Case history

Case history #1

A 3-year-old girl presents to the accident and emergency department after being found with her grandmother's open pill container. There was no witnessed ingestion. However, the child started falling asleep about 30 minutes after being found. The mother called an advice line and was instructed to take her child in for assessment. She arrived at the hospital 2 hours after the ingestion. The child has no medical problems, was born full-term without any complications, and is meeting her developmental milestones. She lives with her parents and her grandmother; her grandmother is the only family member who takes medication. She does not know which medications she takes, but is being treated for hypertension and diabetes mellitus. The vital signs are BP of 60/30 mmHg, heart rate of 50 beats per minute, respiratory rate of 16 breaths per minute, temperature of 37°C (98.6°F) rectally, and oxygen saturation of 100% in room air. Physical examination reveals 2-mm pupils, normal capillary refill, clear lungs, normal heart and bowel sounds, and profound CNS depression; the child wakes up when agitated.

Case history #2

A 12-year-old boy presents with altered mental status. He is unable to provide any history, but his friends state that he had eaten a plant that he found in a ditch. Since that time he has been mumbling incoherently and trying to grab objects that are not present. His friends brought him into hospital because they were concerned. They do not think that he has any past medical problems. His vital signs are BP of 160/90 mmHg, pulse of 125 beats per minute, respiratory rate of 24 breaths per minute, temperature of 38.8°C (101.8°F) rectally, and oxygen saturation of 98% in room air. Physical examination reveals fixed, dilated 8-mm pupils, dry mouth, decreased bowel sounds, and his skin is red and feels warm. He is mumbling incoherent words and making picking movements with his fingers.

Other presentations

Paediatric patients who have ingested poisons or medications in toxic amounts may have any number of symptoms or signs. These include, but are not limited to, seizures, cardiac dysrhythmias, autonomic instability, hypoglycaemia, movement disorders due to rigidity or ataxia, hepatic failure, lethargy, agitation, acute kidney injury, breathlessness, rashes, changes in mental status, visual disturbances, and hypotonia/weakness.

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