Vol. 5 No. 2 RESUBSCRIPTION ISSUE April 1985


Table of Contents

I. Introduction: Pesticide Waste Disposal
II. Poisonings: Drugs are No. 1 Cause
III. Outbreak of Diarrhea Linked to Dietetic Candies - New
IV. Poultry Giblet-Associated Salmonellosis -- Maine
V. Botulism from Fresh Foods -- California
VI. Outbreaks of Respiratory Illness Among Employees in Large
Office Buildings -- Tennessee, District of Columbia
VII. Carbon Monoxide Poisoning -- South Dakota
VIII. Exposure to Ammonia during Removal of Paint from Artificial
Turf - Ohio


This newsletter once again contains a potpourri of toxicological tidbits taken from a variety of sources. Before delving into them in detail, I would like to cover an area that has become increasingly important and controversial in the last couple of months. That area has to do with Pesticide Waste Disposal. At the end of January the EPA sponsored a National Workshop on Pesticide Waste Disposal in Denver. There were over 400 participants from all over the country. A proceedings of this first workshop will be forthcoming in the future, so I will only touch on what I feel was the most important conclusion of the workshop; that is, that there are currently no affordable, approved technologies that would allow small scale commercial applicators to fully comply with current waste disposal regulations. I mention this because it is a problem that many readers will have to face in the near future.

The UC Extension Toxicology program will make the area of pesticide waste disposal site cleanup the top priority during the next year or so. We first became involved in this almost five years ago when the Sutter County Airport was found to have a large illegal pesticide disposal site. Since then I have been planning a newsletter to address this topic but have been reticent to proceed because of the rapidly mutating legislative and regulatory framework surrounding hazardous-waste in California. Most readers are familiar with the Superfund and how it is to be used to cleanup hazardous waste disposal sites. The State Department of Health Services has recently published a list of sites slated for cleanup under Superfund. A significant number of these sites are associated with airports that were used by aerial applicator operations. We will be working with the owners of some of these sites, the Department of Health Services and the Regional Water Quality Control Boards to try to find means to mitigate the hazards associated with these sites. During the next twelve months there should be some exciting developments in this area and I will try to keep readers current with significant changes as they develop.

My comments associated with the articles that follow will be marked in the following way *(comments)* in order to avoid any confusion about the source of the comment.

Art Craigmill

II. Poisonings: Drugs are No. 1 Cause

Dangerous chemicals and products in the home cause an estimated 2.3 million poisonings per year in the USA, and children are the chief victims.

The largest-ever study of poisonings shows that 90 percent occurred in the home and 64 percent involved children under age

The study documents 251,012 reports of poisonings in 1983. The reports were made to 16 poison centers that serve 11 percent of the USA's population. Extended to the entire population, the number of poisonings reaches at least 2 million.

Among the major findings:

Drugs - over-the-counter and prescription - were the biggest culprits, causing 150,857 poisonings. Painkillers, such as aspirin and acetaminophen, led with 25,771 poisonings, including 22 deaths. Sedatives, sleep aids and tranquilizers caused 8,487, and 11 deaths. Vitamins caused 7,765 poisonings; and no deaths.

Cleaning agents were the chief non-drug culprits; bleaches, disinfectants and detergents accounted for 22,347 poisonings and four deaths.

Eating the leaves of toxic house plants led to 22,326 poisonings. No deaths were reported. Most dangerous: philodendron, dieffenbachia and poinsettia.

Cosmetics - hair-care products, bath oils, nail polish removers, perfumes and aftershaves - 13,192 poisonings, two deaths. Ninety-four percent involved children under 6.

Insecticides and pesticides - 8,438 poisonings, four deaths. *(The author of the article is obviously not familiar with terminology!)*

83 percent of all alcohol poisonings involved children under age 6. The center reported 9,201 poisonings, 12 deaths.

91 percent of poisonings were accidental, 8.2 percent intentional. Suicide attempts accounted for 5.4 percent.

The study, published in the current American Journal of Emergency Medicine is being released this week at the association's meeting in San Diego.

USA TODAY, Wednesday, October 10, 1984

III. Outbreak of Diarrhea Linked to Dietetic Candies - New Hampshire

A 13-year-old girl was treated at a Milford, New Hampshire, hospital emergency room April 30, 1984, for acute abdominal pain and diarrhea. Induced vomiting yielded partially digested pieces of a hard candy.

Investigation disclosed that, earlier that day, eight neighborhood playmates, ages 5-13 years (mean 9 years), had experienced abdominal cramps, urgency in defecation, and two to six loose bowel movements each, 1/2 to 1 1/2 hours after eating three to 16 pieces of a dietetic candy per child. There was no known common exposure to other food, drink, or toxic substance. Only the 13-year-old girl received medical attention; the other seven children recovered spontaneously within 2-3 hours after the illness began. Each of three additional playmates who ate one piece of candy and four who ate no candy did not become ill.

The candies in this outbreak each contained approximately 3 grams of sorbitol as a sweetener. Sorbitol, a hexahydric sugar alcohol, acts as an osmotic laxative *(it simply pulls water into the bowel and thus increases the quantity and fluidity)*. The candies were purchased in bulk and individually wrapped. The wrappers carried no ingredient information and no warning of adverse effects if eaten in excess.

MMWR, September 7, 1984, Vol. 33/No. 35

IV. Poultry Giblet-Associated Salmonellosis -- Maine

In November 1982 and October 1983, two unrelated outbreaks of foodborne salmonellosis caused by improperly cooked poultry giblets occurred in Maine. The two restaurants involved were located 50 miles apart but were part of the same restaurant chain.

Editorial Note: Poultry products are a frequent source of Salmonella infections, and reported outbreaks from turkey increase markedly during the Thanksgiving and Christmas holiday seasons. Culture surveys of poultry flocks and market poultry have demonstrated that salmonellae may be recovered frequently, a fact that is often not known or is overlooked during rushed holiday preparations.

The outbreaks described here were unusual in that they involved giblets that had been stored under refrigeration for several days and that, because they had oxidized, appeared to have been cooked. Domestic and commercial foodhandlers should be aware of the misleading appearance of giblets and other poultry organs that have been refrigerated for prolonged periods. *(This is just something to keep in mind the next time you consider the risk/benefit ratio for eating out!)*

MMWR, November 9, 1984, Vol. 33/No. 44

V. Botulism from Fresh Foods -- California

In August 1984, three cases of botulism were reported in California from two episodes in which the ill persons had eaten improperly handled food made from fresh ingredients.

Episode 1: Three days before onset, the grandmother prepared two turkey loaves that included cereal, onion, and green pepper. One loaf was consumed without incident immediately after cooking. The other was inadvertently stored in the gas oven with the pilot light on (later measured at 32.2 C [90 F]), until the grandmother discovered it the next afternoon. She tasted a small portion before reheating it at approximately 150 C (300 F) for approximately 20 minutes and served the turkey loaf to the three other members of her household. Only the granddaughter developed symptoms. When questioned, she could not recall tasting the turkey loaf with her grandmother before reheating, but did recall eating a portion from the center of the loaf.

Episode 2: A 22-year-old Orange County man awoke at 2 a.m. with vomiting, blurred vision, and a "thick tongue". Symptoms progressed to total quadriplegia *(paralysis of all four limbs)*, then respiratory failure requiring mechanical ventilation. Forty hours before onset, he had consumed stew prepared by his roommate from fresh ingredients (including meat and unpeeled potatoes and carrots), then left overnight at room temperature. The patient tasted it without reheating 16 hours later and complained of a bad taste. The roommate confirmed a sour taste, immediately spit it out, rinsed his mouth, and remained well. The stew was then discarded and could not be tested. He was treated with botulinal antitoxin and recovered after extended hospitalization.

Editorial Note: Because spores of Clostridium botulinum are ubiquitous in soil, they can contaminate fresh foods, particularly those harvested from the ground. The spores are quite heat resistant and can survive boiling for several hours. For spores to germinate and produce toxin, several conditions must be met, including appropriate temperature and pH and oxygen contents. Foodborne botulism generally results from home-canned vegetables that are contaminated with spores and are improperly prepared, thereby allowing the production of botulinal toxin. Toxin can also be elaborated in foods that are initially cooked, then held at ambient temperatures for at least 16 hours. The cases presented here are not unique, since the same mechanism of toxin production appears to have accounted for previous episodes of botulism from commercial pot pies, sauteed onions, and, in one instance, a baked potato. These foods were cooked, allowed to stand at ambient temperatures, and consumed later without reheating. Foods heated for serving should either be eaten hot or refrigerated and later reheated thoroughly (since the toxin is heat labile) before re-serving.

MMWR, March 22, 1985, Vol. 34/No. 11

VI. Outbreaks of Respiratory Illness Among Employees in Large Office Buildings -- Tennessee, District of Columbia

Recurring outbreaks of respiratory illness among office workers have led to epidemiologic and environmental investigations and to relocation of some or all occupants of the affected office areas.

Knoxville, Tennessee: An outbreak of febrile illness began during the afternoon and evening of September 21, 1981. About 40% of the 325 office workers in a seven-story building met the case definition of at least three symptoms (headaches, muscle aches, fever, chills, cough, or wheezing) and a time of onset after 11 a.m. (use of this time of onset helped to exclude individuals with preexisting respiratory conditions that were unrelated to exposures in the building). In most affected individuals, these symptoms subsided by the following morning. Subsequent outbreaks of febrile illness occurred in this same building on October 13 and October 15. After the latter outbreak, building occupants were moved to other office facilities.

Editorial Note: Outbreaks of hypersensitivity pneumonitis (HP), humidifier fever, and similar syndromes among office workers have been described since 1970. Symptoms include headache, fatigue, muscle aches, chills, and fever. Manifestations of pulmonary disease, such as chest tightness, coughing, and wheezing, were also observed. These outbreaks have been attributed to thermophilic actinomycetes, nonpathogenic amoeba, several fungi, and endotoxins. Sources of microbial contamination included humidifiers, air washers, and contaminated filters in air- handling units.

Engineering measures thought to prevent the occurrence of such outbreaks are straightforward, feasible, and inexpensive. They include: (1) promptly and permanently repairing all external and internal leaks; (2) maintaining relative humidity below 70% in occupied spaces and in low-air-velocity plenums (at higher levels of humidity, the germination and proliferation of fungal spores is enhanced); (3) preventing the accumulation of stagnant water under cooling-deck coils of air-handling units through proper inclination and continuous drainage of drain pans; (4) using steam, rather than recirculated water, as a water source for humidifiers in HVAC systems; however, such steam sources should not be contaminated with volatile amines; (5) replacing filters in air-handling units at regular intervals; (6) discarding, rather than disinfecting, carpets, upholstery, ceiling tiles, and other porous furnishings that are grossly contaminated; (7) providing outdoor air into ventilation systems at minimum rates per occupant of at least 20 cubic feet per minute in areas where occupants are smoking and at least 5 cubic feet per minute in non-smoking areas. These activities should be considered in on- going preventive-maintenance programs.

MMWR, September 14, 1984, Vol. 33/No. 36

VII. Carbon Monoxide Poisoning - South Dakota

On October 17, 1984, a physician of the Pierre (South Dakota) Service Unit, Indian Health Service, reported a nighttime incident of poisoning by an unknown substance involving a family of six that resided in a newly renovated, well-insulated house.

Shortly after midnight, the mother and two youngest children were taken by ambulance to a local hospital, with symptoms of nausea, dyspnea *(difficult breathing)*, vomiting, tachycardia *(rapid heart rate)*, cyanosis *(bluish discoloration of skin)*, and faintness. Around 1:00 a.m., the mother called home and learned that the oldest child had developed similar symptoms. A second call, 45 minutes later, found the father and second oldest child to be symptomatic also. All family members were evacuated and recovered without treatment.

Within 1 hour of closing the windows and starting the furnace, high levels of CO (35 or more parts per million [ppm]) (1) were detected in the two rooms. The air shutters on the furnace burners were closed to such an extent that sufficient air supply was precluded, causing incomplete combustion. As a consequence, soot accumulated in the combustion chambers' flues to the extent that proper venting/drafting became impossible. The products of combustion then leaked from the furnace into the basement air, where they were drawn into the air-return duct and disseminated throughout the house.

(1) There are currently no indoor air pollution standards. However, the U.S. Environmental Protection Agency ambient air quality standards for CO are: 9 ppm, maximum 8-hour concentration, and 35 ppm, maximum 1-hour concentration, neither to be exceeded more than once per year.

The system was rectified by providing sufficient air to the burners, cleaning the soot from the flues, and closing the basement intake vent in the air-return duct.

Editorial Note: Despite efforts to reduce the number of unintentional CO poisonings through public education, standards, and improved product design, nonfatal and fatal CO poisonings continue to occur. Each year, an estimated 10,000 persons in the United States seek medical attention because of exposure to CO gas, and approximately 1,500 die from CO poisoning.

Exposure to low levels of CO causes headache, dizziness, and sleepiness. Continued exposure brings on nausea, vomiting, and heart palpitation. Prolonged exposure to high levels of CO causes unconsciousness or death. Death can occur when blood contains from 60% to 80% COHb. *(COHb is carboxyhemoglobin which is formed when CO binds to hemoglobin. COHb will not transport oxygen and this is the mechanism of CO toxicity. A level of 50% COHb saturation can be caused by as little as .1% CO because CO has 200 times more affinity for hemoglobin than does oxygen.)*

Other prevention recommendations include: (1) never burn charcoal inside the home or in confined spaces; (2) never use a gas oven to warm a room; (3) never burn anything in an improperly vented stove or fireplace; (4) never run an automobile engine, lawn mower, or any combustion engine in an enclosed area; and (5) always ensure adequate natural ventilation for portable, fuel- fired space heaters.

MMWR, March 1, 1985, Vol. 34/No. 8

VIII. Exposure to Ammonia during Removal of Paint from Artificial Turf - Ohio

Complaints of respiratory and conjunctival irritation were reported among workers using anhydrous ammonia to remove painted lines from artificial turf at a sports stadium in Cincinnati, Ohio. About five times each year, when professional baseball and football seasons overlap, lines on the playing field must be altered repeatedly to accommodate the use of the stadium for both sports.

Of 26 workers interviewed, 25 (96.2%) reported "burning eyes", 18 (69.2%) "nasal congestion", and 16 (61.5%) "acute shortness of breath" during the paint-removal operation. Although NIOSH-certified respirators were available, the respirators were old, poorly maintained, and used sporadically. No formal respiratory protection program was followed. Few workers were observed wearing gloves and goggles.

Editorial Note: Ammonia is a severe irritant of the eyes, respiratory tract, and skin. Acute exposure to high concentrations of ammonia gas may produce severe burns of the cornea and skin; splashing liquid ammonia into the eyes has caused blindness. Repeated exposure may cause chronic irritation of the conjunctivae and upper respiratory tract.

The major hazard found in this investigation was the short- term exposure of workers to high concentrations (over 300 ppm) of ammonia. By diluting the ammonia and using appropriate protective equipment, this problem is preventable.

MMWR, October 12, 1984, Vol. 33/No. 40

Arthur L. Craigmill
Extension Toxicologist