title: The impact of bittering agents on suicidal ingestions of antifreeze.
abstract: BACKGROUND
  Legislation requiring the addition of bittering agents to antifreeze enables assessment of the impact on frequency, volume and severity of suicidal antifreeze ingestions.
  
  
  METHODS
  U.S. poison control data were analyzed comparing 130 suicidal antifreeze ingestions occurring in two states after enactment of bittering requirements with 3,493 cases occurring in states (or at times) where bittering was not required.
  
  
  RESULTS
  The frequency of suicidal antifreeze ingestions was unchanged after implementation of bittering. The volume implicated, medical outcome distribution, and use of antidotes, hemodialysis, intubation, or critical care, showed no significant difference between bittered and non-bittered groups. Bittering was not a significant contributor (positively or negatively) in predicting lethal or life-threatening medical outcomes.
  
  
  CONCLUSIONS
  The addition of bittering agents to antifreeze for the purpose of limiting the frequency or severity of suicidal ingestions could not be justified using U.S. poison control data.
authors.affiliation: University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: White
authors.forename: Toby
authors.initials: T
authors.lastname: Litovitz
authors.forename: Marisa K
authors.initials: MK
authors.lastname: White
authors.forename: William A
authors.initials: WA
authors.lastname: Watson
authors.forename: Blaine E
authors.initials: BE
authors.lastname: Benson
authors.forename: B Zane
authors.initials: BZ
authors.lastname: Horowitz
authors.forename: Lisa
authors.initials: L
authors.lastname: Marr-Lyon
mesh_terms: D000931:Antidotes / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D003422:Critical Care; D019855:Ethylene Glycol / Q000506:poisoning*; D005260:Female; D006801:Humans; D007440:Intubation / Q000706:statistics & numerical data; D008297:Male; D009922:Oregon / Q000453:epidemiology; D011039:Poison Control Centers; D000644:Quaternary Ammonium Compounds; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013406:Suicide, Attempted / Q000517:prevention & control*; D013649:Taste; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000931:Antidotes; D000644:Quaternary Ammonium Compounds; C043414:denatonium; D019855:Ethylene Glycol