Amy Shimamoto of the Hawaii Poison Center is the only certified specialist on poison information in Hawaii. Photo by Ken Sakamoto, Star-Bulletin

Poison center is the calm at the other end of the line

By Burl Burlingame
Star-Bulletin

"She was an older lady who lived by herself on the Big Island. I was describing the symptoms of ciguatera poisoning, and she began to cry," said Shimamoto. "She said, 'Those are the symptoms I've lived with for 10 years, and the doctors think it's all in my head. They've been giving me anti-depressants.'"

One call, to the right number, can change a life. Often, the one call can save a life. Shimamoto, the only certified specialist in poison information in the state, works the day shift at the Hawaii Poison Center. She's the calming voice at the other end of 941-4411 when a toddler has gotten into the medicine cabinet, when a child has erupted in lesions, when a grown-up has mixed medications.

Established in 1957 by the Honolulu Pediatric Society so physicians could get up-to-the-minute poison data, the center later installed public lines. Since then, it has been taken thousands of emergency calls a year. A nurse is on duty 24 hours a day, with a database of more than 600,000 toxic substances the computer program is called PoisIndex. The center is also available to neighbor island callers via toll-free 1-800-362-3585.

However, during budget cuts by the Legislature last year, the Poison Center was red-lined out of existence. Shimamoto, after working there more than 15 years, was "devastated."

Kapiolani Medical Center, which administered the program, decided it was too valuable a resource to toss out. They've gotten into fund-raising to keep the center's hot-line open, and if they haven't started selling car washes or barbequed chicken yet, it could be just around the corner.

"The Legislature didn't just target the Poison Center," said Kapiolani's Willow Morton, Director of Community Services. "Emergency medical services overall lost a million dollars. OK, let's look at numbers. The Poison Center is averaging 13,000 to 14,000 calls a years. At that rate, you're performing call-triage."

"About 85 percent of those calls are from the lay public," said Dr. Alson Inaba, a pediatrician who's director of the Poison Center. "The other 15 percent are from physicians in emergency rooms who need the assistance of the center to treat someone.

"Maybe people in government don't see how efficient it is to have one regional poison control center. Last night a pediatrician called from San Mateo for a child who had taken a huge amount of aspirin. The San Francisco poison center had given him advice, but he wasn't comfortable with it, and wanted another opinion."

Aspirin is bad for you?

"Teen-agers OD on aspirin all the time. The most common teen overdose, in fact, is Tylenol, and it can damage the liver. A lot of teen-agers out there waiting for liver transplants actually killed their liver with Tylenol."

"Iron tablets, too," said Morton. "And pre-natal vitamins. From 1983 to 1990, a third of all pediatric ingestion deaths were due to iron it can cause shortness of breath, GI (gastrointestinal) bleeding, coma. In 1990, child-restraint caps were put on iron pills which we think of as pretty benign and child fatalities since then have dropped dramatically."

Since 1992, there has not been a single poisoning fatality in Hawaii, largely due to the Poison Center. Some legislators think that computerized data bases of poisons have done away with the need for such specialized knowledge.

"But that's only half of it," said Inaba. "You have to calculate milligrams per body weight, other ingested substances, gauge time. It also doesn't tell you if the toxic reaction is to a mix of prescribed anti-biotics conflicting with prescribed anti-histamines. Every case is different."

Hawaii poisonings tend to follow mainland trends, with the usual regional differences. We get jellyfish and centipede stings, they get poison ivy. Nearly 60 percent of victims are under 6 years of age, with the critical period running 18 to 36 months old. "Watch out for toddlers giving infants 'medicine,' imitating their parents," said Inaba.

Poisonous plants around the house include diffenbaccia, oleander, azalea, crown flowers, Angel's trumpet, raw kukui nuts, and the old standard, plumeria.

The busy time is late afternoon, and the nights are slow, said veteran Shimamoto.

"Latch-key kids in the afternoons, sometimes baby-sitting infants. Sometimes older people living alone have ailments, and they think they're being poisoned by their medicines. You have to reassure them. When mothers call, they're usually pretty frantic, and you hear the baby crying in the background. First thing is, hey, calm down lady!"

On cue, the phone rang. It was a mother whose toddler had gotten into the Pine-Sol.

Shimamoto calmed her, had her figure out logically how much the child had ingested, if any. She consulted the computer, discovered that the pine oil in Pine-Sol was the most dangerous ingredient, prescribed rinsing the child's mouth and observation. She made a record of the call, for data tracking and to check back later.

"That's one of the intangibles you can't get off a computer," said Inaba. "And often when a parent calls they're guilt-ridden because their child got into a poison. And some people are suicidal when they call."

One freaked-out father called because his nine-month-old had sucked down an entire 12-ounce bottle of baby lotion. It was a bit hard to believe, but Shimamoto had to take his word for it, and, because of the amount, prescribed a visit to the emergency room. She warned the attending physician, who didn't believe an infant would suckle on Johnson & Johnson.

The physician called an hour later. After pumping the child stomach, there was indeed a full bottle of lotion there. "You have to believe the parents for the history," said Shimamoto.

One helpful remedy is syrup of Ipecac, available inexpensively at drugstores, and one taste of which induces vomiting. But don't do so unless given the go-ahead by the Poison Center; some poisons cause more damage coming out than going in. It's a good idea to keep a Poison Center Mr. Yuk sticker right on the Ipecac bottle.

The phone rang again. A child was foaming at the mouth after squirting Wizard air freshener down his throat. The mother, who by coincidence had taken a first aid class the day before, had washed the child's mouth out, given him a glass of water and some spaghetti to eat. And had then called the Poison Center to make sure.

It turns out air freshener is a low-toxic substance. But trying to dilute and absorb the toxins is not a good idea with many poisons. The fat in milk, for example, will actually speed up ingestion of certain poisons, like the naptha in mothballs.

Sometimes, the Poison Center learns from its callers.

"The oxilates in taro can cause rashes, which is why it's processed before eating," said Shimamoto. "But mainland visitors will sometimes make a green salad with taro leaves! Cool water and soap doesn't help. But a Hawaiian lady told us that lime juice will kill the hurt. She freezes lime juice in an ice tray so she can rub it on when she's working with taro or with chili peppers."

The phone rang again. Someone on Maui wanted to know why her Realtor insisted on a waiver because of termite treatments. "How long since it was tented?" asked Shimamoto. "The pesticide company is supposed to be able to declare it safe."

One of the most common poisonings is children eating cigarettes, which is potentially fatal. "A lethal adult dose of nicotine is 40 to 60 milligrams of nicotine, and a cigarette contains about 15 to 20 milligrams," said Shimamoto. "But most of that isn't ingested when it's smoked. But if it's eaten, and the person's body mass is less than that of an adult kids who eat just a cigarette butt go right to the emergency room."

And then there are calls from folks wanting just a little too much information.

"Like, 'Where can I buy cyanide?' Or, 'How much Tylenol does it takes to kill somebody?' Or, 'Will Paraquat kill my neighbor's dog?' There are some questions we just won't answer," said Shimamoto. "We can tell which ones."