firetender
Community Leader Emeritus
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You laid what's called a "McGuffin" on us. Threw us off the trail. Hand soap, hand sanitizer, "Nobody's sure." Someone made the call.
jrm818
Playtime Peculiarity
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You laid what's called a "McGuffin" on us. Threw us off the trail. Hand soap, hand sanitizer, "Nobody's sure." Someone made the call.
jrm818
abckidsmom
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I bet you didn't drink 6 ounces of bleach. I've read a little on this, and the most (volume-wise) I've seen are a couple of mouthfuls by a toddler, which are enough to make them significantly altered.
This was definitely a zebra, Mr Brown. I'm standing by the tastes-to-bad-to-be-real argument.
reaper
Working Bum
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All bleach is going to do is clean out the GI tract. It will kill the bacteria and make you have a wonderful time in the bathroom.
First time I ever dealt with it, was a drunk that drank a liter of it. Of course I thought the worse. Poison control and docs all agreed, that it is not fatal.
First time I ever dealt with it, was a drunk that drank a liter of it. Of course I thought the worse. Poison control and docs all agreed, that it is not fatal.
I bet you didn't drink 6 ounces of bleach. I've read a little on this, and the most (volume-wise) I've seen are a couple of mouthfuls by a toddler, which are enough to make them significantly altered.
This was definitely a zebra, Mr Brown. I'm standing by the tastes-to-bad-to-be-real argument.
Well since it was my guess I guess I should defend it a bit. I've never actually tasted hand sanitizer directly, and don't have any available at this second to sample. Anecdotally my hands taste awful after using the stuff, but I don't know for sure about the actual gel.
This guy claims to, however, and claims that its rather yummy: http://www.thepoisonreview.com/2010/07/14/pediatric-hand-sanitizer-ingestions-not-always-benign/
Maybe some are tastier than others? A service I used to work for had a frequent flier that seemed pretty fond of the stuff. Any connoisseurs here? There is a small but real population of children who suffer from Pica as well. I know we had "no medical history," but perhaps it was new onset or previously undiagnosed.
More importantly there is a case report of major sequale after a pediatric ingestion of hand sanitizer: http://www.ncbi.nlm.nih.gov/pubmed/20622632. I don't have access to the full text, unfortunately, but I assume the abstract is a good representation of the report. It sounds very similar to this case.
That said, I think overall you're right. The case report claims that it is the first report (ever anywhere) of such a toxic ingestion, and this review of poison control records demonstrated only minor effects from hundreds of reported ingestions: http://www.ncbi.nlm.nih.gov/pubmed.
I'd say one case ever qualifies this as a zebra, and I think "unicorn" would be an even better label. Still, it happened at least once, putting it into the universe of possibility.
discussion
If I could perhaps go over this case since there was an answer without an explanation or discussion?
I always try to make a big deal out of treating patients and not numbers.
Starting with:,
"a seven year old girl, came back into class after recess."
If recess there is anything like what I had, the supervisors wouldn't know a kid got hit by a car even if it flew through the air in front of her. So really the kids are unsupervised just limited in movement.
The child stated she felt unwell and about 10 minutes later became unconscious and began to sieze."
Apparently whatever happened at recess, caused an acute dysfunction of CNS.
"No history of illness lately the child has been well and nobody in the school or family can think of anything."
This is the clue to an acute event.
"The teacher states she saw the child come out of the bathroom during recess"
But not constantly going in an out of the bathroom or going to the bathroom/drinking fountain all day. Nor complaining of thirst and/or hunger.
This is why ddetailed historical information and pertinent negatives should always be listed.
Whatever caused an acute neuro dysfunction had to be found in or taken into the bathroom. I see a lot of people with the current prominence of bacterial phobia carrying around alcoholic hand sanitizers. Though not in amounts to get intoxicated from.
Teenagers are also a rather genious bunch when it comes to getting high. Glue, white out, and nyquil. But now popular alcohol based hand sanitizers. There is a learned behavior kids watching other kids are at risk for.
The disease also has to have initial or preferential symptoms manifesting in the brain/cns.
Vominting reflex is stimulated in both the stomach and brain, however there is usually immediate releif of symptoms when vomiting originating from the GI.
Seizure confirms neurotoxicity.
So the game becomes figuring out what the likely toxin is.
Don't know about in the rest of the civilized world, but in the US, schools and churches are not held to commercial building code. (it would cost too much to retrofit, but strangley enough causes the largest loss of life from not having building codes)
My primary suspicion was lead because of the acute onset of seizure. However, without more findings no form of toxin could be settled on without doubt.
There are also a few congenital enzymatic malformations that can make otherwise nontoxic substances toxic for those with the mutation. Some of which might go undiagnosed at birth.
Later on it was described that the hand cleaner was empty. Whether or not it tastes good or the kid was craving paint chips or whatever, is really irrelavent. Who knows why patients do the things they do? Maybe she had something to really hide in a game of truth or dare?
AV malformation manifests as bleeding, and this now nor later was presented with signs of acute stroke.
numbers:
BP 90/40
RR 8
PR 40
SPO2 93%
BGL 2.5mmol/l (~50mg/dl)
ECG sinus bradycardia
Aside from the poster, many healthcare providers get caught up in dx by the numbers. But let us analyze it.
Would you expect somebody who was in DKA be breathing more or less to try and compensate for metabolic acidosis?
While the heart rate is slow, the blood pressure is within expected limits, further leading to a neuro pathology.
If you look at this without the blood sugar, you see somebody who has systemic depression. It is hard to come to a conclusion of other but toxin adding this to the already discussed findings. (I think so anyway.)
When you then add in the blood sugar, something must be causing it. Since the kid is listed as previously healthy and not on insulin, a decrease in blood sugar must be from something inhibiting metabolism. Like a toxin.
If the kid was an acute attack of undx diabetis, it would most likely be type I, and the finding would be DKA. The only things other than toxin or likely known from birth genetic condition that would account for the low blood sugar is a neoplasm or acute liver failure. (like from a female with an lower ability to metabolize alcohol)
It is never lupus because while it has some outrageous findings it is relatively easy to dx.
TSS would be massive hypotension, S. Aureus also needs fe, found in blood, to rapidly reproduce and secrete enough toxin to cause acute onset within hours. So even if the kid did put something from a learned behavior in the anus of vagina, without some respectable amont of blood for some time, I don't think an acute onset would be seen without a steady decline in the child's behavior.
If I could perhaps go over this case since there was an answer without an explanation or discussion?
I always try to make a big deal out of treating patients and not numbers.
Starting with:,
"a seven year old girl, came back into class after recess."
If recess there is anything like what I had, the supervisors wouldn't know a kid got hit by a car even if it flew through the air in front of her. So really the kids are unsupervised just limited in movement.
The child stated she felt unwell and about 10 minutes later became unconscious and began to sieze."
Apparently whatever happened at recess, caused an acute dysfunction of CNS.
"No history of illness lately the child has been well and nobody in the school or family can think of anything."
This is the clue to an acute event.
"The teacher states she saw the child come out of the bathroom during recess"
But not constantly going in an out of the bathroom or going to the bathroom/drinking fountain all day. Nor complaining of thirst and/or hunger.
This is why ddetailed historical information and pertinent negatives should always be listed.
Whatever caused an acute neuro dysfunction had to be found in or taken into the bathroom. I see a lot of people with the current prominence of bacterial phobia carrying around alcoholic hand sanitizers. Though not in amounts to get intoxicated from.
Teenagers are also a rather genious bunch when it comes to getting high. Glue, white out, and nyquil. But now popular alcohol based hand sanitizers. There is a learned behavior kids watching other kids are at risk for.
The disease also has to have initial or preferential symptoms manifesting in the brain/cns.
Vominting reflex is stimulated in both the stomach and brain, however there is usually immediate releif of symptoms when vomiting originating from the GI.
Seizure confirms neurotoxicity.
So the game becomes figuring out what the likely toxin is.
Don't know about in the rest of the civilized world, but in the US, schools and churches are not held to commercial building code. (it would cost too much to retrofit, but strangley enough causes the largest loss of life from not having building codes)
My primary suspicion was lead because of the acute onset of seizure. However, without more findings no form of toxin could be settled on without doubt.
There are also a few congenital enzymatic malformations that can make otherwise nontoxic substances toxic for those with the mutation. Some of which might go undiagnosed at birth.
Later on it was described that the hand cleaner was empty. Whether or not it tastes good or the kid was craving paint chips or whatever, is really irrelavent. Who knows why patients do the things they do? Maybe she had something to really hide in a game of truth or dare?
AV malformation manifests as bleeding, and this now nor later was presented with signs of acute stroke.
numbers:
BP 90/40
RR 8
PR 40
SPO2 93%
BGL 2.5mmol/l (~50mg/dl)
ECG sinus bradycardia
Aside from the poster, many healthcare providers get caught up in dx by the numbers. But let us analyze it.
Would you expect somebody who was in DKA be breathing more or less to try and compensate for metabolic acidosis?
While the heart rate is slow, the blood pressure is within expected limits, further leading to a neuro pathology.
If you look at this without the blood sugar, you see somebody who has systemic depression. It is hard to come to a conclusion of other but toxin adding this to the already discussed findings. (I think so anyway.)
When you then add in the blood sugar, something must be causing it. Since the kid is listed as previously healthy and not on insulin, a decrease in blood sugar must be from something inhibiting metabolism. Like a toxin.
If the kid was an acute attack of undx diabetis, it would most likely be type I, and the finding would be DKA. The only things other than toxin or likely known from birth genetic condition that would account for the low blood sugar is a neoplasm or acute liver failure. (like from a female with an lower ability to metabolize alcohol)
It is never lupus because while it has some outrageous findings it is relatively easy to dx.
TSS would be massive hypotension, S. Aureus also needs fe, found in blood, to rapidly reproduce and secrete enough toxin to cause acute onset within hours. So even if the kid did put something from a learned behavior in the anus of vagina, without some respectable amont of blood for some time, I don't think an acute onset would be seen without a steady decline in the child's behavior.
abckidsmom
Dances with Patients
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Thanks, I appreciate you spelling it out. The thought process is helpful.
HappyParamedicRN
Forum Crew Member
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My guess is that this is neuro.
Brain tumor or she hit her head and now has a bleed.
Or maybe she vagaled?
Brain tumor or she hit her head and now has a bleed.
Or maybe she vagaled?
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Cohn
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Was there ever a psych evaluation after this event?
for a kid who ate soap?
Cohn
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YES for a 7 YEAR OLD who ATE SOAP.
abckidsmom
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This is completely where I'm sitting on this one. One mouthfull, maybe...whole bottle, at 7 yo? There's a problem.
Cohn
Forum Lieutenant
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Not only that but the taste alone of a soap that contains alcohol would make any kid spit it out...
But for a kid even at seven to even think about eating soap is one of those Darwin moments.
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kravturtle
Forum Crew Member
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I totally agree. But at the same time, if we knew why people did things, our jobs would be so much less interesting. B)
Developmentally challenged?
Maybe she was taking her HSV prophylaxis to the extreme?
Lost a bet?
Liked the taste?
Maybe she didn't do her homework and figured making herself sick would get her out of class?
I have seen a lot of crazy things, but a 7 y/o suicide attempt from drinking soap seems way far fetched to me.
Figured cutting required too much pain?
Or perhaps felt that soap was the bulimic's best friend?
Is schitzo and trying to escape the matrix?
Sorry everyone, but I just don't buy psych.
Maybe she was taking her HSV prophylaxis to the extreme?
Lost a bet?
Liked the taste?
Maybe she didn't do her homework and figured making herself sick would get her out of class?
I have seen a lot of crazy things, but a 7 y/o suicide attempt from drinking soap seems way far fetched to me.
Figured cutting required too much pain?
Or perhaps felt that soap was the bulimic's best friend?
Is schitzo and trying to escape the matrix?
Sorry everyone, but I just don't buy psych.
Cohn
Forum Lieutenant
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So going along with a bet to eat soap or liking the taste of soap or even wanting to make her self sick does not make you wonder?
stupid yes, psych. not really
Cohn
Forum Lieutenant
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But you would rule out psych?
abckidsmom
Dances with Patients
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I wasn't thinking psych as in suicidal. Just psych like in sensory issues, autism spectrum issues, and developmental stuff.
It would take a supreme overcoming of nature's design for a 7 yo to drink an entire bottle of alcohol-based hand sanitizer. I really think that the take-home for people on this one is that just a mouthful can intoxicate, the bottle can kill, and neither are very common, even though sanitzer is ubiquitous.
HappyParamedicRN
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Maybe she has Dysautonomia?
Or ictal bradycardia... hmmm...
Or ictal bradycardia... hmmm...
I think it would be better to review the diagnostic criteria of those. Both present and require considerable history and there are far more accurate dx for dysautonomia.
As for psych, I guess we could just ask her why she did it?
I would think though that by 7 years of age, prior issues with developmental milestones were likely to be uncovered. Are we willing to accept that there was no other sign or symptom of a psychiatric or psychological illness until one day some girl drank some soap?
But it then gets into the realm of assumptions we cannot answer. Truthfully, if the girl basically admitted to an outside influence or stupidity, I would be satisfied.
We certainly don't send everyone who does something stupid for a psych eval.