A 2-year-old boy was brought to the emergency when his mother noticed that he had developed dusky appearance and lethargy over the past 6-8 hours. The child had been prescribed some medicine for vomiting by a local practitioner. Examination revealed normal sized pupils reacting to light, GCS 9, and shallow breathing with cyanosis. Arterial blood gas revealed a PaO2 of 80 mmHg and SpO2 of 60%. Which one of the following drugs may be implicated?
Metoclopramide
The dissociation between a normal-to-high PaO2 (80 mmHg) and a very low SpO2 (60%), together with dusky (cyanotic) appearance and lethargy, is classic for methemoglobinemia, where hemoglobin cannot bind oxygen despite adequate PaO2. Metoclopramide, an antiemetic commonly misused in young children, is a well-recognized cause of drug-induced methemoglobinemia, especially in infants and toddlers.
Important Questions from Childhood Injuries and Poisoning
- Consider the following pairs :How many of the pairs given above are correctly matched ?
Urine colour Possible causative agent in a child with suspected poisoning 1. Pink - Cephalosporin 2. Brown - Chloroquine 3. Greenish blue - Phenazopyridine 4. Red-orange - Amitriptyline - A child presents to the emergency following ingestion of around 20 mL of kerosene oil about 40 minutes back. The child appears stable. Which one of the following measures should be done for the management of the child?
- In case of a child with an acute poisoning by ingestion, activated charcoal may be used in which one of the following situations?
- After sustaining a head injury, an 18 month old child displays eye opening only to pain, moans on painful stimuli and withdraws to painful stimuli. What is the modified Glasgow Coma Scale Score in this child ?
An 8 year old child has consumed a few tablets of a drug that were being taken by his motheron a regular basis. Following this the child develops gastric necrosis, acidosis, shock and hepatic necrosis. Which is the most likely drug?
