The number to call for information or exposures about poison.

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Cold and cough preparations are also considered a top rated substance.

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Household cleaners are considered a top rated substance that are abused.

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Biotransformation

Principles and Practices of Toxicology in Public Health written by Ira S. Richards indicates the importance of understanding biotransformation. This process is the sum of all chemical processes of the body that modify endogenous or exogenous chemicals. This heavily applies to the concept of toxicokinetics which is the process at what rate a chemical will enter the body and what will happen when it is applied. Areas of focus within toxicokinetics besides biotransformation include: absorption, distribution, storage, and elimination.

Biotransformation Factors

Biotransformation is strongly affected by factors pertaining age, sex, existing disease, genetic variability (toxicogenetics), enzyme induction, and nutritional status. The ability to metabolize a toxin can vary greatly with age. For the developing fetus and very young, limited biotransformation capability is noted primarily due to the lack of important enzymes. With this being said, the elderly can also have difficulties with this process due to loss of function with aging. Differences in hormones also account for gender-specific variability of some toxicants. Specific vitamins, minerals, and protein deficiencies can decrease the body's ability to synthesize the essential enzymes needed for biotransformation.

Enzymes

Enzymes generally reach their optimal capacity for this process by the time adulthood is reached. Enzyme fluctuations are at their lowest in early adulthood, which corresponds with the most efficient time for metabolism. These are considered biological catalysts and high-molecular-weight proteins they allow for biotransformation reactions to occur at rates that are consistent with life. "Lock and key" arrangement is often times referred to the process in which enzymes provide the molecular surface for a chemical reaction to proceed for substrates with the correct molecular architecture to fit onto the anchoring reaction sites. Without this, biotransformation uf the substrate may not proceed and the degree of enzyme specificity for substrates determine the extent of involvement with different chemicals. This degree of specificity may be absolute and catalyze only one specific reaction, may be less restrictive and catalyze reactions of structurally similar chemicals such as those with a particular type of chemical bond or functional group.

Biotransformation Phase 1

The University of Idaho indicates that this phase is commonly known for its involvement in functional group modification. In Phase 1 of biotransformation, oxidation enzyme reactions are considered the most important. This process adds an oxygen, removes a hydrogen, and increases valence. Reduction reactions also occur in this phase and are considered to be of less importance compared to oxidation. They remove an oxygen, add a hydrogen, and decrease valence. Hydrolysis reactions also occur in this phase which adds a water to the chemical component. 

Principles and Practices of Toxicology in Public Health continues to state that these reactions can be either microsomal or nonmicrosomal and are considered to be very polar (water-loving). Enzyme induction occurs, which is the process in which results in an increased ability to metabolize toxicants. Because Phase 1 is polar and causes the metabolite to be more hydrophillic (water-loving) in nature, it requires additional biotransformation to further increase hydrophillicity that is sufficient enough to permit significant elimination from the body. This is where Phase 2 comes in. 

Biotransformation Phase 2

Metabolites that have undergone Phase 1 of biotransformation produce an intermediate metabolite that now contains a "polar handle", such as a carboxyl, amino acid, or hydroxyl functional group. Conjugation reactions occur in this phase, indicating the combination of two or more chemical compounds. Muhammad Bilal Mirza indicates that Phase 2 is when the parent drug participates in the formation of covalent linkage between the parent compound functional group and either a glucuronic acid, sulfate, glutathione, amino acid, or an acetate compound, Conjugates are considered to be high in molecular weight, generally inactive, and rapidly excreted in urine. The primary organ that is affected by Phase 1 and Phase 2 of biotransformation is the liver. Other metabolizing organs that are affected include: gastrointestinal tract lungs, kidney, and the skin. 

Dose/Response Relationship

When we consider Paracelsus's famous phrase, "The right dose differentiates a poison and a remedy", the relationship between dose and response is crucial in understanding what may be harmful to our body and what may be beneficial for intake. In toxicology, the basic principle to understand is that for every dose, there is a response. According to Dose-Response Relationships in Toxicology, An important assumption in this relationship is that there is almost always a dose below which no response occurs or can be measured. A second assumption is that once a maximum response is reached any further increases in the dose will not result in any increased effect. 

The basis for establishing this relationship comes primarily from experimental data using laboratory animals, in vitro studies, and information from humans. The quantitative relationship provides information to assess the relative toxicity of a chemical when compared with others tested under similar conditions of exposure.  

Toxicity Rating

MicroCare discusses toxicity ratings which include the threshold limit value (TLV) , Personal Exposure Limit (PEL), and Assigned Exposure Limit (AEL). The best ratings are known as the TLV ratings. These are only assigned by the organization ACGIH. The Extension Toxicology Network states that the threshold limit value (TLV) for a chemical is the airborne concentration of a the chemical (expressed in ppm) that produces no adverse effects in workers exposed for eight hours a day per five days per week. This value is usually set to prevent minor toxic effects like skin or eye irritation.  

Dose

The administered or applied dose is considered the amount presented to an absorption barrier and available for absorption (although not necessary having yet crossed the outer boundary of the organism). This is otherwise specified. The internal does is more of a general term denoting the amount absorbed without respect to specific absorption barriers or the exchange boundaries. The delivered dose is the amount of the chemical available for interaction with any particular organ or cell. 

Reference Dose

NCBI states that the reference dose has been introduced in the field of toxicology in order to avoid use of prejudicial terms, such as "safety" and "acceptable", to promote greater consistency in the assessment of noncarcinogenic chemicals, and to maintain the functional separation between risk assessment and risk management. 

Median Doses

Deranged Physiology states that ED50 is the dose required to achieve 50% of the desired response pr intended use in 50% of the population. TD50 is the dose to achieve 50% of the population reporting this specific toxic effect. LD50 is defined as the dose that is required to achieve 50% morality from toxicity. EC50 is the concentration of a drug at which 50% of its maximum response is observed. LC50 is when the concentration of half of the drug at which 50% of mortality from toxicity is observed. 

The dose/response relationship is highly dependent on the interactions with exposure time (how long the subject has been exposed) and exposure route (how the substance entered the body). Understanding this relationship within the subject of toxicology is extremely important. 

AAPCC.org

The American Association of Poison Control Centers (AAPCC) supports the nation's 55 poison centers in their continuous efforts to prevent and treat poison exposures. They offer free, confidential medical advice 24 hours a day, seven days a week through their hotline at 1-800-222-1222. This service is established for the purpose of reducing hospital costs through in-home visits through information, advocacy, education, and research. The poison center encounters either situations involving an exposed human or animal (exposure call) or a request for information with no human or animal exposure to any foreign body, viral, bacterial, venomous, chemical agent, or commercial product (information call).

According to the AAPCC current national report, 91,306 calls were received in 2014. This number has decreased from the previous year by 19.5%. The most common information requested about drugs recorded were the drug interactions, followed by the drug information, questions about dosage, inquiries of adverse effects, and therapeutic use and indications.  Also in 2014, intentional exposures accounted for 16.7% of human exposures. Of this, suicidal intent was suspected at 11.2% of these cases, intentional misuse was at 2.5%, and intentional abuse at 2.2%. Unintentional exposures outnumbered intentional exposures in all age ranges except for ages 13-19 years, where intentional exposures were reported more than unintentional exposures in this age group.

For routes of exposure, ingestion was reported for 83.7% of cases, followed by dermal at 7%, inhalation/nasal at 6.1%, and occular routes at 4.3%. For the exposure-related fatalities (1, 173 cases), ingestion was reported at 81.4%, inhalation/nasal at 10.1%, unknown at 7.8%, and parental at 5.2%. More than one route could be reported for each exposure-related fatality cases.

Top rated substances include: Analgesics, cosmetics/personal care products, household cleaning products, sedative/hypnotics/antipsychotics, antidepressants, antihistamines, cardiovascular drugs, foreign bodies/toys/miscellaneous/ pesticides, topical preparations, alcohols, vitamins, cold and cough preparations, stimulants and street drugs, anticonvulsants, hormones and hormone antagonists, antimicrobials, and more.

Most human exposures, 87.7% of 1,898, 862 were acute cases compared to 944 acute cases among 1,835 fatalities (51.4%). Acute cases are defined as single, repeated, or continuous exposure occurring eight hours or less. Chronic exposures are defined as continuous or repeated exposures occurring more than eight hours. Chronic exposures comprised 2% (44,088) cases of all human exposures. Acute-on-chronic exposures are considered single exposures that have been preceded by a continuous, repeated, or intermittent exposure occurring over a greater period than eight hours. This was numbered at 8.9% (192, 428) of all human cases. Within the last decade, the percent of exposures determined to be suspected suicides ranged from 30.3% to 53.9% and the percent of pediatric cases has ranged from 1.5% to 3.2%.

The reason for most human exposures were unintentional (79.4%), unintentional therapeutic error (53.8%), and unintentional misuse (5.8%). In 2014, the participation poison centers logged 2,890,909 total encounters including 2,165,142 closed human exposure cases, 56,265 animal exposures, 663,305 information calls, 6,085 human confirmed non-exposures, and 112 animal confirmed non-exposures. The cumulative AAPCC database contains more than 62 million exposure case records. A total of 17.764.183 information calls have been logged into the AAPCC database since the year 2000.