Tramadol overdoses frequently cause CNS depression, nausea/vomiting, tachycardia, and seizures. Symptoms generally resolve within 24 hours. Accidental ingestions in children were well tolerated, primarily causing sedation.

In this cohort of hospitalized lithium exposure patients, death was rare. Reported cardiac complications were unusual with instances requiring cardiovascular intervention occurring only in cases of chronic lithium overdose. The majority of lithium toxicity cases were managed without HD.

Over 200 000 persons of Hmong ethnicity live in the United States. The majority of this Southeast Asian ethnic group live in California, Minnesota and Wisconsin. Tradition plays a strong role in the Hmong population, and difficulty in assimilation into "Western ways" has been reported to result in depression and suicide attempts. Some products sold at Southeast Asian ethnic markets are well-known within the Hmong community to be lethal but are essentially unknown to the outside community. We describe eight cases in which cyanide-containing products were ingested by Hmong patients. Seven cases were suicide attempts involving the ingestion of a locally-purchased substance intended for cleaning metal, coins, or jewelry. One case involved the fatal ingestion of a cyanide-containing "herbal" cure. In the majority of the cases, cyanide was not initially suspected, and treatment was delayed due to lack of information regarding the product ingested. In the two patients who survived, the cyanide antidote kit (sodium nitrite, amyl nitrite, and sodium thiosulfate) was administered early. Clinicians should be aware that unusual and potentially lethal products are easily available at ethnic markets. Cyanide toxicity should be suspected, and empiric antidote therapy initiated early, in patients of Hmong or Southeast Asian descent who present with sudden and unexplained cardiovascular collapse and metabolic acidosis, especially in the setting of a suspected suicidal ingestion.

Extension, Kern CountyPoisonous Plants T his publication describes typical adverse symptoms and health effects that selected common poisonous plants and plant parts can cause in people. It also includes a table of poisonous plants commonly found around the home and garden and explains how to make a plant identification file. Plants associated with poisonings and other health problems that have been frequently reported throughout the state to the California Poison Control System are listed. Plant species that can cause dermatitis (an inflammation or swelling of the skin) or other form of poisoning, as reported by other reliable sources, are also included.The table in this publication lists plants alphabetically by scientific name to avoid confusion that sometimes occurs with use of common names. We include common names of plants and, for most plants, the following toxicity information: the name of the toxin, which part of the plant contains the toxin, and the human body part or parts that are affected by the toxin. Note that the publication does not include all known poisonous plants that could be found in California gardens or landscapes, only those commonly found in these settings and that are toxic in some way to people. Some of the plants listed in this publication are quite toxic to animals. Animal genera and species vary in their sensitivity to the respective poisonous components. Livestock injury and mortality from ingestion of poisonous plants are well documented, with an extensive research base. However, a discussion of plant toxicity to livestock or other domestic animals is outside the scope of this publication.Sources used in compiling this information include California Poison Control Center data, textbooks, scientific journal articles, and field guides. A bibliography at the end of the publication provides reference materials.

Introduction: Poison Control Centers (PCCs) have been shown to reduce health expenditures by reducing emergency department and clinic visits. The effect or association of PCC call frequency on acute hospitalization rates for poisonings has not been studied extensively.Methods: All nonfederal hospital discharges for acute poisoning principal diagnosis codes (960-979, 980-989, 9956X, 3030, and 005) in California between October 1999 and June 2002 were examined. Approximately 3.3% of the discharges had county/hospital information suppressed in the public-use database because of confidentiality criteria and were excluded from the analysis. U.S. Census Bureau population estimates for appropriate years by counties were also obtained. The 58 California counties were condensed to 48 counties and 3 "small-county" geographic groupings. Exposure calls by counties/groupings to the California Poison Control System (CPCS) for the same period were tabulated.

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