5
1
2
3
4
5
verapamil
1
1
40 y F
890
892 ha
Substance
Rank
Substances
39 y M
887 h
889
Downloaded by [AAPCC] at 12:54 01 December 2015
Age
Chronicity
Route
Reason
RCF
C
Par
Unt-T
3
A
Ingst
Int-S
1
U
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-M
1
A/C
Ingst
Int-S
2
Analyte
Blood Concentration
@ Time
digoxin
7.2 mcg/mL In Serum
@ Unknown
ethanol
261 mg/dL In Blood
(unspecified)
@ Unknown
carbamazepine
15.7 mg/L In Blood
(unspecified)
@ Unknown
propranolol
3.5 mg/L In Plasma
@ 23 h (pe)
diltiazem
metoprolol
metformin
ethanol
1
2
3
4
1
2
3
4
amlodipine
atenolol
clonazepam
carbamazepine
1
2
3
4
1
2
3
4
oxycodone
bupropion
acetaminophen
5
6
7
5
6
7
metoprolol
lisinopril
1
2
1
2
metoprolol
oxcarbazepine
1
2
1
2
calcium antagonist
alprazolam
amphetamine
lithium
1
2
3
4
1
2
3
4
metoprolol
oxycodone
zolpidem
diazepam
escitalopram
1
2
3
4
5
1
2
3
4
5
propranolol
1
1
propranolol
clonidine
alprazolam
tramadol
zolpidem
acetaminophen/
hydrocodone
oxycodone
acetaminophen/
oxycodone
venlafaxine
doxylamine
acetaminophen/
codeine
2
3
4
5
6
7
2
3
4
5
6
7
8
9
8
9
10
11
12
10
11
12
amlodipine
propranolol
1
2
1
2
verapamil
1
1
verapamil
40000 ng/mL In Blood
(unspecified)
@ Autopsy
baclofen
acetaminophen/
hydrocodone
trazadone
cyclobenzaprine
2
3
2
3
hydrocodone (free)
7.7 ng/mL In Whole Blood
@ Autopsy
4
5
4
5
cyclobenzaprine
1900 ng/mL In Whole Blood
@ Autopsy
valproic acid
6
6
41 y F
U
42 y F
42 y M
42 y F
42 y F
43 y F
44 y F
44 y F
Ingst
Int-S
2
A
Ingst
Int-S
2
C
Ingst
Int-S
1
A
Ingst
Int-S
2
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A/C
Ingst
Unk
2
A/C
Ingst
Int-S
1
(continued)
1046
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
900 ha
45 y F
Downloaded by [AAPCC] at 12:54 01 December 2015
901 a
902pa
903
904
905
906 a
907
908 h
909 ha
Substance
Rank
Cause
Rank
ethanol
7
7
atenolol
1
1
atenolol
13000 ng/mL In Blood
(unspecified)
@ Autopsy
amlodipine
zolpidem
2
3
2
3
zolpidem
230 ng/mL In Blood
(unspecified)
@ Autopsy
carvedilol
ethanol
1
2
1
2
ethanol
ethanol
2
2
ethanol
145 mg/dL In Serum
@ 1 h (pe)
147 mg/dL In Blood
(unspecified)
@ 1 h (pe)
hydrochlorothiazide/
lisinopril
fluoxetine
3
3
4
4
norfluoxetine
fluoxetine
4
4
fluoxetine
acetaminophen/
dextromethorphan/
pseudoephedrine
lamotrigine
5
5
acetaminophen
6
6
lamotrigine
venlafaxine
7
7
venlafaxine
7
7
o-desmethylvenla
faxine
venlafaxine
acetaminophen/
dextromethorphan
8
8
verapamil
metoprolol
fluoxetine
ethanol
1
2
3
4
1
2
3
4
ethanol
ethanol
4
4
ethanol
diltiazem
(extended release)
diltiazem
eszopiclone
promethazine
cyclobenzaprine
1
1
2
3
4
5
2
3
4
5
amlodipine
metoprolol
baclofen
celecoxib
gabapentin
1
2
3
4
5
1
2
3
4
5
amlodipine/
olmesartan
thiazide
1
1
2
2
flecainide
diltiazem
warfarin
1
2
3
1
2
3
nadolol
atenolol
verapamil
1
2
3
1
2
3
verapamil
1
1
verapamil
verapamil
1
1
norverapamil
verapamil
1
1
verapamil
verapamil
1
1
norverapamil
verapamil
1
1
verapamil
cyclobenzaprine
topiramate
2
3
2
3
topiramate
topiramate
3
3
topiramate
beta blocker
1
1
Substances
45 y F
Chronicity
Route
Reason
A
Ingst
Int-S
A/C
45 y F
A
46 y F
46 y F
46 y F
46 y F
46 y M
47 y F
47 y M
Ingst
Ingst
Int-S
Int-S
RCF
1
Int-S
1
A/C
Ingst
Int-S
1
U
Ingst
Int-S
1
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
Int-S
0.16 mg/L In Serum
@ 1 h (pe)
0.28 mg/L In Serum
@ 1 h (pe)
16 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
18 mg/L In Serum
@ 1 h (pe)
0.14 mg/L In Serum
@ 1 h (pe)
0.45 mg/L In Serum
@ 1 h (pe)
2
Ingst
Ingst
Blood Concentration
@ Time
1
A
A/C
Analyte
0.23 % (wt/Vol) In Blood
(unspecified)
@ Unknown
0.33 % (wt/Vol) In Urine
(quantitative only)
@ Unknown
0.29 mg/L In Blood
(unspecified)
@ 30 m (pe)
1.3 mg/L In Blood
(unspecified)
@ Autopsy
150 mg/kg In Liver
@ Autopsy
40 mg/kg In Liver
@ Autopsy
7 mg/L In Blood
(unspecified)
@ Autopsy
14 mg/L In Blood
(unspecified)
@ Autopsy
40 mg/L In Blood
(unspecified)
@ 30 m (pe)
1
metoprolol
6700 ng/mL In Blood
(unspecified)
@ Autopsy
(continued)
AAPCC 2014 Annual Report of the NPDS
1047
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
910 a
911ai
912
913ai
Downloaded by [AAPCC] at 12:54 01 December 2015
914
915
916
917 h
918
919 h
920 ph
921 p
922
923
924
Age
Substance
Rank
Cause
Rank
diltiazem
2
2
beta blocker
calcium antagonist
1
2
1
2
verapamil
alprazolam
hydroxyzine
1
2
3
1
2
3
amlodipine
venlafaxine
clonidine
1
2
3
1
2
3
flecainide
1
zolpidem
Substances
Chronicity
Route
Reason
RCF
Analyte
Blood Concentration
@ Time
diltiazem
230 ng/mL In Blood
(unspecified)
@ Autopsy
1
flecainide
2
2
zolpidem
5.6 mcg/mL In Serum
@ 2 h (pe)
1900 ng/mL In Blood
(unspecified)
@ Autopsy
carvedilol
(extended release)
amlodipine
1
1
2
2
amlodipine
carisoprodol
3
3
meprobamate
carisoprodol
3
3
carisoprodol
atenolol
citalopram
trazodone
buspirone
eszopiclone
levothyroxine
clonazepam
ethanol
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
verapamil
propranolol
1
2
1
2
carvedilol
diltiazem
clonidine
lisinopril
metoprolol
(extended release)
phenytoin
clopidogrel
potassium chloride
1
2
3
4
5
1
2
3
4
5
6
7
8
6
7
8
atenolol
amlodipine
hydralazine
1
2
3
1
2
3
amlodipine
metoprolol
lisinopril
1
2
3
1
2
3
nifedipine
ethanol
1
2
1
2
carvedilol
simvastatin
acetaminophen/dextromethorphan/doxalamine
ethanol
1
2
3
1
2
3
4
4
amlodipine
methocarbamol
phenothiazine
1
2
3
1
2
3
verapamil
hydrochlorothiazide/
lisinopril
hydrochlorothiazide
alprazolam
zolpidem
ethanol
1
2
1
2
3
4
5
6
3
4
5
6
amlodipine/benazepril
amlodipine/benazepril
venlafaxine
ethanol
1
2
3
4
1
2
3
4
49 y F
49 y F
50 y M
50 y M
51 y M
U
Ingst
Int-S
2
A
Ingst
Int-U
2
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A/C
51 y M
51 y F
52 y F
52 y M
52 y F
52 y M
52 y M
53 y M
53 y F
53 y F
Ingst
Int-S
1
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A/C
Ingst
Unt-T
1
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A
Ingst
Unt-M
2
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
233 ng/mL In Blood
(unspecified)
@ Autopsy
17.88 mcg/mL In Blood
(unspecified)
@ Autopsy
2.08 mcg/mL In Blood
(unspecified)
@ Autopsy
ethanol
114 mg/dL In Blood
(unspecified)
@ Unknown
ethanol
233 mg/dL In Serum
@ Unknown
ethanol
75 mg/dL In Serum
@ Unknown
3
(continued)
1048
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
925pha
53 y M
926 h
53 y M
927
53 y F
[928ha]
53 y M
Downloaded by [AAPCC] at 12:54 01 December 2015
929 h
930
931
Substance
Rank
Cause
Rank
metoprolol
(extended release)
sertraline
1
1
2
2
sertraline
sertraline
2
2
norsertraline
quetiapine
3
3
quetiapine
mirtazapine
benztropine
gabapentin
sildenafil
hydrochlorothiazide
ethanol
4
5
6
7
8
9
4
5
6
7
8
9
ethanol
320 mg/dL In Blood
(unspecified)
@ Unknown
metoprolol
1
1
amlodipine
0.39 mg/L In Blood
(unspecified)
@ Unknown
21 mg/L In Blood
(unspecified)
@ Autopsy
0.71 mg/L In Blood
(unspecified)
@ Autopsy
Substances
933 h
[934h]
935 h
936
Int-S
A
Ingst
Int-S
1
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
1
metoprolol
1
1
metoprolol
venlafaxine
2
2
venlafaxine
pregabalin
paliperidone
clonazepam
baclofen
3
4
5
6
3
4
5
6
clonidine
amlodipine/benazepril
venlafaxine
(extended release)
quetiapine
zolpidem
alprazolam
potassium chloride
ethanol
1
2
3
1
2
3
4
5
6
7
8
4
5
6
7
8
1
2
3
1
2
3
4
5
6
7
8
9
10
11
12
4
5
6
7
8
9
10
11
12
A
carvedilol
dabigatran
bupropion
(extended release)
lisinopril
mirtazapine
furosemide
1
2
3
1
2
3
4
5
6
4
5
6
amlodipine
carvedilol
fluoxetine
1
2
3
1
2
3
amlodipine
1
1
nadolol
fluoxetine
lamotrigine
topiramate
spironolactone
1
2
3
4
5
1
2
3
4
5
amlodipine
carvedilol
hydrochlorothiazide/
lisinopril
1
2
3
1
2
3
amlodipine
1
1
54 y F
54 y F
54 y F
54 y M
Ingst
Int-S
Blood Concentration
@ Time
3
1
54 y M
54 y F
Ingst
Analyte
amlodipine
54 y F
54 y M
A/C
RCF
1
53 y M
938
Reason
1
53 y F
937
Route
verapamil
metoprolol
baclofen
acetaminophen/
hydrocodone
benazepril
hydralazine
citalopram
clonazepam
metformin
meloxicam
gabapentin
furosemide
pravastatin
932 h
Chronicity
1100 ng/mL In Blood
(unspecified)
@ Autopsy
150 ng/mL In Blood
(unspecified)
@ Autopsy
1400 ng/mL In Blood
(unspecified)
@ Autopsy
1
A/C
Ingst
Int-S
2
C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
3
A
Ingst
Int-S
1
amlodipine
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
A
Ingst
Int-S
2
46 ng/mL In Blood
(unspecified)
@ Unknown
(continued)
AAPCC 2014 Annual Report of the NPDS
1049
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
939
940 h
941
942
943 ph
944 h
Downloaded by [AAPCC] at 12:54 01 December 2015
945
946
947 h
948
949pha
950
951
952 ph
953 h
954
955 h
956 p
[957ha]
Age
Substance
Rank
Cause
Rank
amlodipine/
olmesartan
nebivolol
1
1
2
2
labetalol
opioid
1
2
1
2
diltiazem
(extended release)
carisoprodol
clonazepam
1
1
2
3
2
3
verapamil
1
1
amlodipine
lisinopril
alprazolam
1
2
3
1
2
3
verapamil
tizanidine
pyrethroids
1
2
3
1
2
3
verapamil
chlorthalidone
1
2
1
2
amlodipine
baclofen
quetiapine
metoprolol
ethanol
1
2
3
4
5
1
2
3
4
5
metoprolol
amlodipine
verapamil
clonazepam
1
2
3
4
1
2
3
4
bisoprolol/
hydrochlorothiazide
amlodipine
gabapentin
fluoxetine
alprazolam
1
1
2
3
4
5
2
3
4
5
diltiazem
(extended release)
hydrocodone
1
1
2
2
diltiazem
1
1
diltiazem
propafenone
2
2
propafenone
ethanol
3
3
ethanol
verapamil
fluoxetine
fluphenazine
1
2
3
1
2
3
cardiac glycoside
1
1
carvedilol
amiodarone
hydralazine
2
3
4
2
3
4
propafenone
1
1
amlodipine/benazepril
progestins
emtricitabine/tenofovir
salicylate
1
2
3
4
1
2
3
4
amlopidipine
lisinopril
1
2
1
2
verapamil
theophylline
1
2
theophylline
Substances
55 y M
55 y F
Chronicity
Route
Reason
A
Ingst
Int-S
2
Ingst + Aspir
Int-S
1
A
Ingst
Int-S
1
U
Ingst
Int-S
1
U
Unk
Unk
2
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
U
Ingst
Int-U
1
A/C
56 y F
56 y F
56 y F
56 y M
56 y F
57 y M
57 y F
57 y F
57 y M
57 y F
57 y M
RCF
A
Ingst
Int-S
1
C
Ingst
AR-D
3
Analyte
Blood Concentration
@ Time
0.025 mg/L In Blood
(unspecified)
@ Unknown
0 ng/mL In Blood
(unspecified)
@ Unknown
82 mg/dL In Blood
(unspecified)
@ Unknown
digoxin
3.8 ng/mL In Serum
@ 24 h (pe)
1
2
theophylline
2
2
theophylline
theophylline
2
2
theophylline
17.4 mcg/mL In Blood
(unspecified)
@ 2.5 h (pe)
20.7 mcg/mL In Blood
(unspecified)
@ 10 h (pe)
26.1 mcg/mL In Blood
(unspecified)
@ 14 h (pe)
verapamil
topiramate
quetiapine
1
2
3
1
2
3
propranolol
1
1
57 y F
57 y F
58 y F
59 y M
59 y F
59 y F
A/C
Ingst
Int-S
1
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
2
U
Ingst
Int-S
2
A
Ingst
Int-S
1
(continued)
1050
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
958 h
59 y F
959 h
960
961 ph
962 h
963 h
Downloaded by [AAPCC] at 12:54 01 December 2015
964
965
966
967
968
969 h
beta blocker
amlodipine
metformin/
sitagliptin
clonazepam
1
2
3
1
2
3
4
4
verapamil
1
1
metoprolol
clonidine
alprazolam
1
2
3
1
2
3
metoprolol
quetiapine
citalopram
trazodone
1
2
3
4
1
2
3
4
verapamil
nebivolol
lisinopril
1
2
3
1
2
3
diltiazem
sertraline
1
2
1
2
metoprolol
amlodipine
pregabalin
benzonatate
1
2
3
4
1
2
3
4
metoprolol
amlodipine
angiotensin converting
enzyme inhibitor
1
2
3
1
2
3
amlodipine/benazepril
ibuprofen
1
2
1
2
amlodipine
1
1
amlodipine
metoprolol
2
2
metoprolol
clonidine
3
3
clonidine
candesartan/
hydrochlorothiazide
hydrochlorothiazide/
triamterene
glucagon
4
4
5
5
6
6
diltiazem
1
1
60 y F
60 y F
61 y M
61 y F
61 y F
61 y M
61 y F
62 y F
62 y F
62 y M
62 y M
971 h
63 y F
972 ha
63 y M
973 h
64 y F
amlodipine
1
1
angiotensin receptor
blocker
ethanol
2
2
3
3
ethanol
3
3
amlodipine
1
1
flecainide
olmesartan
zolpidem
1
2
3
1
2
3
nifedipine
1
1
64 y M
976
65 y M
Chronicity
Route
Reason
A/C
Ingst
Int-S
2
C
Ingst
Unt-T
2
A
Ingst
Unt-G
1
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
1
metoprolol
metoprolol
(extended release)
1
2
1
2
beta blocker
isosorbide mononitrate
oxycodone
naproxen
1
2
3
4
1
2
3
4
beta blocker
1
1
metoprolol
cardiac glycoside
acetaminophen/
hydrocodone
baclofen
ethanol
1
2
3
1
2
3
4
5
4
5
amlodipine
carvedilol
1
2
1
2
65 y M
RCF
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
Analyte
Ingst
Int-S
2
A/C
Ingst
Int-S
2
Ingst
Int-S
2
A
Par
Unt-T
1
U
Ingst
Int-S
2
U
Ingst
Int-S
3
A/C
Ingst
Int-S
1
U
Ingst
Int-S
1
Blood Concentration
@ Time
330 ng/mL In Blood
(unspecified)
@ 10 h (pe)
14 ng/mL In Blood
(unspecified)
@ 10 h (pe)
3.6 ng/mL In Blood
(unspecified)
@ 10 h (pe)
amlodipine
500 ng/mL In Blood
(unspecified)
@ Unknown
ethanol
68 mg/dL In Blood
(unspecified)
@ Unknown
78.2 mg/dL In Serum
@ Unknown
ethanol
A
A/C
64 y M
975 ph
977 h
Cause
Rank
60 y M
970
974 h
Substance
Rank
Substances
(continued)
AAPCC 2014 Annual Report of the NPDS
1051
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
978 ph
65 y F
979 h
980
981 h
982
Downloaded by [AAPCC] at 12:54 01 December 2015
983
984 h
985 h
986
987 p
988 h
989 h
990
991 h
992 ph
993 h
994 h
Substance
Rank
Cause
Rank
carvedilol
benzodiazepine
1
2
1
2
terazosin
1
1
amlodipine
quetiapine
fluoxetine
hydroxyzine
alprazolam
1
2
3
4
5
1
2
3
4
5
metoprolol
cardiac glycoside
1
2
1
2
digoxin
cardiac glycoside
2
2
digoxin
warfarin
lisinopril
simvastatin
3
4
5
3
4
5
ranolazine
acetaminophen
1
2
1
2
acetaminophen
acetaminophen
2
2
acetaminophen
diltiazem
sotalol
warfarin
oxycodone
lorazepam
metformin
1
2
3
4
5
6
1
2
3
4
5
6
diltiazem
(extended release)
ethanol
1
1
2
2
verapamil
glycol/methanol
1
2
1
2
methanol
glycol/methanol
2
2
methanol
glycol/methanol
2
2
ethylene glycol
glycol/methanol
2
2
ethylene glycol
diltiazem
ethanol
1
2
1
2
digoxin*
factor Xa inhibitor*
2
1
1
1
hydrochlorothiazide/
metoprolol
amlodipine
lorazepam
paroxetine
donepezil
1
1
2
3
4
5
2
3
4
5
metoprolol
(extended release)
1
1
amlodipine
losartan
atorvastatin
potassium chloride
1
2
3
4
1
2
3
4
cardiac glycoside
warfarin
1
2
1
2
amlodipine
venlafaxine
lisinopril
ethanol
1
2
3
4
1
2
3
4
cardiac glycoside
1
1
digoxin
1
1
Substances
66 y M
66 y F
66 y M
67 y F
67 y M
68 y M
68 y F
69 y F
69 y F
69 y F
70 y M
70 y M
70 y F
70 y M
71 y M
71 y F
996 ph
71 y F
Route
Reason
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
3
A/C
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A
67 y M
995 h
Chronicity
cardiac glycoside
1
Ingst
Int-S
RCF
Analyte
Blood Concentration
@ Time
13.6 ng/mL In Blood
(unspecified)
@ 5 h (pe)
46 ng/mL In Blood
(unspecified)
@ 1 h (pe)
2
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
C
Ingst
AR-D
3
A/C
Ingst
Int-S
1
A
Ingst
Int-U
2
A/C
Ingst
Int-S
2
C
Ingst
AR-D
3
A/C
Ingst
Int-S
1
U
Ingst
Unk
2
C
Ingst
Unk
1
C
Ingst
AR-D
1
U
Ingst
Unk
1
1
400 mg/L In Serum
@ 30 m (pe)
469 mg/L In Serum
@ 1 h (pe)
0.223 g/dL In Blood
(unspecified)
@ Unknown
0.554 g/dL In Blood
(unspecified)
@ Unknown
23 mg/dL In Blood
(unspecified)
@ Unknown
35 mg/dL In Blood
(unspecified)
@ Unknown
digoxin
13 ng/mL In Blood
(unspecified)
@ 10 m (pe)
digoxin
2.7 ng/mL In Serum
@ Unknown
digoxin
2.8 ng/mL In Serum
@ 3 d (pe)
(continued)
1052
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
997
998 h
999 ha
Downloaded by [AAPCC] at 12:54 01 December 2015
1000h
1001h
1002 ha
1003
1004h
1005
1006
1007a
Age
Substance
Rank
Cause
Rank
cardiac glycoside
1
1
sotalol
alprazolam
salicylate
1
2
3
1
2
3
digoxin
1
1
Substances
71 y F
73 y F
73 y M
Chronicity
Route
Reason
RCF
A/C
Ingst
Int-S
2
A/C
Ingst
AR-D
3
U
Ingst
Int-S
1
Analyte
digoxin
4.2 ng/mL In Blood
(unspecified)
@ 30 m (pe)
digoxin
3.22 ng/mL In Plasma
@ Unknown
110 mcg/mL In Serum
@ 0.01 d (pe)
19.1 mcg/mL In Serum
@ 1 d (pe)
28.5 mcg/mL In Serum
@ 0.01 d (pe)
21.2 mcg/mL In Serum
@ 4 d (pe)
24.1 mcg/mL In Serum
@ 1 d (pe)
34 mcg/mL In Serum
@ 0.01 d (pe)
carvedilol
amiodarone
acetaminophen
1
2
3
1
2
3
acetaminophen
phenytoin
4
4
phenytoin
phenytoin
4
4
phenytoin
phenobarbital
5
5
phenobarbital
phenobarbital
5
5
phenobarbital
phenobarbital
5
5
phenobarbital
lisinopril
levothyroxine
6
7
6
7
amlodipine
metformin
glipizide
losartan
1
2
3
4
1
2
3
4
cardiac glycoside
1
1
digoxin
cardiac glycoside
1
1
digoxin
amlodipine
1
1
amlodipine
atenolol
2
2
atenolol
losartan
atenolol/chlorthalidone
clopidogrel
simvastatin
3
4
5
6
3
4
5
6
metoprolol
baclofen
metformin
1
2
3
1
2
3
propranolol
1
1
propranolol
acetaminophen
2
2
acetaminophen
glipizide
metformin
cyclobenzaprine
3
4
5
3
4
5
cyclobenzaprine
alprazolam
6
6
alprazolam
omeprazole
oxybutynin
montelukast
7
8
9
7
8
9
amlodipine
calcium
1
2
1
2
atenolol
diltiazem
acetaminophen/
oxycodone
zolpidem
1
2
3
1
2
3
4
4
diltiazem
1
1
diltiazem
propranolol
2
2
propranolol
fluoxetine
3
3
fluoxetine
fluoxetine
3
3
norfluoxetine
73 y M
74 y F
74 y M
A/C
Ingst
Int-S
2
C
Ingst
AR-D
3
A
74 y F
76 y M
76 y M
76 y F
76 y F
Ingst
Unt-G
Blood Concentration
@ Time
6.1 ng/mL In Blood
(unspecified)
@ Unknown
7.2 ng/mL In Blood
(unspecified)
@ Unknown
1
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A/C
Ingst
Unt-T
3
A
Ingst
Int-S
1
A/C
Ingst
Int-S
1
53 ng/mL In Serum
@ 7 h (pe)
1900 ng/mL In Serum
@ 7 h (pe)
329 ng/mL In Blood
(unspecified)
@ Autopsy
996 mcg/mL In Blood
(unspecified)
@ Autopsy
196 ng/mL In Blood
(unspecified)
@ Autopsy
17.4 ng/mL In Blood
(unspecified)
@ Autopsy
1700 ng/mL In Blood
(unspecified)
@ Autopsy
1600 ng/mL In Blood
(unspecified)
@ Autopsy
5000 ng/mL In Blood
(unspecified)
@ Autopsy
630 ng/mL In Blood
(unspecified)
@ Autopsy
(continued)
AAPCC 2014 Annual Report of the NPDS
1053
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
[1008]
77 y M
1009
77 y F
1010 ph
78 y F
1011h
Downloaded by [AAPCC] at 12:54 01 December 2015
Age
1012h
1013
1014
1015h
1016a
1017h
1018h
1019
temazepam
4
4
temazepam
ethanol
5
5
ethanol
ethanol
5
5
ethanol
promethazine
6
6
promethazine
warfarin
potassium chloride
levothyroxine
pravastatin
furosemide
7
8
9
10
11
7
8
9
10
11
propafenone
1
1
amlodipine
1
1
cardiac glycoside
1
1
diltiazem
clonidine
bisoprodol
tramadol
bupropion
(extended release)
sertraline
clonazepam
promethazine
acetaminophen/
hydrocodone
diphenhydramine
meloxicam
1
2
3
4
5
1
2
3
4
5
6
7
8
9
6
7
8
9
10
11
10
11
cardiac glycoside
atenolol
carvedilol
furosemide
diuretic, unknown
1
2
3
4
5
1
2
3
4
5
propranolol
insulin
1
2
1
2
cardiac glycoside
1
1
81 y F
81 y F
82 y F
Route
Reason
RCF
A
Ingst
Int-S
1
A
Ingst
Int-S
2
C
Ingst
AR-D
3
A/C
Ingst
Int-S
2
A/C
Ingst
AR-D
3
A/C
Ingst + Par
AR-D
3
A/C
Ingst
AR-D
2
C
Ingst
AR-D
2
Analyte
digoxin
7 ng/mL In Serum
@ Unknown
0.9 ng/mL In Blood
(unspecified)
@ Unknown
2.7 ng/mL In Blood
(unspecified)
@ Unknown
digoxin
cardiac glycoside
1
1
digoxin
diltiazem (extended release)
alprazolam
trazodone
1
2
3
1
2
3
cardiac glycoside
1
1
cardiac glycoside
1
1
metoprolol
verapamil
2
3
2
3
cardiac glycoside
1
1
cardiac glycoside
1
1
83 y F
Ingst
Int-S
2
C
Ingst
AR-D
3
C
83 y M
cardiac glycoside
1
1
amlodipine
1
1
angiotensin receptor
blocker
2
2
cardiac glycoside
1
1
amlodipine
metformin
furosemide
phenytoin
1
2
3
4
1
2
3
4
83 y F
AR-D
1
C
Ingst
AR-D
3
C
Ingst
AR-D
3
A
Ingst
Ingst
Ingst
Int-S
Unt-G
Int-S
digoxin
3.37 ng/mL In Blood
(unspecified)
@ Unknown
digoxin
1.7 ng/mL In Plasma
@ Unknown
digoxin
4.4 ng/mL In Blood
(unspecified)
@ Unknown
amlodipine
770 ng/mL In Blood
(unspecified)
@ Autopsy
digoxin
4.7 ng/mL In Serum
@ Unknown
phenytoin
4 mg/L In Blood
(unspecified)
@ Unknown
3
Ingst
A/C
84 y M
AR-D
C
A/C
84 y M
Ingst
270 ng/mL In Blood
(unspecified)
@ Autopsy
0.08 g/dL In Vitreous
@ Autopsy
82 mg/dL In Blood
(unspecified)
@ Autopsy
43 ng/mL In Blood
(unspecified)
@ Autopsy
2.3 mcg/mL In Blood
(unspecified)
@ Unknown
1
A/C
Blood Concentration
@ Time
digoxin
1
82 y M
83 y M
Chronicity
cardiac glycoside
82 y F
83 y M
1024h
Cause
Rank
79 y M
1021h
1023
Substance
Rank
79 y F
1020h
1022 ha
Substances
1
3
2
(continued)
1054
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1025
85 y M
1026
1027h
1028
1029a
Downloaded by [AAPCC] at 12:54 01 December 2015
1030
1031h
Substance
Rank
Cause
Rank
cardiac glycoside
1
1
amlodipine
alpha blocker
finasteride
omeprazole
1
2
3
4
1
2
3
4
verapamil
angiotensin converting
enzyme inhibitor
1
2
1
2
carvedilol
amlodipine
clopidogrel
salicylate
isosorbide mononitrate
drug, unknown
rosuvastatin
hydralazine
Vitamin D
1
2
3
4
5
6
7
8
9
1
2
3
4
5
6
7
8
9
beta blocker
1
1
amlodipine/benazepril
metformin
memantine
sitagliptin
ibuprofen
tetrahydrocannabinol
vitamin D
ibandronate
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
digoxin
1
1
cardiac glycoside
1
1
Substances
85 y M
85 y F
85 y F
86 y F
86 y F
86 y F
1032h
86 y F
1033h
87 y F
digoxin
1034h
1035 ph
1036
1037
90 y M
1042h
91 y F
1046h
amlodipine
trazodone
tamulosin
olanzapine
paroxetine
vitamin D
omeprazole
montelukast
docusate
melatonin
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
diltiazem (extended release)
diltiazem
diltiazem (extended release)
carvedilol
nitroglycerin
1
2
3
4
5
1
2
3
4
5
cardiac glycoside
1
1
metoprolol
1
1
diltiazem (extended release)
1
1
amlodipine
metoprolol
lisinopril
1
2
3
1
2
3
amiodarone
1
1
89 y F
1041
1045
1
2
88 y F
89 y F
1044h
1
2
87 y F
88 y M
1043
carvedilol
ezetimibe
87 y F
1039h
Route
Reason
C
Ingst
AR-D
RCF
propranolol
primidone
hydroxyurea
1
2
3
1
2
3
cardiac glycoside
1
1
digoxin
1
1
cardiac glycoside
1
1
metoprolol
2
2
metoprolol
diltiazem
1
2
1
2
92 y F
94 y F
A
Ingst
Int-S
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A
Ingst
Unk
3
A
Ingst
Unt-G
1
C
Ingst
AR-D
3
C
Ingst
Unt-T
2
C
Ingst
AR-D
3
A/C
Ingst
Unt-G
2
A/C
Ingst
Int-S
2
A/C
Ingst + Par
Unt-T
3
C
Ingst
AR-D
3
U
Ingst
Unk
3
U
Ingst
Unk
3
A
Ingst
Int-S
1
U
Unk
Unk
2
A
Ingst
Unt-T
3
C
Ingst
AR-D
3
C
94 y F
C
94 y F
A
Ingst
Ingst
Par
AR-D
Unt-T
Unt-T
Analyte
Blood Concentration
@ Time
3
1
87 y F
1038
1040 ha
1
Chronicity
digoxin
2.4 mcg/dL In Blood
(unspecified)
@ 1 h (pe)
digoxin
4.5 ng/mL In Serum
@ Unknown
digoxin
3.9 ng/mL In Blood
(unspecified)
@ Unknown
digoxin
2.1 ng/mL In Blood
(unspecified)
@ Unknown
digoxin
4.2 ng/mL In Serum
@ Unknown
2
3
2
(continued)
AAPCC 2014 Annual Report of the NPDS
1055
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1047
80 + y F
Substance
Rank
Cause
Rank
digoxin
1
1
digoxin
digoxin
1
1
digoxin
digoxin
1
1
digoxin
Substances
Chronicity
Route
Reason
C
Ingst
AR-D
RCF
Analyte
Blood Concentration
@ Time
2
3.3 ng/mL In Blood
(unspecified)
@ 1 d (pe)
3.4 ng/mL In Blood
(unspecified)
@ 2 d (pe)
3.5 ng/mL In Blood
(unspecified)
@ Unknown
U
Ingst
Int-S
1
Unknown adult
(4¼ 20 yrs)
M
propranolol
1
1
ibuprofen
2
2
naproxen
3
3
citalopram
4
4
tramadol
5
5
See Also case 68, 74, 124, 383, 391, 415, 469, 482, 513, 541, 594, 618, 647, 689, 702, 715, 727, 743, 753, 756, 761, 764, 766, 769, 771, 773, 779, 784, 788, 789, 793, 807, 811, 814, 815, 816, 817, 819, 826, 1067,
1083, 1088, 1092, 1101, 1132, 1135, 1182, 1209, 1214, 1337, 1405
Cold and Cough Preparations
[1049pha]
12 y F
A
Ingst
Int-S
1
benzonatate
1
1
[1050ph]
12 y F
A
Ingst
Int-S
1
benzonatate
1
1
1051a
19 y F
A/C
Ingst
Int-S
1
1
1
acetaminophen/
dextromethorphan/
doxalamine
antipsychotic (atypical)
2
2
benzodiazepine
3
3
ethanol
4
4
1052 ha
34 y M
A/C
Ingst
Int-S
1
1
1
acetaminophen/
antihistamine/
dextromethorphan
aripiprazole
2
2
3
3
acetaminophen/
decongestant/
dextromethorphan
ibuprofen
4
4
pregabalin
5
5
varenicline
6
6
varenicline
7
7
ethanol
8
8
ethanol
24 mg/dL In Serum
@ 10 m (pe)
salicylate
9
9
salicylate
13.4 mg/dL In Serum
@ 15 m (pe)
1053 ha
36 y M
A
Ingst
Int-S
2
doxylamine
1
1
hydrocodone
2
2
cyclobenzaprine
3
3
1054
46 y F
A
Ingst
Int-S
2
diphenhydramine
1
1
1055 ha
51 y F
U
Ingst
Int-U
3
cough and cold preparation
1
1
acetaminophen/codeine
2
2
hydrocodone
0.212 mg/L In Whole Blood
@ Autopsy
acetaminophen/codeine
2
2
acetaminophen
180 mcg/mL In Whole Blood
@ Autopsy
acetaminophen/codeine
2
2
acetaminophen
42 mcg/mL In Serum
@ Unknown
oxycodone
3
3
oxycodone
0.37 mg/L In Whole Blood
@ Autopsy
1056
71 y M
A
Ingst
AR-D
2
dextromethorphan/
1
1
guaifenesin
morphine (extended
2
2
release)
See Also case 249, 336, 388, 433, 589, 755, 766, 829, 897, 901, 921, 964, 1137, 1210, 1214, 1259
Dietary Supplements/Herbals/Homeopathic
1057h
18 y M
A
Ingst
Int-A
2
dietary supplement
1
1
dietary supplement
2
2
dinitrophenol
3
3
[1058ha]
22 y M
A
Ingst
AR-O
1
energy product, other
1
1
1059h
48 y F
A
Ingst
Int-S
1
calcium/epigallocatechin
1
1
gallate/ginseng/green tea
See Also case 605, 788, 1035, 1116
Electrolytes and Minerals
[1060ha]
5y M
A
Ingst
Oth-M
2
sodium
1
1
1061p
42 y M
A
Ingst
Unk
2
dietary supplement
1
1
acetaminophen/
2
2
hydrocodone
1062h
57 y F
A
Ingst
Int-U
1
sodium chloride
1
1
sodium bicarbonate
2
2
tramadol
3
3
See Also case 734, 917, 1005, 1132
Downloaded by [AAPCC] at 12:54 01 December 2015
1048
(continued)
1056
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
Substances
Substance
Rank
Cause
Rank
loperamide
1
1
loperamide
2
2
loperamide
1
1
loperamide
1
loperamide
loperamide
Gastrointestinal Preparations
[1063ha]
25 y F
1064 ph
[1065pha]
Chronicity
Route
Reason
A
Ingst
Int-A
Downloaded by [AAPCC] at 12:54 01 December 2015
1070
[1071h]
1072p
1073 ph
1074 ha
1075h
loperamide
1
1
loperamide
1
1
loperamide
0.013 mg/L In Blood
(unspecified)
@ 14.5 h (pe)
0.034 mg/L In Blood
(unspecified)
@ Autopsy
1.4 mg/kg In Liver
@ Autopsy
27 y M
U
Unk
Int-A
2
U
Ingst
Int-U
1
1078a
1079p
1080
1081
1
Ingst
Int-S
1
metformin
4.4 mcg/mL In Blood
(unspecified)
@ Unknown
1100 ng/mL In Blood
(unspecified)
@ Unknown
21 mcg/mL In Blood
(unspecified)
@ Unknown
32 mcg/mL In Blood
(unspecified)
@ Unknown
2
3
quetiapine
valproic acid
4
4
valproic acid
valproic acid
4
4
valproic acid
ibuprofen
5
5
metformin
fluoxetine
ibuprofen
1
2
3
1
2
3
metformin
diazepam
1
2
1
2
insulin
bupropion
1
2
1
2
androgen
1
1
androgen
ethanol
1
2
1
2
glipizide
gabapentin
1
2
1
2
metformin
1
clonazepam
35 y F
35 y M
38 y M
A/C
Ingst
Int-S
2
A
Ingst
Int-S
1
A/C
Ingst
Int-S
2
C
Unk
Int-A
3
C
Par
Int-A
3
ethanol
68 mg/dL In Blood
(unspecified)
@ Unknown
1
metformin
2
2
clonazepam
cocaine
3
3
benzoylecognine
190 mcg/mL In Blood
(unspecified)
@ Unknown
102 ng/mL In Blood
(unspecified)
@ Unknown
11547 ng/mL In Blood
(unspecified)
@ Unknown
insulin
1
1
40 y M
41 y F
47 y M
49 y F
Int-S
2
3
32 y F
1077h
Ingst
clonidine
quetiapine
25 y F
48 y M
1
1
25 y M
1076a
Blood Concentration
@ Time
35 ng/mL In Blood
(unspecified)
@ Unknown
53 y M
A
doxylamine/pyridoxine
1
1
See Also case 312, 350, 513, 788, 809, 811, 870, 1004, 1026, 1035, 1087, 1098, 1116, 1178
Hormones and Hormone Antagonists
1067 ha
14 y M
A/C
metformin
1
1
1069
Analyte
loperamide
1066p
1068h
RCF
A
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Par
Int-S
1
A
Ingst
AR-D
1
Ingst + Par
Int-S
1
Ingst
Int-S
1
insulin
372 microU/mL In Serum
@ Unknown
0.2 % (wt/Vol) In Serum
@ 2.5 h (pe)
0.27 % (wt/Vol) In Urine
(quantitative only)
@ 2.5 h (pe)
metformin
1
1
insulin
oxymorphone
tizanidine
drug, unknown
1
2
3
4
1
2
3
4
metformin
ethanol
1
2
1
2
ethanol
ethanol
2
2
ethanol
A/C
50 y F
A
lamotrigine
3
3
insulin
risperidone
zopiclone
zolpidem
1
2
3
4
1
2
3
4
metformin
1
1
glipizide
1
1
52 y F
A
54 y M
57 y M
Ingst + Par
Int-S
1
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
(continued)
AAPCC 2014 Annual Report of the NPDS
1057
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1082
57 y M
1083a
58 y F
1084
Downloaded by [AAPCC] at 12:54 01 December 2015
Substance
Rank
Cause
Rank
metformin
1
1
59 y F
1086h
60 y F
1087
63 y F
66 y M
1090
67 y M
1091h
68 y M
RCF
A
Ingst
Unk
3
A/C
Ingst
Int-S
1
Analyte
metformin
clonidine
2
2
clonidine
asenapine
3
3
metformin
clonazepam
1
2
1
2
insulin
1
1
A
Ingst
Int-S
A/C
Par
Int-S
1
A/C
Ingst
Int-U
2
A/C
Ingst + Derm
+ Par
Int-S
2
A/C
Ingst
Int-S
1
Blood Concentration
@ Time
8.6 mg/L In Blood
(unspecified)
@ Unknown
55 ng/mL In Blood
(unspecified)
@ Unknown
1
metformin
1
1
insulin
acetaminophen
oxybutynin
1
2
3
1
2
3
metformin
1
1
metformin
280 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
carvedilol
diazepam
2
3
2
3
diazepam
diazepam
3
3
nordiazepam
0.1 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
1 mcg/mL In Blood
(unspecified)
@ 1 h (pe)
metformin
1
1
metformin
ethanol
82 y F
Reason
1
metformin
1092h
Route
1
65 y M
1089h
Chronicity
metformin
59 y F
1085
1088a
Substances
1
1
2
C
Unk
Unk
A/C
Ingst
Unt-T
2
1
U
Ingst
Int-U
3
A/C
Ingst
Int-S
2
1
1
2
ethanol
172 mg/dL In Plasma
@ Unknown
metformin
1
1
enalapril
2
2
levothyroxine
3
3
See Also case 125, 312, 384, 398, 491, 630, 640, 717, 753, 785, 788, 799, 809, 811, 814, 818, 821, 868, 870, 881, 889, 891, 915, 931, 953, 958, 983, 999, 1000, 1003, 1004, 1007, 1013, 1024, 1030, 1129, 1300, 1399
Miscellaneous Drugs
1093
31 y M
A/C
Ingst
Int-S
2
atomoxetine
1
1
lurasidone
2
2
[1094h]
39 y F
A
Vag
Unt-T
1
glycine
1
1
[1095ph]
43 y F
A
Par
Unk
1
succinylcholine
1
1
1096h
83 y F
A/C
Ingst
Int-S
2
pramipexole
1
1
See Also case 306, 732, 755, 802, 868, 967, 988, 1026, 1030, 1042, 1052, 1215
Muscle Relaxants
1097
30 y M
U
Ingst
Int-U
2
cyclobenzaprine
1
1
cyclobenzaprine
1.6 mg/L In Blood
(unspecified)
@ Autopsy
1098 ha
33 y M
A/C
Ingst
Int-S
1
baclofen
1
1
tizanidine
2
2
promethazine
3
3
carisoprodol
4
4
morphine
5
5
morphine
0.018 mg/L In Blood
(unspecified)
@ Unknown
hydromorphone
6
6
oxybutynin
7
7
acetaminophen/
8
8
diphenhydramine
3.6 mg/kg In Liver
diphenhydramine
@ Autopsy
lorazepam
9
9
polyethylene glycol
10
10
lactulose
11
11
clonazepam
12
12
7-aminoclonazepam
0.67 mg/L In Blood
(unspecified)
@ Unknown
clonazepam
12
12
clonazepam
0.74 mg/L In Blood
(unspecified)
@ Unknown
1099 ph
33 y F
A/C
Ingst
Int-S
2
metaxalone
1
1
1100h
35 y M
A
Ingst
Int-S
2
cyclobenzaprine
1
1
1101
36 y F
A
Ingst
Int-S
1
baclofen*
2
1
verapamil*
1
1
cyclobenzaprine
3
2
alprazolam
4
3
(continued)
1058
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1102pha
37 y F
1103p
1104
1105p
Downloaded by [AAPCC] at 12:54 01 December 2015
1106
1107
1108 ha
1109h
1110h
[1111a]
1112
1113
1114 ph
Substance
Rank
Cause
Rank
cyclobenzaprine
1
1
cyclobenzaprine
drug, unknown
2
2
oxycodone
benzodiazepine
3
3
nordiazepam
benzodiazepine
3
3
diazepam
tizanidine
drug, unknown
1
2
1
2
cyclobenzaprine
hydrocodone
oxycodone
1
2
3
1
2
3
carisoprodol
acetaminophen
1
2
1
2
baclofen
diazepam
tramadol
ethanol
1
2
3
4
1
2
3
4
tizanidine
acetaminophen
1
2
1
2
zolpidem
3
3
baclofen
acetaminophen/oxycodone
drug, unknown
1
2
3
1
2
3
metaxalone
acetaminophen/
hydrocodone
1
2
1
2
diazepam
3
3
cyclobenzaprine
morphine
lorazepam
1
2
3
1
2
3
carisoprodol
1
1
carisoprodol
1
1
paroxetine
2
2
carisoprodol
ethanol
1
2
1
2
baclofen
diclofenac
1
2
1
2
Substances
39 y F
42 y M
47 y M
48 y F
49 y F
Chronicity
Route
Reason
U
Ingst
Int-S
Ingst
Int-S
1
A/C
Ingst
Int-S
1
A/C
Ingst
Unk
2
A/C
Ingst
Int-S
2
54 y F
55 y F
57 y F
Blood Concentration
@ Time
101 ng/mL In Blood
(unspecified)
@ Unknown
228 ng/mL In Blood
(unspecified)
@ Unknown
404 ng/mL In Blood
(unspecified)
@ Unknown
496 ng/mL In Blood
(unspecified)
@ Unknown
ethanol
15 mg/dL In Blood
(unspecified)
@ Unknown
acetaminophen
135 mcg/mL In Serum
@ Unknown
acetaminophen
65 mcg/mL In Blood
(unspecified)
@ 4 h (pe)
carisoprodol
(n-isopropyl
meprobamate)
carisoprodol
7.29 mcg/mL In Blood
(unspecified)
@ Unknown
72.17 mcg/mL In Blood
(unspecified)
@ Unknown
3
Ingst
Int-S
2
A
Ingst
Int-S
2
U
56 y F
Int-S
U
A/C
55 y F
Ingst
Analyte
3
A/C
A/C
49 y F
RCF
Ingst + Par
Int-U
2
Ingst
Unk
1
A
Ingst
Int-S
3
A/C
Ingst
Int-S
2
62 y F
U
Ingst
Int-S
3
carisoprodol
1
1
acetaminophen/
2
2
hydrocodone
See Also case 10, 17, 30, 39, 54, 310, 315, 334, 360, 383, 398, 407, 422, 466, 468, 489, 496, 540, 558, 559, 589, 612, 655, 692, 755, 777, 779, 788, 799, 855, 878, 899, 903, 904, 908, 914, 922, 929, 931, 940, 943,
945, 976, 1003, 1004, 1053, 1077, 1116, 1160, 1214
Sedative/Hypnotics/Antipsychotics
1115pa
16 y F
A
Ingst
Int-S
1
quetiapine
1
1
quetiapine
6.6 mg/L In Blood
(unspecified)
@ Unknown
diazepam
2
2
diazepam
0.044 mg/L In Blood
(unspecified)
@ Unknown
lorazepam
3
3
lorazepam
0.013 mg/L In Blood
(unspecified)
@ Unknown
carbamazepine
4
4
carbamazepine
2.7 mcg/mL In Blood
(unspecified)
@ Unknown
fluoxetine
5
5
fluoxetine
0.25 mg/L In Blood
(unspecified)
@ Unknown
cetirizine
6
6
hydroxyzine
7
7
hydroxyzine
46 ng/mL In Blood
(unspecified)
@ Autopsy
1116pa
20 y M
A
Ingst
Unk
2
diazepam
1
1
nordiazepam
134 ng/mL In Blood
(unspecified)
@ Unknown
(continued)
AAPCC 2014 Annual Report of the NPDS
1059
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Downloaded by [AAPCC] at 12:54 01 December 2015
1117p
Age
21 y M
1119p
25 y M
1121pha
1122 ph
1123pha
1124p
1125 ph
1126pha
1127pai
Cause
Rank
diazepam
1
1
diltiazem
cyclobenzaprine
2
2
cyclobenzaprine
dicyclomine
gabapentin
3
4
3
4
gabapentin
buprenorphine/naloxone
(sublingual)
5
5
norbuprenorphine
l-theanine
chlordiazepoxide
6
7
6
7
chlordiazepoxide
hydroxyzine
8
8
hydroxyzine
olanzapine
clonazepam
mirtazapine
ethanol
1
2
3
4
1
2
3
4
quetiapine
1
1
21 y M
1118h
1120 ph
Substance
Rank
Substances
Chronicity
Route
Reason
RCF
U
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
Unk
Int-A
2
Analyte
diazepam
1
1
oxazepam
diazepam
1
1
temazepam
diazepam
1
1
nordiazepam
benzodiazepine
2
2
alprazolam
codeine
3
3
codeine
codeine
3
3
morphine
alprazolam
opioid
drug, unknown
1
2
3
1
2
3
quetiapine (extended
release)
1
1
25 y M
26 y F
26 y M
A
Ingst + Inhal
Int-M
2
A
Ingst
Int-S
1
A
Ingst
Int-A
2
U
Ingst
Int-S
1
temazepam
1
1
temazepam
temazepam
1
1
oxazepam
cocaine
2
2
benzoylecognine
ethanol
3
3
ethanol
alprazolam
4
4
alprazolam
alprazolam
hydrocodone
1
2
1
2
temazepam
risperidone
drug, unknown
1
2
3
1
2
3
quetiapine
1
1
quetiapine
duloxetine
2
2
duloxetine
hydroxyzine
3
3
alprazolam
1
1
diphenhydramine
2
2
29 y F
30 y M
30 y F
Ingst
Int-A
2
A/C
Ingst
Int-S
2
U
Ingst
Int-S
3
A
Ingst + Par
Int-A
425 ng/mL In Blood
(unspecified)
@ Unknown
55 ng/mL In Blood
(unspecified)
@ Unknown
503 ng/mL In Urine
(quantitative only)
@ Unknown
620 ng/mL In Urine
(quantitative only)
@ Unknown
903 ng/mL In Urine
(quantitative only)
@ Unknown
39 ng/mL In Urine
(quantitative only)
@ Unknown
133 ng/mL In Urine
(quantitative only)
@ Unknown
3785 ng/mL In Urine
(quantitative only)
@ Unknown
3477 ng/mL In Blood
(unspecified)
@ Unknown
55 ng/mL In Blood
(unspecified)
@ Unknown
977 ng/mL In Blood
(unspecified)
@ Unknown
0.064 g/dL In Blood
(unspecified)
@ Unknown
326 ng/mL In Blood
(unspecified)
@ Unknown
1
2
3
4
A/C
1.9 mcg/mL In Blood
(unspecified)
@ Unknown
1.5 ng/mL In Blood
(unspecified)
@ Unknown
1.08 mg/L In Serum
@ 2 h (pe)
1
2
3
4
29 y F
162 ng/mL In Blood
(unspecified)
@ Unknown
11.9 ng/mL In Blood
(unspecified)
@ Unknown
quetiapine
alprazolam
methadone
cocaine
opioid
29 y F
Blood Concentration
@ Time
380 ng/mL In Blood
(unspecified)
@ Autopsy
230 ng/mL In Blood
(unspecified)
@ Autopsy
2
alprazolam
230 ng/mL In Blood
(unspecified)
@ Autopsy
(continued)
1060
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1128pa
30 y M
Downloaded by [AAPCC] at 12:54 01 December 2015
1129h
1130pha
1131 ph
1132
1133ai
Cause
Rank
olanzapine
1
1
olanzapine
fluvoxamine
2
2
fluvoxamine
diazepam
3
3
nordiazepam
diazepam
3
3
diazepam
diazepam
3
3
oxazepam
diazepam
3
3
temazepam
tramadol
4
4
tramadol
tramadol
4
4
o-demethyl tramadol
aripiprazole
5
5
aripiprazole
propofol
ketamine
insulin
opioid
benzodiazepine
1
2
3
4
5
1
2
3
4
5
quetiapine
1
1
quetiapine
morphine
2
2
morphine (free)
oxycodone
3
3
oxycodone
methamphetamine
4
4
methamphetamine
methamphetamine
4
4
amphetamine
alprazolam
hydroxyzine
topiramate
fluoxetine
zolpidem
drug, unknown
1
2
3
4
5
6
1
2
3
4
5
6
quetiapine
propranolol
valproic acid
paliperidone
lisinopril
potassium salts
thiazide
buspirone
alprazolam
benztropine
paroxetine
simvastatin
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
butalbital
citalopram
oxycodone
1
2
3
1
2
3
alprazolam
1
1
32 y F
33 y F
35 y M
36 y F
37 y F
Chronicity
Route
Reason
A/C
Ingst
Unk
quetiapine
1
1
clonidine
2
2
zolpidem
clonazepam
duloxetine
aripiprazole
amphetamine
marijuana
1
2
3
4
5
6
1
2
3
4
5
6
quetiapine
1
1
37 y F
38 y F
RCF
Analyte
Blood Concentration
@ Time
3
A
Par
Int-S
2
U
Ingst
Int-S
1
A/C
35 y M
1135pa
1137pha
Substance
Rank
31 y F
1134ai
1136h
Substances
Ingst + Unk
Unk
1
A
Ingst
Int-U
3
A
Ingst
Int-U
2
A
Unk
Int-U
2
U
Ingst
Int-S
1
A/C
Ingst
Int-S
3
A/C
Ingst
Int-S
1
440 ng/mL In Blood
(unspecified)
@ Autopsy
700 ng/mL In Blood
(unspecified)
@ Autopsy
1500 ng/mL In Blood
(unspecified)
@ Autopsy
490 ng/mL In Blood
(unspecified)
@ Autopsy
67 ng/mL In Blood
(unspecified)
@ Autopsy
68 ng/mL In Blood
(unspecified)
@ Autopsy
210 ng/mL In Blood
(unspecified)
@ Autopsy
97 ng/mL In Blood
(unspecified)
@ Autopsy
420 ng/mL In Blood
(unspecified)
@ Autopsy
5529 ng/mL In Blood
(unspecified)
@ Autopsy
27 ng/mL In Blood
(unspecified)
@ Autopsy
59 ng/mL In Blood
(unspecified)
@ Autopsy
50 ng/mL In Blood
(unspecified)
@ Autopsy
50 ng/mL In Blood
(unspecified)
@ Autopsy
quetiapine
4.2 mcg/mL In Blood
(unspecified)
@ Autopsy
quetiapine
2911 ng/mL In Blood
(unspecified)
@ Unknown
(continued)
AAPCC 2014 Annual Report of the NPDS
1061
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Downloaded by [AAPCC] at 12:54 01 December 2015
Annual
Report ID
Age
1138 pi
39 y F
1139ai
40 y M
1140
42 y F
1142 ph
43 y F
1143
43 y M
1144 ha
44 y F
1146 ha
1147 ph
1148h
Substance
Rank
Cause
Rank
venlafaxine
2
2
venlafaxine
fluoxetine
3
3
norfluoxetine
fluoxetine
3
3
fluoxetine
fluoxetine
3
3
fluoxetine
pseudoephedrine
4
4
pseudoephedrine
topiramate
5
5
topiramate
dextromethorphan
6
6
dextromethorphan
pregabalin
7
7
pregabalin
quetiapine
1
1
alprazolam
hydrocodone
methadone
1
2
3
1
2
3
quetiapine
buspirone
gabapentin
midazolam
1
2
3
4
1
2
3
4
quetiapine
1
1
41 y F
1141
1145
Substances
olanzapine
zolpidem
1
2
1
2
quetiapine
1
1
Chronicity
Route
Reason
RCF
U
Ingst
Int-S
2
A
Ingst
Int-U
2
C
Ingst
Int-S
2
A/C
Ingst + Aspir
Int-S
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
1
A
Ingst
Int-S
1
Analyte
Blood Concentration
@ Time
24592 ng/mL In Blood
(unspecified)
@ Unknown
1.06 mg/L In Blood
(unspecified)
@ Autopsy
2.2 mg/L In Blood
(unspecified)
@ Autopsy
358 pg/mL In Blood
(unspecified)
@ Unknown
205 ng/mL In Blood
(unspecified)
@ Unknown
3.31 mg/L In Blood
(unspecified)
@ Autopsy
545 ng/mL In Blood
(unspecified)
@ Unknown
21.3 mcg/mL In Blood
(unspecified)
@ Unknown
quetiapine
1
1
quetiapine
paroxetine
2
2
paroxetine
lamotrigine
3
3
lamotrigine
oxycodone
4
4
oxycodone (free)
hydrochlorothiazide
bupropion
alprazolam
5
6
7
5
6
7
quetiapine
1
1
quetiapine
quetiapine
2
2
quetiapine
quetiapine
3
3
quetiapine
ethanol
4
4
ethanol
quetiapine
1
1
quetiapine
5.2 mcg/mL In Blood
(unspecified)
@ 2 d (pe)
lamotrigine
topiramate
gabapentin
2
3
4
2
3
4
gabapentin
26 mcg/mL In Blood
(unspecified)
@ 2 d (pe)
clonazepam
1
1
lorazepam
temazepam
zolpidem
quetiapine
lithium
1
2
3
4
5
1
2
3
4
5
lithium
1.8 mEq/L In Serum
@ Unknown
risperidone
bupropion
benztropine
lurasidone
paroxetine
6
7
8
9
10
6
7
8
9
10
44 y F
A/C
44 y F
A
44 y F
45 y M
Ingst
Ingst
Int-S
Int-S
32 mg/mL In Blood
(unspecified)
@ Autopsy
1.68 mg/L In Blood
(unspecified)
@ Autopsy
8.2 mg/mL In Blood
(unspecified)
@ Autopsy
7 ng/mL In Blood
(unspecified)
@ Autopsy
1
2310 ng/mL In Blood
(unspecified)
@ Autopsy
2310 ng/mL In Blood
(unspecified)
@ Autopsy
2310 ng/mL In Blood
(unspecified)
@ Autopsy
221 mg/dL In Blood
(unspecified)
@ Autopsy
1
A
Ingst
Int-S
2
A
Ingst
Int-S
2
(continued)
1062
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1149h
45 y F
1150
1151ai
1152i
1153 ha
1154 ph
Downloaded by [AAPCC] at 12:54 01 December 2015
1155
1156 ph
1157pha
[1158ha]
1165p
1
2
alprazolam
hydrocodone
oxycodone
oxymorphone
1
2
3
4
1
2
3
4
clonazepam
bupropion
venlafaxine
gabapentin
lamotrigine
1
2
3
4
5
1
2
3
4
5
asenapine
diphenhydramine*
1
3
1
2
paroxetine*
2
2
benzodiazepine
tramadol
citalopram
1
2
3
1
2
3
quetiapine
1
1
zolpidem
ethanol
1
2
1
2
benzodiazepine
1
opioid
60 y F
1173pa
61 y M
2
A/C
Ingst
Int-S
2
A
Ingst + Oth
Int-S
2
U
Ingst
Int-S
3
Ingst + Par
Unk
3
alprazolam
2
2
oxycodone
14 ng/mL In Blood
(unspecified)
@ 1 d (pe)
108 ng/mL In Blood
(unspecified)
@ 1 d (pe)
propofol
1
1
olanzapine
1
1
A/C
Ingst
Unk
2
A
Ingst
Int-S
2
U
Ingst
Int-S
2
A
butalbital
carisoprodol
oxycodone
1
2
3
1
2
3
diazepam
alprazolam
1
2
1
2
quetiapine
1
1
quetiapine
benzodiazepine
1
2
1
2
alprazolam
1
1
alprazolam
acetaminophen/
hydrocodone
1
2
1
2
alprazolam
1
1
zolpidem
1
1
olanzapine
1
1
diazepam
midazolam
1
2
1
2
quetiapine
clonazepam
1
2
1
2
quetiapine
1
1
temazepam
1
1
clonazepam
1
1
quetiapine
lithium
1
2
1
2
sertraline
3
3
diazepam
1
1
phenobarbital
phenytoin
1
2
1
2
62 y M
62 y M
Par
Int-U
Int-S
2
1
Ingst
Int-S
2
A
Ingst
Int-U
2
A
Ingst
Int-U
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A
Ingst
Int-S
3
U
Ingst
Int-A
3
A
Ingst
Int-S
2
A
Ingst
Int-S
3
Ingst + Unk
AR-O
3
A
Ingst
Int-U
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A
Ingst + Aspir
Int-S
2
A
Ingst
Unk
2
A/C
62 y F
Unk
A/C
A/C
60 y M
1172 ph
Int-S
A
56 y M
59 y F
Ingst
Blood Concentration
@ Time
1
54 y F
1170
A/C
Analyte
0.22 mg/mL In Blood
(unspecified)
@ Unknown
54 y F
59 y F
RCF
ethanol
52 y M
59 y M
Reason
0.18 mg/L In Blood
(unspecified)
@ Unknown
52 y M
1169ai
Route
diphenhydramine
51 y M
1168 ph
Chronicity
A/C
51 y M
57 y F
1176 ph
1
2
51 y M
58 y F
1175
alprazolam
drug, unknown
50 y M
1167i
1174h
1
2
50 y F
1166
1171h
1
2
50 y F
52 y F
1164p
quetiapine
zolpidem
49 y F
52 y M
1163
Cause
Rank
49 y M
1160ai
1162h
Substance
Rank
47 y F
1159h
1161ai
Substances
Ingst
Int-S
propofol
0.61 mcg/mL In Serum
@ 1 h (pe)
clonazepam
6.8 ng/mL In Serum
@ Autopsy
lithium
0.39 mcg/mL In Blood
(unspecified)
@ 15 m (pe)
2
A/C
Ingst
Int-S
3
U
Ingst
Int-S
1
(continued)
AAPCC 2014 Annual Report of the NPDS
1063
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1177p
66 y M
1178p
68 y M
1180h
69 y F
Downloaded by [AAPCC] at 12:54 01 December 2015
1182i
73 y F
74 y F
1187
1188
1189
1190h
haloperidol
tramadol
salicylate
1
2
3
1
2
3
salicylate
salicylate
3
3
salicylate
opioid
4
4
clonazepam
mirtazapine
trazodone
zolpidem
antacid (proton pump
inhibitor)
drug, unknown
1
2
3
4
5
1
2
3
4
5
6
6
triazolam
1
1
Chronicity
A/C
A
quetiapine
clonazepam
citalopram
1
2
3
1
2
3
temazepam
oxycodone
1
2
1
2
temazepam
losartan
tramadol
1
2
3
1
2
3
benzodiazepine
1
1
73 y F
1184 ha
1186a
Cause
Rank
72 y F
1183p
1185
Substance
Rank
67 y F
1179h
1181h
Substances
Route
Reason
Ingst + Unk
Int-S
Ingst
Int-S
RCF
Analyte
2
A/C
Ingst
Int-S
3
A
Ingst
Int-S
2
A/C
Ingst
Int-S
3
A/C
Ingst
Int-S
3
A
Ingst
Int-S
2
U
Ingst
Unk
2
1
1
diazepam
diazepam
1
1
nordiazepam
ethanol
propylene glycol
2
3
2
3
zolpidem
acetaminophen/codeine
1
2
1
2
trazodone
acetaminophen/
hydrocodone
3
4
3
4
temazepam
acetaminophen/
hydrocodone
venlafaxine
citalopram
naproxen
1
2
1
2
3
4
5
3
4
5
alprazolam
zolpidem
1
2
1
2
temazepam
1
1
lorazepam
fluoxetine
1
2
1
2
A
76 y F
81 y M
85 y F
88 y F
Ingst
Int-S
4.7 mg/dL In Serum
@ Unknown
5 mg/dL In Serum
@ 1 d (pe)
2
diazepam
75 y F
Blood Concentration
@ Time
0.12 mg/L In Blood
(unspecified)
@ Autopsy
0.18 mg/L In Blood
(unspecified)
@ Autopsy
2
acetaminophen
A/C
Ingst
Int-S
2
A
Ingst
Int-S
2
A/C
Ingst
Int-S
2
A/C
Ingst
Int-S
2
85 mcg/mL In Serum
@ Unknown
93 y M
A
Ingst
Int-S
2
alprazolam
1
1
diphenhydramine
2
2
A/C
Ingst
Int-S
2
1191 pi
Unknown adult
(4¼ 20 yrs)
F
zolpidem
1
1
methadone
2
2
clonazepam
3
3
methylphenidate
4
4
See Also case 3, 5, 11, 17, 18, 25, 30, 34, 50, 55, 68, 71, 74, 92, 116, 124, 139, 179, 197, 198, 309, 310, 312, 315, 319, 321, 322, 323, 325, 337, 338, 340, 341, 344, 345, 346, 347, 348, 349, 351, 360, 361, 362, 365,
368, 370, 373, 375, 379, 383, 384, 389, 390, 406, 409, 413, 415, 417, 418, 422, 433, 439, 441, 451, 452, 454, 461, 468, 480, 482, 490, 498, 499, 506, 510, 512, 514, 521, 534, 537, 540, 549, 552, 556, 559, 560, 570,
571, 575, 576, 583, 586, 587, 589, 598, 606, 612, 614, 618, 619, 622, 628, 632, 635, 636, 639, 649, 656, 658, 659, 662, 668, 670, 672, 676, 692, 698, 711, 714, 716, 717, 720, 721, 724, 727, 731, 733, 741, 742, 743,
745, 746, 747, 749, 753, 755, 759, 763, 764, 766, 770, 774, 778, 779, 784, 785, 787, 788, 789, 790, 791, 796, 799, 801, 802, 804, 805, 807, 808, 809, 811, 818, 821, 822, 826, 828, 835, 841, 844, 847, 849, 867, 869,
872, 876, 878, 881, 882, 885, 892, 895, 896, 897, 900, 903, 911, 913, 915, 922, 923, 925, 929, 930, 931, 940, 942, 945, 946, 947, 950, 956, 958, 960, 961, 971, 978, 980, 983, 988, 997, 999, 1004, 1006, 1007, 1011,
1016, 1035, 1051, 1052, 1067, 1069, 1074, 1079, 1083, 1084, 1088, 1093, 1098, 1101, 1102, 1103, 1106, 1107, 1109, 1110, 1217, 1219, 1226, 1239, 1246, 1259, 1261, 1263, 1275, 1277, 1286, 1290, 1298, 1314,
1320, 1321, 1322, 1328, 1338, 1345, 1346, 1360, 1373, 1378, 1406
Stimulants and Street Drugs
1192 ph
15 y M
A
Ingst + Inhal
Int-A
1
amphetamine
1
1
(hallucinogenic), 2 C
mushroom
2
2
(psilocybin-psilocin)
marijuana
3
3
1193 pi
16 y M
A
Ingst
Int-A
2
amphetamine
1
1
(hallucinogenic)
1194pa
17 y F
A/C
Ingst + Unk
Int-A
1
1
1
amphetamine
(hallucinogenic),
25 C-NBOMe
(continued)
1064
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
1195ai
17 y M
1196pha
17 y F
1197pha
1198pha
1199
[1200ph]
Downloaded by [AAPCC] at 12:54 01 December 2015
Age
1201 ph
1202 pi
1203pai
1204
1205i
1206 ha
1207p
1208 ha
1209h
1210 ph
1211
Substance
Rank
Cause
Rank
amphetamine
(hallucinogenic), 2 C-I
marijuana
oxycodone
2
2
3
4
3
4
heroin
1
1
RCF
U
Unk
Int-A
2
A
Unk
Int-A
1
A
Ingst
Int-A
1
U
Unk
Int-A
1
Analyte
amphetamine
(hallucinogenic), 2 C
1
1
amphetamine
1
1
methamphetamine
amphetamine
1
1
methamphetamine
diphenhydramine
2
2
diphenhydramine
amphetamine
(hallucinogenic)
lysergic acid diethylamide
(LSD)
1
1
2
2
lysergic acid diethylamide
(LSD)
methylenedioxymethamphetamine (MDMA)
1
1
2
2
amphetamine
(hallucinogenic), 2 C-I
marijuana
1
1
2
2
amphetamine
(hallucinogenic)
1
1
caffeine
1
1
methylenedioxymethamphetamine (MDMA)
ethanol
1
1
2
2
tryptamine
(hallucinogenic)
1
1
methylenedioxymethamphetamine (MDMA)
1
methylenedioxymethamphetamine (MDMA)
17 y M
18 y M
18 y M
18 y M
A
Ingst
Int-A
1
A
Ingst
Int-A
2
A
Inhal
Int-A
2
A
Ingst
Int-A
2
U
Ingst
Unt-U
2
Blood Concentration
@ Time
0.1 mg/L In Blood
(unspecified)
@ Autopsy
0.21 mg/L In Blood
(unspecified)
@ Unknown
0.02 mcg/mL In Blood
(unspecified)
@ Autopsy
caffeine
100 mcg/mL In Blood
(unspecified)
@ Autopsy
1
mda (3,4-methylene
dioxyamphetamine)
1
1
mdma
(3,4-methylenedioxy
-metham
-phetamine)
110 ng/mL In Blood
(unspecified)
@ Autopsy
5400 ng/mL In Blood
(unspecified)
@ Autopsy
heroin
1
1
THC homolog
marijuana
1
2
1
2
cocaine
disopyramide
oxycodone
1
2
3
1
2
3
methamphetamine
morphine
codeine
pseudoephedrine
1
2
3
4
1
2
3
4
methylenedioxymethamphetamine (MDMA)
1
1
methamphetamine
1
1
18 y F
19 y M
19 y M
19 y F
19 y M
19 y M
19 y F
19 y M
19 y F
Reason
1
17 y M
19 y M
Route
1
17 y M
1213p
Chronicity
heroin
17 y F
1212h
1214pa
Substances
heroin
1
1
heroin
1
1
codeine
2
2
codeine
2
2
codeine
2
2
hydrocodone
3
3
20 y F
A
Ingst
Int-A
1
A
Unk
Int-A
2
A
Ingst
Int-A
1
A
Unk
Int-A
1
A
Inhal + Par
Int-A
2
A
Ingst
Unt-G
2
A
Oth + Unk
Int-A
2
A
Ingst
Int-A
1
U
Ingst
Int-A
2
U
Unk
Int-A
1
A
Ingst + Inhal
Int-A
1
6-monoacetylmorphine 0.96 mg/L In Urine
(quantitative only)
@ Autopsy
morphine
0.096 mg/L In Blood
(unspecified)
@ Autopsy
codeine
0.22 mg/L In Urine
(quantitative only)
@ Autopsy
morphine
3.9 mg/L In Urine
(quantitative only)
@ Autopsy
hydrocodone
0.089 mg/L In Urine
(quantitative only)
@ Autopsy
(continued)
AAPCC 2014 Annual Report of the NPDS
1065
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
1215pha
1216pai
1217p
[1218ph]
Downloaded by [AAPCC] at 12:54 01 December 2015
1219pa
1220h
1221h
1222pai
[1223ph]
[1224ha]
1225p
1226pa
1227pa
Age
Substances
Substance
Rank
Cause
Rank
oxycodone
4
4
oxymorphone
oxycodone
4
4
oxycodone
citalopram
5
5
citalopram
citalopram
5
5
citalopram
cyclobenzaprine
dextromethorphan
diltiazem
6
7
8
6
7
8
cocaine
1
1
lipid emulsion
2
2
methylenedioxymethamphetamine (MDMA)
1
1
methamphetamine
benzodiazepine
1
2
1
2
amphetamine
(hallucinogenic)
1
1
heroin
1
alprazolam
20 y M
Chronicity
U
Route
Par + Unk
Reason
AR-D
RCF
Analyte
Blood Concentration
@ Time
0.02 mg/L In Urine
(quantitative only)
@ Autopsy
1.1 mg/L In Urine
(quantitative only)
@ Autopsy
0.2 mg/L In Blood
(unspecified)
@ Autopsy
1.3 mg/kg In Liver
@ Autopsy
1
benzoylecognine
0.8 mg/L In Blood
(unspecified)
@ Autopsy
1
morphine
2
2
alprazolam
alprazolam
2
2
alprazolam
0.026 mg/L In Urine
(quantitative only)
@ Autopsy
0.11 mg/L In Blood
(unspecified)
@ Autopsy
0.12 mg/kg In Blood
(unspecified)
@ 14 h (pe)
amphetamine
(hallucinogenic), 2 C
1
1
amphetamine
bupropion
amphetamine
(hallucinogenic)
1
2
3
1
2
3
heroin
1
1
cocaine
2
2
methamphetamine
1
methamphetamine
20 y M
20 y M
20 y M
21 y M
21 y M
21 y M
21 y F
A
Unk
Int-A
1
U
Unk
Int-U
2
A/C
Ingst
Int-A
1
C
Unk
Int-A
1
A
Ingst
Int-A
2
U
Unk
Unk
2
A/C
Unk
Int-A
2
morphine
151 ng/mL In Blood
(unspecified)
@ Autopsy
1
amphetamine
1
1
methamphetamine
0.32 mg/L In Blood
(unspecified)
@ Autopsy
12.53 mg/L In Blood
(unspecified)
@ Autopsy
methylenedioxymethamphetamine (MDMA)
1
1
mda (3,4-methylene
dioxyamphetamine)
methylenedioxymethamphetamine (MDMA)
1
1
mdma (3,4-methylene
dioxymethamp
hetamine)
amphetamine
(hallucinogenic)
1
1
heroin
1
1
morphine
oxycodone
2
2
oxycodone
clonazepam
3
3
clonazepam
clonazepam
3
3
7-aminoclonazepam
amphetamine
(hallucinogenic),
25 C-NBOMe
amphetamine
(hallucinogenic), 2 C-I
marijuana
1
1
2
2
3
3
marijuana
3
3
21 y F
U
21 y F
A
21 y F
22 y M
22 y M
Ingst
Ingst
Int-U
Int-A
1
1
A
Ingst
Int-A
1
A
Ingst + Inhal
Int-A
1
A
Inhal
Int-A
16 ng/mL In Blood
(unspecified)
@ Autopsy
460 ng/mL In Blood
(unspecified)
@ Autopsy
0.092 mg/L In Blood
(unspecified)
@ Autopsy
0.012 mg/L In Blood
(unspecified)
@ Autopsy
0.005 mg/L In Blood
(unspecified)
@ Autopsy
0.065 mg/L In Blood
(unspecified)
@ Autopsy
1
25 c-nbome
31.7 ng/mL In
Whole Blood
@ 17 h (pe)
carboxy-thc
68.5 ng/mL In
Whole Blood
@ 17 h (pe)
thc
7.9 ng/mL In
(tetrahydrocannabinol) Whole Blood
@ 17 h (pe)
(continued)
1066
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1228 ph
22 y F
1229ai
22 y F
1230 ph
22 y F
1231
22 y M
1232
22 y F
1233pha
Downloaded by [AAPCC] at 12:54 01 December 2015
1234p
1235p
1236
1237pai
[1238pa]
1239 ha
1240pha
1241p
Substance
Rank
Cause
Rank
heroin
1
1
methamphetamine
1
1
Substances
A
heroin
1
1
methamphetamine
1
1
marijuana
diet aid, nonprescription
1
2
1
2
heroin
1
1
heroin
1
1
heroin
1
1
methamphetamine
2
2
methamphetamine
2
2
marijuana
3
3
marijuana
3
3
heroin
cocaine
1
2
1
2
gamma-hydroxybutyric
acid
methamphetamine
1
1
2
2
heroin
droperidol/
fentanyl
1
2
1
2
ethanol
3
3
22 y F
23 y M
23 y M
23 y F
23 y M
Int-A
Unk
Int-U
2
Unk
1
A
Ingst
Int-A
2
A
Ingst + Inhal
Int-U
1
A
Par
Int-A
1
Int-A
morphine
92 ng/mL In Blood
(unspecified)
@ Unknown
morphine
121 ng/mL In Blood
(unspecified)
@ Autopsy
1
6-monoacetylmorphine 220 ng/mL In Urine
(quantitative only)
@ Autopsy
morphine
92 ng/mL In Blood
(unspecified)
@ Autopsy
amphetamine
120 ng/mL In Blood
(unspecified)
@ Autopsy
methamphetamine
300 ng/mL In Blood
(unspecified)
@ Autopsy
delta-9-thc
3.1 ng/mL In Blood
(unspecified)
@ Autopsy
delta-9-carboxy-thc
37 ng/mL In Blood
(unspecified)
@ Autopsy
A
Ingst
Int-A
2
A
Ingst
Int-A
2
C
Ingst + Inhal
Int-A
1
fentanyl
ethanol
Unk
Int-A
methamphetamine
methamphetamine
1
1
amphetamine
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
marijuana
2
2
carboxy-thc
marijuana
2
2
thc (tetrahydro
cannabinol)
heroin
1
1
clonazepam
2
2
3,4-methylenedioxyamphetamine (MDA)
1
1
mda (3,4-methylene
dioxyamphetamine)
ethanol*
3
2
ethanol
methylenedioxymethamphetamine (MDMA) *
2
2
cocaine
fentanyl
1
2
1
2
caffeine
1
1
A
Unt-U
10000 ng/mL In Urine
(quantitative only)
@ Autopsy
10000 ng/mL In Urine
(quantitative only)
@ Autopsy
413 ng/mL In Blood
(unspecified)
@ Autopsy
8036 ng/mL In Blood
(unspecified)
@ Autopsy
6.9 ng/mL In Blood
(unspecified)
@ Autopsy
62 ng/mL In Urine
(quantitative only)
@ Autopsy
1
6-monoacetylmorphine 9 mcg/L In Vitreous
@ Autopsy
clonazepam
43 ng/mL In Blood
(unspecified)
@ Unknown
A
1
Unk
3.1 ng/mL In Blood
(unspecified)
@ Unknown
0.232 % In Serum
@ Unknown
1
1
heroin
Blood Concentration
@ Time
1
Par
Par
Analyte
1
23 y M
24 y M
Par
RCF
methamphetamine
23 y F
24 y M
Reason
U
A
23 y M
1243h
Route
U
U
23 y F
1242 ph
Chronicity
Ingst + Inhal
Int-A
1
A
Inhal
Int-A
1
A
Unk
Int-U
2
A/C
Par
Int-A
1
12000 ng/mL In Blood
(unspecified)
@ Unknown
115 mg/dL In Blood
(unspecified)
@ Unknown
1
(continued)
AAPCC 2014 Annual Report of the NPDS
1067
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1244pa
24 y F
1245p
1246
1247 ph
1248pai
1251
26 y M
1252a
26 y M
Downloaded by [AAPCC] at 12:54 01 December 2015
1
2
heroin
1
1
amphetamine/
dextroamphetamine
alprazolam
1
1
2
2
heroin
drug, unknown
1
2
1
2
heroin
1
1
heroin
1
1
26 y M
1255pha
26 y M
Chronicity
Route
Reason
A
Unk
Int-A
1
A
Par
Int-A
1
Ingst
Int-S
2
C
Par
Int-A
1
A
Par
Int-A
1
A/C
amphetamine
1
1
methamphetamine
1
1
cocaine
heroin
methamphetamine
1
2
3
1
2
3
heroin
drug, unknown
1
2
1
2
cocaine
1
1
26 y M
1254p
1259pa
1
2
25 y F
25 y M
1258
heroin
oxycodone
25 y M
25 y M
[1257ha]
Cause
Rank
25 y M
1250
1256 ph
Substance
Rank
24 y M
1249ai
1253 pi
Substances
RCF
A
Unk
Int-U
2
A/C
Par
Int-A
3
A
Ingst
Int-M
2
U
Unk
Int-A
3
A
Ingst
Int-A
2
A
Ingst
Int-M
1
A
Unk
Unk
1
Analyte
morphine
260 ng/mL In Blood
(unspecified)
@ Autopsy
1395 ng/mL In Urine
(quantitative only)
@ Unknown
79 ng/mL In Urine
(quantitative only)
@ Unknown
heroin
1
1
morphine
heroin
1
1
codeine
methamphetamine
1
1
amphetamine
(hallucinogenic)
1
1
amphetamine
(hallucinogenic)
1
1
cocaine
opioid
marijuana
1
2
3
1
2
3
heroin
1
heroin
27 y F
27 y M
U
Inhal
Int-A
1
U
Ingst
Int-A
1
Blood Concentration
@ Time
mda (3,4-methylene
dioxyam
phetamine)
mdma (3,4-methylene
dioxymetham
phetamine)
0.096 mg/L In
Whole Blood
@ Unknown
4.46 mg/L In
Whole Blood
@ Unknown
1
morphine
1
1
morphine
heroin
1
1
6-mono
acetylmorphine
heroin
1
1
codeine
heroin
1
1
codeine
heroin
1
1
6-mono
acetylmorphine
hydroxyzine
2
2
hydroxyzine
dextromethorphan
3
3
dextromethorphan
diphenhydramine
4
4
diphenhydramine
clonazepam
5
5
7-aminoclonazepam
clonazepam
5
5
7-aminoclonazepam
lamotrigine
6
6
lamotrigine
topiramate
7
7
topiramate
quetiapine
8
8
quetiapine
10 mg/L In Urine
(quantitative only)
@ Autopsy
19069 ng/mL In Blood
(unspecified)
@ Autopsy
3261 ng/mL In Blood
(unspecified)
@ Autopsy
3261 ng/mL In Blood
(unspecified)
@ Autopsy
3503 ng/mL In Urine
(quantitative only)
@ Autopsy
5503 ng/mL In Urine
(quantitative only)
@ Autopsy
1327 ng/mL In Blood
(unspecified)
@ Autopsy
1206 ng/mL In Blood
(unspecified)
@ Autopsy
114.3 mg/L In Blood
(unspecified)
@ Autopsy
356 ng/mL In Urine
(quantitative only)
@ Autopsy
52.9 ng/mL In Blood
(unspecified)
@ Autopsy
7.3 ng/mL In Blood
(unspecified)
@ Autopsy
3.9 ng/mL In Blood
(unspecified)
@ Autopsy
1225 ng/mL In Blood
(unspecified)
@ Autopsy
28 y M
28 y F
A
Ingst
Int-A
2
U
Ingst
Int-S
1
(continued)
1068
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
1260pai
Downloaded by [AAPCC] at 12:54 01 December 2015
1261pai
Age
28 y M
29 y F
1266pha
acetaminophen
9
9
guaifenesin
10
10
heroin
1
ethanol
30 y F
1269p
30 y F
1270h
30 y M
1271ai
30 y F
1272p
30 y M
1273 ha
31 y M
1274 ph
31 y F
1275pha
31 y F
RCF
Analyte
Blood Concentration
@ Time
morphine
2
2
ethanol
104 ng/mL In Blood
(unspecified)
@ Autopsy
0.221 % (wt/Vol) In Blood
(unspecified)
@ Autopsy
cocaine
1
1
benzoylecognine
alprazolam
2
2
alprazolam
oxycodone
(extended release)
3
3
oxycodone
quetiapine
clonazepam
lidocaine
4
5
6
4
5
6
heroin
1
1
A
U
Par
Ingst + Unk
Int-A
Int-A
3
1
U
Unk
Int-A
2
U
Unk
Int-A
1
heroin
1
1
morphine (free)
citalopram
2
2
citalopram
clonazepam
3
3
clonazepam
clonazepam
3
3
7-aminoclonazepam
hydroxyzine
4
4
hydroxyzine
methamphetamine
1
1
amphetamine
methamphetamine
1
1
methamphetamine
amphetamine
(hallucinogenic)
2
2
amphetamine
1
1
amphetamine
methamphetamine
2
2
methamphetamine
methylenedioxymethamphetamine (MDMA)
marijuana
3
3
4
4
heroin
1
1
morphine (free)
heroin
1
1
6-mono
acetylmorphine
heroin
1
1
codeine (free)
heroin
1
1
U
A
29 y M
30 y M
Reason
1
29 y M
1268h
Route
119 ng/mL In Blood
(unspecified)
@ Autopsy
29 y M
1267 pi
Chronicity
acetaminophen
28 y M
1263pha
1265pha
Cause
Rank
28 y M
1262 ph
1264 ha
Substance
Rank
Substances
U
cocaine
1
1
heroin
1
1
methamphetamine
1
1
heroin
1
1
heroin
1
1
heroin
1
1
heroin
1
1
1
Par
Int-A
Int-U
190 ng/mL In
Whole Blood
@ Unspecified
120 ng/mL In Blood
(unspecified)
@ Unknown
21 ng/mL In Blood
(unspecified)
@ Unknown
40 ng/mL In Blood
(unspecified)
@ Unknown
15 ng/mL In Blood
(unspecified)
@ Unknown
1
177 ng/mL In Blood
(unspecified)
@ Autopsy
8728 ng/mL In Blood
(unspecified)
@ Autopsy
1
0.42 mcg/mL In Blood
(unspecified)
@ Autopsy
10 mcg/mL In Blood
(unspecified)
@ Autopsy
1
A
Par
Int-A
2
Unk
Unk
3
A
Par
Int-A
2
A
Unk
Int-S
1
A
Par
Int-U
2
A/C
Par
Int-A
1
A
Unk
Int-A
3
U
1
Unk
Int-U
A
A/C
amphetamine
Unk
0.6 mg/L In Blood
(unspecified)
@ Autopsy
0.13 mg/L In Blood
(unspecified)
@ Autopsy
0.1 mg/L In Blood
(unspecified)
@ Autopsy
Par
Int-A
1
Ingst
Int-A
1
160 ng/mL In Blood
(unspecified)
@ Unknown
4.7 ng/mL In Blood
(unspecified)
@ Unknown
7.2 ng/mL In Blood
(unspecified)
@ Unknown
morphine (free)
7 ng/mL In Serum
@ Unknown
amphetamine
8098 Other (see abst)
In Urine
(quantitative only)
@ 9 h (pe)
(continued)
AAPCC 2014 Annual Report of the NPDS
1069
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
1276ai
Downloaded by [AAPCC] at 12:54 01 December 2015
[1277pa]
1278p
1279p
1280 ha
1281 ph
1282 pi
1283 ph
1284pa
Age
1291ai
2
3
3
ethanol
alprazolam
4
4
alpha-oh-alprazolam
alprazolam
4
4
alprazolam
clonazepam
5
5
7-aminoclonazepam
fentanyl (transdermal)
6
6
norfentanyl
fentanyl (transdermal)
6
6
fentanyl
phencyclidine
1
1
amphetamine
1
1
amphetamine
amphetamine
1
1
methamphetamine
benzodiazepine
2
2
cocaine
1
1
32 y M
Chronicity
Route
Reason
RCF
U
Unk
Int-U
2
A
Ingst
Unk
1
A
Ingst
Int-M
1
U
Inhal
Int-A
2
A
Unk
Int-A
1
Analyte
THC homolog
1
1
methamphetamine
1
1
methamphetamine
methamphetamine
1
1
amphetamine
32 y M
cocaine
2
2
heroin
1
1
cocaine*
fentanyl*
2
1
1
1
heroin
1
1
cocaine
1
1
cocaethylene
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
levamisole
2
2
heroin
1
1
32 y M
32 y F
33 y F
33 y M
35 y M
1290ai
2
32 y M
1286 ph
1289pa
acetaminophen/
hydrocodone
ethanol
31 y M
33 y M
1288 ha
Cause
Rank
31 y M
1285pa
1287ai
Substance
Rank
Substances
U
Unk
Int-S
2
A
Inhal + Par
Int-A
2
U
Par
Int-A
2
Inhal
Int-U
1
A/C
A
heroin
benzodiazepine
acetaminophen/
hydrocodone
1
2
3
1
2
3
methamphetamine
hydrocodone
freon
1
2
3
1
2
3
35 y M
35 y M
Unk
Int-S
1
A/C
Ingst + Par
Int-U
2
A
Ingst + Unk
Int-U
2
U
Ingst + Par
+ Unk
Unk
1
cocaine
1
1
benzoylecognine
ethanol
2
2
ethanol
heroin
3
3
36 y M
6-mono
acetylmorphine
A
Unk
Int-A
1
1
morphine (free)
cocaine
2
2
benzoylecognine
methamphetamine
alprazolam
1
2
1
2
methamphetamine
heroin
1
2
1
2
36 y M
151 mg/dL In Serum
@ 1 h (pe)
116 Other (see abst)
In Urine (quantitative only)
@ 9 h (pe)
172 Other (see abst) In Urine
(quantitative only)
@ 9 h (pe)
264 Other (see abst) In Urine
(quantitative only)
@ 9 h (pe)
114 Other (see abst) In Urine
(quantitative only)
@ 9 h (pe)
72 Other (see abst) In Urine
(quantitative only)
@ 9 h (pe)
262 ng/mL In Blood
(unspecified)
@ Unknown
9796 ng/mL In Blood
(unspecified)
@ Unknown
3800 ng/mL In Blood
(unspecified)
@ Autopsy
72 ng/mL In Blood
(unspecified)
@ Autopsy
0.013 mg/L In Blood
(unspecified)
@ Autopsy
2.9 mg/L In Blood
(unspecified)
@ Autopsy
8.2 mg/L In Blood
(unspecified)
@ Autopsy
800 ng/mL In Blood
(unspecified)
@ Unknown
0.031 g/dL In Blood
(unspecified)
@ Unknown
6 ng/mL In Vitreous
@ Autopsy
3
heroin
36 y M
Blood Concentration
@ Time
A
Ingst + Unk
Int-U
2
A
Unk
Int-U
2
35 mcg/L In Blood
(unspecified)
@ Autopsy
0.3 mg/L In Blood
(unspecified)
@ Autopsy
(continued)
1070
J. B. Mowry et al.
Downloaded by [AAPCC] at 12:54 01 December 2015
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1292h
36 y M
1293p
37 y M
1294phi
37 y M
1295ai
37 y M
1296 ph
37 y M
1297
37 y M
1298a
37 y M
1299h
1300 ph
1301 ph
cocaine
methamphetamine
heroin
1
2
3
1
2
3
heroin
1
1
heroin
1
1
methamphetamine
1
1
methamphetamine
1
1
heroin
1
1
38 y M
1304ai
38 y F
1305pai
38 y M
1306 ph
38 y F
1307p
38 y M
1308p
39 y M
Route
Reason
Unk
Int-A
RCF
Analyte
A/C
Par
Int-A
2
A
Par
Int-A
2
A
Unk
Int-U
2
A/C
Ingst
Int-M
1
U
Par
Unk
1
U
Ingst
Unk
1
1
1
methamphetamine
methamphetamine
1
1
methamphetamine
methamphetamine
1
1
amphetamine
methamphetamine
1
1
amphetamine
cocaine
2
2
benzoylecognine
clonazepam
3
3
7-aminoclonazepam
clonazepam
3
3
7-aminoclonazepam
alprazolam
4
4
alprazolam
alprazolam
4
4
alpha-oh-alprazolam
alprazolam
4
4
alprazolam
buprenorphine
5
5
buprenorphine
buprenorphine
5
5
buprenorphine
marijuana
6
6
carboxy-thc
marijuana
6
6
carboxy-thc
gabapentin
7
7
gabapentin
cocaine
opioid
marijuana
1
2
3
1
2
3
amphetamine*
cocaine*
opioid
glipizide
2
1
3
4
1
1
2
3
heroin
1
1
methamphetamine
1
1
methamphetamine
1
1
methamphetamine
1
1
THC homolog
1
1
heroin
1
1
methamphetamine
1
1
heroin
1
1
39 y M
methamphetamine
oxycodone
1
2
1
2
methamphetamine
1
1
39 y M
Blood Concentration
@ Time
1
methamphetamine
38 y F
38 y M
Chronicity
U
37 y F
1303ai
1310ai
Cause
Rank
37 y M
1302ai
1309ai
Substance
Rank
Substances
A
Ingst
Int-S
2
A/C
Ingst
Int-A
2
A
Ingst
Unk
2
A
Unk
Int-U
2
A
Unk
Int-A
2
A
Unk
Int-U
2
A
Ingst
Int-A
2
A
Par
Int-S
2
A
Ingst
Int-U
1
U
Par
Int-S
2
A
Unk
Int-U
2
A
Unk
Int-U
2
250 mcg/L In Urine
(quantitative only)
@ Unknown
3320 ng/mL In Blood
(unspecified)
@ Unknown
71 ng/mL In Blood
(unspecified)
@ Unknown
8280 ng/mL In Urine
(quantitative only)
@ Unknown
4420 ng/mL In Urine
(quantitative only)
@ Unknown
14.5 ng/mL In Blood
(unspecified)
@ Unknown
263 ng/mL In Urine
(quantitative only)
@ Unknown
260 ng/mL In Urine
(quantitative only)
@ Unknown
429 ng/mL In Urine
(quantitative only)
@ Unknown
9.1 ng/mL In Blood
(unspecified)
@ Unknown
1 ng/mL In Blood
(unspecified)
@ Unknown
442 ng/mL In Urine
(quantitative only)
@ Unknown
21 ng/mL In Urine
(quantitative only)
@ Unknown
3.1 ng/mL In Blood
(unspecified)
@ Unknown
2.5 mcg/mL In Blood
(unspecified)
@ Unknown
(continued)
AAPCC 2014 Annual Report of the NPDS
1071
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1311h
39 y M
1312ai
40 y M
1313ai
42 y M
1314a
Downloaded by [AAPCC] at 12:54 01 December 2015
1315p
1316
43 y F
1322 ha
1
1
2
3
2
3
methamphetamine
1
1
Chronicity
Route
Reason
RCF
C
Inhal + Unk
Int-A
2
A
Unk
Int-U
2
A
Ingst + Par
Int-U
2
A
Ingst
Int-S
1
Analyte
heroin
ethanol
1
2
1
2
amphetamine
1
1
amphetamine
methamphetamine
2
2
methamphetamine
lamotrigine
3
3
lamotrigine
valproic acid
4
4
valproic acid
acetaminophen
salicylate
paroxetine
quetiapine
ibuprofen
5
6
7
8
9
5
6
7
8
9
cocaine
fentanyl
1
2
1
2
methamphetamine
1
1
methamphetamine
1
1
43 y F
43 y M
1321ai
amphetamine
(hallucinogenic)
methamphetamine
methadone
42 y M
1318ai
1320a
Cause
Rank
42 y F
1317h
1319 ha
Substance
Rank
Substances
A
Inhal
Int-A
1
A
Ingst
Int-S
2
A
Ingst
Int-U
3
A
Ingst + Unk
Int-U
2
A
Inhal
Int-A
3
A/C
Ingst
Int-S
1
methamphetamine
hydrocodone
ethanol
1
2
3
1
2
3
amphetamine
methamphetamine
1
2
1
2
cocaine*
1
1
benzoylecognine
cocaine*
1
1
cocaine
oxycodone (extended
release)*
2
1
oxycodone (free)
topiramate
3
3
topiramate
zolpidem
4
4
zolpidem
chlorpromazine
5
5
chlorpromazine
duloxetine
6
6
duloxetine
alprazolam
7
7
alprazolam
cocaine
alprazolam
1
2
1
2
caffeine
1
1
caffeine
caffeine
1
1
caffeine
cocaine
2
2
benzoylecognine
cocaine
2
2
benzoylecognine
lorazepam
3
3
lorazepam
lorazepam
3
3
lorazepam
ethanol
4
4
ethanol
44 y M
44 y M
44 y F
44 y F
U
Unk
Int-U
2
U
Ingst
Int-A
1
Blood Concentration
@ Time
88 ng/mL In Blood
(unspecified)
@ Unknown
170 ng/mL In Blood
(unspecified)
@ Unknown
19 mcg/mL In Blood
(unspecified)
@ Unknown
4.5 mcg/mL In Blood
(unspecified)
@ Unknown
2300 ng/mL In Blood
(unspecified)
@ Unknown
91 ng/mL In Blood
(unspecified)
@ Unknown
720 ng/mL In Blood
(unspecified)
@ Unknown
770 ng/mL In Blood
(unspecified)
@ Unknown
18 ng/mL In Blood
(unspecified)
@ Unknown
240 ng/mL In Blood
(unspecified)
@ Unknown
130 ng/mL In Blood
(unspecified)
@ Unknown
53 ng/mL In Blood
(unspecified)
@ Unknown
150 mg/L In Blood
(unspecified)
@ Autopsy
96 mg/L In Blood
(unspecified)
@ 2 h (pe)
0.024 mg/L In Blood
(unspecified)
@ 2 h (pe)
0.038 mg/L In Blood
(unspecified)
@ Autopsy
0.042 mg/L In Blood
(unspecified)
@ Autopsy
0.044 mg/L In Blood
(unspecified)
@ 2 h (pe)
100 mg/dL In Blood
(unspecified)
@ 2 h (pe)
(continued)
1072
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1323ai
44 y M
1324pai
45 y M
Substances
methamphetamine
1325ai
45 y F
1326pha
45 y M
1327h
45 y F
1328pha
45 y M
Downloaded by [AAPCC] at 12:54 01 December 2015
[1330ha]
1331ai
1
1
methamphetamine
1
1
47 y M
48 y M
48 y F
1339a
1340ai
50 y M
1343
51 y M
Unk
Int-U
2
Unk
Int-A
1
A
Unk
Int-U
2
U
Ingst + Inhal
+ Par
Unk
1
2
2
benzoylecognine
ethanol
3
3
ethanol
ethanol
3
3
ethanol
phentermine
1
1
1
2
1
2
3
4
3
4
methamphetamine
ethanol (non-beverage)
methemoglobin causing
chemical
1
2
3
1
2
3
methamphetamine
1
1
cocaine
1
1
methamphetamine
1
1
methamphetamine
1
1
heroin
methadone
ethanol
1
2
3
1
2
3
heroin
1
1
heroin
1
1
heroin
1
1
ethanol
2
2
cocaine
1
1
A/C
Ingst
Int-A
2
U
Unk
Int-U
2
C
Unk
Unk
3
A
Ingst
Int-M
1
methamphetamine
A
Unk
Int-U
2
A
Unk
Int-U
2
A
Unk
Int-U
2
A
Unk
Int-A
2
A
Unk
Int-A
3
A
Unk
Int-U
2
U
Ingst + Par
+ Unk
Int-A
2
A
Ingst
Int-A
1
1
2
3
4
5
cocaine
1
1
cocaine
cocaine
1
1
benzoylecognine
quetiapine
ethanol
2
3
2
3
cocaine
phencyclidine
1
2
1
2
methamphetamine
1
1
heroin
1
1
1
1
methamphetamine
acetaminophen
heroin
1
2
3
1
2
3
4.1 ng/mL In Blood
(unspecified)
@ Autopsy
130 ng/mL In Blood
(unspecified)
@ Autopsy
152 mg/dL In Urine
(quantitative only)
@ Unknown
157 mg/dL In Blood
(unspecified)
@ Unknown
6.7 mcg/mL In Blood
(unspecified)
@ Autopsy
12.5 ng/mL In Blood
(unspecified)
@ Autopsy
6-monoacetylmorphine 16.6 ng/mL In Blood
(unspecified)
@ Autopsy
morphine
334 ng/mL In Blood
(unspecified)
@ Autopsy
ethanol
0.167 % In Blood
(unspecified)
@ Autopsy
1
2
3
4
5
amphetamine
Blood Concentration
@ Time
codeine
heroin
clonidine
mirtazapine
lisinopril
carbamazepine
49 y F
50 y F
A
A/C
Analyte
cocaine
49 y M
1342pha
RCF
fentanyl
48 y M
1341pai
Reason
1
48 y M
1337p
Route
1
48 y M
1336ai
Chronicity
heroin
46 y M
47 y M
1338pa
1
46 y F
1333ai
1335pa
1
46 y M
1332ai
1334 pi
Cause
Rank
heroin
cocaine
acetaminophen/
hydrocodone
heroin
clonazepam
1329 ha
Substance
Rank
A
Ingst
Unk
3
U
Unk
Int-U
2
A
Par
Int-A
2
A
Ingst
Int-A
1
U
Ingst + Par
+ Unk
Int-A
2
0.06 mg/L In Blood
(unspecified)
@ Unknown
2.41 mg/L In Blood
(unspecified)
@ Unknown
(continued)
AAPCC 2014 Annual Report of the NPDS
1073
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1344ai
51 y M
1345pa
51 y F
Substances
Downloaded by [AAPCC] at 12:54 01 December 2015
methamphetamine
1346ai
1347ai
1348
1349p
1356ai
1
heroin
1
1
heroin
1
1
heroin
1
1
ethanol
2
2
ethanol
2
2
ethanol
2
2
oxycodone
3
3
oxycodone
3
3
bupropion
quetiapine
4
5
4
5
cocaine
ethanol
temazepam
1
2
3
1
2
3
methamphetamine
morphine
1
2
1
2
cocaine
ethanol
1
2
1
2
heroin
ethanol
1
2
1
2
cocaine
1
1
cocaine
1
1
methadone
2
2
heroin
hypochlorite
1
2
1
2
amphetamine
(hallucinogenic)
1
1
heroin
cocaine
1
2
cocaine
Reason
RCF
A
Unk
Int-U
2
A
Ingst
Int-A
3
Analyte
Blood Concentration
@ Time
morphine
151 ng/mL In Urine
(quantitative only)
@ Autopsy
morphine
183 ng/mL In Blood
(unspecified)
@ Autopsy
6-mono
4.7 ng/mL In Blood
acetylmorphine
(unspecified)
@ Autopsy
6-monoacetylmorphine 853 ng/mL In Urine
(quantitative only)
@ Autopsy
ethanol
0.187 % In Blood
(unspecified)
@ Autopsy
ethanol
0.195 % In Vitreous
@ Autopsy
ethanol
0.259 % In Urine
(quantitative only)
@ Autopsy
oxycodone
131 ng/mL In Urine
(quantitative only)
@ Autopsy
oxycodone
21.8 ng/mL In Blood
(unspecified)
@ Autopsy
A
Unk
Int-U
2
A
Unk
Int-U
2
A
Ingst
Int-U
3
A
Ingst + Par
Int-A
2
U
Unk
Int-A
2
U
Ingst + Unk
Int-A
1
1
2
cocaine
2
2
benzoylecognine
5660 ng/mL In Urine
(quantitative only)
@ Unknown
637 ng/mL In Blood
(unspecified)
@ Unknown
ethanol
3
3
cocaine
1
1
methamphetamine
hydrocodone
oxycodone
1
2
3
1
2
3
cocaine
1
1
55 y M
56 y M
56 y M
Route
37872 Other (see abst)
In Urine (quantitative only)
@ Unknown
55 y M
56 y F
Chronicity
cocaine
53 y M
1358pha
1360
1
53 y M
1357ai
1359 ph
heroin
53 y M
53 y F
1355
1
52 y M
53 y F
1354 ha
1
52 y F
1351 ha
1353 ph
Cause
Rank
51 y M
1350p
1352 ph
Substance
Rank
cocaine
opioid
1
2
1
2
ethanol
3
3
methamphetamine
1
methamphetamine
1
A
Par
Unt-M
2
A
Ingst
Int-A
2
A
Unk
Unk
3
A
Inhal
Int-A
2
A
Ingst + Unk
Int-U
2
A
Unk
Int-U
2
U
Unk
Int-A
1
ethanol
200 mg/dL In Serum
@ 30 m (pe)
1
methamphetamine
1
methamphetamine
2000 ng/mL In Urine
(quantitative only)
@ 1 h (pe)
440 ng/mL In Blood
(unspecified)
@ 1 h (pe)
56 y M
A
amphetamine
2
2
cocaine
alprazolam
acetaminophen
1
2
3
1
2
3
57 y M
A/C
Unk
Ingst
Unk
Int-A
2
3
(continued)
1074
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
Age
1361
59 y M
1362pa
1363pha
62 y F
62 y M
1366ai
64 y M
1367ai
66 y M
Downloaded by [AAPCC] at 12:54 01 December 2015
1369 ph
1371 pi
1372 pi
1373a
1374 pi
1375 ph
1376ai
methamphetamine
fluoxetine
1
2
1
2
methamphetamine
1
1
methamphetamine
1
1
methamphetamine
amphetamine
2
2
amphetamine
cocaine
opioid
3
4
3
4
fentanyl
1.3 ng/mL In Blood
(unspecified)
@ Unknown
methamphetamine
1
1
ethanol
86 mg/dL In Blood
(unspecified)
@ Unknown
61 y F
1365ai
1370 ph
Cause
Rank
2m F
1364ai
1368 ph
Substance
Rank
Substances
methamphetamine
1
1
methamphetamine
1
1
methamphetamine
1
1
heroin
ethanol
1
2
1
2
gamma-hydroxybutyric
acid
marijuana
ethanol
1
1
2
3
2
3
1
1
2
3
2
3
67 y M
20 + y M
20 + y M
gamma-hydroxybutyric
acid
marijuana
ethanol
Unknown adult
(4¼20 yrs)
U
heroin
Unknown adult
(4¼20 yrs)
U
heroin
Unknown adult
(4¼20 yrs)
M
methamphetamine
heroin
1
1
heroin
2
2
heroin
2
2
clonazepam
3
3
clonazepam
3
3
diazepam
4
4
diazepam
4
4
ethanol
5
5
ethanol
1
Reason
RCF
A
Ingst
Int-S
1
A
Ingst
Oth-C
1
C
Par
Int-A
3
A
Unk
Int-U
2
A
Unk
Int-U
2
U
Unk
Int-U
2
A
Unk
Int-U
2
A/C
Par
Int-A
1
A
Ingst + Inhal
Int-A
2
A
Ingst + Inhal
Int-A
2
A
Par
Int-A
2
A
Par
Int-A
2
A
Ingst
Int-A
1
Analyte
Blood Concentration
@ Time
358 ng/mL In Blood
(unspecified)
@ Unknown
50.8 ng/mL In Blood
(unspecified)
@ Unknown
1
1
2
1
Route
1
1
2
Unknown adult
(4¼20 yrs)
U
heroin
Unknown adult
(4¼20 yrs)
M
heroin
Unknown adult
(4¼20 yrs)
F
THC homolog, XLR-11
ethanol
Chronicity
codeine
10.2 ng/mL In Blood
(unspecified)
@ Autopsy
morphine
138 ng/mL In Blood
(unspecified)
@ Autopsy
6-monoacetylmorphine 32 ng/mL In Blood
(unspecified)
@ Autopsy
clonazepam
11.3 ng/mL In Blood
(unspecified)
@ Autopsy
7-aminoclonazepam
59.1 ng/mL In Blood
(unspecified)
@ Autopsy
diazepam
546 ng/mL In Blood
(unspecified)
@ Autopsy
nordiazepam
910 ng/mL In Blood
(unspecified)
@ Autopsy
ethanol
0.153 % (wt/Vol) In Blood
(unspecified)
@ Autopsy
A
Par
Int-A
2
A
Par
Int-A
1
U
Inhal
Int-A
1
1
1
1
2
1
2
ethanol
2
2
ethanol
0.057 mg/dL In Vitreous
@ Unknown
0.08 mg/dL In Urine
(quantitative only)
@ Unknown
(continued)
AAPCC 2014 Annual Report of the NPDS
1075
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
1377 pi
1378 pi
Cause
Rank
diphenhydramine
3
3
caffeine
4
4
heroin
oxycodone
ethanol
1
2
3
1
2
3
heroin
diazepam
ethanol
1
2
3
1
2
3
Unknown
age M
Unknown
age M
1380i
Unknown
age U
1382pa
Substance
Rank
Substances
Unknown
age F
1379 pi
1381i
Downloaded by [AAPCC] at 12:54 01 December 2015
Age
heroin
1
1
heroin
1
1
heroin
1
1
Unknown
age U
Unknown
age M
Chronicity
Route
Reason
RCF
Analyte
diphenhydramine
U
Unk
Unk
2
U
Unk
Unk
2
A
Unk
Int-U
2
A
Inhal
Int-A
1
A
Inhal
Int-A
2
U
Unk
Int-A
1
Blood Concentration
@ Time
81 ng/mL In Blood
(unspecified)
@ Autopsy
heroin
1
1
fentanyl
2
2
See Also case 5, 7, 11, 17, 66, 161, 198, 282, 308, 318, 324, 325, 328, 330, 339, 342, 344, 346, 347, 363, 364, 375, 387, 407, 425, 447, 452, 461, 463, 467, 479, 510, 521, 543, 547, 558, 572, 588, 591, 605, 625, 693,
734, 749, 770, 816, 819, 830, 869, 881, 895, 1030, 1074, 1122, 1123, 1130, 1136, 1191, 1392, 1396, 1399
Topical Preparations
1383
86 y M
A
Ingst+ Aspir
Unt-G
3
camphor/eucalyptus oil/
1
1
menthol
Unknown Drug
1384p
20 y F
drug, unknown
1385 ph
1386i
26 y F
1387 ph
26 y M
1388p
27 y F
1389
27 y F
1390 ph
29 y F
1391p
29 y M
1392a
30 y M
1393
30 y M
1394
31 y F
1395ai
1396
1397 ph
1
drug, unknown
opioid
1
2
1
2
drug, unknown
1
1
drug, unknown
1
1
drug, unknown
1
1
drug, unknown
1
1
drug, unknown
1
1
46 y M
2
Int-A
2
A/C
Par+ Unk
Unk
2
A/C
Ingst
Int-S
1
Ingst
Int-S
3
A
Ingst+ Par
Int-A
2
U
Ingst
Int-S
2
U
Unk
Unk
2
U
Unk
Unk
2
1
1
drug, unknown
cocaine
1
2
1
2
benzoylecognine
opioid
3
3
morphine
drug, unknown
1
1
A
Unk
Unk
2
U
Unk
Unk
3
drug, unknown
1
1
acetaminophen
drug, unknown
1
1
salicylate
drug, unknown
1
1
drug, unknown
cocaine
1
2
1
2
drug, unknown
acetaminophen
1
2
1
2
drug, unknown
1
1
34 y M
43 y M
Int-S
Unk
drug, unknown
34 y F
1399pha
Ingst
A
A/C
34 y F
1398phi
A
1
25 y F
A
Unk
Int-U
2
A
Ingst+ Inhal
Int-S
3
A
Ingst
Int-S
2
A
Par
Int-A
2
A
Unk
Unk
3
772 ng/mL In Blood
(unspecified)
@ Unknown
39.6 ng/mL In Blood
(unspecified)
@ Unknown
142 mcg/mL In Blood
(unspecified)
@ Unknown
25 mg/dL In Blood
(unspecified)
@ Unknown
acetaminophen
61 mg/L In Blood
(unspecified)
@ Unknown
0.208 mg/L In Urine
(quantitative only)
@ Unknown
2.628 mg/L In Blood
(unspecified)
@ Autopsy
5.841 mg/L In Urine
(quantitative only)
@ Unknown
drug, unknown
cocaine
1
2
1
2
cocaine
cocaine
2
2
benzoylecognine
cocaine
2
2
benzoylecognine
(continued)
1076
J. B. Mowry et al.
Table 21. Listing of Fatal Nonpharmaceutical and Pharmaceutical Exposures.
Annual
Report ID
1400pai
Age
Substance
Rank
Cause
Rank
metformin
3
3
drug, unknown
1
1
drug, unknown
1
1
49 y F
1401p
49 y M
1402 ha
52 y M
1403 ph
53 y F
1404 ph
54 y M
1405p
58 y M
1406
Substances
drug, unknown
1
1
drug, unknown
1
1
drug, unknown
ethanol
1
2
1
2
drug, unknown
atorvastain
1
2
1
2
drug, unknown
acetaminophen/
hydrocodone
alprazolam
1
2
1
2
58 y M
Chronicity
Route
Reason
RCF
Analyte
metformin
A/C
Ingst
Int-S
2
A
Ingst
Int-S
2
A/C
Ingst
Int-U
2
A
Unk
Int-S
2
A
Unk
Int-S
2
A
Ingst
Unk
2
A
Ingst
Int-S
3
Blood Concentration
@ Time
20 mg/L In Blood
(unspecified)
@ Autopsy
3
3
A
Ingst
Int-S
2
drug, unknown
1
1
U
Unk
Unk
2
1408 ph
Unknown adult
(4¼20 yrs)
M
drug, unknown
1
1
See Also case 31, 92, 310, 410, 547, 584, 645, 651, 702, 744, 798, 815, 838, 1028, 1077, 1102, 1108, 1120, 1125, 1131, 1150, 1178, 1247, 1253
Downloaded by [AAPCC] at 12:54 01 December 2015
1407p
64 y M
Listing of 1,408 (1,173 Direct + 235 Indirect) fatalities classified as Relative Contribution to Fatality category ¼ 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).
Annual Report ID: Bracketed [case number] ¼ Narrative provided for this case in Appendix C
i ¼ Indirect case; identified through other sources (news feeds, medical examiner data, or other) about which no inquiry to the PC was made, p ¼ prehospital cardiac and/or respiratory arrest, h ¼ hospital
records reviewed, a ¼ autopsy report reviewed.
Age Gender: y ¼ years, m ¼ months, d ¼ days, F ¼ female, M ¼ male, F-Pregnant ¼ pregnant, U ¼ unknown
Chronicity: C ¼ chronic exposure, A ¼ acute exposure, A/C ¼ acute on chronic, U ¼ unknown
Route: Aspir ¼ Aspiration (with ingestion), B-S ¼ Bite/sting, Derm ¼ Dermal, Ingst ¼ Ingestion, Inhal ¼ Inhalation/nasal, Oc ¼ Ocular, Ot ¼ Otic, Oth ¼ Other, Par ¼ Parenteral, Rec ¼ Rectal,
Unk ¼ Unknown, Vag ¼ Vaginal
Reason: AR-D ¼ Adverse reaction – Drug, AR-F ¼ AR – Food, AR-O ¼ AR – Other, Int-A ¼ Intentional – Abuse, Int-M ¼ Int – Misuse, Int-S ¼ Int – Suspected Suicide, Int-U ¼ Int – Unknown, OthC ¼ Other – Contamination/tampering, Oth-M ¼ Oth – Malicious, Oth-W ¼ Oth – Withdrawal, Unk ¼ Unknown reason, Unt-B ¼ Unintentional – Bite/sting, Unt-E ¼ Unt – Environmental, UntF ¼ Unt - Food poisoning, Unt-G ¼ Unt – General, Unt-M ¼ Unt – Misuse, Unt-O ¼ Unt – Occupational, Unt-T ¼ Unt - Therapeutic error, Unt-U ¼ Unt – Unknown
RCF (Relative Contribution to Fatality): 1 ¼ Undoubtedly responsible, 2 ¼ Probably responsible, 3 ¼ Contributory. Provided by the RPC for Indirect cases and the AAPCC Fatality Review Team for the
direct (non-Indirect) cases.
Nonpharmaceuticals
Adhesives/Glues
Miscellaneous Adhesives/Glues
Cyanoacrylates (Superglues, etc)
5,295
Epoxy
509
Non-Toxic Adhesives/Glues
1,125
(White Glue, Paper Glue, etc)
Toluene/Xylene (Adhesives Only)
336
Unknown Types of Adhesive,
3,609
Glue, Cement or Paste
Category Total:
10,874
Alcohols
Miscellaneous Alcohols
Ethanol (Beverages)
49,305
Ethanol (Non-Beverage, Non4,280
Rubbing)
Higher Alcohols (Butanol, Amyl
128
Alcohol, Propanols, etc)
Isopropanol (Excluding Rubbing
2,868
Alcohols and Cleaning Agents)
Methanol (Excluding Automotive
590
Products and Cleaning Agents)
Other Types of Alcohol
287
Unknown Types of Alcohol
561
Rubbing Alcohols
Rubbing Alcohols: Ethanol with
3
Methyl Salicylate
Rubbing Alcohols: Ethanol with189
out Methyl Salicylate
Rubbing Alcohols: Isopropanol
240
with Methyl Salicylate
Rubbing Alcohols: Isopropanol
9,587
without Methyl Salicylate
Rubbing Alcohols: Unknown
71
Category Total:
68,109
Arts/Crafts/Office Supplies
Miscellaneous Arts/Crafts/Office Supplies
Artist Paints (Non-Water Color)
3,118
Artist Paints (Water Color)
1,047
Chalks
1,853
Clays
1,956
Crayons
2,034
Glazes
127
Office Supplies: Miscellaneous
138
Other Types of Arts/Crafts/
5,024
Writing Products
Pencils
1,229
Pens or Inks
10,631
2,568
163
706
160
1,629
5,226
1,475
2,477
43
1,117
105
191
59
0
122
160
5,039
32
10,820
2,373
893
1,722
1,599
1,683
33
74
3,473
548
7,355
325
3,385
10,432
6,026
3,508
92
2,445
457
269
208
1
181
231
8,799
60
22,277
3,018
1,028
1,822
1,915
1,948
123
134
4,725
1,183
10,381
5¼5
5,228
468
1,"026
No. of
No. of
Single
Case
Mentions Exposures
454
1,741
183
75
41
141
141
17
6
449
2
762
278
4
5
1
9
13
6
89
2
157
196
859
11
311
317
15
205
6-12
89
774
85
12
27
52
42
45
4
162
2
1,430
354
8
6
0
3
20
36
102
8
771
120
542
16
185
285
25
31
13-19
58
355
314
36
28
90
65
20
42
507
19
8,049
2,732
53
46
0
58
105
270
1,011
33
3,109
613
2,959
100
988
1,596
209
66
4¼20
12
27
7
4
3
9
6
0
0
13
0
17
5
0
1
0
0
1
0
1
0
5
4
31
4
5
19
2
1
15
113
52
7
1
22
10
8
5
109
4
1,039
367
6
0
0
8
7
33
108
5
417
84
715
31
237
388
45
14
7
16
4
1
0
2
1
0
3
12
1
160
24
0
1
0
0
3
7
17
1
92
14
100
3
30
55
9
3
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
1,074
9,869
2,955
1,012
1,798
1,876
1,914
116
127
4,569
46
15,899
7,467
216
162
1
259
105
393
1,863
83
2,076
3,228
9,979
304
3,192
5,054
445
984
Unint
82
411
38
8
21
23
29
5
6
105
13
5,470
1,177
15
18
0
8
82
51
537
8
3,340
221
298
13
113
130
12
30
Int
21
47
8
5
1
8
1
1
0
27
1
439
96
0
0
0
0
7
6
18
1
285
25
59
0
31
19
3
6
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
1
41
16
2
1
6
0
1
1
17
0
196
21
0
0
0
1
3
0
12
0
144
15
79
7
43
17
8
4
Adv
Rxn
53
291
116
11
38
71
49
13
21
207
20
5,934
1,720
46
31
0
34
85
213
705
21
2,726
333
2,115
51
607
1,307
114
36
Treated in
Health Care
Facility
121
1,236
396
134
218
207
182
20
24
638
23
4,140
1,849
72
46
0
46
36
101
505
24
662
776
1,613
75
617
725
87
109
None
74
245
111
13
50
49
55
12
15
217
10
3,266
1,298
38
27
0
32
38
88
500
15
984
236
1,646
46
539
925
108
28
4
15
10
0
2
2
3
2
0
14
3
1,694
385
5
3
0
4
24
30
175
5
1,021
39
290
9
96
162
23
0
0
0
0
0
0
0
0
0
0
0
0
29
1
0
0
0
0
1
7
1
0
15
4
0
0
0
0
0
0
(continued)
0
0
0
0
0
0
0
0
0
0
0
315
30
0
1
0
1
10
11
29
1
219
13
10
2
5
1
2
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1077
Typewriter Correction Fluids
701
684
Unknown Types of Arts/Crafts/
108
101
Writing Products
Category Total:
27,966 27,062
Automotive/Aircraft/Boat Products
Automotive Products
Automotive Products: Brake
830
783
Fluids
Automotive Products: Ethylene
6,078
5,552
Glycol (Including Antifreeze)
Automotive Products: Glycol and
209
190
Methanol Mixtures
2,066
1,937
Automotive Products:
Hydrocarbons (Transmission
Fluids, Power Steering Fluids,
etc)
1,235
1,153
Automotive Products: Methanol
(Dry Gas, Windshield Washing
Solutions, etc)
Automotive Products: Other
187
178
Glycols
Miscellaneous Automotive/Aircraft/Boat Products
Automotive/Aircraft/Boat
15
15
Products: Non-Toxic
Automotive/Aircraft/Boat
1,434
1,381
Products: Other
Automotive/Aircraft/Boat
194
171
Products: Unknown
Category Total:
12,248 11,360
Batteries
Disc Batteries
Disc Batteries: Alkaline (MNO2)
422
417
Disc Batteries: Lithium
168
140
Disc Batteries: Mercuric Oxide
4
3
Disc Batteries: Nickel Cadmium
3
3
Disc Batteries: Other
4
4
Disc Batteries: Silver Oxide
47
46
Disc Batteries: Unknown
2,662
2,616
Disc Batteries: Zinc-Air
111
105
Miscellaneous Batteries
Automotive/Aircraft/Boat
638
630
Batteries
Other Types of Battery
204
198
Penlight/Flashlight/Dry Cell
4,834
4,704
Batteries
Unknown Types of Battery
85
70
Category Total:
9,182
8,936
No. of
No. of
Single
Case
Mentions Exposures
77
21
3,346
16
129
14
55
50
13
1
66
6
350
63
19
0
1
1
5
378
5
17
10
520
5
1,024
20,244
206
432
51
661
221
70
11
543
37
2,232
273
60
0
1
1
25
1,740
37
48
33
2,722
25
4,965
6-12
433
58
5¼5
6
428
55
227
51
10
11
0
0
0
0
68
0
763
15
73
0
4
87
97
8
431
48
1,365
67
6
13-19
30
2,082
71
981
429
58
42
3
1
2
16
386
63
6,851
95
590
3
81
655
960
98
3,942
427
1,613
85
13
4¼20
1
24
2
12
1
0
1
0
0
0
0
7
0
22
1
4
0
0
4
4
0
8
1
85
3
1
3
373
19
219
78
12
7
0
0
0
0
35
0
1,048
12
93
0
10
126
149
18
557
83
360
17
1
0
40
8
23
6
1
0
0
0
0
0
2
0
94
5
12
0
0
10
11
1
53
2
49
2
1
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
62
8,318
185
4,274
624
399
111
3
3
3
46
2,506
102
10,043
155
1,328
15
158
1,058
1,837
171
4,596
725
26,036
631
95
Unint
4
490
10
360
2
9
15
0
0
1
0
88
1
999
7
28
0
9
75
71
14
753
42
772
39
5
Int
3
67
0
44
1
7
2
0
0
0
0
9
1
187
6
8
0
9
8
16
1
131
8
129
10
0
Other
Reason
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0
33
3
15
3
1
9
0
0
0
0
1
1
51
1
14
0
1
2
9
3
18
3
87
0
1
Adv
Rxn
14
3,671
47
901
225
310
109
0
2
2
30
1,983
48
4,071
79
429
2
47
412
587
59
2,134
322
948
72
6
Treated in
Health Care
Facility
20
3,099
72
1,252
54
246
54
2
1
2
29
1,300
67
2,221
23
280
2
47
289
377
50
992
161
3,330
140
14
None
9
929
23
488
189
38
23
0
0
0
4
150
5
2,479
42
385
0
36
240
599
31
916
230
904
59
4
4
219
9
91
56
8
20
0
0
0
1
29
1
722
20
77
1
2
51
116
5
411
39
62
9
1
0
2
0
0
0
0
1
0
0
0
0
1
0
19
0
0
0
0
2
0
1
16
0
0
0
0
(continued)
0
20
0
2
1
2
5
0
0
0
0
10
0
162
0
3
0
1
5
7
1
141
4
1
0
1
Minor Moderate Major Death
Outcome
1078
J. B. Mowry et al.
Bites and Envenomations
Aquatic
Fish Stings
584
Jellyfish and Other Coelenterate
274
Stings
Other or Unknown Marine Animal
305
Bites and/or Envenomations
Exotic Snakes
Exotic Snake: Unknown If
2
Poisonous
Exotic Snakes: Non-Poisonous
28
Exotic Snakes: Poisonous
49
Insects
Ant or Fire Ant Bites
757
Bee, Wasp, or Hornet Stings
3,968
Caterpillars
1,293
Centipede or Millipede Bites
864
Mosquito Bites
164
Other Insect Bites and/or Stings
6,049
Scorpion Stings
16,440
Tick Bites
1,203
Mammals
Bat Bites
694
Cat Bites
741
Dog Bites
2,302
Fox Bites
21
Human Bites
23
Other Mammal Bites
703
Raccoon Bites
112
899
Rodent or Lagomorph Bites
(Squirrels, Rats, Mice, Gerbils,
Hamsters, Rabbits, etc)
Skunk Bites
15
Miscellaneous Bites and Envenomations
Other or Unknown Animal Bites
297
Other or Unknown Reptile Bites
392
2,883
Unknown Types of Insect or
Spider Bite and/or
Envenomation
Miscellaneous Snake Bites and Envenomations
Unknown or Known Non722
Poisonous Snake Bites
Unknown Types of Snake
1,581
Envenomation
Snakes
Copperhead Envenomations
1,840
Coral Envenomations
91
Cottonmouth Envenomations
232
17
41
161
0
0
6
236
713
366
140
38
1,329
1,591
276
79
48
325
4
5
97
10
207
3
41
143
666
56
99
63
3
5
296
2
28
46
717
3,861
1,292
860
157
5,883
16,421
1,180
685
733
2,296
21
23
690
110
878
15
294
387
2,841
715
1,554
1,809
90
227
5¼5
577
269
No. of
No. of
Single
Case
Mentions Exposures
145
4
18
198
111
30
85
184
0
74
57
448
1
0
93
5
160
54
403
195
74
14
401
1,622
109
6
2
0
22
28
70
6-12
179
11
20
172
106
23
26
179
0
77
51
227
3
2
58
9
81
33
219
92
59
10
372
1,403
47
3
2
0
19
62
27
13-19
1,380
69
179
1,014
402
162
110
1,456
9
324
477
1,110
13
12
342
74
322
325
2,134
527
501
73
3,085
10,870
561
17
32
2
82
420
115
4¼20
1
0
0
4
1
0
2
15
0
13
3
11
0
0
8
0
9
3
10
1
3
3
11
14
9
0
0
0
1
0
1
39
1
4
54
36
27
17
291
3
95
82
135
0
3
73
8
82
55
344
98
70
16
594
735
170
2
4
0
10
43
11
2
2
1
13
3
11
4
50
0
23
15
40
0
1
19
4
17
11
38
13
13
3
91
186
8
0
0
0
1
7
4
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
1,806
90
224
1,551
711
289
365
2,810
15
656
731
2,293
21
22
678
108
847
703
3,858
1,264
856
157
5,717
16,413
1,179
28
45
2
270
566
267
Unint
4
1
3
0
1
2
1
2
11
10
0
3
0
3
0
0
0
1
1
4
0
14
1
0
16
5
0
0
0
0
16
Int
0
0
0
0
0
1
4
15
0
2
0
0
0
1
2
1
24
8
2
4
1
0
111
0
0
0
1
0
1
2
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
0
0
0
0
1
1
4
2
0
0
2
0
0
0
5
0
6
1
1
10
2
0
15
1
1
0
0
0
3
5
0
Adv
Rxn
1,743
76
208
1,323
406
101
76
471
8
437
461
1,674
17
11
357
72
284
97
498
238
111
28
949
1,379
261
20
23
1
49
259
70
Treated in
Health Care
Facility
6
3
24
3
3
44
28
12
31
58
2
91
8
17
2
0
64
5
39
16
30
52
38
1
214
85
36
1
0
0
36
None
539
41
74
735
345
85
92
670
2
63
225
822
4
5
137
27
229
181
1,287
371
278
50
1,174
9,966
171
16
10
1
38
187
99
1,067
17
106
409
46
42
13
108
0
2
29
183
3
2
20
3
17
42
245
65
31
9
348
730
37
1
13
1
9
82
26
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
(continued)
38
3
6
17
2
2
1
1
0
0
0
7
0
0
0
0
0
1
15
0
0
0
5
16
0
0
2
0
0
0
1
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1079
Rattlesnake Envenomations
774
754
Unknown Crotalid Envenomations
1,028
1,011
Spiders
Black Widow Spider Bites and/or
1,717
1,692
Envenomations
Brown Recluse Spider Bites and/
1,330
1,306
or Envenomations
Other Necrotizing Spider Bites
119
115
and/or Envenomations
Other Spider Bites and/or
4,464
4,420
Envenomations
Tarantula Bites and/or
43
43
Envenomations
Category Total:
55,003 54,298
Building and Construction Products
Insulation
Asbestos
336
292
Fiberglass
506
482
Other Types of Insulation
112
106
Unknown Types of Insulation
424
407
Urea or Formaldehyde Insulations
20
19
Miscellaneous Building and Construction Products
Caulking Compounds and
2,501
2,435
Construction Putties
Cement or Concrete (Excluding
1,075
1,008
Glues)
Other Types of Building or
2,498
2,313
Construction Products
Soldering Flux
177
169
Unknown Types of Building or
73
66
Construction Products
Category Total:
7,722
7,297
Chemicals
Acids
Hydrochloric Acid
1,947
1,596
Hydrofluoric Acid
645
531
Other Types of Acid
4,553
3,877
Unknown Types of Acid
180
151
Miscellaneous Chemicals
Acetone (Excluding Nail Polish
1,206
1,026
Removers)
3,735
3,270
Alkalis (Excluding Cleaning
Agents, Bleaches, Batteries, and
Detergents)
Ammonia (Excluding Cleaning
2,990
2,083
Agents)
Borates or Boric Acid (Excluding
3,497
3,159
Topicals and Pesticides)
No. of
No. of
Single
Case
Mentions Exposures
44
89
78
62
8
288
3
5,185
12
47
4
24
2
85
30
103
4
3
314
53
1
222
3
47
116
113
226
107
92
19
463
5
7,547
37
187
43
257
3
1,715
311
1,014
57
15
3,639
71
18
542
13
337
530
514
1,557
6-12
30
63
5¼5
88
122
283
85
189
24
270
15
264
13
0
77
37
64
17
33
6
17
0
4,299
5
345
9
89
126
50
103
13-19
1,057
1,070
1,972
467
1,078
444
2,334
88
2,354
61
37
830
549
430
149
163
42
85
8
32,578
24
2,833
75
843
1,270
609
725
4¼20
13
4
7
5
6
0
7
0
64
0
1
19
3
28
5
5
0
3
0
136
0
11
0
1
0
1
0
200
226
327
79
175
37
461
29
604
32
9
242
75
100
66
45
10
20
5
3,900
6
437
4
212
96
16
27
18
34
35
6
24
7
41
3
58
2
1
28
3
13
6
2
1
1
1
653
0
43
0
7
15
4
4
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
2,929
1,943
3,078
920
1,505
508
3,647
138
7,078
163
65
2,229
981
2,386
284
456
101
395
18
53,842
41
4,400
115
1,304
1,689
744
1,007
Unint
0
4
0
0
0
6
1
116
77
91
60
49
13
101
4
97
2
0
43
10
25
3
6
4
4
0
110
Int
57
25
51
27
22
2
43
7
33
1
0
14
1
8
2
4
0
3
0
189
0
7
0
0
1
0
1
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
47
25
29
10
10
5
56
0
74
2
1
23
12
15
2
16
0
3
0
74
2
6
0
1
0
3
2
Adv
Rxn
453
720
1,629
288
636
435
1,447
78
1,269
37
27
430
408
168
57
77
26
36
3
15,584
11
934
37
481
765
704
944
Treated in
Health Care
Facility
556
274
286
169
96
48
468
6
1,377
50
7
524
116
507
38
57
14
62
2
1,150
2
81
1
28
54
15
20
None
302
556
945
249
529
221
1,161
37
982
33
27
372
198
142
24
114
13
58
1
20,268
10
1,088
39
275
484
190
258
36
226
571
41
219
117
427
31
356
12
5
94
198
19
2
11
7
8
0
5,443
2
309
9
218
285
373
541
1
0
2
0
2
2
3
0
1
0
0
1
0
0
0
0
0
0
0
6
0
0
0
0
0
3
1
(continued)
4
16
38
6
13
15
26
0
15
0
0
6
7
1
0
1
0
0
0
271
1
4
0
11
13
66
59
Minor Moderate Major Death
Outcome
1080
J. B. Mowry et al.
Chlorates (Excluding Matches and
Fireworks)
Cyanides (Excluding
Rodenticides)
Dioxins
Ethylene Glycol (Excluding
Automotive, Aircraft, or Boat
Products)
Formaldehyde or Formalin
Ketones
Methylene Chloride (Excluding
Paint Strippers)
Nitrates and Nitrites (Excluding
Medications and Substances of
Abuse)
Other Chemicals
Other Glycols (Excluding
Automotive, Aircraft, or Boat
Products)
Phenol or Creosotes (Excluding
Disinfectants)
Strychnine (Excluding
Rodenticides)
Toluene Diisocyanate
Unknown Chemicals
Category Total:
Cleaning Substances (Household)
Automatic Dishwasher Detergents
Automatic Dishwasher
Detergents: Granules (Unit
Dose)
Automatic Dishwasher
Detergents: Granules (Various
Containers)
Automatic Dishwasher
Detergents: Granules with
Liquids (Unit Dose)
Automatic Dishwasher
Detergents: Liquids (Unit Dose)
Automatic Dishwasher
Detergents: Liquids (Various
Containers)
Automatic Dishwasher
Detergents: Tablets
Automatic Dishwasher Rinse
Agents
20
187
4
537
594
290
161
990
10,163
566
220
27
426
3,260
33,138
638
2,426
7,158
611
1,934
2,938
933
2,172
26
245
7
731
648
337
179
1,094
11,622
700
239
31
457
3,525
38,594
641
2,460
7,193
617
1,970
2,951
967
2,201
No. of
No. of
Single
Case
Mentions Exposures
1,838
737
2,759
1,626
563
6,865
2,053
601
91
581
8,970
16
25
3,893
226
319
73
65
35
1
40
13
10
5¼5
29
20
19
30
8
36
40
6
12
177
2,144
2
5
826
32
245
39
7
5
0
9
2
2
6-12
27
11
23
17
5
33
37
3
21
268
2,223
3
7
578
27
98
77
16
10
0
31
9
2
13-19
219
141
114
216
27
174
238
21
226
1,699
16,139
5
149
3,952
200
266
327
168
87
3
421
121
5
4¼20
2
1
1
2
1
7
1
1
1
14
101
0
1
34
1
1
3
2
0
0
2
0
0
53
19
19
39
7
42
53
6
63
450
3,166
1
31
770
72
54
68
29
21
0
34
38
1
4
4
3
4
0
1
4
0
12
71
395
0
2
110
8
7
7
3
3
0
0
4
0
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
2,143
915
2,923
1,903
605
7,139
2,387
635
412
2,648
30,013
15
209
9,304
490
829
536
279
154
2
321
126
20
Unint
0
6
5
8
9
1
9
8
2
10
117
1,402
4
4
394
23
126
27
3
2
0
162
19
Int
19
11
5
19
5
7
30
1
0
309
763
1
1
114
11
26
15
3
3
0
21
25
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
4
0
2
3
0
3
1
0
4
87
644
5
5
298
31
7
15
4
2
1
3
0
0
Adv
Rxn
135
94
128
122
70
359
90
30
125
1,076
10,661
10
101
2,322
180
214
260
129
74
1
345
134
4
Treated in
Health Care
Facility
3
394
193
764
492
157
1,831
533
162
48
629
4,747
6
28
1,551
90
177
84
54
28
0
108
38
None
231
186
372
237
117
1,263
328
91
103
629
7,357
4
73
1,856
108
128
191
105
44
0
68
43
5
17
15
10
26
8
27
14
2
20
257
2,687
1
25
494
50
32
33
29
10
0
55
13
0
0
0
0
0
0
0
0
0
0
1
32
0
0
2
0
0
0
0
0
0
10
9
0
(continued)
0
1
1
0
1
0
1
0
1
16
251
0
2
28
3
3
1
2
1
0
72
4
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1081
Other or Unknown Types of
Automatic Dishwasher
Detergent
Bleaches
Bleaches: Borates
Bleaches: Hypochlorite (Liquid
and Dry)
Bleaches: Non-Hypochlorite
Bleaches: Other or Unknown
(Household)
Cleansers
Anionic or Nonionic Cleansers
Other or Unknown Types of
Household Cleanser
Disinfectants
Disinfectants: Hypochlorite (NonBleach Products)
Disinfectants: Other or Unknown
Disinfectants: Phenol
Disinfectants: Pine Oil
Drain Cleaners
Drain Cleaners: Acids
Drain Cleaners: Alkalis
Drain Cleaners: Hydrochloric
Acid
Drain Cleaners: Other or
Unknown
Drain Cleaners: Sulfuric Acid
Fabric Softeners/Antistatic Agents
Fabric Softener/Antistatic Agent:
Other or Unknown
Fabric Softeners/Antistatic
Agents: Aerosol or Spray
Fabric Softeners/Antistatic
Agents: Dry or Powder (Unit
Dose)
Fabric Softeners/Antistatic
Agents: Dry or Powder (Various
Containers)
Fabric Softeners/Antistatic
Agents: Liquid (Unit Dose)
Fabric Softeners/Antistatic
Agents: Liquid (Various
Containers)
Fabric Softeners/Antistatic
Agents: Solid or Sheet
Glass Cleaners
154
37,066
326
423
1,789
2,472
2,423
5,560
838
3,867
70
2,362
32
684
378
14
91
5
10
11
800
564
1,658
187
43,771
390
496
1,946
2,740
2,783
5,896
877
4,386
89
2,775
52
848
479
16
93
5
10
12
856
577
1,876
No. of
No. of
Single
Case
Mentions Exposures
1,321
474
631
6
9
4
80
12
38
115
10
337
5
3,405
551
2,249
1,038
1,391
1,589
136
182
67
15,157
5¼5
49
14
21
1
0
0
0
0
12
12
2
62
4
340
61
133
88
41
75
22
13
4
1,411
6-12
66
12
14
1
0
0
1
0
11
20
2
83
1
254
32
127
115
43
81
15
39
6
2,431
13-19
193
41
108
2
0
0
8
0
259
415
49
1,542
21
1,253
152
1,111
972
255
601
134
174
65
15,143
4¼20
1
2
0
1
0
0
0
0
2
3
0
5
0
11
0
8
3
4
5
0
0
0
68
24
18
26
0
1
1
2
2
48
106
7
301
0
254
39
206
190
45
108
15
14
12
2,553
4
3
0
0
0
0
0
0
8
13
0
32
1
43
3
33
17
10
13
4
1
0
303
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
1,573
550
761
10
9
5
90
14
369
612
65
2,184
28
5,216
785
3,630
2,266
1,747
2,298
285
347
142
33,693
Unint
63
7
17
1
0
0
1
0
5
44
4
119
1
207
42
153
92
29
95
25
37
8
2,310
Int
16
4
4
0
0
0
0
0
0
12
0
15
1
63
9
43
35
7
58
6
30
1
608
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
4
3
16
0
1
0
0
0
3
15
0
38
1
63
1
25
25
5
11
6
7
3
294
Adv
Rxn
149
20
79
5
1
0
2
2
154
205
25
728
11
627
89
672
533
142
474
81
153
31
9,137
Treated in
Health Care
Facility
371
93
190
4
0
2
16
6
40
92
10
341
7
1,040
232
965
338
429
476
56
88
25
5,317
None
202
22
93
1
2
1
5
1
120
145
20
628
15
1,025
117
731
557
158
360
93
98
29
9,881
14
3
4
0
0
0
2
0
75
53
9
257
1
90
15
45
119
14
72
16
18
4
1,272
0
0
0
0
0
0
0
0
0
0
0
4
0
0
1
1
0
0
0
0
0
0
5
(continued)
0
0
0
0
0
0
0
0
4
10
1
40
0
3
0
6
5
0
4
0
0
0
38
Minor Moderate Major Death
Outcome
1082
J. B. Mowry et al.
Glass Cleaners: Ammonia
Containing
Glass Cleaners: Anionics or
Nonionics
Glass Cleaners: Isopropanol
Glass Cleaners: Other or
Unknown Types of Household
Hand Dishwashing
Anionic or Nonionic Hand
Dishwashing Detergents
Other or Unknown Types of
Household Hand Dishwashing
Detergent
Laundry Additives
Enzyme and/or Microbiological
Laundry Additives
Laundry Bluing and/or
Brightening Agents (without
Detergent)
Laundry Detergent Boosters
Other or Unknown Laundry
Additives or Miscellaneous
Products
Water Softeners
Laundry Detergents
Laundry Detergents: Granules
(Unit Dose)
Laundry Detergents: Granules
(Various Containers)
Laundry Detergents: Granules
with Liquids (Unit Dose)
Laundry Detergents: Liquids (Unit
Dose)
Laundry Detergents: Liquids
(Various Containers)
Laundry Detergents: Other or
Unknown Types of Household
Laundry Detergent and/or
Fabric Cleaner
Laundry Detergents: Soaps
Laundry Prewash/Stain Removers
Laundry Prewash/Stain Removers:
Aerosol or Spray Solvent Based
Laundry Prewash/Stain Removers:
Aerosol or Spray Surfactant
Based
Laundry Prewash/Stain Removers:
Dry Solvent Based
89
1,702
1,539
4,696
2,531
72
17
325
924
45
290
2,737
325
12,403
6,503
330
132
175
192
2
102
1,856
1,694
5,335
2,798
79
18
365
973
47
306
2,856
327
12,686
6,807
354
147
185
198
3
No. of
No. of
Single
Case
Mentions Exposures
2
174
158
95
245
4,928
11,458
308
2,087
226
32
235
764
9
44
1,061
3,030
1,241
1,107
53
5¼5
0
1
6
5
12
194
407
8
91
13
3
18
39
0
2
66
224
71
60
4
6-12
0
3
2
4
12
175
111
1
56
5
0
12
22
2
0
48
117
59
68
6
13-19
0
12
7
19
51
998
333
4
425
42
6
57
81
3
23
462
1,131
294
251
22
4¼20
0
0
0
0
2
7
29
1
4
1
0
0
2
0
0
2
10
2
5
1
0
2
2
8
5
182
48
3
69
3
4
3
15
3
3
880
176
29
43
2
0
0
0
1
3
19
17
0
5
0
0
0
1
0
0
12
8
6
5
1
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
2
189
173
126
316
6,294
12,317
324
2,641
279
44
314
898
15
68
2,439
4,465
1,622
1,433
82
Unint
5
0
2
1
2
7
144
61
1
59
6
0
6
9
1
0
16
94
68
78
Int
0
0
1
2
2
40
8
0
23
2
1
4
16
0
0
59
102
7
18
1
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
0
1
0
2
5
17
9
0
12
3
0
1
1
1
4
8
29
1
8
1
Adv
Rxn
0
18
19
14
100
1,204
5,621
149
458
75
4
27
83
2
20
116
329
154
187
14
Treated in
Health Care
Facility
0
29
31
27
80
1,150
2,134
68
484
72
6
98
204
2
12
979
622
353
329
14
None
1
33
37
26
92
1,497
6,206
144
588
71
7
48
107
5
18
277
812
220
186
15
0
5
5
3
17
170
861
22
60
13
0
4
10
0
0
9
46
11
14
2
0
0
0
0
0
0
3
1
0
0
0
0
0
0
0
0
1
0
0
0
(continued)
0
0
0
0
0
5
55
0
0
0
0
0
0
0
0
0
2
1
0
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1083
Laundry Prewash/Stain Removers:
113
110
Dry Surfactant Based
Laundry Prewash/Stain Removers:
936
912
Liquid Solvent Based
Laundry Prewash/Stain Removers:
1,633
1,549
Liquid Surfactant Based
Laundry Prewash/Stain Removers:
2,111
2,003
Other or Unknown
24
22
Laundry Prewash/Stain Removers:
Other or Unknown Solvent
Based
39
38
Laundry Prewash/Stain Removers:
Other or Unknown Surfactant
Based
Miscellaneous Cleaners
Miscellaneous Cleaning Agents:
1,191
1,031
Acids
Miscellaneous Cleaning Agents:
7,339
6,539
Alkalis
Miscellaneous Cleaning Agents:
5,276
4,759
Anionics or Nonionics
Miscellaneous Cleaning Agents:
2,518
2,318
Cationics
544
520
Miscellaneous Cleaning Agents:
Ethanol (Excluding Automotive
Products)
544
498
Miscellaneous Cleaning Agents:
Glycols (Excluding Automotive
Products)
1,813
1,728
Miscellaneous Cleaning Agents:
Isopropanol (Excluding
Automotive Products and Glass)
18
18
Miscellaneous Cleaning Agents:
Methanol (Excluding
Automotive Products)
3,985
3,601
Miscellaneous Cleaning Agents:
Other or Unknown Household
Cleaning Agents
9
9
Miscellaneous Cleaning Agents:
Phenol (Excluding
Disinfectants)
Miscellaneous Cleaning Substances (Household)
Ammonia Cleaners (All Purpose)
815
555
Carpet, Upholstery, Leather, or
3,306
3,093
Vinyl Cleaners
No. of
No. of
Single
Case
Mentions Exposures
5
11
20
51
0
1
30
184
151
96
20
33
165
0
223
0
20
87
745
1,336
1,535
17
32
439
4,044
3,183
1,294
403
319
1,107
8
2,029
3
179
2,180
6-12
91
5¼5
24
62
0
170
0
82
14
11
106
149
253
43
1
1
34
15
10
2
13-19
283
672
5
970
10
287
108
78
706
1,071
1,752
446
2
4
331
144
119
12
4¼20
0
7
0
12
0
4
1
0
3
13
13
4
0
0
3
1
1
0
45
78
1
168
0
75
21
8
101
174
260
64
2
0
44
29
22
0
4
7
0
29
0
8
2
0
12
18
33
5
0
0
5
4
4
0
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
508
2,990
8
3,322
16
1,634
468
502
2,147
4,532
6,204
975
37
21
1,959
1,508
895
109
Unint
9
0
32
47
0
149
2
61
19
10
118
122
218
28
1
1
20
20
Int
9
32
0
72
0
18
7
2
30
68
58
21
0
0
8
11
3
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
6
18
1
41
0
8
3
6
16
25
39
5
0
0
16
10
4
1
Adv
Rxn
121
405
1
693
4
148
78
35
437
637
1,244
263
1
6
229
134
134
6
Treated in
Health Care
Facility
82
604
3
736
3
338
108
99
428
887
1,367
218
5
6
439
279
280
22
None
113
460
3
725
4
236
89
59
461
681
1,154
241
4
8
377
241
136
9
13
43
0
101
0
21
6
4
68
71
252
51
1
1
21
18
14
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
(continued)
1
1
0
4
0
0
0
0
5
2
20
2
0
0
1
1
0
0
Minor Moderate Major Death
Outcome
1084
J. B. Mowry et al.
Hydrofluoric Acid or Bifluoride
Wheel Cleaners
Starches, Fabric Finishes, or
Sizing
Oven Cleaners
Oven Cleaners: Acids
Oven Cleaners: Alkalis
Oven Cleaners: Detergent Types
Oven Cleaners: Other or Unknown
Rust Removers
Rust Removers: Acids Other Than
Hydrofluoric Acid Types
Rust Removers: Alkalis
Rust Removers: Anionics or
Nonionics
Rust Removers: Hydrofluoric
Acid
Rust Removers: Other or
Unknown
Spot Removers/Dry Cleaning Agents
Spot Removers/Dry Cleaning
Agents: Anionics or Nonionics
Spot Removers/Dry Cleaning
Agents: Glycols
Spot Removers/Dry Cleaning
Agents: Isopropanol
Spot Removers/Dry Cleaning
Agents: Other Halogenated
Hydrocarbon Containing
Products
Spot Removers/Dry Cleaning
Agents: Other Hydrocarbon
and/or Non-Halogenated
Containing
Spot Removers/Dry Cleaning
Agents: Other or Unknown
Spot Removers/Dry Cleaning
Agents: Perchloroethylene
Toilet Bowl Cleaners
Toilet Bowl Cleaners: Acids
Toilet Bowl Cleaners: Alkalis
Toilet Bowl Cleaners: Other or
Unknown
Wall/Floor/Tile Cleaners
Wall/Floor/Tile/All-Purpose
Cleaning Agents: Acids
Wall/Floor/Tile/All-Purpose
Cleaning Agents: Alkalis
58
246
10
2,163
10
258
301
3
1
296
161
114
107
35
24
388
94
10
2,518
3,899
3,080
1,503
5,937
59
255
10
2,231
10
274
356
3
1
308
180
118
114
39
26
404
98
10
3,440
4,246
3,302
1,770
6,609
No. of
No. of
Single
Case
Mentions Exposures
6
3,993
980
1,120
3,145
2,661
6
63
237
15
21
73
82
20
49
0
1
100
3
391
3
37
202
5¼5
149
43
84
67
56
0
2
14
0
2
6
6
4
2
0
0
10
0
74
0
10
8
1
6-12
194
47
104
67
41
0
3
14
1
2
3
2
6
8
0
0
5
3
154
2
16
9
5
13-19
1,349
350
1,009
513
253
3
25
103
7
9
20
23
109
209
2
0
165
4
1,243
5
169
20
41
4¼20
10
6
2
1
5
0
0
0
0
0
0
0
0
1
0
0
1
0
8
0
1
0
0
215
71
184
98
57
1
1
20
1
1
4
1
21
16
1
0
18
0
271
0
20
7
4
27
6
15
8
7
0
0
0
0
0
1
0
1
11
0
0
2
0
22
0
5
0
1
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
5,641
1,442
2,382
3,830
3,029
10
90
372
22
33
104
111
150
276
3
1
291
10
2,032
9
236
239
56
Unint
3
1
191
40
90
55
29
0
1
8
1
2
1
2
5
12
0
0
6
0
43
1
6
Int
54
8
10
3
7
0
2
3
1
0
1
1
1
2
0
0
2
0
64
0
10
2
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
43
9
27
10
9
0
1
4
0
0
0
0
5
3
0
0
2
0
20
0
4
1
0
Adv
Rxn
1,079
276
503
472
286
1
14
73
3
6
16
12
40
147
3
0
72
2
741
4
95
16
45
Treated in
Health Care
Facility
4
1,190
360
545
1,157
786
3
15
87
2
9
16
21
19
81
0
1
69
4
271
3
32
58
None
1,349
307
706
571
221
3
18
77
6
4
24
16
46
140
1
0
77
1
575
2
57
22
19
149
31
110
59
25
0
1
16
0
0
1
3
14
21
1
0
21
1
260
0
31
1
18
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(continued)
11
2
7
7
1
0
0
0
0
0
0
0
0
0
0
0
1
0
11
0
5
0
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1085
Wall/Floor/Tile/All-Purpose
Cleaning Agents: Anionics or
Nonionics
Wall/Floor/Tile/All-Purpose
Cleaning Agents: Cationics
Wall/Floor/Tile/All-Purpose
Cleaning Agents: Ethanol
Wall/Floor/Tile/All-Purpose
Cleaning Agents: Glycols
Wall/Floor/Tile/All-Purpose
Cleaning Agents: Isopropanol
Wall/Floor/Tile/All-Purpose
Cleaning Agents: Other or
Unknown
Category Total:
Cosmetics/Personal Care Products
Dental Care Products
False Teeth Cleaning Agents
Other Dental Care Products
(Excluding Fluoride
Supplements)
Toothpastes (with Fluoride)
Toothpastes (without Fluoride)
Hair Care Products
Curl Activators
Hair Coloring Agents (Excluding
Peroxides)
Hair Oils
Hair Relaxers (with Other
Alkalines)
Hair Relaxers (with Other NonAlkalines)
Hair Relaxers (with Sodium
Hydroxide)
Hair Rinses, Conditioners,
Relaxers
Hair Sprays
Other Hair Care Products
(Excluding Peroxides)
Permanent Wave Solutions
Shampoos
Hand Sanitizers
Hand Sanitizers: Ethanol Based
Hand Sanitizers: Isopropanol
Based
Hand Sanitizers: Non-Alcohol
Based
Hand Sanitizers: Unknown
51
2,089
471
320
49
512
1,959
1,252
2,703
214
5,674
18,322
169
1,603
491
488
323
50
518
2,068
1,396
2,846
217
5,970
18,715
172
1,632
527
197,717 178,973
52
2,165
1,467
1,590
18,948
1,959
456
497
19,421
2,029
806
873
2,461
1,951
114,009
385
409
2,492
2,020
1,042
2,162
2,420
295
1,267
14,494
134
129
4,346
839
1,987
1,654
358
37
409
247
43
1,013
16,606
1,694
308
695
374
628
298
1,430
7,742
4,979
5¼5
8,555
No. of
No. of
Single
Case
Mentions Exposures
73
130
1,415
10
4
289
45
78
67
14
0
10
7
1
37
561
50
54
125
5,814
36
7
23
15
93
228
6-12
40
57
557
5
5
205
81
112
50
17
0
10
8
1
127
357
39
38
135
6,287
39
13
18
12
75
254
13-19
68
122
1,586
18
62
688
237
426
152
103
10
32
50
5
757
1,155
141
1,843
834
43,457
302
50
116
43
466
1,980
4¼20
0
3
32
0
0
7
3
2
3
1
0
0
0
0
3
19
2
0
4
307
1
0
1
2
2
9
12
23
210
1
14
117
40
89
31
15
2
9
8
1
135
227
31
207
142
8,231
42
9
18
15
92
261
3
1
28
1
0
22
7
9
2
4
0
1
0
0
17
23
2
11
16
868
5
3
2
0
4
31
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
403
1,539
16,918
153
200
5,430
1,104
2,566
1,885
489
48
463
310
47
1,806
18,378
1,913
2,365
1,805
169,922
1,405
439
779
373
2,024
7,328
Unint
57
50
1,093
13
3
158
133
37
37
5
0
4
4
1
23
237
18
56
46
5,707
35
9
19
7
97
318
Int
27
13
251
2
1
10
7
6
5
0
0
3
0
0
11
102
5
10
3
1,910
12
4
3
2
29
55
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
0
0
14
0
10
70
5
86
29
18
1
1
5
3
243
215
23
26
92
1,033
13
1
5
2
9
29
Adv
Rxn
76
72
1,291
19
70
400
186
368
147
224
12
66
153
12
375
306
15
114
172
33,279
213
33
88
19
293
1,209
Treated in
Health Care
Facility
104
274
4,634
44
32
690
267
488
390
102
12
110
74
11
368
3,202
290
439
295
34,776
324
99
163
102
468
1,625
None
78
86
1,363
11
65
874
168
382
179
155
5
56
91
6
405
870
65
163
222
38,617
200
55
113
45
352
1,090
7
7
161
4
17
51
35
51
19
47
5
9
44
0
79
26
4
7
20
5,079
33
3
6
0
27
108
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
19
0
0
0
0
0
0
(continued)
0
0
11
0
0
0
2
1
0
0
0
0
5
0
1
1
0
0
0
270
0
0
0
0
3
7
Minor Moderate Major Death
Outcome
1086
J. B. Mowry et al.
Miscellaneous Cosmetics/Personal Care Products
Baby Oils
1,866
1,816
Bath Oils and/or Bubble Baths
2,690
2,632
Creams, Lotions, and Make-Up
22,876 22,117
Deodorants
19,154 18,900
Depilatories
718
702
Douches
63
60
Eye Products
1,422
1,369
Lipsticks and Lip Balms (with
1,021
993
Camphor)
Lipsticks and Lip Balms (without
5,027
4,873
Camphor)
Perfumes, Colognes, and
9,658
9,323
Aftershaves
Peroxides
7,242
6,764
Powders Made of Material Other
1,919
1,884
Than Talc
Powders Made of Talc
2,427
2,365
Soaps (Bar, Hand or Complexion)
13,784 13,093
Suntan and/or Sunscreen Products
9,291
9,162
Mouthwashes
Mouthwashes: Ethanol Containing
7,122
6,539
Mouthwashes: Fluoride
6,057
5,974
Containing
Mouthwashes: Non Ethanol
1,826
1,763
Containing
Mouthwashes: Unknown
221
203
Nail Products
Acrylic Nail Adhesives
898
890
Acrylic Nail Primers
236
226
Acrylic Nail Removers
20
20
Miscellaneous Nail Products
822
792
Nail Polish Removers (Acetone
2,205
2,147
Containing)
Nail Polishes
8,660
8,434
Other Nail Polish Removers
928
901
Unknown Nail Polish Removers
7,689
7,412
Category Total:
198,943 192,552
Deodorizers
Air Freshener
Air Fresheners: Aerosols
1,963
1,920
Air Fresheners: Liquids
7,581
7,485
Air Fresheners: Solids
3,513
3,483
Air Fresheners: Unknown Form
1,509
1,484
Miscellaneous Deodorizers
Diaper Pail Deodorizers
17
15
(Excluding Moth Repellants)
5,042
4,847
No. of
No. of
Single
Case
Mentions Exposures
25
120
572
324
19
4
22
31
137
484
309
50
88
636
369
637
1,124
182
22
119
8
3
26
95
276
44
348
9,044
152
244
107
69
0
203
4,450
7,618
2,200
1,712
1,974
9,693
8,178
1,919
4,099
671
58
352
183
11
558
1,561
7,525
670
5,206
147,396
1,355
6,532
3,079
1,235
15
3,511
6-12
1,658
2,359
18,618
17,239
257
44
1,146
882
5¼5
142
0
60
97
36
24
152
43
424
5,880
113
9
1
21
98
13
98
460
116
67
437
96
361
32
366
66
25
23
413
475
75
2
29
21
13-19
784
0
295
499
205
129
386
125
1,191
25,275
263
22
5
150
340
93
717
3,009
552
176
1,995
412
3,222
65
721
144
82
102
2,044
694
286
8
139
43
4¼20
6
0
2
7
6
1
12
0
6
267
2
0
0
3
3
0
0
10
3
7
14
11
9
4
13
5
3
6
37
34
1
0
1
4
152
0
50
94
46
23
73
17
211
4,178
36
4
0
30
46
17
90
466
69
48
286
86
608
19
107
41
19
20
357
120
57
2
23
12
49
0
6
12
4
3
10
2
26
512
5
0
0
4
4
0
5
38
11
5
32
10
55
2
14
30
4
2
76
14
7
0
9
0
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
4,675
15
1,819
7,343
3,429
1,443
8,288
860
7,083
183,605
859
221
20
767
2,065
174
1,658
5,450
5,867
2,293
12,450
9,021
6,216
1,851
8,833
4,693
1,780
2,582
21,427
18,454
522
55
1,324
970
Unint
98
0
56
70
33
25
104
33
249
5,246
18
4
0
4
63
19
67
1,008
73
45
342
43
252
19
343
30
17
31
204
245
36
1
8
13
Int
45
0
28
46
16
3
22
6
53
990
4
1
0
2
12
2
2
28
2
13
87
15
49
6
107
3
4
4
47
52
5
0
7
1
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
20
0
15
16
3
8
14
1
13
2,423
3
0
0
17
5
7
33
28
29
10
183
80
223
8
21
142
12
14
419
141
137
4
29
9
Adv
Rxn
532
0
151
534
197
150
545
103
897
12,729
362
68
5
143
234
23
67
964
83
253
746
273
985
130
855
81
148
126
713
577
171
5
73
21
Treated in
Health Care
Facility
952
6
356
1,608
666
317
1,474
245
1,546
31,592
87
54
6
148
506
29
266
977
964
415
1,748
1,079
795
274
1,999
541
378
442
2,912
2,408
98
8
188
179
None
685
1
307
985
263
177
873
138
969
18,066
254
49
4
140
304
23
93
649
175
452
1,592
816
1,299
309
1,583
201
172
235
998
1,215
166
5
69
39
54
0
14
49
12
10
24
4
51
1,638
60
9
0
22
20
4
11
209
6
37
77
33
180
10
74
9
14
14
73
38
50
0
14
2
0
0
1
0
0
0
0
0
0
6
0
0
0
0
0
0
0
2
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
(continued)
1
0
1
1
0
1
0
0
1
77
0
3
0
1
1
1
0
20
0
3
5
0
14
0
1
0
0
1
2
2
1
0
0
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1087
Other Types of Deodorizer (Not
For Personal Use)
Toilet Bowl Deodorizers
517
507
Unknown Types of Deodorizer
76
73
(Not for Personal Use)
Category Total:
20,218 19,814
Dyes
Miscellaneous Dyes
Dyes: Chlorate Containing
2
2
Dyes: Fabrics
380
368
Dyes: Foods (Including Easter
991
925
Egg)
Dyes: Leathers
53
51
Dyes: Other
378
349
Dyes: Unknown
43
36
Category Total:
1,847
1,731
Essential Oils
Miscellaneous Essential Oil
Cinnamon Oil
592
527
Clove Oil
510
471
Eucalyptus Oil
755
693
Miscellaneous Essential Oils
8,536
8,171
Pennyroyal Oil
23
18
Tea Tree Oil
2,647
2,512
Category Total:
13,063 12,392
Fertilizers
Miscellaneous Fertilizers
Household Plant Foods (Generally
1,514
1,462
for Indoor Plants)
Other Types of Fertilizer
1,406
1,273
Outdoor Fertilizers
1,915
1,824
Plant Hormones
54
51
Unknown Types of Fertilizer
103
90
Category Total:
4,992
4,700
Fire Extinguishers
Miscellaneous Fire Extinguisher
Miscellaneous Fire Extinguishers
2,624
2,562
Category Total:
2,624
2,562
Foreign Bodies/Toys/Miscellaneous
Miscellaneous Foreign Bodies/Toys/Miscellaneous
Ashes
359
336
Bubble Blowing Solutions
3,676
3,628
Charcoals
553
466
Christmas ornaments
300
296
Coins
4,701
4,636
Desiccants
23,254 23,096
Feces/Urine
5,834
5,069
Glass
5,953
5,863
No. of
No. of
Single
Case
Mentions Exposures
15
2
792
0
38
84
5
66
1
194
67
8
28
287
2
114
506
109
90
119
0
7
325
373
373
6
156
15
13
632
1,319
170
418
16,212
2
272
768
34
144
23
1,243
278
318
438
6,247
4
1,474
8,759
803
752
1,187
15
42
2,799
220
220
280
3,380
358
228
3,907
19,689
4,084
1,295
6-12
435
50
5¼5
7
23
17
6
31
345
100
326
352
352
40
44
2
0
128
42
60
12
11
144
1
79
307
1
73
3
106
0
7
22
365
5
1
13-19
32
50
56
30
48
1,293
523
2,407
1,074
1,074
326
398
30
37
1,207
416
100
106
190
1,195
8
693
2,292
10
47
7
144
0
44
36
1,972
46
14
4¼20
1
8
1
0
11
79
18
67
166
166
7
3
0
0
12
2
5
3
2
17
0
3
30
0
1
0
8
0
0
7
23
1
0
9
9
17
17
5
314
154
1,233
314
314
53
65
4
3
208
83
13
21
23
257
3
137
454
1
15
2
32
0
6
8
376
5
6
1
2
2
2
2
57
20
117
63
63
5
8
0
1
21
7
4
3
1
24
0
12
44
0
3
0
4
0
1
0
74
0
0
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
331
3,602
433
294
4,553
22,738
4,895
5,729
2,258
2,258
1,219
1,766
48
85
4,534
1,416
385
429
654
7,843
14
2,318
11,643
50
315
32
1,646
2
356
891
19,287
495
68
Unint
9
4
1
18
10
2
71
228
28
42
70
70
17
16
1
2
49
13
111
16
20
119
4
96
366
0
16
1
40
0
6
17
295
Int
3
2
4
0
6
111
133
57
211
211
18
28
0
2
72
24
6
1
2
31
0
23
63
0
1
0
4
0
2
1
141
2
1
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
1
6
15
0
1
8
7
30
7
7
17
13
1
0
37
6
24
24
17
163
0
72
300
1
16
3
40
0
4
16
63
1
0
Adv
Rxn
14
120
31
24
1,540
957
191
331
602
602
100
106
14
12
287
55
82
101
149
732
5
353
1,422
2
27
3
88
0
28
28
1,643
65
14
Treated in
Health Care
Facility
44
419
83
60
1,144
2,549
638
853
402
402
250
371
8
13
894
252
57
109
165
1,689
3
656
2,679
19
54
8
299
1
91
126
4,044
125
14
None
24
501
20
21
463
191
119
267
625
625
100
109
6
10
274
49
183
114
139
1,509
4
301
2,250
2
28
2
93
0
18
43
2,481
52
11
0
9
2
0
33
3
8
16
111
111
11
13
1
1
26
0
20
7
12
86
0
34
159
0
2
1
9
0
0
6
147
5
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
2
1
0
(continued)
0
0
2
0
5
0
0
0
2
2
0
0
1
0
1
0
0
0
2
1
0
1
4
0
0
0
0
0
0
0
5
0
1
Minor Moderate Major Death
Outcome
1088
J. B. Mowry et al.
Glow Products
Incense (Punk)
Other Types of Foreign Body,
Toy, or Miscellaneous
Substance
Oxygen Absorbers
Soil
Toys
Unknown Types of Foreign Body,
Toy, or Miscellaneous
Substance
Thermometers
Thermometers: Mercury
Thermometers: Other
Thermometers: Unknown
Category Total:
Fumes/Gases/Vapors
Miscellaneous Fumes/Gases/Vapors
Carbon Dioxide
Carbon Monoxide
Chloramine Gas
Chlorine Gas
Chlorine Gas (When Household
Acid is Mixed with
Hypochlorite)
Hydrogen Sulfide (Sewer Gas)
Methane and Natural Gas
Other Types of Fume, Gas or
Vapor
Polymer Fume Fever
Simple Asphyxiants
Unknown Types of Fume, Gas or
Vapor
Category Total:
Heavy Metals
Miscellaneous Heavy Metals
Aluminum
Arsenic (Excluding Pesticides)
Barium, Soluble Salts
Cadmium
Copper
Fireplace Flame Colors
Gold
Lead
Manganese
Mercury (Other)
Mercury, Elemental (Excluding
Thermometer)
19,382
230
21,844
485
1,811
6,195
705
1,592
898
216
96,748
399
12,478
1,888
3,604
1,998
742
4,730
1,389
4
2,190
1,816
31,238
679
651
13
29
513
23
2
2,241
34
101
1,322
19,445
248
23,060
489
2,070
6,259
723
1,607
919
220
99,670
417
13,636
1,977
3,898
2,087
941
5,014
1,561
4
2,404
1,908
33,847
742
738
20
42
648
24
4
2,374
44
106
1,384
No. of
No. of
Single
Case
Mentions Exposures
127
111
922
107
3,670
6
2,313
6-12
377
124
1
0
67
11
0
1,110
5
12
79
3,290
1
238
96
62
928
125
28
1,387
70
285
70
41
23
1
1
52
3
0
184
6
3
104
2,422
0
183
75
29
383
63
93
1,244
31
266
55
321
245
314
155
55
23
70,266 10,408
202
1,239
4,905
481
14,721
173
14,634
5¼5
25
15
6
1
126
0
0
102
1
3
166
2,073
0
180
132
17
285
116
43
840
94
244
122
126
97
14
2,538
32
46
121
21
397
10
819
13-19
179
405
4
22
220
4
1
652
21
64
630
18,058
3
1,197
908
499
2,315
774
163
7,000
1,412
2,308
1,479
504
213
97
9,297
92
335
177
69
393
34
2,944
4¼20
6
3
0
0
0
2
0
10
0
0
46
364
0
20
47
2
57
31
1
139
5
18
44
32
5
0
398
0
3
24
5
54
0
90
44
68
1
5
45
3
1
140
1
19
201
4,421
0
324
466
111
685
259
64
1,590
262
456
204
315
106
25
3,371
30
66
42
21
126
7
875
7
13
0
0
3
0
0
43
0
0
96
610
0
48
92
22
77
21
7
278
14
27
24
49
8
2
470
2
11
4
1
21
0
169
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
635
410
11
16
455
22
1
2,078
29
75
1,101
30,038
4
2,006
1,738
732
4,701
1,310
365
12,068
1,777
3,430
1,907
1,545
869
215
94,346
447
1,740
6,090
669
19,126
210
20,860
Unint
11
13
2
1
33
0
1
39
0
5
110
875
0
165
19
5
17
40
27
302
108
102
90
28
14
0
1,317
19
35
75
10
234
15
487
Int
20
112
0
4
7
1
0
39
0
7
30
88
0
7
33
0
2
11
1
20
0
13
1
11
9
1
702
17
6
14
21
9
1
297
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
12
8
0
0
12
0
0
17
4
8
41
110
0
3
9
3
2
23
2
17
1
50
0
5
3
0
291
1
30
12
3
7
4
158
Adv
Rxn
52
346
5
14
168
1
0
1,129
17
32
362
10,045
0
634
468
355
878
335
85
5,346
365
1,042
537
113
50
16
6,806
27
142
373
59
854
29
1,935
Treated in
Health Care
Facility
99
88
2
1
65
3
0
747
4
30
394
6,083
3
415
251
111
1,296
207
50
3,073
203
268
206
306
150
12
12,899
77
212
850
125
1,953
40
3,384
None
32
48
1
7
141
2
0
98
6
7
49
8,139
0
475
440
224
784
338
82
3,207
583
1,287
719
29
50
3
6,737
12
127
315
42
3,487
24
1,042
6
30
1
0
26
0
0
55
2
4
14
2,649
0
166
123
79
116
88
23
1,159
178
453
264
1
3
0
254
0
10
15
3
48
6
97
0
2
0
1
0
0
0
0
0
0
0
67
0
6
0
9
0
3
0
46
1
2
0
0
0
0
0
0
0
0
0
0
0
0
(continued)
1
1
0
2
1
0
0
4
1
0
2
201
0
5
2
14
8
7
0
154
1
8
2
0
0
0
11
0
1
0
0
0
0
3
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1089
Metal Fume Fever
366
Other Types of Heavy Metal
2,808
Thallium
26
Unknown Types of Heavy Metal
64
Category Total:
9,390
Hydrocarbons
Miscellaneous Hydrocarbons
Benzene
103
Carbon Tetrachloride
39
Diesel Fuels
777
Freon and Other Propellants
5,051
Gasolines
10,344
Kerosenes
922
Lamp Oils
1,314
Lighter Fluids and/or Naphtha
2,350
Lubricating Oils and/or Motor
3,627
Oils
Mineral Seal Oil
14
Mineral Spirits
1,459
Other Types of Halogenated
240
Hydrocarbon
Other Types of Hydrocarbon
4,168
Toluene and/or Xylene (Excluding
611
Adhesives)
Turpentine
328
Unknown Types of Hydrocarbon
501
Category Total:
31,848
Industrial Cleaners
Miscellaneous Industrial Cleaners
Industrial Cleaner: Disinfectants
2,390
Industrial Cleaner: Other or
1,446
Unknown
Industrial Cleaners: Acids
1,719
Industrial Cleaners: Alkalis
2,388
Industrial Cleaners: Anionics or
638
Nonionics
Industrial Cleaners: Cationics
869
Category Total:
9,450
Infectious and Toxin-Mediated Diseases
Botulinum Toxins
Botulism
231
Ichthyosarcotoxins
Ciguatera Poisoning
161
Clupeotoxic Fish Poisoning
13
Other Types of Seafood Poisoning
208
Paralytic Shellfish Poisoning
142
Scombroid Fish Poisoning
144
Tetrodon Poisoning
107
22
646
3
6
2,463
5
4
112
357
1,952
359
871
1,156
1,923
11
374
27
1,807
65
67
155
9,245
183
428
410
472
294
111
1,898
43
4
0
5
6
4
18
65
35
733
4,795
9,916
869
1,291
2,222
3,384
14
1,310
212
3,813
503
290
455
29,907
2,233
1,330
1,442
2,222
570
831
8,628
214
157
12
186
134
136
104
5¼5
343
1,864
17
59
7,891
No. of
No. of
Single
Case
Mentions Exposures
1
0
8
6
3
15
4
29
229
35
43
19
67
36
12
12
1,341
151
9
1
43
7
1
3
25
211
576
59
43
66
122
17
108
0
3
546
6-12
8
1
18
2
12
9
2
152
633
59
143
19
177
83
15
31
2,095
173
24
1
80
14
2
0
34
473
916
35
34
141
122
32
94
1
2
574
13-19
131
8
129
94
103
49
131
441
4,864
791
1,314
202
1,451
665
161
216
14,172
1,375
348
0
684
142
39
19
466
2,974
5,413
343
286
709
997
231
815
11
36
3,295
4¼20
0
0
0
0
0
0
0
0
37
4
20
6
4
3
0
5
73
9
0
0
8
2
0
0
1
12
17
7
2
4
6
2
3
0
0
72
11
3
24
22
13
11
29
93
894
135
199
29
328
110
33
31
2,555
269
51
1
112
19
18
8
88
552
958
62
42
126
185
36
182
2
11
759
2
0
2
4
1
2
5
5
73
8
31
1
23
5
2
5
426
29
6
0
9
1
0
1
7
216
84
4
13
20
29
3
16
0
1
182
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
132
8
149
106
99
91
139
740
7,982
1,363
2,052
538
2,057
1,232
236
379
26,971
3,595
458
13
1,207
200
64
30
688
3,709
9,053
807
1,246
2,035
3,251
301
1,483
5
41
6,663
Unint
0
0
4
0
0
7
10
72
388
46
72
20
128
50
45
63
2,323
129
30
1
60
7
0
0
32
985
742
40
25
88
76
21
143
1
2
382
Int
0
0
3
1
0
3
12
9
161
21
74
6
18
33
2
6
358
43
5
0
22
0
0
1
9
43
73
20
14
78
42
7
52
3
5
287
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
25
4
23
26
37
3
51
8
72
11
15
6
23
9
4
4
141
33
6
0
10
4
0
4
1
27
20
0
1
14
13
9
164
2
6
283
Adv
Rxn
87
4
54
31
40
23
70
296
3,158
446
1,130
140
648
498
105
197
8,305
1,021
245
3
484
78
37
9
198
1,788
2,074
286
417
700
663
118
397
11
27
2,679
Treated in
Health Care
Facility
0
0
13
10
10
12
30
164
1,169
221
262
89
225
208
52
83
5,211
812
46
3
203
24
10
14
103
655
1,328
157
348
430
943
26
290
4
7
1,760
None
24
1
35
27
28
15
13
259
2,560
410
704
110
684
393
74
121
7,919
817
162
3
363
79
13
5
221
1,279
3,156
224
279
592
531
85
195
1
5
677
57
2
24
12
27
4
18
32
820
109
355
21
182
121
10
49
1,669
168
51
0
100
13
6
1
36
561
293
56
107
137
81
41
63
3
5
250
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
18
0
0
0
0
0
0
0
0
14
3
0
1
0
0
0
0
0
0
3
(continued)
7
0
6
3
1
0
4
2
37
4
21
1
7
2
4
4
123
12
4
0
7
0
0
0
2
43
13
7
9
9
9
1
7
1
0
21
Minor Moderate Major Death
Outcome
1090
J. B. Mowry et al.
Infectious Diseases
Bacterial Diseases
375
Fungal Diseases
2,155
83
Other Types of Bacterial Food
Poisoning (Salmonella,
Shigella, Vibrio,
Staphylococcus, Streptococcus,
etc)
Parasitic Diseases
21
Prion Diseases
1
Unknown Types of Bacterial Food
258
Poisoning
Unknown Types of Suspected
11,285
Food Poisoning
Viral Diseases
46
Category Total:
15,230
Information Calls
Food Information Calls
9,789
Information Calls About Food
Products, Additives or
Supplements
Information Calls About Possibly
7,193
Spoiled Foods
Category Total:
16,982
Lacrimators
Miscellaneous Lacrimators
Lacrimators: Capsicum Defense
3,213
Sprays
Lacrimators: CN
554
(Chloroacetophenone)
Lacrimators: CS (O19
Chlorobenzylidene Malonitrile)
Lacrimators: Other
88
Lacrimators: Unknown
251
Category Total:
4,125
Matches/Fireworks/Explosives
Miscellaneous Matches/Fireworks/Explosives
Explosives
167
Fireworks
758
Matches
518
Other Types of Match, Firework,
91
or Explosive
Unknown Types of Match,
4
Firework, or Explosive
Category Total:
1,538
Miscellaneous Foods
Foods
Capsicum Peppers
2,748
75
552
25
2
0
32
1,837
9
2,612
4,158
1,693
5,851
615
108
2
2
32
759
93
642
445
66
1
1,247
532
16
1
246
11,017
43
14,778
8,147
7,012
15,159
3,181
543
18
51
250
4,043
152
748
512
90
4
1,506
2,670
5¼5
359
2,071
82
No. of
No. of
Single
Case
Mentions Exposures
294
87
1
11
54
11
10
3
55
799
1
82
658
1,387
744
643
1
1,081
800
3
0
14
40
174
12
6-12
410
40
0
12
14
10
4
2
51
834
1
110
670
818
435
383
3
984
722
2
0
18
18
160
9
13-19
1,090
103
2
27
32
33
9
31
61
1,145
11
157
885
5,533
3,247
2,286
14
8,148
6,190
6
1
159
175
928
30
4¼20
41
2
0
1
1
0
0
0
0
30
0
1
29
70
25
45
1
51
36
2
0
1
3
8
0
277
24
0
8
4
11
1
13
50
357
2
37
255
1,248
714
534
3
1,692
1,281
1
0
20
44
224
6
26
3
0
0
1
2
0
0
1
119
1
48
69
252
154
98
12
210
151
0
0
2
4
25
0
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
2,004
1,455
3
143
736
491
82
50
190
3,083
16
392
2,435
12,995
6,469
6,526
38
13,598
10,350
15
1
238
325
1,830
77
Unint
0
0
0
1
5
0
218
32
1
5
9
14
3
0
11
238
0
45
182
397
14
383
0
50
23
Int
24
14
0
3
3
4
4
1
45
551
2
81
422
724
239
485
1
336
134
1
0
3
21
153
4
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
416
3
0
1
0
1
1
0
1
41
0
8
32
959
267
692
1
748
488
0
0
5
10
75
0
Adv
Rxn
222
144
2
32
79
18
13
13
50
759
8
110
578
992
241
751
13
1,470
1,010
4
1
25
53
51
4
Treated in
Health Care
Facility
76
419
1
31
247
116
24
2
5
120
0
12
101
1,704
697
1,007
2
1,070
691
3
0
8
32
251
8
None
1,041
91
0
18
48
13
12
30
159
1,932
11
219
1,513
1,309
438
871
7
2,249
1,895
3
0
43
47
104
7
75
19
1
6
9
1
2
2
7
150
2
22
117
230
108
122
0
592
422
0
1
1
13
9
2
0
1
0
0
0
1
0
0
0
0
0
0
0
2
0
2
0
0
0
0
0
0
0
0
0
(continued)
1
0
0
0
0
0
0
1
0
4
1
1
1
8
2
6
0
33
8
0
0
0
4
0
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1091
Food Additives
448
413
Food Products
4,409
4,009
Other Adverse Reactions to Food
1,475
1,381
Category Total:
9,080
8,473
Mushrooms
Miscellaneous Mushrooms
Group 1 Mushrooms:
50
43
Cyclopeptides
Group 2 Mushrooms: Muscimol
45
37
(Ibotenic Acid)
Group 3 Mushrooms:
45
44
Monomethylhydrazine (MMH)
Group 4 Mushrooms: Muscarine
28
26
and Histamine
Group 5 Mushrooms: Coprine
18
14
484
335
Group 6 Mushrooms:
Hallucinogenics (Psilocybin and
Psilocin)
Group 7 Mushrooms:
208
195
Gastrointestinal Irritants
Mushrooms: Miscellaneous, Non97
81
Toxic
Mushrooms: Other Potentially
129
117
Toxic
Mushrooms: Unknown
5,370
5,225
Category Total:
6,474
6,117
Other/Unknown Nondrug Substances
Miscellaneous Other/Unknown Nondrug Substances
Other Non-Drug Substances
27,164 24,339
Unknown Substances Unlikely to
4,611
4,349
be Drug Products
Category Total:
31,775 28,688
Paints and Stripping Agents
Miscellaneous Paints and Stripping Agents
Other Types of Paint, Varnish or
446
419
Lacquer
Unknown Types of Paint, Varnish
5,296
4,988
or Lacquer
Varnishes and Lacquers
993
938
Paints
Anti-Algae Paints
13
13
Anti-Corrosion Paints
47
41
Oil-Base Paints
2,030
1,911
Water Base Paints (Acrylic, Latex,
2,896
2,829
etc)
Wood stains
625
600
No. of
No. of
Single
Case
Mentions Exposures
48
333
138
813
2
1
4
0
3
4
17
4
7
486
528
1,972
258
2,230
21
205
36
0
0
168
97
28
7
5
3
4
6
22
60
34
42
3,379
3,562
11,169
1,166
12,335
196
3,342
259
2
10
600
2,241
264
6-12
125
2,151
256
3,064
5¼5
24
1
2
143
61
38
147
18
1,246
1,010
236
260
421
2
0
15
0
132
2
2
5
3
28
173
75
686
13-19
225
9
27
790
355
459
981
146
9,570
7,592
1,978
950
1,402
60
35
99
1
156
19
33
24
25
166
1,054
642
2,952
4¼20
0
0
0
6
3
7
15
0
180
158
22
15
16
0
1
0
0
0
0
0
0
0
0
19
13
73
55
1
2
190
70
114
274
35
2,506
1,923
583
103
148
6
7
3
4
14
1
2
2
6
41
239
231
788
4
0
0
14
2
25
24
3
621
515
106
32
40
0
0
1
0
7
0
0
0
0
5
40
26
97
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
582
13
38
1,765
2,777
905
4,851
407
25,134
22,147
2,987
4,480
4,926
88
61
151
13
49
18
26
12
28
297
3,347
616
6,264
Unint
8
0
2
101
23
12
66
4
801
642
159
589
931
7
5
26
0
266
1
6
21
10
22
105
17
362
Int
0
0
1
18
7
7
24
4
1,403
729
674
5
12
0
0
0
0
7
0
0
0
0
12
78
82
196
Other
Reason
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10
0
0
22
22
11
35
3
718
543
175
129
216
20
14
18
1
8
7
12
4
3
80
464
647
1,607
Adv
Rxn
74
3
17
402
204
178
571
78
4,883
3,443
1,440
1,669
2,196
34
25
109
5
265
15
18
28
28
63
238
244
767
Treated in
Health Care
Facility
99
3
7
238
477
143
781
59
4,692
4,265
427
2,145
2,273
21
14
42
5
23
1
12
4
6
45
484
74
679
None
96
0
9
403
157
207
335
70
4,405
3,796
609
678
907
38
8
72
1
83
10
10
4
3
72
332
335
1,780
6
1
4
83
18
36
89
17
810
559
251
248
466
5
4
29
0
142
5
8
19
6
10
82
130
297
0
0
0
1
0
0
0
0
17
5
12
0
3
0
0
0
0
0
0
0
0
3
0
0
0
0
(continued)
1
0
0
5
0
4
5
0
58
28
30
15
37
1
0
0
0
7
0
2
5
7
2
4
3
10
Minor Moderate Major Death
Outcome
1092
J. B. Mowry et al.
5¼5
6-12
13-19
4¼20
Stripping Agents
Methylene Chloride Stripping
356
338
43
8
17
212
Agents
Other Types of Stripping Agent
454
422
94
8
22
248
Unknown Types of Stripping
81
74
9
1
4
55
Agent
Category Total:
13,237 12,573
7,060
572
477
3,507
Pesticides
Fumigants
Aluminum Phosphide
85
55
0
4
2
42
Methyl Bromide
1
1
0
0
0
1
Other Fumigants
46
40
5
3
3
25
Sulfuryl Fluoride
241
205
29
16
7
123
Unknown Fumigants
79
74
4
5
1
51
Fungicides (Non-medicinal)
Carbamate Fungicides
86
71
18
7
1
39
Copper Compound Fungicides
68
64
4
2
3
48
Mercurial Fungicides
1
1
0
0
0
1
Other Types of Non-Medicinal
452
366
86
14
7
210
Fungicide
Phthalimide Fungicides
38
31
18
4
0
9
Unknown Types of Non41
27
5
1
0
17
Medicinal Fungicide
Wood Preservatives
114
104
9
4
2
77
Herbicides (Including Algaecides, Defoliants, Desiccants, Plant Growth Regulators)
Carbamate Herbicides (Excluding
11
11
1
0
0
10
Metam Sodium)
Chlorophenoxy Herbicides
1,782
1,534
350
83
40
877
Diquat
383
352
73
13
7
229
Glyphosate
3,315
3,003
727
111
75
1,724
Other Types of Herbicide
1,300
1,025
228
39
40
596
Paraquat
90
69
2
1
1
56
Triazine Herbicides
204
154
29
7
9
91
Unknown Types of Herbicide
460
390
87
21
20
224
Urea Herbicides
80
38
17
4
3
9
Insecticides (Including Insect Growth Regulators, Molluscicides, Nematicides)
Carbamate Insecticides Alone
1,469
1,362
465
63
50
634
Carbamate Insecticides in
192
184
44
6
6
97
Combination with Other
Insecticides
Chlorinated Hydrocarbon
180
161
45
5
8
81
Insecticides Alone
168
160
49
7
11
75
Chlorinated Hydrocarbon
Insecticides in Combination
with Other Insecticides
Insect Growth Regulators
166
82
35
8
2
27
Metaldehyde
52
47
22
1
0
21
Nicotine (Excluding Tobacco
49
45
17
0
5
17
Products)
No. of
No. of
Single
Case
Mentions Exposures
40
45
5
831
5
0
3
20
10
4
7
0
39
0
3
10
0
162
25
336
114
8
17
24
3
136
28
19
17
8
3
4
3
2
0
36
2
0
1
1
1
0
0
0
2
0
1
0
0
8
0
6
2
0
0
11
1
3
0
1
0
0
0
0
2
0
2
1
2
11
3
14
5
24
6
1
1
3
1
0
2
0
0
2
0
0
8
0
0
0
9
2
90
3
0
15
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
77
47
40
150
139
1,257
180
1,470
338
2,830
981
65
143
352
37
11
98
30
26
64
62
1
351
52
1
38
195
70
12,129
402
68
321
Unint
9
1
0
2
4
11
69
1
25
4
38
14
3
4
19
1
0
3
1
0
2
2
0
4
3
0
1
3
1
242
13
4
Int
0
0
0
2
0
11
2
9
2
30
9
0
3
10
0
0
1
0
0
1
0
0
1
0
0
1
6
1
63
1
0
1
Other
Reason
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4
0
3
4
9
19
1
27
8
97
18
0
4
8
0
0
2
0
1
3
0
0
8
0
0
0
1
2
114
4
2
5
Adv
Rxn
8
12
11
25
40
321
25
283
52
504
191
38
42
93
8
5
25
4
5
20
9
0
75
39
1
16
27
23
1,867
172
35
133
Treated in
Health Care
Facility
13
11
4
16
37
293
33
314
83
639
178
13
21
50
16
0
14
4
3
8
9
0
60
7
0
6
23
3
1,880
48
7
18
None
6
5
13
37
23
209
17
339
68
686
218
13
44
64
5
3
15
1
7
14
15
0
81
16
1
12
14
14
1,569
125
23
144
2
0
1
5
9
61
5
51
15
70
38
7
6
15
1
0
3
0
1
5
1
0
10
6
0
5
0
12
352
51
12
35
0
0
0
0
0
1
0
0
0
1
1
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
1
0
1
0
0
0
(continued)
0
0
0
0
0
7
0
0
0
0
0
1
0
1
0
0
0
0
0
0
0
0
0
3
0
0
0
0
18
2
1
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1093
Organophosphate Insecticides
Alone
Organophosphate Insecticides in
Combination with Carbamate
Insecticides
Organophosphate Insecticides in
Combination with NonCarbamate Insecticides
Other Types of Insecticide
Pyrethrins
Pyrethroids
Rotenone
Unknown Types of Insecticide
Miscellaneous Pesticides
Arsenic Pesticides
Borates and/or Boric Acid
Pesticides (Excluding Other
Uses)
Metam Sodium
Repellents
Animal Repellents
Insect Repellents with DEET
Insect Repellents without DEET
Naphthalene Moth Repellants
(Excluding Deodorizing
Products)
Other Types of Moth Repellant
Paradichlorobenzene Moth
Repellants (Excluding
Deodorizing Products)
Unknown Types of Insect
Repellent
Unknown Types of Moth
Repellant
Rodenticides
ANTU (1-naphthalenylthiourea)
Bromethalin Rodenticides
Cholecalciferol Rodenticides
Long-Acting Anticoagulant
Rodenticides
Other Types of Rodenticide
PNU (n-3-pyridylmethyl-n1-pnitrophenyl urea)
Sodium Monofluoroacetate
Strychnine Rodenticides
Unknown Types of Rodenticide
Warfarin Type Anticoagulant
Rodenticides
Zinc Phosphide Rodenticides
2,180
39
474
8,729
5,304
21,490
28
3,943
31
5,997
1
437
3,805
1,316
1,198
1
94
115
1,819
2
609
3
8,372
318
1
4
53
1,186
181
94
2,355
40
506
9,275
5,667
22,695
30
4,321
34
6,078
1
458
3,899
1,343
1,220
1
100
123
1,851
2
647
3
8,645
331
1
4
66
1,323
188
99
No. of
No. of
Single
Case
Mentions Exposures
30
1
6
790
142
200
0
0
459
1
7,180
986
54
1
54
131
2,028
959
773
0
16
5,197
4,063
1,706
5,388
4
966
86
10
596
5¼5
3
0
2
28
8
18
0
0
16
0
162
89
7
0
1
35
520
107
66
0
2
126
367
444
1,108
1
211
22
5
132
6-12
1
2
2
29
3
9
0
0
6
0
79
41
2
0
3
12
161
30
22
0
1
45
205
226
875
2
179
23
0
70
13-19
46
1
33
257
23
77
1
1
96
2
746
479
42
0
30
185
889
175
260
1
11
498
3,252
2,362
11,619
17
2,005
276
18
1,124
4¼20
0
0
0
6
0
1
0
0
3
0
14
9
1
0
0
3
16
0
9
0
0
3
20
20
54
0
25
0
0
13
14
0
6
59
4
10
0
1
21
0
142
199
8
0
5
61
161
42
65
0
1
111
713
478
2,167
4
479
65
6
214
0
0
4
17
1
3
0
0
8
0
49
16
1
0
1
10
30
3
3
0
0
17
109
68
279
0
78
2
0
31
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
85
2
27
1,002
170
293
1
1
567
3
7,960
1,726
105
1
89
410
3,479
1,258
1,148
1
30
5,897
8,425
4,842
19,989
26
3,459
446
33
2,010
Unint
4
2
10
104
7
22
0
0
22
0
301
57
2
0
2
8
66
13
33
0
0
51
95
148
537
1
157
12
2
72
Int
0
0
11
63
4
1
0
0
15
0
76
17
3
0
0
9
44
11
4
0
0
29
47
31
201
0
122
4
2
31
Other
Reason
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2
0
0
3
0
2
0
0
2
0
14
18
4
0
3
6
202
33
10
0
1
16
143
254
697
1
159
9
2
52
Adv
Rxn
42
4
31
466
61
53
1
1
253
0
2,352
292
19
0
14
52
381
74
178
0
5
475
773
944
3,344
4
1,071
104
6
573
Treated in
Health Care
Facility
30
1
15
306
64
70
0
0
207
0
2,335
403
19
0
21
57
554
207
361
0
8
1,230
1,585
723
3,059
4
495
71
10
478
None
14
1
2
32
6
17
0
0
22
0
111
177
23
0
5
111
1,041
212
83
1
3
183
802
1,202
5,121
7
708
96
6
473
2
0
7
20
1
8
0
0
1
0
37
22
4
0
1
9
73
20
7
0
0
11
93
219
633
1
184
26
1
109
0
1
1
0
0
1
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
1
0
1
0
2
0
0
3
(continued)
0
0
2
4
0
3
0
0
1
0
11
1
0
0
0
0
1
0
1
0
0
1
6
1
25
0
6
3
0
20
Minor Moderate Major Death
Outcome
1094
J. B. Mowry et al.
Category Total:
82,459
Photographic Products
Miscellaneous Photographic Products
Developers, Fixing Baths, Stop
97
Baths
Other Types of Photographic
117
Product
Photographic Coating Fluids
2
Unknown Types of Photographic
6
Product
Category Total:
222
Plants
Miscellaneous Plants
Plants: Amygdalin and/or
3,649
Cyanogenic Glycosides
Plants: Anticholinergics
668
Plants: Cardiac Glycosides
1,410
(Excluding Drugs)
Plants: Colchicine
27
Plants: Depressants
186
6,432
Plants: Gastrointestinal Irritants
(Excluding Oxalate Containing
Plants)
635
Plants: Hallucinogenics (Code as
Street Drug Unless Plant Part
Involved)
Plants: Nicotine (Excluding
169
Tobacco Products)
Plants: Non-Toxic
5,136
Plants: Other Toxic Types
4,058
Plants: Oxalates
5,134
Plants: Skin Irritants (Excluding
5,005
Oxalate Containing Plants)
Plants: Solanine
1,664
Plants: Stimulants
347
Plants: Toxalbumins
248
Plants: Unknown Toxic Types or
9,783
Unknown if Toxic
Category Total:
44,551
Polishes and Waxes
Miscellaneous Polishes and Waxes
Floor Waxes, Polishes, or Sealers
434
Furniture Polishes
1,496
2,274
Miscellaneous Polishes and
Waxes (Excluding Mineral Seal
Oils)
Category Total:
4,204
34,196
19
60
0
1
80
1,930
329
797
18
83
4,279
151
68
3,228
2,526
3,740
2,028
1,046
111
84
6,494
26,912
245
1,245
1,633
3,123
79
111
2
6
198
3,587
610
1,372
25
151
6,177
510
162
4,733
3,813
5,044
4,646
1,632
323
239
9,327
42,351
397
1,445
2,177
4,019
5¼5
77,480
No. of
No. of
Single
Case
Mentions Exposures
100
8
30
62
4,976
113
32
21
1,135
647
473
591
499
31
26
5
7
668
52
169
507
9
0
0
7
2
3,909
6-12
85
12
14
59
1,315
39
22
12
195
132
111
128
194
13
104
1
15
147
60
37
105
39
1
1
10
27
2,331
13-19
571
95
123
353
7,271
336
122
95
1,138
558
593
477
1,545
32
202
1
34
865
135
303
835
61
1
3
31
26
29,937
4¼20
7
2
1
4
162
1
1
0
56
23
9
10
21
0
1
0
1
18
2
8
11
0
0
0
0
0
237
120
33
30
57
1,525
87
33
24
261
126
86
90
329
18
22
0
9
182
27
50
181
8
0
0
3
5
6,041
13
2
2
9
190
10
2
3
48
19
15
8
30
0
4
0
2
18
5
8
18
1
0
1
0
0
829
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
3,899
379
1,414
2,106
38,625
1,496
278
189
8,755
4,256
3,473
4,731
4,133
130
254
22
107
5,737
454
1,279
3,331
186
2
6
106
72
72,590
Unint
65
9
18
38
2,025
53
32
22
325
176
184
234
172
26
205
3
24
252
133
62
122
7
0
0
2
5
1,944
Int
28
4
8
16
195
7
2
18
27
8
11
8
53
0
7
0
1
20
3
6
24
2
0
0
1
1
814
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
26
4
5
17
1,386
75
10
5
190
284
132
67
272
3
39
0
17
155
15
20
102
3
0
0
2
1
1,852
Adv
Rxn
392
57
114
221
4,074
134
64
102
682
273
398
382
691
52
213
6
29
477
191
169
211
38
1
2
16
19
13,475
Treated in
Health Care
Facility
None
995
97
435
463
7,612
380
89
74
1,629
584
804
969
482
35
79
6
27
1,168
164
367
755
31
1
1
14
15
14,171
470
55
195
220
4,160
115
48
27
653
316
273
966
734
39
87
5
18
583
71
92
133
33
0
3
16
14
12,399
58
7
15
36
834
14
7
13
94
56
87
47
193
16
100
0
9
77
80
20
21
6
0
0
2
4
1,818
0
0
0
0
4
0
0
0
0
0
1
0
1
0
0
0
0
0
0
0
2
0
0
0
0
0
19
(continued)
0
0
0
0
40
0
1
0
4
1
7
1
2
2
7
0
0
2
8
2
3
0
0
0
0
0
98
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1095
Radiation
Ionizing Radiation
Ionizing Radiation: Type
91
Unknown
Radon
58
Specific Nonpharmaceutical
41
Radionuclides
X-ray Radiation
15
Miscellaneous Radiation
Nonpharmaceutical Radiation:
1
Type Unknown
Non-ionizing Radiation
Extremely Low-frequency
2
Radiation
Infrared Radiation
1
Microwave Radiation
30
Non-ionizing Radiation: Type
13
Unknown
Radio Frequency Radiation
12
Ultraviolet Radiation
6
Visible Light Radiation (Lasers)
13
Category Total:
283
Sporting Equipment
Miscellaneous Sporting Equipment
Fishing Baits
46
Fishing Products, Miscellaneous
14
Golf Balls (Including Liquid
4
Center of Golf Balls)
Golf Products, Miscellaneous
1
Gun Bluing Compounds
29
Hunting Products, Miscellaneous
246
Other Types of Sporting
14
Equipment
Unknown Types of Sporting
1
Equipment
Category Total:
355
Swimming Pool/Aquarium
Miscellaneous Swimming Pool/Aquarium
Algicides
1,206
Aquarium Products,
1,135
Miscellaneous
Bromine Shock Treatments
70
Chlorine Shock Treatments
2,909
Other Types of Swimming Pool or
1,400
Aquarium Product
Swimming Pool and Aquarium
96
Test Kits
Category Total:
6,816
5
6
1
3
0
0
0
0
0
0
0
0
15
36
10
1
0
17
147
12
1
224
350
809
26
435
351
49
2,020
51
27
15
1
2
1
24
13
12
3
13
248
45
14
4
1
26
240
14
1
345
1,162
1,068
64
2,824
1,320
79
6,517
5¼5
86
No. of
No. of
Single
Case
Mentions Exposures
736
13
6
395
147
118
57
22
0
0
2
18
1
1
0
0
2
0
1
17
0
0
0
0
0
0
7
0
7
6-12
383
1
2
204
91
61
24
24
0
0
0
19
0
2
1
2
0
0
3
6
0
0
0
0
1
0
1
1
0
13-19
2,847
14
25
1,501
631
543
133
62
0
1
7
47
1
3
2
1
7
2
3
150
1
12
6
2
0
9
32
23
53
4¼20
25
1
0
16
4
2
2
0
0
0
0
0
0
0
0
0
0
0
3
4
0
0
1
0
0
0
0
0
0
440
1
5
244
82
68
40
11
0
0
0
8
0
2
1
0
3
0
3
51
0
12
6
0
0
3
3
1
20
66
0
0
29
14
20
3
2
0
0
0
1
0
1
0
0
0
1
0
5
0
0
0
0
0
0
2
1
1
Unknown Unknown Unknown
Child
Adult
Age
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
6,261
78
64
2,688
1,261
1,123
1,047
311
1
1
26
211
14
43
12
3
11
2
11
211
0
20
13
1
0
11
50
25
67
Unint
1
0
1
0
0
0
4
0
1
0
1
0
0
0
0
2
91
1
0
47
17
14
12
15
0
0
0
13
0
Int
22
0
0
12
1
3
6
10
0
0
0
8
0
0
2
0
1
0
1
6
0
2
0
0
0
0
0
0
2
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
128
0
0
68
36
21
3
3
0
0
0
2
0
1
0
0
0
0
0
18
1
1
0
0
0
3
0
1
12
Adv
Rxn
1,379
12
7
785
265
221
89
94
0
0
7
83
1
2
1
0
7
2
3
95
0
4
5
1
1
5
17
13
37
Treated in
Health Care
Facility
655
27
11
156
124
103
234
96
1
0
9
70
3
11
1
1
2
0
0
29
0
4
0
0
0
1
5
3
14
None
2,043
12
20
1,117
480
343
71
33
0
1
5
21
1
3
2
0
0
1
1
20
0
2
2
1
0
1
3
4
5
497
1
1
325
78
88
4
12
0
0
2
9
0
1
0
0
1
0
0
8
0
1
1
1
0
0
1
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(continued)
16
1
0
10
3
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Minor Moderate Major Death
Outcome
1096
J. B. Mowry et al.
Tobacco/Nicotine/eCigarette Products
eCigarettes: Nicotine Containing
eCigarettes: Nicotine Device
71
65
Flavor Unknown
eCigarettes: Nicotine Device With
4
4
Added Flavors
eCigarettes: Nicotine Device
3,208
3,122
Without Added Flavors
eCigarettes: Nicotine Liquid
171
168
Flavor Unknown
eCigarettes: Nicotine Liquid With
15
15
Added Flavors
eCigarettes: Nicotine Liquid
545
536
Without Added Flavors
Miscellaneous Tobacco Products
Chewing Tobacco
1,307
1,285
Cigarettes
5,893
5,714
Cigars
116
110
Dissolvable Tobacco
5
5
Filter Tips Only (i.e. Butts)
66
62
Other Types of Tobacco Product
202
169
Snuff
459
443
Unknown Types of Tobacco
1,640
1,554
Product
Category Total:
13,702 13,252
Waterproofers/Sealants
Miscellaneous Waterproofers/Sealants
Waterproofers/sealants: aerosols
232
223
Waterproofers/sealants: liquids
90
87
Waterproofers/sealants: solids
2
2
Waterproofers/sealants: unknown
35
31
form
Category Total:
359
343
Weapons of Mass Destruction
Miscellaneous Weapons of Mass Destruction
Anthrax
6
6
Nerve Gases
1
1
Other Biological Weapons
50
50
Other Chemical Weapons
80
58
Other Radiological Weapons
1
1
Other Suspicious Powders
141
126
Other Suspicious Substances
1,639
1,504
(Non-Powder)
Suspicious Powders in Envelope
45
40
or Package
Category Total:
1,963
1,786
Nonpharmaceuticals Total:
1,106,662 999,812
No. of
No. of
Single
Case
Mentions Exposures
0
7
16
45
2
0
1
6
6
30
191
13
4
0
0
17
0
0
0
0
0
14
69
3
9
372
1,158
5,373
74
2
53
74
378
981
10,452
107
45
1
12
165
0
0
2
3
0
23
306
4
1
0
0
5
2
0
14
100
16
11
3
0
2
429
41
47
12
0
1
28
15
75
21
0
11
16
3
1
32
41
1
52
759
121
77
31
1
12
1,787
55
207
17
3
5
42
37
385
119
3
42
854
0
0
0
1
0
1
11
1
1
0
0
0
15
2
1
1
0
0
0
0
4
1
0
0
6
0
3
0
8
3
0
19
206
22
14
3
0
5
340
11
36
3
0
2
17
5
70
15
3
6
166
0
6
252
53,402
0
107
174
1
0
69
7,542
2
0
0
3
8
0
3
53
1
0
1
0
0
38
2
5
1
0
0
2
2
9
1
0
2
14
0
0
Unknown Unknown Unknown
Child
Adult
Age
338
86
122
905
14
555,458 63,538 42,908 273,804 3,160
75
1,833
1
17
4¼20
13
0
2
3
13-19
1
3
6-12
36
5¼5
Age
Table 22A. Demographic profile of SINGLE SUBSTANCE Nonpharmaceuticals exposure cases by generic category.
1
3
2
0
0
2
0
0
13
104
5
2
2
0
1
389
20
52
9
0
1
26
14
94
14
4
9
142
Int
15
1
1
1
16
0
27
252
2
2
0
0
0
75
15
23
0
0
1
1
3
9
1
0
4
18
0
0
Other
0
0
0
0
0
0
0
57
13
11
1
1
0
283
8
30
11
0
0
14
4
58
3
0
0
148
1
6
Adv
Rxn
20
4
1
29
37
0
43
605
94
62
24
1
7
3,091
285
787
14
0
4
43
107
456
213
7
66
1,087
2
20
Treated in
Health Care
Facility
1,063
121
313
57
739
935,623 34,415 11,619 14,213 161,845
22
4
0
41
41
1
79
875
322
208
83
1
30
12,468
1,240
5,602
89
5
60
128
422
1,379
517
11
152
2,805
2
56
Unint
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
4
0
0
4
14
0
22
276
61
45
12
0
4
2,824
388
973
16
1
9
30
147
316
163
3
61
696
2
19
1
1
0
1
6
0
7
143
28
20
6
0
2
272
32
41
1
0
0
11
14
51
17
1
12
91
0
1
35
2,164
0
0
0
1
0
0
1
33
1
1
0
0
0
9
2
0
0
0
0
2
0
3
0
0
0
2
0
0
8
262
1
0
0
0
1
0
0
6
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
Minor Moderate Major Death
214
320
159
164,270 162,874 30,892
13
3
0
3
2
0
31
162
56
34
15
1
6
4,089
339
1,922
34
1
18
23
116
401
189
5
56
966
1
18
None
Outcome
AAPCC 2014 Annual Report of the NPDS
1097
Pharmaceuticals
Analgesics
Acetaminophen Alone
Acetaminophen Alone, Adult
Acetaminophen Alone, Pediatric
Acetaminophen Alone, Unknown
if Adult or Pediatric
Acetaminophen Combinations
Acetaminophen in Combination
with Other Drugs, Adult
Formulations
Acetaminophen in Combination
with Other Drugs, Pediatric
Formulations
Acetaminophen with Codeine
Acetaminophen with
Diphenhydramine
Acetaminophen with
Hydrocodone
Acetaminophen with Other
Narcotics or Narcotic Analogs
Acetaminophen with Oxycodone
Acetaminophen with
Propoxyphene
Acetylsalicylic Acid Alone
Acetylsalicylic Acid Alone, Adult
Formulations
Acetylsalicylic Acid Alone,
Pediatric Formulations
Acetylsalicylic Acid Alone,
Unknown if Adult or Pediatric
Formulations
Acetylsalicylic Acid Combinations
Acetylsalicylic Acid in
Combination with Other Drugs,
Adult Formulations
Acetylsalicylic Acid in
Combination with Other Drugs,
Pediatric Formulations
Acetylsalicylic Acid with
Carisoprodol
Acetylsalicylic Acid with Codeine
Acetylsalicylic Acid with Other
Narcotics or Narcotic Analogs
23,029
22,097
5,270
3,238
39
1,763
3,804
9,833
249
3,967
58
3,495
382
5,948
844
2
6
28
5
9
34,863
23,799
8,525
5,956
48
3,362
6,369
22,349
533
8,824
147
5,980
653
11,837
1,335
2
12
53
11
15
No. of
No. of
Single
Case
Mentions Exposures
1
3
1
0
2
253
1,769
256
1,434
643
3
44
1,688
345
755
33
850
6,807
20,347
1,840
5¼5
0
1
0
0
0
41
265
45
173
80
1
7
276
114
90
4
120
902
1,449
262
6-12
0
5
0
0
0
91
1,268
32
667
301
10
38
1,109
296
689
1
979
5,120
121
1,011
13-19
6
18
3
6
0
419
2,473
43
1,131
2,666
33
153
6,168
904
2,127
1
1,210
9,420
136
1,992
0
0
0
0
0
4
7
1
0
3
0
0
5
2
2
0
3
13
25
7
2
1
1
0
0
27
114
5
75
229
10
6
510
79
114
0
60
650
12
110
0
0
0
0
0
9
52
0
15
45
1
1
77
23
27
0
16
117
7
48
Unknown Unknown Unknown
4¼20
Child
Adult
Age
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
Int
3
9
1
2
2
463
2,632
319
1,913
1,833
18
107
4,445
832
1,303
37
1,318
5
16
2
3
0
319
2,999
53
1,470
1,774
34
121
4,618
728
2,417
1
1,769
11,952 10,518
21,814
174
2,859 2,223
Unint
0
0
0
0
0
0
6
1
4
8
0
0
26
0
4
0
10
14
9
6
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
1
1
1
1
0
50
128
9
69
268
2
14
582
181
45
1
105
5
20
2
5
0
426
3,775
109
1,847
2,244
37
155
5,327
892
2,622
11
2,004
263 13,041
73 2,983
71 2,968
2
7
2
2
1
192
1,328
111
901
896
13
65
2,385
426
779
10
837
6,201
4,661
1,436
Treated in
Adv Health Care
Facility
None
Rxn
10
489
405
7
24
835
162
691
0
394
1
7
0
1
0
137
0
10
0
2
0
134
981 1,158
14
468
847
11
52
2,000
360
935
1
754
2,980 1,758
284
47
632
429
1
7
0
1
0
0
0
0
0
0
2
9
0
4
(continued)
1
0
0
0
0
17
147
0
54
92 10
0 0
9
144 24
16
89
0
36
475 49
6 0
129 16
Minor Moderate Major Death
Outcome
1098
J. B. Mowry et al.
Acetylsalicylic Acid with
Oxycodone
Acetylsalicylic Acid with
1
Propoxyphene
Miscellaneous Analgesics
230
Non-Aspirin Salicylates
(Excluding Topicals and/or
Gastrointestinal Drugs)
Other Analgesics
358
Phenacetin
1
Phenazopyridine
1,090
Salicylamide
7
Unknown Analgesics
223
Nonsteroidal Antiinflammatory Drugs
Colchicine
339
Cyclooxygenase-2 Inhibitors
816
Ibuprofen
79,615
Ibuprofen with Diphenhydramine
2,885
Ibuprofen with Hydrocodone
207
Indomethacin
477
Ketoprofen
86
Naproxen
14,060
Other Types of Nonsteroidal
7,039
Antiinflammatory Drug
Unknown Types of Nonsteroidal
21
Antiinflammatory Drug
Opioids
Buprenorphine
3,484
Butorphanol
65
Codeine
1,709
Dihydrocodeine
5
Fentanyl
1,418
1,956
Hydrocodone Alone or in
Combination (Excluding
Combination Products with
Acetaminophen, Acetylsalicylic
Acid or Ibuprofen)
Hydromorphone
1,588
Levorphanol
4
Meperidine
129
Methadone
3,425
Morphine
3,527
Nalbuphine
20
Other or Unknown Narcotics
1,487
7,740
Oxycodone Alone or in
Combination (Excluding
Combination Products with
Acetaminophen or
Acetylsalicylic Acid)
0
122
159
0
596
6
22
51
151
42,482
377
14
65
10
2,644
1,483
2
929
14
487
0
45
233
69
0
10
214
242
1
58
672
198
298
0
872
6
95
233
404
61,902
1,824
111
243
34
8,438
3,922
11
2,137
45
1,254
3
797
989
657
3
53
1,450
1,633
10
432
3,300
5¼5
0
No. of
No. of
Single
Case
Mentions Exposures
5
0
13
0
4
21
36
0
6
103
29
2
190
0
8
62
0
5
15
3,430
43
3
9
2
288
174
11
0
34
0
3
6-12
17
1
0
70
72
0
29
197
89
1
83
1
32
94
1
6
11
7,221
329
20
29
4
1,935
268
17
0
31
0
26
18
0
13-19
500
1
34
1,039
1,140
8
296
2,054
907
27
448
2
645
510
6
161
197
7,765
992
65
125
15
3,189
1,742
97
0
196
0
33
47
0
0
0
0
1
2
0
1
6
3
0
0
0
1
2
0
0
0
50
1
0
0
0
4
1
0
0
0
0
1
0
0
51
1
5
86
123
1
29
224
147
1
43
0
52
78
0
9
28
771
65
9
14
3
326
235
14
0
13
0
5
5
0
7
0
0
19
18
0
13
44
33
0
3
0
14
10
2
1
2
183
17
0
1
0
52
19
0
0
2
0
5
1
0
Unknown Unknown Unknown
4¼20
Child
Adult
Age
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
0
0
21
0
56
0
58
35
Int
331
1
32
553
929
4
76
1,763
1,207
38
1,049
1
186
646
6
259
1
13
718
540
1
236
1,286
620
4
133
2
496
243
5
164
37
352
30
50,521 10,652
892
897
56
42
153
63
22
8
5,108 2,930
3,266
490
257
0
767
6
32
155
Unint
11
0
0
34
16
1
54
26
84
0
2
0
9
2
0
0
0
24
1
0
0
0
2
2
1
0
0
0
0
0
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
43
0
212
1
62
67
0
48
1
7
74
106
4
20
159
185
2
64
0
81
76
0
389
1
30
1,121
929
9
371
1,828
1,529
17
266
1
582
351
5
30
112
22
60
553 12,786
28
938
12
48
25
74
4
10
353 3,069
149
783
18
0
44
0
1
7
0
0
131
2
14
181
300
0
21
649
291
11
345
0
71
188
0
53
86
13,674
350
30
70
10
2,003
905
68
0
292
3
15
49
Treated in
Adv Health Care
Facility
None
Rxn
127
0
16
256
309
2
80
782
652
9
148
0
160
211
3
42
17
3,492
364
21
30
3
1,073
356
37
0
89
1
18
23
0
91
0
2
394
241
3
114
397
406
1
29
1
217
47
2
27
1
757
261
8
3
1
233
59
6
0
17
0
13
16
0
1
0
0
0
5
4
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
(continued)
20 1
0 0
3 0
169 12
56 10
0 0
80 5
81 15
44
0
5
0
102
2
0
4
0
52
14
0
1
0
7
7
0
0
4
0
0
1
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1099
5¼5
Oxymorphone
542
249
33
Pentazocine
33
13
2
Propoxyphene
19
5
1
Sufentanil
1
1
0
Tapentadol
310
179
13
Tramadol
13,120
6,478
1,331
Other Acetaminophen and Acetylsalicylic Acid Combinations
6,911
4,807
2,142
Acetaminophen and
Acetylsalicylic Acid with Other
Ingredients
270
177
65
Acetaminophen and
Acetylsalicylic Acid without
Other Ingredients
Category Total:
289,891 187,329
91,819
Anesthetics
Inhalation Anesthetics
Nitrous Oxide
179
134
18
Other Types of Inhalation
88
66
6
Anesthetic
Unknown Types of Inhalation
2
2
1
Anesthetic
Local and/or Topical Anesthetics
Dibucaine
20
20
14
Lidocaine
1,508
1,303
508
Other or Unknown Local and/or
3,871
3,667
2,384
Topical Anesthetic
Miscellaneous Anesthetics
Ketamine and Analogs
327
162
15
Other Types of Anesthetic
27
19
3
Unknown Types of Anesthetic
10
7
4
Category Total:
6,032
5,380
2,953
Anticholinergic Drugs
Miscellaneous Anticholinergic Drugs
10,774
8,271
297
Anticholinergic Drugs (Excluding
Cough and Cold Preparations,
and Plants)
Category Total:
10,774
8,271
297
Anticoagulants
Miscellaneous Anticoagulants
Glycoprotein IIIa/IIb Inhibitors
5
4
0
Heparins
302
244
42
Other Antiplatelets
2,746
1,028
203
Other Types of Anticoagulant
1,826
1,168
147
Unknown Types of Anticoagulant
17
10
3
Warfarin (Excluding
3,402
1,766
355
Rodenticides)
Category Total:
8,298
4,220
750
No. of
No. of
Single
Case
Mentions Exposures
21
2
0
0
90
122
28
1
0
264
127
127
0
9
11
10
1
19
50
20
1
1
0
78
168
7
3
0
278
70
70
0
2
13
6
0
16
37
3,039
4
158
703
899
4
1,271
6,636
6,636
109
11
3
1,594
5
539
812
0
69
46
2
0
0
0
2
0
0
3
3
0
0
0
8
0
0
7
0
0
1
155
0
8,614 24,191 56,846
19
5
1,302
0
0
0
0
0
10
0
1,122
115
182
9
2
1
142
3,974
84
11
1
0
0
10
688
13-19
4
0
0
0
2
162
6-12
314
0
28
91
100
2
93
1,079
1,079
2
0
0
241
1
73
152
0
4
9
4,743
4
108
16
1
2
0
12
257
28
0
5
7
4
0
12
59
59
1
1
0
42
0
15
22
0
2
1
961
0
18
3
0
0
0
0
56
Unknown Unknown Unknown
4¼20
Child
Adult
Age
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
73
1,851
116
4
3
1
66
3,118
Int
3,649
4
195
950
1,010
5
1,485
7,774
7,774
35
13
5
4,539
17
1,064
3,307
0
48
50
316
0
17
44
48
2
205
336
336
112
1
0
371
0
70
119
0
62
7
126,372 54,352
93
2,797
108
5
1
0
93
2,840
Unint
5
129
13
2
0
0
16
381
105
2,259
163
7
5
1
98
4,173
10
0
1
1
1
2
5
9
9
5
0
0
32
0
6
15
0
2
4
221
0
29
31
99
0
62
128
128
5
5
2
410
3
150
219
2
21
3
1,078
4
87
170
305
5
507
721
721
149
9
3
1,090
3
319
487
2
82
36
25
801
33
416
54
47
1
1
0
1
0
1
37
23
1,408 1,000
838
2
54
225
228
2
327
1,052
1,052
20
2
0
1,360
4
301
1,006
0
17
10
163
1
19
28
50
1
64
255
255
34
4
1
652
4
172
395
0
25
17
227
0
15
14
60
1
137
200
200
59
1
0
238
0
66
78
2
25
7
0
1
1
0
0
0
0
4
7
0
1
0
6
0
0
1
1
1
0
0
4
0
2
1
0
0
0
(continued)
37
0
3
3
15
0
16
16
16
13
0
0
44
0
17
11
0
3
0
2,085 184
5
11
17
0
0
0
4
181
Minor Moderate Major Death
Outcome
43,002 21,112 11,424
34
1,256
39
5
0
0
26
1,575
Treated in
Adv Health Care
Facility
None
Rxn
408 4,484 70,978
0
2
3
1
0
0
0
45
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
1100
J. B. Mowry et al.
Anticonvulsants
Anticonvulsants: Carbamazepine and Analogs
Carbamazepine
3,734
1,880
Oxcarbazepine
3,620
1,674
Anticonvulsants: Gamma Aminobutyric Acid and Analogs
Gabapentin
15,465
5,367
3,204
1,205
Other Types of Gamma
Aminobutyric Acid
Anticonvulsant
Anticonvulsants: Hydantoins
Fosphenytoin
14
13
Phenytoin
2,745
1,712
Miscellaneous Anticonvulsants
Felbamate
41
19
Lamotrigine
9,208
3,600
Levetiracetam
4,341
2,258
Other Types of Anticonvulsant
701
270
(Excluding Barbiturates)
Primidone
317
107
Succinimides
164
114
Topiramate
4,598
1,838
20
10
Unknown Types of
Anticonvulsant (Excluding
Barbiturates)
Valproic Acid
7,902
2,998
Zonisamide
545
249
Category Total:
56,619
23,314
Antidepressants
Lithium Salts
Lithium
6,850
3,597
Miscellaneous Antidepressants
Antidepressants: Type Unknown
87
22
to Consumer
Bupropion
11,222
5,195
Other Types of Antidepressant
635
277
Trazodone
18,382
6,853
Monoamine Oxidase Inhibitors (MAOI)
Isocarboxazid
7
2
Other Types of Monoamine
86
42
Oxidase Inhibitor (MAOI)
Phenelzine
46
23
Selegiline
40
16
Tranylcypromine
58
26
Selective Serotonin Reuptake Inhibitors (SSRI)
Citalopram
10,193
3,969
Escitalopram
6,607
2,729
Fluoxetine
10,920
4,343
Fluvoxamine
439
138
3,010
1,299
Other Types of Selective
Serotonin Reuptake Inhibitor
(SSRI)
No. of
No. of
Single
Case
Mentions Exposures
66
226
109
40
0
17
4
205
237
28
0
44
167
0
170
25
1,338
80
1
141
10
207
0
1
0
0
0
203
235
318
7
76
884
284
2
100
5
544
875
69
20
52
470
3
369
71
4,394
133
2
634
56
513
0
6
4
1
1
926
503
802
21
303
6-12
253
393
5¼5
79
7
769
4
6
2,012
884
140
10
1,475
3,696
762
1,331
584
969
878
1,622
39
330
1
0
0
0
2
963
34
1,442
5
410
1,680
999
1,447
63
546
16
13
24
2
29
3,180
160
4,400
9
2,835
427 1,912
24
116
2,722 13,787
3
11
361
1
4
640
194
25
1
48
356
62
151
414
13-19
4
3
3
0
0
0
0
0
0
0
3
1
1
0
1
0
0
15
0
0
0
0
0
1
0
0
0
0
4
3
6
1
163
97
120
7
39
2
1
1
0
4
242
15
223
4
119
99
10
930
5
0
64
2
0
176
62
7
0
63
288
45
61
48
24
14
31
1
5
0
1
0
0
0
32
1
67
1
19
21
3
128
0
0
7
0
0
22
6
1
0
9
30
9
12
8
Unknown Unknown Unknown
4¼20
Child
Adult
Age
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
2,019
1,361
1,846
86
608
12
10
12
0
35
2,789
131
1,717
6
952
1,327
204
12,578
79
103
1,077
9
17
2,152
1,832
207
4
618
2,503
638
800
1,008
Unint
1,828
1,242
2,385
44
626
4
2
7
0
3
2,236
118
4,945
14
1,202
1,162
36
8,401
17
7
663
1
2
1,261
361
55
0
459
2,522
471
777
607
Int
10
2
83
0
0
149
48
6
9
504
246
58
216
44
52
30
919
4
4
1,816
659
122
12
1,381
2,992
653
1,336
853
4
6
5
2
2
1
0
2
0
0
7
2
16
1
96
101
82
5
50
6
4
4
2
3
105
24
108
0
9 1,202
2,204
1,476
2,584
51
812
15
6
20
1
11
3,330
178
5,240
13
3,014
1,149
781
1,472
40
339
6
2
4
0
10
1,084
59
1,400
5
513
681
63
5,283
25
42
537
1
3
648
619
65
1
233
1,360
328
300
377
Treated in
Adv Health Care
Facility
None
Rxn
5
376 1,964
0
7
64
53 1,758 12,861
1
1
2
0
0
5
3
0
0
3
23
8
1
1
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
7
1
170
1
0
435
70
28
4
482
479
159
429
206
1
729
511
791
24
256
2
1
7
0
5
439
298
338
11
156
7
2
8
1
4
833 1,115
59
42
2,259 1,195
3
799 1,219
650
476
24
5
5,199 2,952
32
25
377
2
3
877
299
44
4
505
1,184
223
543
407
2
0
1
0
0
0
0
0
0
0
4
0
1
0
7
0
0
6
0
0
0
0
0
0
1
0
0
1
4
0
0
0
(continued)
53
10
26
2
22
1
0
2
0
0
338
10
72
1
160
61
2
345
0
0
7
0
0
66
7
7
0
45
53
21
62
14
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1101
Paroxetine
Sertraline
Serotonin Norepinephrine Reuptake
Duloxetine
Nefazodone
Other Types of Serotonin
Norepinephrine Reuptake
Inhibitor (SNRI)
Venlafaxine
Tetracyclic Antidepressants
Maprotiline
Mirtazapine
Tricyclic Antidepressants (TCA)
Amitriptyline
Amoxapine
Clomipramine
Desipramine
Doxepin
mipramine
Loxapine
Nortriptyline
Other Types of Tricyclic
Antidepressant (TCA)
Protriptyline
Tricyclic Antidepressants (TCA)
Formulated with a
Benzodiazepine
Tricyclic Antidepressants (TCA)
Formulated with a
Phenothiazine
Tricyclic Antidepressants (TCA):
Type Unknown to Consumer
Category Total:
Antihistamines
Miscellaneous Antihistamines
Cimetidine and Other Histamine-2
Blockers
Diphenhydramine Alone (Over the
Counter)
Diphenhydramine Alone
(Prescription)
Diphenhydramine Alone
(Unknown if Over the Counter
or Prescription)
Other Antihistamines Alone
(Excluding Cough and Cold
Preparations)
Category Total:
2,210
3
1,271
2,790
8
116
38
561
129
40
524
208
3
12
17
4
46,517
6,205
20,663
1,116
9,682
35,323
72,989
5,738
6
4,112
6,354
11
241
69
1,523
298
105
1,159
495
14
18
45
17
111,985
8,425
28,086
1,618
14,193
49,747
102,069
3,899
1,524
14,232
6,577
Inhibitors (SNRI)
4,196
1,570
46
15
825
366
No. of
No. of
Single
Case
Mentions Exposures
41,671
20,035
4,762
500
11,653
4,721
7,847
0
6
0
2
418
1
14
2
45
25
3
64
36
1
182
1
0
0
1
426
0
10
3
36
19
2
69
29
0
180
256
121
0
21
232
2,070
13-19
3
11
1
8
1,730
4
78
24
442
60
31
357
134
2
792
1,246
796
9
191
812
2,288
4¼20
7,404
4,943
695
110
1,418
238
6,602
2,699
309
4,879
893
6,714 15,382
2,867
1,236
168
2,249
194
2,074 10,171 24,422
0
0
0
0
116
2
2
0
12
18
2
17
4
0
69
63
50
0
9
523
5
128
537
52
379
6-12
355
1,595
5¼5
Age
48
17
8
0
19
4
22
0
0
0
0
0
0
0
0
0
0
0
1
0
0
1
0
0
0
0
0
4
1,510
757
224
19
368
142
1,673
0
0
2
1
76
1
12
9
21
5
2
15
4
0
43
97
65
1
15
62
205
260
102
58
10
77
13
308
0
0
0
0
24
0
0
0
5
2
0
1
1
0
4
11
15
0
2
11
36
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
2
7
0
5
1,665
4
33
9
376
49
24
243
112
0
730
782
392
5
91
605
3,175
Int
3,876
3,131
371
5,396
240
58,605 13,014
30,899
6,285
704
14,834
5,883
20,302 22,965
1
10
1
7
974
3
77
21
161
70
14
242
74
3
477
1,292
1,073
10
250
820
3,138
Unint
0
0
2
0
89
1
5
8
18
8
2
28
7
0
47
97
81
0
23
74
207
3
10
1
6
2,124
6
51
17
431
71
26
328
161
1
832
1,210
700
5
153
768
3,764
35
15
6
2
9
3
6,247
4,007
486
7,407
517
998 18,664
428
174
29
294
73
0
0
0
4
614
3
23
6
144
27
10
100
34
0
349
362
261
3
48
269
1,470
2
4
0
0
830
2
19
5
149
17
7
103
56
0
171
294
133
0
29
139
683
16,529
8,564
1,903
220
4,428
1,414
18
141
814
7,453 4,420
2,397
1,618 1,224
204
3,036 2,223
198
0
0
0
0
7
0
0
1
3
0
0
0
1
0
1
2
2
0
0
0
0
0
3
1
3
(continued)
390 17
37
136 10
19
198
0
1,138 32
1
0
0
1
225
0
5
3
47
6
2
19
34
0
7
46
6
0
3
7
29
Minor Moderate Major Death
Outcome
11,211 10,006 7,479
0
5
0
3
415
0
25
4
83
24
9
92
25
0
302
619
465
5
120
379
1,772
Treated in
Adv Health Care
Facility
None
Rxn
120 2,489 29,623
1
0
0
0
8
0
0
0
2
0
0
1
1
0
5
14
14
0
2
9
6
Other
Reason
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1102
J. B. Mowry et al.
Antimicrobials
Anthelmintics
Diethylcarbamazine
Levamisole
Other Types of Anthelmintic
Piperazine
Unknown Types of Anthelmintic
Antibiotics
Systemic Antibiotic Preparations
(Oral, Intravenous,
Intramuscular)
Topical Antibiotic Preparations
(Dermal, Otic, Ophthalmic,
Nasal)
Unknown Types of Antibiotic
Preparation
Antifungals
Systemic Antifungal Preparations
(Oral, Intravenous,
Intramuscular)
Topical Antifungal Preparations
(Dermal, Otic, Ophthalmic,
Nasal)
Unknown Types of Antifungal
Preparation
Antiparasitics
Antimalarials
Metronidazole
Other Types of Antiparasitic
Antituberculars
Isoniazid
Other Types of Antitubercular
Rifampin
Antivirals
Amantadine
Antiretrovirals
Other Anti-Influenza Agents
Systemic Antiviral Preparations
(Oral, Intravenous,
Intramuscular)
Topical Antiviral Preparations
(Dermal, Otic, Ophthalmic,
Nasal)
Unknown Types of Antiviral
Preparations
Miscellaneous Antimicrobials
Other Types of Antimicrobial
Unknown Types of Antimicrobial
38
15
1,664
205
8
25,145
5,741
232
1,150
8,032
14
501
672
29
123
9
47
79
346
720
915
171
317
176
9
38
33
1,799
213
11
31,245
5,996
336
1,415
8,395
18
790
1,079
32
172
25
76
244
672
772
1,252
175
522
194
13
No. of
No. of
Single
Case
Mentions Exposures
112
5
114
101
19
67
268
235
26
2
15
122
200
6
7
5,870
587
119
4,070
11,651
15
2
900
155
3
5¼5
6
0
19
9
10
4
194
31
8
0
1
28
22
6
0
238
90
23
263
2,407
1
0
116
9
0
6-12
2
0
25
3
7
14
59
57
32
0
5
52
40
0
0
104
29
18
125
1,559
0
0
37
6
2
13-19
47
4
140
44
43
214
169
521
52
7
23
261
339
15
6
1,498
357
55
1,043
8,158
21
12
521
27
2
4¼20
Age
0
0
0
0
0
0
2
0
0
0
0
0
1
0
0
15
1
0
7
38
1
0
3
1
0
8
0
19
14
0
43
26
69
5
0
3
37
63
2
1
288
81
10
206
1,216
0
1
76
6
1
1
0
0
0
0
4
2
2
0
0
0
1
7
0
0
19
5
7
27
116
0
0
11
1
0
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
168
8
266
161
57
278
645
770
68
9
38
405
525
23
14
7,802
1,025
183
5,531
21,322
36
8
1,564
192
6
Unint
4
0
32
6
16
64
6
96
36
0
6
54
49
2
0
53
22
15
61
1,225
0
4
45
11
1
Int
1
3
49
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7
1
0
5
4
1
17
4
6
3
66
46
17
0
3
41
97
4
0
164
102
34
142
25
1
68
5
32
95
60
176
73
1
15
182
107
12
1
514
133
35
207
3,142
2
11
174
24
2
44
1
69
34
25
63
144
166
26
1
11
122
106
6
0
1,259
215
38
847
3,924
6
2
405
59
2
Treated in
Adv Health Care
Facility
None
Rxn
14 2,524
1
0
2
1
1
Other
Reason
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15
0
18
11
10
29
43
59
15
0
9
57
51
4
3
512
76
21
250
1,785
1
1
125
8
2
2
0
9
0
10
11
13
14
14
0
5
34
11
2
0
48
26
4
29
330
0
4
10
1
0
0
0
1
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
3
0
0
0
0
0
(continued)
1
0
2
0
2
0
1
4
17
0
0
3
0
0
0
3
0
0
0
31
0
1
0
0
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1103
37
37
664
3
785
1,054
12
138
1
2,657
21
475
107
19
161
1,087
359
123
14
1,224
6
2
38
1
3
27
0
0
37
3,704
254
254
3,053
14
3,755
1,559
62
215
0
8,658
238
2,995
803
152
1,794
875
2,952
1,214
94
1,769
128
49
471
0
71
268
6
3
202
14,084
4¼20
Age
338
12
3,244
1,279
1,239
236
207
208
26
119
6,285
2,198
877
2,345
434
825
3,382
2,648
2
800
122
622
576
107
419
995
995
1
0
7
19
90
2,365 23,351
21
0
175
12
741
16
7
7
1
5
416
93
13
111
403
84
241
662
0
208
6
51
243
3
151
45
45
2,176 13,579
13-19
and/or Antihistamine
0
0
0
3,485
6-12
24,671
5¼5
Category Total:
55,517
46,358
Antineoplastics
Miscellaneous Antineoplastics
Antineoplastic Drugs
1,931
1,474
Category Total:
1,931
1,474
Asthma Therapies
Miscellaneous Asthma Therapies
Albuterol
5,154
4,643
Aminophylline or Theophylline
199
133
Leukotriene Antagonist or
6,743
5,189
Inhibitor
Non-Selective Beta Agonists
3,774
3,729
Other Asthma Therapeutic Agents
319
224
Terbutaline and Other Beta-2
1,312
1,133
Agonists
Unknown Asthma Therapeutic
7
3
Agents
Category Total:
17,508
15,054
Cardiovascular Drugs
Miscellaneous Cardiovascular Drugs
Alpha Blockers
3,643
1,232
Angiotensin Converting Enzyme
16,959
7,391
Inhibitors
Angiotensin Receptor Blockers
7,200
3,418
Antiarrhythmics
1,956
1,127
Antihyperlipidemics
12,157
4,705
Antihypertensives (Excluding
5,090
2,856
Diuretics)
Beta Blockers (Including All
24,755
10,459
Propranolol Cases)
Calcium Antagonists
12,007
5,001
Cardiac Glycosides
2,220
1,432
Clonidine
9,710
5,063
Hydralazine
1,085
403
Long-Acting Nitrates
856
282
Nitroglycerin
1,177
759
Nitroprusside
31
28
Other Types of Cardiovascular
561
212
Drug
Other Types of Vasodilator
1,065
703
Unknown Types of
60
18
Cardiovascular Drug
Unknown Types of Vasodilator
16
10
Vasopressors
639
367
Category Total:
101,187
45,466
Cold and Cough Preparations
Acetaminophen and Acetylsalicylic Acid with Decongestant
1
1
No. of
No. of
Single
Case
Mentions Exposures
0
0
0
18
1
0
2
0
0
0
0
1
0
0
2
1
0
3
4
0
4
23
0
7
0
2
7
0
7
3
3
69
0
0
17
1,780
40
0
224
30
77
14
17
30
0
14
401
205
59
280
42
59
271
369
0
96
19
97
86
5
66
127
127
2,175
0
0
2
164
8
0
19
3
13
3
0
4
0
0
44
11
7
11
11
5
23
37
0
5
3
8
14
1
6
13
13
203
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
1
9
341
37,904
521
11
4,309
615
3,460
348
255
648
12
203
8,701
3,185
1,032
4,416
2,429
916
6,493
13,944
2
3,588
175
1,007
4,068
83
5,021
1,318
1,318
41,104
Unint
0
1
11
5,569
74
5
565
74
1,427
44
13
85
1
7
1,506
180
45
162
330
258
781
702
1
106
22
71
356
12
134
45
45
1,808
Int
95
1
101
665
121
10
13
18
15
1
187
46
47
118
65
50
102
337
0
22
25
47
185
32
26
104
104
260
7
2,447
1,101
3,553
168
82
243
25
46
4,221
665
443
496
1,420
451
2,227
2,392
1
1,026
58
130
572
81
524
458
458
0
0
0
0
0
4
1
13
84
48 1,668 17,943
7
0
5
1
12
0
0
4
0
0
6
1
0
2
6
0
3
33
0
11
1
2
18
0
1
1
1
5,097
0
6
81
14,377
202
3
1,933
218
994
136
87
340
4
61
4,015
1,031
438
789
949
350
2,740
2,726
1
272
49
147
1,081
23
1,153
306
306
7,575
Treated in
Adv Health Care
Facility
None
Rxn
32 3,328
Other
Reason
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914
72
82
19
402
87
206
674
1
303
18
65
245
37
5
65
65
577
38
3
0
0
0
2
42
31
3,515 4,415
79
1
300
423
137
526
1,145 1,518
40
32
22
26
49
24
4
3
16
7
537
138
74
100
443
123
265
2,263
0
1,593
25
86
474
15
70
157
157
3,105
0
8
0
0
1
0
2
0
0
0
0
0
2
0
0
0
6
0
0
0
(continued)
0
0 0
2 0
501 82
4
0
86 20
122 38
143 0
1 0
1 0
0 0
2 1
1 0
89 14
3
19
3
16
0
9
11
0
1
2
0
0
8
0
12
12
65
Minor Moderate Major Death
Outcome
1104
J. B. Mowry et al.
Acetaminophen and
Acetylsalicylic Acid with
Antihistamine without Opioids
1
1
Acetaminophen and
Acetylsalicylic Acid with
Decongestant and
Antihistamine without Opioids
55
35
Acetaminophen and
Acetylsalicylic Acid with
Decongestant and/or
Antihistamine Combinations
without Phenylpropanolamine
or Opioids
99
79
Acetaminophen, Acetylsalicylic
Acid, and Dextromethorphan
Combinations with
Decongestant and/or
Antihistamine without
Phenylpropanolamine
1
0
Acetaminophen, Acetylsalicylic
Acid, and Dextromethorphan
with Antihistamine
1
0
Acetaminophen, Acetylsalicylic
Acid, and Dextromethorphan
with Decongestant
2
2
Acetaminophen, Acetylsalicylic
Acid, and Dextromethorphan
with Decongestant and
Antihistamine
14
9
Acetaminophen, Acetylsalicylic
Acid, and Opioid Combinations
with Decongestant and/or
Antihistamine without
Phenylpropanolamine
Acetaminophen with Decongestant and/or Antihistamine
26
21
Acetaminophen and Codeine
Combinations with
Decongestant and/or
Antihistamine without
Phenylpropanolamine
11,732
6,851
Acetaminophen and
Dextromethorphan
Combinations with
Decongestant and/or
Antihistamine without
Phenylpropanolamine
13
10
No. of
No. of
Single
Case
Mentions Exposures
1
6
9
0
0
0
0
1
559
1
18
52
0
0
2
2
14
3,266
6
6-12
0
5¼5
1
1,021
2
2
0
0
0
8
1
0
13-19
1
1,825
4
4
0
0
0
9
7
0
4¼20
Age
0
4
0
0
0
0
0
0
0
0
0
146
0
0
0
0
0
1
3
0
1
30
0
1
0
0
0
0
0
0
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
1
6
4,670
17
2
2
0
0
68
26
Unint
1
5
0
0
0
9
6
0
2
1,855
Int
1
9
0
0
0
0
0
0
0
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
1
264
3
2
0
0
0
2
3
0
2
2,285
4
6
0
0
0
18
9
0
0
2
1,524
6
2
0
0
0
14
10
Treated in
Adv Health Care
Facility
None
Rxn
0
941
2
3
0
0
0
9
2
0
2
401
0
1
0
0
0
0
1
0
0
2
0
0
0
0
0
0
0
0
(continued)
0
20
0
0
0
0
0
0
0
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1105
2
1
0
0
2
3
155
0
3
0
0
3
5
4
1
6
6
842
2
19
0
0
29
6-12
3
5¼5
Acetaminophen and
Dextromethorphan with
Antihistamine
14
8
Acetaminophen and
Dextromethorphan with
Decongestant
23
12
Acetaminophen and
Dextromethorphan with
Decongestant and
Antihistamine
13
4
Acetaminophen and Other Opioid
Combinations with
Decongestant and/or
Antihistamine without
Phenylpropanolamine
1
1
Acetaminophen and Other Opioid
with Decongestant and
Antihistamine
Acetaminophen with
14
9
Antihistamine without Opioids
12
10
Acetaminophen with
Decongestant and
Antihistamine without Opioids
2,742
1,744
Acetaminophen with
Decongestant and/or
Antihistamine Combinations
without Phenylpropanolamine
or Opioids
Acetaminophen with
4
3
Decongestant without Opioids
Acetylsalicylic Acid with Decongestant and/or Antihistamine
36
30
Acetylsalicylic Acid and
Dextromethorphan
Combinations with
Decongestant and/or
Antihistamine without
Phenylpropanolamine
Acetylsalicylic Acid with
1
0
Antihistamine without Opioids
1
0
Acetylsalicylic Acid with
Decongestant and
Antihistamine without Opioids
73
46
Acetylsalicylic Acid with
Decongestant and/or
Antihistamine Combinations
without Phenylpropanolamine
or Opioids
No. of
No. of
Single
Case
Mentions Exposures
7
0
0
2
1
302
1
0
0
0
2
0
13-19
7
0
0
6
0
414
0
1
0
0
4
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
29
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
Unknown Unknown Unknown
4¼20
Child
Adult
Age
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
8
1
4
7
7
35
0
0
25
3
1,218
10
Unint
0
1
0
0
4
1
7
0
0
2
0
447
Int
0
0
0
0
0
5
0
0
0
0
0
0
Other
Reason
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4
0
0
3
0
62
0
0
0
0
1
0
10
0
0
8
0
560
1
6
0
0
5
1
1
5
0
1
2
1
10
0
0
8
0
373
Treated in
Adv Health Care
Facility
None
Rxn
8
0
0
5
0
212
1
2
0
0
3
1
3
0
0
1
0
154
0
0
0
0
2
0
0
0
0
0
0
1
0
0
0
0
0
0
(continued)
0
0
0
0
0
8
0
0
0
0
0
0
Minor Moderate Major Death
Outcome
1106
J. B. Mowry et al.
Antihistamine and/or Decongestant
Antihistamine and Decongestant
1
with Codeine
Antihistamine and Decongestant
29
with Dextromethorphan
Antihistamine and Decongestant
16
without Opioid
926
Antihistamine and/or
Decongestant with Codeine
without Phenylpropanolamine
10,561
Antihistamine and/or
Decongestant with
Dextromethorphan without
Phenylpropanolamine
554
Antihistamine and/or
Decongestant with Other Opioid
without Phenylpropanolamine
11,399
Antihistamine and/or
Decongestant without
Phenylpropanolamine and
Opioid
Antihistamine with Codeine
2
Antihistamine with
23
Dextromethorphan
Antihistamine without Opioid
6
Decongestant with
12
Dextromethorphan
Decongestant without Opioid
16
Miscellaneous Cold and Cough Preparations
166
Acetaminophen in Combination
with Dextromethorphan
(Without Decongestants or
Antihistamines)
2
Acetylsalicylic Acid in
Combination with
Dextromethorphan
Cough and Cold Preparations (Not
2,077
Otherwise Classified)
Dextromethorphan Preparations
13,197
(Not Otherwise Classified)
Dextromethorphan With
13
Expectorants
3,153
Expectorants or Antitussives
(Without Narcotics or Narcotic
Analogs)
Expectorants Without
9
Dextromethorphan
14
1
14
11
243
4,430
150
5,104
1
9
4
4
2
76
0
1,376
4,183
8
981
5
4
25
14
705
8,588
443
8,636
2
19
5
6
11
116
2
1,745
10,189
12
2,226
6
10
5¼5
1
No. of
No. of
Single
Case
Mentions Exposures
1
8
0
4
0
177
2
1,339
117
0
13
3
1
1
1
2
930
46
902
88
6-12
0
1
186
1
1,660
72
0
13
0
0
0
0
4
582
29
1,692
68
0
2
0
13-19
2
0
762
1
2,763
155
1
13
5
0
1
0
4
1,818
199
1,488
290
1
0
0
4¼20
Age
0
0
3
0
9
3
0
0
0
0
0
0
0
8
0
4
0
0
0
0
0
0
108
0
196
20
1
0
0
0
0
0
0
167
19
60
14
1
1
0
0
0
9
0
39
2
0
1
1
0
0
0
0
27
0
12
2
0
0
0
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
1
8
6
1,879
11
6,987
1,625
1
91
9
5
4
2
10
7,779
377
5,720
551
12
24
Unint
0
0
0
2
0
245
1
2,878
81
1
21
1
0
1
0
7
621
50
2,690
122
Int
0
0
3
0
5
1
0
0
0
0
0
0
1
7
1
9
1
0
0
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
0
0
91
0
259
34
0
4
1
0
1
0
0
205
11
125
20
2
1
0
1
0
511
1
3,592
176
1
33
2
0
2
0
9
1,373
143
3,281
205
4
1
0
1
8
0
3
1
496
2
1,773
394
0
29
1
1
0
1
1
2,134
113
1,700
157
Treated in
Adv Health Care
Facility
None
Rxn
33
0
0
0
34
0
6
1
0
1
0
6
232
23
1
0
152
1
0
0
52
0
1,679 1,277
103
1
17
0
0
1
0
1
698
93
1,394 1,270
135
4
3
0
0
0
3
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
(continued)
0
0
3
0
43
2
0
0
0
0
0
0
1
8
3
57
1
0
0
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1107
53
257
0
1
7
0
4
0
1
9
41
3
40
1
Antihistamine
8
0
1
6-12
0
5¼5
Non-Acetylsalicylic Acid
Salicylates in Combination with
Dextromethorphan
Non-Narcotic Antitussives
4
3
Excluding Dextromethorphan
Unknown Types of Cough and
1,718
841
Cold Preparation
Non-Acetylsalicylic Acid Salicylates with Decongestant and/or
17
12
Non-Acetylsalicylic Acid
Salicylates and
Dextromethorphan
Combinations with
Decongestant and/or
Antihistamine without
Phenylpropanolamine
2
2
Non-Acetylsalicylic Acid
Salicylates and Opioid
Combinations with
Decongestant and/or
Antihistamine without
Phenylpropanolamine
14
12
Non-Acetylsalicylic Acid
Salicylates with Decongestant
and/or Antihistamine without
Phenylpropanolamine and
Opioid
Phenylpropanolamine Containing Preparations
109
67
Acetaminophen and
Phenylpropanolamine
Combinations with
Decongestant and/or
Antihistamine without Opioid
13
7
Acetaminophen, Acetylsalicylic
Acid, and Phenylpropanolamine
Combinations with
Decongestant and/or
Antihistamine without Opioid
86
60
Acetaminophen, Acetylsalicylic
Acid, Phenylpropanolamine,
and Dextromethorphan
Combinations with
Decongestant and/or
Antihistamine
7
1
Acetaminophen, Acetylsalicylic
Acid, Phenylpropanolamine,
and Opioid Combinations with
Decongestant and/or
Antihistamine
No. of
No. of
Single
Case
Mentions Exposures
0
5
3
8
2
0
1
211
0
13-19
0
11
0
11
0
1
3
282
2
4¼20
Age
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
0
27
0
0
0
0
0
0
0
0
10
0
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
2
1
51
3
58
11
2
11
360
Unint
1
0
7
4
9
0
0
0
439
Int
0
0
0
0
0
0
0
2
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
0
1
0
0
1
0
1
22
0
1
11
3
21
1
1
1
521
1
1
1
9
3
19
1
2
1
156
Treated in
Adv Health Care
Facility
None
Rxn
0
5
1
7
1
0
0
184
0
0
2
0
5
0
0
0
125
0
0
0
0
0
0
0
0
0
1
(continued)
0
0
0
0
0
0
0
8
0
Minor Moderate Major Death
Outcome
1108
J. B. Mowry et al.
Acetaminophen,
Phenylpropanolamine, and
Codeine Combinations with
Decongestant and/or
Antihistamine
Acetaminophen,
Phenylpropanolamine, and
Dextromethorphan
Combinations with
Decongestant and/or
Antihistamine
Acetaminophen,
Phenylpropanolamine, and
Other Opioid Combinations
with Decongestant and/or
Antihistamine
Acetylsalicylic Acid and
Phenylpropanolamine
Combinations with
Decongestant and/or
Antihistamine without Opioid
Acetylsalicylic Acid,
Phenylpropanolamine, and
Dextromethorphan
Combinations with
Decongestant and/or
Antihistamine
Acetylsalicylic Acid,
Phenylpropanolamine, and
Other Opioid Combinations
with Decongestant and/or
Antihistamine
Antihistamine and/or
Decongestant with
Phenylpropanolamine and
Codeine
Antihistamine and/or
Decongestant with
Phenylpropanolamine and
Dextromethorphan
Antihistamine and/or
Decongestant with
Phenylpropanolamine and Other
Opioid
Antihistamine and/or
Decongestant with
Phenylpropanolamine without
Opioid
0
167
0
41
20
1
7
355
6
207
1
247
1
49
22
1
13
415
7
283
No. of
No. of
Single
Case
Mentions Exposures
0
144
4
233
3
0
13
23
0
118
5¼5
0
30
0
41
1
0
3
4
0
12
6-12
13
0
21
0
0
1
6
0
14
0
13-19
20
1
55
3
1
3
8
0
22
0
4¼20
Age
0
0
1
0
0
0
0
0
1
0
0
1
2
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
0
184
4
297
6
1
19
30
0
146
Unint
0
19
1
50
0
0
1
8
0
16
Int
0
0
0
0
0
0
0
0
0
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
3
1
8
1
0
0
3
0
4
0
45
3
80
2
0
6
8
0
39
0
0
66
4
97
5
0
9
9
0
44
Treated in
Adv Health Care
Facility
None
Rxn
13
1
47
0
1
0
6
0
23
0
4
0
18
0
0
0
3
0
5
0
0
0
0
0
0
0
0
0
0
0
(continued)
0
0
1
0
0
0
0
0
0
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1109
7
Non-Acetylsalicylic Acid
Salicylates and
Phenylpropanolamine
Combinations with
Decongestant and/or
Antihistamine without Opioid
11
Non-Acetylsalicylic Acid
Salicylates,
Phenylpropanolamine, and
Dextromethorphan
Combinations with
Decongestant and/or
Antihistamine
218
Other Phenylpropanolamine
Preparations (Excluding Street
Drugs and Diet Aids)
Category Total:
60,300
Diagnostic Agents
Miscellaneous Diagnostic Agents
Diagnostic Tablets for Glucose or
1
Ketones
Other Types of Diagnostic Agent
368
Unknown Types of Diagnostic
8
Agent
Category Total:
377
Dietary Supplements/Herbals/Homeopathic
Amino Acids
Creatine
258
Other Amino Acid Dietary
671
Supplements
Botanical Products
Citrus Aurantium (Single
11
Ingredient)
Echinacea
187
Ginkgo Biloba
102
Ginseng
89
Kava Kava
48
Ma Huang/Ephedra (Single
24
Ingredient)
Multi-Botanicals with Citrus
108
Aurantium
Multi-Botanicals with Ma Huang
131
Multi-Botanicals without Ma
1,870
Huang or Citrus Aurantium
Other Single Ingredient Botanicals
2,941
St. John’s Wort
199
Valerian
236
Yohimbe
209
7
6
89
21,883
0
55
1
56
114
261
4
103
29
39
3
5
42
33
879
1,414
74
44
22
9
183
43,645
1
333
6
340
196
473
8
146
60
68
28
13
81
87
1,504
2,310
127
130
159
5¼5
7
No. of
No. of
Single
Case
Mentions Exposures
3
2
0
93
4
5
3
0
70
2
17
3
1
0
0
2
11
23
5
5
0
0
4,543
6-12
78
1
0
4¼20
89
16
11
12
15
105
12
3
3
1
4
3
0
25
26
10
9
0
1
597
26
62
111
36
392
24
18
20
24
18
4
2
39
142
211
207
4
0
5,948 10,291
3
0
0
13-19
Age
7
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
1
0
0
34
0
0
0
100
6
5
10
2
52
1
5
5
3
3
1
0
3
15
50
49
1
0
807
10
0
0
10
1
3
1
1
6
0
0
0
0
0
0
0
4
5
7
7
0
0
139
0
0
0
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
9
7
1,931
93
72
55
44
1,056
49
135
49
53
4
5
8
149
366
287
283
3
1
32,598
183
Unint
0
0
0
111
22
41
19
26
178
16
7
3
3
12
4
0
14
43
4
3
1
0
9,616
Int
0
0
0
9
1
1
5
1
0
0
1
2
0
0
0
0
0
0
0
0
2
1
1
0
0
250
10
16
83
16
261
16
3
8
12
11
4
0
29
60
48
46
2
0
336
28
48
98
53
425
42
10
8
14
17
7
1
54
91
136
134
2
0
2
1
453
26
25
13
16
287
28
37
8
12
3
2
0
35
96
59
58
1
0
9,262
58
Treated in
Adv Health Care
Facility
None
Rxn
45 1,144 13,005
0
0
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
0
0
0
180
7
17
31
16
175
9
2
7
5
6
3
1
22
43
62
62
0
0
69
6
11
52
13
103
9
2
2
3
3
0
0
11
13
16
16
0
0
5,767 3,662
5
1
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
9
0
0
0
(continued)
4
0
0
1
1
6
0
0
0
0
0
0
0
1
3
5
4
1
0
155
0
0
0
Minor Moderate Major Death
Outcome
1110
J. B. Mowry et al.
5¼5
Cultural Medicines
Asian Medicines
127
113
60
Ayurvedic Medicines
15
11
5
Hispanic Medicines
4
4
1
Other Cultural Medicines
45
35
15
Energy Products
1,123
824
424
Energy Drinks: Caffeine
Containing (From Any Source
Including Guarana, Kola Nut,
Tea, Yerba Mate, Cocoa, etc)
1,039
741
450
Energy Drinks: Caffeine Only
(Without Guarana, Kola Nut,
Tea, Yerba Mate, Cocoa, etc)
152
46
14
Energy Drinks: Ethanol and
Caffeine Containing (From Any
Source Including Guarana, Kola
Nut, Tea, Yerba Mate, Cocoa,
etc)
2
1
1
Energy Drinks: Ethanol and
Caffeine Only (Without
Guarana, Kola Nut, Tea, Yerba
Mate, Cocoa, etc)
2
1
1
Energy Drinks: Ethanol
Containing Without Caffeine
(From Any Source)
Energy Drinks: No Caffeine
14
11
5
(From Any Source)
Energy Drinks: Unknown
538
362
153
Energy Products: Other
349
277
136
Hormonal Products
Androgen or Androgen Precursor
127
92
63
Dietary Supplements
Glandular Dietary Supplements
47
36
27
Melatonin
16,843
13,860
10,451
Phytoestrogen Dietary
54
35
11
Supplements
Miscellaneous Dietary Supplements/Herbals/Homeopathic
Homeopathic Agents
10,100
9,547
8,597
Unknown Dietary Supplements or
1,975
1,564
1,001
Homeopathic Agents
Other Dietary Supplements
Blue-Green Algae
221
163
41
Glucosamine (with or without
571
395
292
Chondroitin)
Other Single Ingredient Non1,834
1,061
747
Botanical Dietary Supplements
Category Total:
42,266
34,569
25,561
No. of
No. of
Single
Case
Mentions Exposures
8
1
0
3
142
73
13
0
0
0
59
30
3
1
995
2
114
81
13
8
33
1,904
74
68
2
0
0
1
37
19
0
0
1,631
1
348
66
34
8
73
2,605
13-19
6
2
0
1
6-12
3,845
180
56
70
394
361
7
669
14
17
98
88
5
0
0
16
135
165
34
3
3
15
43
1
1
0
11
1
0
15
0
1
0
0
0
0
0
0
0
2
3
0
0
0
533
25
16
14
74
47
1
83
6
7
14
4
0
0
0
1
11
16
2
0
0
1
78
2
2
3
9
7
0
16
1
1
1
0
0
0
0
0
4
1
0
0
0
0
Unknown Unknown Unknown
4¼20
Child
Adult
Age
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
29,985
934
151
374
9,202
1,206
31
12,246
19
70
226
186
8
1
1
17
556
561
96
9
1
21
Unint
7
0
2
5
2,584
50
1
7
126
103
0
1,396
5
8
70
41
0
0
0
24
114
126
Int
71
7
13
207
238
5
123
11
13
61
46
3
0
0
4
68
132
9
2
1
9
5,192
121
42
28
681
391
5
2,084
11
21
101
102
2
0
0
22
110
184
35
2
3
15
6,830
158
19
74
1,694
302
5
3,024
5
24
60
63
2
0
1
6
159
165
24
1
0
3
Treated in
Adv Health Care
Facility
None
Rxn
78 1,802
3
2
1
5
4
0
42
0
1
2
0
0
0
0
1
2
3
1
0
0
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
2,981
60
27
15
243
143
0
1,556
1
3
58
52
2
0
0
11
110
153
15
2
2
4
709
22
10
3
29
91
2
54
2
3
36
28
0
0
0
8
42
69
6
0
1
6
5
1
0
0
0
1
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
(continued)
43
1
0
1
2
7
0
0
0
0
1
1
0
0
0
1
2
9
1
0
0
1
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1111
Diuretics
Miscellaneous Diuretics
Furosemide
3,291
1,061
Other Types of Diuretic
2,243
890
Thiazide
4,413
1,612
Unknown Types of Diuretic
239
76
Category Total:
10,186
3,639
Electrolytes and Minerals
Miscellaneous Electrolytes and Minerals
Calcium and Calcium Salts
12,768
11,335
Chromium, Trivalent
255
214
Colloidal Silver
90
77
1,664
1,559
Fluoride (Excluding Vitamins,
Hydrofluoric Acid &
Mouthwashes)
Iron and Iron Salts (Excluding
5,455
4,024
Vitamins with Iron)
Magnesium and Magnesium Salts
1,554
1,246
Multi-Mineral and Multi-Herbal
909
725
Dietary Supplement
Multi-Mineral Dietary
161
137
Supplements
Other Types of Electrolyte or
39
30
Mineral
Potassium and Potassium Salts
1,437
594
Selenium and Selenium Salts
77
54
Sodium and Sodium Salts
3,795
3,042
Unknown Types of Electrolyte or
14
10
Mineral
Vanadium and Vanadium Salts
1
1
Zinc and Zinc Salts
1,158
989
Category Total:
29,377
24,037
Eye/Ear/Nose/Throat Preparations
Miscellaneous Eye/Ear/Nose/Throat Preparations
Topical Steroids For Eye/Nose/
1,644
1,343
Throat
Nasal Preparations
2,215
2,103
Other Nasal Decongestants or
Sympathomimetics (Excluding
Tetrahydrazoline)
Other Types of Nasal Preparation
581
558
Tetrahydrozoline, Nasal
25
25
Preparations
Unknown Types of Nasal
11
10
Preparation
Ophthalmic Preparations
Contact Lens Products
2,344
2,280
Glaucoma Medications
422
378
No. of
No. of
Single
Case
Mentions Exposures
48
46
116
4
214
545
17
3
159
141
62
25
6
2
12
3
277
1
0
33
1,286
245
110
12
0
0
35
11
10,060
83
26
1,276
2,095
506
418
83
5
183
14
1,664
6
0
543
16,962
720
977
343
18
1
1,261
106
6-12
405
369
674
30
1,478
5¼5
129
2
0
10
1
118
39
0
47
988
25
2
151
0
1
9
56
104
417
143
7
3
23
32
48
53
5
138
13-19
727
226
5
151
4
750
268
1
307
4,084
334
29
767
2
20
34
543
169
1,209
476
75
34
84
521
390
708
30
1,649
4¼20
Age
2
0
0
1
0
0
4
0
4
50
0
0
7
0
0
0
0
1
6
21
10
0
1
0
0
3
0
3
116
32
4
37
2
136
63
0
51
589
35
6
149
1
2
4
69
7
142
79
19
10
15
50
35
52
6
143
10
1
0
4
0
12
4
0
4
78
5
0
27
0
0
1
10
1
14
11
3
1
1
5
2
6
1
14
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
2,234
344
10
541
24
1,888
1,258
0
816
21,668
485
42
2,605
9
26
118
1,006
504
3,244
11,081
193
50
1,489
962
765
1,430
58
3,215
Unint
23
7
0
1
0
59
34
1
67
1,457
77
6
296
0
2
7
107
139
547
182
5
5
16
70
83
142
14
309
Int
2
1
0
2
0
12
5
0
2
82
5
1
54
0
0
0
2
0
8
3
5
0
2
1
0
3
0
4
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
20
25
0
14
1
140
42
0
98
764
24
4
72
1
2
11
126
80
205
63
11
19
48
24
41
29
4
98
377
50
0
30
10
219
46
1
107
2,814
128
25
431
4
7
24
174
274
1,152
343
30
28
86
265
226
382
22
895
255
74
1
71
8
548
210
0
107
4,265
145
11
588
5
2
23
200
196
957
1,702
38
13
278
241
248
446
20
955
Treated in
Adv Health Care
Facility
None
Rxn
376
26
5
54
2
207
107
0
112
1,624
23
6
397
1
9
17
150
121
465
205
29
4
85
126
64
84
5
279
89
12
0
6
0
29
5
0
24
351
27
4
37
0
0
2
28
66
133
22
2
3
3
36
29
23
4
92
0
0
0
0
0
0
0
0
0
2
0
0
1
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
(continued)
1
1
0
0
0
2
0
0
0
14
1
0
3
0
1
0
5
3
1
0
0
0
0
0
0
3
0
3
Minor Moderate Major Death
Outcome
1112
J. B. Mowry et al.
Other Ophthalmic
1,193
Sympathomimetics
Other Types of Ophthalmic
1,979
Preparation
Tetrahydrozoline, Ophthalmic
1,125
Preparations
Unknown Types of Ophthalmic
52
Preparation
Otic Preparations
Combination Products
1,629
Other Types of Otic Preparation
2,108
Unknown Types of Otic
50
Preparation
Throat Preparations
Other Types of Throat Preparation
546
Throat Lozenges with Local
354
Anesthetics
Throat Lozenges without Local
1,017
Anesthetics
Unknown Types of Throat
4
Preparation
Category Total:
17,299
Gastrointestinal Preparations
Antacids
Antacids: Other Types
4,120
Antacids: Proton Pump Inhibitors
10,446
Antacids: Salicylate-Containing
2,580
Antidiarrheals
Antidiarrheals: Diphenoxylate and
288
Atropine Containing
Antidiarrheals: Loperamide
1,230
Antidiarrheals: Non-Narcotic
23
Containing (Excluding Salicyl
Containing)
Antidiarrheals: Paregoric
5
Containing
Antispasmodics
Antispasmodics: Anticholinergic
2,755
Containing
Antispasmodics: Other Types
133
Miscellaneous Gastrointestinal Preparations
Laxatives
15,821
Other Types of Gastrointestinal
10,624
Preparation
Unknown Types of
37
Gastrointestinal Preparation
Category Total:
48,062
718
1,089
776
19
748
751
15
148
137
763
1
8,591
3,449
2,657
1,822
67
407
6
3
577
14
10,017
6,799
11
25,829
1,891
1,095
44
1,609
2,078
46
522
316
939
4
16,378
3,849
5,363
2,321
159
887
13
4
1,325
82
13,824
8,597
16
36,440
5¼5
1,137
No. of
No. of
Single
Case
Mentions Exposures
1,706
1
666
344
1
100
0
40
0
4
157
208
185
954
1
63
57
24
160
84
0
0
24
93
35
6-12
1,042
0
450
162
1
104
0
31
0
5
30
215
44
697
2
22
67
36
46
61
0
5
39
59
61
13-19
6,698
4
2,255
1,091
60
481
1
354
4
74
183
1,962
229
5,049
0
71
202
96
541
986
26
15
201
531
249
39
0
13
15
0
1
0
0
0
1
4
3
2
23
0
0
1
0
2
3
0
0
2
8
0
1,024
0
384
165
5
56
0
47
3
6
24
298
36
983
0
19
43
22
103
178
5
4
47
104
68
102
0
39
21
1
6
0
8
0
2
2
20
3
81
0
1
4
1
9
15
0
1
6
7
6
Unknown Unknown Unknown
4¼20
Child
Adult
Age
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
33,465
14
12,720
8,055
63
1,022
3
632
11
126
3,763
4,908
2,148
15,357
4
877
462
283
1,588
2,042
46
31
983
1,766
976
Unint
1,753
2
597
252
7
221
1
190
1
26
63
286
107
368
0
44
39
19
7
8
0
3
42
41
41
Int
0
427
258
11
67
0
55
1
3
19
154
62
427
0
17
20
13
10
25
0
4
5
65
26
3,731
3
1,211
871
23
456
2
311
1
107
85
483
178
1,846
0
23
54
19
141
246
7
15
234
163
212
6,279
3
1,904
1,626
21
387
1
292
1
49
459
1,033
503
3,167
0
174
108
67
267
207
3
8
428
334
404
Treated in
Adv Health Care
Facility
None
Rxn
83 1,057
0
56
17
0
1
0
2
0
0
2
4
1
196
0
0
0
0
2
3
0
5
62
14
88
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
2,186
0
1,309
296
11
193
0
86
0
27
46
151
67
2,145
1
28
42
22
397
584
10
10
75
119
80
435
2
152
83
5
110
1
34
0
22
3
13
10
270
0
2
3
1
24
44
2
1
14
28
10
4
0
1
1
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(continued)
24
0
1
3
1
4
0
12
0
1
0
1
1
10
0
0
1
0
2
0
0
0
1
1
1
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1113
Hormones and Hormone Antagonists
Miscellaneous Hormones and Hormone Antagonists
Androgens
564
485
Corticosteroids
11,599
9,557
Estrogens
1,330
908
nsulin
7,012
6,038
oral Contraceptives
4,765
3,958
Other Hormone Antagonists
594
454
Other Hormones
785
555
Progestins
1,338
1,120
Selective Estrogen Receptor
322
194
Modulators
Thyroid Preparations (Including
13,623
9,301
Synthetics and Extracts)
Unknown Hormones or Hormone
17
13
Antagonists
Oral Hypoglycemic
Oral Hypoglycemics: Biguanides
8,412
3,793
Oral Hypoglycemics: Other or
1,252
574
Unknown
Oral Hypoglycemics:
3,827
1,584
Sulfonylureas
Oral Hypoglycemics:
324
117
Thiazolidinediones
Category Total:
55,764
38,651
Miscellaneous Drugs
Other Miscellaneous Drugs
Allopurinol
875
311
Disulfiram
179
61
Ergot Alkaloids
65
49
Levo-Dopa and Related Drugs
1,256
681
Neuromuscular Blocking Agents
25
15
(Succinylcholine, Curare, etc)
Nicotine Pharmaceuticals
1,335
1,250
16,625
10,747
Other Types of Miscellaneous
Prescription or Over the
Counter Drug
Category Total:
20,360
13,114
Muscle Relaxants
Miscellaneous Muscle Relaxants
Baclofen
3,916
1,681
Carisoprodol (Formulated Alone)
4,683
1,873
Cyclobenzaprine
10,299
4,388
Metaxalone
533
265
Methocarbamol
2,115
891
Other Types of Muscle Relaxant
987
411
Tizanidine
3,132
1,353
Unknown Types of Muscle
230
43
Relaxant
No. of
No. of
Single
Case
Mentions Exposures
18
822
25
78
161
28
87
49
10
427
1
110
11
47
4
1,878
16
0
4
6
0
106
631
763
46
11
261
3
24
12
32
0
4,444
5
769
198
778
47
15,331
154
2
21
156
2
755
4,302
5,392
237
144
1,192
47
136
63
250
9
6-12
136
4,439
557
164
2,753
150
181
650
60
5¼5
56
665
2,387
325
4
3,597
257
3,356
235
5,196
557
223
215
291
93
136
94
432
31
75
35
73
7
635
29
592
4
4
3
3
0
1,194
1,537
2,319
166
605
284
926
26
5,557
311
4,568
121
50
16
480
11
1,683 17,457
0
57
285
13
1
295
19
345
51
128
375
16
32
55
11
13-19
1
1
0
1
0
0
0
0
13
0
12
0
0
1
0
0
44
0
1
5
1
0
7
0
20
2
1
2
1
3
1
0
51
69
154
17
45
13
62
1
683
39
582
16
5
4
35
2
2,055
10
32
221
23
2
482
49
529
33
424
96
34
35
65
20
16
17
30
0
6
4
10
0
71
10
60
0
0
0
1
0
203
0
4
16
3
0
49
6
46
5
47
14
2
2
9
0
Unknown Unknown Unknown
4¼20
Child
Adult
Age
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
595
355
2,262
150
411
172
662
11
11,461
1,060
9,412
293
27
41
618
10
34,837
107
1,316
3,069
520
9
8,843
372
8,889
834
5,378
3,405
419
497
997
182
Unint
918
1,444
1,973
97
444
207
615
31
764
72
621
7
19
4
41
0
2,490
5
164
596
28
0
322
56
171
42
543
477
23
24
33
6
Int
3
79
110
22
3
111
50
470
28
75
65
11
31
86
4
13
2
4
0
0
6
5
0
55
26
27
1
1
0
0
0
100
28
89
12
28
22
51
0
780
86
646
10
14
4
16
4
1,231
1,564
2,683
118
518
270
914
38
2,932
229
2,424
48
21
25
173
12
7,505
35
1,205
1,011
170
2
1,197
113
653
56
2,422
315
58
134
111
23
208
226
1,048
58
199
89
209
10
2,985
381
2,352
88
8
14
140
2
8,473
52
595
894
234
1
1,661
68
1,234
157
2,547
552
83
159
197
39
Treated in
Adv Health Care
Facility
None
Rxn
42 1,148
2
3
3
1
1
2
3
12
2
9
4
0
0
0
0
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
3
437
196
27
0
53
26
72
3
880
7
5
13
7
2
380
638
1,013
54
241
102
312
12
1,619
199
1,294
9
12
4
96
5
463
475
732
37
96
76
386
10
506
29
415
5
10
5
41
1
1,659 1,731
4
64
319
24
1
169
55
382
39
338
146
17
56
40
5
0
2
7
0
0
0
1
1
0
3
0
0
0
0
0
0
1
2
1
0
0
0
0
3
0
2
0
0
0
0
1
(continued)
175
81
63
6
9
14
46
1
44
3
32
1
0
2
4
2
135 14
0
40
35
1
0
3
7
4
0
45
0
0
0
0
0
Minor Moderate Major Death
Outcome
1114
J. B. Mowry et al.
Category Total:
25,895
10,905
Narcotic Antagonists
Miscellaneous Narcotic Antagonists
Miscellaneous Narcotic
512
219
Antagonist
Category Total:
512
219
Radiopharmaceuticals
Miscellaneous Radiopharmaceutical
Specific Pharmaceutical
43
33
Radionuclides
Category Total:
43
33
Sedative/Hypnotics/Antipsychotics
Barbiturates
Long Acting Barbiturates
1,880
1,115
Short or Intermediate Acting
171
83
Barbiturates
Unknown Types of Barbiturate
33
12
Miscellaneous Sedative/Hypnotics/Antipsychotics
Atypical Antipsychotics
40,617
15,907
Benzodiazepines
74,182
27,060
Buspirone
4,074
1,155
Chloral Hydrate
24
16
Glutethimide
4
3
Meprobamate
24
11
Methaqualone
6
2
17,536
7,551
Other Types of Sedative/
Hypnotic/Anti-Anxiety or AntiPsychotic Drug
Phenothiazines
4,633
1,806
1,428
833
Sleep Aids, Over the Counter
Only (Excluding
Diphenhydramine)
309
99
Unknown Types of Sedative/
Hypnotic/Anti-Anxiety or AntiPsychotic Drug
Category Total:
144,921
55,653
Serums, Toxoids, Vaccines
Miscellaneous Serums, Toxoids, Vaccines
Miscellaneous Serums, Toxoids
1,801
1,588
and Vaccines
Category Total:
1,801
1,588
Stimulants and Street Drugs
Cannabinoids and Analogs
eCigarettes: Marijuana Device
1
0
Flavor Unknown
Marijuana
5,624
2,047
Tetrahydrocannabinol (THC)
3,681
2,799
Homologs
No. of
No. of
Single
Case
Mentions Exposures
389
2
2
2
2
46
4
0
955
687
41
3
0
0
0
416
60
21
3
2,236
105
105
0
86
30
9
9
6
6
273
8
0
1,976
5,044
195
3
0
1
0
921
225
209
10
8,865
343
343
0
298
28
6-12
2,078
5¼5
8
705
55
21
21
168
168
7,057
4¼20
49
1,263
448
653
1,044
0
99
99
887
1,541
0
821
821
6,951 34,805
23
157
126
2,888 9,468
2,840 17,022
171
695
2
5
0
3
1
8
0
2
699 5,074
1
38
5
0
0
16
16
883
13-19
Age
8
3
0
10
10
27
0
2
0
1
15
2
0
0
0
0
5
0
2
0
0
0
1
1
3
87
111
0
191
191
2,239
11
82
23
505
1,150
41
3
0
1
0
363
2
47
11
4
4
20
20
412
28
42
0
19
19
530
3
17
6
114
302
10
0
0
0
0
73
1
4
0
0
0
3
3
83
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
7
226
25
1
1
64
64
5,729
Int
72
804
513
534
120
0
1,208
1,208
1,213
2,449
0
6
6
20,092 32,646
18
774
292
5,822 9,103
8,999 16,923
474
622
6
4
0
3
2
8
0
1
2,849 4,335
1
806
49
21
21
76
76
4,618
Unint
11
426
42
15
15
134
134
7,336
1
184
17
82
1,248
543
703 11,816
403 19,390
45
701
5
12
0
3
0
9
0
2
213 5,017
0
43
1
10
10
58
58
330
78
114
0
1
1
149
28
0
364
364
1,446
2,505
0
440
440
2
118
14
0
0
45
45
25
414
154
20
463
189
4,481 3,639
8,803 3,413
288
101
5
5
1
1
1
4
0
1
2,713
981
3
163
17
1
1
38
38
2,752 2,275
134
95
0
157
157
0
64
64
604
491
745 1,132
0
259
259
0
0
1
0
0
0
0
4
0
1
0
1
5
0
1
1
(continued)
37
227
0
3
3
948 41
1
41
18
399 15
370 18
5 0
0 0
1 0
3 0
0 0
68 6
0
38
4
1
1
5
5
395
Minor Moderate Major Death
Outcome
10,422 17,068 8,951
10
327
173
2,850
5,342
324
0
0
1
0
1,143
0
238
14
4
4
27
27
2,047
Treated in
Adv Health Care
Facility
None
Rxn
401 1,615 39,302
2
7
1
50
298
2
1
0
0
0
29
0
9
2
1
1
17
17
30
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
AAPCC 2014 Annual Report of the NPDS
1115
Tetrahydrocannabinol (THC)
Pharmaceuticals
Diet Aids
Diet Aids: Phenylpropanolamine
and Caffeine Combinations
Diet Aids: Phenylpropanolamine
Only
Other Types of Diet Aid, Over the
Counter Only
Other Types of Diet Aid,
Prescription Only
Unknown Types of Diet Aid
Miscellaneous Stimulants and Street
Amphetamines and Related
Compounds
Amyl or Butyl Nitrites (Street
Drugs)
Caffeine
Cocaine
Ephedrine
gamma-Hydroxybutyric Acid
including Analogs or Precursors
Hallucinogenic Amphetamines
Heroin
Lysergic acid diethylamide (LSD)
Mescaline/Peyote
Methamphetamines
Methylphenidate
Other Hallucinogens
Other Stimulants (Excluding
Amphetamines)
Other Street Drugs
Phenylcyclohexylpiperidine (PCP)
Unknown Hallucinogens
Unknown Stimulants or Street
Drugs
Category Total:
Topical Preparations
Miscellaneous Topical Preparations
Acne Preparations
Boric Acid or Borates (As
Antiseptics, Excluding
Insecticides)
Calamine (Including All Caladryl
Type Products)
Camphor
Camphor and Methyl Salicylate
Combinations
27
3,543
5
169
24
51
9,813
88
2,811
1,171
123
310
1,309
2,463
520
56
2,781
6,695
66
330
428
375
12
164
34,660
2,525
74
2,489
10,920
1,372
7
220
33
78
Drugs
15,522
108
3,749
4,289
173
509
2,305
4,928
770
73
4,926
9,726
106
509
684
742
17
264
59,130
2,640
79
2,556
11,084
1,395
9,204
1,116
1,838
1,440
22
7,139
22
13
0
10
18
15
4
14
223
1,583
2
119
985
39
60
6
20
11
81
2
5
11
11
11
39
5¼5
75
No. of
No. of
Single
Case
Mentions Exposures
2
1
2
0
0
3
235
34
71
134
5
4,898
5
3
0
3
4
21
10
0
77
2,694
0
4
87
10
2
4
1
1,849
6-12
303
289
6
84
742
2,085
139
33
1,894
960
42
170
1,120
949
43
253
56
2,409
18
9
60
1
4
17
4¼20
183
21
22
340
2
1,070
168
487
514
39
6,694 14,114
64
40
5
49
451
149
338
7
202
1,352
18
26
446
59
11
25
2
1,721
3
2
20
1
2
4
13-19
Age
14
3
2
6
0
56
0
0
0
1
2
1
5
0
17
6
0
0
1
3
0
0
0
9
0
0
0
0
0
0
197
29
66
80
4
1,361
27
20
0
14
63
135
10
1
290
86
3
8
146
91
6
16
6
231
1
0
6
1
0
2
17
1
3
11
2
398
7
10
1
3
29
57
14
1
78
14
1
3
26
20
1
6
3
51
0
1
0
0
0
2
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
347
256
11
119
1,166
2,230
476
19
1,928
1,163
62
82
754
974
31
184
46
2,509
8
6
29
1
2
16
Int
10,695
1,329
2,462
2,336
68
138
17
16
59
2
16,048 16,081
54
35
0
21
77
104
29
34
665
5,321
2
207
1,591
105
87
75
39
6,775
32
12
102
3
7
17
Unint
5
6
0
2
8
14
4
1
25
138
1
33
421
14
5
8
0
331
10
5
37
1
2
5
365
337
12
137
1,107
2,232
459
23
2,236
2,231
60
149
844
1,002
35
270
39
4,954
18
16
67
3
4
24
15
1
1
12
2
64
25
8
117
1
1,063
152
132
190
9
0
3
3
2,967
397
374
461
14
5,885
19
23
0
13
42
223
24
2
319
1,712
1
90
390
175
27
18
6
2,508
13
5
40
Treated in
Adv Health Care
Facility
None
Rxn
561 1,253 20,575
13
8
0
12
38
61
5
1
85
18
1
2
22
24
0
28
1
47
1
0
1
0
0
1
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
4
4
20
0
0
5
173
132
9
66
549
811
266
8
790
700
45
53
316
343
10
108
13
1,185
181
192
255
7
71
8
9
29
2
6,394 7,561
75
63
0
26
235
404
101
16
447
1,014
6
63
511
195
13
65
15
1,741 1,513
7
3
30
2
2
11
2
9
0
0
0
6
0
0
0
0
0
0
1
1
0
0
1
0
0
0
0
(continued)
10
0
0
0
0
1,252 113
39
24
2
20
89 12
386 43
32 1
3 0
146 30
24 1
5 1
8 0
15
60
1
46
2
85
0
0
0
0
0
1
Minor Moderate Major Death
Outcome
1116
J. B. Mowry et al.
Diaper Care and Rash Products
29,645
Hexachlorophene Containing
14
Antiseptics
Hydrogen Peroxide 3%
8,163
odine or Iodide Containing
1,042
Antiseptics
Mercury Containing Antiseptics
53
Methyl Salicylate
7,503
Minoxidil, Topical
145
3,870
Other Types of Rubefacient or
Liniment (Excluding Camphor
and Methyl Salicylate)
Other Types of Topical Antiseptic
2,322
Podophyllin
35
Silver Nitrate
107
9,864
Topical Steroids (Including Otic,
Ophthalmic, and Dermal
Preparations)
984
Topical Steroids in Combination
with Antibiotics (Including
Otic, Ophthalmic, and Dermal
Preparations)
Wart Preparations and Other
1,195
Keratolytics
Category Total:
82,696
Unknown Drug
Miscellaneous Unknown Drug
Miscellaneous Unknown Drugs
21,202
Category Total:
21,202
Veterinary Drugs
Miscellaneous Veterinary Drugs
Miscellaneous Veterinary Drugs
3,359
without Human Equivalent
Category Total:
3,359
Vitamins
Miscellaneous Vitamins
Other Types of Vitamin
732
Unknown Types of Vitamin
751
Multiple Vitamin Liquids: Adult Formulations
Multiple Vitamin Liquids: Adult
5
Formulations with Fluoride (No
Iron)
155
Multiple Vitamin Liquids: Adult
Formulations with Iron (No
Fluoride)
5
Multiple Vitamin Liquids: Adult
Formulations with Iron and
Fluoride
27,769
5
2,759
238
30
5,505
40
2,586
1,323
15
15
5,781
479
739
60,904
4,379
4,379
857
857
390
392
3
56
3
7,829
942
50
7,411
135
3,791
2,233
33
93
9,556
960
1,170
80,746
14,799
14,799
3,119
3,119
544
552
5
125
3
5¼5
29,149
14
No. of
No. of
Single
Case
Mentions Exposures
0
10
1
46
60
84
84
601
601
2,436
97
61
114
1
5
630
2
295
5
109
361
36
240
1
6-12
246
335
581
13
37
2,428
14
1,152
76
812
3,775
490
780
6
4¼20
0
9
0
17
27
89
89
1,927
1,927
0
41
1
74
44
1,788
1,788
6,653
6,653
1,876 13,023
35
21
89
2
28
229
2
186
3
97
375
75
165
1
13-19
Age
0
0
0
4
8
7
7
84
84
109
2
1
3
0
0
13
0
8
0
5
5
5
42
0
0
9
0
12
17
252
252
819
819
2,221
48
54
121
2
8
449
2
248
10
166
514
92
130
1
0
0
0
1
4
42
42
336
336
177
3
9
2
0
0
26
0
17
1
16
40
6
23
0
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
3
104
5
497
502
2,973
2,973
6,231
6,231
78,719
1,113
930
2,116
23
74
9,425
40
7,184
117
3,434
7,531
768
29,061
13
Unint
0
9
0
23
29
41
41
5,199
5,199
789
19
6
64
3
2
41
5
72
4
30
200
86
25
0
Int
34
23
37
7
16
80
4
135
13
319
43
69
32
1
0
2
0
0
0
5
5
781
781
0
10
0
20
18
88
88
0
16
1
67
79
378
378
592 10,251
592 10,251
4,493
189
54
233
10
24
205
10
672
32
227
554
226
510
1
0
13
1
103
97
704
704
2,680
2,680
12,787
243
113
412
6
7
1,158
14
1,534
36
560
884
153
3,452
2
Treated in
Adv Health Care
Facility
None
Rxn
149 1,028
3
0
13
0
1
8
1
13
0
7
40
8
24
0
Other
Reason
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384
39
4
21
0
5
17
0
34
8
40
49
30
18
0
0
11
1
26
17
447
447
0
0
0
8
6
65
65
2,238 2,824
2,238 2,824
6,304
187
155
208
5
17
319
2
1,026
13
584
1,184
165
617
2
2
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
(continued)
0
0
0
2
0
6
6
964 81
964 81
22
3
0
2
0
0
0
0
1
1
1
1
3
0
0
Minor Moderate Major Death
Outcome
AAPCC 2014 Annual Report of the NPDS
1117
Multiple Vitamin Liquids: Adult
259
191
Formulations without Iron or
Fluoride
Multiple Vitamin Liquids: Pediatric Formulations
96
87
Multiple Vitamin Liquids:
Pediatric Formulations with
Fluoride (No Iron)
445
421
Multiple Vitamin Liquids:
Pediatric Formulations with
Iron (No Fluoride)
47
42
Multiple Vitamin Liquids:
Pediatric Formulations with
Iron and Fluoride
402
375
Multiple Vitamin Liquids:
Pediatric Formulations without
Iron or Fluoride
Multiple Vitamin Tablets: Adult Formulations
72
59
Multiple Vitamin Tablets: Adult
Formulations with Fluoride (No
Iron)
5,543
4,520
Multiple Vitamin Tablets: Adult
Formulations with Iron (No
Fluoride)
27
19
Multiple Vitamin Tablets: Adult
Formulations with Iron and
Fluoride
82
72
Multiple Vitamin Tablets: Adult
Formulations with Iron
Carbonyl (No Fluoride)
5,179
4,120
Multiple Vitamin Tablets: Adult
Formulations without Iron or
Fluoride
Multiple Vitamin Tablets: Pediatric Formulations
326
303
Multiple Vitamin Tablets:
Pediatric Formulations with
Fluoride (No Iron)
5,088
4,807
Multiple Vitamin Tablets:
Pediatric Formulations with
Iron (No Fluoride)
Multiple Vitamin Tablets:
37
34
Pediatric Formulations with
Iron and Fluoride
14
13
Multiple Vitamin Tablets:
Pediatric Formulations with
Iron Carbonyl (No Fluoride)
26,807
26,072
Multiple Vitamin Tablets:
Pediatric Formulations without
Iron or Fluoride
No. of
No. of
Single
Case
Mentions Exposures
25
4
13
1
24
6
115
0
2
418
28
461
6
3
4,322
83
400
40
342
51
3,505
15
47
2,934
275
4,240
28
10
20,888
6-12
124
5¼5
485
0
0
50
0
150
2
2
123
1
4
0
3
0
10
13-19
284
0
0
46
0
528
19
2
662
1
5
0
3
0
28
4¼20
Age
45
0
0
4
0
5
0
0
10
0
0
0
2
0
0
30
0
0
5
0
77
2
0
98
0
0
1
0
0
4
18
0
0
1
0
8
0
0
7
0
0
0
0
0
0
Unknown Unknown Unknown
Child
Adult
Age
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
25,038
13
32
4,701
297
3,778
65
17
4,312
57
367
40
415
86
172
Unint
1
3
0
2
1
7
996
0
2
88
6
226
3
1
151
Int
5
0
0
0
0
3
0
0
2
1
0
2
0
0
2
Other
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
18
0
0
13
0
106
4
1
52
0
5
0
4
0
10
1,130
1
6
424
11
307
11
2
397
3
28
2
32
4
20
4,268
2
4
951
49
754
11
4
983
12
62
16
69
20
35
Treated in
Adv Health Care
Facility
None
Rxn
491
1
1
288
4
158
6
2
149
2
14
3
24
0
10
17
0
1
17
0
14
0
0
19
0
2
0
2
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(continued)
1
0
0
1
0
1
0
0
0
0
0
0
0
0
0
Minor Moderate Major Death
Outcome
1118
J. B. Mowry et al.
GRAND TOTAL
(Nonpharmaceuticals +
Pharmaceuticals):
4
0
102
37
9
421
10
0
1
0
2
0
1
0
15
0
0
0
1
0
0
0
0
1
0
47
83,396
1
18
8
0
1
0
2,557,756 1,925,657 1,002,495 124,312 125,328 573,765 4,167
17
95
0
165
0
12,194
12
1
13
1
4
17
0
88
4,652
0
0
0
0
0
0
1
0
Unknown Unknown Unknown
Child
Adult
Age
60
28
97
10
27
132
10
667
29,994
0
3
41
0
4¼20
3,725
167
94
375
5
275
21
15
104
1
417
26
132
688
1
133
7
6
31
1
846
136
34
87
2
3,034
285
119 1,138
3
376
22
10
47
1
43,976 6,369 1,353 4,391
94
447,037 60,774 82,420 299,961 1,007
36
759
0
13-19
0
0
6-12
2
5¼5
Age
0
Multiple Vitamins, Unspecified Adult Formulations
2
2
Multiple Vitamins, Unspecified
Adult Formulations with
Fluoride (No Iron)
1,531
1,050
Multiple Vitamins, Unspecified
Adult Formulations with Iron
(No Fluoride)
6
3
Multiple Vitamins, Unspecified
Adult Formulations with Iron
and Fluoride
165
137
Multiple Vitamins, Unspecified
Adult Formulations without Iron
or Fluoride
Multiple Vitamins, Unspecified Pediatric Formulations
19
19
Multiple Vitamins, Unspecified
Pediatric Formulations with
Fluoride (No Iron)
49
43
Multiple Vitamins, Unspecified
Pediatric Formulations with
Iron (No Fluoride)
9
9
Multiple Vitamins, Unspecified
Pediatric Formulations with
Iron and Fluoride
550
535
Multiple Vitamins, Unspecified
Pediatric Formulations without
Iron or Fluoride
Other Vitamins
Other B Complex Vitamins
6,027
4,438
Vitamin A
528
445
Vitamin B3 (Niacin)
1,700
1,374
Vitamin B6 (Pyridoxine)
311
189
Vitamin C
1,671
1,136
Vitamin D
6,398
4,728
Vitamin E
695
466
Category Total:
65,733
56,938
Pharmaceuticals Total:
1,451,094 925,845
No. of
No. of
Single
Case
Mentions Exposures
Table 22B. Demographic profile of SINGLE SUBSTANCE Pharmaceuticals exposure cases by generic category.
2
0
21
0
1
0
13
0
43
Int
0
0
0
0
1
0
0
0
Other
1
0
0
0
3
0
13
0
25
1
2
1
7
2
118
1
1,630,281 224,368 14,955 43,696 447,605
0
12
2
0
2
3
1
27
1
0
0
0
0
0
0
2
0
355,245 272,575 93,723
0
0
0
0
0
0
0
0
10,845 882
0 0
0 0
3 0
0 0
0 0
0 0
0 0
8 0
8,681 620
0
0
0
0
0
0
0
0
Minor Moderate Major Death
Outcome
735
81
12
65
24
5
73
409
80
30
5
4
184
56
8
797
153
18
64
14
1
9,728 1,998
219
190,975 109,701 62,831
90
4
14
2
25
2
189
Treated in
Adv Health Care
Facility
None
Rxn
4,234
99
1
91
268
392
26
1
25
48
708
233
0
425
337
168
9
0
11
16
1,051
62
1
19
55
4,513
105
0
96
432
442
13
2
7
21
53,710 2,173
23
952 3,875
694,658 189,953 3,336 29,483 285,760
513
9
42
19
120
3
993
Unint
Reason
Downloaded by [AAPCC] at 12:54 01 December 2015
AAPCC 2014 Annual Report of the NPDS
1119
1120
J. B. Mowry et al.
Appendix A – Acknowledgments
Downloaded by [AAPCC] at 12:54 01 December 2015
The compilation of the data presented in this report was
supported in part through the US Centers for Disease
Control and Prevention AAPCC Contract 200-2014-58726.
The authors wish to express their profound appreciation
to the following individuals who assisted in the preparation
of the manuscript: Katherine W. Worthen and Laura J.
Rivers.
The authors express their sincere gratitude to the staff
at the AAPCC Central Office for their support during the
preparation of the manuscript: Stephen Kaminski, JD,
Executive Director, Beth Copes and the entire staff.
Poison Centers (PCs)
We gratefully acknowledge the extensive contributions of
each participating PC and the assistance of the many health
care providers who provided comprehensive data to the
PCs for inclusion in this database. We especially acknowledge the dedicated efforts of the Specialists in Poison
Information (SPIs) who meticulously coded 2,890,909 calls
made to US PCs in 2014.
As in previous years, the initial review of reported
fatalities and development of the abstracts and case data for
NPDS was the responsibility of the staff at the 56
participating PCs. Many individuals at each center
participated in the fatality case preparation. These
toxicology professionals and their centers are:
Arizona Poison and Drug Information Center
Keith Boesen, PharmD, CSPI
F. Mazda Shirazi, MS, MD, PhD, FACEP, FAMCT
Nicholas Hurst, MD, MS
Denise Holzman, RPh, CSPI
Matthew Andrews, PharmD
Arkansas Poison & Drug Information Center
Henry F. Simmons, Jr., MD
Pamala R. Rossi, PharmD
Howell Foster, PharmD, DABAT
Banner Poison & Drug Information Center
Daniel Brooks, MD
Jane Klemens, RN, CSPI
Sharyn Welch, RN
Rebecca Hilder, RN, CSPI
Diane Glogan, RN
Aaron Skolnik, MD
Blue Ridge Poison Center
Christopher P. Holstege, MD
Nathan P. Charlton, MD
Joshua D. King, MD
Jennifer Parker Cote, MD
California Poison Control System – Fresno/Madera
Division
Richard J. Geller, MD, MPH
California Poison Control System – Sacramento
Division
Timothy Albertson, MD, PhD
Justin Lewis, PharmD, CSPI
California Poison Control System – San Diego Division
Richard F. Clark, MD
Lee Cantrell, PharmD
Janna Villano, MD
Chuck O’Connell, MD
Landon Rentmeester, MD
Alicia Minns, MD
California Poison Control System – San Francisco
Ilene Anderson, PharmD
Ann Arens, MD
Jo Ellen Dyer, PharmD
Hallam Gugelmann, MD
Sandra Hayashi, PharmD
Raymond Ho, PharmD
Susan Kim-Katz, PharmD
Beth Manning, PharmD
Kathryn Meier, PharmD
Kent R. Olson, MD
Freda Rowley, PharmD
Craig Smollin, MD
Ben Tsutaoka, PharmD
Todd Olivia, BS
Carolinas Poison Center
Michael C. Beuhler, MD
Anna Rouse Dulaney, PharmD
Sara K. Lookabill, PharmD
Christine M. Murphy, MD
William Kerns II, MD
Central Ohio Poison Center
Hannah Hays, MD
Marcel J. Casavant, MD, FACEP, FACMT
Henry Spiller, MS, DABAT, FAACT
Glenn Burns MD
Jason Russell, DO
Devin Wiles DO
Kaitlyn Day
Central Texas Poison Center
Ryan Morrissey, MD
S. David Baker, PharmD, DABAT
Children’s Hospital of MI Regional Poison Center
Cynthia Aaron, MD
Lydia Baltarowich, MD
Aimee Nefcy, MD
Bram Dolcourt, MD
Susan C. Smolinske, PharmD
Matthew Hedge, MD
Andrew King, MD
Keenan Bora, MD
Cincinnati Drug and Poison Information Center
Shan Yin, MD, MPH
Sara Pinkston, RN
Connecticut Poison Center
Charles McKay, MD, ABMT
Mary Kay Balboni, RN, CSPI
Dana Bartlett, MSN, MA, CSPI
Bernard C. Sangalli, MS, DABAT
Florida/USVI Poison Information Center – Jacksonville
Thomas Kunisaki, MD, FACEP, ACMT
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Florida Poison Information Center – Miami
Jeffrey N. Bernstein, MD
Richard S. Weisman, PharmD
Florida Poison Information Center – Tampa
Tamas Peredy, MD, FAACT
Alfred Aleguas, PharmD, DABAT, FAACT
Aryne Patterson, RN, CSPI
Maria T Reyes, CSPI
Judy Turner, RN, CSPI
Charisse Webb, RN, CSPI
Georgia Poison Center
Robert J. Geller, MD
Brent W. Morgan, MD
Ziad Kazzi, MD
Stella Wong, DO
Gaylord P. Lopez, PharmD
Stephanie Hon, PharmD
Adam Pomerleau, MD
Justin Arnold, DO
Alaina Steck, MD
Derek Eisnor, MD
Mehruba Anwar, MD
Natalija Farrell, PharmD
Illinois Poison Center
Michael Wahl, MD
Sean Bryant, MD
Indiana Poison Center
Gwenn Christianson, MSN, CSPI
R. Brent Furbee, MD
James B. Mowry, PharmD
Iowa Poison Control Center
Sue Ringling, RN
Linda B. Kalin, RN
Edward Bottei, MD
Kentucky Regional Poison Control Center
George M. Bosse, MD
Ashley N. Webb, MSc, PharmD, DABAT
Louisiana Poison Center
Mark Ryan, PharmD
Thomas Arnold, MD
Maryland Poison Center
Suzanne Doyon, MD, FACMT
Minnesota Poison Control System
Deborah L. Anderson, PharmD
Jon B. Cole, MD
Rebecca Gardner, MD
Samantha Lee, PharmD
David J. Roberts, MD
Jill Topeff, PharmD
Laurie Willhite, PharmD, CSPI
Mississippi Poison Control Center
Robert Cox MD, PhD, DABT, FACMT
Christina Parker, RN, CSPI
Missouri Poison Center at SSM Cardinal Glennon
Children’s Medical Center
Rebecca Tominack, MD
Shelly Enders, PharmD, CSPI
National Capital Poison Center
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Cathleen Clancy, MD, FACMT
Nicole Reid, RN, BA, BSN, MEd, CSPI, DABAT
Nebraska Regional Poison Center
Prashant Joshi, MD
Ronald I. Kirschner, MD
New Jersey Poison Information and
Education System
Steven M. Marcus, MD
Bruce Ruck, PharmD
New Mexico Poison and Drug Information Center
Steven A. Seifert, MD, FAACT, FACMT
Brandon Warrick, MD
Susan Smolinske, PharmD, DABAT
New York City Poison Control Center
Maria Mercurio-Zappala, MS, RPh
Mark Su, MD
Lewis Nelson, MD
Larissa Laskowski, MD
Vince Nguyen, MD
Scott Lucyk, MD
Denise Fernandez, MD
Daniel Repplinger, MD
Liz Hines, MD
Betty Chen, MD
Lauren Shawn, MD
Hong Kim, MD
North Texas Poison Center
Brett Roth MD, ACMT, FACMT
Rachel Harvey, RN, BSN, CSPI
Anelle Menendez, CSPI
Melody Gardner, RN, MSN, MHA, CCRN
Northern Ohio Poison Center
Hannah Hays MD
Marcel J Casavant MD
Northern New England Poison Center
Karen E. Simone, PharmD, DABAT, FAACT
Tammi H. Schaeffer, DO, FACEP, FACMT
Oklahoma Poison Control Center
William Banner, Jr., MD, PhD, ABMT
Scott Schaeffer, RPh, DABAT
Oregon Poison Center
Zane Horowitz, MD
Sandra L. Giffin, RN, MS
Palmetto Poison Center
William H. Richardson, MD
Jill E. Michels, PharmD
Pittsburgh Poison Center
Michael Lynch, MD
Puerto Rico Poison Center
José Eric Dı̂az-Alcalá, MD
Andrés Britt, MD
Elba Hernández, RN
Regional Center for Poison Control and Prevention
Serving Massachusetts and Rhode Island
Michele M. Burns, MD, MPH
Diana J. Felton, MD
Rebecca Bruccoleri, MD
Bradley L. Demeter, MD
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Regional Poison Control Center – Children’s of
Alabama
Erica Liebelt, MD, FACMT
Michele Nichols, MD
Sherrel Kirkland, RN, CSPI
Ann Slattery DrPH DABAT
Diane Smith, RN, CSPI
Rocky Mountain Poison & Drug Center
Alvin C. Bronstein MD, FACEP
Beau Braden, DO, MPH
Dazhe Cao, MD
Janetta L. Iwanicki, MD
Eric J. Lavonas, MD
Shireen Banerji, PharmD, DABAT
Carol Hesse RN, CSPI
Regina R. Padilla
Evan Poncher, MD
Elizabeth ter Haar, MD
Sahaphume Srisuma, MD
South Texas Poison Center
Cynthia Abbott-Teter, PharmD
Douglas Cobb, RPh
Miguel C. Fernandez, MD
George Layton, MD
C. Lizette Villarreal, MA
Southeast Texas Poison Center
Wayne R. Snodgrass, MD, PhD, FACMT
Jon D. Thompson, MS, DABAT
Jean L. Cleary, PharmD, CSPI
Tennessee Poison Center
John G. Benitez, MD, MPH
Donna Seger, MD
Texas Panhandle Poison Center
Shu Shum, MD
Jeanie E. Jaramillo, PharmD
Cristie Johnston, RN, CSPI
The Poison Control Center at the Children’s Hospital of
Philadelphia
Fred Henretig, MD
Kevin Osterhoudt, MD
Jeanette Trella, PharmD
University of Kansas Hospital Poison Control Center
Tama Sawyer, PharmD, DABAT
Stephen Thornton, MD
Upstate NY Poison Center
Jeanna M. Marraffa, PharmD
Nicholas Nacca, MD
Rachel Schult, Pharm.D.
Christine M. Stork, PharmD
William Eggleston, PharmD
Utah Poison Control Center
B. Zane Horowitz, MD
Amberly Johnson, PharmD
Virginia Poison Center
Rutherfoord Rose, PharmD
Kirk Cumpston, DO
Brandon Wills, DO
Michael Emswiler, MD
Kevin Maskell, MD
Michelle Hieger, DO
Washington Poison Center
William T. Hurley, MD, FACEP, FACMT
Curtis Elko, PharmD
David Serafin, CPIP
Tom Martin, MD, MPH, FACEP
West Texas Regional Poison Center
Hector L. Rivera, RPh, CSPI
Stephen W. Borron, MD, MS, FACEP, FACMT
Salvador H. Baeza, PharmD, DABAT
West Virginia Poison Center
Elizabeth J. Scharman, PharmD, DABAT,
BCPS, FAACT
Anthony F. Pizon, MD, ABMT
Wisconsin Poison Center
David D. Gummin, MD
Amy E. Zosel, MD
AAPCC Fatality Review Team
The Lead and Peer review of the 2014 fatalities was carried
out by the 47 individuals listed here including 4 who
reviewed the pediatric cases [Peds]. The authors and the
AAPCC wish to express our appreciation for their
volunteerism, dedication, hard work and good will in
completing this task in a limited time frame.
Aaron Skolnik, MD, Banner Poison and Drug and
Information Center, Phoenix, AZ
Alexander Garrard, PharmD, DABAT, Washington Poison
Center, Seattle, WA
Alfred Aleguas Jr, PharmD, DABAT, FAACT, Florida
Poison Information Center, Tampa, FL
Amber R. Johnson, PharmD, Utah Poison Control Center,
Salt Lake City, UT
Amy Zosel, MD, Wisconsin Poison Center, Milwaukee, WI
Andy King, MD, Children’s Hospital of Michigan RPCC,
Detroit, MI
Anna Rouse Dulaney*, PharmD, DABAT, Carolinas
Poison Center, Charlotte, NC
Annette Lopez, MD, Oregon Poison Center, Portland, OR
Ann-Jeannette Geib, MD, FACEP, FACMT, Rutgers Robert
Wood Johnson Medical School, New Brunswick, NJ
Ashley Webb, MSc, PharmD, DABAT, Kentucky Regional
Poison Control Center, Louisville, KY
Bernard C Sangalli*, MS, DABAT, Connecticut Poison
Center, Farmington, CT
Christine Murphy, MD, Carolinas Medical Center,
Charlotte, NC
Curtis Elko*, PharmD, CSPI, Washington Poison Center,
Seattle, WA
Cynthia Lewis-Younger, MD, MPH, Vancouver,
Washington
Diane Calello, MD, FAAP, FACMT, New Jersey Poison
Information and Education System, Newark, NJ [Peds]
Elizabeth J Scharman, PharmD, DABAT, BCPS, FAACT,
West Virginia Poison Center, Charlottesville, WV
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AAPCC 2014 Annual Report of the NPDS
Frank LoVecchio, DO, Banner Poison and Drug and
Information Center, Phoenix
Gar Chan, MD, FACEM, Launceston General Hospital,
Tasmania, Australia
Hannah Hays, MD, Central Ohio Poison Center, Columbus,
OH
Henry Spiller*, MS, DABAT, FAACT, Central Ohio
Poison Center, Columbus OH
Jan Scaglione*, PharmD, DABAT, Cincinnati Drug and
Poison Information Center, Cincinnati, OH
Jeffrey S Fine, MD, NYU School of Medicine/Bellevue
Hospital, New York, NY [Peds]
Jennifer Lowry, MD, Division of Clinical Pharmacology,
Toxicology, and Therapeutic Innovations, Children’s
Mercy Hospital, Kansas City, MO [Peds]
Jill E Michels, PharmD, DABAT, Palmetto Poison Center,
Columbia, SC
Justin Lewis, PharmD, CSPI, California Poison Control
System-Sacramento, Sacramento, CA
Kathy Hart, MD, Connecticut Poison Control Center,
Farmington, CT
L Keith French, MD, Oregon Poison Center, Portland, OR
Maria Mercurio-Zappala, RPh, MS, DABAT, FAACT,
New York City Poison Control Center, New York, NY
Mark J. Neavyn, M.D. Division of Medical Toxicology,
Hartford Hospital, Hartford, CT
Mark Su, MD, MPH, FACEP, FACMT, New York City
Poison Control Center, New York, NY
Michael Levine*, MD, Banner Good Samaritan Medical
Center, Phoenix, AZ; University of Southern California,
Los Angeles, CA
Nathanael McKeown*, DO, Oregon Poison Center,
Portland, OR
Nima Majlesi, DO, Staten Island University Hospital, NY
Paul Starr, PharmD, DABAT, Maryland Poison Control
Center, Baltimore, MD
Rachel Gorodetsky, PharmD, Upstate New York Poison
Center, Syracuse, NY
Rachel Schult, PharmD, Upstate New York Poison Center,
Syracuse, NY
Rais Vohra, MD, California Poison Control System,
Fresno/Madera, Madera, CA
Robert Goetz*, PharmD, DABAT, Cincinnati Drug and
Poison Information Center, Cincinnati, OH
Salvador Baeza, PharmD, DABAT, West Texas Regional
Poison Center, El Paso, TX
Sara Miller, PharmD, Grady Health System, Atlanta, GA
Shana Kusin, MD, Department of Emergency Medicine,
OHSU
Sheila Goertemoeller, PharmD, DABAT, ICPS, Cincinnati
Drug and Poison Information Center, Cincinnati, OH
Sophia Sheikh MD, Department of Emergency Medicine,
University of Florida College of Medicine-Jacksonville,
Jacksonville, FL
Stephanie Hon, PharmD, Georgia Poison Center, Atlanta,
GA
Steven M Marcus*, MD, NJ Poison Information and
Education System, NJ Medical School, of the School of
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1123
Biomedical and Health Sciences of Rutgers University,
The State University of NJ, Newark, NJ [Peds]
Susan Smolinske*, PharmD, New Mexico Poison Center,
Albuquerque, NM
Timothy Wiegand, MD, University of Rochester, Medical
Center and Strong Memorial Hospital; SUNY Upstate
Poison Center
Tom Martin, MD, Utah Poison Control Center, Salt Lake
City, UT
*These reviewers further volunteered to read the top ranked
200 abstracts and judged to publish or omit each.
AAPCC Micromedex Joint Coding Group
Chair: Elizabeth J. Scharman, Pharm.D., DABAT,
BCPS, FAACT
Alvin C. Bronstein, MD, FACEP, FACMT
Rick Caldwell
Christina Davis, PharmD
Sandy Giffin, RN, MS
Kendra Grande, RPh
Katherine M. Hurlbut, MD
Wendy Klein-Schwartz, PharmD, MPH
Fiona McNaughton
Susan C. Smolinske, PharmD
AAPCC Rapid Coding Team
Chair: Alvin C. Bronstein, MD, FACEP, FACMT
Elizabeth J. Scharman, Pharm.D., DABAT,
BCPS, FAACT
Jay L. Schauben, PharmD, DABAT, FAACT
Susan C. Smolinske, PharmD
AAPCC Surveillance Team
NPDS surveillance anomalies are analyzed daily by a team
of 10 medical and clinical toxicologists working across the
country in a distributed system. These dedicated professionals interface with the Health Studies Branch, National
Center for Environmental Health, Centers for Disease
Control and Prevention (HSB/NCEH/CDC) and the PCs on
a regular basis to identify anomalies of public health
significance and improve NPDS surveillance systems:
Alvin C. Bronstein, MD, FACEP, FACMT - Director
Alfred Aleguas, Pharm D, DABAT
S. David Baker, PharmD, DABAT
Douglas J. Borys, PharmD, DABAT
John Fisher, PharmD, DABAT, FAACT
Jeanna M. Marraffa, PharmD, DABAT
Maria Mercurio-Zappala, RPH, MS, DABAT, FAACT
Henry A. Spiller, MS, DABAT, FAACT
Richard G. Thomas, Pharm D, DABAT
Regional Poison Center Fatality Awards
Each year the AAPCC and the Fatality Review team
recognized several regional PCs for their extra effort in
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their preparation of fatality reports and prompt responses
to reviewer queries during the review process. The awards
were presented each year at the North American Congress
of Clinical Toxicology Annual meeting.
First Center to Complete all Cases (11-Dec 2014, last of
their 12 cases)
Regional Poison Control Center – Children’s Hospital
(Birmingham)
Largest Number with Autopsy Reports (34 of 75 cases)
Carolinas Poison Center (Charlotte)
Highest Percentage with Autopsy Reports (90% of 10 cases)
Oklahoma Poison Control Center (Oklahoma City)
Largest Number of INDIRECT cases (146 of 276 total
cases reported for 2014)
Oklahoma Poison Control Center (Oklahoma City)
Highest Overall Quality of Reports (12.4 of possible 22 for
18 cases)
Nebraska Regional Poison Center (Omaha)
Greatest improvement in Overall Quality of Reports (4.33
increase from last year)
Southeast Texas Poison Center (Galveston)
Most Abstracts Published 2013 Annual report (9 of the 76
published narratives)
Carolinas Poison Center (Charlotte)
Most Abstracts Published 2014 Annual report (6 of the 70
published narratives)
3 way tie
Carolinas Poison Center (Charlotte)
Florida Poison Information Center (Tampa)
Kentucky Regional Poison Center (Louisville)
Most Helpful Regional Poison Center Staff (based on
survey of AAPCC review team)
New Jersey Poison Information and Education System
(Newark)
Honorable mention:
Arizona Poison & Drug Information Center (Tucson)
Florida Poison Information Center (Tampa)
Illinois Poison Center (Chicago)
Appendix B – Data Definitions
Reason for Exposure
NPDS classifies all calls as either EXPOSURE (concern
about an exposure to a substance) or INFORMATION (no
exposed human or animal). A call may provide information
about one or more exposed person or animal (receptors).
Specialists in Poison Information (SPIs) coded the
reasons for exposure reported by callers to PCs according
to the following definitions:
Unintentional general: All unintentional exposures not
otherwise defined below.
Environmental: Any passive, non-occupational exposure
that results from contamination of air, water, or soil.
Environmental exposures are usually caused by manmade contaminants.
Occupational: An exposure that occurs as a direct result of
the person being on the job or in the workplace.
Therapeutic error: An unintentional deviation from a
proper therapeutic regimen that results in the wrong
dose, incorrect route of administration, administration to
the wrong person, or administration of the wrong
substance. Only exposures to medications or products
used as medications are included. Drug interactions
resulting from unintentional administration of drugs or
foods which are known to interact are also included.
Unintentional misuse: Unintentional, improper or
incorrect use of a nonpharmaceutical substance.
Unintentional misuse differs from intentional misuse in
that the exposure was unplanned or not foreseen by the
patient.
Bite/sting: All animal bites and stings, with or without
envenomation, are included.
Food poisoning: Suspected or confirmed food poisoning;
ingestion of food contaminated with microorganisms is
included.
Unintentional unknown: An exposure determined to be
unintentional, but the exact reason is unknown.
Suspected suicidal: An exposure resulting from the
inappropriate use of a substance for reasons that are
suspected to be self-destructive or manipulative.
Intentional misuse: An exposure resulting from the
intentional improper or incorrect use for reasons other
than the pursuit of a psychotropic effect.
Intentional abuse: An exposure resulting from the intentional improper or incorrect use where the patient was
likely attempting to gain a high, euphoric effect or some
other psychotropic effect, including recreational use of a
substance for any effect.
Contaminant/tampering: The patient is an unintentional
victim of a substance that has been adulterated (either
maliciously or unintentionally) by the introduction of an
undesirable substance.
Malicious: Patients who are victims of another person’s
intent to harm them.
Withdrawal: Inquiry about or experiencing of symptoms
from a decline in blood concentration of a pharmaceutical or other substance after discontinuing therapeutic
use or abuse of that substance.
Adverse Reaction Drug: Unwanted effects due to an
allergic, hypersensitivity, or idiosyncratic response to
the active ingredient(s), inactive ingredient(s) or excipient of a drug, chemical, or other drug substance when
the exposure involves the normal, prescribed, labeled or
recommended use of the substance.
Adverse Reaction Food: Unwanted effects due to an
allergic, hypersensitivity, or idiosyncratic response to a
food substance.
Adverse Reaction Other: Unwanted effects due to an
allergic, hypersensitivity, or idiosyncratic response to a
substance other than drug or food.
Unknown Reason: Reason for the exposure cannot be
determined or no other category is appropriate.
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Medical Outcome
No effect: The patient did not develop any signs or
symptoms as a result of the exposure.
Minor effect: The patient developed some signs or
symptoms as a result of the exposure, but they were
minimally bothersome and generally resolved rapidly
with no residual disability or disfigurement. A minor
effect is often limited to the skin or mucus membranes
(e.g., self-limited gastrointestinal symptoms, drowsiness,
skin irritation, first-degree dermal burn, sinus tachycardia
without hypotension, and transient cough).
Moderate effect: The patient exhibited signs or symptoms as
a result of the exposure that were more pronounced, more
prolonged, or more systemic in nature than minor
symptoms. Usually, some form of treatment is indicated.
Symptoms were not life-threatening, and the patient had
no residual disability or disfigurement (e.g., corneal
abrasion, acid-base disturbance, high fever, disorientation,
hypotension that is rapidly responsive to treatment, and
isolated brief seizures that respond readily to treatment).
Major effect: The patient exhibited signs or symptoms as a
result of the exposure that were life-threatening or resulted
in significant residual disability or disfigurement (e.g.,
repeated seizures or status epilepticus, respiratory compromise requiring intubation, ventricular tachycardia with
hypotension, cardiac or respiratory arrest, esophageal
stricture, and disseminated intravascular coagulation).
Death: The patient died as a result of the exposure or as a
direct complication of the exposure.
Not followed, judged as nontoxic exposure: No follow-up
calls were made to determine the outcome of the
exposure because the substance implicated was nontoxic,
the amount implicated was insignificant, or the route of
exposure was unlikely to result in a clinical effect.
Not followed, minimal clinical effects possible: No followup calls were made to determine the patient’s outcome
because the exposure was likely to result in only minimal
toxicity of a trivial nature. (The patient was expected to
experience no more than a minor effect.).
Unable to follow, judged as a potentially toxic exposure:
The patient was lost to follow-up, refused follow-up, or
was not followed, but the exposure was significant and
may have resulted in a moderate, major, or fatal outcome.
Unrelated effect: The exposure was probably not responsible for the effect.
Confirmed nonexposure: This outcome option was coded
to designate cases where there was reliable and objective
evidence that an exposure initially believed to have
occurred actually never occurred (e.g., all missing pills
are later located). All cases coded as confirmed
nonexposure are excluded from this report.
Death, indirect report: Death, indirect report are deaths that
the poison center acquired from medical examiner or
media, but did not manage nor answer any questions about
the death.
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1125
Relative Contribution to Fatality (RCF)
The Case Review Team (CRT) includes the Author and
Reviewer from the RPC, The AAPCC Lead Reviewer, Peer
Reviewer and Manager.
The definitions used for the Relative Contribution to
Fatality (RCF) classification were as follows:
Undoubtedly responsible – In the opinion of the CRT the
Clinical Case Evidence establishes beyond a reasonable
doubt that the SUBSTANCES actually caused the death.
Probably responsible – In the opinion of the CRT the
Clinical Case Evidence suggests that the SUBSTANCES
caused the death, but some reasonable doubt remained.
Contributory – In the opinion of the CRT the Clinical
Case Evidence establishes that the SUBSTANCES
contributed to the death, but did not solely cause the
death. That is, the SUBSTANCES alone would not have
caused the death, but combined with other factors, were
partially responsible for the death.
Probably not responsible – In the opinion of the CRT the
Clinical Case Evidence establishes to a reasonable
probability,
but
not
conclusively,
that
the
SUBSTANCES associated with the death did not cause
the death
Clearly not responsible – In the opinion of the CRT the
Clinical Case Evidence establishes beyond a reasonable
doubt that the SUBSTANCES did not cause this death.
Unknown – In the opinion of the CRT the Clinical Case
Evidence is insufficient to impute or refute a causative
relationship for the SUBSTANCES in this death.
Appendix C – Abstracts of Selected Cases
Selection of Abstracts for Publication
The abstracts included in Appendix C were selected for
publication in a 3-stage process consisting of qualifying,
ranking and reading. Changes for the selection of the top
200 cases for the 2014 report: include all pregnant subjects,
include all children (0–2 y/o) subjects, increase (double)
the weight on the autopsy report, add a weighting for Age
of subject (1/age in years), add a weighting for infrequency
of substance category (Generic Code).
Qualifying cases were thus: Age 0–2 y/o, Pregnant, or
RCF ¼ 1-Undoubtedly
Responsible,
2-Probably
Responsible or 3-Contributory. Fatalities by Indirect
report were excluded beginning with the 2008 annual
report. The ranking was based on Final Case Weighting
(FCW).
FCW ¼ f [1/(num substances in this case), WCS, 1/Age
(years), 1/(num cases in that generic code this year)]
Where
Weighted Case Score (WCS) ¼ Hospital records *
8.8 + Postmortem * 15.2 + Blood levels * 6.9 + Quality/
Completeness * 6.4 + Novelty/Educational value * 13.2
WCS Scores were normalized (z-score) within
each AAPCC reviewer before the final weighting:
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25% for each (1/NumSubstances, WCS, 1/Age, 1/
NumCodes).
The WCS weighting factors were the averages of review
team recommendations gathered in 2006.
The top ranked abstracts (200 + ties) were each read by
individual reviewers who volunteered (See Appendix A)
and the 2 managers (DAS and DEB). Each reader judged
each abstract as ‘‘publish’’ or ‘‘omit’’ and all abstracts
receiving 8 or more of 12 publish votes were selected,
further edited, cross-reviewed by the 2 managers and JBM,
and published in this report.
Abstracts
Abstracts of the cases were selected (see Selection of
Abstracts for Publication, above) from the human fatalities
judged related to be an exposure as reported to US PCs in
2014. A structured format for abstracts was required in the
PC preparation of the abstracts and was used in the
abstracts presented. Abbreviations, units and normal ranges
omitted from the abstracts are given at the end of this
appendix.
Case 4. Acute methanol unknown: undoubtedly
responsible.
Scenario/Substances: 19 y/o female presented to the ED
with a one day history of vomiting and altered mental
status.
Physical Exam: Initially the patient had a normal
examination but became combative and required sedation.
BP 125/71, HR 91, RR 18, O2 sat 99% RA, T 35.5 C. On
re-evaluation she was unresponsive to verbal commands,
pupils 3 mm and sluggishly responsive.
Laboratory Data: The initial head CT was normal. ECG
showed sinus tachycardia, QRS 98 and QTc 451. Na 149, K
4.7, Cl 106, CO255, Glu 269, BUN 9, Cr 0.9. On venous
blood gas-pH 6.8/pCO2 26/pO2 105. COHb was 1.5, lactate
12.4 and serum osmolality 372. Acetaminophen and
salicylate were not detected. An ‘‘initial’’ methanol was
130 mg/dL, a second level was 65. Ethylene glycol, acetone
and isopropanol were not detected.
Clinical Course: Initially she was hyperventilating but
ambulating and talking the in the ED. She became agitated
and combative, and was uncooperative with interventions
requiring sedation with lorazepam haloperidol and diphenhydramine. Approximately 15 minutes after receiving these
medications she seized. She was then given more
lorazepam, fosphenytoin, and intubated. She was alkalinized and treated with empiric doses of pyridoxine and
fomepizole. She developed severe metabolic acidosis with
elevated lactate, and was hemodialyzed. Her initial
methanol concentration resulted after these interventions.
A repeat head CT revealed diffuse cerebral edema. Her
family opted for comfort measure. Several days later she
died and her organs were donated.
Autopsy Findings: Cause of death: complications of
methanol toxicity. Manner of death: suicide.
Case 20. Chronic methanol ingestion: undoubtedly
responsible.
Scenario/Substances: A 34 y/o female had one week of
progressive confusion and visual loss. Her family found an
empty container of windshield washer fluid. EMS was
called and transported her to the ED.
Past Medical History: Previous suicide attempts, ethanol
abuse.
Physical Exam: She was confused but intermittently
answered questions and moved all 4 extremities. Pupils
4–6 mm and reactive. BP 110/68,HR 110,RR 24,afebrile.
Laboratory Data: Na 145, K3.6, Cl 101, CO255, Glu
175, BUN 8, Cr 1.35, albumin 5, bilirubin 0.4, Ca 8.4, AST
39, ALT 44, troponin I50.01, CK 78,WBC 11.9, Hgb 15.4,
Hct 46.5, platelets 278, PTT 24.8, INR 1.01. Serum
acetaminophen, ethanol and salicylate were not detected.
Serum osmolality 381, serum methanol 182 mg/dL. ABG
(post-intubation)-pH 6.68/pCO2 26.5/pO2 331, lactate 6.3.
UA: SG41.030, no crystals; UDS was negative. Head CT
unremarkable, ECG: Sinus tachycardia at 107, QRS 90,
QTc 488.
Clinical Course: The patient was intubated in the ED for
progressive lethargy. There were several brief seizure-like
episodes that responded to lorazepam. She received IVFs
and sodium bicarbonate. In the ICU she was treated with
a sodium bicarbonate infusion, fomepizole, folic acid and
hemodialysis. Despite correction of her acidosis she
remained unresponsive off sedation. Repeat head CT
showed diffuse cerebral edema with loss of gray-white
differentiation. Based on the prognosis, the family
opted for institution of comfort measures and she died
on Day 3.
Autopsy Findings: Not performed.
Case 85. Acute envenomation (Crotalid) bite: undoubtedly responsible.
Scenario/Substances: A 4 y/o boy was bitten on his
forearm by a Canebrake rattlesnake while playing in his
yard. He vomited and became unresponsive. He was
intubated by EMS and given epinephrine, diphenhydramine, and methylprednisolone prior to transport.
Physical Exam: Intubated, edematous forearm; BP 99/57,
HR 107.
Laboratory Data: PT16.8, PTT 54, platelets 250, fibrinogen 268, CK 164,000.
Clinical Course: He received IVFs and a 6 vial loading
dose of antivenin (Crotalidae polyvalent immune Fab)in
the ED, and then transferred to a tertiary care pediatric
hospital. Additional antivenin was given for increased
edema and a maintenance dose was given once edema was
controlled. Antibiotics were given, and on Day 2 he went to
the OR for a forearm fasciotomy and received additional
antivenin. On Day 3 he remained intubated and unresponsive but hemodynamically stable. Repeat laboratory data
showed platelets 227, PT 17.9, PTT 27.9 and fibrinogen
344. On Day 4 he was still unresponsive and there was a
concern for brain injury. An MRI revealed cerebral edema.
He developed hepatic injury (AST 300, ALT 650) with
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hyperammonemia (156) and was treated with lactulose. He
died on Day 8.
Autopsy Findings: Not available.
Case 89. Acute envenomation (Crotalid) bite: undoubtedly responsible.
Scenario/Substances: A 74 y/o female was bitten in her
left hand by a snake reported to have been a Northern
Pacific rattlesnake.
Physical Exam: Initial assessment showed significant
edema in her left hand and arm; she was hypotensive.
Laboratory Data: Initial laboratory values: INR410,
PTT4200, platelets 90, Hgb 6.4, Hct 20.1, fibrinogen560
and D-Dimer410,000 mcg/L.
Clinical Course: In the ED she received 6 vials of
antivenin (Crotalidae polyvalent immune Fab) and then
transferred to a tertiary facility. She had a cardiac arrest
upon arrival to the second facility but was intubated and
resuscitated with IVFs and vasopressors. Blood was noted
in the trachea and around the endotracheal tube. She
remained hypotensive and had multiple cardiac arrests. She
received a total of 36 vials of antivenin, vitamin K, and was
transfused RBCs, cryoprecipitate and FFP. She remained
unconscious with fixed and dilated pupils, and died
approximately 28 hours after presentation.
Autopsy Findings: Not performed.
Case 95. Acute cyanide ingestion: undoubtedly
responsible.
Scenario/Substances: A23 y/o male ingested sodium
cyanide after fighting with his family. He rapidly
collapsed; his family started CPR and called EMS.
Clinical Course: CPR was in progress upon his arrival to
the ED. Cardiac monitor showed asystole. He was given 1
amp of sodium bicarbonate, epinephrine, and defibrillated
twice. Resuscitation measures were unsuccessful.
Autopsy Findings: Cyanide concentration in postmortem
blood was 166 mcg/mL.
Case 99. Acute ethylene glycol and ethanol ingestion:
undoubtedly responsible.
Scenario/Substances: A 33 y/o male was seen to collapse
by his father. EMS was called, he received naloxone and
glucose with no improvement, and was transported to the
ED.
Past Medical History: Manic depressive disorder.
Medications included fluoxetine, chlorophyll liquid extract,
colon cleanser, and several dietary supplements.
Physical Exam: Initial BP 170/100, HR in the 90’s,
afebrile, and intubated on the ventilator. His physical exam
was otherwise unremarkable.
Laboratory Data: ABG-pH 6.77/pCO253/pO2334/HCO3
8/Lactate 1.9, Na 148, Cl 107, K 5.4, CO2 7, BUN 17, Cr
1.5, Glu 222, Ca 10.5, EtOH 17 mg/dL, lipase 376, serum
acetaminophen and salicylate were not detected, ketones
negative, measured serum osmolality 643, head CT was
unremarkable.
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Clinical Course: In the ED, the patient was obtunded but
had return of spontaneous respirations immediately after
being intubated. He received a nicardipine infusion for
hypertension, treatment for presumptive toxic alcohol
ingestion (fomepizole, folate and pyridoxine), prophylactic
antibiotics and sodium bicarbonate and hemodialysis for
severe acidosis. Despite these interventions, neither his OG
nor AG metabolic acidosis improved. He became hypotensive, tachycardic, and developed refractory seizures. On
Day 3, he developed a ventricular arrhythmia and died
despite cardioversion.
Autopsy Findings: The ME reported an ethylene glycol of
1,394 mg/dL and the death was ruled a suicide by ethylene
glycol.
Case 102. Acute cyanide ingestion: undoubtedly
responsible.
Scenario/Substances: A 34 y/o female presented to the
ED, with a male companion, several hours after a motor
vehicle collision, reporting dizziness.
Physical Exam: Initial BP 120/76,HR 89,RR 20, O2sat
100%. She was alert and oriented x3. Examination was
unremarkable.
Laboratory Data: Na 127, K 5.3, Cl 94, HCO3 9, BUN 11,
Cr 0.9, Glu 833, AG 24 mg/dL, AST 93, ALT 34, serum
acetaminophen and salicylate were not detected, HCG
negative, VBG-pH 7.05/pCO2 27/pO2, lactate 14.7 initially. Repeat VBG-pH 7.09/pCO2 54/pO2 79, lactate 23, CK
214, troponin50.01, cyanide 6.7 mcg/mL (pre-mortem).
EKG Sinus rhythm 58, QRS 100, QTC 402, RBBB.
Clinical Course: In the ED she was given meclizine to
treat her dizziness and observed for 3.5 hours with normal
repeat neurologic examination. Prior to being discharged
both she and her companion were observed to have brief,
self-limited, tonic/clonic convulsions. She was found to
have a Glu of 17 immediately after the seizure and was
treated with IV dextrose with no improvement in status.
Shortly after, she became apneic and required intubation
after which she had a cardiac arrest with PEA. ACLS was
initiated with brief return of circulation, but she remained
hypotensive and bradycardic despite norepinephrine and
dobutamine infusion. She had another cardiac arrest with
PEA several minutes later from which she could not be
resuscitated. The patient was pronounced dead in the ED.
Autopsy Findings: The ME reported cause of death: acute
cyanide poisoning. Pre-mortem blood cyanide concentration was 6.7 mcg/mL.
Case 113. Acute cyanide ingestion: undoubtedly
responsible.
Scenario/Substances: A 52 y/o male threatened suicide
during a court proceeding. He went to the restroom and was
found unresponsive in PEA arrest.
Laboratory Data: His blood pH ranged from 6.9–7.25,
lactate 18.2 mmol/L. Serum acetaminophen and salicylate
were not detected.
Clinical Course: In the ED he remained unresponsive in
cardiac arrest. He was intubated, received ACLS
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interventions and hydroxocobalamin with ROSC. He
experienced 3 more episodes of asystole. In the ICU, he
received a second dose of hydroxocobalamin. Over the
next 2 days he continued to be acidotic and required
vasopressors for BP support. He died 48 h after exposure.
Autopsy Findings: Hospital blood cyanide: 6.4 mcg/mL.
Cause of death: cyanide poisoning, Manner of death:
suicide.
Case 123. Chronic cobalt exposure: undoubtedly
responsible.
Scenario/Substances: A 65 y/o female was found to
have an elevated cobalt level after surgical revision of
her prosthetic hip with a chromium-cobalt containing
device.
Past Medical History: Right hip replacement with
revision 9 years later, recent diagnosis of pulmonary
emboli, new onset cardiomyopathy with LVEF 35–40%,
anosmia, hearing loss, dysgeusia.
Physical Exam: Alert and oriented, decreased hearing.
Laboratory Data: Serum cobalt level was 817 mcg/L
[normal51.8 mcg/L]; repeat serum cobalt (4 days later)
was 642. 24-hour urine cobalt was 4831 mcg/L [52 mcg/L].
Na 135, K 3.8, CO2 17, BUN 31, Cr 0.78, Glu 244, TSH
1.46, WBC 14.6, Hgb 11.6, AST 32, ABG-pH 7.36/pCO2
13/pO2 107/HCO3 7. Echocardiogram showed normal left
ventricle size with severe global hypokinesis and a LVEF
of 10–20%.
Clinical Course: The patient was started on n-acetylcysteine and chelated with succimer for cobalt toxicity. Her
revised hip could not be removed due to her worsening
cardiomyopathy. She became progressively hypotensive
and weak. She was intubated and required vasopressors for
cardiogenic shock. Hemodialysis was started for acidosis.
She had a PEA arrest and did not respond to resuscitation
efforts.
Autopsy Findings: Not available.
Case 130. Acute hydrofluoric acid ingestion and dermal:
probably responsible.
Scenario/Substances: A female of unknown age, covered
in white powder, was attacking shoppers in a flea market
with a screwdriver. EMS brought her to the ED.
Physical Exam: HR 120, BP 116/53, O2 sat of 100%. She
had a red irritated rash on her face with blisters over the left
cheek.
Laboratory Data: Na 139, K 3.8, Cl 102, CO2 16, BUN
11, Cr 0.9, Glu 208, Calcium 5.2, lactate 6.9, Mg 0.8, Phos
3.4, troponin 0.07, Hgb 13.8, WBC 22.9, platelets 403.
Serum acetaminophen and salicylate were not detected.
UDS was positive for amphetamines and opiates.
Clinical Course: She was decontaminated outside the ED
but then had a cardiac arrest (described as Torsades de
pointes) immediately on arrival in the ED. She was
intubated and defibrillated.. The fire department’s
HazMat team identified the powder as ammonium
bifluoride. She was treated with calcium, but died after
recurrent cardiac arrests shortly after arrival.
Autopsy Findings: Not available.
Case 133. Acute drain cleaner (alkali) ingestion:
undoubtedly responsible.
Scenario/Substances: A25 y/o male was found unresponsive, with a suicide note, in a bathroom at home. EMS
noted hematemesis, chemical burns to his lips and face and
a half empty bottle of alkali drain cleaner. He was
transported to the hospital, requiring copious suction en
route.
Past Medical History: Prior suicide attempts.
Physical Exam: BP 170/109, HR 81, RR 24,O2 sat 100%
(intubated). Oropharyngeal burns were present with active
emesis.
Laboratory Data: Na 142, K 4.0, Cl 104, CO2 24, BUN
15, Cr 1.13, Glu 144, AST 44, ALT 23, Alk phos 86, Ca
9.8, lipase 85, ABG-pH 7.44/pCO2 29/pO2178/
HCO320.2.WBC 10.4, Hgb 16.7, Hct 49.7, platelets 131,
INR 1.1. Acetone, ethanol, isopropanol, methanol, barbiturates, benzodiazepine, cocaine, opiates, acetaminophen,
ethylene glycol, salicylates were not detected.
Clinical Course: In the ED he was intubated with
placement of a nasogastric tube. Head CT showed small
intra-parenchymal hemorrhage. On Day 2 he developed
chest pain and signs of pericarditis. Troponin I peaked at
30.0 and he later developed pleural effusions. He was
subsequently extubated and started on small volume oral
fluids. An esophagram on Day 14 confirmed scarring in the
hypopharynx preventing epiglottis closure and narrowing
of the lower esophagus. A feeding tube was placed on Day
15. On Day 22 bronchoscopy and esophagoscopy found a
large tracheo-esophageal fistula. Attempts to place a stent
were unsuccessful and the patient decompensated. Based
on the prognosis, the family opted for institution of comfort
measures and he died on Day 29.
Autopsy Findings: Cause of death: drain cleaner ingestion.
Manner of death: suicide.
Case 147. Acute laundry detergent (pod) ingestion and
aspiration: probably responsible.
Scenario/Substances: A 100 y/o female bit into a laundry
detergent pod and started to cough.
Past Medical History: Dementia
Clinical Course: In the ED she had significant wheezing
and an O2 sat 59% on room air. She was admitted to the
ICU with aspiration pneumonia and started on BiPAP and
dopamine for hypotension. She abruptly became asystolic
but was not resuscitated due to pre-existing DNR orders.
She died about 18 h after exposure.
Autopsy Findings: Not performed.
Case 148. Acute hypochlorite dermal: undoubtedly
responsible.
Scenario/Substances: A 17 m/o female removed bleach
from under a sink and poured it on herself. Her mother
found her crying in a puddle of bleach, and reported that
the child’s skin peeled off when she was cleaning her off
with a wet towel.
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Physical Exam: Diffuse 2nd degree burns to perineum and
legs with minimal lower leg involvement. Extensive burns
to the lower back and buttocks. No splash markings noted,
no irregularities consistent with clothing were noted.
Clinical Course: The child developed Pseudomonal sepsis
and died on Day 3.
Autopsy findings: Extensive excoriations on 430% of the
abdomen, back, pelvis and lower extremities.
Microscopically the tissue showed thermal burns with
complete necrosis of the epidermis. Cause of death was
Pseudomonas aeruginosa sepsis. The ME determined the
manner of death to be accidental due to dermal bleach
burns.
Case 154. Acute hydrogen peroxide ingestion: undoubtedly responsible.
Scenario/Substances: 75 y/o male reportedly ingested 6
ounces of 35% hydrogen peroxide that he had been using
(at 6 drops per 6 ounces of water) for a toothache. He
became confused and started vomiting.
Physical Exam: In the ED he was intubated for respiratory
distress and then transferred to a tertiary care facility. At
that facility his vital signs were: BP 106/65, HR 58, RR 31,
T 36.2 C. On examination he was sedated and ventilated;
NG tube had bloody secretions. Abdomen was benign
without distention.
Laboratory Data: VBG-pH 7.23/pCO2 61/pO2 54/HCO3
25/BE 4.6. COHb 4%, MetHgb 1.1%. WBC 19.8, Hgb
19.5, Hct 60.4, platelets 194, Na 139, K 5, Cl 108, CO2 22,
BUN 16, Cr 1, Glu 170, AST 57, ALT 19, troponin I 1.73,
PT 13.1, PTT 21.3. CxR showed bilateral lower lobe
infiltrates; ECG showed sinus bradycardia.
Clinical Course: Prior to transfer the patient was noted to
be in shock with respiratory failure and acute GI bleed.
Eight h after arrival he developed severe acidosis, ARDS
and worsening shock that required increased vasopressors.
Endoscopy showed diffuse severe esophagitis, gastritis, and
moderate duodenitis. Despite aggressive supportive management he died within 24 h of the exposure.
Autopsy Findings: Not performed.
Case 156. Acute peroxides ingestion: undoubtedly
responsible.
Scenario/Substances: An 81 y/o male accidentally drank 8
ounces of 35% hydrogen peroxide which he normally used
in small amounts as a homeopathic treatment for diabetes.
Shortly after he started vomiting and had altered mentation.
Past Medical History: Coronary artery disease, diabetes
mellitus, hypertension, deep vein thrombosis in his right
leg.
Physical Exam: BP 191/83, HR 83, RR 18, O2 sat 99%, T
36.5 C. He was diaphoretic, confused and ill-appearing,
but intermittently followed commands. He had paralysis of
the right arm and both legs. Cardiovascular and pulmonary
examinations were normal, abdomen had mild diffuse
tenderness.
Laboratory Data: Na 138, K 3.6, Cl 105, CO2 21, Glu
256, BUN 16, Cr 1.29, WBC 9.3, Hgb 16.3, Hct 48.2,
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platelets 139, AST 30, ALT 26. ABG-pH 7.39/pC02 34/p02
59/HCO3 20.4/BE 4.0. Troponin I 0.04, PT 11.3, PTT
23.4, CK 169. UDS was negative, salicylates were not
detected.
Clinical Course: Upon ED arrival he had multiple
episodes of hematemesis. CT of his abdomen revealed
portal venous gas and pneumatosis of the distal esophagus
and stomach. An MRI of the brain demonstrated acute
infarction of the right frontal, left frontal and left parietal
lobes. He was intubated for loss of airway reflexes and
transferred to a tertiary facility for HBO. Upon arrival at
that facility he was too unstable for HBO. He was started
on antibiotics for aspiration pneumonitis. Based on the
prognosis, the family opted for institution of comfort
measures on Day 2 and he died on Day 3.
Autopsy Findings: Not performed.
Case 180. Acute helium inhalation: undoubtedly
responsible.
Scenario/Substances: A 19 y/o man intentionally inhaled
large quantities of helium gas to harm himself. His
roommate found him ‘‘hooked up’’ to a helium tank. The
patient had a cardiac arrest during EMS transport. He was
intubated and had CPR performed with ROSC.
Laboratory Data: Serum acetaminophen and salicylate
were not detected.
Clinical Course: In the ED his hypotension was treated
with IVFs and vasopressors, and he was admitted to the
ICU where a hypothermia protocol was initiated. His pupils
were fixed and dilated. He became hypertensive and
vasopressors were discontinued. On Day 2 he remained
unresponsive with fixed and dilated pupils. He became
hypotensive again and vasopressin was reinstituted. HR
88,BP 102/67 on vasopressin. On Day 4 the patient had
another cardiac arrest and died.
Autopsy Findings: Cause of death was anoxic encephalopathy due to inhalation of helium. Microscopic examination of the brain revealed multiple hypereosinophilic and
shrunken degenerative neurons and cortical rarefaction in
the hippocampus. Toxicology report was negative for any
drugs of abuse.
Case 206. Acute hydrogen sulfide inhalation: probably
responsible.
Scenario/Substances: 47 y/o male was working above a
tank of hydrogen sulfide in an oil field. He had a syncopal
event and fell into the tank. EMS removed him from the
tank about 20 min later. He was in cardiac arrest and CPR
was started.
Physical Exam: Unresponsive, intubated with transient
myoclonic activity in his extremities. Pupils were constricted and non-reactive; no gag or corneal reflexes. BP
167/111, HR 96, RR 29 (ventilated), O2 sat 97%.
Laboratory Data: Na 139, K 5.9, Cl 105, CO2 20, Ca 7.9,
BUN 12, Cr 1.1 AST 118, ALT 102, BNP 1,034, PT11.2,
WBC 16, Hgb 15.6, Hct 47, COHb 3.0, Methemoglobin 0.3.
Clinical Course: He was intubated in the ED, started on a
lidocaine infusion and transferred to a tertiary care center.
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A hypothermia protocol was started and he received 2
doses of sodium nitrite. A head CT revealed diffuse
hypoxic ischemic changes with loss of gray/white differentiation, deep gray nuclei infarctions and cerebral edema.
He was started on desmopressin for oliguria, and
norepinephrine and vasopressin for hypotension (87/48).
On Day 3 an EEG showed no cerebral electrical activity
and a brain flow study showed no blood flow. He died on
Day 3.
Autopsy Findings: Not available.
Case 216. Acute chlorine gas inhalation: probably
responsible.
Scenario/Substances: A 58 y/o male was pouring 55
gallons of liquid chlorine into heated water and was
exposed to the vapors. He presented to the ED 24 hours
later, ‘‘felt lousy’’ but had no respiratory problems and a
normal CxR so he was released. Four days later he returned
to the ED with weakness and shortness of breath.
Physical Exam: He was awake and alert, oxygen
saturation on room air was 66%. His vital signs on
BiPAP with 100% O2 were: HR 118, BP 129/80, RR 18,
O2 sat 92%.
Laboratory Data: His CxR showed bilateral multilobar
pneumonia. K 6.4, CO2 34, BUN 27, Cr 1.2, Glu 350, CK
704. On Day 11: T 40.5 C. K 4.2, BUN 52, Cr 2.3, CO2 32,
WBC 16.6, platelets 80.
Clinical Course: The patient was treated with oxygen and
albuterol nebulizers. He was initially afebrile but had
‘‘Staph’’ in a sputum culture. He continued to require
oxygen, pulse oximetry dropping into the 80 s when his
face mask was removed for eating. On Day 9 he was
intubated for continued respiratory distress and developed
AF (HR 114). He was treated with amiodarone and had a
normal bronchoscopy. Breath sounds were diminished and
coarse on the left. His clinical condition worsened. He
became unresponsive off sedation, had continued respiratory distress, intermittent AF and a bowel ileus. Day 12
arterial pH 7.12, BUN 86, Cr 4.5, WBC 29.8. He died on
Day 12.
Autopsy Findings: Not performed.
Case 248. Acute lamp oil ingestion: undoubtedly
responsible.
Scenario/Substances: A 5 y/o male was found next to an
empty bottle of lamp oil with his ‘‘eyes rolled back in his
head’’. The product’s MSDS listed contents as 100% C10–
C13 isoalkanes.
Past Medical History: Developmentally delayed.
Physical Exam: The child presented to the ED, 30 min
later, in respiratory distress. He was transferred to a tertiary
care facility’s PICU. His vital signs there: BP 83/40, HR
145 and T 36 C.
Laboratory Data: His initial CxR revealed pulmonary
edema.
Clinical Course: He was started on a norepinephrine drip
and subsequently intubated and placed on an oscillating
ventilator for progressive desaturation. His condition
worsened and on Day 2 he was placed on ECMO and
corticosteroids. A repeat CXR showed complete whiteout
of his lungs. Pulse oximetry was 89%; and ABG-pH 7.3/
pCO2 38/pO2 371/HCO3 18. He developed leukopenia and
hypokalemia. Two days later he had a CVA with
herniation. He was taken off ECMO and died approximately 53 h after the exposure.
Autopsy Findings: Not available.
Case 249. Acute-on-chronic freon inhalation and
chlorpheniramine/dextromethorphan ingestion: probably
responsible.
Scenario/Substances: A 20 y/o male was found down at
home, bystander CPR was initiated. There were many cans
of air duster and boxes of over-the-counter cough and cold
medications nearby.
Past Medical History: Depression, substance abuse (daily
inhalant and dextromethorphan abuse), attention deficit
disorder.
Physical Exam: The patient was in PEA upon ED arrival;
there was no evidence of traumatic injury or asphyxiation.
Laboratory Data: Post-resuscitation: ABG-pH of 7.31/
pCO2 36.3/pO2 139/HCO3 18 on FiO2 70%. AST 475,
ALT 189.
Clinical Course: After initial ROSC he required treatment
for VF. In the ICU a head CT showed diffuse axonal injury
consistent with hypoxia. Based on the prognosis, the family
opted for institution of comfort measures and he died 24
hours after arrival. His organs were donated.
Autopsy Findings: Analysis of antemortem of whole
blood: positive for caffeine; negative for ethanol, difluoroethane, dextromethorphan, chlorpheniramine, guaifenesin,
and acetaminophen. Vitreous electrolytes: Na 180, K 8.8,
Cl 171, Ca 1.7, Mg 0.72, Glu 62, lactate 12, BUN 20, Cr
0.80. Postmortem urine was positive for dextromethorphan
and chlorpheniramine. A tissue sample was found to
contain no difluoroethane. The cause of death: anoxic brain
injury secondary to myocardial infarction due to complications of difluoroethane inhalation.
Case 263. Acute water ingestion: probably responsible.
Scenario/Substances: A 46 m/o female was at a family
gathering where she drank between 80 and 128 ounces of
either a dilute kool aid or lemonade type of beverage,
within 2 hours, from other family members’ cups. She had
3 episodes of projectile vomiting and then became
unresponsive. She was driven by private vehicle to the ED.
Past Medical History: Failure to thrive, slow verbal
development and abnormal eating behaviors (eat and drink
to the point of vomiting).
Laboratory Data: Serum Na 124, K 2.7, Cl 94, CO2 18,
BUN 14, Cr 0.4, Glu 121, cortisol 40.4 mcg/dL, osmolality
252, WBC 8.4, Ca 8.5, CK 658, ammonia 30, AST 64,
ALT 37, Alk phos 99, urine K 9.6. Serum acetaminophen,
ethanol and salicylate were not detected, UDS was
negative.
Clinical Course: She was obtunded and bradycardic with
agonal respirations (RR 6) upon ED arrival. Her initial Na
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was 122 and she received NS IVFs, was intubated and
transferred to a tertiary care center’s PICU. A repeat Na
was 127 prior to transport. About 6 h later her pupils were
fixed and dilated. She had no corneal, cough, gag pain
responses; HR 100, RR 15. She was started on 3% saline at
3 ml/kg. Head CT showed ‘‘reversal sign and obliteration
of cisterns.’’ An MRI showed ‘‘diffuse injury involving the
cortical ribbon and deep gray likely due to underlying
hypoxic ischemic insult.’’ Cerebral edema and increased
intracranial pressure with mild transtentorial and tonsillar
herniation were noted. She became hypotensive, developed
diabetes insipidus for which she received vasopressin and
IVFs but a normal body temperature was unable to be
maintained. At PICU hour 18 her neurologic exam showed
an absence of all detectable brain stem activity, diffuse
hypotonia and areflexia. EEG showed ‘‘little detectable
activity.’’ A comprehensive urine drug screen done by thin
layer chromatography showed ‘‘a small amount’’ of
substances consistent with diphenhydramine and on an
immunoassay there was evidence of a benzodiazepine. At
PICU hour 46 an apnea test was performed and she was
pronounced brain dead.
Autopsy Findings: The pathologic diagnoses were: 1)
acute water intoxication with hyponatremia, altered mental
status and respiratory failure, 2) failure to thrive with
height and weight less than 3rdpercentile for age. Cause of
death was hyponatremia due to water intoxication. The
manner of death was listed as homicide.
Case 265. Acute Amanita phalloides ingestion: probably
responsible.
Scenario/Substances: A 31 y/o male living at residential
mental health facility was found in the yard holding about
one-half of a mushroom cap. The cap was described as
being about 5 inches in diameter with white cap and white
gills. The patient was referred to the ED for activated
charcoal and mushroom identification.
Past Medical History: Schizophrenia.
Physical Exam: The patient presented with no symptoms;
BP 129/60, HR 93, RR 16, T 36 C, O2 sat 97% on room
air.
Laboratory Data: The patient refused all labs on initial
presentation. On return to the ED 2 days later: Na 138, K
6.1, Cl 111, CO2 10, BUN 63, Cr 2.96, PT 15.5, ALT 333,
AST 306, lactate 5.6.
Clinical Course: During his first ED visit he denied
ingesting the mushroom and refused activated charcoal
and lab draws. He was medically cleared and the mushroom
was discarded. The patient returned to the ED on Day 2 with
vomiting and diarrhea. He was hypotensive (BP 60/30) and
in acute renal failure. He was intubated, given IVFs,
bicarbonate and norepinephrine. He also received nacetylcysteine and octreotide. His hypotension persisted
despite maximum doses of norepinephrine and phenylephrine. Liver enzymes continued to rise, peaking at ALT 3,519,
AST 2,631, PT 55.8, Cr 3.24. The patient died on Day
5.While identification of the original mushroom was
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impossible, a mycologist identified similar-looking mushrooms, from the same area, as Amanita phalloides.
Autopsy Findings: Not available.
Case 266. Acute mushroom (cyclopeptides) ingestion:
probably responsible.
Scenario/Substances: A 60 y/o male ate wild mushrooms
that were picked by his sister. They were described as
white, with white gills, growing under pine trees. After a
delay of several hours he developed nausea, vomiting and
diarrhea. He came to the ED 4 days after ingestion.
Physical Exam: In the ED BP 80/47, HR 111, RR 24, T
37.6 C, O2 sat 100%. He was awake and oriented but
complained of fatigue and shortness of breath. His
abdomen was tender and distended.
Laboratory Data: Na 133, K 3.7, Cl 9 2, CO2 10, BUN 53,
Cr 5.9, Glu 93, AST 2,209, ALT 2,784, bilirubin 2.4,
Lipase 2,746, INR 4.8, Hgb 13.9, Hct 41%, WBC 19.0.
Clinical Course: He was admitted and treated aggressively
with IVF, FFP, and n-acetylcysteine. His transaminitis
worsened (AST 4,700, ALT43,500) and he developed
hypotension and diffuse bleeding. He died on Day 2.
Autopsy Findings: Not available.
Case 268. Acute mushroom (gastrointestinal), Coprinus
comatus, Coprinus atrametarius ingestion: undoubtedly
responsible.
Scenario/Substances: An 88 y/o female presented to the
ED after an intentional ingestion of several mushrooms
found growing in her yard. Within 30 minutes of ingestion
she developed sweating, vomiting, diarrhea, abdominal
pain, and respiratory distress. The mushroom was
described as having a ‘‘white cap with an umbrella.’’
Past Medical History: Coronary artery disease.
Clinical Course: Within 7 h she had progressive encephalopathy and respiratory distress with pulmonary edema
requiring ETT. Her husband provided pictures of the
mushrooms, identified by a mycologist as Clitocybe
species, Coprinus comatus and Coprinus atrametarius.
She subsequently died.
Autopsy Findings: Death due to wild mushroom poisoning, (muscarinic, likely Clitocybe). Ingested mushroom in
stomach on autopsy morphologically consistent with same
species. No definitive competing cause of death was
identified. A forensic pathologist felt patient’s presentation
was consistent with muscarinic toxicity, likely from having
ingested a muscarinic Clitocybe mushroom.
Case 276. Acute dinitrophenol ingestion: undoubtedly
responsible.
Scenario/Substances: A 19 y/o male admitted to ingesting
3 g of dinitrophenol 4 h earlier.
Physical Exam: He was initially agitated but following
commands; GCS 12, BP 142/62, RR 30–40, O2 sat 97%, T
39.3 C. ECG showed QRS 98, elevated R wave in avR.
Laboratory Data: Venous BG-pH 7.38/pCO2 52/HCO3
31. Lactate 3.0, K 5.2, salicylate 22.4 [considered a false
positive due to chromophore qualities of DNP].
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Clinical Course: He was treated with oxygen and cooled
with IVFs, wet sheets and ice packs. Despite these
interventions his temperature was rising within 15 min.
He was intubated and hyperventilated, and given activated
charcoal. His heart rate fell to the 90 s and his QRS
widened. He developed muscle rigidity and became
pulseless and then asystolic. He was unsuccessfully
coded for 45 minutes and died within 6 h of presentation.
Autopsy findings: Not available.
Case 279. Acute sulfuryl fluoride inhalation: probably
responsible.
Scenario/Substances: A 30 y/o female was extricated by
EMS from a residence that was fumigated with sulfuryl
fluoride. The patient may have been in the home for up to
9 h. EMS found her anxious and complaining of shortness
of breath with mottled skin and tachypnea that did not
improve with supplemental oxygen.
Past Medical History: Substance abuse.
Physical Exam: In the ED she was apneic, pulseless,
mottled and cyanotic. Pupils were fixed and dilated; IV
track marks were noted.
Laboratory Data: Glu 217. Prehospital ECG showed sinus
tachycardia. A post intubation CxR showed diffuse
perihilar interstitial markings.
Clinical Course: She was intubated and resuscitated
without ROSC.
Autopsy Findings: Not available.
Case 280. Acute rodenticide (anticoagulant) ingestion:
undoubtedly responsible.
Scenario/Substances: A 45 y/o female presented to a
hospital with complaints of ‘‘not feeling well.’’
Past Medical History: Depression, chronic back pain,
alcohol and prescription opiate abuse.
Physical Exam: Large ecchymotic areas on her
extremities.
Laboratory Data: Initial INR411, normal liver function
tests. Factor 7 undetectable. Blood sent to a reference
laboratory was positive for ‘‘rat poison.’’
Clinical Course: The patient received 4 units of FFP and
vitamin K 50 mg daily. The INR decreased but fluctuated
and required changes in vitamin K dosages. On Day 26 she
was transferred to a rehabilitation facility with an INR of
10 and a vitamin K dose of 10 mg twice daily. On Day 50
she was discharged home with an INR of 1.33 and a
vitamin K dose of 10 mg three times daily. She was
readmitted to a different hospital, 4 days later, with
bleeding and an INR of 29. She was treated again with FFP
and vitamin K. Her INR at discharge was 1.59. At followup 7 days later her INR was 9.5. She was readmitted and
treated. Concerns for self-harm via repeated/continued
exposure were addressed. She had several repeated
inpatient admissions for coagulopathy, anemia (transfused
blood for hemoglobin of 7.4 and INR47), subdural
hemorrhage and abdominal hematoma. On her final
admission she was intubated for vomiting and suspected
pulmonary hemorrhage, developed multiple organ failure
and died 2 days later.
Autopsy Findings: Not available.
Case 281. Acute-on-chronic, brodifacoum ingestion:
probably responsible.
Scenario/Substances: A 48 year-old female presented
after ingesting an unknown quantity of long-acting anticoagulant rat poison.
Past Medical History: Multiple prior suicide attempts.
Physical Exam: She was intubated with ecchymotic areas
all over her body. Initial vital signs on dopamine: BP 121/
68, HR 123, RR 14, O2 sat 100%, T 35.6 C.
Laboratory Data: Her initial INR was too high to
quantify, Hgb 10.2 and Hct 32. After vitamin K and FFP
repeat testing showed the following: INR 3.3, PT 36.7, PTT
55. Serum Na 156, K 2.9, Cl 134, CO2 15, BUN 6, Cr 0.57,
Glu 266, lactic acid 0.7, Mg 1.9 and Phos51.
Clinical Course: She was found to have a right parietal
intracranial hemorrhage. She was intubated, received
vitamin K (5 mg) and 4 units of FFP before being
transferred. At the second facility she was given more
vitamin K and FFP as well as prothrombin complex
(15 mg/kg). Her nadir INR was 1.3 but increased to 2.1.
She developed anuric acute kidney injury, hypernatremia
(Na 165) and hyperchloremia (Cl 146). Her Hgb and Hct
decreased (8.6 and 25.7) and she required dopamine and
then phenylephrine for hypotension. She developed a large
intracranial hemorrhage with midline shift and died on
Day 2.
Autopsy Findings: Not available.
Case 282. Acute glyphosate and cocaine ingestion:
undoubtedly responsible.
Scenario/Substances: A 50 y/o male inadvertently drank
an unknown herbicide stored in a refrigerated sports bottle.
The liquid was subsequently determined to be 41%
glyphosate. He developed diarrhea, increased secretions,
dizziness, and a headache shortly after ingestion. EMS
arrived and noted bradycardia and bigeminy.
Laboratory Data: Na 134, K 3.4, Cl 101, CO2 23, BUN
11, Cr 0.9, Glu 104, AG 10, INR 1.02, CK 239. Laboratory
tests that resulted after his death: benzoylecgonine4299
ng/mL, RBC cholinesterase 13,211 [ref range 9,572 –
15,031], plasma cholinesterase 4,274 [ref range 3,334 –
7,031].
Clinical Course: In the ED he received atropine,
pralidoxime and ondansetron, but continued to have
diarrhea. Later that day he became confused and agitated.
On Day 2 his confusion and diarrhea resolved but on Day 3
his Cr increased to 5.7, AST450, ALT 904.A bicarbonate
drip was started. Later that day he developed delirium,
cogwheel rigidity, tremors and increased tone on the right
side; mental status remained intact. Serum Cr 6.1, Na 129,
CO2 15, AG 19. He was intubated and sedated, and
hemodialysis was initiated. On Day 4 he became
hypotensive and required multiple vasopressors. He
became anuric and was switched to CRRT; antibiotics
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were started for oral and esophageal burns. On Day 5 he
was taken off sedation, but remained unresponsive and died
on Day 6.
Autopsy Findings: The cause of death was complications
of glyphosate ingestion notable for facial, oropharyngeal,
respiratory, and esophageal corrosive effects and multiorgan failure. The manner of death was accident.
Case 283. Acute sodium fluoroacetate ingestion:
probably responsible.
Scenario/Substances: A 55 y/o male was found unresponsive shortly after fighting with his family. When EMS
arrived he was intubated. Initially he was tachycardic but
then became bradycardic and went into PEA. He had
ROSC with ACLS interventions.
Physical Exam: Intubated, unresponsive. Miotic pupils,
diaphoresis, wet mucous membranes with white powder
around nose and mouth. A Mexican rodenticide (active
ingredient - sodium fluoroacetate) was found in his pocket.
BP 104/61, HR 100, RR 22, T 35 C. Clear lung sounds;
abdomen benign.
Laboratory Data: Na 145, K 3.5, Cl 105, CO2 18, BUN
19, Cr 1.3, Glu 318, AST 168, ALT 161, ammonia 71. CxR
was normal. On ABG-pH 6.8 (prior to intubation) and 7.07
after. Acetaminophen, ethanol and salicylate were not
detected. UDS was negative.
Clinical Course: He developed rapid AF that spontaneously resolved and had excessive secretions and
diaphoresis that responded to atropine. Two bloody
bowel movements were noted and he received antibiotics
for a fever and suspected aspiration pneumonia. He
remained unresponsive with fixed, pinpoint pupils. On
Day 3 a brain MRI revealed a massive bilateral CVA (not
reported if ischemic or hemorrhagic) and an EEG showed
seizure activity. His K decreased to 2.6 and Phos 2.0. Based
on the prognosis, the family opted for institution of comfort
measures on Day 5 and was transferred to hospice where he
subsequently died.
Autopsy Findings: Not Available.
Case 284. Acute organophosphate (chlorpyrifos) ingestion: undoubtedly responsible.
Scenario/Substances: A 57 y/o male presented to a
hospital with abdominal pain, diarrhea and green-colored
emesis. The patient stated that he had ingested a weed
killer that he obtained from a farmer.
Past Medical History: Hypertension, diabetes mellitus.
Physical Exam: Slightly altered mentation in moderate
distress and vomiting. BP 124/67, HR 66, O2 sat 100% on a
non-rebreather mask.
Laboratory Data: Na 131, K 3.1, Cl 100, CO2 16, BUN 8,
Cr 1.0, AST 49. UDS was negative.
Clinical Course: On Day 2 the patient was awake with
throat and abdominal pain. His vomiting and diarrhea had
stopped, he had minimal urine output. Repeat labs showed
a BUN 24, Cr 2.6, AST 169. His respiratory status
declined and he became progressively more hypoxic. He
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1133
was made DNR, developed bradycardia and died,
following cardiac arrest 40 hours after arrival to the ED.
Autopsy Findings: Not performed. The Department
of Pesticide Regulation tested the involved product
and found chlorpyrifos (52%) and an unknown
hydrocarbon.
Case 285. Acute phosphine inhalation/nasal: probably
responsible.
Scenario/Substances: A 58-year-old female was vacuuming up aluminum phosphide pellets that a relative had
spread through her home. The vacuum bag ruptured and
spread the contents into the air. The patient developed
malaise, shortness of breath and emesis several h later.
Past Medical History: Hypertension, tobacco use.
Physical Exam: BP 121/89, HR 139, RR 24. Lungs were
clear to auscultation.
Laboratory Data: Na 135, K 2.9, BUN 20, Cr 1.1, Glu
334, WBC 12.8, Hgb 13.3 and Hct 38.5. On ABG-pH 7.38/
pCO2 15/pO2 165 on room air. Troponin-I 0.07; EKG
showed AF at 139, 1-mm ST elevations in aVL and diffuse,
nonspecific ST-T changes. CxR was normal.
Clinical Course: Approximately 3 h after arrival she went
into VF and then cardiac arrest. She was intubated and
received ACLS interventions including CPR and defibrillation. Despite aggressive care she died approximately 5
hours after arrival.
Autopsy Findings: Not performed.
Case 287. Unknown, glyphosate ingestion: undoubtedly
responsible.
Scenario/Substances: A 59 y/o female intentionally drank
5 ounces of a presumed glyphosate herbicide from a
beverage bottle. The patient was disoriented, combative
and vomiting. She was decontaminated and intubated by
EMS prior to ED arrival.
Physical Exam: Unresponsive, intubated and cold to
touch, bilateral rhonchi. BP 142/66, HR 74, RR 20
(ventilated), O2 sat 100%.
Laboratory Data: Initial labs included a Na 142, K 4.1, Cl
112, CO2 18, BUN 13, Cr 0.8, Glu 170, AG 12, Ca 8.5,
AST 58. Serum acetaminophen and salicylate were not
detected. ABG-pH 7.42/pCO2 22/HCO3 14. The ECG
showed sinus rhythm with first degree AV block and QRS
of 110. On Day 2 her AST was 148.
Clinical Course: She was given activated charcoal via NG
tube, IVFs and pantoprazole. The patient had spontaneous
movements off sedation. She had no seizures or signs of
cholinergic symptoms. She developed a fever (T 38.9 C)
and hypotension, and only withdrew to pain. She was
treated with dextrose, antibiotics, vasopressors and tube
feeds. Brain MRI (Day 5) showed diffuse anoxic injury.
On Day 11 family decided to withdraw life support and
she died.
Autopsy Findings: The cause of death was acute
respiratory failure with toxic metabolic encephalopathy,
CVA and sepsis as contributory.
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Case 288. Acute carbofuran ingestion: contributory.
Scenario/Substances: A 60 y/o female presented after
ingestion carbofuran in a suicide attempt. She quickly
became dyspneic with defecation, urination, lacrimation,
spitting, drooling, and lip smacking.
Past Medical History: Graves’ Disease, cervical fusion
with chronic pain, cocaine and opiate abuse.
Physical Exam: BP 188/106, HR 92. She was diaphoretic
and dyspneic with ‘‘wet’’ lungs.
Laboratory Data: Cholinesterase 1,507 [normal 2,673–
6,592]
Clinical Course: The patient was intubated and treated
with atropine and pralidoxime. After 2 days in the ICU she
was extubated and doing well and then transferred to an
inpatient psychiatric unit on Day 3.On Day 6 she developed
dyspnea, wheezing and anxiety. She was given propranolol
and trazodone. Her O2 sats were 96 to 100%.
Approximately3 hours later she was found in cardiac
arrest and was resuscitated with ROSC. She was intubated
but never regained consciousness. A brain blood flow study
on Day 8 was consistent with brain death and she was
pronounced dead.
Autopsy Findings: Not available.
Case 289. Acute paraquat ingestion: undoubtedly
responsible.
Scenario/Substances: A 65 y/o male accidentally ingested
a small amount of concentrated paraquat that had been
stored in a refrigerated soda bottle. He was seen and
released from an ED on the day of exposure but returned 3
days later with dyspnea and painful blisters in his mouth.
Physical Exam: In the ED he had oral blisters;
neurological examination was unremarkable. BP 110/54,
HR 90 and afebrile.
Laboratory Data: Na 135, K 4, Cl 103, CO2 25, BUN 49,
Cr 3.4, Glu 99, pH 7.36,AST 55,ALT 30,Alk phos 94,WBC
17.0,Hgb13.2,INR 1.1.
Clinical Course: CxR was consistent with chemical
pneumonitis. He was placed on a nonrebreather mask for
hypoxia (O2 sat 87%) and started on antibiotics. He was
admitted to ICU and started on cyclophosphamide and
methylprednisolone. Patient and family did not wish the
patient to be intubated so he was placed on BiPAP.
Dexamethasone was added on Day 2. The patient remained
alert; BiPAP was continued with 80% oxygen. Serum Cr
increased to 4.0. On Day 4, BiPAP requirements had
increased to 100% oxygen without improvement. Based on
the prognosis, the family opted for institution of comfort
measures and he died on Day 4.
Autopsy Findings: Not performed.
Case 294. Acute rodenticide (aldicarb) ingestion:
undoubtedly responsible.
Scenario/Substances: An 85 y/o male ingested Tres
Pasitos in a suicide attempt and was brought to the ED.
Physical Exam: BP170/80, O2 sat 98%, vomiting.
Clinical Course: In the ED gastric lavage was performed,
atropine and activated charcoal were given. He responded
to initial treatment, was alert and stopped vomiting. At
Hour 8 he became hypotensive (75/39) and tachycardic
(123), with no cholinergic signs. At Hour 24 he was
transferred to ICU, O2 sat 96%, troponin 0.04, EKG
showed AF with RBBB. At Hour 36 O2 sat 93%, wheezing,
BP 102/79,HR 114, no cholinergic effects. At Hour 46, he
developed hypotension, tachycardia, bronchorrhea, sweating, with respiratory depression requiring intubation and
ventilation. BP 99/65, HR 128, O2 sat 100%. He received
atropine, pralidoxime, and midazolam. On Day 7 the
patient developed ARDS and hypotension requiring
vasopressors. He failed to improve and died on Day 12.
Autopsy Findings: Not available.
Case 296. Acute Aconitum napellus ingestion: probably
responsible.
Scenario/Substances: A 62 y/o male ingested an unknown
amount of an Aconitum napellus (monkshood) decoction
and presented to the ED with vomiting. The man was of
Russian extraction and had purchased the monkshood
preparation in Kazakhstan. The monkshood was brewed
into a tea and was to be used as a topical poultice.
Physical Exam: In the ED he was alert and oriented.HR
127, BP 97/69, T 36.4 C, O2 sat 99% on a non-rebreather
mask.
Clinical Course: He soon developed altered mental status
with vomiting, and was intubated for airway protection.
Initial ECG: Sinus tachycardia, QRS 132, QTc 529. He
developed multiple episodes of VF and VT requiring CPR
and defibrillation. He was treated with IVFs, sodium
bicarbonate, magnesium, amiodarone, and lidocaine. He
received a bolus and infusion of 20% intravenous lipid
emulsion for persistent arrhythmias. He was admitted to the
ICU and continued to have episodes of VF and PEA
requiring CPR and defibrillation. He became hypotensive
and was treated with epinephrine and norepinephrine. He
continued to have episodes of ventricular arrhythmias and
cardiac arrest, and died 13 h after presentation.
Autopsy Findings: Not available.
Case 304. Acute buprenorphine ingestion: undoubtedly
responsible.
Scenario/Substances: A 2 y/o male had an acute cardiorespiratory arrest at home. Parents reported that he went to
bed normally but they heard him gasp and found him
apneic later in the night. It was reported that there was
buprenorphine/naloxone in the home.
Physical Exam: Child presented in cardiac arrest.
Laboratory Data: UDS was negative.
Clinical Course: The patient was intubated and resuscitated
with epinephrine, vasopressin dopamine, norepinephrine,
IVF, insulin and antibiotics. The patient’s initial ‘‘brain
study’’ was abnormal. His pupils were fixed and dilated. BP,
80s/60s, HR 124, RR 18, O2 sat 95–98%, T 36.8 C. He
remained unresponsive with no purposeful movements. On
Day 2 a brain flow study determined brain death. Based on
the prognosis, the family opted for institution of comfort
measures and he died on Day 3.
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Autopsy findings: Cause of death was listed as complications of out of hospital cardiorespiratory arrest due to
buprenorphine intoxication. A peripheral serum sample
drawn on Day 2 found a buprenorphine concentration50.2
ng/ml. A buprenorphine tablet that was submitted as
evidence and the mother was charged with murder.
Case 305. Acute methadone ingestion: undoubtedly
responsible.
Scenario/Substances: A 4 y/o female was given a dose of
liquid methadone for ‘‘fussiness.’’ She was found the
following morning pulseless and apneic.
Laboratory Data: Initial ABG showed respiratory and
metabolic acidosis. A methadone level, drawn 4 days postexposure was 43 ng/ml. Daily methadone levels were
drawn; the last positive level was 16 ng/mL on Day 11.
Clinical Course: The patient arrived in PEA and was
resuscitated with ROSC. No evidence of physical trauma
but she had suffered profound hypoxic/ischemic insult and
developed a severe encephalopathy. The patient persisted
in a vegetative state for 4 years, then died of pneumonia.
Autopsy Findings: Cause of death: complications of
anoxic encephalopathy due to remote methadone intoxication. An ‘‘other condition’’ of basilar pneumonia was
reported and the post-mortem exam was consistent with
significant pneumonic process. Manner of death was ruled
homicide.
Case 394. Unknown, fentanyl inhalation/nasal: undoubtedly responsible.
Scenario/Substances: A 33 y/o male was found snorting a
powdery substance in a hospital bathroom. Soon thereafter,
he went into cardiac arrest.
Physical Exam: Intubated, unresponsive. BP 160/70, HR
72 bpm.
Laboratory Data: ECG showing NSR with QRS 120 and
QTc 588. UDS was negative.
Clinical Course: He was intubated and successfully
resuscitated. He was placed on a hypothermia protocol,
and received IVFs and dobutamine for hemodynamic
support. On Day 2 he had multiple seizures and was
treated with benzodiazepines, phenobarbital and levetiracetam. He was paralyzed due to continued agitation and
difficulty with ventilation. He died on Day 4.
Autopsy Findings: The cause of death was reported
as fentanyl toxicity; manner of death: accidental. An
antemortem blood sample showed the following drug
concentrations: fentanyl 3.64 ng/mL, diphenhydramine
0.061 mg/L and propofol.
Case 663. Acute tramadol ingestion: undoubtedly
responsible.
Scenario/Substances: A 71 y/o male was found unresponsive at home with self-inflicted neck and wrist lacerations
and an empty bottle of 60 tramadol 50 mg tablets. The
patient had a seizure en route to the ED.
Past Medical History: Hodgkin’s lymphoma, resected
brain tumor, early Alzheimer’s dementia and alcoholism.
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1135
Physical Exam: The patient was comatose; pupils 2 mm
and sluggish. BP 124/58, HR 70, RR 14 (ventilated), O2 sat
94% on FiO2 90%, T 36 C.
Laboratory Data: Na 139, K 3.5, Cl 108, CO2 19, BUN
14, Cr 1.3, Glu 153, AG 12, Ca 8.6, AST 73, CK 440,
lactate 7.6. ABG-pH 7.25/pCO2 45.7/pO2 52.4 on 100%
FiO2. Serum acetaminophen, ethanol and salicylate
were not detected. UDS was negative. ECG: sinus
rhythm with LBBB. CxR was consistent with right lobe
aspiration pneumonia. Head CT and EEG were
unremarkable.
Clinical Course: The patient was intubated upon ED
arrival and had no further seizures but became progressively more difficult to oxygenate. He remained hypotensive and acidotic, received IVFs, bicarbonate, antibiotics
and norepinephrine. On Day 2 he was alert and following
commands. He died 35 hours after hospital arrival.
Autopsy Findings: The cause of death was tramadol
overdose. The manner of death was suicide. Sutured
wounds on the neck and wrist were noted.
Case 688. Acute acetaminophen ingestion: probably
responsible.
Scenario/Substances: A 90 y/o female filled an acetaminophen bottle with water and drank the contents. She was
found unresponsive with emesis in her mouth. EMS
reported a GCS of 4 and administered naloxone without
response.
Past Medical History: Depression, breast cancer, hypertension and cerebral aneurysm.
Physical Exam: BP128/74, HR 144, RR 25, T 37 C, O2
sat, 95% on bag mask.
Laboratory Data: Na 133,K 3.7,Cl 105,CO2 16, BUN 36,
Cr 1.6, AST 16, ALT 8, lactate 5.1, INR 0.98. Serum
acetaminophen 815 mcg/mL. Serum ethanol and salicylate
were not detected. UDS was negative.
Clinical Course: Patient was intubated, given a dose of
activated charcoal and started on n-acetylcysteine. In the
ICU a repeat acetaminophen level was 477. She became
progressively acidemic and hypotensive, and required
vasopressors. Although her liver enzymes did not rise she
did have an NSTEMI and died on Day 5 after an asystolic
arrest.
Autopsy Findings: Cause of death: self-medication
intoxication. Manner of death: undeterminable.
Case 691. Acute morphine unknown: undoubtedly
responsible.
Scenario/Substances: A 15 m/o female, last seen in her
normal state 8 hours prior, was found dead in her crib. A
large amount of extended family was at home the day
before she died. EMS was called, performed CPR,
intubated her, and administered epinephrine via an
interosseous line.
Past Medical History: Previously healthy; her mother was
prescribed 30 mg morphine tablets.
Physical Exam: Apneic, cyanotic, no neurological function. Skin cool with posterior lividity. No signs of trauma
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Laboratory Data (Postmortem): Na 139, K 23.6, Cl 108,
BUN 13, Cr 0.5, Glu 127. Caffeine positive in blood.
Serum methanol, isopropanol and salicylate, codeine and
6-monoacetylmorphine were not detected in blood or urine.
Lung tissue culture positive for MRSA and normal upper
respiratory flora, blood culture was positive for
Coryneforms, CSF: WBCs but no organisms seen, culture
no growth. Morphine (aortic blood) 1300 ng/mL, morphine
(10 mL of stomach secretions) 2100 ng/mL.
Clinical Course: She was pronounced dead upon ED
arrival, 1 h after being found.
Autopsy Findings: No signs of internal injury or disease
and anatomically and microscopically normal. Toxicology
showed elevated morphine levels with no detectable 6monoacetylmorphine. Morphine level was consistent with
fatal and nonfatal outcomes and ingestion of 3 or 4 3o mg
tablets. Cause of death per the ME was acute morphine
toxicity, and manner was homicide.
Case 692. Oxycodone, carisoprodol, clonazepam, alprazolam, ethanol, and cleaner (ammonia), laundry (prewash)
cleaner (anionic/nonionic), balt salts ingestion: undoubtedly responsible.
Scenario/Substances: A 23 m/o male, playing with his
3 y/o sister, was found apneic by his grandmother on the
floor with cleaners, detergents, and bath salts (for
bathing).EMS began resuscitation efforts after they found
him in cardiac arrest.
Clinical Course: The resuscitative measures continued in
the ED but he died shortly after arrival without ROSC.
Autopsy Findings: Post mortem blood: clonazepam
9.2 ng/mL; alprazolam 15.1 ng/mL; oxycodone 838 ng/
mL; oxymorphone 20.8 ng/mL; carisoprodol 27.5 mcg/
mL; meprobamate 19.8 mcg/mL. The cause of death was
acute mixed drug intoxication; ‘‘prescription bottles were
found at the scene.’’
Case 695. Acute lidocaine ingestion: undoubtedly
responsible.
Scenario/Substances: A 15 y/o female sent a suicidal text
message and was then found seizing by her parent after a
suspected ingestion of 2% viscous lidocaine. During EMS
transport she became apneic and asystolic, and was
intubated and treated with CPR and epinephrine.
Past Medical History: Depression, post-traumatic stress
disorder, and aphthous ulcers; medications included sertraline, diphenhydramine and 2% viscous lidocaine.
Physical Exam: Intubated, in cardiac arrest with seizures.
First measurable vital signs: BP 90/60, HR 160.
Laboratory Data: Na 145, K 3.5, Cl 107, HCO3 6, AG
32,Glu 276, BUN 14, Cr 1.26, Ca 9.5, Ca (ionized) 1.15,
bilirubin 4.3,Alk phos 76, ALT 128, AST 117, CK 337.
VBG-pH
6.6/pCO2
91.6.Serum
acetaminophen,
ethanol and salicylate were not detected. UDS was positive
for tricyclic antidepressants. Serum lidocaine was
16.6 mcg/mL.
Clinical Course: Upon transfer to a tertiary medical center
she was rigid and posturing. She received midazolam with
improvement, and sodium bicarbonate for acidosis. ECG:
sinus tachycardia, QRS 80, QTc 438, R-waves in aVR.
Patient was placed on continuous EEG monitoring that
showed occasional seizures when the midazolam infusion
was weaned. At Hour 15 pupils were small and minimally
reactive, patient became febrile (T 38 C). On Day 2, head
MRI showed evidence of anoxic injury. She failed
extubation on Day 4. By Day 7, she was receiving
clonidine for autonomic dysregulation, and baclofen and
lorazepam for spasticity. On Day 11, CxR showed
increased bibasilar pulmonary opacities and a head CT
showed diffuse hypoxic ischemic change of the bilateral
cerebral hemispheres and basilar cisterns. Based on the
prognosis, the family opted for institution of comfort
measures and she died on Day 11.
Autopsy Findings: Not performed.
Case 696. Acute methoxetamine: undoubtedly
responsible.
Scenario/Substances: A 24 y/o male was found unresponsive, 12 hours after last being seen, with a package of
methoxetamine in the room and a line of a white powder on
his desk top. EMS performed CPR with ROSC. Family
reported a history of methoxetamine abuse.
Past Medical History: Depression, taking duloxetine
60 mg daily.
Physical Exam: Unresponsive; BP 144/110 (then dropped
to 79/41), HR 93, RR 25, T 35.6 C.
Laboratory Data: K 8.9, Phos 10.6, Cr 3.04, ABG-pH
7.08/pCO2 58/pO2 41, CK 47,414, AST 649, ALT 811, Alk
phos 166, lipase 83, lactate 9.6. Acetaminophen, ethanol
and salicylate were not detected. UDS was positive for
THC.
Clinical Course: The patient was intubated and received
4 L of IVFs and vasopressors. A head CT showed
cerebellar edema and herniation. The patient received
lorazepam for possible seizure activity and was then
transferred to a tertiary care center. He developed multiorgan failure, cerebellar infarction and worsening herniation. Neurosurgery examination was consistent with brain
death. Based on the prognosis, the family opted for
institution of comfort measures and he died within 24 h
of hospitalization.
Autopsy Findings: Cause of death: acute methoxetamine
intoxication. Manner of death; accidental.
Case 699. Chronic fondaparinux ingestion: probably
responsible.
Scenario/Substances: A 67 y/o male on fondaparinux
presented with severe posterior epistaxis and hemoptysis.
Past Medical History: Glioblastoma multiforme treated
with surgery, chemotherapy, and radiation therapy with
progressive left hemiparesis, deep vein thrombosis, and
vena cava filter placement. He also had diabetes mellitus
and hypertension.
Physical Exam: BP 202/79, HR 150, RR 26, T 37 C. He
presented in respiratory distress, awake but nonverbal and
not following commands. His left pupils was 3 mm and
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reactive; right pupil was unreactive. Arterial bleeding was
noted from his right nares with blood going down the
posterior pharynx.
Laboratory Data: Na 140, K 4.3, Cl 102, CO2 28, Ca 9,
Mg 1.7, bilirubin 0.7, AST 60, ALT 116, Hgb 18, WBC
8.9, platelets 248. Coagulation studies were reported to be
‘‘within normal limits.’’
Clinical Course: He vomited a large amount of blood and
was intubated for respiratory distress. He was given IVFs
and had a posterior nasal packing placed on the right. He
was administered factor VII and then a left sided nasal
packing was placed. He developed T-wave inversions on
his ECG and head CT showed a focal area of hemorrhage
in the right thalamus. Extensive right hemispheric edema
developed with brainstem compression. Based on the
prognosis, comfort measures were instituted and he died.
Autopsy Findings: Not available
Case 709. Acute topiramate and ethanol ingestion:
undoubtedly responsible.
Scenario/Substances: A 20 y/o female injected a substance
called ‘‘Yukon’’ while at a party with friends. Friends
reported it to be a ‘‘heroin type drug.’’ The patient texted a
friend that evening stating she didn’t feel well. The next
day her mother noticed her to be very lethargic and, that
evening, found her ‘‘slumped over’’. The following
morning, the patient was unresponsive and EMS was
called. On arrival, EMS thought she was seizing and
gave her lorazepam. Her GCS was 3 and she was
hypothermic.
Past Medical History: No known history of drug abuse.
Laboratory Data: Hepatic enzymes and bilirubin unremarkable, serum acetaminophen and salicylate were not
detected, UDS obtained 2 days post exposure was negative.
Another UDS repeated on Day 4 was also negative.
Methanol, acetone, and isopropyl were not detected.
Clinical Course: The patient was transferred to a
tertiary care center, but remained in metabolic acidosis and
hypothermic. She developed hypotension that transiently
required IVFs and a vasopressor. She was rewarmed but
did not breath over the ventilator; her pupils remained fixed
and dilated. Head CT showed diffuse cerebral edema with
herniation. BP 108/48, RR 20, T 36.2 C, O2 sat 100%. She
developed hemodynamic instability and had no blood flow
to her brain. She was pronounced dead on Day 6; tissue and
organs were donated.
Autopsy Findings: Post-mortem examination revealed
severe cerebral edema. Antemortem blood (Day1): ethanol
32 mg/dL, topiramate 51,000 ng/mL (410 times therapeutic
and 2 days after reported injection). The final cause and
manner of death were listed as: acute topiramate toxicity;
suicide.
Case 754. Acute-on-chronic venlafaxine ingestion:
probably responsible.
Scenario/Substances: A 31 y/o female was found confused
by EMS after a suspected venlafaxine overdose. She had
several pre-hospital seizures and seized again in the ED.
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Past Medical History: Schizophrenia, epilepsy, depression, previous suicide attempts.
Physical Exam: She was agitated with mydriasis. In the
ICU BP 120/80, HR 137, RR 8, O2 sat 98% on room air, T
37.6 C.
Laboratory Data: Na 140, K 3.4, Cl 103, CO2 25, BUN 9,
Cr 0.92, Glu 59, AG 12, AST 19, Hgb 11.7, platelet 254,000,
WBC 9.9. Serum acetaminophen, ethanol and salicylates
were not detected. UDS was negative. An ECG showed
normal sinus rhythm and intervals. Head CT and abdominal
x-ray were normal. Hour 18 K 5.3, Cr 1.69, Glu 219, lactate
9.3, troponin 0.48. ABG-pH 7.26/pCO2 28/pO2 61/HCO3 13.
Clinical Course: She received lorazepam and phenytoin
for repeated seizures but developed VF and cardiac arrest.
She was intubated and resuscitated, received norepinephrine and bicarbonate. A hypothermia protocol was initiated.
Her post resuscitation rhythm was AF. She developed
bradycardia, PEA cardiac arrest, and died 31 hours after
ED arrival.
Autopsy Findings: The cause of death was venlafaxine
poisoning. The manner of death was suicide.
Case 823. Acute-on-chronic bupropion (extended
release) ingestion: undoubtedly responsible.
Scenario/Substances: A 68 y/o female told her husband
that she had taken an overdose of her medication
(bupropion 300 mg extended release tablets) and cut her
wrists 1 hour earlier. A suicide note and empty bottle of
bupropion were found.
Past Medical History: Depression with prior suicide
attempts, chronic back pain, hypothyroidism.
Laboratory Data: Na 137, K 3.3, Cl 102, CO2 22, liver
and renal function tests were normal. Serum acetaminophen, ethanol and salicylates were not detected. Initial
ABG-pH 7.35/pCO2 39; later the pH was 7.19. ECG
showed LBBB, QRS 170, QTc 722.
Clinical Course: On arrival she was responsive to verbal
commands, moving all extremities. BP 113/65, HR 90, O2
sat 92%, T 36 C. She received activated charcoal via
nasogastric tube. She became progressively obtunded and
hypotensive. She was intubated, resuscitated with 5 liters of
IVFs and started on phenylephrine. She had multiple
seizures that responded to lorazepam, and received sodium
bicarbonate and a 20% intravenous lipid emulsion therapy.
Her QRS initially appeared to respond but she developed
elevated ST segments and continued widened QRS/QTc.
An ECHO revealed a hyperdynamic left ventricular and
right heart strain. She had a cardiac arrest that was
successfully treated with a transvenous pacemaker. She had
multiple cardiac arrests and died.
Autopsy Findings: Anatomic pathology revealed a
pericardial effusion, pleural effusions, pulmonary edema
and peritoneal effusion. Hospital blood sample (unknown
time; thought to have been drawn before intravenous lipid
emulsion was given) revealed a bupropion concentration of
285 mcg/L (hydroxybupropion was not checked). Cause of
death: drug overdose of bupropion; manner of death:
accidental.
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Case 853. Acute rifampin ingestion: probably
responsible.
Scenario/Substances: A 15 y/o female ingested an
unknown amount of rifampin in a suicide attempt 8 h
prior to EMS being called.
Physical Exam: Alert and oriented, asymptomatic upon
ED arrival. BP 121/58, HR 113, RR 18, T 37.1 C.
Laboratory Data: Her UDS was negative; acetaminophen
and salicylate were not detected. The complete blood
count and comprehensive metabolic profile were reportedly
normal.
Clinical Course: After arrival she developed a headache,
nausea and pruritus. She received IVFs, methylprednisolone, diphenhydramine and ondansetron. Her urine subsequently turned red but on Day 1 she again was
asymptomatic with normal vital signs except for tachycardia. Approximately 42 h post-ingestion she was intubated
for pulmonary edema. On Day 3 she developed metabolic
acidosis and hypotension (systolic BP in the 40 s) that did
not respond to epinephrine, milrinone and vasopressin
infusions. Intravenous lipid emulsion therapy was given,
and norepinephrine and sodium bicarbonate were started.
Later that evening the patient went into ventricular
tachycardia and received multiple cardioversions. Cardiac
arrest continued and she died 64 h post-ingestion.
Autopsy Findings: Not available.
Case 858. Acute tilmicosin parenteral: undoubtedly
responsible.
Scenario/Substances: A 57 y/o female was found unresponsive in a barn with a vial of injectable tilmicosin. She
was intubated, defibrillated and had CPR performed by
EMS prior to ED arrival.
Clinical Course: Future resuscitation efforts in the ED
were unsuccessful.
Autopsy Findings: Her right arm had a puncture site with
surrounding ecchymosis at the antecubital fossa and
multiple small scars on the dorsal forearm. Postmortem
examination revealed no evidence of trauma, and tilmicosin was confirmed on postmortem toxicological analysis.
Hospital blood showed tilmicosin 4100 ng/mL. The cause
of death was acute tilmicosin toxicity; manner of death was
suicide.
Case 866. Acute (possibly chronic) flecainide ingestion:
undoubtedly responsible.
Scenario/Substances: An 18 y/o female intentional
ingested 16 flecainide tablets (unknown strength). EMS
found her in wide complex PEA, and performed CPR with
ACLS during transport.
Clinical Course: In the ED resuscitation efforts continued.
She was intubated, received sodium bicarbonate and taken
to the catheterization lab for transvenous pacing and IABP
placement. These interventions failed at Hour 8 and she
had another cardiac arrest secondary to bradycardia. She
received IVFs, intravenous lipid emulsion (bolus and
maintenance infusion), vasopressors (epinephrine and
dobutamine), sodium bicarbonate (infusion, and calcium.
After ROSC, she was placed on ECMO and vasopressors
continued for hypotension. At Hour 14 she had no
neurologic activity and necrotic bowel secondary to
abdominal compartment syndrome. She died at Hour 28
from a respiratory arrest.
Autopsy Findings: Not available.
Case 928. Acute-on-chronic amlodipine ingestion:
undoubtedly responsible.
Scenario/Substances: A 53 y/o male admitted to taking 80
amlodipine 10 mg tablets in a suicide attempt.
Past Medical History: Depression, schizophrenia,
hypertension.
Physical Exam: Awake and alert on arrival but became
agitated and confused within 1 h. BP 70/40, HR 95, RR 15,
O2 sat 98% on 10 L O2, T 37 C.
Laboratory Data: Na 138, K 3.3, Cl 104, HCO3 22, BUN
15, Cr 1.3, Glu 164, AG 12, Ca 9.4, AST 95, ALT 75,
albumin 3.3, Alk phos 135, total bilirubin 0.8, CK 287,
lactate 1.4, troponin I 0.0, Hgb14.3, Hct 41.8, platelets 125,
WBC 7.16, PT 10.5, PTT 26.3. VBG -pH 7.42/pCO2 32/
pO2 51/HCO3 20, COHb 0.4, MetHgb 0.5. Serum
acetaminophen, ethanol and salicylates were not detected.
Serum amlodipine 0.39 mg/L.
Clinical Course: In the ED, the patient received IVFs,
calcium, norepinephrine, dopamine, insulin and intravenous lipid emulsion therapy. On Day 2, methylene blue,
vasopressin and epinephrine were added. The patient had
exchange transfusions, CRRT and ECMO was started. An
ABG (on ECMO) showed a pH of 6.98. The patient was
resuscitated after a cardiac arrest but based on the
prognosis, the family opted for institution of comfort
measures and he died 45 hours after arrival.
Autopsy Findings: Cause of death was anoxic encephalopathy following cardiac arrest due to amlodipine poisoning.
The manner of death was suicide.
Case 934. Acute amlodipine ingestion: undoubtedly
responsible.
Scenario/Substances: A 54 y/o female took 15 amlodipine
tablets of unknown strength.
Physical Exam: Patient was asymptomatic 20 min following the ingestion.
Laboratory Data: Initial Glu 200. At 6 h later: K 3.2, Glu
443. At 14 h later: pH was 6.88/HCO3 12. There was no
AG; Cr 2.8. Her LVEF was 65%.
Clinical Course: Within 1 h of ED arrival her BP fell to
70/30 and then 66/32. Her mentation remained normal. She
was resuscitated with calcium gluconate, 6 L of IVFs,
norepinephrine, insulin infusion, dextrose and intravenous
lipid emulsion therapy. She was intubated 6 h later. She
required bicarbonate and increased vasopressors: norepinephrine, vasopressin, dopamine and phenylephrine.
Methylene blue was also administered. On Day 2 an
IABP was inserted without improvement. Based on the
prognosis, the family opted for institution of comfort
measures and she died 31 hours post ingestion.
Autopsy Findings: Not available.
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Case 957. Acute propranolol ingestion: undoubtedly
responsible.
Scenario/Substances: A 59 y/o female presented to
the ED shortly after ingesting 55 of her propranolol
20 mg tablets. She received 25 g of activated charcoal
by EMS.
Past Medical History: hypertension, diabetes mellitus,
depression, prior suicide attempt 2 days earlier.
Physical Exam: BP 158/128, HR 70, RR 16, O2 sat 98%.
She was anxious and ill-appearing; diaphoretic and had
delayed capillary refill.
Laboratory Data: Na 141, K 4.6, Cl 107, CO2 22.8, BUN
11, Cr 1.4, Glu 210 Alk phos 102, AST 28, ALT 38, PT 14,
CK 80, WBC 12.4, Hgb 11.8, HCT 38.6, platelets 399.
Acetaminophen, ethanol and salicylate were not detected.
ABG-pH 7.22/pCO2 43/pO2 55/HCO3 18/BE 10. CxR
showed cardiomegaly and a right upper lobe infiltrate. ECG
showed sinus bradycardia at 33, QRS 102, QTc 375.
Clinical Course: She developed bradycardia and respiratory distress shortly after ED arrival. She was intubated and
then had an unmeasurable blood pressure. A short course of
CPR with epinephrine obtained ROSC with a HR in the 30 s.
Despite 3 boluses of glucagon, and dopamine and epinephrine infusions, she remained hypotensive and bradycardic.
She did not respond to transcutaneous pacing. The patient
had 48 episodes of PEA/asystole which responded to
resuscitation efforts. She was transferred to the catheterization lab for placement of a transvenous pacer when her HR
dropped to the 20 s and BP blood pressure was unmeasurable. During CPR a ventricular pacing wire was placed with
ventricular capture; however, there was no perfusion.
Despite CPR and several rounds of epinephrine and atropine,
she died within several hours of ED arrival.
Autopsy Findings: Patient died as a result of propranolol
intoxication, by manner of suicide.
Case 1008. Acute propafenone ingestion: undoubtedly
responsible.
Scenario/Substances: A 77 y/o male intentionally ingested
7 of his propafenone 150 mg tabs.
Past Medical History: Cardiac dysrhythmia.
Physical Exam: On arrival the patient was alert, oriented
and asymptomatic. BP 120/76, HR 67, RR 12, O2 sat 95%,
T 36.4 C.
Laboratory Data: Initial ECG revealed a QRS of 96.
Acetaminophen was not detected, electrolytes were
described as normal. UDS was positive for opioids.
Clinical Course: Two h after arrival he had several
episodes of diarrhea and a near syncopal episode. A repeat
ECG showed a widened QRS at 156 and a sodium
bicarbonate infusion was started. About 4 h after arrival he
had a seizure, cardiac arrest (QRS 200) and died.
Autopsy Findings: Not available.
Case 1049. Acute benzonatate ingestion: undoubtedly
responsible.
Scenario/Substances: A 12 y/o female was found unresponsive, pulseless and in VF after ingesting an unknown
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1139
amount of benzonatate 100 mg tablets. The time of
ingestion was estimated to be 1 h prior to ED arrival.
Past Medical History: Previous suicide attempt.
Physical Exam: Unresponsive and intubated. BP 110/74,
HR 150, RR 22.
Laboratory Data: Na 127, AST 1,158, ALT 959, Alk phos
486. Acetaminophen was not detected. ECG showed
tachycardia with non-specific ST changes, QRS 70, QTc
440. Head CT showed anoxic injury with cerebral edema.
On Day 2 an ABG-pH 6.8/pCO2 38/pO2 204/HCO3 7.5/BE
25.
Clinical Course: She was intubated and defibrillated for
narrow complex PEA upon ED arrival. She received IVFs
and intravenous lipid emulsion therapy with an initial and
repeat (2 h later) boluses. Vital signs 10 h later: BP 154/98,
HR 127, RR 22, T 35 C. She remained unresponsive with
occasional spontaneous breaths. She was started on
dopamine and epinephrine for hypotension (72/43) and nacetylcysteine for transaminitis. She had minimal urine
output. A repeat brain CT showed multiple basal ganglia
and cerebellar infarcts with worsening edema. She had
another cardiac arrested and died 33 h after presentation.
Autopsy Findings: Not available.
Case 1050. Acute benzonatate ingestion: undoubtedly
responsible.
Scenario/Substances: A 12 y/o female, in psychological
distress for being bullied, took #100 tablets of 100 mg
benzonatate capsules in a suicide attempt. Almost immediately after telling her mother what she had done, she
collapsed and seized. EMS found her unresponsive and
intubated her. She coded en route to the ED but regained a
rhythm with cardioversion.
Physical Exam: In the ED: BP 124/90, HR 164, O2 sat
87% (being bagged). Her skin was cold, T 37 C.
Laboratory Data: Initial Glu 277, ABG-pH 6.9/pCO2 14/
BE 29.
Clinical Course: In the ED she was intubated and given
activated charcoal via NG tube and then transferred to a
tertiary care center’s PICU. Approximately 12 hours after
initial presentation: BP 129/99, HR 182, T 38.6 C. She
received IVF and calcium for hypocalcemia (Ca 6.6). Her
pH normalized; AST 160, ALT 90, and CK 4,671. She
remained unresponsive on the ventilator with midazolam
for sedation. On Day 2 her systolic BP dropped into the
60’s requiring norepinephrine and dopamine. She developed posturing and started coughing pink tinged sputum.
On Day 3 she was started on levetiracetam and valproic
acid for generalized myoclonic movements. Her neurologic exam revealed good brain stem function with
suppressed cortical function. On Day 4, she was started
on tube feedings, but was noted to have a Na of 166. EEG
showed absent cortical function. She continued on fluids,
anticonvulsants, and received sodium acetate and potassium phosphate. CxR showed increased left lower lobe
atelectasis. On Day 5 she was suspected to have
herniated. Her pupils were fixed and dilated, and she
lost respiratory drive, gag and corneal reflexes. The
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patient was pronounced dead and the family consented to
organ donation.
Autopsy Findings: Not performed.
Case 1058. Acute energy product, other ingestion:
undoubtedly responsible.
Scenario/Substances: A 22 y/o male presented to the ED
6 h after ingesting 800 mg of dinitrophenol as a body
building supplement.
Physical Exam: He presented with diaphoresis, hyperthermia, hyperventilation and palpitations. BP 127/58, HR 130,
RR 30, T 40.5 C.
Laboratory Data: UDS was negative.
Clinical Course: The patient was given IVFs and active
cooling. Several hours later BP 129/58, HR 103, RR 28 and
T 37.2 C. About 12 h after presentation he went into
cardiac arrest and died.
Autopsy Findings: The cause of death was 2,4 dinitrophenol toxicity (63 mg/L from antemortem blood) complicated by pre-existing cardiomegaly. The manner of death
was accidental.
Case 1060. Acute sodium ingestion: probably
responsible.
Scenario/Substances: A 5 y/o male was brought to ED by
his mother after he had seizure-like movements.
Past Medical History: Failure to thrive with gastric
tube placement. The mother only had previously treated
him with holistic medications. Six days PTA the patient
had a T 40 C, saw his pediatrician 4 days PTA and
returned home without interventions being recommended.
At 3 days PTA he was seen in an ED for twitching
movements but had a normal head CT and EEG, and he
was discharged home.
Clinical Course: His mother brought him to another ED
for the abnormal movements where he was admitted. Initial
laboratories were unremarkable. On Day 2 he seized while
in the hospital, was intubated and received an anticonvulsant. Initial Na 144, K 3.2, Cl 114, CO221, BUN 6, Cr
0.37, Glu 120; at 5.9 hours Na 182, Cl 160, CO29, Glu 271;
at 6.2 hours Na 178, Cl 155, CO212, Glu 246.He was
transferred to a tertiary care center where over the next 2
days his metabolic status improved. On Day 3 he was
awake and alert, and extubated, but shortly after he
suddenly decompensated and was found to have brain
herniation. On Day 4 he was declared brain dead. The case
was the subject of a criminal investigation.
Autopsy Findings: Cause of death was determined to be
sodium intoxication.
Case 1063. Acute on chronic loperamide ingestion:
undoubtedly responsible.
Scenario/Substances: A 25 y/o female presented to
the ED with a 1 day history of nausea, emesis and
dizziness. She later admitted to abusing 30–60 loperamide
tablets at time for 2 years for its opiate-like effects
to help with withdrawal from oxycodone with
acetaminophen.
Past Medical History: She had three admissions in the 3.5
months prior to this admission with symptoms ranging
from chronic constipation and abdominal pain to bradycardia, syncope, hypotension, QT prolongation and VT.
Echocardiography showed LVEF deteriorating from
50–54% to 520% with severe global LV and RV
hypokinesis. Treatment from prior admissions included
sodium bicarbonate, amiodarone, intravenous lipid emulsion and an implantable cardioverter-defibrillator.
Loperamide use was confirmed on the last admission
with a blood loperamide concentration of 35 ng/mL.
Clinical Course: On admission she was oriented and
appropriate; BP 65/33. HR 72, RR 12, O2 sat 98% on
room air, T 37 C. Her examination was remarkable for
horizontal nystagmus; abdomen was soft, non-tender with
bowel sounds. Na 138, K 4.7, Cl 103, CO2 25, BUN 18, Cr
2.0, Glu 117, Ca 9.3, Mg 2.0, phos 5.8, AST 21, ALT 13,
Free T4 1.1 ng/dL, WBC 9.3, Lactate 3.1, brain natriuretic
peptide 505 pg/mL. Serum acetaminophen, ethanol, ethylene glycol, methanol and salicylate were not detected.
UDS was positive for benzodiazepines and opiates. She
was given promethazine and became too drowsy to offer a
reliable history. Her HR was in the 30’s and she
experienced refractory hypotension despite 2 liters of IV
NS. She was intubated and a central line was placed. She
received atropine, sodium bicarbonate and dopamine. At
Hour 5: BP 65/48 on dopamine 20 mcg/kg/min and
vasopressin at 2 u/min. She received 500 mL of 20%
intravenous lipid emulsion without response. At Hour 15
she was placed on ECMO, but continued to be profoundly
hypotensive. Based on the prognosis, the family opted for
institution of comfort measures and she died 22 h after ED
arrival.
Autopsy Findings: The forensic pathologist reported that
death was due to complications of loperamide intoxication.
The manner of death was accident.
Case 1065. Unknown, loperamide ingestion: undoubtedly responsible.
Scenario/Substances: 27 y/o male was found unresponsive
at home by his wife. EMS found him in cardiac arrest; CPR
was commenced with ROSC.
Past Medical History: Bipolar disorder, narcotic drug
abuse, seizure disorder.
Laboratory Data: CO2 17, Cr 2.3, Glu 38, AST 584, ALT
663, lactate 16.4, AG 23, OG 23, acetaminophen 4 mg/dL.
Prior to intubation: ABG-pH 6.82/pCO2 85/pO2 100/HCO3,
14. Repeat ABG (after intubation) pH 7.07/pCO2 51/pO2
117/HCO3 14. UDS was positive for THC.
Clinical Course: In the ED he was intubated and received
IVFs, norepinephrine, epinephrine and bicarbonate infusions. BP 99/76, HR 107, RR 26, O2 sat 100% (FiO2
100%). Brain imaging revealed cerebral edema. On Day 2
his EEG was ‘‘flat’’ and the patient died.
Autopsy Findings: Antemortem blood (14 h after admission); loperamide 0.013 mg/L, liver 1.4 mg/kg). ME
determined the cause of death to be due to loperamide
toxicity; manner of death was accidental.
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Case 1071. Chronic androgen unknown: contributory.
Scenario/Substances: A 35 y/o male body builder with a
history of abusing anabolic steroids had increasing shortness of breath for two days. He was intubated by EMS for
respiratory distress.
Physical Exam: Intubated and paralyzed. BP 211/79, HR
119, RR 14, O2 sat 91%, T 37 C.
Laboratory Data: Na 128, K 8.0, Cr 1.26, AG 12, CK
7,969, Glu 264, AST 194, ALT 242, Hgb 19.4, Hct 57,
lactate 3.9, UDS was negative. ABG-pH 7.30/pCO2 46/pO2
72. Serial CPKs eventually peaked at 450,000.
Clinical Course: The patient was found to have pulmonary
edema and new heart failure with LVEF of 15%. Over the
next 24 hours he developed bilateral upper extremity
edema and blistering; pulses could not be detected with
ultrasound. He developed rhabdomyolysis and acute kidney
injury (Cr42). The patient was taken to surgery for
bilateral upper extremity fasciotomies, and then developed
shock (hypotension and tachycardia) requiring vasopressors. The patient’s CK was trending up with worsening
renal and respiratory failure. Hemodialysis was started and
he returned to the OR for lower extremity fasciotomies and
left hand amputation. The patient remained critical with
CK continuing to trend up, progressive renal failure and
ventilator requirements. Due to the extent of his injury, the
surgical team suggested amputation of all 4 extremities.
Based on the prognosis, the family opted for institution of
comfort measures and he died on Day 3.
Autopsy Findings: Autopsy was not performed.
Case 1094. Acute glycine transvaginal: undoubtedly
responsible.
Scenario/Substances: A 39 y/o female underwent elective
hysteroscopy and myomectomy with general anesthesia.
During the procedure, glycine 1.5% solution was used for
irrigation transvaginally. The OR records documented 6 L of
glycine irrigation in and out. There was no observed
bradycardia, hypotension, hypoxia, or cyanosis. Immediately after the procedure she was alert and oriented but then
became hypotensive, altered and developed hyponatremia.
Laboratory Data: Pre-op: Na 138, K 3.5, Cl 101, CO231,
BUN 13, Cr 0.6. Post-op: Na 117, K 3,3, Cl 81, CO225,
BUN 18, Glu 151,WBC 13.2, Hgb 13.6, Hct 39, platelets
194, ABG-pH 7.37/pCO244/pO274/HCO324. Head CT
showed cerebral edema.
Clinical Course: Within 2 h she developed respiratory
problems and was put on BiPAP and given furosemide.
Soon after her mental status deteriorated, she developed
nausea and vomiting, was intubated and started on
mannitol. Her cardiovascular status worsened and she
required norepinephrine. Following brain death testing she
was declared brain dead on Day 12.
Autopsy Findings: Not performed.
Case 1095. Acute succinylcholine parenteral: undoubtedly responsible.
Scenario/Substances: A 43 y/o female nurse was
found unresponsive and asystolic in her bedroom. She
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was last seen 30 min prior. Empty bottles of succinylcholine and a syringe labeled succinylcholine were found in
her room. She was resuscitated by EMS for 45 min with
ROSC.
Past Medical History: Depression.
Physical Exam: Comatose with no evidence of trauma.
Her pupils were 5 mm and fixed; she had no oculocephalic,
cough or gag response. There were fresh needle marks in
her right arm.
Laboratory Data: ABG- pH 7.18/PCO2 53/PO2 72/HCO3
19. Ethanol was 11 mg/dL; acetaminophen and salicylate
were not detected. UDS was positive for benzodiazepines.
Na 142, K 4.8, Cl 102, CO2 20, BUN 11, Cr 1.4, Glu
345, AG 20, lactate 5.3, AST 865, ALT 624. An
ECG showed sinus tachycardia with nonspecific
abnormalities.
Clinical Course: In the ED she was hypotensive (systolic
blood pressure in the 70 s) and bradycardic (weak HR in the
40 s), She received IVFs and norepinephrine. An extraglottic device was exchanged for an ETT. She had evidence
of aspiration and was started on antibiotics. She remained
comatose; a hypothermia protocol was initiated.
Progressive worsening of gas exchange was consistent
with ARDS. Follow-up neuroimaging revealed diffuse
cerebral edema, global anoxic injury and uncal herniation.
Transcutaneous Doppler revealed no cerebral blood flow.
The patient was declared brain dead and died within 30 h
of presentation.
Autopsy Findings: Not available. A police search of her
home found several unmarked syringes and the following
medications: phenylephrine, succinylcholine, cefazolin,
lidocaine, propofol, neostigmine, ephedrine, rocuronium,
midazolam, fentanyl, glycopyrrolate, promethazine, hydromorphone, citalopram, ketamine, bupivacaine, alprazolam,
armodafinil and zolpidem.
Case 1111. Unknown, carisoprodol and paroxetine
ingestion: undoubtedly responsible.
Scenario/Substances: A 55 y/o female was found unresponsive by her husband when she did not come to bed as
expected. EMS was called and administered naloxone with
no effect. They noted her husband’s carisoprodol tablets
lying near the patient.
Physical Exam: Unresponsive, hypertensive (systolic BP
163); tachycardic, seizure activity.
Laboratory Data: Serum acetaminophen, ethanol and
salicylate were not detected.
Clinical Course: In the ED she received lorazepam
for seizure activity. O2 sat was 89% and she was
intubated. HR 125; BP 146/89. She was transferred to the
ICU where she developed hypotension requiring dopamine
and norepinephrine. Based on the prognosis, comfort
measures were instituted and she died 1 hour later (36
Hours).
Autopsy Findings: An autopsy was not performed,
but
toxicology
testing
on
admission
blood
showed carisoprodol 72.2 mcg/ml and meprobamate
7.29 mcg/ml.
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1142
J. B. Mowry et al.
Case 1158. Acute propofol parenteral: undoubtedly
responsible.
Scenario/Substances: A 51 y/o male was found unresponsive with 4 empty vials of propofol, needles and
syringes around him. EMS found him unresponsive with
respiratory depression and considerable blood loss at the
scene.
Laboratory Data: ABG-pH 6.66/pCO232/pO2191, lactate
15.9. Subsequent VBG-pH 6.55/pCO268/pO220, lactate
420, Na 139, K 5.2, CL 108,CO2 9, BUN 31,Cr 1.6, Glu
164, WBC 21.7, Hgb: 2.3, Hct 11.2, platelets 95, D-dimer:
420 mcg/ml, fibrinogen 560, PT490, INR411.0.
Clinical Course: On ED arrival he was bradycardic and
then became asystolic. He was intubated and treated with
CPR and ACLS including multiple rounds of epinephrine
and bicarbonate. After nearly 1.5 hours, he had ROSC and
was started on epinephrine infusion to maintain HR and
BP. He remained unresponsive with fixed and dilated
pupils, and was bleeding from all IV sites. He received
IVFs and blood products without improvement.
Approximately 3 hours ED arrival he developed PEA
followed by asystole. Resuscitation efforts were unsuccessful; a bedside ultrasound showed no cardiac wall motion
and he died.
Autopsy Findings: Serum propofol concentration (from
hospital blood) was 0.61 mcg/mL. Cause of death:
complications of propofol toxicity. Manner of death:
accident.
Case 1200. Acute lysergic acid diethylamide (LSD) and
methylenedioxymethamphetamine (MDMA) ingestion:
probably responsible.
Scenario/Substances: A 17 y/o male reportedly took 30
hits of LSD and possibly MDMA while camping with
friends. He was found vomiting blood and seized multiple
times. His friends who also used the drugs were
asymptomatic.
Physical Exam: He presented to the ED pulseless and
apneic.
Laboratory Data: Na 139, K 5.0, Cl 106, CO2 18, BUN
21, Cr 1.50, Glu 235, AG 15, AST 101, ALT 50. Serum
acetaminophen and salicylate not detected. UDS positive
for THC. Repeat labs: CO2 14, BUN 33, Cr 2.7,
Glu 478, Lactate 9.7, AST 881. ABG-pH 7.28/pCO2
36.5/pO2 68.4.
Clinical Course: CPR was performed for 25 minutes, a
pulse and blood pressure was established after epinephrine
was administered. He was intubated but had recurrent
seizures. He received 8 mg of midazolam without noticeable improvement. After resuscitation his systolic BP
improved from 78 to 172/81, HR 124. ECG showed
peaked T-waves. He was transferred to a tertiary care
center where a hypothermia protocol was initiated and
sodium bicarbonate was infused. BP 120/80, HR 80, RR
24 (ventilated), O2 sat 100% (60% FIO2), T 35.3 C. A
head CT revealed cerebral edema with poor brain
perfusion. On Day 3 he remained unresponsive (off
sedation) with slower wave forms on EEG, and required
continued epinephrine. Later that evening he experienced
brain herniation and died on Day 5. His organs were
donated.
Autopsy Findings: Not available.
Case 1218. Acute-on-chronic, amphetamine (hallucinogenic) ingestion: undoubtedly responsible.
Scenario/Substances: A 20 y/o male collapsed at a rave
and had a witnessed seizure. His sibling reported that he
had taken ‘‘Molly.’’
Physical Exam: Intubated and unresponsive; pupils 5 mm
and fixed bilaterally. Hypotensive, HR 160, T 45 C.
Laboratory Data: K 6.9, Cr 2.4, CK 1,312. On ABG-pH
7.25/pCO2 23/pO2 138/BE 9.1; lactate 8.4, troponin-I
18.8, AST 37, ALT 23, Alk phos 41, PT 83.7, PTT 137.0.
Acetaminophen, ethanol and salicylates not detected. UDS
was negative.
Clinical Course: The patient received 15 mg of midazolam
and was intubated. He received IVFs and multiple doses of
diazepam and lorazepam, and then started on a midazolam
infusion. The patient was cooled and became normothermic within 1 h. Norepinephrine was started for persistent
hypotension; albuterol, insulin/dextrose, calcium and
sodium bicarbonate were given for hyperkalemia. He
started to bleed from his orogastric tube and was thought
to be in DIC. He was transfused with RBCs, FFP, platelets
and cryoprecipitate. His pH decreased to 7.1 and he
developed wide complex tachycardia and PEA. Despite
resuscitation efforts for 35 minutes he died less than 4 h
after admission to the hospital.
Autopsy Findings: Not available.
Case 1223. Unknown, methamphetamine ingestion:
undoubtedly responsible.
Scenario/Substances: A 21 y/o female abused an unknown
amount of methamphetamine over several days before
becoming unresponsive. Her boyfriend found her unconscious with reported seizure activity. EMS noted a GCS of
3 and dilated pupils. She received midazolam and was
intubated prior to ED arrival.
Past Medical History: Depression, illicit drug abuse.
Physical Exam: Intubated and sedated; pupils 5 mm and
sluggish. BP 113/54, HR 141, RR 30 and T 40 C.
Laboratory Data: Initial ABG-pH 7.29/pCO2 33/pO2 316/
HCO3 16.2/BE 9; repeat ABG-pH 7.01/pCO2 68/pO2 59/
HCO3 16.3/BE 14.8. WBC 7.2, Hgb 13.9, Hct 41,
platelets 62, CK 17,154 (and then 22,057), PT 16.5, PTT
25.8. Serum Na 148, K 4.0, Cl 120, CO2 19, Glu 61 (then
31 and 145), AG 9, BUN 20, Cr 2.9 (and then 4.6), AST
491, ALT 87, lactate 2.5. At the second facility an EKG
showed sinus tachycardia, and her UDS was positive for
benzodiazepine, THC, methamphetamine and tricyclic
antidepressants.
Clinical Course: The patient was sedated with propofol
and lorazepam. She developed acute renal failure and
remained anuric despite IVFs. The patient was transferred
to a tertiary care center 6 h later where she became
hypotensive and was started on vasopressors. She received
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
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dextrose for hypoglycemia but had worsening metabolic
acidosis and rhabdomyolysis. A bicarbonate infusion was
started and hemodialysis was planned. A head CT was
negative but her EEG showed ‘‘severe encephalopathy.’’
She became hypotensive (75/25) and tachycardic (156),
and received norepinephrine, phenylephrine and vasopressin. Antibiotics were started for suspected aspiration
pneumonia. At 14 h after presentation she went into PEA
but was resuscitated with CPR and ACLS interventions.
An epinephrine drip was added to her other vasopressors.
Based on the prognosis, the family opted for institution of
comfort measures. She had another cardiac arrest and died
17 h after presentation.
Autopsy Findings: Cause of death: toxic effects of
methamphetamine. Serum methamphetamine concentration
was 12.53 mg/L and amphetamine was 0.32 mg/L.
Case 1224. Acute methylenedioxymethamphetamine
(MDMA) ingestion: undoubtedly responsible.
Scenario/Substances: A 21 y/o female concert goer
took an unknown amount of ‘‘Molly’’ (MDMA) and
alcohol and then reported a headache to her friend. She was
altered on arrival to the medical tent, and then had a
seizure.
Physical Exam: In the ED he continued to seize, pupils
were unequal (left 7mm; right 4 mm) and sluggish. BP 132/
56, HR 70, and later BP 93/50 and HR 115. Later her pupils
were fixed and dilated; she had minimal response to painful
stimuli.
Laboratory Data: Na 121, K 2.9, Cl 89, CO2 20, BUN 7,
Cr 0.6, Glu 174, Ca 8.0, Mg 1.3, ABG- pH 7.25/pCO2 47.5/
pO2 298/HCO3 20.8/BE 6, lactate 1.04, AST 27, ALT 20,
serum Osm 262, Troponin negative, CK 236. Serum
acetaminophen, ethanol and salicylate were not detected.
UDS positive for benzodiazepines. Head CT showed
diffuse cerebral edema with effacement of the cerebral
sulci, subarachnoid cisterns and the 4th ventricle.
Clinical Course: The patient was given midazolam for
clonic activity, intubated and admitted to the ICU. After
hyponatremia (Na 121) was determined she was given
hypertonic saline (250 mL bolus and an infusion). Sodium
increased to 174 about 22 hours later. She remained
unresponsive and required norepinephrine, phenylephrine
and vasopressin for hypotension. Brainstem reflexes were
absent, but patient had flexion of her upper and lower
extremities to noxious stimulation. She was started on
mannitol and taken to the OR for posterior fossa
decompression, but showed no improvement in neurologic
function. The patient had 2 brain death exams and was
pronounced dead on Day 2.
Autopsy Findings: Blood MDMA was 460 ng/ml; 3, 4methylenedioxyamphetamine (MDA) was 16 ng/ml; midazolam was 34 ng/ml. Patient ‘‘died of complications of
Ecstasy intoxication which included associated hyponatremia. The level of Ecstasy observed in the postmortem
analysis is not considered within fatal limits, however the
low sodium level can result in brain swelling producing
coma and death.’’
Copyright ß Taylor & Francis 2015
1143
Case 1238. Acute methamphetamine and marijuana
exposure: undoubtedly responsible.
Scenario/Substances: A 23 y/o male was taken to an ED
after being found unresponsive at a friend’s home.
Past Medical History: Drug abuse for the previous month.
Physical Exam: On arrival to the ED he was hyperthermic
(rectal T41.7 C) with seizure-like activity.
Laboratory Data: Na 146, K 6.5, Cr, 1.8, Glu 53, WBC
14.8, troponin 0.32, Serum acetaminophen and salicylate
were not detected. UDS positive for THC and
methamphetamine.
Clinical Course: He was transferred to a tertiary care
center where he received naloxone, lorazepam and
dantrolene for seizure activity. He then had a cardiac
arrest and CPR was started. He received atropine, calcium,
sodium bicarbonate, and epinephrine with ROSC. He then
received 4 L of NS and was actively cooled with a cooling
blanket and ice packs. He became hyperglycemic (Glu 500)
and then died, 3.5 H, after a second cardiac arrest.
Autopsy Findings: Post mortem blood: methamphetamine
8,036 ng/ml; amphetamine 413 ng/ml; lorazepam 18.5 ng/
ml; THC-COOH 6.9 ng/ml. Post mortem urine: methamphetamine 410,000 ng/ml; amphetamine 410,000 ng/ml;
THC-COOH 62 ng/ml. Autopsy showed pulmonary edema/
congestion and mild early cerebral edema. Cause of death
was methamphetamine toxicity.
Case 1257. Acute amphetamine (hallucinogenic) ingestion: undoubtedly responsible.
Scenario/Substances: A 27 y/o male was found delirious
at an amusement park and reported taking ‘‘Molly
powder.’’
Physical Exam: He was anxious, tremulous and sweaty
before he experienced a cardiac arrest. BP 155/96, HR 188,
RR 26, O2 sat 98%, T 42.5 C. In the ICU, systolic BP 30
and HR 120.
Laboratory Data: Na 146, K 5, Cl 107, Glu 110, BUN 16,
Cr 1.58, AST 27, CK 320, AG 15, lactate 9.5, WBC 12,
Hgb 16.9, platelets 455. Serum acetaminophen, ethanol and
salicylates were not detected. Hour 7: Na 160, K 8.0, Cl 99,
CO2 24, BUN 19, Cr 3.0, AST 3,273, ALT 3,359,
CK420,000. CxR and ECHO were unremarkable. An
EEG showed diffuse slowing but no seizure activity.
Clinical Course: He was intubated and sedated but
remained hypotensive despite receiving dopamine, norepinephrine, epinephrine, phenylephrine and vasopressin.
He was therapeutically cooled but had repeated cardiac
arrests and died 8 hours after arrival.
Autopsy Findings: The cause of death was MDMA
toxicity. The manner was accidental.
Case 1277. Acute amphetamine and benzodiazepine
ingestion: undoubtedly responsible.
Scenario/Substances: A 31 y/o male was incarcerated for
possession of drug paraphernalia and suspected to have
swallowed a packet of methamphetamine. He was found 48
hours later unresponsive, sweating, and having a possible
seizure. He was taken from jail to an ED.
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1144
J. B. Mowry et al.
Laboratory Data: ABG-pH 7.0/pCO2 86/pO2 118, Hgb
14, WBC 10.5, platelets 243, AST 1,297, ALT 49, CK
8,000, Cr 2.18. UDS positive for benzodiazepines and
amphetamines.
Clinical Course: On arrival in the ED, the patient was in
acute respiratory failure and asystolic arrest. Post resuscitation he was tachycardic (HR 130) and received the
hospital’s hypothermia protocol including fentanyl, midazolam and vecuronium. His pupils were 3 mm and poorly
reactive. He was noted to have rhabdomyolysis and DIC.
Repeat ABG-pH 7.46/pCO2 22, lactate 4.1, Na 141, K 3.1,
Cl 112, CO2 20, Glu 121, BUN 27, Cr 1.5, Ca 7.2, Hgb 10,
WBC 1.8, platelets 20, AST 1,945, ALT 347, CK 111,000.
He received antibiotics, IVFs, dextrose, potassium, calcium, and a platelet infusion. At 18 Hours: BP 132/82, HR
98, O2 sat 100%. The rewarming protocol was completed
at 48 Hours but the patient was not responsive and not
moving off sedation. Urine output ceased and became
edematous. The patient died at 72 Hours.
Autopsy Findings: Toxicology testing on hospital admission blood: methamphetamine 9,796 ng/ml; amphetamine
262 ng/ml. Methamphetamine was found in his jail cell and
cellophane was found in the gastric lumen. Cause of death
was acute methamphetamine intoxication.
Case 1330. Acute methamphetamine ingestion:
undoubtedly responsible.
Scenario/Substances: A 46 y/o female and her husband
were stopped by police while driving in their car. While in
custody she became altered with ‘‘shaking extremities’’,
and was transported to an ED 4 hours later. Her husband
later disclosed that she ingested approximately 1 gram of
methamphetamine immediately prior to the traffic stop.
Clinical Course: In the ED, she was uncooperative and
difficult to examine. HR 148, BP 96/52, T 38.2 C. Initial
heart rhythm was VT, and cardiac arrest ensued shortly
after arrival. She was intubated and given ACLS with
ROSC. Cooling measures were not successful, and temperature rose to 39.4 C.. Terminal cardiac arrest occurred
at about11 h after ingestion.
Autopsy Findings: Antemortem blood: methamphetamine
44 mcg/L, amphetamine 0.14 mcg/L. Postmortem femoral
blood: methamphetamine 6.7 mcg/L, amphetamine
0.29 mcg/L.
Abbreviations & Normal Ranges for Abstracts
Disclaimer – all laboratories are different and provide their
own normal ranges. Units and normal ranges are provided
here for general guidance only. These values were taken
from Harrison’s (12), Goldfrank’s (13) or Dart (14).
¼ approximately
ABG-pH/pCO2/pO2/HCO3 /BE
¼ arterial blood gases
ABG
¼ partial pressure of carbon dioxide
ABG-pCO2
[38–42]
ABG-pH
ABG-pO2
Base Excess
ACLS
ADHD
AF
AG
AICD
Alk phos
ALT
AMA
Ammonia
amp
APLS
ARDS
AST
AV block
BAL
BE
Bicarbonate
bili (direct)
bili (indirect)
Bilirubin
BiPAP
BLQ
BMI
BP
BPH
BUN
C
Ca (ionized)
Ca
CABG
CAD
Carbon Dioxide
CIWA
CK
CKMB
¼ hydrogen ion concentration
[7.38–7.42]
¼ partial pressure of oxygen
[90–100]
¼ [2 to + 2 mmol/L]
¼ advanced cardiac life support,
protocol for the provision of cardiac
resuscitation
¼ attention deficit hyperactivity
disorder
¼ atrial fibrillation
¼ anion gap Na – (Cl + HCO3)
[12 4 mEq/L or mmol/L]
¼ automatic implanted
cardiodefibrillator
¼ alkaline phosphatase [13–100] U/L
¼ Alanine aminotransferase [7–41]
U/L ¼ (SGPT)
¼ against medical advice
¼ [25–80] mcg/dL ¼ [15–47]
mcmol/L
¼ ampoule
¼ advanced pediatric life support,
protocol for the provision of cardiac
resuscitation
¼ acute respiratory distress
syndrome
¼ Aspartate aminotransferase [12–38]
U/L ¼ (SGOT)
¼ atrio-ventricular block
¼ British anti-Lewisite
¼ base excess, mmol/L
¼ [22–26] mmol/L
¼ direct bilirubin [0.1, 0.4] mg/dL
¼ indirect bilirubin [0.2, 0.9] mg/dL
¼ total [0.3–1.3] mg/dL, direct [0.1, 0.4]
mg/dL, indirect [0.2, 0.9] mg/dL
¼ bilevel positive airway pressure, pressure support with 2 levels of continuous
positive airway pressure
¼ below the limit of quantitation
¼ body mass index
¼ Blood Pressure, systolic/diastolic,
(Torr)
¼ benign prostatic hypertrophy
¼ see Urea nitrogen
¼ degrees Centigrade
¼ ionized calcium, [4.5–5.6] mg/dL
¼ calcium, [8.7–10.2] mg/dL
¼ coronary artery bypass graft
¼ coronary artery disease
¼ CO2 [22–26] mmol/L
¼ Clinical Institute Withdrawal
Assessment for Alcohol
¼ creatinine kinase (CPK), total:
[39–238] U/L females, [51–294] U/L
males
¼ MB fraction of CK [0.0–5.5 mcg/L ¼
0.0–5.5 ng/mL]
¼ 0–4.0%]
Clinical Toxicology 53(10) 2015
AAPCC 2014 Annual Report of the NPDS
Fraction of total
CK activity
[0–0.04
Cl
CNS
CO2
COHb
COPD
CPR
Cr
CRRT
Downloaded by [AAPCC] at 12:54 01 December 2015
CSF
CT
CVA
CVVHD
CxR
D10W
D50W
D5NS
D5W
Day
DIC
DNR
Dx
ECG
leads
ECHO
ECMO
ED
EDDP
EEG
EF
ELISA
EMS
ER
ETT
FFP
FiO2
g
g/dL
GCS
GERD
GI
Glu
h
HBO
¼ chloride [102–109] mmol/L
¼ central nervous system
¼ Carbon Dioxide Serum or Plasma
[22–26] mmol/L
¼ carboxyhemoglobin (RR53%)
¼ chronic obstructive pulmonary
disease
¼ cardio pulmonary resuscitation
¼ creatinine [0.5–0.9] mg/dL females,
[0.6–1.2] males,
¼ continuous renal replacement
therapy
¼ cerebrospinal fluid
¼ computed tomography (CAT scan)
¼ cerebrovascular accident
¼ continuous venovenous
hemodiafiltration
¼ chest radiograph, chest xray
¼ 10% dextrose in water
¼ 50% dextrose in water
¼ 5% dextrose in normal saline
¼ 5% dextrose in water
¼ when capitalized, Day ¼ hospital day,
i.e., days since admission to the initial
hospital for this exposure
¼ disseminated intravascular
coagulation
¼ do not resuscitate
¼ diagnosis
¼ electrocardiogram (EKG),
¼ I, II, III, aVR, aVL, aVF, V1, V2, V3,
V4, V5, V6
¼ echocardiogram
¼ extracorporeal membrane
oxygenation
¼ emergency department, in these
abstracts refers to the initial health
care facility
¼ principal methadone metabolite, 2ethylidene-1,5-dimethyl-3,3diphenylpyrrolidine
¼ electroencephalogram
¼ ejection fraction
¼ enzyme-linked immunosorbent
assay
¼ emergency medical services,
paramedics, the first responders
¼ extended release (sustained
release)
¼ endotracheal tube
¼ fresh frozen plasma
¼ fraction of inspired oxygen
¼ grams
¼ grams per deciliter
¼ Glasgow Coma Score, ranges from 3
to 15
¼ gastroesophageal reflux disease
¼ gastrointestinal
Copyright ß Taylor & Francis 2015
HCF
HCG
HCO3
HCP
Hct
Hgb
HIV
Hour
HR
IABP
ICP
ICU
IgE
IM
INR
IU/L
IV
IVF
K
kg
L
Lactate
LBBB
Leukocyte count
LVEF
m/o
MAP
mcg/dL
mcg/L
mcg/min
mcg/mL
mcmol/L
MDA
MDMA
ME
MetHgb
mEq
mEq/L
Mg
mg
mg/dL
mg/kg
mg/L
min
ml
mmol/L
mosm/kg
1145
¼ glucose, fasting [75–110] mg/dL
¼ hours
¼ hyperbaric
oxygen
treatment/
therapy
¼ health care facility
¼ human chorionic gonadotropin test
for pregnancy
¼ bicarbonate
¼ health care provider
¼ hematocrit [35.4–44.4] females,
[38.8–46.4]% males
¼ hemoglobin
[12.0–15.8]
g/dL
females, [13.3–16.2] g/dL males
¼ human immunodeficiency virus
¼ when capitalized, Hour ¼ hours since
admission to the ED/hospital
¼ HR, beats per min
¼ intraaortic balloon pump
¼ intracranial pressure
¼ intensive care unit
¼ immunoglobulin E
¼ intramuscular
¼ international normalized ratio (PT to
control) [0.8–1–2]
¼ international units per Liter
¼ intravenous
¼ intravenous fluid(s)
¼ potassium, [3.5–5] mmol/L
¼ kilogram
¼ Liter
¼ lactic acid [4.5–14.4] mg/dL arterial,
[4.5–19.8] mg/dL venous
¼ left bundle branch block on ECG
¼ white blood count [3.54–9.06]
103/mm3
¼ left ventricular ejection fraction
¼ months old
¼ mean arterial pressure
¼ micrograms per deciliter
¼ micrograms per Liter
¼ micrograms per minute
¼ micrograms per milliliter
¼ micromoles per liter
¼ 3,4-methylenedioxyamphetamine
¼ methylenedioxymethamphetamine
(ecstasy, molly)
¼ medical examiner
¼ methemoglobin (RR51%)
¼ milliequivalents
¼ milliequivalents per Liter
¼ magnesium [1.5–2.3] mg/dL
¼ milligrams
¼ milligrams per deciliter
¼ milligrams per kilogram
¼ milligrams per Liter
¼ minutes
¼ milliliter
¼ millmoles per Liter
¼ milliosmoles per kilogram
1146
J. B. Mowry et al.
Downloaded by [AAPCC] at 12:54 01 December 2015
mosm/L
MRI
MRSA
¼ milliosmoles per Liter
¼ Magnetic Resonance Imaging
¼ methicillin-resistant Staphylococcus
aureus
¼ milliseconds
ms
Narrative Headers:
Scenario/Substances: concise narrative of EMS & preHCF events
Past Medical History: available relevant past medical
history
Physical Exam: initial physical exam if available
Laboratory Data: initial results, give units except for
units given in abbreviations
Clinical Course: concise narrative of HCF & beyond
with outcome
Autopsy Findings: ¼ medical examiner and/or autopsy
results
¼ sodium [136–146] mmol/L
Na
¼ nasogastric
NG
¼ nanograms per milliliter
ng/mL
¼ analyte below the level of quantitanot detected
tion, negative
¼ nil per os, nothing by mouth
NPO
¼ normal saline
NS
¼ non-ST segment elevation myocardial
NSTEMI
infarction
¼ oxygen percent saturation [94–100]%
O2 sat
at sea level
¼ serum osmol gap ¼ measured serum
OG
osmolality
–
calculated
serum
osmolality
[0 10 mOsmol/kg]
¼ operating room
OR
¼ osmole
Osm
¼ pediatric advanced life support
PALS
¼ poison center ( ¼ PCC, or Poison
PC
Control Center)
¼ prothrombin complex concentrate
PCC
¼ primary care provider
PCP
¼ pulseless electrical activity
PEA
¼ positive end expiratory pressure
PEEP
¼ pediatric intensive care unit
PICU
¼ platelet count [150–400] x109/L
Platelets
¼ per os (‘‘by mouth’’ in Latin)
PO
¼ [3.5–5] mmol/L
Potassium
¼ parts per million
ppm
¼ P-R interval [120–200] msec on the
PR
ECG
¼ as needed
PRN
¼ prothrombin time, INR is preferred,
PT
but PT may be used if INR is not
available
¼ Prior to admission
PTA
¼ partial thromboplastin time [26.3–
PTT
39.4] sec
¼ premature ventricular contraction
PVC
¼ ECG QRS complex duration [60–
QRS
100] msec
QT
QTc
RBBB
RBC
ROSC
RPC
RR
s/p
sec
SL
SVT
Synthetic
Stimulant
T (oral)
T (rectal)
T (tympanic)
t-bili
THC
THC Homolog
TPN
Tprot
Troponin I
U
U/dL
U/L
U/mL
UA
UDS
Urea nitrogen (BUN)
VBG
VF
VT
WBC
WNL
y/o
¼ Q to T interval on the ECG waveform, varies with HR
¼ QT interval corrected for HR, usually
QTcB ¼ QT/RR½ (Bazett correction)
1–15 y–o [5440] msec, adult male
[5430] msec, adult female [5450]
msec
¼ right bundle branch block on ECG
¼ red blood cell(s)
¼ return of spontaneous circulation
¼ regional poison center
¼ respiratory rate, breaths per minute
¼ status post
¼ seconds
¼ sublingual
¼ supraventricular tachycardia
¼ one or more of the products (6-APB,
bath salts, plant food, Bliss, Ivory
Wave, Purple Wave, Vanilla Sky,
et al) or chemicals (3,4 methylenedioxypyrovalerone [MDPV], 6-(2-aminopropyl)benzofuran [6-APB], butylone,
desoxypipradrol [2-DPMP], ethylone,
flephedrone, naphyrone, mephedrone,
methylenedioxypyrovalerone, methylone, methcathinone, et al)
¼ Temperature (oral) [36.4, 37.2] C
or
¼ Temperature (rectal) [36.4, 37.2] C
or
¼ Temperature
(tympanic)
[36.4,
37.2] C
¼ total bilirubin
¼ tetrahydrocannabinol
¼ one or more of the products (Blaze,
Dawn, herbal incense, K2, Red X, spice,
et al) or chemicals (cannabicyclohexanol, CP-47,497, JWH-018, JWH-073,
JWH-200, et al)
¼ total parenteral nutrition
¼ total protein
¼ normal range [0–0.08] ng/mL, Cutoff for MI40.04 ng/mL
¼ units
¼ units per deciliter
¼ units per liter
¼ units per milliliter
¼ urinalysis
¼ urine drug screen
¼ [6–17] mg/dL
¼ venous blood gasses
¼ Ventricular fibrillation
¼ Ventricular tachycardia
¼ white blood count, see leukocyte
count
¼ within normal limits
¼ years old
Clinical Toxicology 53(10) 2015
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