Question

The following case corresponds to Juan Pérez, a healthy minor of 2 years, who arrives at an emergency department of a Hospital, after having ingested 1 ampoule of 2 ml of a homeopathic medicine (Belladona CH 6), which he received as symptomatic treatment for the pains associated with acute otitis media (AOM) with one month of evolution, the dose prescribed by the health professional being 6 drops 2 times a day.
The nursing staff that received the patient in the emergency department asked the parents about the symptoms observed in the minor, the knowledge they have of the information that appears in the package leaflet of the medicine administered to the child, then they proceed to perform the examination. of the patient, identifying that he was slightly symptomatic. On physical examination, he presented stable pediatric evaluation, a heart rate of 110 bpm, blood pressure of 90 / 60mmHgel, Neurological examination: conscious, with agitation and a little disoriented.
Checking the composition of the medicine in its package leaflet, it was observed that it contained in each 1 ml container, belladonna D6 11mg, Chamomilla D4, dulcamara D6, plantago D4 ana 25mg, 2ulsatila D6 50mg and calcium carbonicum hahnemanni D8 75mg. According to the results of the institution's toxicology laboratory, Belladonna is identified as the cause of the symptoms presented by the child, it was decided to administer activated charcoal using a nasogastric tube and admitted for monitoring. The patient remained in the emergency department for 24 hours, until progressive neurological recovery was achieved until normalization. They give him the exit, but previously the doctor sent the parents of the minor to the pharmaceutical service with the prescription for the treatment of AOM with Clavunil 250 mgr bottle suspension X 80ml for 10 days.

Answer the 3 points below:

1: Evaluate and identify the problem: in the case presented.
2: Define the problem: specify the identified problem.
3: Propose hypotheses about the possible causes of the problem, against theoretical or scientific principles

Note: Consulting the mechanism of action of the toxic substance in this case of homeopathic Belladonna, consult the toxicokinetics of belladonna, identify the symptoms presented by the child, identify the procedure and treatment performed by the emergency department doctor. So that it pertinently carries out each of the 3 points

Answer 1

ANSWER :

1.EVALUATION :

• Proper history of intake of the dose of the drug orally should be enquired from the parents.
• The doctor should potentially evaluate patient's airway, respiratory and circulatory status.
• Vitals signs like temperature ,heart rate ,respiratory rate , blood pressure and oxygen saturation should be evaluated.
• In this case the minor vitals are - BP -90/60 mmhg and HR - 110bpm.
• IV access should be established.
• Continuos cardiac monitoring should be done.
• Look for the neurological symptoms.In this the baby is consciuos , with agitation and little disorientation.
• Should obtain further laboratory evaluation.

The problem identified is ANTICHOLINERGIC TOXIC SYNDROME.

2.DEFINITION :

• Anticholinergic syndrome is produced by inhibition of cholinergic neurotransmission at central and peripheral muscarinic receptor sites.

Signs and symptoms :

• Central anticholinergic syndrome - ataxia , disorientation,confusion ,hallucinations ,psychosis,agitated delirium,seizures and respiratory failure.
• Peripheral effects - mydriasis with cycloplegia ,dry mucus membranes ,hyper reflexia diminished bowel sounds ,tachycardia ,urinary retention ,hypo or hypertension .
• In childhood meaningless speech ,lethargy ,absense of tachycardia are omnious signs in deadly intoxication.

Toxicokinetics :

• Anticholinergic agents act within 2 hours when orally ingested.Their effect on central nervous system last over 24 hrs whereas on cardiovascular system last shorter.

Management :

• Treatment is mainly symptomatic including gastro intestinal decontamination with activated charcoal.
• In severe cases physostigmine is used as antidote.

3.Hypothesis about the possible causes of the problem :

• Accidental poisoning is most common in young children from 2-3 years of age.
• They dont know the difference between what is safe and what is dangerous.
• Children likely to get hold of medicines when they are being used at home regularly.
• We should try not to use poisonous medicines at home rather than we should look for an alternative.
• As in the above case they changed the drug from Belladona CH6 to Clavunil for AOM.
• Overdose of any drug can be poisonous so we should keep medicines away from the reach of the children.

These can be the reasons for possible cause of poisoning.