The Impact of Bittering Agents on Pediatric Ingestions of Antifreeze
Background. Legislation requiring bittering of antifreeze enables assessment of the impact on frequency, volume, and severity of pediatric antifreeze ingestions. Methods. US poison control data for antifreeze ingestions in children younger than 5 years were analyzed comparing 232 ingestions occurrin...
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| Veröffentlicht in: | Clinical pediatrics 2009-11, Vol.48 (9), p.913-921 |
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| creator | White, Nicole C. Litovitz, Toby Benson, Blaine E. Horowitz, B. Zane Marr-Lyon, Lisa White, Marisa K. |
| description | Background. Legislation requiring bittering of antifreeze enables assessment of the impact on frequency, volume, and severity of pediatric antifreeze ingestions. Methods. US poison control data for antifreeze ingestions in children younger than 5 years were analyzed comparing 232 ingestions occurring in states after enactment of bittering requirements with 6218 cases occurring in states (or at times) where bittering was not required. Results. The frequency of pediatric antifreeze ingestions was unchanged after implementation of bittering in Oregon and California. The medical outcome distribution, median volume ingested, and observed clinical effects were no different in bittered compared with nonbittered groups. Likewise, the rates of hospital admission, critical care treatment, and use of alkalinization, hemodialysis, or intubation showed no differences with bittering. Conclusion. Despite the appealing logic of limiting the ingested volume and thereby the severity of poisonings by adding aversive agents, and despite promising results in volunteer studies, bittering agents do not decrease the frequency or severity of pediatric antifreeze poisonings. The addition of bittering agents to household products cannot be justified based on actual poisoning data. |
| doi_str_mv | 10.1177/0009922809339522 |
| format | Article |
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Zane ; Marr-Lyon, Lisa ; White, Marisa K.</creator><creatorcontrib>White, Nicole C. ; Litovitz, Toby ; Benson, Blaine E. ; Horowitz, B. Zane ; Marr-Lyon, Lisa ; White, Marisa K.</creatorcontrib><description>Background. Legislation requiring bittering of antifreeze enables assessment of the impact on frequency, volume, and severity of pediatric antifreeze ingestions. Methods. US poison control data for antifreeze ingestions in children younger than 5 years were analyzed comparing 232 ingestions occurring in states after enactment of bittering requirements with 6218 cases occurring in states (or at times) where bittering was not required. Results. The frequency of pediatric antifreeze ingestions was unchanged after implementation of bittering in Oregon and California. The medical outcome distribution, median volume ingested, and observed clinical effects were no different in bittered compared with nonbittered groups. Likewise, the rates of hospital admission, critical care treatment, and use of alkalinization, hemodialysis, or intubation showed no differences with bittering. Conclusion. Despite the appealing logic of limiting the ingested volume and thereby the severity of poisonings by adding aversive agents, and despite promising results in volunteer studies, bittering agents do not decrease the frequency or severity of pediatric antifreeze poisonings. The addition of bittering agents to household products cannot be justified based on actual poisoning data.</description><identifier>ISSN: 0009-9228</identifier><identifier>EISSN: 1938-2707</identifier><identifier>DOI: 10.1177/0009922809339522</identifier><identifier>PMID: 19571333</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Accident Prevention - methods ; Accidents, Home - mortality ; Accidents, Home - prevention & control ; Accidents, Home - statistics & numerical data ; Age Factors ; Antidotes - therapeutic use ; Chemistry, Pharmaceutical ; Child, Preschool ; Children ; Control data (computers) ; Eating ; Ethylene Glycol - chemistry ; Ethylene Glycol - poisoning ; Female ; Flavoring Agents - chemistry ; Follow-Up Studies ; Hemodialysis ; Household products ; Household Products - poisoning ; Humans ; Incidence ; Infant ; Intubation ; Legislation ; Male ; Pediatrics ; Poison Control Centers ; Poisoning ; Registries ; Retrospective Studies ; Risk Assessment ; Survival Rate ; Taste ; United States</subject><ispartof>Clinical pediatrics, 2009-11, Vol.48 (9), p.913-921</ispartof><rights>2009 The Author(s)</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c364t-351f5ecac1680f41541d704613e5f25b628fc3b45d061c865dcd9338fcb8da7f3</citedby><cites>FETCH-LOGICAL-c364t-351f5ecac1680f41541d704613e5f25b628fc3b45d061c865dcd9338fcb8da7f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0009922809339522$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0009922809339522$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19571333$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>White, Nicole C.</creatorcontrib><creatorcontrib>Litovitz, Toby</creatorcontrib><creatorcontrib>Benson, Blaine E.</creatorcontrib><creatorcontrib>Horowitz, B. Zane</creatorcontrib><creatorcontrib>Marr-Lyon, Lisa</creatorcontrib><creatorcontrib>White, Marisa K.</creatorcontrib><title>The Impact of Bittering Agents on Pediatric Ingestions of Antifreeze</title><title>Clinical pediatrics</title><addtitle>Clin Pediatr (Phila)</addtitle><description>Background. Legislation requiring bittering of antifreeze enables assessment of the impact on frequency, volume, and severity of pediatric antifreeze ingestions. Methods. US poison control data for antifreeze ingestions in children younger than 5 years were analyzed comparing 232 ingestions occurring in states after enactment of bittering requirements with 6218 cases occurring in states (or at times) where bittering was not required. Results. The frequency of pediatric antifreeze ingestions was unchanged after implementation of bittering in Oregon and California. The medical outcome distribution, median volume ingested, and observed clinical effects were no different in bittered compared with nonbittered groups. Likewise, the rates of hospital admission, critical care treatment, and use of alkalinization, hemodialysis, or intubation showed no differences with bittering. Conclusion. Despite the appealing logic of limiting the ingested volume and thereby the severity of poisonings by adding aversive agents, and despite promising results in volunteer studies, bittering agents do not decrease the frequency or severity of pediatric antifreeze poisonings. The addition of bittering agents to household products cannot be justified based on actual poisoning data.</description><subject>Accident Prevention - methods</subject><subject>Accidents, Home - mortality</subject><subject>Accidents, Home - prevention & control</subject><subject>Accidents, Home - statistics & numerical data</subject><subject>Age Factors</subject><subject>Antidotes - therapeutic use</subject><subject>Chemistry, Pharmaceutical</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Control data (computers)</subject><subject>Eating</subject><subject>Ethylene Glycol - chemistry</subject><subject>Ethylene Glycol - poisoning</subject><subject>Female</subject><subject>Flavoring Agents - chemistry</subject><subject>Follow-Up Studies</subject><subject>Hemodialysis</subject><subject>Household products</subject><subject>Household Products - poisoning</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infant</subject><subject>Intubation</subject><subject>Legislation</subject><subject>Male</subject><subject>Pediatrics</subject><subject>Poison Control Centers</subject><subject>Poisoning</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Survival Rate</subject><subject>Taste</subject><subject>United States</subject><issn>0009-9228</issn><issn>1938-2707</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM1PwzAMxSMEYmNw54QicS7YSZO0x7HxMWkSHMa5atOkdGLtSLID_PWk2iQQEidL9u8924-QS4QbRKVuASDPGcsg5zwXjB2RMeY8S5gCdUzGwzgZ5iNy5v0aADkIfkpGmAuFnPMxma_eDF1stqUOtLf0rg3BuLZr6LQxXfC07-iLqdsyuFbTRdcYH9q-8wM77UJrnTFf5pyc2PLdm4tDnZDXh_vV7ClZPj8uZtNlorlMQ8IFWmF0qVFmYFMUKdYKUoncCMtEJVlmNa9SUYNEnUlR6zo-FptVVpfK8gm53vtuXf-xi6cU637nuriywJxlEgWAjBTsKe16752xxda1m9J9FgjFEFvxN7YouToY76qNqX8Eh5wikOwBXzbm19b_DL8BmFdy0g</recordid><startdate>200911</startdate><enddate>200911</enddate><creator>White, Nicole C.</creator><creator>Litovitz, Toby</creator><creator>Benson, Blaine E.</creator><creator>Horowitz, B. Zane</creator><creator>Marr-Lyon, Lisa</creator><creator>White, Marisa K.</creator><general>SAGE Publications</general><general>Westminster Publications, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7QR</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope></search><sort><creationdate>200911</creationdate><title>The Impact of Bittering Agents on Pediatric Ingestions of Antifreeze</title><author>White, Nicole C. ; Litovitz, Toby ; Benson, Blaine E. ; Horowitz, B. Zane ; Marr-Lyon, Lisa ; White, Marisa K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c364t-351f5ecac1680f41541d704613e5f25b628fc3b45d061c865dcd9338fcb8da7f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Accident Prevention - methods</topic><topic>Accidents, Home - mortality</topic><topic>Accidents, Home - prevention & control</topic><topic>Accidents, Home - statistics & numerical data</topic><topic>Age Factors</topic><topic>Antidotes - therapeutic use</topic><topic>Chemistry, Pharmaceutical</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Control data (computers)</topic><topic>Eating</topic><topic>Ethylene Glycol - chemistry</topic><topic>Ethylene Glycol - poisoning</topic><topic>Female</topic><topic>Flavoring Agents - chemistry</topic><topic>Follow-Up Studies</topic><topic>Hemodialysis</topic><topic>Household products</topic><topic>Household Products - poisoning</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infant</topic><topic>Intubation</topic><topic>Legislation</topic><topic>Male</topic><topic>Pediatrics</topic><topic>Poison Control Centers</topic><topic>Poisoning</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Survival Rate</topic><topic>Taste</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>White, Nicole C.</creatorcontrib><creatorcontrib>Litovitz, Toby</creatorcontrib><creatorcontrib>Benson, Blaine E.</creatorcontrib><creatorcontrib>Horowitz, B. Zane</creatorcontrib><creatorcontrib>Marr-Lyon, Lisa</creatorcontrib><creatorcontrib>White, Marisa K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Clinical pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>White, Nicole C.</au><au>Litovitz, Toby</au><au>Benson, Blaine E.</au><au>Horowitz, B. Zane</au><au>Marr-Lyon, Lisa</au><au>White, Marisa K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Impact of Bittering Agents on Pediatric Ingestions of Antifreeze</atitle><jtitle>Clinical pediatrics</jtitle><addtitle>Clin Pediatr (Phila)</addtitle><date>2009-11</date><risdate>2009</risdate><volume>48</volume><issue>9</issue><spage>913</spage><epage>921</epage><pages>913-921</pages><issn>0009-9228</issn><eissn>1938-2707</eissn><abstract>Background. Legislation requiring bittering of antifreeze enables assessment of the impact on frequency, volume, and severity of pediatric antifreeze ingestions. Methods. US poison control data for antifreeze ingestions in children younger than 5 years were analyzed comparing 232 ingestions occurring in states after enactment of bittering requirements with 6218 cases occurring in states (or at times) where bittering was not required. Results. The frequency of pediatric antifreeze ingestions was unchanged after implementation of bittering in Oregon and California. The medical outcome distribution, median volume ingested, and observed clinical effects were no different in bittered compared with nonbittered groups. Likewise, the rates of hospital admission, critical care treatment, and use of alkalinization, hemodialysis, or intubation showed no differences with bittering. Conclusion. Despite the appealing logic of limiting the ingested volume and thereby the severity of poisonings by adding aversive agents, and despite promising results in volunteer studies, bittering agents do not decrease the frequency or severity of pediatric antifreeze poisonings. The addition of bittering agents to household products cannot be justified based on actual poisoning data.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>19571333</pmid><doi>10.1177/0009922809339522</doi><tpages>9</tpages></addata></record> |
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| subjects | Accident Prevention - methods Accidents, Home - mortality Accidents, Home - prevention & control Accidents, Home - statistics & numerical data Age Factors Antidotes - therapeutic use Chemistry, Pharmaceutical Child, Preschool Children Control data (computers) Eating Ethylene Glycol - chemistry Ethylene Glycol - poisoning Female Flavoring Agents - chemistry Follow-Up Studies Hemodialysis Household products Household Products - poisoning Humans Incidence Infant Intubation Legislation Male Pediatrics Poison Control Centers Poisoning Registries Retrospective Studies Risk Assessment Survival Rate Taste United States |
| title | The Impact of Bittering Agents on Pediatric Ingestions of Antifreeze |
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