changes from baseline in systolic/diastolic blood pressure ranged from 22.6 to 27.0mmHg/14.3 to 25.4 mmHg across hydroxocobalamin doses compared with 0.2 to6.7 mmHg/�3.0 to 3.8 mmHg in the corresponding placebo groups. The highestindividual maximum increases from baseline in systolic blood pressure were 57, 54,46, and 49 mmHg during or after infusion of 2.5, 5, 7.5, and 10 g hydroxocobalamin,respectively, compared with 15, 30, 28, and 28 mmHg in the corresponding placebogroups. The corresponding values for diastolic blood pressure were 31, 52, 33, and 38mmHg during or after infusion of 2.5, 5, 7.5, and 10 g hydroxocobalamin, respectively,compared with 13, 25, 13, and 21 mmHg in the active placebo groups. The time ofmaximal blood pressure in individuals ranged from the second min of infusion to 12 hpostinfusion but generally occurred near the end of infusion and resolved within 4 h.Coinciding with the increases in systolic and diastolic blood pressure, mean pulse ratesdecreased from baseline. Between 2 and 3 h postdose, mean pulse rates after activetreatment returned to near-baseline values.

Conclusion: In healthy human volunteers, antidotal doses of hydroxocobalaminwere associated with a moderate increase in blood pressure. This finding corroboratesprevious observations in animals and cyanide-poisoned patients. The increases inblood pressure were not clearly dose related. They may be beneficial in counteractinghypotension commonly observed in patients with cyanide toxicity and do not appearto pose untoward risks in individuals without cyanide toxicity.

337 Treatment of Copperhead Envenomation inChildren

Rowden AK, Holstege CP, Kirk MA/University of Virginia, Charlottesville, VA

Study Objectives: Although mortality from copperhead envenomation is rare,local tissue injury can cause serious morbidity. The extent of injury associated withcopperhead envenomation in children has not been previously reported. We report aretrospective study examining the degree of morbidity and the treatment associatedwith copperhead envenomation in the pre-teen population managed by a singleregional poison center.

Methods: All snake envenomation cases were reviewed from both the universitybased medical toxicology consultation service and the regional poison center databasesfrom Jan 2003 through March 2006. Severity of bite was coded according to Toxicalloutcome standards. Distributions were compared using Fisher’s exact test.

Results: A total of 31 cases were identified. The age range was 2-12 (mean 7.5).Females accounted for 42% of bites. 65% of bites were on the lower extremity. Thedistribution of upper versus lower extremity bites compared between males andfemales was not statistically significant (p� 0.29). Outcomes were coded as moderatein 80% of cases, none were severe. Ovine polyvalent Fab immunoglobulin fragments(CroFab®) was used in 62% of cases. Between 4 and 6 vials of Crofab were used asthe initial dose for those treated. Of those treated 29% were given additional Crofabdoses following the initial loading dose. No adverse events were reported aftertreatment with Crofab. 57% (17) of bites were admitted to general ward beds, withanother 7% (2) being admitted to intensive care unit setting. Male and femalechildren were treated with Crofab and admitted with equal frequency (p�0.14 and0.09 respectively).

Conclusion: The majority of bites were moderate. Although systemic, life-threatening signs are rare after copperhead bites, inflicted tissue damage can causesignificant morbidity. Crofab remains a viable yet controversial treatment option forchildren and appeared to be safe in this small sample. The majority of the bites in thisstudy occurred on the lower extremity, which differs from previous studies pertainingto adult bites. This retrospective study represents one of the largest studies of theincidence and treatment of pre-teen children. More research is needed to determinethe optimal treatment for pediatric victims of copperhead envenomation.

338 ED Caregivers Rarely Assess Non-Traditional DrugAbuse

Anderson BB, Mycyk MB, Bhatia R/Northwestern University, Chicago, IL

Study Objectives: According to DAWN and NIDA, recreational drug abusepatterns in the ED have changed significantly in the last 10 years. We sought toidentify ED caregiver perceptions and practices of recognizing drug abuse in EDpatients.

Methods: An anonymous and confidential IRB approved survey instrumentwas administered to currently practicing ED RNs, ED attendings, and EDresidents. Study site was an urban, academic, level 1 trauma center with �75,000 ED patient visits yearly. Information obtained included demographics of

the caregivers, perceptions of current ED drug abuse patterns, and reportedpractices in evaluating ED drug abuse. Survey responses were on a 5-point Likertscale (Never(1) to Often(5)), data are reported as proportions.

Results: 60 caregivers completed the survey. 21 were RNs (mean ED years ofexperience�8.1, SD�8.0), 10 were attendings (experience�5.6, SD�4.0), 29were residents (experience�2.6, SD�1.3). 46% were female, 54% male. Overall,98% of respondents perceive drug abuse is a problem in ED patients, and 92%perceive it goes unrecognized. 43% reported not knowing if drug abuse patternshave changed in the last 10 years, and 57% do not know if demographics havechanged. 98% Sometimes or Often perceive illegal drugs (cocaine, heroin) areabused by ED patients: 90% Sometimes or Often routinely ask about illegaldrugs. 90% Sometimes or Often think prescription narcotics are abused by EDpatients: only 35% Sometimes or Often ask about prescription narcotic abuse.50% Sometimes or Often think non-narcotic prescription medications are abusedby ED patients: only 18% Sometimes or Often ask about non-narcoticprescription abuse, 78% Rarely or Never ask. 58% Sometimes or Often thinkcough products are abused by ED patients: only 6% Sometimes ask about coughproduct abuse, 90% Rarely or Never ask. Of current media forms, 87% ofrespondents deemed the internet to be a significant influence on changing drugabuse patterns, more significant than TV, movies, and magazines.

Conclusion: This study confirms that most ED caregivers perceive that drugabuse is a problem in ED patients and that it often goes unrecognized.Respondents appropriately perceive illegal drugs to be a problem and theirreported practice reflects this since most routinely ask. Even though there is aperception that recreational abuse of non-traditional drugs like prescriptionnarcotics, non-narcotics, and cough medicines is a problem, this is not reflectedin their reported practice since most do not ask. If so much drug abuse goesunrecognized because caregivers are not asking about non-traditional drug abuse,future efforts need to focus on this disconnect between perceptions and reportedpractices.

339 Hospitalization for Caffeine Abuse Is Associatedwith Concomitant Abuse of Other PharmaceuticalProducts

McCarthy D, Mycyk MB, DesLauriers C/Northwestern University, Chicago, IL;Illinois Poison Center, Chicago, IL

Study Objectives: Abuse of legal alternatives to traditional illegal drugs hasincreased among young adults according to recent data from the U.S. Monitoringthe Future Study and the National Institute on Drug Abuse. Since caffeine hasbeen promoted as an effective legal stimulant in energy drinks or dietarysupplements on popular pro-drug websites like www.erowid.org , we examined thecharacteristics of patients seeking treatment for abuse of supplemental caffeine forenergy or euphoria.

Methods: A 3-year (01/01/02-12/31/04) retrospective analysis of all caffeineabuse cases reported to a regional poison center (annual census � 90,000) wasconducted. Included were intentional ingestions in patients age 10 and older.Excluded were suicide attempts, therapeutic errors, and cases involving only a coffeeor tea product. Student’s T, Chi-square, Fisher’s exact test, and odds ratios werecalculated where appropriate.

Results: 265 cases of caffeine abuse met inclusion criteria. Mean age was 21years(95%CI:19.9-21.9; range 10-64), 50% were female. Caffeine was in the form ofa medication in 205 cases, a dietary supplement in 37 cases, and a caffeine-enhancedbeverage in 41 cases. Caffeine was abused alone in 186 cases(68%), with alcohol in 7cases, illegal drugs in 6 cases, and with other pharmaceutical products in 81(29%)cases. 31 patients(12% of total) were hospitalized from the ED for medicalcomplications from caffeine; 20 required ICU admission. Of all variables examined,only concomitant recreational abuse of other pharmaceutical products wassignificantly associated with hospitalization(odds ratio 3.9, 95%CI:1.8-8.5, p �

0.0001).Conclusion: In this cohort caffeine was abused primarily by young adults.

Concomitant abuse of alcohol or illegal drugs was uncommon, but abuse of otherpharmaceuticals was common and was associated with hospitalization. Recreationalabuse of caffeine or other pharmaceuticals is not safe. Educating the public andfurther prospective evaluation of this growing problem is needed.

Research Forum Abstracts

Volume , . : October Annals of Emergency Medicine S101