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A 2-year old is brought in on New Year’s Eve for altered mental status. The parents had been hosting a party with many guests present. The child is maintaining his airway and spontaneously breathing but hypoventilatory and requires occasional stimulation. Vital signs: Temp 37.6 C, HR 90, RR 14, BP 82/40, pulse ox 95% on room air. Other than stupor, physical exam is normal: PERRL, no signs of trauma, not diaphoretic. POC glucose is 58, and the child is given IV dextrose.
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January 4, 2025 at 8:55 pm
C) Alcohol from a glass left out on the coffee table
Busy parties where children may not be watched closely can lead to inadvertent alcohol intoxication if adults leave their drinks unattended. Small children can reach a high BAC from just a 1-2 ounces of alcohol. Just as with adults, slurred speech and ataxic gait progressing to altered mental status and hypoventilation occur; children are especially susceptible to hypoglycemia due to low glycogen stores. Mistletoe is not as poisonous as its reputation – it mainly causes GI upset. CCB overdose would cause hypotension, bradycardia, and could cause hyperglycemia (beta-blocker overdoses present similarly but are more likely to cause hypoglycemia). Cannabis edibles can be quite toxic to toddlers, and often come in enticing candy and cookie forms. While edibles can result in stupor, they do not generally affect blood sugar. Improperly home-canned foods are associated with food botulism, which may present initially with nonspecific GI symptoms, progressing to cranial neuropathies and descending weakness characteristic of botulism.