Case#3 Toxin and Discussion

What is the Differential Diagnosis of Radiopaque Toxins?

• C=ChloralHydrate, CCl4, Cocaine Packets
• O=Opiate Packets
• I=Iron and Heavy Metals (Lead, Arsenic, Mercury
• N=Neuroleptic Agents
• S=Sustained Release, Enteric Coated Preparations.

What drug levels should be ordered to help determinte this child's Toxin?

With the child demonstrating an anion gap metabolic acidosis with radiopaque pills on KUB, the diferential is narrowed down to iron and possibly enteric coated salycilates. Therefore Aspirin and Iron levels should be drawn.

What method of gastric decontamination is most appropriate for this patient?

• Syrup of ipecac- NOT INDICATED (Child has already vomited a number of times
• Activated Charcoal- ?Mixed ingestion? DOES NOT BIND IRON WELL
• Gastric Lavage- May be appropriate, iron may form concretion in stomach.
• Whole-Bowel Irrigation- Indicated, Positive KUB, Considered Safe in Children.

Clinical Course:

Whole bowel irrigation is instituted at 25cc/kg/hr. The childs iron level returns with a value of 520 mcg/Dl (ASA=0). Deferoxamine therapy is initiated at 15mg/kg/hr with a positive "vin-rose" urinary color change (click HERE for a demonstration). The child is admitted to the PICU. She demonstrates clinical improvement of acidosis, urine color change, and clinical improvement after 48 hours of therapy.