(BQ) Part 2 book “Pediatrics CCS” has contents: My knee hurts, pink baby sometimes, my baby dislikes milk, currant jelly again, my kid has a rash on his bottom, machines and much more, single truncus, acute rheumatic fever, and other contents. | CHAPTER 7 POISONING CASE 1: Acetaminophen Setting: ED CC: “My child took acetaminophen.” HPI: A 3-year-old girl is brought to the emergency department for ingestion of an unknown amount of acetaminophen. The mother states that the girl was left home with the grandmother, who fell asleep on the couch. When the grandmother woke up, she found the child playing with a bottle of acetaminophen with multiple pills on the floor. There was an unknown number of pills in the bottle and an unknown number ingested. The grandmother found her more than an hour ago; an exact time of ingestion is unknown, but less than 2 hours is suspected. The patient currently has no symptoms. Physical Exam: Within normal limits Which of the following is the next step in the management of this patient? a. Activated charcoal b. Intubation c. Gastric lavage d. Emergent dialysis Answer a. Activated charcoal Children who may have a toxic ingestion of acetaminophen should receive activated charcoal if the event occurs less than 4 hours after the ingestion. Intubation is not needed in patients who can protect their airways. There is no indication that the child cannot protect her airway. If the test wants you to know the answer, it has to tell you something! Gastric lavage is not indicated in adults or children because there is a high rate of aspiration. Activated charcoal is more effective with fewer risks. Emergency dialysis is not indicated as initial management. The proper medication is administered, and labs are drawn. Which of the following is the treatment of choice for toxicity? a. N-acetylcysteine b. Dimercaprol c. Deferoxamine d. Glucagon e. Octreotide Answer a. N-acetylcysteine All of the answers are antidotes for a specific type of poisoning: Antidotes The child is administered the antidote, and the acetaminophen level, international normalized ratio, and liver enzymes are monitored. The patient never develops abnormalities of the liver enzymes. Mechanism of acetylcysteine • .
