By Alan Mozes
NEW YORK, January 27 (Reuters Health) -- One of the most important steps
in childproofing a home is keeping dangerous household chemicals, such as
cleaning agents, out of the reach of children. A report published recently in
the journal Chest points out that these chemicals are also dangerous to elderly
people with dementia, who may drink them by mistake.
The report, from Drs. James A. Walker and Gary P. Zaloga of Washington
Hospital Center in Washington, DC, includes details of a case of an 88-year-old
woman with Alzheimer's disease who drank 10 ounces of a pine oil-based cleaning
solution.
Over 10,000 such cases, in which people drank pine oil-based cleaning
products, are reported each year in the US, making these products second only to
gasoline as the most common type of substance involved in accidental toxic
poisoning, the authors note. The researchers also point out that since many
incidents go unreported, the actual number of such cases is probably much
higher.
"We've done a great job on preventing unintentional childhood poisoning...
we think it's one of the great success stories of public health. But the issue
of older people unintentionally swallowing substances is much more complicated,"
said US Product Safety Commission spokesman Ken Giles, when asked to comment
about the problem.
The Alzheimer's patient in the report was being cared for at home by her
grandson. Mentally disoriented but physically functional, she had been left
alone in her bathroom for approximately 5 minutes -- during which time she
swallowed the cleaning solution. She was quickly brought to an emergency
department, put on a mechanical ventilator and treated for poisoning, but
subsequently died of pneumonia and multiple organ failure.
In an interview with Reuters Health, Giles said that such accidents in the
general population --and particularly in children under the age of 5 -- have
greatly diminished in the US since the passage of the Poison Prevention
Packaging Act in 1970. However, he emphasized that in the 28 years since the
first child-resistant packaging was designed for aspirin in 1972, the focus has
been on the protection of children, not the elderly, which involves a different
set of concerns and strategies.
"Children under 5 put things in their mouth because that's their approach
to learning about their world," he said. "But with older people you begin to
have a lot of other factors... not reading the label, not turning the light on
at night, mixing substances together, so that you get a bad synergistic effect
-- lots of issues that are not there with children."
However, the investigators point out that both the demented elderly and
children have in common the ability to move about their environment while doing
so with limited cognitive faculties, leaving both groups vulnerable to the
dangers of toxic ingestion.
Walker and Zaloga also note that less than 0.1% of reported cases of toxin
ingestion have fatal outcomes. Elderly patients account for about 17% of these
fatal cases, and the risk of dying from ingesting a toxin rises with age.
Because of physical changes associated with aging, the elderly are likely to be
exposed to toxins for longer periods after ingestion than children.
The researchers advise medical practitioners to become familiar with the
treatment of pine oil intoxication. Quick response to signs of ingestion --
which include the aroma of pine on the breath of the patient, blurred vision,
headache, sore throat, vomiting, and abdominal pain and respiratory failure --
is important to prevent serious and potentially fatal complications.
