05 October 2010

The Deadliest Cough Syrup

Pediatric overdoses can be something of a mixed bag. Most -- indeed almost all -- are utterly harmless. Either the stuff consumed was in a quantity which is sub-toxic (which is why pediatric bottles of tylenol are so small -- to limit the possible total dose if little Johnny likes it so much he drinks it all) or the stuff ostensibly taken was not actually taken.  Of course, many OTC medicines and a surprising number of prescription medications are also relatively innocuous even at very high doses.  On there other hand, some OTC meds are surprisingly toxic, particularly some cough and cold formulations, and there are a few really dangerous meds for kids -- the so-called "one pill kill" meds.

So when I saw the two-year-old in room six was here for an overdose, I was not particularly worried.  You need to be alert for the bad things, but in general these are benign presentations. I saw from the triage note that he had drunk a whole bottle of cough syrup.  As I went to see the kid and his parents, I ran through a mental list of what possible toxic effects he could have from that. Dextromethorphan can make you pretty weird. Antihistamines also can cause some problems, in a high enough doses.  A little kid with a whole bottle of that could actually be pretty sick. It would all depend on the formulation he drank and what ingredients were in it.

I was relieved to see a happy, completely normal-looking and -behaving kid with normal vital signs.  Mom was beside herself with fear and guilt, as usual, but otherwise seemed a normal, reasonable parent.  Fortunately she had had the presence of mind to bring in the bottle of the offending agent.  I eagerly accepted it from her shaking hands and scanned the label to review the ingredients. I was relieved to see this box:



In case you can't read the label, it's clearly marked as "Homeopathic Cough Syrup."  (I can't recall if it was this brand or another similar one.) I chuckled a bit and the mom asked if there was anything wrong. I explained that the theory of homeopathic medicine is that the lower the dose, the more potent the effect, and so the most dangerous overdose would be if he had not taken any! The mom looked confused at that, so I gave up on my terribly clever joke and explained that this stuff was entirely inert sugar water, harmless as an overdose and useless as a medicine. I did want to double-check to ensure that there weren't any bizarre ingredients (just because it says homeopathic doesn't mean it doesn't actually contain active compounds), and I wasn't familiar with most of the listed ingredients:
Causticum 6X HPUS
Drosera Rotundifolia 6X HPUS
Ipecacuanha 6X HPUS
The last one almost sounded like real medicine, but a quick call to poison control confirmed that it was essentially inert.  (Funny note: the box lists the water as an "inactive ingredient," but I thought water's magical power of memory was what made homeopathy work?)

So I was able to reassure her that her child would be fine, and educate her so she didn't waste any more money on snake oil. (She wasn't a devotee of homeopathic medicine; she'd just grabbed the bottle off the shelf at the pharmacy.)  It was a happy ending, and gives me a change to repost this classic James Randi takedown of homeopathy (as well as other charlatans and hoaxters):



10 comments:

  1. Hahahaha this story was so very well played!! I chuckled as soon as I saw the Homeopathy bottle. I can't believe they sell this stuff in the pharmacy section.

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  2. Did you notice the "6X" portion? That means those few ingredients were diluted to 1/100th strength *six times*. That's one part in a trillion.

    Arsenic's threshold for safety (per the WHO) is ten parts per billion, or ten thousand times that concentration.

    http://en.wikipedia.org/wiki/Homeopathy#Dilutions

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  3. It was probably effective though because of the honey. Didn't I read a study a few years ago that honey was more effective than any of the pharmaceutical ingredients in otc cough meds?
    I am not one for homeopathic cures, but I gotta tell ya those Hyland's homeopathic teething tabs were awesome for the early teeth (nothing but motrin works for the molars though!). Maybe it just seemed like it works 'cause teething pain waxes and wanes anyway. I was just glad when he went back to sleep!

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  4. http://www.youtube.com/watch?v=HMGIbOGu8q0

    LOVE THIS ONE.

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  5. I had a 67 year old "doctor" of homeopathic medicine call 911 once because he slept on his arm wrong and it fell asleep.

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  6. I'm not sure exactly why I read your blog; I'm a librarian, not a doctor or anyone who has anything to do with the medical field really. Still, you write well and I very much enjoy your RSS feed.

    I don't think I've commented before, but your post about children's overdoses reminded me of an experience I had that I thought I'd share.

    When my daughters were toddlers, they were pretty adept at climbing out of their cribs. I'd given one Tylenol cold medicine while half asleep, and managed to leave the bottle in the nursery, cap off. In the morning, I awoke to find my 3 year old with grape-smelling breath and sticky hands. Poison Control was called immediately, and my fears were put to rest. No harm, no foul.

    Flash forward a year or so. My husband was experiencing some acute, um, abdominal distress. In his particular state, he left a bottle of Immodium pills open on the bathroom sink. Somehow - it's like the kids knew it was there - within 15 minutes of his vacating the bathroom, they were in there and the bottle was empty.
    Neither of us knew how many pills were left in the bottle and one just can't trust a 4 year old in this situation. I called Poison Control. "How fast can you get to the ER?" they asked. A mother's worst nightmare, indeed.

    We sped to the hospital 10 miles away and were ushered in immediately by a very friendly security guard. Poison Control had called ahead for us. The guard handed us off to nurse who met the girls and calmly weighed them. Then we were put in a large room, both girls on one bed. There were four (4!) doctors in the room, all speaking very calmly to me and my husband and explaining that the best course of treatment involved getting the kids to swallow some sort of charcoal concoction.
    I can't stress enough how incredibly calm everyone was. They even seemed to joke around a bit, as if this were just a normal day and no such thing as 'emergency' existed.

    It wasn't until the girls had been given their charcoal and admitted to the hospital for overnight evaluation that it dawned on me: we'd arrived at a busy city hospital ER, waited zero minutes, and were seen by four doctors immediately! Their calm demeanor, I can only assume, belied the actual emergency of the situation.

    (My kids are now 9 and 10 and still swear that they'd only poured the pills down the sink drain.)

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  7. This was really unbelievable! I never thought that there such a thing as deadly cough syrup because for all I know, medicines must bring cure for every person who's sick. But I think too much medicine can bring damage to our body, that's why certain pharmaceutical companies have their own near infrared spectroscopy. This NIR technology optimizes and checks the components used in a medicine to ensure that it's safe for all.

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  8. @jaymcjay

    Actually, 6X means diluted to 1/10 six times. That's one part in a million. That really could be dangerous.

    That said, the final step of putting the magic water on sugar is a big dilution and they won't start with pure whatever-it-is. Not least because the starting substance for homeopathy tends to be poisonous so it's in their interests to make sure you don't take any of it.

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  9. well for mom with a child that has heart desease a homeopathic cough medicine is pretty much the only thing we can give our child to make them feel better that and tylenol but tylenol is jsut a fever reducer and make the child sleepy. I really dont think its ok for you to say that its stupid of us mom to believe that something homeophatic would actulaly make our kids feel better. Who is the dumb mom, the one that gives her child somthing that if taken the wrong dose could possibly harm your child or the mom that is giving her child something natural that would not harm her child. Think before you right something againts these types of medicines. I bet you are a doctor of course always advocating for pharmasuatical companies and there harmful toxic ingredients.

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  10. My fiance has to get the flu shot every year because he is in the army. He also has to get injected with a ton of other things, that we dont even know what they are. This year a chiropractor suggested some homeopathic remedies. Thuja occidentalis and Ledum Palustre
    to be exact. This is the first time that he hasnt had the flu immediately following his shots. I understand how RCT's work and that one patients experience with it doesnt make it fact. but personal experience is one way to gather information is, is it not? Thanks for sharing!

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