Objectives:The purpose of this study was to describe unintentional opioid exposures in young children, including demographics, medical interventions, and clinical outcomes.Methods: This was a retrospective, cross-sectional study of children 0 to 6 years of age with possible opioid exposure over a 3-year period (July 2010 to June 2013). Data collected included sex, age, specific drug, whether they were referred to the emergency department (ED) by the Regional Poison Control Center, presence of symptoms, therapeutic interventions, ED disposition, and clinical outcomes for admitted patients.Results: Median age of patients included in the study was 2 years, and 64% of these children were male. The most common drug of exposure was buprenorphine/naloxone. Of the 429 charts screened, 140 patients were reported to be symptomatic and referred to the ED, of which 113 patients actually presented to the ED. An additional 122 patients presented to the ED without Regional Poison Control Center referral. Of the total 235 patients presenting to ED, 76 (32%) received a therapeutic intervention. Of 231 total opioid exposures, 31 exposures were administered naloxone. Three children underwent endotracheal intubation. Sixty-five patients were hospitalized, with a median length of stay of 1 day. Although there were no fatalities, 1 child suffered severe morbidity (anoxic brain injury).Conclusions: While opioid exposures in young children are a common and potentially life-threatening problem, most children remain asymptomatic. The majority of patients are able to be discharged from the ED after observation, and of those who are admitted, most have favorable outcomes and brief hospital stays. A small number of these patients require considerable medical interventions.
Alcohol exposure can occur in all age groups but occurs much less commonly in infants. Prior studies have shown that no level of alcohol exposure is safe, and can affect the brain and other areas of development. We report a 32 day old previously healthy male who presented to an outside hospital early morning for "not acting normal". Earlier that morning, mom had fed him 3 ounces of formula mistakenly prepared with a clear liquid thought to be water, but later confirmed to be gin. The baby was mildly agitated on arrival, and the blood alcohol level 4 hrs postingestion was 230 mg/dl. This is one of the youngest documented cases of alcohol ingestion, and was remarkable for having a mild course with normal vital signs and electrolytes, and a non-focal physical exam. This case highlights the importance of having a high level of suspicion for alcohol exposure and a low threshold for checking blood ethanol levels in infants presenting with altered mental status, as there may be no hallmark signs, symptoms, or electrolyte abnormalities. Keywords: Ethanol; Bayley scales; Intoxication CaseWe report a case of a 32 day old previously healthy male who presented to an outside hospital in the early morning with chief complaint of "not acting normal". The mother reported that she woke up at 4am and prepared a 4 ounce bottle of formula with Enfamil and water for the baby, and the baby drank 3 ounces of the formula. Approximately an hour later, she observed that the baby was not acting right [1]. The baby was having excessive oral secretions, shaking his arms up and down, and was agitated. The father later recalled that he had left clear undiluted gin that he had shared with his friend earlier that evening in a disposable water bottle on the nightstand next to the formula powder. Waking up in the middle of the night and mistaking it for water, the mother then used the alcohol while mixing the patient's formula. The patient was immediately taken to an outside hospital.On arrival, the patient was afebrile with a heart rate of 150, respiratory rate of 28, temperature of 97.7, and oxygen saturation of 99%. Initial exam revealed a mildly agitated, somewhat somnolent male who appeared well hydrated. No obvious craniofacial abnormalities suggestive of Fetal Alcohol Syndrome. Head was atraumatic with a flat anterior fontanelle, and pupils were bilaterally equal, round, and reactive to light. Respirations were nonlabored and lungs were clear to auscultation bilaterally. Cardiac and abdominal exams were normal. Skin was warm and well perfused without bruises or lesions. Review of other systems yielded negative results. The mother denied any alcohol use during pregnancy or post-partum. Initial labs were drawn 3.5 hrs after ingestion of alcohol. His serum electrolytes, blood urea nitrogen, creatinine, bicarbonate, and glucose were within reference ranges. Blood alcohol level at 4 hrs post ingestion was 230 mg/dl and at 5 hrs 15 minutes was 211 mg/dl. Our institution was contacted as a tertiary care referral center and he was subseque...
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