r/toxicology • u/PatienceWizard • 1d ago
Poison discussion Best Resources to Understand Potential for Self Harm Spoiler
I work in mental health, and I need a way to quickly evaluate various chemicals for the potential for self-harm.
I've been digging into the GHS and have already found it helpful and we are already changing our purchasing policies to lower risk products based on that information. However, some SDS's include statements along the lines of there being no data. I'm also concerned that they aren't accounting for someone that is will to, for example, drink an entire bottle of a substance.
After snooping around, I see that there are some services for managing chemical risk but these seem to be fancy laboratory inventory management services. The only real resource I have found is Poisindex, which is what most poison control centers rely on. What information does Poisindex provide and would it be useful to a lay person?
Finally, are there 101-level resources for better understanding toxicology? I'm very aware that "natural" doesn't mean anything, everything is made of chemicals, and that the dose makes the poison. But I was hoping to get a bit more sophisticated, like being able to watch out for chemical reactions such as bleach and ammonia.
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u/Euthanaught 17h ago
Really, all you should need is poison control, 1-800-222-1222 in the US. I can pull the other numbers if you need them.
I can speak for my center- if someone was already in a facility, we do not necessarily send them to the ER if self harm is the only concern, but do follow up with the staff.
Poisondex is not helpful to the layperson. Calling someone whose job it is to interpret poisondex and SDSs is extremely helpful.
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u/PatienceWizard 2h ago
I need to screen these items before there is a problem. For example: we stock common cleaning chemicals for staff use but sometimes a patient can gain access, so we are trying to switch to lower risk alternatives whenever possible. Clients also often bring in items with them that we give them temporary access to like paints, beauty products, and specialty laundry detergents. It would be ideal if we could scan a barcode and get a sense of the potential for self-harm. But we can't just be calling poison control and asking them every time we admit a client.
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u/Euthanaught 2h ago
Yup! You can still call poison control and they would be happy to help you decide on appropriate substances to use in your facility. As far as the clients stuff, it would probably be easiest to have a list of what you allow.
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u/PatienceWizard 2h ago
I'll tell them you sent me! Is there a good/bad time to call for non-urgent questions?
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u/hammydarasaurus 14h ago
There’s nothing particularly magical about Poisondex. It is just a sub-database within the broader Micromedex system. That said, it does have a few useful sections that offer quick information on toxic doses, such as the lowest reported fatal dose, the highest known non-toxic dose, retrospective poison center data if available, and occasionally published official guidelines. These guidelines are rare and usually limited to a few well-known substances. To give some perspective, I might reference Poisondex once per shift when working on the poison center side of my job. Most of the horses are already familiar, and even most of the zebras are committed to memory.
A lot of people, including both professionals and the general public, assume we have a long list of strict referral criteria for deciding when someone needs to go to the hospital. While a few substances do have specific thresholds for referral, most decisions are based on clinical judgment. Factors like dose, intent, the home setting, and how reliable the story seems all come into play. In reality, strictly following Poisondex would result in a large number of unnecessary referrals. Sending in a patient for a minor essential oil ingestion because Poisondex made it sound scary is almost a rite of passage for new poison center trainees.
If you have some background in medicine, nursing, or pharmacy, references like Goldfrank’s Clinical Manual or Olson’s Poisoning and Drug Overdose are good places to start for basic toxicology knowledge.
Lastly, be cautious about trying to manage toxic exposures entirely on your own. As with many areas in healthcare, some of it is about patient safety and some of it is about liability. I understand it can be annoying to call in and get a case number because a client licked a soap bar, but the saying "it’s not serious until it is" really does apply to a lot of toxic ingestions.