DESCRIPTION

A patient presentation that involves an exposure to a substance thought to be nontoxic.

A compound should be considered nontoxic only if the following conditions are met:

• The product has been unequivocally identified.
• Only one product is involved.
• The label does not contain a warning from the Consumer Product Safety Commission, and the product in the bottle appears to be the original product (i.e., no substitution has occurred).
• The amount of product ingested can be accurately estimated.
• The route of exposure can be accurately determined.
• The patient is free of signs or symptoms of drug effect, both subjectively and objectively.
• Follow-up must be both available and reliable (e.g., parent or guardian).

If any of these conditions are not met or are questionable, the patient should be managed as an unknown ingestion. As Paracelsus said, "All substances are poisons; there is none that is not a poison, the right dose differentiates a poison and a remedy."

PATHOPHYSIOLOGY

By definition, a nontoxic ingestion should not produce any adverse health effects. Massive ingestions may produce some mild effects such as GI discomfort or obstruct the airway.

DRUG INTERACTIONS

Nontoxic compounds may interact with medications that are being taken therapeutically.

Section Outline:

• DESCRIPTION
• PATHOPHYSIOLOGY
• DRUG INTERACTIONS

DIFFERENTIAL DIAGNOSIS

Following is an alphabetical list of items generally considered to be nontoxic.

Household Items

• Ashes
• baby products
• ballpoint pen ink
• body conditioner
• bubble bath
• candles
• caps for toy guns
• caulk
• chalk produced in the United States
• charcoal
• clay
• cosmetics
• crayons produced in the United States
• deodorant
• erasers
• fabric softener
• felt-tip pens
• hand lotions
• highlighting markers
• household bleach
• indelible markers
• kitty litter
• latex paint
• laundry detergent (liquid)
• lipstick
• magic markers
• newspapers produced in the United States
• pencil lead (actually graphite)
• petroleum jelly
• pet foods or chew toys (not including pet medications)
• photographs
• plastics
• playing cards
• Play-doh
• rubber cement
• shampoos
• shaving cream
• shoe polish
• silica gel
• Silly Putty
• soaps
• spackle
• starch
• sunscreens
• sweeteners
• teething ring contents
• thermometer mercury
• toilet water
• toothpaste
• water color paints
• white glue

Medications

• Antacids
• calamine lotion
• birth control pills (if single ingestion)
• corticosteroids (if single ingestion)
• mineral oil (unless aspirated)
• oral antibiotics (some exceptions)
• water-soluble vitamins (excluding iron)
• zinc oxide
• zirconium oxide

Plants

Many plants are nontoxic. Due to regional variations in names, a poison center should be contacted if a substantial amount of any plant is ingested. A partial list of nontoxic plants is as follows:

• African violet
• aralia
• baby tears
• bird's nest fern
• bridal veil
• Coleus X hydrus
• corn plant
• creeping Jenny
• Dracaena indivisa
• dwarf schefflera
• emerald ripple
• fiddle-leaf fig
• gardenia
• grape ivy
• jade plant
• wandering Jew
• parlor palm
• peacock plant
• piggyback begonia
• piggyback plant
• prayer plant
• rubber tree
• snake plant
• spider plant
• string of hearts
• swedish ivy
• velvet plant
• wax plant
• zebra plant

Miscellaneous

Dehumidifying packets (silica or charcoal), grease and motor oils (unless aspirated), magnesium silicate, paint (indoor or latex), titanium oxide

SIGNS AND SYMPTOMS

History is a crucial element in determining a nontoxic ingestion.

• What substances did the patient have access to?
• What medications were prescribed to the patient or other family members?
• When was the last time the patient was seen?
• Were there initial symptoms that have resolved?
• Were substances at the scene brought to the emergency department for possible identification and/or analysis?
• There should be no signs or symptoms at presentation. If they do develop, the patient should be managed as an unknown ingestion.
• Refer to the specific drug chapter when particular findings suggest that drug as a possible source of toxicity. For example, rapid heart rate is covered in the Tachycardia chapter in SECTION II.

LABORATORY TESTS

If history confirms a nontoxic exposure, no testing is required. Suicidal ingestions should be managed as unknown ingestions, even if the patient claims that only nontoxic materials were ingested.

Section Outline:

• DIFFERENTIAL DIAGNOSIS
  • Household Items
  • Medications
  • Plants
  • Miscellaneous
• SIGNS AND SYMPTOMS
• LABORATORY TESTS

DIRECTING PATIENT COURSE

Dosage and timing should be determined for all substances that could be involved. It is important to evaluate the need for consultation with a poison center or other specialists in order to confirm the lack of toxicity of the ingestion.

DECONTAMINATION

Do not induce emesis or other decontamination procedures for a nontoxic ingestion.

Section Outline:

• DIRECTING PATIENT COURSE
• DECONTAMINATION

Failure to accurately identify substance(s) ingested and confirm their lack of toxicity.

RECOMMENDED READING

Ellenhorn MJ. Plants-mycotoxins-mushrooms. In: Ellenhorn's medical toxicology: diagnosis and treatment of human poisoning, 2nd ed. Baltimore: Williams & Wilkins, 1997.

Mofenson HC, Greensher J, Caraccio TR. Ingestions considered nontoxic. Clin Lab Med 1984;4:587-602.

POISINDEX Editorial Staff: Nontoxic ingestion. In: Rumack BH, Sayre NK, Gelman CR, eds. POISINDEX System. Englewood, CO: MICROMEDEX, Inc., November 30, 1997.

Weisman RS. Nontoxic ingestion. In: Goldfrank LR, et al., eds. Goldfrank's toxicologic emergencies, 6th ed. Norwalk, CT: Appleton & Lange, 1998.

Authors: Gregory M. Bogdan and Gerald F. O'Malley

Reviewer: Luke Yip