Child Poising..
3 years child is left under the supervision of this 6 years old sibling while the parents are outside of the home. About 2 hours later the parents returns to find the 3 years old child along lying on the floor with several opened bottles of medicines and loose pills surrounding him. They rush him to a nearby hospital but forget to bring any of the medication containers .In emergency department, child is disoriented, vomiting, has an increased respiratory rate and is hyperpyrexia shortly after arrival he has a generalized tonic-clonic seizure .Laboratory data reveal mild hyperglycemia ,metabolic acidosis and a respiratory alkalosis .
What is the most likely diagnosis and what is the most appropriate next step?
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Filed Under: Discussion
Salicylate Poisoning
next step is to do:-
Serum salicylate level
ABGs test
n 4 rx is:-
Activated charcoal
Alkaline diuresis with extra KCl
Salicylate Poisoning seems to be the best diagnosis as stated by drmadhu. The simple test that could be performed to give the hint to the correct diagnosis is the ferric chloride test on the urine.
Gastric lavage is usually indicated within 2 hours.
If Late, then Intravenous sodium lactate with urine test for acetone.
Supportive therapy- oxygen
Sponging for hyperpyrexia
Vitamin K an thiamin
Methionine for liver damage
I would like to point out that the use of multiple-dose charcoal in salicylate poisoning is controversial. One animal study and 2 of 4 volunteer studies did not demonstrate increased salicylate clearance with multiple-dose charcoal therapy.
Special consideration- Haemodialysis. It effectively removes salicylate and corrects the fluid and electrolyte disturbance.