Case Study:
Late in your evening shift in the emergency department (ED), you receive a call from your local EMS unit. They are on the way to the ED with a 3-year-old male. About an hour ago, he came to his mother complaining of nausea and abdominal pain. When questioned, he admitted to playing with medication bottles in the upstairs bathroom. His mother found several open bottles and pills scattered about the bathroom. She states that “many” pills were missing from several of the bottles. The medications included prenatal vitamins, acetaminophen, a diuretic, a beta-blocker, and 2 other medications in unlabeled bottles that were left in the home by the boy’s grandmother. The boy cannot say when he took the pills, but the mother states that he had been playing alone upstairs for about an hour prior to complaining of abdominal pain. The boy is awake and alert with stable vital signs. Your charge nurse pulls a 40 French orogastric tube from the supply room and asks, “Should we pump his stomach?”
Case Study Conclusion:
You reassure the charge nurse that this awake and alert child with a normal heart rate and blood pressure does not need gastric lavage. From a detailed interview with the mother, you determine that the child may have ingested these pills between 1 and 2 hours ago. A call to the grandmother reveals that she had left some penicillin and aspirin at the home. A complete physical examination shows no abnormalities. After phone consultation with poison control and your local toxicologist, you order a urine toxicology screen, aspirin level, acetaminophen level (to be drawn in 3 hours), iron level (to be drawn in 3 hours), 12- lead electrocardiogram, and 1 g/kg of activated charcoal. He takes the charcoal orally without incident. You ask the social worker to do an assessment of the family and discuss poison prevention with them while you wait for his labs. All of his laboratory values are normal, and he remains stable and asymptomatic during his ED stay. After 8 hours, he is discharged from the ED with plans to follow up by phone with social work and poison control.
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