The impact of bittering agents on pediatric ingestions of antifreeze.
BACKGROUND
Legislation requiring bittering of antifreeze enables assessment of the impact on frequency, volume, and severity of pediatric antifreeze ingestions.


METHODS
US poison control data for antifreeze ingestions in children younger than 5 years were analyzed comparing 232 ingestions occurring in states after enactment of bittering requirements with 6218 cases occurring in states (or at times) where bittering was not required.


RESULTS
The frequency of pediatric antifreeze ingestions was unchanged after implementation of bittering in Oregon and California. The medical outcome distribution, median volume ingested, and observed clinical effects were no different in bittered compared with nonbittered groups. Likewise, the rates of hospital admission, critical care treatment, and use of alkalinization, hemodialysis, or intubation showed no differences with bittering.


CONCLUSIONS
Despite the appealing logic of limiting the ingested volume and thereby the severity of poisonings by adding aversive agents, and despite promising results in volunteer studies, bittering agents do not decrease the frequency or severity of pediatric antifreeze poisonings. The addition of bittering agents to household products cannot be justified based on actual poisoning data.
White
Nicole C
NC
University of Virginia School of Medicine, Charlottesville, Virginia, USA.
Litovitz
Toby
T
Benson
Blaine E
BE
Horowitz
B Zane
BZ
Marr-Lyon
Lisa
L
White
Marisa K
MK
D000056:Accident Prevention / Q000379:methods*; D000061:Accidents, Home / Q000401:mortality / Q000517:prevention & control* / Q000706:statistics & numerical data; D000367:Age Factors; D000931:Antidotes / Q000627:therapeutic use; D002626:Chemistry, Pharmaceutical; D002675:Child, Preschool; D004435:Eating; D019855:Ethylene Glycol / Q000737:chemistry* / Q000506:poisoning*; D005260:Female; D005421:Flavoring Agents / Q000737:chemistry*; D005500:Follow-Up Studies; D006795:Household Products / Q000506:poisoning*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011039:Poison Control Centers; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013649:Taste; D014481:United States
D000931:Antidotes; D005421:Flavoring Agents; D019855:Ethylene Glycol