Do you need a cuppa? - British Association for Community Child

Do you need a
Dr. Anushma Sharma
ST5 Paediatrics
Department of Community Paediatrics Salford
1. Present an interesting case
2. Discuss the outcome
3. Discuss the causes of the presenting symptoms
Admission 1
1 year old
Vomiting, loose stools, unwell
Tachycardiac, irrtable, breathless
Metabolic acidosis – pH 7.13, pCO2 2.2, BE -23 , Lac 27, Glu
Improved quickly within 12 hours with ventilatory support and
fluids + sodium bicarbonate correction
Metabolic disorder suspected
acyl carnitine
plasma amino acids
free fatty acids
urine organic and amino acids
LFT and renal funtions
salicylate levels
Admission 2
13 months
Had been well
Found unresponsive on bedroom floor at 0800
No hypoglycaemia
Severe metabolic acidosis pH 6.91, pCO2 2.96, Bicarb 4.3, BE 27.9, lactate>30
Sent to PICU and recovered in 12 hours
Skin biopsy and toxicology investigations
Parents 18 years old, both unemployed, separated
H/o domestic violence
Good pregnancy
No significant neonatal diagnoses
Satisfactory growth and development
7 weeks old
Unwitnessed fall from sofa while being watched by mother's
Attended A+E promptly
Parietal skull fracture
Discharged back to mother after child protection investigations
11th admission
Recent Burn????
Urine positive for Glycolate
Antifreeze= Ethylene Glycol
Very sweet
Present in Radiator fluid, Deicer, Wind screen wash, Window
cleaning fluid
Fake vodka health warning in UK
The Guardian, Saturday 31 December 2011
Counterfeit vodka seized by council trading
standard teams. Photograph: Nottinghamshire
County Council/PA
Ethylene Glycol Toxicity
Toxic dose requiring medical trematment is 0.1ml/kg body
weight or 4 ml for 20 Kg child
Lethal dose in humans is 1.4ml/kg or 56 ml for a 20 kg
Ethylene glycol does not evaporate so inhalational
exposure is unlikely
Ethylene glycol is not absorbed through skin so dermal
exposure is also uncommon
Forensic samples obtained
Police investigations started and mother was taken in custody
BC and sister 10 months old in foster care
Ethyl alcohol
NPIS annual Report 2010-2011
Prospective audit
Toxic alcohol and glycol cases reported through telephone
enquiries to the NPIS in 2010
➲ Aim:
1. To provide information on the frequency, current
management and outcomes of systemic toxic alcohol
2. To provide information on which to base the planning of
clinical services for this type of poisoning, including
appropriate availability of assays and antidotes.
488 individual exposures
250 in non hospital sourced
89 (18%) cases less than 5 years old
238 in hospital sources
182 potentially systemic exposures
99 (20%) reqiured treartment with antidotes
33 haemodialysis, heamofiltration
At least 2 severe cases each week nationally
Main difficulty in management is unavailability of lab assay
and inadequate stock of antidote
Glycol and Toxic alcohol toxicity though less common in
UK is a significant differntial diagnosis to consider
especially in cases of disproportionate metabolic acidosis
It is important to plan and consider how we can treat such
a case in our unit, especially when most of us donot stock
any of the antidotes