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November 16, 2008

Poison: It Isn’t Just For Breakfast Any More
Posted by Jim Macdonald at 07:40 PM *

What cheerful thing shall we talk about today? How about poison!

Razors pain you;
Rivers are damp;
Acids stain you;
And drugs cause cramp.
Guns aren’t lawful;
Nooses give;
Gas smells awful;
You might as well live.
Dorothy Parker

Two, maybe three, of those things can be classified as poisons. (For the others: direct pressure, high volume oxygen, treatment for shock, and rapid transport to the closest appropriate facility are the keys. Your friends at 9-1-1 are waiting to hear from you!)

We remember poison from Altered Level of Consciousness, when O=Overdose was one of the items in our mnemonic. You might think of any poisoning episode as an overdose. What’s the recommended dose of hydrogen cyanide? Zero? Did someone get more than that? Woo! Overdose!

If you suspect poisoning, call the National Poison Control Center at 1-800-222-1222. That’s a toll-free call. If you can’t get to them, call 9-1-1.

NOTE: If the patient collapses, or stops breathing, or starts convulsing, or you can’t wake him/her up … skip Poison Control. Save a couple of minutes. Go directly to 9-1-1.

Okay, so. Let’s classify acute poisoning, then see what to do about it.

There are four basic kinds of poisons:

  1. Ingested poisons
  2. Inhaled poisons
  3. Injected poisons
  4. Absorbed poisons

The best treatment for all kinds of poisoning is prevention. Please don’t put the bleach into an old Pepsi bottle and store it where Junior can get at it. Please put a carbon monoxide detector in your bedroom. Please don’t leave the chicken lying out on the kitchen counter at room temperature for a couple of hours. If you’re an artist working with arsenic-based pigments, don’t put the brush in your mouth. Y’know. All that simple stuff.

Okay, ingested poisons. Stuff that you swallow. Deliberately or by accident. This can be medicines (your classic is a nice young lady who breaks up with her boyfriend, swallows every Tylenol in the house, pukes, decides the boyfriend wasn’t worth it, and dies a month later of liver failure), or rat poison, or lye, or what may have you.

Here’s what the nice folks at the Poison Control Center, or at 9-1-1, or the nice EMTs who come to your house, or the nice nurse at the ED, will want to know:

What was it?
This is your starting point. We can figure a lot of things out … ringing in the ears, think aspirin … but it’s nice if we don’t have to play Sherlock Holmes. You should be aware that lots of drug names sound similar (e.g. Xanax vs. Zantac). If it’s possible, and it’s safe to do so, take the original packaging with you.

In a work environment you’ll find information on every substance in the place in the MSDS (Material Safety Data Sheets) that are stored at some known and accessible location (e.g. by the front door, in the custodian’s office, in the supervisor’s desk). They’re required by OSHA. Know where the MSDS for your workplace are stored.

When did the patient ingest the substance?
Two minutes ago, an hour ago, a week ago … what (if anything) we can do about the situation can be time-critical. If you don’t know the exact time, a range (e.g. sometime after 2:00 pm but before 4:00 pm) is the next best thing, and is often the only thing you’ll know if it was a toddler getting into the cardiac meds in Granny’s purse.
How much was ingested?
Count the number of pills left in the bottle, or see how much lye was in the bottle, or your best guesstimate. What’s the most it could have been? That’s the number we’re going with.
What was the time-frame?
Chronic exposure? Eating paint chips vs. drinking the bottle labeled “Drink Me.”
What are the signs and symptoms?
Practically everything has nausea and vomiting. What else? Slurred speech? Jaundice? Slow pulse? Rapid pulse? Sweating? Diarrhea? Drowsiness? Hyperactivity? Don’t forget to check for things like burns around the mouth and unusual odors.
How much does the patient weigh?
For figuring out doses of both poisons and antidotes. The same amount of substance ingested by a 20 kg patient and a 100 kg patient can have a very different prognosis.
What treatments have already been given?
Did anyone already do any first aid? What? With what results?

Let’s talk about the possible first aid now. Beyond maintaining an open airway and treating for shock, I personally wouldn’t do anything without talking to the Poison Control Center. There are millions of substances out there; the treatments are changing all the time based on research. You can’t possibly memorize them all. The nice folks at the Poison Control Center have a huge database with all the most recent information. Use them!

Having said that, what are the possibilities? First, doing nothing may be the best course. Second, you may be advised to give the patient some activated charcoal to drink. Activated charcoal absorbs various substances so that they aren’t available to pass through the wall of the patient’s intestines and into their body. You may want to have a bottle of activated charcoal (it’s a slurry of charcoal and water) around the house, so that if the Poison Control Center tells you to administer it, you’ll have it. Activated Charcoal comes both with and without Sorbitol (a laxative) mixed with it. The usual dose is 12.5 to 25 grams for children and 25 to 50 grams for adults.

Activated charcoal is contraindicated and/or useless in some cases:

  1. Heavy metals
  2. Caustics (strong acids or bases)
  3. Hydrocarbons (e.g. gasoline)
  4. Narcotics
  5. Alcohol

Oh yeah — if the patient is unconscious or otherwise unable to swallow (say he’s convulsing), don’t give anything by mouth, okay? The guy’s already poisoned—you don’t need to fill his lungs with charcoal.

Activated charcoal is nasty. It tastes horrible, it’s thick and has grotesque mouth-feel. Someone who downs a glass of the stuff is pretty likely to vomit. So: before you give ‘em the charcoal, take a big plastic garbage bag, cut a slit along one top edge, and put it around the patient’s head like a big lobster bib. That way, when they hurl, you just open the bag, they barf into it, and your clean-up situation is greatly eased.

Please don’t add anything to the charcoal before the patient drinks it. Mixing in chocolate syrup, for example, won’t make it taste any better. What will happen is that the charcoal will absorb the chocolate, leaving less charcoal to absorb whatever nasty the patient ate or drank.

Next stuff that Poison Control may tell you to do is give the patient milk or water to drink. “The solution to pollution is dilution,” as the saying goes. The usual dose is one-half to one glass of milk or water for children, one to two glasses of milk or water for adults.

Okay, how about Syrup of Ipecac?

If you have any in your house, get rid of it. Really. Flush it down the toilet. Yeah, I know it’s sold all over, and you can get it in commercial Poison Kits and Babysitter Kits and whatnot. Dump it.

Here’s why. First, the purpose of Syrup of Ipecac is to induce vomiting. When you get that vomiting going, you’re inducing the chance of aspirating fluids into the lungs. Second, it takes about 20 minutes for the stuff to work. So all that time the ingested poison is sitting there, moving down into the intestines where vomiting won’t touch it. But in 20 minutes the patient could be in the ED, where the correct treatment might involve charcoal (which the patient will promptly vomit all over the nice nurses), or the treatment might involve an oral antidote (the treatment for Tylenol ingestion is NAC (N-acetylcysteine) (which smells so bad that it can clear out an entire ED)) which the patient swallows, then promptly barfs up, meaning that the patient doesn’t get treated. Oh, yeah—the other thing about Syrup of Ipecac: At its best it only evacuates about one-third of the stomach contents, so why bother?

One more note about ingested poisons: If you find yourself in a situation where you have to give artificial respiration to an ingested poison patient, you’d better be using a pocket face mask. You don’t want to get whatever it was into your own mouth.

Now let’s look at inhaled poisons.

The first and most important thing is to stay safe yourself. You breathe. Stuff in the air can jump out and get you too. So that may require you to wait for properly trained and equipped people to come and haul the patient out of where-ever he/she was lying.

Signs and symptoms of inhaled poisons may include headache, dizziness, shortness of breath, nausea and vomiting, or cyanosis (blue tinge to the lips or nail beds). Be aware of the situation! Be alert for unusual smells (e.g. rotten eggs, new-mown hay, almonds, fruit, where those items aren’t present). If you suspect that you may possibly be in a poisonous atmosphere and you aren’t personally wearing a self-contained breathing apparatus, friggin’ get out of there right now!

Some examples of inhaled poisons include carbon monoxide (you do have a CO detector, right?), various other by-products of combustion, paints and thinners (when the label says “Use only in a well-ventilated space” freakin’ believe it). Your various war gasses mostly fall into this area. The treatment for accidental, deliberate, and terrorist-based inhaled poisoning is the same: Get the patient away from the source of the gas, provide high-volume oxygen if you have it, keep the airway open, provide artificial respiration if necessary, and transport to an appropriate facility. If you ever lose your place, drop back to airway, breathing, circulation. Your friends at 9-1-1 are waiting to hear from you. Again, you’ll want to know what the material is; if there’s any way of finding out (bottles or cans present; MSDS) the ED will want to know.

Information you’ll want to gather, for Poison Control, 9-1-1 and ED staff:

  1. What was the exact substance?
  2. When did the exposure take place (earliest and latest possible times)?
  3. How long were they breathing it?
  4. What are the signs and symptoms?

If a fire was involved, you may have burns in the airway. The world has just started to suck. Get professional help, right now.

Now we come to injected poisons. These move through a break in the skin. One of your classics is the bee sting. Or, the snake bite. Or, recreational drugs. (Overdose of insulin … diabetic shock … is covered elsewhere. Short version: oral or IV sugar.)

A swarm of bees may make the scene unsafe for you. Keep your eyes open. Same for snakes in the grass. The situations where you come on an injected narcotic overdose may be generally unsafe for reasons other than the poison itself.

Here’s what to do with bee stings. First, remove the stinger. When a bee stings you, the stinger (which is barbed) remains in the skin, with the little poison sac attached, pumping more formic acid into you. This is painful (and for people who are allergic, potentially fatal). Here’s how to remove the stinger: Don’t try to use your fingers or a tweezers. All you’ll do is squeeze the poison sac and put more poison into the patient. What you do is scrape along the skin with a credit card, a drivers’ license, or a knife held perpendicular to the skin. That’ll remove the stinger without squeezing that sac.

Speaking of bee/wasp stings, those are the only kinds of venoms where you’ll want to put ice on the injury site. Don’t ice spider bites or snake bites. What else to do? Put the limb lower than the heart (gravity is your friend!) to keep the poison out of central circulation, and put a constricting band (not a tourniquet) between the site and the heart. A constricting band limits the movement of lymph. When it’s tight enough you can still slip your finger under it. (Don’t be cutting snake bites and trying to suck out the poison. Okay? But it is okay to use a Sawyer Extraction Device on snakebites.)

The treatment for injected narcotics is lots of fun: Narcan. That is, naloxone. This is a narcotic antagonist. It reverses the effects of the narcotic, instantly. You should be very careful with this: The patient may wake up pissed off that you took away the high that he paid good money for. Or, you could induce instant withdrawal. So go slow. (Note: Narcan can be used by just about every route except oral, so the only folks who get to play with it are your EMTs. Sorry, guys, if you want to do this, take the course and join a squad.)

Last we come to absorbed poisons. These are poisons that move through intact skin. Again, use caution when you suspect absorbed poisons. Like inhaled poisons, these too can reach out and nail you. Don’t come into contact with the material yourself.

Some examples include medicines like Duragesic patches, or insecticides like Parathion. You may or may not see skin irritation at the site of the poison contact.

What to do: Call Poison Control. Get 9-1-1 rolling. Support Airway, Breathing, Circulation. Treat for shock. Remove the patient’s clothing, bag it up (staying safe yourself while you’re doing this) and (after consulting with Poison Control) flush the skin with a copious amount of water.

Once more: The people you call for help will want to know…

  • The exact name of the substance.
  • When did the exposure take place?
  • How much substance was involved?
  • Over what time period?
  • What have you (or anyone else) already done?
  • What are the signs and symptoms?

Any time you see sudden-onset similar symptoms in two or more patients, you should start thinking about poisoning.

Stay safe, kids. More than anything else, poisons can hurt you, too.


Copyright © 2008 by James D. Macdonald

I am not a physician. I can neither diagnose nor prescribe. This post is presented for entertainment purposes only. Nothing here is meant to be advice for your particular condition or situation.

Creative Commons License
Poison: It Isn’t Just For Breakfast Any More by James D. Macdonald is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.

(Attribution URL: http://nielsenhayden.com/makinglight/archives/010798.html)


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Comments on Poison: It Isn't Just For Breakfast Any More:
#1 ::: edward oleander ::: (view all by) ::: November 16, 2008, 08:05 PM:

Yummy... save some for me!

#2 ::: edward oleander ::: (view all by) ::: November 16, 2008, 08:18 PM:

Seriously though... The Poison Control folks are wonderful... If you're in a large metro area, the line will answered by local people. I can't count how often I have used them to identify random pills found in a patient's pocket. When someone is too drunk to tell you if and what else they may have taken, a quick consult with the P.C. hotline will often tell me whether I need to shuffle these guys off to the ER... They are worth their weight in gold...

Good post, Mr. MacMedic! Thank you!

#3 ::: David Bilek ::: (view all by) ::: November 16, 2008, 08:28 PM:

The scariest absorbed toxin I know is dimethylmercury. I didn't like even being in the same room as the stuff. A single drop can kill you... through latex gloves. Doubleplus ungood.

My recommendation for the handling of dimethylmercury is as follows: don't.

#4 ::: James D. Macdonald ::: (view all by) ::: November 16, 2008, 08:33 PM:

You bring up a good point, Edward: Alcohol is an ingested poison.

Please note the whole ingested poison thing works here: What was it? Alcohol. When did they drink it? An hour ago. How much? A fifth of Jack Daniel's. What was the time-frame? Chugging is different from sipping all day. And someone who's been drinking a fifth of JD every day for the past thirty years is going to have a different presentation (and probably outcome) than someone who just turned twenty-one and this is the first time he ever took a drink. What are the signs and symptoms? Nausea, vomiting, altered mental status. How much does the patient weigh? A 120-pound lady and a 300-pound football player are going to have a different response to a fifth of JD. What treatment has already been given? His chums made him drink a pot of black coffee (not so good) or his chums rolled him into the recovery position (better choice).

And -- is the scene safe? Any time you've got a bunch of drunks around, the answer is Probably Not So Much.

#5 ::: Seth Gordon ::: (view all by) ::: November 16, 2008, 08:51 PM:

After a Dartmouth professor accidentally and fatally poisoned herself with dimethylmercury, MIT's chemistry department held a retraining session on What Gloves To Use (like What Fork To Use, only with higher stakes). My wife, a grad student in chemistry at the time, started using nitrile gloves for just about everything.

(She did pretty well coming out with a Ph.D. and no obvious liver disease. Fires, on the other hand....)

#6 ::: edward oleander ::: (view all by) ::: November 16, 2008, 09:02 PM:

It's funny... When asked how much and when they drank, the answer is nearly always inflated beyond survivability. While they might tell the cop they had the famous "two beers," they will tell us at Detox they polished off a whole gallon just that afternoon...

And Jack Daniels? Maybe for the first week of the month... After that it's Popov and Listerine... Although Dr. Tischner's is now available locally (140 proof mouthwash with peppermint oil... makes for some nasty DT's)...

BTW: We had one last month come from the county hospital who popped a .656 by blood draw (down below .300 when they come to us)... They had one 5 years ago who survived a .680... I'd be so dead. No more nom nom nom...

#7 ::: P J Evans ::: (view all by) ::: November 16, 2008, 09:09 PM:

The first job I had was in electronics assembly. We were using silver (conductive) epoxy, and the solvent of choice for uncured epoxy was TCE. We had small beakers, open, next to our stations. Not only that, but we were using tweezers (style C3), and those were wiped clean by jabbing them into a wad of tissue held in the other hand, which resulted in palms full of tweezer holes (and probably epoxy).

Sometimes I'm surprised I'm still alive and well.

#8 ::: James D. Macdonald ::: (view all by) ::: November 16, 2008, 09:11 PM:

I remember one case where we needed every ambulance in the area: a group of young adults up for a weekend vacation in wintertime who all presented with dizziness, shortness of breath, nausea and vomiting, all staring within about five minutes of each other.

The first suspicion was carbon monoxide since it was winter and the furnace hadn't been used in a while. The fire department got involved, but couldn't detect any unusual gases. Eventually, the story came out: They'd stopped for supper en route, and had all had the same entrée. Food poisoning, it turned out. (An ingested, rather than inhaled, poison.)

Let's say you find Granny out in the garden, with altered mental status, and drooling. What's your thought process? Well, any signs of insecticide around? Because organophosphate insecticides have very distinctive symptoms: SLUDGE.

Salivation
Lacrimation
Urination
Defecation
GI Upset
Emesis

(Sometimes you see the signs and symptoms listed as "The Killer B's": Bronchospasm, Bronchorrhea, Bradycardia, and Blurred vision.)

(Other times you hear 'em listed as DUMBELS: Diaphoresis, Urination, Meiosis, Bradycardia, Excessive Lacrimation, and Salivation.)

You get those both from parathion or malathion and from nerve gas. But the odds are that if I see those, it's because someone was spraying their cranberry bog, not because of bin Laden. Remember, a terrorist attack is just a badly-placarded HAZMAT incident.

What you do about this (after you've made sure you aren't going to get exposed) is to give the patient atropine (IV or IM). (Which probably isn't going to be in your first-aid kit.) So what you really do is call someone who does carry atropine (your friends at 9-1-1 can do this), and in the meantime support airway, breathing, and circulation.

Speaking of atropine, atropine is an anticholinergic, and anticholinergics have their own set of symptoms (in case someone gets all Borgia on you; atropina is otherwise known as Belladonna.).

Blind as a bat
Mad as a hatter
Hot as a hare
Dry as a bone
Red as a beet

That's the signs and symptoms of Jimson Weed, 'mongst other things.


#9 ::: edward oleander ::: (view all by) ::: November 16, 2008, 09:29 PM:

Seth, I wish I knew more about mercury in general. I can remember playing barehanded with the mercury from a broken thermometer when I was a kid. Probably didn't even wash my hands afterward... Since I'm alive and not noticeably impaired, I assume the dimethyl version is lots worse.

It doesn't sound common enough that I'll ever likely run into it... and if I do, I'll have a great resource... The expert quoted in your link (Rob Skoglund) is the brother of a high school acquaintance... Nice to know he made it to the big time!

#10 ::: BigHank53 ::: (view all by) ::: November 16, 2008, 09:43 PM:

Metallic mercury isn't good for you, but it's not terribly dangerous, as it's hard to get it into your system where it can screw with your nerves, liver, and kidneys. Methylated mercury will soak right through your skin and kill you right quick. As noted above, it'll go right through latex gloves, too.

I used to work in a silicon fab. Fun chemicals there included hydrofluoric acid, also a skin penetrant. Lethal dose is a couple ounces; I regularly worked with a bucket full of the stuff. The real entertaining one was the bottle of arsine gas: lethal levels are something like 6 parts per million and the level of detectability is 10 ppm.

I learned all kinds of entertaining stuff. Proper treatment for inhalation of sulfur hexafluoride gas? It's non-toxic, but heavier than air, so someone who breathes it in won't be able to breathe it back out once it settles to the bottom of their lungs. So what you do is drape them over a railing so the heavy gas flows out of them again....

#11 ::: Joel Polowin ::: (view all by) ::: November 16, 2008, 09:46 PM:

Another nasty absorbed toxin is fluoride ion. It doesn't go through any of the usual glove materials, but it's readily absorbed through skin, and of course you can get HF gas by acidifying a fluoride solution. No symptoms, I'm told, until that tingling sensation tells you that your nervous system is having problems due to calcium being glommed onto. (This is distinct from fluorine gas, which rots your lungs like chlorine gas only much worse, and then does the fluoride ion thing. You're not likely to encounter fluorine gas outside of a chemistry lab which deals with moderately exotic reactions, mind you. I spent one summer in such a lab, and we had a tiny leak one day. Prompt evacuation. Fluorine smells similar to chlorine, FYI.)

I mention this because there's recently been a rash of graffiti/vandalism in Ottawa which involves people using glass-etching cream to leave their marks on windows. These creams are usually fluoride-based -- they react with the silica. The etchants present a hazard to the vandals and to anyone who touches the graffiti before the remaining etchant is removed.

#12 ::: Joel Polowin ::: (view all by) ::: November 16, 2008, 09:51 PM:

BigHank53: re: sulfur hexafluoride: gases mix easily; there's very little tendency for them to remain separate based on density except briefly in the absence of any turbulence. A few breaths of normal air would flush a lungful of SF6.

#13 ::: Joy ::: (view all by) ::: November 16, 2008, 10:03 PM:

There was a local family here who had jimsonweed poisoning after a large extended family dinner. Apparently the jimsonweed invaded their mint garden and the older person who harvested the mint wasn't paying attention or was unable to tell the difference.

When a younger person at this big family dinner who didn't have the affected dish (a potato stew) noticed that almost everyone else including the older people were acting "like they were high on pot" thought something amiss and called 9-1-1. Everyone recovered in a few days, but they had to be hospitalized.

#14 ::: Thomas Lumley ::: (view all by) ::: November 16, 2008, 10:18 PM:

The Australian guidelines on snakebite go a bit further with bandaging, though the rationale of preventing lymph flow and the NO TOURNIQUETS advice are the same. The recommendation is to apply local pressure to the site and then bandage towards the heart if you have more bandage left, and to immobilize with a splint or sling. The same advice is applied to other critters with neurotoxic venom: funnelweb spiders, blue-ringed octopus, cone shells.

Of course, it makes sense to get local advice if you are venturing into the outdoors: the first-aid for venom from tropical fish is quite different from that for rattlesnakes.

#15 ::: Ginger ::: (view all by) ::: November 16, 2008, 10:27 PM:

A very appropriate post on the 30th anniversary of Jonestown.

Some veterinary medications are toxic to humans, although certainly not in dimethymercury-levels. There's a drug called M99 (etorphine) that is used to capture large game or zoo animals; it's essentially an extremely potent form of morphine. It's so hazardous that personnel must draw up the antidote before drawing up the anesthetic agent.

#16 ::: Diatryma ::: (view all by) ::: November 16, 2008, 10:30 PM:

A couple friends of mine have been going through a CO scare-- they wake up with headaches, and when I described CO poisoning as 'the worst hangover ever', not my own description, one of them said, "That's exactly it!" The fire department, once called, did not find anything, nor did the energy folks. I am skeptical, but they've done what there is to do.

One thing many people who don't work in labs forget about gloves is that just about everything will go through gloves eventually. Nitrile gloves hold things off a little faster, but the idea is to a) keep you from touching your face, gnawing your fingers, scrubbing your eyes (I fail at this) and b) give you time to rip the glove off before whatever you've spilled all over your hand goes through.

Again, not my own experience, but I have been told that you never take off any glove as fast as the one that's on fire.

#17 ::: P J Evans ::: (view all by) ::: November 16, 2008, 10:34 PM:

#10
I remember the Dire Warnings in chemstry and physics labs about hydrofluoric acid and hydrogen fluoride. One of them was that they act in some way as an anesthetic, so you can be pretty badly hurt without feeling it.

#13
Jimsonweed and mint don't look anything alike.
(The poisoning I read about was someone who was using jimsonweed as rootstock for tomatoes, and the toxic substances were migrating up the stem into the tomato part of the plant.)

#18 ::: Andrew T ::: (view all by) ::: November 16, 2008, 10:35 PM:

regarding Narcan: If you're really determined to get your hands on it, but don't want to take EMT courses, you could move to Vancouver and go to a harm-reduction overdose prevention course. According to this article they will hook you up with a Narcan kit after a brief training session.

#19 ::: Vicki ::: (view all by) ::: November 16, 2008, 10:41 PM:

A friend of mine posted elsenet some months ago that she was having a great deal of trouble finding activated charcoal for her first aid kit. This was in the Boston area. Is this some specific-to-Massachusetts thing, or is it no longer a readily available drugstore item? And if so, where should we be looking?

#20 ::: Henry Troup ::: (view all by) ::: November 16, 2008, 11:11 PM:

#17 When I was with the Nortel Emergency Response Team, the asserted symptoms of HF included intense pain. The claim was that the stuff has a very high affinity for calcium ion. Calcium is key to making your nerves work normally, but loss of it causes irritability. The first antidote is calcium gluconate gel, applied topically.

We also got training for cyanide exposures. The cyanide kits were in multiple parts - amyl nitrate ampules for part one, and an additional package to go to the hospital with the patient for part two. Someone in the training asked about the hazards of the antidote; I think I embarassed the trainer by remarking that they were a sought-after recreational drug in some circles.

I see that the UK has new recommendations on cyanide treatments.

The only call I ever took from the chemical facilities was "difficulty breathing" - very scary, of course. It turned out to be a peanut butter allergy, though - a different ingested poison.

***

Back in university, when we were using HCN, they showed us the solutions A & B antidote - nasty looking stuff - and assured us that we'd vomit out everything we'd ever ingested, back to mother's milk. That turns out to be
"ferrous sulphate dissolved in aqueous citric acid, and aqueous sodium carbonate".

One of our comp. sci labs had a mysterious cupboard - when we opened it, we found a kit of "poison antidotes" with last inspection dates in the 1940's. They were in classic ground-glass stoppered bottles, and there were still liquids in them.

***

I'll dispose of the ipecac - I've been keeping it on hand for years.

#21 ::: Joel Polowin ::: (view all by) ::: November 16, 2008, 11:13 PM:

Diatryma @ 16: I'd expect there to be a simple blood test for CO poisoning. The toxic effect is that the CO binds strongly to hemoglobin, forming bright-red carboxyhemoglobin, inhibiting the usual transport of oxygen -- a usual symptom of serious CO poisoning is that the victim appears flushed. Your friends might want to consult a doctor. There are probably other environmental problems that could also produce chronic headaches.

#22 ::: Marilee ::: (view all by) ::: November 16, 2008, 11:30 PM:

I take colchicine, which is toxic in very small amounts. I'm very careful to take it as prescribed. And before there were good inhalers, I used atropine in my nebulizer. The atropine came in glass ampoules and I had to buy accountant rubber-fingertips to keep from cutting myself by opening them. Now I use the rubber-fingertips for pulling needles through beads.

#23 ::: A.J. ::: (view all by) ::: November 16, 2008, 11:52 PM:

Another classic absorbed toxin: nicotine.

My cousin's research involves administering drugs to flies. When she got her lab safety training, they told her this about the nicotine solution: "If you get any of it on yourself, wash and have someone call 911. Then sit down, and relax, try to stay as calm as possible. You don't want to have a heart attack before the ambulance arrives."

#24 ::: Leva Cygnet ::: (view all by) ::: November 17, 2008, 12:05 AM:

I once took a couple of quarts of liquid mercury -- neatly sealed in glass canning jars -- to a hazardous waste disposal day. The reaction from the workers was pretty dramatic: they called their supervisor who called his supervisor. They did, however, accept it, after interrogating me for a bit.

My grandfather was a prospector in the 1960's, and used mercury for recovering placer gold. When Gramma passed away several years ago, we found his mercury in a cupboard.

I suspect Gramma was the one who canned the mercury.

#25 ::: xeger ::: (view all by) ::: November 17, 2008, 12:05 AM:

In no particular order:

Poison Control will also (once you explain why you want to know[0]) help you to understand what to keep around the house, and how much to worry about plants in your garden.

Carbon monoxide poisoning is nasty. I'm very, very, very glad that I still have parents[1], and that one parent "smelled something funny"[2]. I hadn't known until then that (sensibly) they use the same treatment as you would for divers -- a hyperbaric chamber.

If you don't have carbon monoxide detectors... get them. It's a cheap investment at the price. CO detectors -DO EXPIRE-, so check them often, and be sure there's a (working) battery backup if yours is mains powered.

[0] I've grown Atropa Belladonna on-and-off for years, when I've had an appropriate garden area, but only had it fruit once. At that point, despite the garden being in a fenced back yard, it seemed wise to find out what a problem dose would be; the fruit look rather appetizing to anybody that doesn't know better (and some that should).

[1] It's a tad disconcerting when the emergency department explains that your parent shouldn't have survived with that CO level, let alone having survived with no immediate damage.

[2] More likely "has been a research chemist, and didn't smell anything, but recognized that there was something wrong", and remembered "smelling something"

#26 ::: Linkmeister ::: (view all by) ::: November 17, 2008, 12:10 AM:

Diatryma @ #16, Joel @ #21, one of those headache-like presentations might be sleeping in a room for extended periods with furniture made of particle board. There's formaldehyde used in the processing of that stuff, and we've called the State Health Dept. to ask about it. They suggest replacing the furniture if you can, but at least ventilate the room if you can't do the first.

Reason we called is that I'm waking up with the occasional headache and the dresser is a 5-foot piece of furniture made of that material. My windows are wide open.

#27 ::: Cynthia Wood ::: (view all by) ::: November 17, 2008, 01:12 AM:

Ahh, old familiar grounds here. I used to work in a neuropharmacology lab. Our MSDS files read like something out of an ED's nightmare. LSD, cocaine, PCP, digitoxin, picrotoxin, barbiturates - you name the dangerous, sometimes voluntarily used substance, we had it (and the five metric tonnes of required paperwork to go with it).

And just to add to the fun, the protocol we were working with required the mixing of these substances with DMSO. Whee! From ingested to contact poisons in one easy step.

The MSDS's could be entertaining. The MSDS for sucose was good - nothing like five pages of warnings attached to a 100g can of something you can buy in 5 lb. lots at the grocery store - but it was not quite as good as the one that got sent us for books. (Hazards: Impact, falling, paper cuts)

#28 ::: Joe McMahon ::: (view all by) ::: November 17, 2008, 01:41 AM:

Way back before I got sensible and left inorganic chemistry, the scary one around our lab was nickel carbonyl. This is essentially a nickel atom cozying up with 4 carbon monoxide molecules. Boils at 43C, extremely easy to absorb through the skin, and with a nice high vapor pressure.

It has the wonderful feature of giving you heavy metal poisoning and carbon monoxide poisoning in one handy package. Plus the vapor is so heavy that regular fume hoods are very, very bad at containing it. Thank heaven I never even had to think about using it.

#29 ::: Raphael ::: (view all by) ::: November 17, 2008, 01:52 AM:

Now I'm scared- where out of garages, factories, and labs do you get CO poisoning, and how? And why didn't anyone tell me about it before?

#30 ::: xeger ::: (view all by) ::: November 17, 2008, 02:02 AM:

Raphael @ 29 ...

Generally anywhere there's combustion and insufficient ventilation, there's an opportunity for CO poisoning.

I'm a tad surprised that you haven't heard about it before -- in most schools these days, it'll come up from kindergarten onwards, as a part of "safety & fire" related days/talks.

#31 ::: Raphael ::: (view all by) ::: November 17, 2008, 02:12 AM:

Xeger, thank you, good to know. I've learned about CO poisoning, but pretty much entirely in connection with cars and other ICE powered stuff. What about city apartments along busy streets with open windows?

#32 ::: Lee ::: (view all by) ::: November 17, 2008, 02:35 AM:

Somewhere around here* I've still got a transparent green plastic capsule with about an 8mm-diameter blob of mercury in it. I got it from my dentist when I was 10 or 11 years old, and thought it was the coolest thing since sliced bread. I don't think I ever took it out -- just rolled it from one end of the capsule to the other, feeling the weight of it and watching it be a very dense liquid.

* Actually, I'm pretty sure I know where it is -- in the dresser drawer that stores a lot of "I've had this forever" sort of tchotchkes that I never use but don't want to throw away.

#33 ::: xeger ::: (view all by) ::: November 17, 2008, 02:42 AM:

Raphael @ 31 ...

In general, as long as the air supply isn't excessively constrained, you should be fine -- open windows along a city street are likely to be stinky, but there's also a very large (planet sized, in fact) amount of 'air' involved, so you'd have to have some pretty impressive amounts of CO for any effect (although my recollection says that in some unusual circumstances, like volcanic eruptions, huge amounts of CO can be pushed into the local area... of course, if you're sitting around a volcanic eruption, there are likely other issues...).

Closed environments are a problem (but note that "closed" means that whatever's producing the CO is doing so at a rate faster than the closed environment can refresh -- ergo advice to not do things like use your propane BBQ for indoor heating during a power outage...).


#34 ::: Devin ::: (view all by) ::: November 17, 2008, 03:16 AM:

Raphael-

Mainly houses with bad furnaces.

#35 ::: dcb ::: (view all by) ::: November 17, 2008, 04:55 AM:

Ginger @ 15

I sometimes give a lecture to final-year veterinary students on remote anaesthesia. Half the lecture is safety such as making sure you've got the Narcan, double-checking whether the vial you're about to draw drug from is the Immobilon (etorphine plus ACP) or Revivon, preferably not using highly potent opioids without someone else there who knows how to inject the Narcan - and ALWAYS ASSUME THE DART GUN IS LOADED. Just because there's one tale of a guy who managed to inject himself with M99 out in the middle of nowhere in Africa then drove back to the hospital, injecting himself with Narcan every 10 minutes or so on the way and survived to tell the tale, doesn't mean this is a good thing to try.

Also, don't clean around the needle cuff of a loaded, pressurised dart wihtout depressurising it. I got a face full of ketamine and xylazine once and, while running to a sink where I could wash it off, was trying to calculate how much might have got into my eyes and mouth (and therefore been absorbed) and whether the dose rate would be high enough to cause physical symptoms (it wasn't).

#36 ::: Daniel Klein ::: (view all by) ::: November 17, 2008, 06:59 AM:

On the CO problem, I'm going to ask along the same lines as Raphael did: in a reasonably modern apartment building (erected at some point in the last five years or so) there shouldn't be any real risk of carbon monoxide poisoning, should there? We tend to have the windows open much of the time, and the only combustion happening in the apartment is that we cook with gas (and that happens in the livingroom/kitchen, where there usually is a half-opened window as well, nevermind the door to the balcony being opened once an hour when my roommate goes outside to administer personal carbon monoxide poisoning to his lungs). CO poisoning doesn't sound like something I realistically need to worry about, right?

#37 ::: G. Jules ::: (view all by) ::: November 17, 2008, 07:13 AM:

Massachusetts requires CO detectors in all rental units. I've got one.

If you're worried about CO, Amazon sells a First Alert detector for $19.88. I hear they make great Giftmas presents.

Another poison-injection-opportunity I remember from my OSHA training: getting cut with broken glass from a poison container.

I saw hydroflouric acid baths in a factory once, and they terrified me. Half of our OSHA training was horror stories about what chemicals will do to you if you don't watch out, and the hydroflouric acid stories were especially terrifying. (The other half was dangling from wires, looking at the dents in the ceiling from when the instructors chopped the top of that compressed air bottle, and all that good stuff.)

@#7: I'd worry more about the TCE than about the silver epoxy. TCE is nasty stuff.

#38 ::: James D. Macdonald ::: (view all by) ::: November 17, 2008, 07:38 AM:

I talked a lot more about carbon monoxide in Stop, Drop, and Roll.

If you're cooking with gas, rather than just a CO detector, get one of the combined CO and explosive gas detectors. It'll probably never go off. If it does, call the fire department ... from across the street. Think of it as very cheap insurance.

#39 ::: sara_k ::: (view all by) ::: November 17, 2008, 07:43 AM:

Our CO monitor went off after a bird thought our clothes dryer exhaust vent made a dandy winter house and I did a week's laundry in one day. I've heard that lint buildup in the exhaust vent is a CO hazard as well as a fire hazard.

#40 ::: dcb ::: (view all by) ::: November 17, 2008, 07:58 AM:

Back in high school, in the 1980s, our chemistry teacher told us about the old-style health-and-safety measures they'd used when dealing with nasty chemicals when she was working in industry: working person sits in a laboratory with a rope round their waist. Someone else watches through a glass window. If the chemist falls over, haul them out the room using the rope... I think things have moved on a bit since then.

#41 ::: inge ::: (view all by) ::: November 17, 2008, 08:31 AM:

G. Jules: Massachusetts requires CO detectors in all rental units. I've got one.

(curious) -- What's the usual mode of heating and cooking there?

It has been over 20 years since I lived in a place that even had a furnace or a gas stove.

#42 ::: John L ::: (view all by) ::: November 17, 2008, 08:44 AM:

Carbon monoxide poisoning can come from a variety of sources, but they all involve combustion; it's a byproduct of burning fuel. One of the most common causes of CO poisoning is when someone uses a propane gas grill inside the house while the electricity is out. Or, hooking up an emergency generator inside the garage instead of outdoors. Running your car in a garage, even with the door open, can elevate the CO levels in the building and it can seep into your house. Bad furnaces will do it too.

A few years ago we had a woman in our office call in sick; she had been working outside the day before in her yard, and that evening found a plethora of red welts all over her skin, and she felt terrible. The doctor looked at the welts with a magnifying glass, asked her some questions, and said "well, they aren't insect stings". When she asked how he knew that, he said "because each one of these welts has TWO punctures".

After some tests, he diagnosed her illness as being caused by tiny little black widow spiders that had just hatched and fallen on her when she was working under one of her trees. Being newly hatched, they were only the size of a pinhead, but they --were-- black widow spiders, and their venom was full strength, only in minuscule quantities.

#43 ::: Rikibeth ::: (view all by) ::: November 17, 2008, 08:45 AM:

inge, while it's a toss-up whether any apartment or house in Massachusetts would have a gas or an electric stove, furnaces are pretty much standard - either gas or home heating oil. I can't think of anywhere I've lived in New England that's relied entirely on electric heat.

#44 ::: BuffySquirrel ::: (view all by) ::: November 17, 2008, 08:46 AM:

I remember some years ago walking into my workplace after a few days off and encountering a staff member on the way to the office who complained that she and all our colleagues had been suffering from headaches. This was at a time when the heating in the building wasn't working and they'd been given a paraffin (kerosene) stove.

When I went into the office proper, I reeled back and then rushed around opening windows. The stink of paraffin fumes was incredible. It's one thing to keep warm, quite another to sit there poisoning yourself and wondering why your body is complaining....

I've had CO poisoning. Not Fun.

#45 ::: Cat Meadors ::: (view all by) ::: November 17, 2008, 09:00 AM:

A second on "where the heck do you get activated charcoal?" When my daughter was born & I took all those baby first-aid classes, I kept looking for it but could never find any. (For the record, the classes have been anti-ipecac for at least 6 years, but you can still get that in drugstores!)

#46 ::: xeger ::: (view all by) ::: November 17, 2008, 09:05 AM:

The new tankless water heaters can also be culprits, since they often have higher combustion requirements.

#47 ::: James D. Macdonald ::: (view all by) ::: November 17, 2008, 09:28 AM:

Get your activated charcoal over at Moore Medical.

#48 ::: Ursula L ::: (view all by) ::: November 17, 2008, 09:43 AM:

Re #23:

If "nicotine solution" is an absorbed poision, is this only a special preparation, or is there risk from, say, cleaning up nicotine stains off of walls and fabrics, from nicotine in the water used to clean?

#49 ::: James D. Macdonald ::: (view all by) ::: November 17, 2008, 09:45 AM:

Other on-line sources of activated charcoal.

The brand name of the stuff we carry is "Actidose," so that's a good search term.

#50 ::: G. Jules ::: (view all by) ::: November 17, 2008, 09:45 AM:

What Rikibeth said.

My apartment is in a converted Victorian house and has natural gas heat delivered via radiators, an electric stove, and electric hot water. Heating here generally is probably 50-50 natural gas to #2 fuel oil. Some newer apartment complexes do have electric, but it's not common; our winters are cold enough that baseboard electric heat isn't all that cost-effective, and AFAIK heat pumps can't really handle this kind of cold.

I'm originally from Maine, which is where you start finding kerosene (Monitor heaters) and wood as heating methods.

#51 ::: James D. Macdonald ::: (view all by) ::: November 17, 2008, 09:50 AM:

Nicotine is a vegetable alkaloid, and it can enter the body through the transdermal route.

While I imagine the amounts that you'd find while washing walls and curtains would be small, it wouldn't hurt to wear gloves.

#52 ::: Alex ::: (view all by) ::: November 17, 2008, 09:53 AM:

13: Way to make the party go with a bang!

I sometimes give a lecture to final-year veterinary students on remote anaesthesia. Half the lecture is safety such as making sure you've got the Narcan, double-checking whether the vial you're about to draw drug from is the Immobilon (etorphine plus ACP) or Revivon, preferably not using highly potent opioids without someone else there who knows how to inject the Narcan - and ALWAYS ASSUME THE DART GUN IS LOADED.

I would think part of the problem here is that if you give the reviver rather than the sedative, what are you going to do with the leopard?

This reminds me of the time I got sprayed with a veterinary insecticide that came in containers with safety warnings including "in remote areas, keep atropine injector handy". We were wearing our usual outback spacesuits - i.e. jeans, boots, old German Army shirt, hat. I was leery, but there was nowhere else to go. And then the boss - did I mention he had been a full colonel in the Royal Engineers and an NBC specialist of all things? - dropped the spraygun. Sprayed!

I ran like hell to a hose, expecting to become the world champion tap dancer at any instant, and soaked myself from head to foot with H2O, the solution to pollution being dilution.

This queered my reputation instantly, marking me out as a piker. I still wonder if the Colonel knew more about the stuff's effects than the safety authority (he mentioned it was similar to some Soviet war gasses), or whether he was just really, really irresponsible.

#53 ::: Joel Polowin ::: (view all by) ::: November 17, 2008, 10:11 AM:

In the organometallic lab where I did my doctoral work, I used iron carbonyls a few times -- start with Fe(CO)5, a somewhat volatile liquid, and photolyze to Fe2(CO)9, a flaky orange solid, or react with a strong base to eventually give dark-green crystalline solid Fe3(CO)12. Though I did what I could to minimize exposure, I sometimes caught a whiff of the stuff. They had a distinctive strong musty odour.

A couple of my colleagues sometimes used CO from a cylinder in their work. Again, though they were as careful as they could be, a couple of times a tiny amount of the gas got out. Same musty smell. I've sometimes wondered if the CO, under pressure in the cylinder, might have been reacting to give traces of iron carbonyls. The cylinder should have been constructed of materials that wouldn't react with the gas, but...

This isn't work I particularly care to repeat.

#54 ::: David Dyer-Bennet ::: (view all by) ::: November 17, 2008, 10:35 AM:

I'm sure it's time to check (probably to replace) my CO detector. I expect I'll find an expiration date on it somewhere.

Do the new ones have an actual readout that show the level before it gets high enough to issue a warning? My old one does, and has never shown a number other than 0.0 (and it keeps track of the max recorded). I actually wish it were *very slightly* higher, as pure perfect 0.0 leaves me wondering a bit.

#55 ::: fidelio ::: (view all by) ::: November 17, 2008, 10:35 AM:

Down here in tobacco-growing country, hospitals regularly see outbreaks of nicotine poisoning when it's time to harvest the stuff--the only way to harvest tobacco is by hand*, and some people regularly ignore any warnings they've received about wearing gloves and long-sleeved shirts, because it's usually hot weather, and thus they collect enough nicotine from the plants on their bare, sweaty skin that they end up feeling quite unwell. I haven't heard of anyone dying as a result, but then, I haven't gone looking for the data either. As far as I know, most people are treated and kept for observation, and then sent home with reminders to be more careful next time.

Why, yes, farming is one of the more interestingly dangerous occupations in the US.

*In case you were wondering, because it requires so much hand-tending (you have to keep plucking off buds so the plant won't flower and go to seed to early, plus there's the tobacco worm issue--these are traditionally pulled off the plant by hand, and droopped in a jar of kerosene or gasoline), besides the picking, tobacco is generally grown in small plots. To harvest it, someone goes down the rows with a big muckin' knife, cutting off the plant close to the ground. They're followed by someone else who picks up the plant, and jams it (near the base of the plant) onto a long stick. When the stick is full, you get another one, and at the end of the day, the sticks are hung up in the rafters of the tobacco barn to cure, either by slow-drying or, in the case of dark-fired tobacco, by means of slow smoking via a smouldering fire of hardwood chips and sawdust. There are also a lot of complaints of shoulder pain from the people hanging the sticks as the harvest wears on, and then there are the folks who need stitches, as they weren't as careful as they should have been with their big muckin' knives.

#56 ::: Columbina ::: (view all by) ::: November 17, 2008, 10:41 AM:

#17 - belatedly - the tomatoes-on-jimsonweed-rootstock is from one of Berton Roueche's excellent medical/epidemiology essays, and I'm pretty sure it's one of the ones which was reprinted in the later re-collection The Medical Detectives. If you're fascinated by these EMT posts (and their subsequent comments) as I am, you want this book, and any of his other collections (the original ones, such as Eleven Blue Men, are now hard to find) that you can locate.

#57 ::: Adrian ::: (view all by) ::: November 17, 2008, 10:54 AM:

Diatryma (16): I've taken off a glove that was on fire more than once, and I was quick about it, but not spectacularly so. They were very thick gloves with high-temperature insulation, designed for reaching into a ceramic furnace. I think my fastest glove-removal ever was when I was up to my wrists in biohazards, and I heard my friend in the other room make that beginning-of-seizure-noise and *thump*.

#58 ::: Adrian ::: (view all by) ::: November 17, 2008, 11:09 AM:

Speaking of Duragesic patches, Jim mentioned them as being absorbed through the skin. That's the way they're supposed to be used. It's possible for a person to overdose that way. Heat makes the drug release faster, and people in a lot of pain tend not to account for fevers or even hot tubs.

When a person deliberately abuses Duragesic, trying to extract 3 days worth of narcotic (or the residual narcotic in a used patch) for an immediate high, they sometimes put the patch in their mouth. The narcotic is absorbed through mucous membranes faster than through other kinds of skin. A friend of mine is an EMT in an area rather like Jim's (rural Vermont), where Duragesic abuse was starting to become popular, and she told me about the problem of using Narcan in those cases. It's easy to miss a bit of plastic under the tongue when checking the airway, but the person still tends to aspirate it during the initial WTF! response to Narcan.

#59 ::: James D. Macdonald ::: (view all by) ::: November 17, 2008, 11:09 AM:

Farming is hazardous. Farming is why I run into a lot of trauma, environmental, and poisoning emergencies. The only thing worse than farming is logging ... and I'm living in a logging area. Keeps us busy.

#60 ::: Lola Raincoat ::: (view all by) ::: November 17, 2008, 11:18 AM:

In Ontario, part of the required home study before they'll let you adopt a child is checking for CO and smoke detectors in the kitchen, near the furnace, and in the bedrooms. So CO poisoning is definitely part of people's consciousness here. Whereas a little to the south ...

In Mexico City, about ten years ago, the air got unusually bad one summer - bad even for Mexico City that is - and then one of the local volcanoes started belching CO among other gases. Mexico City is very high up so there's not a lot of O2 in the air anyway. A friend of mine was quite seriously hurt when, as she was driving along on the Periferica, a pigeon fainted in mid-air and hit her windshield on its way down, because there wasn't enough oxygen to keep a pigeon conscious in the air five meters about her head. Bystanders told her that the pigeon got up and flew away again, apparently unharmed. When the medics got there they told her they were seeing a lot of falling-bird-related injuries.

#61 ::: inge ::: (view all by) ::: November 17, 2008, 11:21 AM:

Rikibeth, G. Jules: The places I lived in lately had heat from local CHP plants. With several apartment blocks and a university campus close together, it's more energy efficient than to have one boiler rooom in every house's basement.

#62 ::: Lila ::: (view all by) ::: November 17, 2008, 12:36 PM:

Columbina @ #56, yep, the jimsonweed/tomato story is in The Medical Detectives, a book notable for the number of episodes in the first season of "House" it spawned (and for the fact that often the real story is more interesting than the TV version).

#63 ::: Charlie Stross ::: (view all by) ::: November 17, 2008, 12:36 PM:

@15: Mmm, etorphine. Binds to opiate receptors with something like 4500 times the affinity of morphine, if I remember my pharmacology lectures properly. Dose is as for diamorphine, only in micrograms rather than milligrams. Not used on human beings; generally used for sedating large animals (from elephants and rhinos on up to whales).

On fluourine ions and related stuff: one of the substances I least want to ever come within a mile of is chlorine trifluoride. As oxidizing agents go, it seems to be the halide equivalent of hydrogen peroxide. There's a wonderful chapter in John D. Clarke's book "Ignition: An informal history of liquid rocket fuels" in which he describes ClF3 as "hypergolic with everything, including rocket scientists" and describes the most essential handling equipment: "a good pair of running shoes".

Yes, I gather this stuff is used in semiconductor production.

#64 ::: SamChevre ::: (view all by) ::: November 17, 2008, 12:52 PM:

Farming also gives you access to odd ways of poisoning yourself, and sufficient lack of funds that you'll try things that suburbanites wouldn't. When I was a boy, a family, friends of mine, got very very sick with organophosphate poisoning. They (like my family, and a lot of others of our acquaintance) had, on the advice of the local vet, been using horse wormer to worm themselves; a perfectly safe enterprise if you use the right wormer and the right dose, but they'd gotten the nearly-same-named wormer that also kills bots. (Brandname vs Brandname-B). Bots are tough, and not helminths, and the usual anti-bot agent is an ACE inhibitor--in this case, triclorofon.


And NEVER go into an enclosed area where one person has collapsed without a rope and a guard. These people and I had mutual friends. Methane is a suffocant, not a poison per se, but it can still kill you, as can CO2.

#65 ::: Alex ::: (view all by) ::: November 17, 2008, 12:55 PM:

Charlie, you should read up on the fuel used in the Messerschmitt Me163 Komet. Elementary safety principle, the first - keep the T-Stoff truck one kilometre away from the C-Stoff truck at all times. The second - wash down aircraft and hardstanding with fire engine after loading either fuel.

The third - don't volunteer to fly the fucking thing, as in the event of a forced landing, the T-Stoff had been known to leak into the cockpit and dissolve the pilot alive. In that event, the fuel tank exploding was actually the best thing that could happen. And all Me163 landings were glide approaches. But you couldn't be certain there wasn't some left in the tank...

Come to think of it, I don't know what the procedure was in the event you had to de-fuel one. I wouldn't be surprised if you just set fire to it.

#66 ::: John L ::: (view all by) ::: November 17, 2008, 01:02 PM:

Oh yeah, farms are hazardous areas everywhere you look. Every year when I was growing up there was always a news story about how someone sent into a silo suffocated from the buildup of CO2 trapped in the bottom of the silo from decomposing grain.

Often the rescue team would find out too late that what they thought was a falling injury was a suffocation, when they realized they were breathing but it wasn't doing them any good at all. But, that's why they were TEAMS; someone could pull them out when they fainted, unlike the farm worker who had already expired.

Then there's the tractors and their engines in the barn (more CO), fertilizers in both liquid and solid form that release noxious and hazardous fumes, nails in the cow manure (quick trip to the doctor for a tetanus shot, yeah, been there done that), washing down the milking areas with bleach and then realizing the cows were about to URINATE there too (not fun with chlorine gas being liberated around big animals), etc, etc.

#67 ::: Leva Cygnet ::: (view all by) ::: November 17, 2008, 01:03 PM:

Re: livestock wormer ...

Pour-on ivermectin is absorbed through the skin, rather efficiently, as the name would suggest. I know someone who made themselves fairly sick when they spilled a large dose on themselves while worming cattle. However, it's safe to say that they're free of worms.

I also discovered I was allergic to penicillin via a needle stick while treating a goat. And then discovered I was allergic to sulfa when washing out poultry waterers after I had put a sulfa drug in the water.

I carry epinephrine now.

#68 ::: Madeline F ::: (view all by) ::: November 17, 2008, 01:23 PM:

Re: #67: when some of the mice here at work got pinworms and they were putting ivermectin in their water to clear that up, the guy mixing it up was just doing it in a bucket, arms wet to the elbows, because no one thought about the danger or mentioned it to him. Then he had his one and only bout of Bell's Palsy...

For happier news, the last time I called poison control was when I was mowing the back yard and got poked by the pineapple-shaped palm tree, which eh, but then there was the feeling of blood running down my arm inside my sweatshirt... Went inside to wash it off and saw that the arm had swollen up like crazy. Was googling for a local poison control phone number, since I seemed to remember from childhood that poison control was a local thing... No luck whatsoever, terribly aggravating. Eventually found a number for poison control for the whole state of California, and the lady was reassuring that there was no info on poisonous palm trees, or allergies to palm trees... It was just "mechanical insult" which was an amusing way of putting it. Basically, the goddamned skewer went deeper than I thought, pissed off a lot of blood vessels, but had such a tiny entry wound that it clotted without letting the released blood flow out. Those things are menaces. Like growing a rapier tree.

Anyway, now I've got the poison control number in my cellphone.

#69 ::: Charlie Stross ::: (view all by) ::: November 17, 2008, 01:28 PM:

Alex @65, T-Stoff was merely stabilized high-test hydrogen peroxide -- nasty stuff, but not remotely as unpleasant as chlorine trifluouride. C-Stoff (the fuel) was hydrazine and methanol -- not nice stuff either, and the two in combination were hypergolic, but again, mild in comparison to things like monomethyl hydrazine.

The USAF were considering the use of ClF3 as an oxidizer during the 1950s. After messing around with it in small (less than 1000 Kg) quantities, they decided to stick to relatively safe oxidizers, like red fuming nitric acid and liquid oxygen. This stuff is evil.

(Drip water into a tank of ClF3: the water will burn. Drip ClF3 onto concrete, or glass, or stainless steel: it'll catch fire. Drip ClF3 onto rocket scientists: they burn good, too. Doesn't work too well in rocket motors, because rocket nozzles are combustible too, if you get them hot enough -- like, above 4000 degrees. Oh, and when it burns, it gives off hydrochloric and hydrofluoric acid.)

#70 ::: Graydon ::: (view all by) ::: November 17, 2008, 01:48 PM:

Actually, Charlie, if I remember the sci.space posts correctly, some of those experiments were -- rocketry worshipping the god Performance -- with Chlorine Pentafluoride. Which is even worse...

I have so far been very lucky with toxins, and I really hope I manage to stay that way.

#71 ::: Xopher ::: (view all by) ::: November 17, 2008, 01:48 PM:

I now suspect I may have had CO poisoning that time I left work in an ambulance. I had been waiting to cross the street at a traffic jam outside Port Authority in NYC: many idling buses. I got to work and got sicker and sicker: barfed out of an empty stomach, had such a headache I was going blind.

I was feeling better by the time the ambulance arrived, but the guy still said I had very little pulse and no blood pressure to speak of; at that point I started getting oxygen and feeling much, much better.

I had a headache for three days. I thought I'd accidentally double-dosed my Verapamil, or was it Atenolol back then? But the symptoms sound a lot like CO poisoning.

#72 ::: Ariella ::: (view all by) ::: November 17, 2008, 01:56 PM:

What smells like new-mown hay?

#73 ::: G. Jules ::: (view all by) ::: November 17, 2008, 02:16 PM:

@#72: New-mown hay is phosgene, I think.

@#61: Central heating plants in the States are generally only found at colleges or in the city centers of older cities. (I know Boston, NYC, and Philadelphia have steam available in some areas as a utility; not sure about other cities.)

Otherwise, you don't really see CHPs in the states. Even a fair number of the multi-building apartment complexes in the US tend to use individual heating units for each apartment. It's too bad, because a CHP would be much more efficient.

#74 ::: Joel Polowin ::: (view all by) ::: November 17, 2008, 02:33 PM:

Ariella @ 72: the "canonical" smell of new-mown hay is from coumarin. (SF geeks may recall this from Asimov's reply to a comment from John W. Campbell about a submitted story, something like "CH3CH2CH2CH2SH", i.e., butyl mercaptan, i.e., "it stinks".)

#75 ::: Nix ::: (view all by) ::: November 17, 2008, 02:34 PM:
Please don’t leave the chicken lying out on the kitchen counter at room temperature for a couple of hours.
OK, so how else do you defrost the bloody things? (Well, you can leave them in the fridge for about four days, if you have four days...)
#76 ::: lorax ::: (view all by) ::: November 17, 2008, 02:35 PM:

I'm perversely amused that the first commenter on the thread shares a name with a famously poisonous plant. Oleander's nasty stuff, and I'm boggled at how common it is around here (southern CA) as an ornamental.

#77 ::: Nix ::: (view all by) ::: November 17, 2008, 02:39 PM:
In a work environment you’ll find information on every substance in the place in the MSDS (Material Safety Data Sheets) that are stored at some known and accessible location (e.g. by the front door, in the custodian’s office, in the supervisor’s desk).
It is to laugh. In the UK at least this is only true if you happen to work in a biomedical facility (e.g. when I was working at the NIBSC fifteen years ago even the laser printers had an MSDS for toner stuck to them). Elsewhere? I found to my surprise that the City firm where I'm now working had MSDSes... once. After much research I found from a retired ex-colleague that they were last seen two takeovers ago in a storage facility in Birmingham, since sold off by our ex-owners.

I would be staggered if anywhere that didn't regularly deal with hazardous substances as a matter of course had such things anywhere accessible.

#78 ::: P J Evans ::: (view all by) ::: November 17, 2008, 02:39 PM:

#76
Lorax, we're also taught from childhood that oleanders are poisonous. (I can't say that I've ever been tempted to try it: the leaves and seed pods look tough and dry, and the flowers aren't that tasty looking.)

#79 ::: Melody ::: (view all by) ::: November 17, 2008, 02:47 PM:

Nix - I defrost mine in cool water, same as fast-defrosting a turkey. It only takes a half-hour to an hour. Having said that, I feel obligated to report that my RN husband (of the famously poisonous plant, above) defrosts it on the counter all the time, and he hasn't poisoned me yet (that I know). When carped at about that habit, he only repeats his tiresome "do as I say, not as I do". Almost as much of a saw with him as the "if it hurts, I'm not doing you any good."

#80 ::: Melody ::: (view all by) ::: November 17, 2008, 02:49 PM:

*sigh* "If it doesn't hurt..." of course.

#81 ::: Nancy Lebovitz ::: (view all by) ::: November 17, 2008, 03:10 PM:

This American Life has a ghosts and poisoning story.

#82 ::: Xopher ::: (view all by) ::: November 17, 2008, 03:36 PM:

Nix 75: I believe it's when the meat is at room temperature for hours that the problems occur. If you use it as soon as it's thawed, that will be well before the danger point.

Jim, correct this if I misinterpret it.

#83 ::: Laurie Mann ::: (view all by) ::: November 17, 2008, 03:43 PM:

One thing that looks toxic but isn't - Vaseline. While my daughter was a master at putting anything in her mouth until she was about three, we managed to keep her away from poisons. Somehow. Then, there was the time she climbed up a bureau and threw herself onto a high window-ledge where we'd put babywipes and Vaseline. She wandered out into the living room a few minutes later, her mouth covered with Vaseline. I called poison control (expecting we'd have to take her somewhere).

"Is she breathing?"

"Yes."

"Just wipe out her mouth. Vaseline can suffocate, but it isn't poisonous."

Good to know!

I'm glad syrup of Ipecac is no longer recommended. I remember my mother had some on hand and it smelled dreadful.

#84 ::: Xopher ::: (view all by) ::: November 17, 2008, 04:06 PM:

Jim 8: What you do about this (after you've made sure you aren't going to get exposed) is to give the patient atropine (IV or IM). (Which probably isn't going to be in your first-aid kit.)

That's interesting; Witches used to make something called Flying Ointment, which was made from belladonna berries, extracted with spirits of wine. There's a famous story about Bernadette Devlin (I think it was) using denatured alcohol instead of spirits of wine for the extraction, and it came out three orders of magnitude stronger than it was supposed to be, and she nearly died just from what she got under her fingernails in the process of making the ointment.

The point is, though, that the way flying ointment was used was to spread it on unbroken skin, and in some period of time the user would feel like s/he was flying (the signature hallucination of atropine).

Reputedly. I'm not a fan of hallucinating generally, and that one in particular sounds like it could lead to dangerous behavior. I've never made flying ointment, and I suspect the drug culture of the 60s and 70s may have been its primary home, more than the traditions of Wicca.

The reason I bring this up, Jim, is that I wonder if it might be useful stuff to have around in case of insecticide poisoning. I'm sure not as much would be absorbed as with an IM injection, but as a first aid kind of thing while we wait for you guys to arrive? I mean, of course, the traditional formulation, not the Devlin version!

#85 ::: James D. Macdonald ::: (view all by) ::: November 17, 2008, 04:20 PM:

Xopher #82: I believe it's when the meat is at room temperature for hours that the problems occur.

Quite right. (And watch the potato salad too, please.)

You should be aware that both E. coli and S. aureus produce heat-stable toxins. While cooking destroys the bacteria, the toxins may well remain.

(Picking the wrong kind of mushroom is a whole 'nother problem.)

#86 ::: James D. Macdonald ::: (view all by) ::: November 17, 2008, 04:30 PM:

Xopher, I personally wouldn't mess around with home-made atropine. If I frequently used organophosphates, I might see about getting an atropine autoinjector (much like the Epi-Pens that folks with anaphyactic reactions to assorted stuff carry) which has the chemically pure stuff in a measured dose.

Any time you're working with insecticides you have to be scrupulously careful to avoid self-contamination. Prevention really is key to poisoning emergencies.

#87 ::: Lee ::: (view all by) ::: November 17, 2008, 04:33 PM:

Nix, #75: Put it in the sink, or in a big stewpot, and run water to cover. This will defrost the meat much faster, which limits the potential growth time for nasty bacteria. Note: don't use the defrosting water for cooking! Also, as Xopher notes, use the meat as soon as it's thawed.

You can also thaw frozen meat in the microwave if you have one, but that tends to give uneven results.

#88 ::: Zack ::: (view all by) ::: November 17, 2008, 04:55 PM:

#69, #70: What the heck do you store these exotic oxidizers in, if they eat glass and stainless steel?

#89 ::: Charlie Stross ::: (view all by) ::: November 17, 2008, 05:14 PM:

Zack @88: you need to use very high grade stainless steel, with a very fine finish and take extreme care, if you're storing liquid ClF3. It's such a strong fluorinating agent that it fluorinates the exposed surface of the steel vessel on contact and hopefully renders it inert. However, if there are any scratches or flaws in the welding, you can end up with a metal-halide fire (burns at a few thousand degrees, melts more of the metal so that it flows into contact with the oxidizer, so it propagates like crazy and makes thermite look like a refrigerating agent).

#90 ::: Nix ::: (view all by) ::: November 17, 2008, 05:16 PM:

Lee, Jim et al, thanks for the advice. The water trick is one I keep learning about and keep forgetting... and, no, using defrosting water for cooking strikes me as unutterably disgusting.

Regarding the heat-stable toxin stuff, that's interesting: I guess they're non-protein-based, whatever they are.

Zack: you store these things in an alembic made of frozen Universal Solvent, of course. (Downside: Universal Solvent freezes at -1K.)

#91 ::: Ginger ::: (view all by) ::: November 17, 2008, 05:37 PM:

dcb@ 35: I know a veterinarian who was accidentally injected with ketamine (she was holding cat, cat moved, student injected her instead of cat). Her description of the subsequent trip was very funny.

I also know a veterinarian (former, perhaps I should say) who gave his kids xylazine in fruit juice when he was supposed to be giving them back to the wife at the end of the visit. He's in prison somewhere in Louisiana.

I'm very grateful that the most toxic stuff I ever worked with was just picric acid.

#92 ::: dcb ::: (view all by) ::: November 17, 2008, 05:38 PM:

Re. Chicken: here in the UK, caterers managed to take out most of a police force with Christmas dinner - they cooked the turkeys well, then put them back into their original bags to "keep them clean" while they were cooling down. The salmonellae thought that was great!

Alex @ 52: I was once sent to get some more Revivon. Driving along with the vial on the passenger seat, thinking how much more careful I'd be if it was Immobilon rather than revivon. Stopped the car, picked it up. Immobilon. Clearly labelled, colour coded (Immobilon is yellow/orange; Revivon is colured blue). I'd STILL managed to pick up the wrong bottle.It really made me think.

Charlie Stross @ 63: Etorphine is great for elephants - knock one down with about 2 mL. Needs about 8 mL to take down a yak. Don't ask me why.

#93 ::: dcb ::: (view all by) ::: November 17, 2008, 05:42 PM:

Ginger @ 91

I had fun trying to work out if my rapid heart rate was due to the ketamine or just the fright - probably the latter. After washing and gargling I did tell someone what had happened and that if I fell of the chair/fell asleep they should call the hospital and tell them what I'd contaminated myself with. Luckily only a wallaby dose, and probably only a small fraction got absorbed through my eyes/mouth.

#94 ::: Leva Cygnet ::: (view all by) ::: November 17, 2008, 06:03 PM:

The reason you do not defrost stuff at room temperature is that the outer bits can be at dangerously warm temperature for dangerous amounts of time while the middle bits are still frozen. For example, you could get e-coli growing on the warm end of a turkey leg while the breast was still frozen like a rock.

#95 ::: Jacque ::: (view all by) ::: November 17, 2008, 06:03 PM:

Another scary faux poison: Give the kid a glass of grapejuice just after dosing her with milk-of-magnesia. Scary green goo ensues.

#96 ::: Elusis ::: (view all by) ::: November 17, 2008, 06:10 PM:

I rarely bother to spend much time asking "how much did you drink?" when someone has visible alcohol poisoning. Usually they 1) don't know, 2) are too far gone to tell me, or 3) lie. In fact, more usually, it's all three. People don't know that the Big Gulp cup of vodka and coke they just drank doesn't equal "one or two drinks" but in fact maybe 8, 10, 12 depending on just how free a hand they had when pouring (or when someone poured it for them.) So trying to assess for detail other than "did you take anything ELSE?" is generally a waste of time, IME. (Asking others around them may be useful, though.)

I taught my alcohol education classes to look for the following:

1) Uncontrollable vomiting. Not being sick once or twice and then stopping; being repeatedly sick, to the point where the stomach is empty, particularly if blood or bile is thrown up. The body is trying to rid itself of a poison that is no longer in the digestive tract, but in the bloodstream, yet the vomiting reflex keeps getting triggered.

2) Loss of consciousness, or "passing out." Not someone saying "I'm so drunk, I'm going to go pass out" - that's called "falling asleep while drunk." Losing consciousness to the point that the person can't be awakened. Slipping into unconsciousness while in mid-conversation or mid-perambulation, or in the middle of a raging party, or to the point where they urinate on themselves. Being "out cold" or lapsing in and out of consciousness.

3) Skin changes - skin that is cold and clammy when the person is in a warm environment (blood vessels are constricted, brain's temperature regulation mechanisms may be suppressed). Skin that is blue, gray, white, or purple, and for dark-skinned folks, mucous membranes in the eyes or mouth that are white rather than pink (heart may not be pumping sufficiently to distribute oxygen; respiration may not be sufficient to oxygenate blood).

4) Breathing problems - breathing that is raspy, labored, choking, gasping. More than 8 seconds between breaths or fewer than 8 breaths per minute. Also, a conscious person reports feeling like they "can't get any breath" or like "someone is standing on my chest" (heart rate may be too low to move enough oxygenated blood.)


I told students if you see #1 or #2, be very concerned, and take steps to make sure the person doesn't get sicker (lay them on their left side to keep the airway clear and support circulation, have someone with them at all times to observe for further changes, don't attempt to give anything by mouth or put them in a shower or any other "folk remedies".) And if you see #3 or #4, call 911 immediately, even if the person is conscious. In case of any doubt, or lack of two or more competent people to manage the situation, call 911 for help.

#97 ::: Xopher ::: (view all by) ::: November 17, 2008, 06:10 PM:

Leva: A turkey? Yeah. A steak? Not so much. The frozen bits would keep the thawed bits cold enough not to be a problem, for something a) relatively uniform in substance and b) relatively compact. Steaks are; turkeys aren't.

But not having to worry about this stuff makes me glad I'm a vegetarian, I'll say that much.

#98 ::: Xopher ::: (view all by) ::: November 17, 2008, 06:13 PM:

Jacque...from which orifice(s)?

#99 ::: dcb ::: (view all by) ::: November 17, 2008, 06:26 PM:

If it's an animal that's eaten the toxin, remember the veterinarian wants the same info as with a person - what, how much, when, animal's bodyweight etc.

60 g or so of good-quality dark chocolate eaten by the 6 kg dog is a lot more worrying than the same amount eaten by a 20 kg dog (multiply kg by 2.2 for pounds).

Do NOT be tempted to home-doctor your cat by giving it a tylenol/paracetamol - first there's the size difference (one tablet in a 5 kg cat = 10 in a 50 kg person i.e. in a small adult), then the fact that cats lack all sorts of enzymes in their liver and can't metabolise that stuff very well.

Read up on what's toxic to your pets, then keep them apart - don't leave lilies in a room with a plant-eating cat. Don't leave a bag containing anything remotely edible (chocolate, ibuprofen, cigarettes etc.) in a room with a dog.

#100 ::: Singing Wren ::: (view all by) ::: November 17, 2008, 07:08 PM:

Jim @ 85:
Quite right. (And watch the potato salad too, please.)

Ah, food poisoning. Also known as: Why I don't like mayonnaise any more.

While on vacation with my family one year, we stopped for dinner at a fast food restaurant. We'd stopped there before, and I knew they put too much mayo on their sandwiches for my taste. But I forgot to ask them to go easy on the mayo when I placed my order. I should have.

That night, my brother and I were both sick. I threw up; he settled for feeling seriously miserable all night and into the next day. At breakfast (the time, since neither my brother nor I felt up to actually eating anything) we tried to figure out what had happened. Our decision was food poisoning, since my brother and I had both eaten sandwiches with mayonnaise, and my parents had both eaten sandwiches without mayonnaise. My sandwich had been extremely warm, and who knows how long it had been sitting under the heat lamps...

I will still eat mayonnaise, but only if I am the only one who has handled it from the grocery store to home.

#101 ::: edward oleander ::: (view all by) ::: November 17, 2008, 07:49 PM:

#96 - All data is useful, in the proper context... At my Detox, we know most of the people who come in, and very few of them are as far gone as to be showing active alcohol poisoning. Comparing their statements with what we know of them can help us figure out what the real story is (including the "what else is on board?" question).

Sometimes the ones who stagger to our door on their own will show some of the signs you mention above soon after admission, and we have protocols that match what you teach very closely. The local medics and cops are all pretty consistently taught that any outward signs of A.P. means a trip to the ED, not Detox, so that gives us more leeway to question the client during the admit process.

Speaking of Alcohol Poisoning, we have seen a fairly dramatic increase in the cases of people using alcohol enemas in the past year or so. We even had one client at Detox come up schnonkered, then get violently sick with full blown DTs, even though she had been with us for 3 weeks (on a court hold). Turns out she was stealing alcohol pads (no longer a possibility) and inserting them rectally. Oh, the joys of denatured alcohol!

#102 ::: cmk ::: (view all by) ::: November 17, 2008, 08:57 PM:

Fidelio @55, wow. I grew up on a tobacco farm; we never wore gloves and, never mind long sleeves, going shirtless was not unheard of. I distinctly remember broken blisters in the course of topping and suckering. I have never heard of nicotine poisoning in connection with growing and harvesting tobacco.

Is Maryland tobacco that much lower in nicotine than the deeper south varieties?

#103 ::: Marilee ::: (view all by) ::: November 17, 2008, 10:18 PM:

P J, #17, here's the WashPost article on the folks who accidentally put jimson weed in the stew. The TV news said they thought it was mint.

#104 ::: P J Evans ::: (view all by) ::: November 17, 2008, 10:26 PM:

Marilee, I have a hard time believing that they couldn't tell it wasn't mint just by the smell. Wikipedia says that jimsonweed smells bad. (They also give another mnemonic for its effects: "Can't see, can't spit, can't pee, can't shit.")

#105 ::: Thomas Lumley ::: (view all by) ::: November 17, 2008, 10:36 PM:

Charlie @88

Derek Lowe at In the Pipeline (who is a drug-discovery chemist) has a section "Things I won't work with" including ClF3.

He also links to a PDF that describes one ton spill of the stuff ("the concrete was on fire") and has photos of its reaction with raw chicken.

#106 ::: Mags ::: (view all by) ::: November 17, 2008, 10:41 PM:

I drank a cup of Clorox when I was a toddler. Well, I don't know if it was a whole cup. I don't really remember the event. My siblings love to tell the story, though. My mother called the doctor and he said "induce vomiting." This was the mid-1960s.

Also had medium-mild case of food poisoning. I was in a drum corps and we toured all over the country in buses along with a Winnebago that was used to cook meals for about 200 teenagers and young adults. They precooked meat before tour and reheated it on the road. Apparently some roast beef went bad, but nobody knew it and it was heated and served to us with gravy. Most of us didn't eat much of it because it tasted gross, which probably saved us. Lots of intestinal upset, they dosed us with Pepto for a couple of days and we kept rolling. One kid ended up in the hospital, though.

#107 ::: Mark J Reed ::: (view all by) ::: November 17, 2008, 11:33 PM:

I didn't know what a Sawyer kit was, so I clicked the link. Looks useful. But I find the Amazon "Customers who viewed this item also viewed" list amusing:

1. The Extractor (the main component of the Sawyer kit, by itself)
2. Premium Snake Bite Kit
3. Snake Bite Kit (not so premium, I guess)
4. Coghlan's Snake Bite Kit
5. "Iron Man" DVD (yeah, the Robert Downey Jr. flick)

So I guess after the snake bite kits the next step is to don a suit of armor so you don't get bit again?

#108 ::: James D. Macdonald ::: (view all by) ::: November 17, 2008, 11:39 PM:

So I guess after the snake bite kits the next step is to don a suit of armor so you don't get bit again?

If you're going to die, might as well see a movie while you're waiting?

#109 ::: Diatryma ::: (view all by) ::: November 18, 2008, 12:03 AM:

Adrian at 57, I have happily never had to run to the rescue of anyone in lab. The gloves in my labmate's story were regular latex, though, a casualty of spraying ethanol on her hands to clean them and then getting a little too close to the burner in the sterile hood. I took the hair of my arm that way.

#110 ::: Meg Thornton ::: (view all by) ::: November 18, 2008, 12:04 AM:

This is the treatment I was taught in primary school for snakebite (context: Western Australia, late 1970s to early 1980s, suburbia but with a lot of "undeveloped" land nearby; most likely snake for us to run across was the dugite).

1) Don't worry about killing the snake. (Most Australian snakes are timid creatures, and will get the hells out of the way of humans wherever possible. The main snakebite avoidance measure we were taught was to make a lot of noise moving from A to B to give the snakes warning).
2) Get the person who was bitten to calm down, lie down, and stop moving.
3) Place a compression bandage over the snakebite site (don't wash off the venom, as traces on the bandage can be used to identify which snake bit the patient if nobody got a good look at the biter) and splint the affected limb.
4) If there's more than two people available, send someone else (aside from the victim and the supplier of first aid) to fetch help or phone 000 (the Australian emergency number). If there's only two people, the first aider goes for help and tells the patient to lie still and keep calm. If there's only one of you, once you've bandaged yourself up, you start yelling.

As an indication of why this was considered a necessary part of our primary schooling, I should point out my mother killed a snake in our back yard shortly after we'd moved into our new home. We were also taught a lot about how to avoid things like red-backed spiders (don't go putting your hands into strange cracks and crevices) and blue-ringed octopi (watch where you're putting your feet when you're at the beach or near tidal pools; if you see something interesting, don't pick it up, just observe from where you're standing; if it's showing those blue rings, don't touch it) as well as snakes, stonefish and magpies.

Oh, and for anyone planning on going swimming along the Queensland coast and across the tropical North of Australia, take a bottle of vinegar with you. No, not for the fish & chips. It's a known first aid trick against the sting of the box jellyfish.

#111 ::: Linkmeister ::: (view all by) ::: November 18, 2008, 12:54 AM:

Meg Thornton @ #100, one needn't go as far as Queensland to find box jellyfish. We get an influx of them (lots of them) every full moon.

Waikiki lifeguards stock gallons of vinegar, I think.

#112 ::: Elusis ::: (view all by) ::: November 18, 2008, 01:24 AM:

#101, oh yeah, it's not like I'm not going to *ask* how much someone has had, but I've come upon situations where either the bystanders are so hung up on that question that they're failing to act in response to the symptoms, or they're so *mislead* by the answer ("He says he only had a few beers!" "Well did you ask him how many is 'a few'?" - I've had college students admit that "a few" really equals "20 or more") that they ignore the symptoms.

Good to know that what we were teaching our students matches what the pros know. :)

Re: enemas, now there's a use for alcohol pads I hadn't thought of. But yeah, at [redacted] University where I was in a sex/drugs harm reduction outreach program, we had a rash (no pun intended) of girls soaking tampons in vodka and inserting them. I had some... interesting conversations with young women about vaginal flora and fauna, and the effects on same of 80-proof alcohol.

A few guys apparently tried it as well but the "putting stuff in your rear is gay" taboo was fairly strong.

And boy, can alcohol up the nether bits OD you right quick.

#113 ::: Alex ::: (view all by) ::: November 18, 2008, 04:49 AM:

My local general hospital in north London has recently started putting locks on the alcohol hand sanitisers, to stop the tramps eating the stuff.

#114 ::: Alex ::: (view all by) ::: November 18, 2008, 05:25 AM:

That document on CiF3 is truly impressive. The fact it ate the concrete floor and the gravel backfill under it as well is pretty scary, but it ate the concrete floor while giving off hydrogen fluoride fumes, which is just silly. I mean, hydrogen fluoride is bad enough...

And it will eat your spacesuit if there is any water on it. Not only that, it will generate enough heat while it's eating it that you must not wear anything under the suit that might melt. And, to cap the lot, you have to wear earplugs around it because the reaction will be so loud if it gets out. Frankly, I'm only surprised that it isn't H.P. Lovecraft who is credited with the first synthesis. (Hey, the historical context overlaps. Which one of Ruff and Krug, back then at some Technische Universität, was into the Mythos?)

As William S. Burroughs so wisely said, trust the Germans to invent some really evil shit.

#115 ::: Andy Brazil ::: (view all by) ::: November 18, 2008, 07:15 AM:

Last year two teenagers snuck into their older brother's car in the garage to listen to the radio and generally hang out. (It was cold out and they lived in a small flat with a big family.)
Unfortunately they thought to turn the engine on to power the heater.

With the garage door shut.

The only consolation is that CO poisoning is apparently a good way to die. You just fall asleep and don't wake up.

Except of course, that there's no good way to die when you're 12 and 14.

#116 ::: inge ::: (view all by) ::: November 18, 2008, 09:55 AM:

Nix @ 75: OK, so how else do you defrost the bloody [chicken] things?

In the pot (or pan). If you need to cut it up before that, microwave for a minute or two on "defrost". If you have no microwave, keep hot water handy and heat the knife or the scissors.

dcb @ 99: Do NOT be tempted to home-doctor your cat [...] first there's the size difference

My cat got prescribed valium, and the one way to make the dose small enough was to grind down the tablets, mix them well with a spoonful of liver sausage, and then measure out the liver sausage. You just cannot reduce the dose from "OK for a 70 kg human" to "OK for a 5 kg cat" with a knife.

Drugging the liver sausage is, of course, not a good idea if you have kids...

Food poisoning: I've been lucky so far, everything I encountered that had gone off had done so in a smelly way.

#117 ::: fidelio ::: (view all by) ::: November 18, 2008, 10:03 AM:

cmk @ 102--

I don't know that tobacco in Kentucky/Tennessee is necessarily higher in nicotine levels--and not everyone who works tobacco ends up having problems, either, so it may be a factor of amount of exposure + general health (and who knows--possibly body mass as well)--I've also never heard of anyone having problems outside of the harvest season either, which is when you'd be most likely to have heavy exposure from a lot of direct physical contact with the plants, especially if you happen to be carrying the full sticks around.


#118 ::: James D. Macdonald ::: (view all by) ::: November 18, 2008, 10:15 AM:

Nicotine poisoning among tobacco harvesters is called Green Tobacco Sickness, and is an occupational hazard. It's less common among those who have harvested tobacco for five or more years, and among those who are themselves smokers.

#119 ::: Jacque ::: (view all by) ::: November 18, 2008, 10:51 AM:

Xopher #98: Ahem. [Several smart-aleck responses considered and discarded.] Reaction is chemical only, not--er, gastric. Apparently the grapejuice mixes with MoM still on the lips.

I don't actually remember this; it was reported to me via family lore. I actually tried it a while back (in a bowl). Was very disappointed. I didn't have any MoM on hand, so I used baking soda. The result was an entirely boring #003F33. I had been imagining a nice, egregious #30FF3F, or at least an interesting #30B00B.

#120 ::: Adrian ::: (view all by) ::: November 18, 2008, 11:23 AM:

Fidelio, CMK, a person can develop a tolerance to relatively high doses to tobacco by either smoking or skin absorption. Some people smoke more than 100 cigarettes in a day, on purpose. A newcomer to tobacco would almost certainly get very sick from that dose.

The tobacco poisoning cases I'm familiar with have involved small children trying to eat tobacco. (Not recently. It seems like the social changes around smoking in the past generation tend to make it harder for toddlers to get to it.) Eating the stuff makes a person throw up, but it doesn't take much absorption to be dangerous with such low body weight.

#121 ::: Charlie Stross ::: (view all by) ::: November 18, 2008, 11:24 AM:

OT, but -- Alex @114: this is why I don't bother writing fiction with Grey Goo in it. Who needs fictional nanotech handwavium when we have real-world 1940s-era Better Dying Through Chemistry?

#122 ::: pericat ::: (view all by) ::: November 18, 2008, 11:53 AM:

Something I didn't think about till I heard a discussion on the radio about it: if you're in a foreign country, and get stung or bit by a native venomous creature, seek local help rather than toughing it out till you get home to your family doctor.

The guest on the show was a doctor who told of a young woman who'd gone on some trip to Central America. On a trek through the jungle, camping, she apparently stepped on a caterpillar. She was barefoot, which factoid made me miss a sentence or two ("barefoot? in the jungle???"). The doctor went on that she initially felt bad, and they started to hike out, but by the time they got out she was feeling better, so carried on home. By the time she was home, the second phase of the venom's action was making her feel very bad indeed.

Her home doctor and hospital did their level best to sort out what was wrong, and to get anti-venom shipped up (since they of course did not have any to hand) but the upshot was it all took too long and the woman died. The doctor on the radio show said that if she'd sought local medical help, they had all the resources she needed, were of course familiar with the local beasties and had standard remedies to hand.

So. Seek help close to the source. Also, with some venoms 'feeling better' is not always a sign of recovery. Sometimes it's but a marker on the continuum.

#123 ::: Charlie Stross ::: (view all by) ::: November 18, 2008, 11:57 AM:

Speaking of poisoning, one thing that our host didn't mention is: drug interactions.

For example: You do not want to feed grapefruit (or grapefruit juice) to folks taking a whole slew of medications, but especially Angiotensin-II antagonists and ACE inhibitors (commonly used for treating hypertension). Grapefruit disrupts the absorption and uptake of a whole bunch of medications, resulting in wild blood level fluctuations -- it can double the bioavailability of Irbesartan, for example, which is Not Good if the patient's high blood pressure is reduced to normal level by their normal dose -- they can end up with symptoms including black-outs and cardiac arrhythmias.

Aside from odd foodstuffs like grapefruit, there are other causes of ADR (adverse drug reactions). If someone's showing signs of poisoning and you can't confirm the cause, it's always worth asking/checking if they've just started taking a new prescription medicine. The medication be interacting badly with something they're already on; their prescriber and pharmacist should have checked the combination, but stuff inevitably slips through the cracks, especially when someone is taking three or more medicines concurrently.

And finally, some folks have unusual (and bad) reactions to some medicines. By way of a personal example, there's me and Chlortalidone. It's a widespread, cheap, well-understood antihypertensive that works for most people with high blood pressure -- and nearly put me in an emergency room when my GP tried me on it. Rather than reducing my blood pressure by about 10-15%, it destabilized me; 36 hours in, after taking three doses, I began oscillating -- from 100/60 to 190/110 in the space of ten minutes. The ensuing see-saw between splitting headaches and black-outs lasted until I washed the stuff out of my system -- which took close to another 48 hours. (Luckily I was sufficiently aware to phone my GP, who said "well, stop taking it!" -- but if I'd collapsed and ended up in an ambulance, SOP with newly admitted patients is to continue their medication pending a review: 95% of the time this is the right thing to do, but once in a blue moon ... let's not go there.

#124 ::: Charlie Stross ::: (view all by) ::: November 18, 2008, 12:06 PM:

(Disclaimer: I used to be a member of the Royal Pharmaceutical Society, but I allowed my membership to lapse in 1990 and I have not practised as a pharmacist (or been legal to practice) in 20 years. You should therefore not construe anything I say as being professional advice. (I retired from the profession two decades ago. Okay?)

#125 ::: Nancy C. Mittens ::: (view all by) ::: November 18, 2008, 12:22 PM:

Followup to Charlie's post - always tell the doctor about anything you are taking, whether it's prescription or OTC. This includes vitamins.

When you add a new drug, talk to your pharmacist, and tell her the same thing. A major part of the pharmacist's job is to know about drug interactions!

#126 ::: Paula Helm Murray ::: (view all by) ::: November 18, 2008, 12:22 PM:

Inge@116, we fostered a cat until it passed away from congestive heart failure. We were able to keep him alive for almost a year after we got him, despite our vet's apprehension. Friend had been living in St. Louis, moved to KC but was fairly destitute, and when his cat got really sick, the friends in St. Louis sent him here. He appeared to be nearly dead when he got here.

My vet is a cat specialist, and after blood testing, gave us a fairly short list of meds. After 24 hours we had a new cat! He was up, acquainting himself with the house, other cats, and litterbox (lots and lots). Lasix, potassium, antacid and a blood pressure med normally prescribed for humans, all fractional tablets.

But the look on the intern's face when he tried to figure out what she had written on the scrip for the blood pressure medicine was priceless. He finally called me back to the counter and I explained it to him. The medicine comes in a capsule, the capsule has fur little tablets in it, and cat got 1/2 tab per day. "The computer won't let me write that dose for the label." It's okay." "But who is getting this?" "Our patient weighs about 8 pounds and is furry, okay. I'm giving him his meds, I don't need directions."

And I've always just pilled my cats, they get the idea quickly because I give them a treat as soon as it's done. Had one who even would remind me when it was time (Myrt really really loved the Pepperidge Farm Goldfish).

#127 ::: Fragano Ledgister ::: (view all by) ::: November 18, 2008, 12:25 PM:

Charlie Stross #123: I've read about this effect of grapefruit juice before, and I'm curious: why don't other citrus juices have similar effects?

#128 ::: joann ::: (view all by) ::: November 18, 2008, 12:31 PM:

Charlie Stross #123: You do not want to feed grapefruit (or grapefruit juice) to folks taking a whole slew of medications, but especially Angiotensin-II antagonists and ACE inhibitors (commonly used for treating hypertension)

Also statins (cholesterol-lowering). Which is where I first encountered the prohibition/interaction (not personally so far--fortunately I'm not a fan of grapefruit anyway, but it turns out to be an ingredient in some fruit juice mixtures that you wouldn't expect). I've also read of a Japanese study suggesting that pomegranate juice has a similar effect.

#129 ::: Xopher ::: (view all by) ::: November 18, 2008, 12:46 PM:

joann 128: Wow. Really? Pomegranate juice?

I'm on a statin, and I've avoided grapefruit juice, but I didn't know about the pomegranate juice. I've eaten pomegranates with no ill effects that I noticed (I eat at least some pomegranate every Samhain). Maybe I'll test and see if I get any weird effects with a small amount of juice. These things don't happen to everyone.

#130 ::: Lisa ::: (view all by) ::: November 18, 2008, 12:53 PM:

Meg Thornton: You can also use meat tenderizer on a jellyfish sting, which is what I remember the lifeguards keeping around when I was growing up in Hawaii.

#131 ::: Terry Karney ::: (view all by) ::: November 18, 2008, 12:54 PM:

To elaborate on Charlie's comment, if you have such a reaction to drugs, get a medic alert bracelet.

This also applies to chronic condititions, which have propensities for secondary problems. I have one from To elaborate on Charlie's comment, if you have such a reaction to drugs, get a medic alert bracelet.

This also applies to chronic condititions, which have propensities for secondary problems. I have one from Lauren's Hope. It lists, in order my sulfa allergy, my disease, blood type (just cause) and tells people to look at my wallet card which explains what the Reiter's makes more likely (GI problems, heart murmers [it's an inflammatory disease, and can progress to the heart... which is why I have an appointment to get a walking EKG study next month, but I digress).

It also has my name on it, in a form I will answer to, and which is likely to make it possible for medical records to not choke on the difference between how I am called, and what is written.


#132 ::: Madeline F ::: (view all by) ::: November 18, 2008, 01:03 PM:

For common drug interactions, one of the postdocs here who had been a Pharmacy PhD emphasized to us: tylenol and alcohol are deadly together. Apparently tylenol is like a little handgun and alcohol is like little bullets, and togther, they shoot the hell out of your liver.

For me, tylenol is a completely useless drug anyway, but it must work for someone, so if so beware of the booze.

#133 ::: Leva Cygnet ::: (view all by) ::: November 18, 2008, 01:32 PM:

#126, Paula -- if you really want to see a pharmacist's eyebrows go up, try filling a script for a horse at a regular pharmacy ...

... Also, same pharmacy, same visit, they tried to stop me from buying horse sized volumes of aspirin tablets for "safety" reasons. It was unsafe to sell me a few thousand tablets. I'm not sure what they thought I was going to do with the tabs other than what I claimed, which was to feed a horse aspirin* -- a new recipe for drugs?

(*Horses metabolize aspirin at, apparently, light speed. I don't remember the dose now, except to recall that it amounted to a fairly large handful of tablets. I was using it -- on vet advice -- for the blood thinning properties and not the pain killing properties.)

#134 ::: Joel Polowin ::: (view all by) ::: November 18, 2008, 01:32 PM:

Fragano @ 127: I've read about this effect of grapefruit juice before, and I'm curious: why don't other citrus juices have similar effects?

Per Wikipedia (and references are cited), "Grapefruit can have a number of interactions with drugs, often increasing the effective potency of compounds. Grapefruit contains naringin, bergamottin and dihydroxybergamottin, which inhibit the protein isoform CYP3A4 predominately in the liver. It is via inhibition of this enzyme that grapefruit increases the effects of a variety of drugs. [...] Grapefruit juice may be the first documented, but apple and orange juices have been also implicated in interfering with etoposide, a chemotherapy drug, some beta blocker drugs used to treat high blood pressure, and cyclosporine, taken by transplant patients to prevent rejection of their new organs."

To elaborate (and to correct the above): All organisms have genes for a variety of cytochrome P450 ("CYP") enzymes, which perform a number of functions but whose primary action is to oxidize chemicals, especially those identified as "foreign". The oxidation generally makes them more water-soluble and hence easier to transport around the body for excretion, as well as doing some degradation in general. Different groups of these enzymes affect different kinds of chemicals and have differing oxidation abilities -- one set is adapted for steroid-like structures, for example. The liver tends to have a lot of these enzymes, for cleanup of more or less toxic substances.

Some drugs are inactive in their original forms, and are activated by CYP450 oxidation. Some are deactivated by CYP450 enzymes. Some are changed to promote their elimination from the body. If you take in a substance which affects the enzyme activity, it can mess up your reaction to the drug. This can happen by inhibiting or promoting production of CYP450s, or by interacting with the enzymes. Some substances will promote production of some forms of CYP450 and inhibit production of others.

And then there's the additional complication that there are genetic variations for each of the different CYP450 enzymes, and for the factors that control their production. Some isoforms of the particular enzyme that handles alkaloids are more or less effective at oxidizing them, for example. This is one of the major reasons why individual responses to drugs can vary so drastically.

#135 ::: lorax ::: (view all by) ::: November 18, 2008, 01:35 PM:

Meg @110, I don't know if it's good enough for box jellies, but for less serious jellyfish stings, urine will work in a pinch if you didn't happen to pack the vinegar. Some people claim this doesn't work, but at least two good friends of mine have used this method on minor stings to good effect.

#136 ::: P J Evans ::: (view all by) ::: November 18, 2008, 01:45 PM:

Joel @ 134
I wonder if this was what was causing my brother's allergy medicine to not work well. (Several years ago, they threw him in the hospital for four days while they worked out the correct dosage. They had to triple the original one, because he was metabolizing it so fast.)

#137 ::: debcha ::: (view all by) ::: November 18, 2008, 04:17 PM:

Diatryma (#16): Again, not my own experience, but I have been told that you never take off any glove as fast as the one that's on fire.

Back when I was a wee little not-quite-a-grad student, I picked up a 4L glass beaker of near-boiling water - and its bottom fell out. The tech who came running in later joked that he had never seen a woman get out of her pants so fast. Fortunately, my lab coat and jeans were enough that my legs were just a bit scalded, with no lasting damage. And I have a great story to tell my students to illustrate critical crack length and crack growth by temperature cycling (we were heating and cooling that beaker frequently).

#138 ::: Jacque ::: (view all by) ::: November 18, 2008, 04:28 PM:

#137 debcha: 'Minds me of my introduction to superheating: brand new coffee mug for Christmas. Fill with water, stick in microwave for usual time: no boiling. Set for more time: still no boiling. Set for still more time: same result. Sigh, reach in, pick up mug.

Ahem. The skin on my hand was only sore for a few days. The mug did not survive being flung across the room.

#139 ::: R. M. Koske ::: (view all by) ::: November 18, 2008, 04:39 PM:

#138, Jacque -

I first heard of that kind of superheating from some unreliable source - friend of a friend, the internet, something like that. My father absolutely didn't believe it was possible when I told him, though I can't recall his justifications. I think his position was that it would require too much perfection in vessel and clarity of water to happen outside a lab.

I'm glad your hand wasn't any worse than it was.

#140 ::: Fragano Ledgister ::: (view all by) ::: November 18, 2008, 05:25 PM:

Joel #134: Thanks! My problem is, of course, that I like grapefruit juice (yeah, yeah, I know, I'm a deviated prevert). I even like without rum, which, I suppose, makes me an especially deviated prevert.

#141 ::: Alex ::: (view all by) ::: November 18, 2008, 06:06 PM:

School sixth-form trip to economics conference. Late homework hand-in up at school. Run to railway station. Miss train with others. Catch bus.

IRA terrorists destroy Northern Regional rail signalling centre, blow secondary device on fleeing crowd.

Arrive at conf, ignorant of this (not every 16 year old had a GSM device then). Others not there. Who cares. Chat up interesting girls from other schools. Trashed Mini Cooper (the real one) dash round Bradford ring road. More conference.

Get out. Trains now beginning to run. (Turns out friends spent 6 hours on stalled train in open country.) Back home. Race home. Get in gear for work. Argument with father. Go to work; pull shift at the supermarket.

Race home. Get into real clothes. Back into town. Drinking with skatepunks. Dancing. Stories about IRA attack. More ale. Back to skatepunk friend's house. Weed. Whisky. Computer games. Maybe some more. Coffee. Friend spills pot of boiling coffee into shoe. GORETEX shoe. Screaming pain.

Friend runs into kitchen. Great. Runs back with cloth soaked in cold water. Not bad. Starts rubbing coffee stain on white carpet.

Friend FAIL.

Hop into kitchen, suddenly stone cold sober. Tear off shoe. Stick foot in sink, cold water on. (Who knew I could do the cancan?) Bits come off. Shit. Keeping in cold water, ring father (Hey, Dad? You know I called you a stuffed-shirt functionary parasite earlier on?) for a trip to the hospital.

#142 ::: Xopher ::: (view all by) ::: November 18, 2008, 06:27 PM:

Friend → ex-friend, sounds like. Wotta dipshit.

#143 ::: Caroline spots spam @ 267 ::: (view all by) ::: November 18, 2008, 06:27 PM:

R.M. @ 139, I've personally observed that kind of superheating several times, with bog-standard microwaves, mugs and tapwater. Usually it's just a matter of heat up water, pitch teabag into mug after taking out of microwave, and watch the water suddenly start bubbling like crazy. I've never had it actually explode on me, although if I'd zapped it for longer, I expect it would have done so.

I think we're back to the burns post now.

#144 ::: David Harmon ::: (view all by) ::: November 18, 2008, 07:04 PM:

Grapefruit juice can also potentiate SSRIs (including Effexor). With Prozac and Effexor XR, it seems to to be an immediate issue, I'm not so sure about Zoloft (much shorter effect period).

Alex @#141: Agreed, "Friend FAIL"!.

#145 ::: Joel Polowin ::: (view all by) ::: November 18, 2008, 07:11 PM:

Ah, yes, superheating.

My B.Sc. research project involved a fairly-large-scale chemical synthesis which wasn't working very well. Over several weeks, I filtered several litres of "dirty" ethanol off batches of my product, and decided to try to distill it for re-use in my process. I did the usual set-up: hot plate, condenser and collection container; liquid in an Erlenmeyer flask, with "boiling chips". That last item is half a dozen or so bits of rough inert ceramic; it provides a good surface for bubbles to nucleate on, and is included specifically to prevent superheating.

The first day of distillation went fine. I pulled about a litre of ethanol out of the system, and shut things down overnight.

I went back the next day and started things up again. But though the flask was heating up, it wasn't boiling. There was a fair bit of sludge at the bottom of the flash, which had precipitated overnight as the solution had cooled. It occurred to me that it might be a good idea to add a few more boiling chips and break up the sludge layer before the flask got too hot, to make sure it would boil smoothly.

It wasn't a good idea, actually.

The moment the first chip hit the liquid, it started boiling violently. And that lovely conical flask funneled the frothing mess into a geyser that sprayed the top half of the room, coated the ceiling, filled the air with a mist of dirty ethanol. I was lucky that the contaminants weren't particularly toxic and that I didn't inhale much of it -- I held my breath and got out of the room. (And, of course, lucky that I didn't get sprayed too much myself, and was wearing protective gear, and that boiling ethanol cools quickly by evaporation.) I took a few deep breaths outside to clear my lungs, held my breath, and went back in to turn off the heater, figuring that it was supposed to be non-sparking and that it less likely to ignite things if it was turned off than if it was left on. Then left the room again to let the ventilation system clear the air.

It seems that the sludge that had precipitated had also coated the rough surfaces of the original boiling chips, making them completely ineffective. Adding the fresh chips let the thing go foom.

#146 ::: B. Durbin ::: (view all by) ::: November 18, 2008, 07:19 PM:

Re: oleander

They don't worry about oleander ingestion a whole lot because, as said above, it just isn't appetizing. However, it's toxic if you cook things on oleander spears (lots of cautionary tales about not cooking on things you don't know the provenance of) and is toxic in smoke.

They use a lot of it on highway medians for beauty, low maintenance, and noise reduction. Always makes me wonder when the state starts burning again, but normal smoke is toxic enough, I guess you don't need extra warnings for the oleander.

#147 ::: Caroline ::: (view all by) ::: November 18, 2008, 07:46 PM:

Dammit, I forgot to change my name back again. D'oh.

#148 ::: debcha ::: (view all by) ::: November 18, 2008, 07:59 PM:

R.M. Koske (#139): I think your father is correct in that it's very difficult to get superheated water on a stove (time, convection, imperfections in the pot, etc.). As you've no doubt figured out by now, it's trivially easy to get superheated water in a microwave.

(on a related note, as Xopher can no doubt attest, it's simple to get a supersaturated sucrose solution)

#149 ::: Thomas Lumley ::: (view all by) ::: November 18, 2008, 08:08 PM:

Madeline @132:

The Tylenol/alcohol thing is a bit more complicated than that. Roughly speaking, the liver has severals ways of handling acetaminophen (paracetamol for the rest of the world). The main ways add something (gluconuride, sulfate) to produce a harmless product, the alternative one oxidises it to make something unpleasant. The unpleasant metabolite is then tidied up by adding glutathione to it.

At the normal dose, about 95% of the drug is handled by the main pathway. The small amount of the liver-killing metabolite is got rid of before it does any harm. No worries.

With overdoses the safe pathway can't work fast enough, so you produce lots of the nasty metabolite, and you quickly run out of glutathione to get of rid it with. The drug suddenly switches from extremely safe to extremely lethal. [The treatment, which is effective if done soon enough, is to supply more glutathione or something that can be turned into glutathione.]


Now, chronic high consumption of alcohol increases the activity of the enzymes that do the oxidation, so rather more than 5% of the acetaminophen ends up as the nasty metabolite and it could start to do damage before it is glutathioned away. This is a potentially a problem if you take lots of Tylenol (even the high end of the recommended dose for a long time). People who drink a lot of alcohol also tend to have less spare liver, so there is even more potential for an unhappy ending. I don't know how much evidence there is of it being an actual problem, though.

And, yes, Tylenol does work better for many people than it does for you. On average it works about as well as any of the other non-opioids for pain relief.

[the actual numbers here are from Wikipedia, which seems to be ok on this topic]

#150 ::: Mycroft W ::: (view all by) ::: November 18, 2008, 08:08 PM:

Fastest glove takeoff was when I dropped a too-big piece of potassium chromate into the sulfuric acid while making chromic acid. You know sulfuric acid, which is so dangerous because it doesn't hurt until it's been burning for a while? Well, at 36M + chromates, that doesn't apply. I should have known; the argument at the time was whether it took organics off glass, or just took the innermost layer of glass off, organics and all.

Oh, and mercury drop potentiometry of heavy metals concentrated from hair dissolved in heated perchloric acid solution; tell me all the "wow, fun" moments in there. On the other hand, the worst safety lecture I got was when I was making and using solutions of thallium sulfate in distilled sulfuric acid. Wheee.

None of that is poison though (except the mercury and the thallium, I guess); the worst one of those was getting a strong lachrymator into my eye. We think it was "fill the 10 microliter syringe, deliver it, touch the base of the syringe putting it down, itchy eye", but whatever it was, I never want to repeat it.

#151 ::: Joel Polowin ::: (view all by) ::: November 18, 2008, 09:17 PM:

Worst job I ever had was a 4-month "co-op" process-development position with Northern Telecom. For 2½ months of that I was a thermostat for three days a week -- long story. The other two days a week, I prepared the silicon wafers for treatment and analyzed the results.

One day I was supposed to refill a reagent container with a solution which I was told was mostly concentrated ammonia. Being safety-minded, I asked the lab manager where I might find a fume hood in which to do the transfer. Unfortunately, the cabinet she pointed me at was not a fume hood, but a laminar blower -- designed to protect the contents from those messy dusty humans, not to protect the humans from the contents of the cabinet. I got a face full of ammonia. Yeah, lachrymators, whee. Ammonia's not as bad as many, I guess, at least from the exposure I got; the worst was over in a few seconds once I got away from the blower.

#152 ::: Don Fitch ::: (view all by) ::: November 18, 2008, 10:53 PM:

Superheating

I sometimes (rather too often, actually) set water to heat in the microwave, go off and do something distracting, and return an hour or so later, by which time the water needs to be re-heated. This sometimes (though not frequently) results in superheating. (Because using water from the hot-water tap often has the same effect, I tend to ascribe it partly to a relatively small amount of dissolved gasses in the water.) My microwave has a turntable, and I've found superheating more common when using those that don't have this feature.

Basic rule-of-thumb, of course, is "Always Be Careful".

#153 ::: Don Fitch ::: (view all by) ::: November 18, 2008, 11:31 PM:

Drug actions/poisoning.

Took the first tablet of a prescribed common antibiotic -- erythromycin --for an ear infection. Ten minutes later started getting agonizing pains of various kinds -- burns, amputations, cuts, muscle spasms, abrasions -- from various parts of my anatomy, each lasting about thirty seconds before switching to another type of pain in some other place. No gross evidence of anything wrong (the right foot wasn't cramped into a ball, it just seemed that way, &cet.). I figured the medication was triggering, at random, the various pain-receptors in my brain, and would wear off before long. This agony continued for about four hours, which was long enough for me to understand why some people become addicted to recreational drugs that have a similar effect on the pleasure-receptors. I don't know if this was an ideopathic reaction or an interaction with other medication I've been taking, but I went in the next day and made sure that Kaiser posted it properly on my Medical Record.

(For some reason, my MD wasn't interested in my plan to isolate the causes of this reaction and make a fortune by selling it to the folks at Guantanamo.)

#154 ::: Lee ::: (view all by) ::: November 19, 2008, 12:47 AM:

Don, #153: Ye ghods. Makes me feel fortunate that my Unfortunate Experience with erythromycin was much milder. First one -- no effects. Second one -- threw up everything in my stomach. Third and fourth -- dry heaves. At which point I decided that I Was Not Taking This Any More until I could talk with the nice folks at Student Health again.

Student Health, unsurprisingly, told me to dispose of the rest of it and gave me something else. I still won't take erythromycin, but some of its later derivatives don't bother me.

#155 ::: Marilee ::: (view all by) ::: November 19, 2008, 01:34 AM:

Don & Lee, #153 & $154, I once had a doctor insist on giving me erythromycin when it was marked as causing a massive reaction with the immunosuppressant that was saving my life. I just waited until morning when I could call my regular doctor and had a fever of 102.7F.

I love grapefruit and grapefruit juice, but I haven't been able to have any since 1990. :::sniff:::

#156 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: November 19, 2008, 01:38 AM:

I've worked in semiconductor fab plants; it's somewhat surreal to be walking down a corridor and notice a pipe near the ceiling labeled "Silane" (silicon tetrahydride). Not terribly toxic, but burns like mad on contact with air; the autoignition temp is 21°C; yet another reason to keep the air-conditioning on high.

A few years ago, some bright bulb PR-type started a campaign to portray the semiconductor fab industry as "clean": "We don't generate the kind of pollution that old technology companies do." Right, they added a lot of new kinds of pollution: arsenides, phosphides, nitrides, among others, and all of them got washed off the wafers and a lot of them got flushed into the sewer system. I've been told they've cleaned up their act a lot since then, but I have no personal experience one way or the other.

#157 ::: m.k. ::: (view all by) ::: November 19, 2008, 02:04 AM:

Just a reminder to vegetarians and vegans: not eating meat or animal products does not mean you are safe from food poisoning. Raw fruits and vegetables can be handled unsafely and it can be as simple as the food preparer not washing their hands, or not washing their hands thoroughly.

#158 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: November 19, 2008, 02:12 AM:

Marilee @ 155

I echo your ":::sniff:::". I love grapefruit juice too, and haven't been able to drink it in years because I'm on beta blockers for hypertension, and using Fexofenadine for allergy symptoms. Sour grapefruit rationalization: it's just as well, because the grapefruit I can get here in Oregon all come from places where they've bred them to be bitter and not very sweet when ripe.

#159 ::: inge ::: (view all by) ::: November 19, 2008, 06:44 AM:

debcha @ 137: Reminds me of an especially "funny" chemistry lesson... We had created some strange apparatuses from the glass-and-rubber-joints kits, filled them with H2SO4 and some other stuff and put on the heat. The overaged rubber joints gave way under pressure with a timing envied by slapstick comedians: Within seconds of each other. You just had time to look at the desk behind you and start processing what you saw when the device on your own desk blew up.

And now imagine 30 sixteen-year-olds getting out of their sweaters and shirts and T-shirts as if they were on fire...

Hot water: I managed to bang a hole into the bottom of a cheap glass tea pot with a tea cup I had lifted for filling up, and it took me enough time for the complete amount of fresh tea to pour over my hand to realize that a) something was wrong, b) something needed to be done about it, c) what to do, and d) do it (i.e., say "sorry, I need to set the cup down", pull my hand away, put down the cup gently, jump backwards three metres and yell "Oh, SHIT!").

In both cases, cold weather and bad heating were a blessing.

#160 ::: R. M. Koske ::: (view all by) ::: November 19, 2008, 08:29 AM:

z#148, debcha -

It was the microwave superheating he didn't think was possible. But yes, it has become apparent to me that though his reasoning was sound, he was operating from enough incorrect information to be just wrong that time.

#149, Thomas -

I can offer the anecdote that a young woman in Georgia died a few years back from a combination of drinking and Tylenol. I imagine that it would be a problem that would most often cause fatalities in college-age women, since they're already the ones most likely to have an alcohol OD.

#161 ::: Ginger ::: (view all by) ::: November 19, 2008, 11:27 AM:

It is true that chronic alcohol use and Tylenol will cause problems, as will overdoses (re 149).

The problem with alcohol and Tylenol is that in rare cases, reasonable amounts of alcohol coupled with supposedly normal amounts of Tylenol results in acute liver failure. One patient who ended up with a liver transplant was also a lawyer, if memory serves me correctly, and that led to a lawsuit against the manufacturer. It's a rare enough complication that no one could have foreseen it. The liver failure is also a rare complication, and I'm not sure whether the underlying cause was determined.

As dcb noted, any amount of Tylenol (also known as APAP, which is easier to type) will be fatal to cats; it's because they lack substantial stores of glutathione and rapidly become unable to metabolize it safely. In general, non-opioid pain killers in cats are poisonous. They do well with steroids and most opiates, luckily.

Personally I no longer use Tylenol as it doesn't work so well anymore. I used to combine it with aspirin for migraines, and this is now marketed as a migraine medication. Professionally, I use a lot of ketoprofen, which is injectable, has a fairly rapid onset of pain relief (up to 30 minutes in some patients), and lasts up to 24 hours.

The one time I tried ketoprofen (brand name Orudis), I became nauseated and couldn't eat my dinner. Naturally, I was on a date.

#162 ::: Lee ::: (view all by) ::: November 19, 2008, 01:20 PM:

Bruce, #158: I've never liked grapefruit (or grapefruit juice or grapefruit-flavored sodas, either); I find it bitter and nasty. When I moved here, my partner insisted loudly and repeatedly that I'd just never had a good grapefruit, that he didn't like yellow grapefruit either, but I needed to try the red kind (trade name Rubysweet). Eventually he wore me down enough to actually taste some.

Yeah, it was sweeter than a yellow grapefruit. But it was still bitter and nasty, and it still tasted like grapefruit!

OTOH, I accidentally did the same thing to him with orange marmalade -- I didn't realize that the reason he objected to it was the bitterness, and fed him a bite of what I consider the really good kind, Cross & Blackwell's Bitter Orange. So I guess we're even. :-)

#163 ::: Leva Cygnet ::: (view all by) ::: November 19, 2008, 01:52 PM:

#158, #162 -- I will eat pretty much anything, allowing for a broad spectrum of allergies. There's very little I truly don't like ... just things I can't eat and things that aren't to my preference.

Grapefruit? As far as I am concerned, grapefruit is vile, disgusting, curl-your-teeth nasty. I'd eat a raw lemon before I'd eat a grapefruit. It is the one food I will not touch.

Sometimes I wonder if there's not a grapefruit specific taste receptor that some people have and others don't. People will swear to me that a particular grapefruit is sweet and, well, it's not.

#164 ::: cmk ::: (view all by) ::: November 19, 2008, 01:56 PM:

As You Know Lee, it's not really necessary in the greater scheme of things that any given person eat any given thing. Still, if you're curious, you might try a pummelo some time. It is, almost exactly, grapefruit without the bitter. (Less juicy, as well, but we're talking flavors.) But then I may be a biased witness, since I love both grapefruit and pummelo.

Back to Green Tobacco Sickness (for which I'd found a Wikipedia entry: by that, a major hazard is getting soaked by dew or rain wet tobacco, which in my experience was more likely to happen during topping and suckering than at harvest), I don't mean to be contrarian. I'm fascinated by the implications, and still puzzled that I'd never encountered the concept.

But then we did all grow up around the Indian weed (one of my earliest memories involves tobacco gum, disliking same) and virtually everyone, barring my mother's children, did smoke (most of my grandfather's generation chewed as well). Clearly we all were simply acclimated to a background level of nicotine.

#165 ::: abi ::: (view all by) ::: November 19, 2008, 02:41 PM:

Lee, Leva, add me to the grapefruit loathers club. I cannot abide the stuff, not plain or in mixes. I examine the ingredients lists of every mixed fruit drink I buy, because if there's grapefruit in, no sale.

Even a small amount in the mix just makes me go ugh. It's not sour, it's bitter, somehow.

Eeeugh.

#166 ::: Caroline ::: (view all by) ::: November 19, 2008, 02:45 PM:

Leva Cygnet @ 163, I wonder if you might be right. Usually when I like something with a distinct flavor, I can understand how someone else might not like it -- or when I dislike something, I can understand how someone else might like it. Different people may have different reactions, but they're tasting the same thing. I think of the famous quote about "For those who like that sort of thing, it's just the sort of thing they would like."

But what you're describing sounds almost more like the cilantro situation -- where to people who don't have certain [receptors? enzymes? I'm not sure], cilantro really does taste of soap. If people are swearing to you that the grapefruit is sweet, and you can't taste a single molecule of sweetness, I don't think it's a matter of personal preference -- you really are tasting something different.

I've never personally experienced this -- the things I hate, which include black licorice, olives, and bleu cheese, all fall into the "distinctive flavors that I can imagine someone else loving" category. But the cilantro thing demonstrates that yes, it's possible that something may actually taste completely different to two different people.

(And I actually ate five Greek olives without a bit of disgust last Sunday. They were so mild. I can't say I loved them, but I didn't have to stop myself from grimacing as I ate them, as I always have before. If I start to like olives, I won't even be sure who I am anymore. Disliking olives has been a constant part of my personality. I also drank and enjoyed absinthe recently. It is possible that I am being taken over by some sort of bodysnatcher.)

#167 ::: P J Evans ::: (view all by) ::: November 19, 2008, 02:51 PM:

I seem to recall reading that 'supertasters' are sensitive to one of the bitter compounds in grapefruit (and other fruits and veggies).

#168 ::: Stefan Jones ::: (view all by) ::: November 19, 2008, 04:32 PM:

I eat grapefruit for lunch now and then. Usually with a bag of carrots. Like This. (Yes, I have a mild OCD. Why do you ask?)

Grapefruit juice I generally avoid, UNLESS I have a bad cold. Then I drink great big glasses full. It seems to help.

#169 ::: Nix ::: (view all by) ::: November 19, 2008, 04:34 PM:

Paula:


The medicine comes in a capsule, the capsule has fur little tablets in it

You win the typo of the month, no, year award. I have mad visions now of fur-covered tablets for mammals, scaly ones for reptiles, feathered for birds...

#170 ::: Charlie Stross ::: (view all by) ::: November 19, 2008, 05:38 PM:

Luckily for me, I hateHateHATE the taste of grapefruit. (I must be one of them supertasters; probably explains why I also hated green vegetables when I was a wee thing, and still dislike many of them.)

#171 ::: pat greene ::: (view all by) ::: November 19, 2008, 06:13 PM:

Per Terry Karney: To elaborate on Charlie's comment, if you have such a reaction to drugs, get a medic alert bracelet.

A nurse once told me I *had* to get a bracelet because of my allergies to several oral anti-fungal drugs. I was surprised, since I assumed that I was not likely to be given them in any emergency situation in which I could not talk. She then pointed out that anti-fungals are often given to patients in comas to prevent or treat yeast infections in the folds of their skin.


My kids all had a talent for finding mushrooms growing in odd places in the yard, in spite of adult efforts at eradication. With the eldest (now seventeen) we were told to give him Ipecac (he was two). He threw up every twenty minutes for *four hours*.

The second and thirdones were taken to the ER, had their stomachs pumped, and given activated charcoal. To this day they won't touch mushrooms, regardless of their provenance.

#172 ::: James D. Macdonald ::: (view all by) ::: November 19, 2008, 06:24 PM:

I remember the week when a particularly ... well, something ... batch of Ecstasy hit town, and we ran out of gastric lavage devices (aka stomach pumps). (They're disposable). We had to send someone to the next hospital down the road (hour and a half round trip) to borrow more.

#173 ::: xeger ::: (view all by) ::: November 19, 2008, 06:47 PM:

I'm perversely curious -- did the gastric lavage feel good to them, or should that have been "Ecstasy" ?

#174 ::: Xopher ::: (view all by) ::: November 19, 2008, 06:56 PM:

Do quote every slang name of something? I don't. I call the drug Ecstasy or E (and sometimes I call people who are on it E-tards, which is very unPC of me I'm sure).

#175 ::: Tlönista ::: (view all by) ::: November 19, 2008, 07:44 PM:

David Harmon @144: I didn't know about Effexor/grapefruit interactions, and I'm on Effexor. Good thing I don't eat grapefruit -- I love the taste, could eat it plain every day (and will eat lemons as well, @163), but it's just too expensive.

I don't like bitter things, but both grapefruit and orange marmalade taste perfectly sweet to me.

Much enjoying the lab horror stories.

#176 ::: Tlönista ::: (view all by) ::: November 19, 2008, 07:51 PM:

Xopher @174: The California drug-nerds I've come to know refer to E by its proper name, MDMA, because slang terms can be so variable. I don't know if they go so far as to use quote marks, though.

#177 ::: xeger ::: (view all by) ::: November 19, 2008, 08:12 PM:

Xopher @ 174 ...
Do quote every slang name of something? I don't. I call the drug Ecstasy or E (and sometimes I call people who are on it E-tards, which is very unPC of me I'm sure).

Sorry Xopher -- I was trying to imply inaccuracy in labeling (eg: Rat poison being sold as Ecstasy/MDMA).

#178 ::: Xopher ::: (view all by) ::: November 19, 2008, 08:20 PM:

Oh. Quite. Sorry, I didn't get it.

#179 ::: Vicki ::: (view all by) ::: November 19, 2008, 08:52 PM:

As I understand it, in most cases, if you like grapefruit and are on one of the relevant medications long-term, the thing to do is not to change your grapefruit intake. So, if you want grapefruit juice for breakfast, you have to have a glass of grapefruit juice for breakfast every day, not just now and then. That way, the dosage can be adjusted for "your body, with n ounces of grapefruit juice every morning."

#180 ::: David Harmon ::: (view all by) ::: November 19, 2008, 09:04 PM:

People's taste receptors certainly do vary -- without being able to remember any of the IDs, I remember there's known variations (some genes known) associated with cilantro, with cabbage-type vegetables, and with glutamate (umame)?. That surely isn't all of them, and there are also developmental variations -- that is, your sense of taste really does change as you grow up and age.

IIRC, "supertaster" refers to the few people who are massively overstocked with tastebuds, who tend to stick to bland food because spices and such are so overwhelming to them.

#181 ::: Angiportus ::: (view all by) ::: November 19, 2008, 09:08 PM:

I guess I'm a little late to this party, but I had a close call a few weeks back. I knew about not taking your meds in the dark, but there are other ways you can get them mixed up. A few weeks back I was tired and muscle-strained, so I looked around for my bottle of Tylenol. I couldn't find it, but I recalled a little teeny box I had filled with them some months back as preparation for a trip that never materialized. I took 3, as I had done occasionally before. Then lay down for a nap, which was oddly drift-in-and-out-ish. When I felt I had dreamed enough, I got up and went about my business at my computer. But after an hour I noticed I felt half-awake, sluggish and kind of bleah. I didn't panic, but I kept note of the time and rehearsed calling 911. After a couple more hours, I realized it wasn't going to get any worse, but I wasn't myself again till next day. Before going to bed, though, I had found my med bottles, and compared the pills in the box to each. Sure enough, what I'd had 3 of was not Tylenol but Hydrocodone APAP. Oops.
Lesson learned--from here on out I not only take my meds in good light but take note of the numbers on each different one, especially those that look kind of alike.
As for other hazardous substances--way back when I was young enough not to need meds, my parents were apt. managers, and they had this drain-opener, for professional use only, that included sulfuric acid. I figured that since I cleaned for a living then, I was a professional, so I took it and used it as directed on my own sink drain. It worked fine, though the noise was a bit spooky. So I took the bottle with the remainder back to the folks' building, carrying it in a big shoulder bag on my lap on the bus. When I got there, lo and behold, there was a hole in the bag...and a hole in my pants. And why there wasn't a hole in ME, I don't know, save that the other 2 materials must have spent the force of the acid. I went back to Drano.
In my neck of the woods, Pugetropolis, there's poison hemlock growing all over the place in spring and summer. And I bet not 1 out of 100 know what it is...
As for food...well so far I have never been sickened by food because I am careful, let my nose warn me, and take bulging cans out for the ritual puncture over the dumpster [my personal record being a vertical launch of 6 feet.] But maybe I also am lucky...

#182 ::: Marilee ::: (view all by) ::: November 19, 2008, 10:53 PM:

Leva, #163, I can eat a raw lemon. I haven't in a while, but they're good on really hot days.

P J, #167, I'm a supertaster (was tested by M&M/Mars when I consulted for them and had to be on the taste panel every week) and the Restasis I'm taking now makes my mouth always salty. When I get meds IV, I can identify them by the taste in my mouth. But I still like bitter and spicy things.

#183 ::: P J Evans ::: (view all by) ::: November 19, 2008, 11:02 PM:

Marilee, my father ate lemons and also raw rhubarb. I don't have his tastebuds, because I can't do that.

#184 ::: Lee ::: (view all by) ::: November 20, 2008, 12:52 AM:

I am quite sure I'm not a supertaster; I just have a very idiosyncratic response to certain flavors. Even my reaction to bitterness varies all over the map; grapefruit is nasty/bitter, as is coffee, but I prefer bitter orange marmalade to sweet, and I like dark chocolate (up to about 72% -- beyond that starts reading to me like baking chocolate).

#185 ::: Bruce Cohen (SpeakerToManagers) ::: (view all by) ::: November 20, 2008, 12:56 AM:

I'm not going to argue with people about grapefruit; de gustibus non disputandum est, but I will say that if you like lemons at all, a fresh raw lemon can be a really delightful treat. The one deep regret I have for moving away from South San Francisco Bay is that our neighbor's lemon tree leaned over the fence, and he told us to take any that were on our side or fell into our yard. He couldn't eat all the lemons on his side, and we gave up on our side after filling two grocery bags. Then we made lemonade, and didn't have to put any sugar in it, the lemons were that sweet.

#186 ::: inge ::: (view all by) ::: November 20, 2008, 07:12 AM:

Angiportus: [I] take bulging cans out for the ritual puncture over the dumpster [my personal record being a vertical launch of 6 feet.]

We had one can of bean stew explode when I still lived at home. My mother had noticed it was bulging, wasn't sure what to do about it, put it on the patio and promptly forgot about it. That was in May. In July, the can blew up.

#187 ::: Carrie S. ::: (view all by) ::: November 20, 2008, 08:37 AM:

there's poison hemlock growing all over the place in spring and summer

We have some variety of nightshade growing in our alley--I think it might be Brazilian, because it's kind of vine-y and the flowers are purple. Since I found out what it was I've been thinking about ripping it up, because we have small children in this area. The berries are very pretty and tempting.

I don't know; city kids are unlikely to get the "red is bad" meme by osmosis the way I did, but they're probably also less likely to eat random plants.

#188 ::: Charlie Stross ::: (view all by) ::: November 20, 2008, 09:25 AM:

Apropos #181 and small boxes with pills in them: I have such a box, because I'm on six different daily meds and I don't enjoy carting a crate of blister-pack boxes out with me of an evening (or morning).

It's got six compartments. So on the inside of the lid I affixed a sticker with a grid identifying each compartment by number, and wrote down a key with the generic name of the medicine, the strength, and the dose noted for each number.

I didn't do this for my convenience, I did it in case a paramedic finds me lying unconscious and has to cart me into hospital, whereupon a house officer will have to figure out what I'm taking without my verbal input or access to my GP.

(When travelling overseas I go a whole lot further, belt and braces: original packaging, repeat prescription form, insurance documents, cardiology clinic attendance form with my consultant's contact details, and a to-whom-it-may-concern from the aforementioned GP with his details.)

#189 ::: inge ::: (view all by) ::: November 20, 2008, 10:16 AM:

Paula @ 126: I got the cat meds directly from the vet, so no fun in the pharmacy...

My cats would swallow everything as long as it was wrapped in liver sausage or cream cheese. Without that, not so much -- they looked at me with "What is that and why do you think I'd eat it"? faces and spit it out.

#190 ::: Faren Miller ::: (view all by) ::: November 20, 2008, 11:12 AM:

I might be one of those wretched supertasters as well, since cilantro does taste soapy and most spicy things tend to overwhelm my taste buds. But the taste I absolutely *cannot* stand is cucumber -- tastes like chlorine to me, and chlorine makes me nauseous.

Not that I have to subsist entirely on bland gruel. Coffee yogurt, baked goods (if they're minus milk fats), mildly spiced chicken, scallops, squash, etc. etc. can all be just fine!

#191 ::: Raphael ::: (view all by) ::: November 20, 2008, 11:37 AM:

The only tastes (of stuff seen as food) I can think of that I really don't like are dill and caraway, and I don't even find them all that horrible.

#192 ::: Sam Kelly ::: (view all by) ::: November 20, 2008, 11:45 AM:

The only poisoning experience I've ever had[1] was from working for six hours in a stagnant pond overhung with trees. I didn't notice anything particularly serious at the time, or during the evening, but when I went to bed that night, and pulled a sheet over my head for warmth, I started rebreathing everything that was still outgassing, and had the classic nausea-vomiting-dizziness-ASC then. I'm rather glad I had someone else in the house to hold my hair and make sure I didn't go back to bed.

One thing to remember is that while these gases (sulphur compounds) hang around, you stop being able to smell them after a while. So if you've had to spend a while around them, and then need to spend time in an enclosed space, get someone else to check you. Some sulphur compounds are extremely malodorous, some are extremely malodorous and toxic, but precisely none of them are oxygen.

[1] Whilst I did have a cyanide explosion in the lab once, it stayed in the fume cupboard.

#193 ::: Fragano Ledgister ::: (view all by) ::: November 20, 2008, 11:45 AM:

Marilee #182: My older son sucks on limes because he was taught to do so as a baby by a friend of the family. Babies, apparently, find them sweet perhaps because their tongues don't have enough sour or bitter taste receptors yet.

#194 ::: OtterB ::: (view all by) ::: November 20, 2008, 12:30 PM:

SpeakertoManagers185 I'm not going to argue with people about grapefruit; de gustibus non disputandum est, but I will say that if you like lemons at all, a fresh raw lemon can be a really delightful treat.

This reminds me of a family story. I have an aunt & uncle who live on the Texas Gulf Coast south of Houston. They have a number of citrus trees on their property. One year they mailed a box of home-grown citrus to friends. Friends replied with a note thanking them for the lovely oranges and grapefruit. Aunt replied "They were oranges and lemons." Friend replied "The kids said the grapefruit were awfully sour." In Friend's defense, they were lovely large, round lemons, without the pointy ends or bright yellow color of the grocery store version.

And, on a totally different line in response to the original post. My daughter is taking a semester Forensics course in high school, and they recently had a unit on toxicology where the students had to pick a substance, research it, and make a class presentation on the symptoms, etc. Leading to the kind of conversation that had better be taken in context: "I want cocaine." "No, I want cocaine." "Okay, I want PCP, and she can have the heroin." My daughter the mystery buff took the cyanide.

#195 ::: Charlie Stross ::: (view all by) ::: November 20, 2008, 01:05 PM:

OtterB: why don't you suggest to your daughter that she look into the combined effects of dimethyl sulphoxide (DMSO) and, oh, BZ (aka 3-Quinuclidinyl benzilate)?

(BZ: the only poison I know of for which the military nerve agent VX has sometimes been used as an antidote. Which has got to be as weird as it gets.)

#196 ::: Lee ::: (view all by) ::: November 20, 2008, 01:32 PM:

Raphael, #191: Heh, dill. Took me years to figure out that the main reason I don't like pickles isn't the pickle, it's the dill! I actually don't mind sweet-pickle relish in small quantities, but don't get me anywhere near dill pickles. Tarragon seems to be related, and triggers the same instant distaste reaction.

Re caraway, you should see me carefully and obsessively picking the caraway seeds out of a slice of rye bread so that I can eat the good part.

#197 ::: David Dyer-Bennet ::: (view all by) ::: November 20, 2008, 02:17 PM:

Fragano@140: Rum, eh? Mostly I drink my grapefruit juice with gin, but sometimes we run out of gin, and some of those times we have rum around, so I'll have to give that a try some day.

#198 ::: Fishwood Loach ::: (view all by) ::: November 20, 2008, 02:30 PM:

I have been on a fairly high dose of warfarin for several years. As a result, I am not supposed to take any other drug, OTC or Rx, that has blood-thinning effects. This includes all NSAIDS, aspirin, ibuprophen, etc.

I badly twisted my ankle this summer. I went to the local Urgent Care Center, and the physician's assistant who didn't think I was hurt all that badly (I could not walk without assistance) prescribed a splint and 800 mg ibuprophen.

I told her I could not take it, and pointed her to the line where the triage nurse had written down "warfarin" in my chart. She said she had never heard of such a thing. She denied that any NSAIDS, including aspirin, have any blood thinning effects, and then tore up the Rx. Then she told me to take Tylenol. I asked for something stronger. She refused, left, and never returned.

I assume she thought I was some sort of drug-seeker looking for a fix. (obviously I nearly broke my ankle to justify my addiction, right?)

I noticed later that the hospital has posted a "patients bill of rights", of which the 2nd or 3rd was "humane pain relief" or something to that effect.

I have since decided that if I ever go to that ER again, I will make a pest of myself and demand to see an actual doctor.

#199 ::: Ginger ::: (view all by) ::: November 20, 2008, 03:49 PM:

Fishwood @ 198: That was -- wow, I would have expected better behavior from a PA.

You are correct; you cannot take any NSAIDs, so acetaminophen or an opiate is needed. I hope you also treated your ankle with rest, ice, compression and elevation. Ibuprofen would have reduced the swelling and thus the pain, but strictly speaking is not required for healing.

Allow me to put on my pedantic hat for a moment: warfarin and other "blood thinners" don't thin the blood, they make the blood less likely to clot. NSAIDs don't make the blood thinner either, but they affect the platelets and make them less sticky, thereby reducing the ability to stop bleeding. Both are part of the hemostasis mechanism, along with vascular spasm, and help your body control the loss of blood.

Technically, one could combine warfarin and NSAID, depending on the specific NSAID, and not have catastrophic bleeding, but why risk it?

(/pedant)

My mother is now on warfarin as well (or coumarin, or whichever related anti-coagulant was prescribed). As a retired chemist, she could not help herself, and immediately figured out which foods she could not consume (anything with high levels of vitamin K), then titrated those that she liked with her dose of anticoagulant. I believe she managed to achieve a happy medium, but each patient has to work this out for him/herself (IOW, YMMV).

#200 ::: Andy Brazil ::: (view all by) ::: November 20, 2008, 06:01 PM:

Grapefruit tasting bitter is indeed a genetic thing apparently. Genetic Taste Markers

#201 ::: Fragano Ledgister ::: (view all by) ::: November 20, 2008, 07:43 PM:

David Dyer-Bennet #197: Rum (Appleton Light) and grapefruit juice (Trout Hall, by preference) was one of my favourite beverages in the days of my youth that are not forgotten.

#202 ::: Terry Karney ::: (view all by) ::: November 20, 2008, 08:39 PM:

Supertasting is not related to things like grapefruit, and cilantro, nor to the way artichoke awakens the sweet receptors in the mouth. Those are the result of various genetic expressions.

Bruce (StM): It sounds as though your neighbor had Meyer lemons, which aren't so much really sweet, as they are lower in acid. They are very good for things like lemondade and pies, etc.

#203 ::: Marilee ::: (view all by) ::: November 20, 2008, 11:18 PM:

Speaking of poison, the current AG, Mukasey, just collapsed while speaking. He started shaking and slurring, and then fainted. The news station says other people at the dinner were feeling off as well, but the DC EMT spokesguy wouldn't say anything about that. Sounds more like a stroke to me.

Ah, they got it up online. And the WashPost.

#204 ::: Adrian ::: (view all by) ::: November 21, 2008, 12:37 AM:

Marilee (182): I can't recognize all injected drugs by taste, but there several drugs I'm supposed to take with transdermal patches. The ones that were specifically prescribed in patch form "because they don't have any systemic effect, they only work locally" both have recognizable tastes if I leave them on long enough. (Antiinflammatory and lidocaine.) I don't think I'm a supertaster, though.

I like lemon. I need to be careful not to rub my face in the rind, because the oil can be irritating, but I can happily eat entire slices of lemon (rind and all). Frangano, last summer I was in a restaurant with a couple of friends and their toddler, and I ate the lemon slice out of my glass of water. The child asked for one, so I fished it out of her father's water glass and gave it to her. She nibbled away at it with every appearance of enjoyment.

#205 ::: David Goldfarb ::: (view all by) ::: November 21, 2008, 05:06 AM:

Andy Brazil@200: Interesting link! I hate grapefruit, broccoli, and coffee, although I like dark chocolate and sharp cheese. I bet I am a PROP taster.

Terry@202: Darn, you beat me to it; I was also going to speculate that Bruce's neighbor had a Meyer lemon tree.

#206 ::: Lila ::: (view all by) ::: November 21, 2008, 08:11 AM:

Adrian @#204, I have watched a toddler (maybe 18 mos-2yrs) happily crunching away on strips of raw onion in a buffet restaurant. No tears, no red face. The parents were fascinated and appalled: "I don't guess it will hurt her..."

#207 ::: Lila ::: (view all by) ::: November 21, 2008, 08:11 AM:

Adrian @#204, I have watched a toddler (maybe 18 mos-2yrs) happily crunching away on strips of raw onion in a buffet restaurant. No tears, no red face. The parents were fascinated and appalled: "I don't guess it will hurt her..."

#208 ::: Chris W. ::: (view all by) ::: November 21, 2008, 09:31 AM:

Having lived for many years with a bona fide supertaster and taste professional (my mother has worked for the last 10 years or so as a part-time food taster), I can categorically say that none of the specific taste differences on individual foods are related to supertasting per se, since my mother adores several of the spices and foods people are advancing as evidence of supertasting.

My understanding is that supertasting is mainly just a function of taste buds per square inch, while taste differences, like the one for cilantro, is primarily a function of what types of receptors your taste buds have (which is in turn primarily related to specific genes.) Basically, certain people have receptors for certain chemicals and perceive them as bitter, while others do not perceive them at all. The confusion enters because these people are called "tasters" for this or that chemical, which term is completely unrelated to the term "super taster" applied to people able to distinguish fine gradations in taste or discern tastes in very small amounts.

As for grapefruit, it's my experience that a really perfect grapefruit is an absolute revelation. But the problem is that I have yet to find a way to visually distinguish between grapefruit that is at that perfect moment of balance between sweet and sour and grapefruit that is underripe and too sour, or overripe and has begun to acquire that slightly painty taste that shows up in overripe citrus fruits. I've also found that the same applies to grapefruit juice (or those fancy sodas made with real grapefruit juice) even within the same brand. So you pays your money and you takes your chances.

#209 ::: Lee ::: (view all by) ::: November 21, 2008, 11:41 AM:

Chris, #208: So do you continue to buy grapefruit, hoping to hit one that's at that magical balance point? If so, you're demonstrating that intermittent reward is the best way to reinforce a behavior. :-)

#210 ::: David Harmon ::: (view all by) ::: November 21, 2008, 01:03 PM:

Chris @#208, Lee @#209: you're demonstrating that intermittent reward is the best way to reinforce a behavior.

Or perhaps, demonstrating why that's so... ;-)

#211 ::: Mary Aileen ::: (view all by) ::: November 21, 2008, 01:10 PM:

Lila (206/7): I happily eat raw onion pieces (although not in large quantities), the sharper the better. No tears, no nothing. (Cutting up onion used to make me cry, but that was 30 years ago.)

I'm another one who adores grapefruit and gf juice but can't eat it anymore because of medications. I like the yellow better than the pink--pink grapefruit is too sweet for me.

#212 ::: Terry Karney ::: (view all by) ::: November 21, 2008, 01:13 PM:

As a note, the thing about lemons is the acid. They have 10-12 percent sugar. Oranges have 12-16 percent (didn't we do all this when Xopher was looking to make lemon extracts? I nearly think we did).

So the Meyer are less acid, which lets the sugar show up, and the flavors show through more cleanly.

#213 ::: Earl Cooley III ::: (view all by) ::: November 21, 2008, 01:14 PM:

I've read that grapefruit can sometimes make medication effects too strong; has anyone officially experimented with the idea of lower (and, as a consequence, less expensive) doses of medications intentionally concentrated by grapefruit? I imagine precision of the effect might be problematic.

#214 ::: Charlie Stross ::: (view all by) ::: November 21, 2008, 01:22 PM:

Earl @213: the word you're looking for is pharmacokinetics. And you bet grapefruit is problematic.

#215 ::: David Harmon ::: (view all by) ::: November 21, 2008, 02:47 PM:

Lila @#207: When my youngest niece was about that age, I watched her eating an onion sprout (cut up). She'd eat a piece, then say "too hot!"... and then eat another piece!

#216 ::: John Houghton ::: (view all by) ::: November 21, 2008, 03:08 PM:

Ginger #199:

As a rather picky eater (especially about vegetables), I was amused when, years ago after my open tib/fib, I was put on Coumadin to lessen the risk of blood clots and firmly told to not increase my veggy intake from what I had been eating in the hospital.

#217 ::: lorax ::: (view all by) ::: November 21, 2008, 03:43 PM:

David @215, what is an onion sprout? Is it the sort of thing that might be called either a "green onion" or a "scallion", where the onion bit is no wider than the stalk? Looks something like this?

My grandfather used to eat those raw pretty regularly. He'd have them on the table in a glass of water, and dip them in salt. One of my younger brothers picked up the habit, but none of the rest of us did.

#218 ::: Xopher ::: (view all by) ::: November 21, 2008, 03:53 PM:

I assumed he meant the green bit of a sprouted Spanish onion. You know, one that's been sitting around too long and has put out a shoot.

#219 ::: David Harmon ::: (view all by) ::: November 21, 2008, 04:18 PM:

lorax @#217: Xopher's got it at #218, though any round onion will do that. The sprout my niece had was something like 6 inches long, from some generic yellow onion. They're not the same as scallions, but you can use them for pretty much the same things....

I've occasionally chopped raw scallions into salads, more often i put them in soups or fry-ups at the very end. Onion sprouts could do well with any of those.

#220 ::: lorax ::: (view all by) ::: November 21, 2008, 05:16 PM:

Ah, thank you.

#221 ::: glinda ::: (view all by) ::: November 21, 2008, 07:27 PM:

Another "thank you" for all those medical posts.

I managed to give myself a partial-thickness burn on my index and first fingers (turned on wrong stove burner, accidently brushed against it five minutes later), and even though I was sure "cold water, then eventually sterile dry bandage" was the right thing to do, seeing it confirmed was reassuring.

(Then I spilled coffee beans on the floor. And *then* dropped the nutmeg I was grating into the (full) coffee mug. Stupid fibroflares and neuropathic klutziness. Also, no piano playing until the burn heals. Damn, damn, damn.) (*end whine*)

#222 ::: eric ::: (view all by) ::: November 21, 2008, 07:49 PM:

One of the kiddos (4yrs old) has decided that he likes plain raw cranberries.

Apparently they're 'sweet'.

#223 ::: Linkmeister ::: (view all by) ::: November 21, 2008, 07:49 PM:

glinda, at least it was coffee beans, not grounds, right?

I once watched in disbelief as a 10-lb bag of dog food fell off a stool and scattered all over the kitchen floor. It all seemed to happen in slow-motion.

#224 ::: Marilee ::: (view all by) ::: November 21, 2008, 09:15 PM:

Adrian, #204, I don't know about patches because we tried a BP med patch years ago and I immediately erupted into welts under and around the adhesive. I've progressed to being allergic to all tapes and adhesives on my skin.

Earl, #213, right. You can't tell how much of the inhibiting factor is in any particular grapefruit/juice so you can't plan how to adjust the med. (Keith Lynch always asks this on Usenet when I mention not getting to have grapefruit. You'd think he'd remember by now.)

#225 ::: Terry Karney ::: (view all by) ::: November 21, 2008, 09:27 PM:

I use onion sprouts. I take the roots of "bunching onions" (which are sold as scallions in the markets) and plant them.

They go to see that year. I save the seeds and sprout them as one would alfalfa, mung beans, etc.. Then I use them in salads, sandwiches, etc..

#226 ::: glinda ::: (view all by) ::: November 22, 2008, 02:38 AM:

Linkmeister @ 223:

Yes, beans, not grounds; easier to vacuum up.

And infinitely easier to clean than an entire french press pot full of hot! coffee, of which the bottom just... separated from the rest of the glass. Not even shattering, just... some fault line in the glass gave way, and there was boiling hot coffee, with grounds, all over the stove, the counter, and the floor.

The burns are much healed; I skipped the bandage since the skin isn't broken, and put split bits of aloe vera leaves on it (one of the few bits of folk medicine I've got, this from a grandmother).

The pain has gone from so intense I considered taking another vicodin, to a *shrug* yeah it's there but not intrusive level. I'd bet they'd be doing far worse had they not soaked in ice water for as long as they seemed to need it.

So... sleep.

#227 ::: Jacque ::: (view all by) ::: November 22, 2008, 05:15 AM:

Linkmeister @223: The bag was falling in slow motion. They do that just to taunt you.

#228 ::: David Harmon ::: (view all by) ::: November 22, 2008, 10:56 AM:

Terry Karney @#255: Hmm, that's an idea... The problem for me would be getting them to seed without the cat getting at them.

#229 ::: Lila ::: (view all by) ::: November 22, 2008, 12:41 PM:

David @ #228, totally unhelpful in this context but you just brought to mind one of my favorite mnemonics, which explains why you should grow catnip from seed rather than from transplants:

"If you set it, the cat will get it, but if you sow it, the cat won't know it." (The transplants get bruised in planting, releasing the characteristic odor.)

#230 ::: Madeline F ::: (view all by) ::: November 22, 2008, 03:12 PM:

My parents protected their catnip patch by putting an old iron fireplace log holder over it. The catnip could grow to 5-6 inches without getting flattened, and the cats could lie in the log holder and roll around on the nip that grew up through the iron bars.

#231 ::: P J Evans ::: (view all by) ::: November 22, 2008, 05:20 PM:

We had catnip inside a double cage. The outer cage was 1x2 inch mesh, or a little larger (not more than 2" square), so the cat could stick a paw inside but no more, and the inner cage was 1 inch square mesh. Both were buried a few inches (that bar and chain idea might be good here!) to keep them from moving. A brick on top helps, too. This keeps the roots and stems safe from cats rolling on them.

#232 ::: glinda ::: (view all by) ::: November 22, 2008, 06:21 PM:

"If you set it, the cat will get it, but if you sow it, the cat won't know it." (The transplants get bruised in planting, releasing the characteristic odor.)

Heh. Planted catnip when I lived in Hawaii. Itcame up fine; first two leaves on each seedling, no problem. Then the second set of leaves developed - apparently with scent, because Casanova-kitty rolled in them, uprooting/destroying the whole patch.

I think a mesh/screen cage would've been a good idea. (The pot of catnip on my porch seems to not attract roaming kitties, and Annie doesn't like fresh catnip, just the dried. *shakes head at vagaries of the felines who own us*)

#233 ::: sara ::: (view all by) ::: November 22, 2008, 09:58 PM:

Perhaps little kids (aged 1-2) aren't sure what "too hot" means and apply it to everything. At 18 months my nephew was impressed with the warning "hot!" and repeated it when he encountered any unknown food item. His mom had to say, "No, that isn't hot."

#234 ::: Terry Karney ::: (view all by) ::: November 23, 2008, 08:57 PM:

re onion sprouts: I am not worried about the cat getting into the sprout jar. These aren't in the ground.

About the Catnip: Rue is the anti-catnip. After I read that little titbit I bought some, in the hope it would save my half-barrels from having the dill seedling (and shallots) dug up.

It did.

Someday I plan to make a planting of it, and inside a ring of rue plant some catnip.

#235 ::: xeger ::: (view all by) ::: November 23, 2008, 10:13 PM:

Terry Karney @ 234 ... Someday I plan to make a planting of it, and inside a ring of rue plant some catnip.

... an ye shall rue the day?

#236 ::: Terry Karney ::: (view all by) ::: November 23, 2008, 11:01 PM:

Xeger, not me, but the cats... with rue shall their hearts be laden.

#237 ::: Terry Karney ::: (view all by) ::: November 23, 2008, 11:02 PM:

Oh, and to add to the topicality, rue is slightly toxic.

#238 ::: xeger ::: (view all by) ::: November 24, 2008, 12:17 AM:

Indeed - rue can give you a rash you'll rue if you handle it too much[0]...

[0] Why yes, there's a reason why I know that...

#239 ::: James D. Macdonald ::: (view all by) ::: November 30, 2008, 11:14 AM:
ASPEN, Colo. -- A Denver family of four found dead at an Aspen home with high levels of carbon monoxide were meeting friends for the holiday weekend, the Pitkin County Sheriff's office said Saturday.

Authorities said two adults, a man and a woman, along with a boy and a girl were found dead inside. The victims have been identified as Parker Lofgren, 39, Caroline Lofgren, 42, and their children, Owen, 10, and Sophie, 8. The Lofgrens were visiting Aspen for the holiday weekend.

Carbon monoxide detectors are cheap (you can get a battery-operated for around twenty dollars). There's no reason in the world you shouldn't have one in your home.

They make excellent presents.

#240 ::: Kevin Riggle ::: (view all by) ::: March 24, 2009, 01:02 AM:

Since I came here looking for this information, a while ago, and didn't quite find it, here it is for the next person:

If you suspect that there is a carbon monoxide problem in your house -- those CO detectors you installed are going off, say, or you are exhibiting any of the abovementioned signs and symptoms of CO poisoning -- the things to do, in this order, are:

1. Get out of the house.
2. Call the local fire department.
3. Go to the nearest emergency room if you're exhibiting any of the symptoms of CO poisoning.

#242 ::: Rikibeth ::: (view all by) ::: August 02, 2013, 08:15 PM:

Just wanted to say how much these posts have influenced me not only as a person who might encounter emergency situations, but as a writer.

A friend of mine is working on a romance story, which is not quite her usual genre, and wanted an opinion from a romance writer's perspective on whether it would be creepy for the hero to find the girl's address from her driver's license and take her to her home, if he found her passing out near her car outside a bar, hypothesis Something In Her Drink.

I said "Why is he taking her HOME? She needs MEDICAL attention. Have him follow the ambulance to the ER and stay there to be sure she can get home OK when she wakes up. How does he know she can sleep it off safely? GET HELP ROLLING."

So, Uncle Jim, you may be improving the romance genre one story at a time.

#243 ::: Jim Macdonald ::: (view all by) ::: August 03, 2013, 02:01 AM:

And ... indirectly someone's life may be saved, when the story is published, someone reads it, and one night finds someone passed out and decides (because of that neat story) to get the person to the ER instead of taking them home.

(People really do die of alcohol poisoning, BTW. It's called intoxication for a reason--that stuff is toxic.)

#244 ::: Xopher Halftongue sees spam ::: (view all by) ::: March 01, 2014, 11:23 PM:

Why is this thread such a target?

#245 ::: Jeremy Leader ::: (view all by) ::: March 01, 2014, 11:53 PM:

Xopher @256 (or lower, after de-spamming): I suspect because it's a page that's been around for a while, possibly with many high-reputation links to it, containing mention of various trade-marked pharmaceuticals.

#246 ::: Idumea Arbacoochee, Speaker to Tall People ::: (view all by) ::: March 09, 2014, 08:49 AM:

I'm loath to do it with any of Jim's emergency medical posts, but I think I'm going to temporarily close this thread to comments. I've calendared a reminder to myself to reopen it in a month, by which time I hope whatever POST SPAM HERE list it's on is superseded.

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