At the California Poison Control System in San Francisco, a call has just come in from a mother whose toddler accidentally drank a stain remover called “Grandma’s Secret.”
“I’m not sure how much she had and whether I should take her to the hospital,” the mom says. “She’s acting like her normal self, but she has her ‘disgusted face’ on.”
“Got it,” says the operator. “So, most stain removers aren’t a problem — they’re detergent-based. With ingestion, mostly what you’ll see are mild effects, like an upset stomach or brief gagging or vomiting. Typically, the remedy is you wash out their mouth, give them some water or juice, and they’ll be absolutely fine.”
Just like that, crisis averted. It’s all in a day’s work for the poison center’s operators, the specially trained physicians, pharmacists and nurses at the Zuckerberg San Francisco General Hospital and Trauma Center. Somebody comes into contact with something they shouldn’t, and a cry for help comes into the center’s 24/7 hotline (1-800-222-1222).
Raymond Ho, managing director of the California Poison Control System in San Francisco, shows off a collection of typical poisons — and antidotes — that are often the subject of hotline calls. (Karl Mondon/Bay Area News Group)
The San Francisco office is one of four in California, with others in Sacramento, San Diego and the Fresno/Madera area. Together, they handle about 235,500 cases per year — roughly 650 a day or one every two minutes — involving everything from drug overdoses to rattlesnake bites, toxic plants and weirder things.
Californians poison themselves in ways that generally follow nationwide trends. In 2022, most poisoning cases in America involved (in order) painkillers, household cleaners, antidepressants, cosmetics and personal care products, with rising numbers for exposure to fentanyl and Delta-8 THC, a compound found in cannabis. Some 47% of those cases involved children, with those ages 3 and under accounting for a whopping 35% of all cases.
It’s important parents keep everything locked up because children can get into anything, says toxicology management specialist Ting Regelman. About once a month, there’s a case involving a child who ate a button battery, the type that powers small devices like car key fobs.
“They get stuck in the esophagus and are still inducing current,” says Regelman. “If you want to do an experiment at home, put one of those button batteries on a piece of ham and leave it for a few hours. You’ll see it’s eating through it — that’s why we send them to the hospital.”
“People call with all sorts of questions,” says managing director Raymond Ho. Much of it is drug-related — painkiller overdoses, for example, vomiting from psychedelic mushrooms or hallucinating from jimsonweed, made infamous in Hunter S. Thompson’s “Fear and Loathing in Las Vegas.” Tylenol overdoses are a big problem, and ever since cannabis was legalized, there are more and more calls about children getting into mommy’s gummies.
Then there are the Black Widow bites, Ivermectin and other drugs meant for large animals and the spicy “One Chip Challenge” (the hotline advises ice chips and Mylanta for that one).
“This guy once called and said he swallowed a bullet,” says Ho. “He was worried the bullet would explode in his stomach. I told him, ‘That’s not going to happen, but there is lead in the bullet, and you can actually die from lead poisoning.’”
A display comparing the similarities of candy and medicine is on display at the San Francisco division of the California Poison Control System at Zuckerberg General Hospital San Francisco. (Karl Mondon/Bay Area News Group)
The next phone call is from a hospital about a 13-year-old patient who swallowed 20 magnesium supplement tablets. Her vitals look fine, but there’s another potential issue.
“It sounds like this was some kind of self-harm gesture?” the operator asks.
“Yeah, we put her in a 5150 hold,” says the medical worker, referring to involuntary psychiatric hospitalization. The operator advises pursuing “full labs” to see what else she might have taken.
Dealing with self-harm is part of the job. “We have suicidal patients calling and asking, ‘How much can I take of this drug, so I can kill myself?’” says Ho. “Of course, we don’t give that information out.”
A plate featuring a toxic interaction is displayed at the San Francisco division of the California Poison Control System at Zuckerberg San Francisco General Hospital and Trauma Center, Calif., Thursday, Oct. 17, 2024. (Karl Mondon/Bay Area News Group)
In a conference room adorned with an “Arizona Rattlesnakes: Creatures of Mystery and Myth” poster, residents and medical students gather to discuss the previous day’s cases with Timur Durrani, the poison center’s assistant medical director.
Among those cases: a man in his 60s who presented with diffuse pulmonary nodules in his lungs. It turns out, he’s a present-day gold miner. The Gold Rush may be long over, but there are still hobbyists hunting for flakes or nuggets using a process that involves heating mercury — and hot mercury releases toxic, colorless fumes.
“Inhaling mercury can cause some interstitial and acute injury,” says Durrani. “If he’s at home cooking mercury, then the question is, who does he share the home with? If there are kids there, or if they’re in an apartment that has shared ventilation with other apartments, you have to notify the health department about mercury contamination, which is expensive and not fun.”
Timur Durrani, assistant medical director at the California Poison Control System’s division in San Francisco, leads a group of residents doing rounds at Zuckerberg San Francisco General Hospital and Trauma Center, Thursday, Oct. 17, 2024. (Karl Mondon/Bay Area News Group)
Next up is a woman who came to the ER with vomiting and auditory hallucinations. She could be a late-presenting case of Tylenol poisoning. But she also has high iron levels, which might indicate an overdose of elemental-iron supplements.
“When you have iron sitting in someone’s stomach, it’s corrosive to the point where it not only is eating through their gut, but getting into their bloodstream, so you see liver failure,” says Durrani. “Usually what happens is nausea and vomiting, and blood coming out of both ends.”
Back in the call center, a mother is on the line describing how her kid just ate a tube of toothpaste.
Ting Regelman, a toxicology management specialist at the San Francisco division of the California Poison Control System, works the hotline phones at Zuckerberg San Francisco General Hospital and Trauma Center, Calif., Thursday, Oct. 17, 2024. (Karl Mondon/Bay Area News Group)
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“A small amount of fluoride isn’t going to hurt her,” the operator reassures the anxious mother. “But she can have an upset tummy. What you can do to help is give her some milk.”
There’s no doubt that hotline work is important, but aiding a parent in crisis is one of the most satisfying aspects of the work.
“They call, almost frantic,” says Regelman. “Then you talk with them, and you can almost hear them sobbing with relief. I find that to be the most rewarding part of the job.”
If you or someone you know is struggling with feelings of depression or suicidal thoughts, the 988 Suicide & Crisis Lifeline offers free, round-the-clock support, information and resources for help. Call or text the lifeline at 988, or see the 988lifeline.org website, where chat is available.
Poison 411 – and when to call 911
Whether you’ve somehow mistaken bleach for a smoothie, downed a Tide POD or caught your toddler eating unknown medication off a hotel room floor, here’s what to do.
If the person is having life-threatening symptoms — difficulty breathing, for example, uncontrollable shaking or unconsciousness — your first call should be to 911. Otherwise, if you have a poison-related question or someone has eaten, breathed or touched something potentially poisonous, call the California Poison Control System at 1-800-222-1222.
The hotline is free, private and operates 24 hours a day. There are translation services available in more than 200 languages. Expertly trained hotline staff can tell you what to do with your individual case — whether to go to the hospital, for instance, or stay at home, and whether to induce vomiting. Some substances will further endanger your health should you throw up.
The list of poisons is long, but here are some common things to be aware of:
Household hazards: prescription and over-the-counter medicines, cleaning substances and small batteries. If you have young children, keep everything locked up and store purses and bags out of reach to avoid children getting into medicines, cosmetics and hand sanitizers. Install carbon monoxide and smoke detectors, and test every six months to check if they’re working.
Pesticides like fungicides, herbicides and insecticides: common substances include bug repellent, bathroom mold-and-mildew removal agents, pet flea-and-tick treatments and algae killer for pools and fish tanks. Keep these substances in their original containers and out of sight of children.
Nature and wildlife: insect stings, toxic plants and mushrooms, poison oak, rattlesnakes and bites from spiders and ticks.
Food and drink: alcohol and contaminated foods can lead to poisoning.
Lead: This toxic metal might be present in homes built before 1978, as well as in some spices produced in other countries, recalled toys and contaminated soil. Find more information at https://calpoison.org.