Holiday Hazards – PediaCast 479

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Show Notes

Description

• Dr Alexandra Funk, director of the Central Ohio Poison Center, visits the studio as we consider holiday hazards. We identify common dangers in the home and share tips for keeping kids and families safe throughout the season. We hope you can join us!

Topics

• Holiday Hazards
• Central Ohio Poison Center

Guest

• Dr Alexandra Funk
  Director, Central Ohio Poison Center
  Clinical Pharmacist and Toxicologist
  Nationwide Children’s Hospital

Links

• Central Ohio Poison Center
• Fire Safety – PediaCast 336
• Poison Safety – PediaCast 344
• Water Safety – PediaCast 348
• Tip-Overs and Falls – PediaCast 361
• Sun Safety – PediaCast 433

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from Nationwide Children's Hospital. We are in Columbus, Ohio. 

It's Episode 479 for December 9th, 2020. We're calling this one "Holiday Hazards". I want to welcome all of you to the program.

0:00:54

So, we have made it to the final episode of PediaCast for the year 2020. And if you're like me, you're kind of happy that the end of 2020 is right around the corner. I mean, really, 2020 cannot end soon enough. And I think now more than ever, we all just need a fresh start and a little bit of hope. And there is hope on the horizon in the form of a COVID vaccine which you can be sure we will be talking about often in 2021.

There's also hope as we learn the best strategies for treating severe COVID infection. And although the number of cases and the number of deaths has exploded in recent weeks as we come off of the Thanksgiving Day holiday surge, the relative death rate, so the number of deaths compared to the number of the cases, has really improve quite a bit. Which is expected as we learn optimal supportive care and the right medications to use, and really the best strategies for treating severe COVID infections.

0:02:00

So, the relative number of deaths is better. Although we do have to worry as hospitals fill up, could rationing of care begin and could we start to see more deaths of folks who would not have died had there been adequate hospital space for them? So, that is certainly not a reason, the fact that we're getting better at treating severe COVID and the fact that there is a vaccine on the horizon, these are not reasons to let our guard down. 

I mean, we're still seeing too many deaths in the United States from COVID with nearly 3,000 deaths per day. And the current trend suggest we could reach half a million deaths by the one-year mark of this pandemic.

Now, I just want to put that into a little bit of perspective. During a really bad flu year, so if we look at influenza, we recommend flu shots for everyone. So we're trying to prevent flu deaths. 

And if you look at a bad flu year, we're still at less than a thousand deaths per day from influenza, even during the worst of abnormal flu years. And so, instead of less than a thousand deaths a day from a COVID, we're seeing nearly 3,000 deaths per day, which is really quite remarkable and something that we would really want to prevent.

0:03:20

So, there's hope because we know what we need to do to make this better, right, to decrease COVID cases, hospitalizations, and deaths. We know what we need to do. We have to stay in our bubble. Stay home when we can. Wear face coverings when we're outside of the house. 

Continue to maintain at least six feet off distance between ourselves and others. And we need to wash our hands frequently, ideally with soap and water while lathering for 20 seconds. All important things as we hang on until spring and anticipate more widespread availability of COVID vaccine.

So, the end is on the horizon but we're not quite there yet. We're in the third quarter, really, and maybe toward the end of the third quarter, but we're nowhere near the end of the game. And so, please stay safe this holiday season and keep those gathering small, keep your distance. It's going to be really important. 

0:04:20

But there's also hope because we have each other, right? We're all in this together. We do have the technology to keep in touch with those we love. And that's something unique to this global pandemic compared to those of the past. We can stay connected digitally as we look forward to a future of seeing each other face to face once again.

And even though 2021 will still be a rough year, we're making progress. The pandemic will not last forever, thanks to the heroic toil of scientists and healthcare workers around the world. And we have hope in you because every time you listen to the recommendations of public health officials and your medical providers, each time you stay home and wear face coverings and keep your distance and wash your hands, every time you do those things, you are saving lives and getting us all one step closer to the end of the COVID-19 pandemic.

0:05:10

In the meantime, the holiday season is upon us and even in the midst of this troubling times, we really do have so much to be thankful for. Truly, we do. And it does us good to stop what we're doing from time to time and reflect on the things that we are grateful for. I'm grateful for my family, for our health, our home, our kitties or our little kitty cats and our birds. Not inside, outside birds, the ones that are feeders, we don't have birds inside the house.

I'm thankful for my job and a roof over my head and food in my belly. And yet, I recognize there are many around me who do not have these essential things. And so, I'm also thankful for opportunities to help others when and where I can. And opportunities have in fact presented themselves to help those in need. And I'm grateful for the chance to help my neighbors. 

0:06:04

And I'm also grateful for you, the PediaCast audience. We've made it through 14 years of episodes together. And I've grown very much as a person and a pediatrician because of your loyalty and participation in this program.

I'm thankful for all the expert guests that we are able to have on the show especially this year. There'd been many obstacles for our guests in 2020. The physical studio has been closed down since March but our guests have persevered in overcoming technological challenges from time to time so that they can still be here virtually, sharing their experience and expertise with all of you. 

Why have they rose to the challenge? Because they care. They care about children, and parents, and families everywhere, and so I'm really grateful for our guests. And we have one more in 2020, one more guest for you as we consider holiday hazards and share tips for keeping your family safe during the holiday season.

0:07:00

Dr. Alexandra Funk will be joining us soon. She is a clinical pharmacist and toxicologist at Nationwide Children's Hospital, and director of the Central Ohio Poison Center.

Before we get to her, I do have a few reminders for you. Don't forget, you can find PediaCast really wherever podcasts are found. We are in the Apple and Google Podcast apps, also iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcast apps for iOS and Android.

If you like what you hear, please remember to subscribe to our shows so you don't miss an episode. Also please consider leaving a review wherever you listen to podcasts so that others who come along looking for evidence-based child health and parenting information will know what to expect.

And we're also on social media. We love connecting with you there. You'll find us on Facebook, Twitter, LinkedIn, and Instagram. Simply search for PediaCast. Don't forget you can also get in touch with me directly. Just head over to pediacast.org and click on the Contact link. I'd love to hear from you if you would like to suggest a topic for a future episode of the program. 

Also, I want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider. 

0:08:13

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.

So, let's take a quick break. We'll get Dr. Ally Funk connected to the studio and then we will be back to explore holiday hazards. It's coming up right after this.

[Start Poison Control Jingle]

Lyrics: 1-800-222-1222. 1-800-222-1222. If you think you might be poisoned and the first thing you should do is call 1-800-222-1222. Poison is the kind of thing you're not supposed to touch. All prescriptions, cleaning stuff, or spider bites and such. If you swallowed something bad or think you took too much, call the Poison Control Center Hotline. We're the people you can trust.

0:09:04

Announcer: For poison emergencies or just questions, the Poison Control Center Hotline is here 24/7 with the expert help you need, free and confidential. We hope you never need us, but keep our number by the phone.

Lyrics: 1-800-222-1222. 1-800-222-1222. If you think it might be poisoned and you don't know what to do, call 1-800-222-1222. 

[End Poison Control Jingle]

[Music]

0:10:00

Dr. Mike Patrick: Dr. Alexandra Funk is a clinical pharmacist and toxicologist at Nationwide Children's Hospital and director of the Central Ohio Poison Center. She's here to talk about holiday hazards and keeping our family safe as we celebrate. So, let's give a warm PediaCast welcome to Dr. Ally Funk. Thanks so much for stopping by today.

Dr. Alexandra Funk: Thanks for having me, Dr. Mike. I'm glad to be here.

Dr. Mike Patrick: I really appreciate you taking time out of your busy schedule. Let's start out with just what do we need to do to safety proof our home, particularly during the holidays? How do we approach this issue of making our home safe for our kids?

Dr. Alexandra Funk: Sure. So, we're going to do the same practices that we would do normally, but there may just be a couple extra things we need to be a little bit more aware, a little bit more conscious-focused on it because the holidays can be a time of distractions. You maybe have friends or family coming over or new gifts in the house, new items in the house that we may not normally have. 

So, doing all of our basics with keeping products, stored away out of reach, out of sight of children, making sure that liquids or chemicals are stored in their original containers, making sure that we're still following our safe practices with medicine, especially if we have visiting grandparents or aunts and uncles in the house that may have additional medicines they're bringing in.

0:11:17

We'll talk about batteries a little bit later on, but making sure that batteries are not left out on the counter, or their toys or products that have batteries are secured, the little battery pouches secured and not open. Making sure that food and alcohol is put away so they're not in reach or not in sight of children. But really, just making sure that we have either the holiday decorations that we'll talk about later on or the products we talk about are really stored, out of reach, out of sight. That's the biggest thing that we can do to ensure that we have safe households this holiday season.

Dr. Mike Patrick: Absolutely, great tips. One thing I always tell parents is to actually get down at your kid's level and look around. So, you get down on your hands and knees, kind of crawl around from room to room and see the world from their eyes and what sort of hazards there may be. You may find an electrical outlet that doesn't have a safety cover on it. Often, you can find something that could be dangerous that maybe you didn't see from the adult level.

0:12:20

And if you are interested really in a comprehensive series on really shoring up things and making our home safe, I did several podcasts with Dr. Lara McKenzie. She's with the Center for Injury Research and Policy at Nationwide Children's. And we did one on the fire safety, poison safety, water safety. We talked about tipovers and falls. We've talked about sun safety during summer. 

So, I'll put a link to each of those episodes in the show notes over at pediacast.org so folks can find them easily if you're interested in more information on keeping your family safe at home.

Now, this year with COVID, things are certainly different and we are encouraging folks to have small gatherings, stay within your bubble, take advantage of digital technology to connect with folks and family and friends and loved ones over the holidays.

0:13:10

But this particular episode is going to live in the archive, hopefully, for a long time and there will be a day when COVID is not a concern. And so, I did want to talk about keeping our kids safe before, during, and after holiday gatherings. So, whether that gathering is at your home or you're traveling to someone else's home, how can we keep our kids safe in and around parties?

Dr. Alexandra Funk: Absolutely. And as you mentioned before, kind of taking a step and actually being mindful and being aware of your surroundings. So, if you're going in to a new environment, taking a few extra seconds to look around, look on the floor especially as you mentioned, furniture moving or stuff like that, maybe new items are exposed. So, being really aware and mindful of surrounding, I think, is a huge part of that.

Also, especially even with small gatherings, this could happen. Maybe you think all the kids are fine playing but making sure that an adult or someone who is able to supervise the kids is acknowledged or pinpointed out ahead of time and that duty or responsibility is known. 

0:14:13

And so, there is one person or a multiple people depending on the number of kids you have or the number of people you have. So, if people don't think "Oh, so and so is watching the kid," it's a true duty that could be assigned.

Dr. Mike Patrick: Yeah, kind of like the swimming pool, in the swimming pool.

Dr. Alexandra Funk: Yeah, exactly. One parent to one kid or it's very similar, especially if you're in a new surrounding or in different environments, not on your own environment. Making sure that kids aren't running off and getting into something that you're not aware within the other room, the living room, et cetera.

Dr. Mike Patrick: And alcohol leftover and cups can certainly be an issue too, may not finish a drink and you just leave the cup laying around somewhere. And even after the party is over, if it was at your house, there may be some cups laying around that are there the next morning and your kids get up before you do. And so, cleaning up after the party is over quickly is going to be pretty important too, correct?

0:15:09

Dr. Alexandra Funk: Absolutely, yup. And making sure that you're not keeping those red solo cups or tumblers with alcohol in them and putting them in the fridge, either discarding that alcohol or putting it back in its original container and putting that locked up and away. We have had situations where a parent or caregiver goes to grab the water bottle in the fridge in the middle of the night, not realizing that it is a clear liquid, a vodka or some other sort of alcohol. And inadvertently, a child can get expose that way. So, absolutely clean up right away and discard or put in original containers.

Dr. Mike Patrick: And I know you mentioned this before but I think it bears repeating, visitors' purses and handbags and things that may have medicine stored in them that are in floor level or counter level and kids can get in those pretty easily. And so, definitely keep that hazard in mind as well.

0:16:00

What I wanted to do is just to take some common things that you may get called about at the Poison Center because I know you field lots of phone calls all year long, but definitely during the holidays as well. And so, I just came up with a list of things that someone might call about and just thought maybe you could walk us through what are the potential problems, what symptoms could occur, what do we watch for, when do you go to the emergency department? And are there any particular things that you would do when a particular exposure happens? 

And I wanted to start with the holiday plants. So, we have pretty things around the home and not only kids but pets. Do you get calls about pets at the poison center?

Dr. Alexandra Funk: We do. And we have very highly trained nurses, pharmacists, physicians here. We don't have any veterinarians on staff. I always say if I were to go back for my second life, I maybe become a veterinarian. 

So, we can handle some pet exposure calls. But there actually are pet poison hotlines, very similar to Poison Control Hotlines that are staffed by veterinarians and vet techs. So they have much more knowledge on animal toxicity. So, some things we can handle, but we mostly are trained and skilled with human exposures.

0:17:16

Dr. Mike Patrick: Got you. Very good to know. So, things like poinsettias, mistletoe, holly, all of these sorts of things, do they pose any danger or not really?

Dr. Alexandra Funk: They can, depending on which plant we're talking about. I'll start with the least likely to cause toxicity or concern and that would  be poinsettias. So, I know everyone think that poinsettias are very poisonous. Well, they can cause problems, it's mostly due to allergens. So, poinsettia is actually in the same plant family as natural rubber latex. So, someone has a latex allergy or they're sensitive to latex, people can often develop kind of one that cause sensitivity, that allergic reaction. 

0:18:00

There have been studies that have looked at how much poinsettia plants or leaf material would one need to consumer in order to be something with serious toxicity or poisoning. And it's up to over 500 leaves or something very large, a large quantity. I think more than one plant won't even hold that would produce severe toxicity or even potentially bad, but again, that's such a large amount. 

And typically kids will maybe touch their hands or maybe get a leaf or two. So, typically poinsettias are not something that we're very worried about.

Dr. Mike Patrick: Unless you have a history of latex allergy.

Dr. Alexandra Funk: Correct.

Dr. Mike Patrick: And you want to make sure you have your EpiPen available because that would be more of the anaphylactic kind of reaction, right? Not a toxic reaction.

Dr. Alexandra Funk: Absolutely, yeah, more of an allergic reaction.

Dr. Mike Patrick: All right. And then, what about mistletoe and the holly?

Dr. Alexandra Funk: Yes. So those two, we're a little bit more worried about. Holly, the thing that we're worried about is the berries. So, the berries can be very upsetting to the gastrointestinal tract, due to toxins that they have. 

0:19:09

However, we get more concerned when it's a large consumption of berries. There's no defined toxic dose that you want to say, but it's generally suggested of 20 to 30 berries would be something that we'd be concerned about and say, "Hey, I think we need to have you get evaluated in the ER."

Our goal at the Poison Center is to keep kids and patients home as much as possible. There obviously are various situations where we deem that additional medical evaluation is needed. We'll say that you need to be referred into an emergency facility, typically in ER.

And then mistletoe, so mistletoe is a parasitic plant that will grow on typically branches of trees. And it has white berries. I know all of our holiday decorations usually have maybe red berries but the actual plant has white berries with it. 

0:20:01

And there are two species of it, American species and then the European species. American species is typically what we would see here in our communities around the holiday time.

Again, similar to the holly, the biggest concern here will be any nausea, vomiting, some of those stomach symptoms, maybe diarrhea. Typically, we don't expect to see too much toxicity or too much poisoning with the small inadvertent accidental ingestion. But again, with either the mistletoe or the holly depending on the quantity, or if it was a teenager who was intentionally trying to do something maybe on a dare or maybe doing it to be funny. 

If it was intentional ingestion in a larger amount, we would be more concerned. And then, of course, if there is extended period on vomiting or patient is not drinking or staying hydrated, we would also be concerned with subsequent symptoms such as dehydration or electrolyte abnormalities with that.

0:21:05

Dr. Mike Patrick: So, really the biggest thing there is going to be the GI upset and vomiting and belly pain and those kinds of things that might end up sending to the hospital.

Dr. Alexandra Funk: Yes, exactly. 

Dr. Mike Patrick: And then what about essential oils? A lot of us have a diffuser and would like the oil scent in the house or you may have it for other purposes. Are there particular essential oils that we have to worry about?

Dr. Alexandra Funk: And so essential oils is such a long broad topic. We could probably have a whole podcast on essential oils. And as you mentioned, they're concentrated oils that typically come from plants and use those diffusers or flavorings. Or some people may use them and try to help with medicinal purposes. 

I think the term really is misleading. The term essential comes from the essence of the plant, rather than it being a vital component for biological function.

0:22:03

And so, I bring that up because people often think, "Oh, well, it's natural. It must be healthy. It must be safe." And that's not always the case. There are some essential oils and this is not an all-inclusive list that we do here and kind of our red flags. Our senses get high and we can be a little concerned.

Some of those include warm oil or which is actually the essential oil that's in essence alcohol, the green, glowing green essence, camphor, clove oil, eucalyptus, lavender, peppermint oil, pine oil, tea tree oil, and oil of wintergreen. And oil of wintergreen, that can be a holiday favorite because it has kind of that wintergreen smell. 

Of all the essential oils, oil of wintergreen, to me, I consider this one to be the scariest. This one, oil of wintergreen, even in very small amount can lead to significant toxicity poisoning. And there's actually been reported deaths in pediatric patients with very small amounts, 3 to 5ml, so one mouthful of it.

Dr. Mike Patrick: Wow. So, this is definitely something that you want to have locked away. 

Dr. Alexandra Funk: Absolutely.

Dr. Mike Patrick: You have to get rid of the bottle itself. And just use a drop in a diffuser, not something you want to pour in.

Dr. Alexandra Funk: Yeah, absolutely. And typically, essential oils will have droppers but if that dropper ever comes out or if you have a bottle that maybe you're refilling your smaller bottles with, definitely want to make sure that your essential oils are locked up and way out of sight. 

Similar to the plants, a lot of them will cause some GI symptoms, the nausea, vomiting. But as mentioned with some of these other ones, we could see potentially seizures, especially with camphor. A lot of times we'll see seizures with that. 

Warm oil, since it is an essence, we could expect to see alcohol intoxication or intoxicated. 

0:24:05

And then, with the oil of wintergreen, it actually gets converted to a salicylate in the body. And so, what happens is you get salicylate poisoning and aspirin is a salicylate. We basically have that aspirin poisoning on our hand that we're dealing with then.

Dr. Mike Patrick: Yeah, very interesting. Oil of wintergreen, so everyone, make note that that's the most dangerous one. But there are other that could potentially be problems. And so, your best bet is to keep them away from kids. And if there is an exposure to call the Poison Center, then they can let you know whether that's a serious exposure or not and what you need to do for it. And we will have the phone number coming up for the Poison Center, so folks can get connected with you easily.

Speaking of oils, one that we definitely worry about would be lamp oil, right?

Dr. Alexandra Funk: Yes. Lamp oil.

Dr. Mike Patrick: It's not an essential oil.

Dr. Alexandra Funk: No, it's not an essential oil. It's more of a lighting source. It can be used for decorations or it may be used as sources for additional lights like oil candles.
 
0:25:12

I always think of them like if I have tiki torches, you could put the oil in and then light the wick. And it will produce the fuel to produce that either light or that heat. Sometimes, they can be just used for decoration as well.

They're often colored. They sometimes can be clear, but the liquid is often colored. And to a kid who is curios, it may look like a fun liquid or it may look like a beverage. And adults can sometimes be fooled with this, too. So, it's not just targeted at kids.

Typically, what was in lamp oil is paraffin which is thankfully poorly absorbed when ingested from the GI tract. However, the biggest risk with lamp oil, since hydrocarbon is oil, is the risk of aspiration.

0:26:02

So, if someone is drinking it and maybe they coughed or gagged a little bit, then the oil goes down into the lungs. And then we can have aspiration pneumonia. We can get injury from the aspiration of the oil getting into the lungs.
 
Dr. Mike Patrick: And that can be life threatening. And so, if these kinds of ingestions come in to the emergency room, we take them very seriously. So, lamp oils as a hydrocarbon, you definitely want to keep those locked away and out of reach of kids and seek help right away if there is any kind of exposure.

And that's a kind of thing, too. You don't necessarily want to induce vomiting if they do ingest that because then they could aspirate it. And it can be extremely dangerous to the lungs, as you mentioned. So, definitely you want to watch out for that.

One that kind of surprise me as I was researching this were the old bubble lights. The bubble lights actually have methylene chloride in them. And that is not necessarily a safe substance, correct?

 0:27:03

Dr. Alexandra Funk: Correct. That's not. And I do want to touch, you mentioned quickly on inducing vomiting. We do not recommend inducing vomiting for any exposure. It could end up causing more harm than good. 

I know back in the day, actually before I was practicing, we would often recommend syrup of Ipecac or other ways to induce vomiting, thinking to get that poison out. But it actually causes more harm than good. So, across the board, we wouldn't recommend inducing vomiting for any exposure.

Dr. Mike Patrick: And if you have syrup of Ipecac in your medicine cabinet, just throw it out, right? We don't recommend that anymore.

Dr. Alexandra Funk: Throw it out. Extend them to me. I'm on a hunt to get a bottle of it to save for my collections. If you have some hanging around, don't use it. Send it over to us or throw it out.

[Laughter]

Dr. Mike Patrick: When I was a resident, I think it was the two-year visit or maybe it was the 18-month visit, we had a pack in our clinic of poison information. And there was a little bottle. 

0:28:05

I'm aging myself here. But we had a little bottle of syrup of Ipecac that we sent home with everybody. And, of course, it was branded with the Children's Hospital logo because it was recommended back then. But definitely, as we know more and science advances, recommendations change. And the recommendation to induce vomiting is definitely one that has changed.

Dr. Alexandra Funk: Correct. Absolutely, yeah, we no longer recommend that. Absolutely. Back to bubble lights though, yes. And what these are, if someone is not familiar with it, you can Google it or pull up a picture, they are still around. 

They were very popular in the 1950s, the 1970s. They're a bulb, per se, with a vial that comes out. And in the bulb, there is a light, an incandescent light that produces heat. And in the vial, there is liquid.

0:29:00

And so, when that bulb gets turned on and it produces heat, it actually causes the liquid in the vial to bubble, to boil and bubble. And so it gives a nice effect of these bubbling lights. However, the liquid inside is what we're concerned about. 

And it will depend and it will vary based on which product you have. Sometimes, there could be water in it. Sometimes there can be oil. But oftentimes, more than not, what is contained in there is methylene chloride. 

And the methylene chloride is something that we are worried about. It is a solvent and so it's used as an agent to help dissolve other items. If you think about this, it's most commonly found in paint thinners.

So, paint thinners, if you get paint on your hands, or I don't encourage you to use methylene chloride in your hands but I want to give you a better example. If you try to clear your paint off with your paint brush or other substance and you're using a paint thinner, it's often methylene chloride.

0:30:01

And so what happens is these bubble lights are very attractive to kids and if they are made of glass or plastic, they're usually a very thin glass or plastic. And so the concern is, if they're playing with them and they break and that methylene chloride liquid gets on their skin, they inhale it or they drink it, we have concerns with that.

Not only are you having concerns with the injury maybe from their broken glass or a plastic, but methylene chloride can be absorbed via inhalation, so inhaling it via the skin and ingesting it. And what we're worried about with methylene chloride is that they can cause symptoms of headache, drowsiness, some nausea, vomiting. 

But the little pearl here with this is that it actually gets converted to carbon monoxide within the body. So you can see symptoms of carbon monoxide toxicity and poisoning. And that's what the problem is, is that then your oxygen that's in that body isn't able to be used as effectively and you are basically presented with a carbon monoxide exposure.

0:31:10

Dr. Mike Patrick: Wow. That is really interesting from the methylene chloride. A carbon monoxide, let's move on to that one because I have that listed with fireplace hazards. But really, anywhere that you have combustion, carbon monoxide can be a by-product of that combustion. And so you want to make sure that that's vented outside of the home.

We're not talking candles but definitely fireplace, your stove, any kind of heating device that you would have in the house that has a flame, certainly your furnace. That's why we vent them out of the house to keep carbon monoxide, which is a by-product of that combustion outside of the home. 

But carbon monoxide is really very dangerous. It binds very strong lead or hemoglobin and displaces oxygen, so we basically suffocate. We're not able to get oxygen to our tissues when we have carbon monoxide poisoning. 

But what are some of the symptoms of that? What would make us concerned that you could be dealing with carbon monoxide in your house?

0:32:08

Dr. Alexandra Funk: Sure. And carbon monoxide is an odorless, tasteless, colorless, non-irritating gas, so you don't know that it's around. And so, the best thing to have obviously is a carbon monoxide detector because that is a specialized machine that can detect various levels of carbon monoxide. 

And so, there's no way for our bodies to say, "Hey, I smell this," or "Hey, I can feel this gas in the air." The only way we would really know is when we start to be symptomatic because of that inability to utilize our oxygen or, as Dr. Mike have mentioned, kind of suffocating our bodies.

We could start with some minor symptoms, such as headaches, maybe nausea, dizziness, weakness. And depending on the amount of carbon monoxide you're exposed to and how long you're exposed to it, that actually could progress to some much more severe symptoms of coma, maybe syncope, or having a fallout episode, having abnormal heart rhythms, having maybe potentially decreasing the blood flow to your heart and causing ischemia or what would be similar to a heart attack, as well as even seizures. 

0:33:18

And unfortunately, carbon monoxide is very deadly because, again, if you don't know that you're exposed to it or you're around it, you maybe kind of say, "Oh, do I have the flu? Do I have the cold? What's going on?" and kind of ignoring those non-specific symptoms.

Dr. Mike Patrick: Absolutely. And so, especially if you have a fireplace, make sure at the beginning of the season that everything is working correctly. And that the parts of your fireplace are doing their intended job of venting the gases outside of your house and not into your living room. It's going to be very important. 

And if you're worried that maybe you are suffering from symptoms of carbon monoxide exposure or your carbon monoxide detector is going off and you can't figure out what the problem is, just call 911 and let the emergency medical folks and the fire department determine what's happening and whether this is dangerous or not.

0:34:12

Dr. Alexandra Funk: Absolutely. The fire department will be able to come out. They will be able to test the air, try to find where it's coming from. Of course, if your alarm is going off, get out of the house. The best thing to do is to get fresh air, to get fresh ambient air and get away from the exposure. 

And it's not quite a holiday hazard per se but in terms of wintertime and snow falling and potentially maybe power outages and losing our heat sources, we'll oftentimes see exposures when people try to either bring generators, either inside the home or near the home. Those should be kept as far away from the home as possible. 

Window is closed, we're not giving that passed off gas from that combustion. Or if there's kerosene heaters or fuel-based heaters that are brought inside, that can also be a source of carbon monoxide.

0:35:02

If you're running your car, you have an attached garage, definitely, you don't want to run your car within your garage. You want to probably pull your car out to make sure that the exhaust is getting outside and not tumbling back into the house because that's a source of carbon monoxide as well.

So, the best thing, absolutely, have a working carbon monoxide detector and if it does go off, get out of the house and call 911, as Dr. Mike has said, and then give us a call. The Poison Center will be able to guide you further on what you need to do next.

Dr. Mike Patrick: Sounds great. Speaking of the fireplace, sometimes folks use some color enhancers, and then there's fire starters. So there's some products related to the fireplace that can potentially be a problem, right?

Dr. Alexandra Funk: Yes. And these are fun to look at. They can make the fire be blue or green colors or they can help you start the fire. But we want to make sure that we're only utilizing them by looking at them, that we're not touching them or we're not ingesting them. Oftentimes, the fire color enhancers contain metals, a variety of heavy metals, most commonly will be copper ammonia that will make the green or the blue flame.

0:36:12

If these products are ingested, again, kind of the theme here but we'll start to see some GI symptoms, nausea, vomiting but it could progress to severe abdominal pain, bloody diarrhea. And typically, that would be a quick onset from the exposure with it. And the reason why this is, is because this can be corrosive. 

And so, it would very damaging to your gastrointestinal tract. And then, if it was a large amount that we were exposed to, we would have to be worried about, "Okay, well, what was the heavy metal do we need to worry about, the heavy metal toxicity here with that as well?"

Dr. Mike Patrick: And so those are definitely things to keep out of the reach of kids. Don't let them just sit by the fireplace. Keep them locked away when they're not in used.

Dr. Alexandra Funk: Absolutely.

Dr. Mike Patrick: And then what about Christmas tree preservatives? So, folks who go out this time of the year, get a live tree, bring it into the house. Sometimes rather than just water at the base of the tree, they'll put preservatives. Can those be dangerous?

0:37:13

Dr. Alexandra Funk: Yes. And oftentimes, it will depend on which product is used. And I do know that a lot of times, they don't even recommend Christmas preservatives. They just say water is the best thing for the trees. 

And we're more of a fake tree family, so I don't have too much personal experience with using these preservatives. But a lot of times, they contain a fertilizer, maybe a type of sugar or a sweetener and maybe some fungicides.

If it's consumed in a small amount, it's typically not a problem. But what we're worried about, again, is a large amount, a large ingestion and this one can be a concern for animals. Maybe the cats or the dogs or a young kid is going under the tree and licking the fluid or the water that's under the base there. 

It can cause GI symptoms, again, upset stomach, potentially even vomiting. But it really will depend on the specific products. A lot of these have fertilizers in them. 

And so, if it's a fertilizer that has ammonia, we'd be a little bit more concerned. Ammonia can be pretty toxic, pretty poisonous.

0:38:20

And then, there are some that people will make at home. I came across a couple recipes that are for homemade preservatives. And depending on what you put in your homemade preservatives, there may be toxic components you're putting in there, whether it's aspirin or bleach or maybe alcohol or vinegar or something. You can potentially create toxic fumes if you're mixing chemicals or mixing products. 

And so, the best thing that we would recommend would be just water. And if you are using this, making sure that you're monitoring who's going around the Christmas tree, make sure no one is licking it up or lapping it up. And then definitely watch out for that gastrointestinal, nausea, vomiting, irritation.

0:39:02

Dr. Mike Patrick: Great advice. Just water under the tree, that's all that you need. 

We are a fake Christmas tree family as well. And so when this came up, it was like, "I didn't realize that that was even a thing." That you use preservatives with the water at the bottom of your tree.

So, we talked about alcohol and unattended cup during a gathering. I just wanted to focus on that a little bit more. It's not just a matter of a child becoming intoxicated if they drink some alcohol. They really can become much dangerous than that, right? Have you seen instances where kids have real alcohol toxicity?

Dr. Alexandra Funk: Yes, and kids can be more sensitive to alcohol. They have smaller bodies. They're not used to drinking it. They don't have a tolerance, per se. 

And so, they can definitely be intoxicated which could affect their mental status, could affect their ability to breathe on their own. And also, what we see with kids too is they tend to get hypoglycemic or their blood sugar blood drops.

0:40:11

And you need glucose in your body. You need your blood sugar to perform your vital functions and if it drops too low, that could further worsen the ability to kind of maintain your mental status, tell your brain to "Hey, keep breathing." 

And so, not only are we worried about the intoxication. Like you said, there are other severe and more systemic symptoms that a kid could experience. And they're most commonly going to be found with hypoglycemia or low blood sugar. 

So, we do want to make sure that we are keeping this alcohol drinks stored away, not saving old drinks in the cup in the fridge and things like that.

Dr. Mike Patrick: Yeah, definitely important. Keep them away from the alcohol. 

And then vaping, the liquid that folks use for vaping, that's something that, again, this is not necessarily holiday related.  Although if you're going over to someone else's house or they're coming over to yours, it could potentially be a source of exposure that you wouldn't have anticipated. But that has very concentrated amount of nicotine in these vaping liquids and that can be dangerous for kids, correct?

0:41:17

Dr. Alexandra Funk: Yes, very concentrated. There are different percentages that vary from a lower percentage up to a much a higher percent. And that higher percent is more of 3 to 3.5 range which you think that's probably not a lot. But if you think about that amount of nicotine that is in that, I'm going to use my math here, it's about 100 cigarettes.  It could be, depending on the concentration and how big your product is. 

And just to put them to perspective, one cigarette or three butts can be toxic to a kid. So, if you have a concentration, a product that is equivalent to 10, 20, 30 , 100 cigarettes, that's a lot of nicotine. And that's very very toxic to anybody, let alone a pediatric patient.

0:42:06

Dr. Mike Patrick: And sometimes, these vials can have very colorful labels. The liquid inside may be colorful and they can have a scent associated with them that can be very pleasing to kids, so even more reason to keep these things out of sight even.

Dr. Alexandra Funk: Absolutely. You said they're colorful. They have flavors, anything from bubble gum to apple pie, to banana, to chocolate. Any flavor, you name it. And if you smell it, it smells just like the flavoring, the product that it is. It doesn't smell like nicotine or it doesn't smell like tobacco or smoke. 

And so, it's very appealing to children. And if someone were to drink it, especially that high concentrate that a small kid gets a couple of drops of that high concentrated product, they can be very very sick and have significant symptoms. Typically, what would happen is they would start to have nausea and vomiting first pretty rapidly, but that can quickly progress to seizures.

0:43:03

Dr. Mike Patrick: So, again, even if you're not seeing symptoms, if a child had exposure to the vaping liquid, you just want to have them seen by a medical provider, right? I mean, you still want to take a chance that they may have taken more and just haven't developed symptoms yet.

Dr. Alexandra Funk: Absolutely. You can always give us a call, too. We can work through it, see kind of how long ago did it happen, how much do we think they got exposed to, kind of what the product is that we're working with.  And when any time when someone does call, we'll ask probably a lot of questions. Or one may think it's a lot of questions, especially for a parent who's anxious or worried. But we do that to get the best picture of what the situation is going on and to get the best information so we can make an appropriate triage in assessment and say, "No, we think you're okay to stay home" or "No, you have to go in." 

But a lot of times, with this concentrated nicotine liquids, it's more so than not that we're high-end aware and we're worried and we'd say, "You probably have to be evaluated."

0:44:00

Dr. Mike Patrick: Absolutely. You've alluded to batteries early on in our time together, especially the small button batteries, those can really be a hazard for kids. Tell us about that risk?

Dr. Alexandra Funk: Yes. In the button batteries, there's little circular ones that are probably about the size of a penny to a nickel, often found in hearing aids or toys, maybe watches. They're also found in either like flameless candles, maybe the meat thermometer. I just had to change ours recently. 

Or even though singing cards, the cards that you get the store, they open and they sing. What's powering that is this button batteries. Kids' toys may even potentially have these. 

And so, what these are, they are very small, about the size of the penny or a nickel. And what happens is if the kid or person, if the child ingests this, the problem is that it can get lodged either in the esophagus or in the stomach somewhere. And what happens in order for these button batteries to work is that you have to have contact on the positive side and on the negative side. And this is easily able to be achieved within the esophagus or in the gastrointestinal tract. 

0:45:15

And so when both sides have contact with, it's saying "Hey, I'm able to produce this current" and what happens, there's a couple of different mechanisms that can cause injury with button batteries. But a lot of the lithium ones around, the injury is due to the electrical current that is produce or could be potentially due to the production of hydroxide which is a corrosive agent.

And so, if this battery is lodged in the esophagus, kids may complain of throat pain or drooling, difficulty swallowing or refusing to drink, maybe coughing, choking, stomach upset. And the biggest thing, obviously, is making sure they can breathe. But what happens is this could actually burn a hole in your esophagus or in your stomach lining. And that's very scary.

0:46:04

And so, typically if we have any concern or history of a battery ingestion, we usually refer in. We need to get an X-ray to see where this battery is and does it need to be removed? Some of these cases, especially if it's in the esophagus and it's lodged there, it needs an immediate removal of the battery. 

The scary thing is even after removal of battery, there is still potential risk of injury due to hemorrhaging if injury or perforation was created.

Dr. Mike Patrick: So, any concern that your child has swallowed a button battery, make sure you get in and see someone right away. And we even have a protocol where we give them honey when they first walk through the door. Do you ever recommend that when you talk to parents on the phone?

Dr. Alexandra Funk: We do. Maybe if they're on their way to the ER, we'd say "Hey, give him a little bit of honey on the way." It's thought to help kind of move that battery down the esophagus and maybe coat the battery to help prevent some of that electrical current or that injury from forming.

0:47:04

Dr. Mike Patrick: And that's not just something grandma said. There's actually research studies that show that kids fared better when they were given honey early on when that kind of ingestion occurs.

Now, this is not necessarily a chemical but magnets can also be an issue especially, well, in particular, when you swallow more than one magnet and they may be attract to one another through loops of bowel, that can be very serious.

Dr. Alexandra Funk: Absolutely, yes. And either, as you mentioned, multiple magnets or magnet and another metal objects, battery, piece of jewelry, whatever it maybe, these magnets are so strong especially if you're talking about the rare earth magnets or those little desk magnets. They are fun to make chains or fun pictures and images with. These are very very strong. 

Ad what happens is even if they're in your stomach and through different loops, they can attract to each other and are hard to pull apart. They won't pull apart with your peristalsis and your gastrointestinal movements.

0:48:13

And so, what happens is this can create perforations and bowel obstruction, bowel ruptures within the stomach. And we're not talking about our household fridge magnets. Of course, those can be a concern of foreign body ingestion, but more so focusing on these strong rare earth magnets they're called.

Just to give some examples, names, products names here, I'm not endorsing anybody or knocking anybody but just to give some examples, Poke Balls or NeoBalls, spheres. And these are readily available on Amazon or other stores where you can buy them from. And sometimes, they're targeted towards kids as a fun toy to use. 

And so, when using these products, you want to make sure that they're being supervised, that all the magnets are left when you're done.  And oftentimes, teenagers may utilize this to mimic lip piercings or nose piercings, tongue piercings. They put one of each side of the skin, and then one falls off and it gets swallowed or the second one gets swallowed. And then we have a serious problem on our hands.

0:49:22

Dr. Mike Patrick: So, again, if you're worried that a magnet has been swallowed in particular to or a small piece of metal or something that it can attract to, then you definitely want to get help right away. And they can be fun toys but if you're going to have those for older kids in the house, keep them away from the younger kids. Younger kids should not have access to these rare magnets at all. 

So we've talked about lots of different hazards that you may get calls about at the poison center. Tell us a little bit more about the Central Ohio Poison Center.

Dr. Alexandra Funk: Sure. We are a poison control center and our state is lucky enough in Ohio to actually have two centers. There are 55 poison centers in the whole United States. Not every state may have a center within their boundaries, but every state is covered by a poison center. 

0:50:14

And so we share the state with our sister poison center over in Cincinnati. But at Central Ohio Poison Center, we cover 64 out of Ohio's 88 counties. And that roughly equates about 5 million or so population. 

And with that, our average annual call line is around 50,000 cases that we manage a year. And breaking that down, that's roughly a 110, 130 plus, depending on the day, patient cases that we're managing on a daily basis. 

Dr. Mike Patrick: You guys are busy.

Dr. Alexandra Funk: Yes, we're busy. And this year definitely had us be busier. More kids are at home, more people are home. All of the concerns with the pandemic and cleaning and what not. So we definitely have been busy this year. 

0:51:04

Who can call us? We serve both the public and healthcare providers. So, if mom or dad, you have concern at home, you can give us a call. We definitely encourage calling before heading to the emergency department because, as I mentioned before, if we can keep you home and we can monitor you safely at home, we want to do that. We want to make sure that you can stay home as much as possible.

However, if there's a situation where we do refer you to into emergency department or you go there first and then it's a poisoning exposure, we can consult with the providers, the doctors and the nurses caring for you directly at bedside and provide specific recommendations. And we'll continue to follow along until we deem that there's no more issues that we'd be expecting or you're able to be discharged from the hospital. 

Dr. Mike Patrick: It is a fantastic resource. And firsthand knowledge on this, when we have an ingestion that comes into the emergency department, we call the poison center.

Dr. Alexandra Funk: Yes. And who do you talk when you call? That's a great question. We have nurses and pharmacists that staff our lines 24/7, 365 days a year, holidays, weekends, evening, middle of the nights. We have highly trained nurses and pharmacists who are nationally certified as poison information specialists that answer the lines. 

0:52:10

And then, we work closely with our medical toxicologist here. We always have a medical toxicologist on the call or myself as a clinical toxicologist on call if cases need to be escalated, or if the specialist need additional assistance. Or if a provider needs to talk to a toxicologist, they have that direct one-on-one consult.

So, those, whichever person you're talking to are highly trained healthcare professional whenever you do call. And we're a great resource. We're completely free for the public. We're private, we're confidential. It's a toll-free number that you can access from anywhere in the United States. 

And like I said, we are available 24/7, 365. We're always available if you need us.

0:53:08

Dr. Mike Patrick: And we'll put a link to the Central Ohio Poison Center in the show notes. But really, when there's an emergency, you're worried about something and you're going to get in touch, you don't go to the website, call. And what is the phone number for the poison center.

Dr. Alexandra Funk: Absolutely. It is 1-800-222-1222.

Dr. Mike Patrick: Great. And that's going to get you wherever you are in the United States of America. If you call that number, it's going to get you to your closest poison center, the one that serves you. Correct?

Dr. Alexandra Funk: Correct. Absolutely.

Dr. Mike Patrick: So, it's kind of like 9-1-1. It gets you to the right place. Just that one national number. And this is a phone number that really you ought to have next to your phone or put it in your contact list on your smartphone. The Poison Center ought to be in there so when there's an emergency, you don't have to look it up. It's easy. Just right there for you to call, 1-800-222-1222. 

And there's another way to remember the number and that is to get this jingle stuck in your head.

0:54:05

[Start Poison Control Jingle]

Lyrics: 1-800-222-1222. 1-800-222-1222. If you think you might be poisoned and the first thing you should do is call 1-800-222-1222. 

[End Poison Control Jingle]

Dr. Mike Patrick: People are going to be cursing my name all day because you're not going to get that out of your head. But that's a good thing because you really do need to remember that phone number.

So, we have lots of links for you in the show notes this week over at pediacast.org. Again, the Central Ohio Poison Center and then also some of those other safety episodes that we've done here on PediaCast on fire safety, poison safety, water safety, tipovers and falls, and the sun safety during the summer. So please be sure to check those out. If you would like more information on keeping your family safe at home.

So, Dr. Alexandra Funk with the Central Ohio Poison Center, director of our Central Ohio Poison Center and clinical pharmacologist, no, clinical pharmacist and toxicologist. I tried to put those together there. Did you notice that? Here at Nationwide Children's. Thank you so much for stopping by today.

0:55:09

Dr. Alexandra Funk: Thank you so much, Dr. Mike. And as we mentioned, if you have any questions or concerns, do not hesitate to give us a call. Again, 1-800-222-1222. And when you do call us, if you need a fridge magnet or a sticker or some resources, we'll be happy to send that out to you as well.

Dr. Mike Patrick: Perfect. Thank you so much.

Dr. Alexandra Funk: Thank you.

[Music]

[Start Poison Control Jingle]

Lyrics: 1-800-222-1222. 1-800-222-1222. If you think you might be poisoned and the first thing you should do is call 1-800-222-1222. 

0:56:13

Poison is the kind of thing you're not supposed to touch. All prescriptions, cleaning stuff, or spider bites and such. If you swallowed something bad or think you took too much, call the Poison Control Center Hotline. We're the people you can trust.

Announcer: For poison emergencies or just questions, the Poison Control Center Hotline is here 24/7, with the expert help you need, free and confidential. We hope you never need us, but keep our number by the phone.

Lyrics: 1-800-222-1222. 1-800-222-1222. If you think it might be poison and you don't know what to do, call 1-800-222-1222.

[End Poison Control Jingle]

Dr. Mike Patrick: I am not sure that I will get that out of my head any time soon. And I apologize in advance if you have the same problem, but it is a good phone number to know. And you're unlikely to forget it at this point. So, we have accomplished our goal. 

Still, it's a good idea to put that phone number, 1-800-222-1222, in your contact list on your smartphones so that you have it readily available at any time. 

0:57:22

And speaking of time, it is time for us to say goodbye. I do want to say thanks to all of you for taking time out of your day and making PediaCast a part of it. I really do appreciate that.

Also, thanks to our guest, once again, Dr. Ally Funk, director of the Central Ohio Poison Center and the clinical pharmacist and toxicologist at Nationwide Children's Hospital.

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0:58:06

And reviews are helpful wherever you get your podcast. We always appreciate when you share your thoughts about the show, and we love connecting with you on social media. You'll find us on Facebook, Twitter, LinkedIn, and Instagram. Simply Search for PediaCast.

If you are a healthcare provider or you know one, don't forget we have a program for them as well. It's similar to PediaCast. It's called PediaCast CME. We turn up the science a couple notches and offer free Continuing Medical Education credit for those who listen. And that includes doctors, nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, even dentists. 

And since Nationwide Children's is jointly accredited by many professional organizations, it's likely we offer the exact credit you need to fulfill your state's Continuing Medical Education requirements. Shows and details are available at the landing site for that program pediacastcme.org. You can also listen wherever podcasts are found. Simply search for PediaCast CME. 

0:59:02

And with that, I would like to wish all of you a happy holidays, merry Christmas, happy New Year. I truly wish health and peace for all of you and we'll see you again on the flipside of the new year. Thanks again for stopping by. 

And until that time when we regroup in 2021, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.

[Music]

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.