PHARMACOLOGY/TOXICOLOGY CASE STUDY #47 A 3-year-old presents to the emergency de
ID: 148187 • Letter: P
Question
PHARMACOLOGY/TOXICOLOGY CASE STUDY #47 A 3-year-old presents to the emergency department with her mother, who reports that she found and ingested an entire tube of Orajel. The mother reports watching her for 20 minutes after the ingestion and then putting her down for a nap. Several minutes later, she heard a weak cry from the room and when she checked on her, she was blue. Paramedics report that the child became progressively blue en route, despite supplemental oxygen administration. The child has had no fever, vomiting, diarrhea or History: respiratory distress. PMH None Physical Examination: T: 96.1 F HR: 131 bpm RR: 25 breaths per minute BP: 113/57 mm Hg Active child in no acute distress. Normocephalic. Pupils equal and reactive to light. Clear to auscultation. Regular rate and rhythm. Soft, no tenderness, no masses. Normal. General: HEENT: Pulmonary: CV Abdomen: Neurologic: Skin: Blue. Cardiac monitor shows sinus tachycardia. Pulse oximeter: 85% with good wave form. QUESTIONS CASE STUDY #47 1. What is the diagnosis? 2. How can the correct diagnosis be suspected and confirmed? 3. What therapy should be initiated? 4. What etiologies are there for this diagnosis? abhomExplanation / Answer
1.The correct diagnosis would include monitoring the symptoms i.e blue skin, and low breath rate per minute, high heart rate and unreliable pulse oximetry.
These are the side effects of using orajel, and it leads to a condition called
Methemoglobinemia.
2.The correct diagnosis can be suspected after seeing the blue skin and noticing shortness of breath and it can be confirmed by asking if she has taken any medications or not which in this case is orajel and its misuse can use a condition like this.
Plus the cardiac monitor also showed sinus tachycardia in which the heart beat tend to increase as a result of shortness in breath.
Pulse oximetry was 85% which is high and indicates fraction of methemoglobinemia.
So these things can confirm the condition.
3.Once confirming the diagnosis, initial treatment would include adminstration of supplemental oxygen and removal of offending oxidizing substances.
Then methylene blue treatment is provided that accelerates the enzymatic reduction og methemoglobinemia.
Hyperbaric O2 and exchange transfusion can also be utilised.
4.The etiology or the cause behind the condition of methemoglobinemia is that , this disease is a altered state of Hemoglobin (Hb) in which the ferrous ions (Fe2+) of heme are oxidized to ferric (Fe3+) state.This ferric iron is unable to bind to oxygen , therefore making it more difficult to breathe.
5.The tests thay will be abnormal are ..Increase in heart rate, Low breaths per minute, Pulse oximetry is inaccurate and unreliable.
Hope it helps and explains your query, Good luck !!!
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