Hypoglycemic Agents, Caustic Agents and Drugs of Abuse

00:01 Next, we sometimes will see infants and children, especially come in with a hypoglycemic state as a result of an ingestion.

00:09 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.

00:23 So let’s go through those.

00:25 Beta-blockers can cause hypoglycemia in infants and children.

00:30 So we need to keep an eye out for infants and children who eat mom’s beta-blocker and present with a hypoglycemic state.

00:38 Sulfonylureas can cause hypoglycemia in children about 8 to 12 hours after ingestion.

00:45 And that’s key, is that there can be a delay in their presentation with a hypoglycemic state.

00:51 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.

01:02 We’re going to check all children with altered mental status for what their glucose level is.

01:07 That’s very important and then we’ll provide supportive care.

01:10 This is incredibly important in young children who get into a pill.

01:15 The reason is that they can be profoundly sick from ingesting even only one tablet.

01:22 So one table of a sulfonylurea may kill a young child due to severity of hypoglycemia.

01:29 Grandparents need to taught to keep their diabetes medications out of range of children’s reach.

01:36 Another common poisoning we worry about is caustic ingestions.

01:40 A child gets into the Drano under the sink.

01:44 In general, base is worse than acid.

01:48 We can make base ourselves to counteract acid in our tissues.

01:51 But base generally causes worse damage.

01:55 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.

02:05 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.

02:14 These children need to be dealt with immediately There is no antidote.

02:18 We don’t give them acid to drink.

02:19 We have to stabilize them and manage their injury.

02:23 One common problem that kids will have is they like to swallow things and put things in their mouth.

02:30 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.

02:38 But the real terror is when they ingest a button battery.

02:43 This is a classic problem in children.

02:45 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.

02:54 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.

03:08 So button battery ingestion which are common are an emergency in children.

03:14 They cause severe electrical damage and we need to emergently go in there and remove that battery through endoscopy.

03:21 So call an ENT or a gastroenterologist.

03:23 They’ll quickly come in and remove the object.

03:26 And then assess for damage.

03:28 There can also be long term damage of the esophagus with strictures and other problems.

03:32 These children need to be managed very aggressively, very quickly, and followed long term.

03:38 So let’s review some common drugs of abuse and what they do in adolescents.

03:45 This is pretty high yield for a multiple choice exam.

03:49 So I like to break it down pretty simply and, I think it makes a lot of sense, into types of drugs.

03:55 And in that way, we can think of things more generally.

03:59 For example, it’s okay - Cocaine and methamphetamine are both stimulants, you can think of them somewhat similarly.

04:06 There’s of course uniquenesses.

04:07 For example, crack cocaine can cause injury to the uvula, but in general, we like to think of these as in groups.

04:15 So let’s talk about stimulants first.

04:17 Stimulants will cause an increase in heart rate, respiratory rate, blood pressure, and temperature.

04:23 They will cause patients to be hyperalert and euphoric.

04:26 And they will cause pupils to dilate.

04:29 They can cause sweating, tremor, and decreased peristalsis.

04:34 The way I like to think about it is when you’re attacked by the lion, your eyes dilate because you’re so surprised.

04:40 So remember, dilation is stimulants.

04:42 Dissociative agents may cause increased heart rate, respiratory rate, and blood pressure and high temperature.

04:50 They may cause disorientation though, lethargy, hallucinations or coma.

04:56 They can cause constricted pupils and they may cause nystagmus or ataxia or vomiting.

05:03 Sedative hypnotics tend to lower the blood pressure, heart rate, and respiratory rate, cause stupor or coma.

05:10 The pupils may be normal size, but they may be sluggish and patients may have decreased peristalsis and decreased reflexes.

05:19 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.

05:29 So distinguishing between the sedative from hypnotics and the opiates is done by looking for those pinpoint pupils.