Next, we sometimes will
see infants and children,
especially come in with a hypoglycemic
state as a result of an ingestion.
And unlike adults who can have pretty
significant stores of glycogen in their livers,
young children are at increased
risk for hypoglycemia
as a result of ingestion
of a variety of agents.
So let’s go through those.
Beta-blockers can cause hypoglycemia
in infants and children.
So we need to keep an eye out for infants
and children who eat mom’s beta-blocker
and present with a
Sulfonylureas can cause hypoglycemia in
children about 8 to 12 hours after ingestion.
And that’s key, is that
there can be a delay
in their presentation with
a hypoglycemic state.
Metformin can cause hypoglycemic
issues in children.
Usually about four to six
hours after ingestion.
So in a child who has altered mental
status as a part of our ABCD,
D stands for not only disability, but
also a D-stick or a dextrose stick.
We’re going to check all children
with altered mental status
for what their glucose level is.
That’s very important and then
we’ll provide supportive care.
This is incredibly important in
young children who get into a pill.
The reason is that they can be profoundly
sick from ingesting even only one tablet.
So one table of a sulfonylurea
may kill a young child
due to severity of hypoglycemia.
Grandparents need to taught to
keep their diabetes medications
out of range of
Another common poisoning we worry
about is caustic ingestions.
A child gets into the
Drano under the sink.
In general, base is worse than acid.
We can make base ourselves to
counteract acid in our tissues.
But base generally causes worse damage.
It can cause a liquefactive necrosis, severe
burns, it can cause significant eye damage
and the one we all worry about is
esophageal emergency and rupture.
So these infants will eat some
caustic soda, drink it down
and it will cause severe
burns of the esophagus,
which can be very life-threatening.
These children need to be
dealt with immediately
There is no antidote.
We don’t give them acid to drink.
We have to stabilize them
and manage their injury.
One common problem that kids will
have is they like to swallow things
and put things in their mouth.
And this is true for coins,
which typically either
pass through on their own
or they are stuck high up
and we can remove them.
But the real terror is when
they ingest a button battery.
This is a classic problem in children.
So these batteries that are flat that we find
in watches and small electronic equipment
can cause dramatic damage to infants
especially in their esophagus.
And this is because
they’re providing a
continuous electrical charge
to the tissues around them,
that can cause severe burn
injury and can actually rupture
through the side of the
esophagus and cause death.
So button battery ingestion which are
common are an emergency in children.
They cause severe
and we need to emergently go in there and
remove that battery through endoscopy.
So call an ENT or a gastroenterologist.
They’ll quickly come in
and remove the object.
And then assess for damage.
There can also be long term damage
of the esophagus with
strictures and other problems.
These children need to be
managed very aggressively,
very quickly, and
followed long term.
So let’s review some common drugs of
abuse and what they do in adolescents.
This is pretty high yield
for a multiple choice exam.
So I like to break it down pretty simply
and, I think it makes a lot of sense,
into types of drugs.
And in that way, we can think
of things more generally.
For example, it’s okay –
Cocaine and methamphetamine
are both stimulants,
you can think of them
There’s of course uniquenesses.
For example, crack cocaine can
cause injury to the uvula,
but in general, we like to
think of these as in groups.
So let’s talk about stimulants first.
Stimulants will cause an
increase in heart rate,
respiratory rate, blood
pressure, and temperature.
They will cause patients to
be hyperalert and euphoric.
And they will cause pupils to dilate.
They can cause sweating, tremor,
and decreased peristalsis.
The way I like to think about it is
when you’re attacked by the lion,
your eyes dilate because
you’re so surprised.
So remember, dilation
Dissociative agents may cause increased
heart rate, respiratory rate,
and blood pressure and
They may cause disorientation though,
lethargy, hallucinations or coma.
They can cause constricted pupils and they
may cause nystagmus or ataxia or vomiting.
Sedative hypnotics tend to lower the blood
pressure, heart rate, and respiratory rate,
cause stupor or coma.
The pupils may be normal size,
but they may be sluggish
and patients may have decreased
peristalsis and decreased reflexes.
And opiates will cause low blood pressure,
low heart rate, and low respiratory rate,
stupor and coma, but now we
have these pinpoint pupils
and otherwise, they’re the same.
So distinguishing between the sedative
from hypnotics and the opiates
is done by looking for
those pinpoint pupils.