Acute obtundation in a 9-month-old patient: ethanol ingestion.

Alcohol ingestion in the pediatric patient can be life threatening. Younger patients consume larger volumes per body weight with accidental ingestions, and children have more serious adverse effects at lower blood alcohol levels. Complications of alcohol poisoning can include hypothermia, hypoglycemia, seizures, coma, and death. We present the course of a 9-month-old female infant who became unresponsive at home and presented to the emergency department comatose. When her blood alcohol level registered 489 mg/dL, it was revealed that she had accidentally been given a bottle of formula mixed with vodka rather than water. The infant required intubation for severely depressed level of consciousness and aggressive fluid resuscitation for hemodynamic instability. She had a peak lactate level of 24 mmol/L and a peak blood alcohol level of 524 mg/dL. Based on the severity of her initial presentation, preparations were made for hemodialysis. The infant responded to supportive measures including mechanical ventilation, fluids, and dextrose, and hemodialysis was not necessary. Her alcohol clearance followed zero-order kinetics at an average rate of 28.6 mg/dL per hour over 15.5 hours from her peak level of 524 mg/dL to the lowest measured value of 80 mg/dL. The kinetics of ethanol clearance at this level of toxicity, which is the highest reported in an infant to date, enhance our knowledge of ethanol metabolism and will assist in management decisions in cases of severe intoxication.

Subarachnoid hemorrhage in a child with status asthmaticus: significance of permissive hypercapnia.

OBJECTIVE: To report an 11-yr-old boy with acute status asthmaticus being managed with permissive hypercapnia who developed a subarachnoid hemorrhage during the course of his illness. SETTING: An eight-bed pediatric intensive care unit in a community hospital. INTERVENTIONS: The patient was intubated for respiratory failure and managed with permissive hypercapnia. After the development of changes in his pupillary exam, computerized tomography of the brain revealed diffuse subarachnoid hemorrhage. Carotid angiography was performed to rule out the possibility of underlying vascular malformation. RESULTS: Aggressive investigation including a normal carotid angiogram failed to reveal underlying pathology that may have put the patient at risk for the event. CONCLUSIONS: We conclude that this patient suffered subarachnoid hemorrhage in association with the use of permissive hypercapnia in the settling of severe asthma.