The impact of bittering agents on suicidal ingestions of antifreeze

Nicole C. White, Toby Litovitz, Marisa K. White, William A. Watson, Blaine E. Benson, B. Zane Horowitz, Lisa Marr-Lyon

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background. Legislation requiring the addition of bittering agents to antifreeze enables assessment of the impact on frequency, volume and severity of suicidal antifreeze ingestions. Methods. U.S. poison control data were analyzed comparing 130 suicidal antifreeze ingestions occurring in two states after enactment of bittering requirements with 3,493 cases occurring in states (or at times) where bittering was not required. Results. The frequency of suicidal antifreeze ingestions was unchanged after implementation of bittering. The volume implicated, medical outcome distribution, and use of antidotes, hemodialysis, intubation, or critical care, showed no significant difference between bittered and non-bittered groups. Bittering was not a significant contributor (positively or negatively) in predicting lethal or life-threatening medical outcomes. Conclusion. The addition of bittering agents to antifreeze for the purpose of limiting the frequency or severity of suicidal ingestions could not be justified using U.S. poison control data.

Original languageEnglish (US)
Pages (from-to)507-514
Number of pages8
JournalClinical Toxicology
Issue number6
StatePublished - Jul 2008


  • Antifreeze poisoning
  • Aversive agents
  • Suicidal ingestions

ASJC Scopus subject areas

  • Toxicology


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