Life-threatening Pyridium Plus intoxication: a case report.

A 16-month-old male presents with an overdose of Pyridium Plus, a combination anticholinergic, azo dye, and barbiturate, resulting in seizures, coma, and methemoglobinemia. This case report reviews the treatment of methemoglobinemia with methylene blue, activated charcoal, and exchange transfusion. Additionally, the role of the pulse oximeter is addressed when methemoglobinemia exists and is treated with methylene blue.

The MORE HEALTH bicycle safety project.

A K-2 MORE HEALTH bicycle safety education program was provided in nine elementary schools in Hillsborough County, Florida. This innovative community program consisted of interactive education sessions and reduced-cost bicycle helmet sales. Evaluation of the pilot program showed that it affected helmet use in the intervention schools compared to nine other schools that served as controls. More than 1,000 helmets were distributed through the bicycle helmet sales. Approximately 3,500 children participated in the education sessions. The preprogram helmet use rate among all schools was 8.5%. Postprogram results showed that the helmet use rate among intervention schools was significantly greater than among control schools (p < .01). This report describes the MORE HEALTH bicycle helmet promotion program.

Autopsies and the pediatric intensive care unit.

The pediatric autopsy can provide great benefits to families at a time when their world is falling apart. It can be invaluable in the processing of grief that families endure, helping them to plan their future. Autopsy results not only provide information but may also provide consolation by giving the family the opportunity to discuss the disease process that resulted in death. Autopsy results also provide information regarding the future and reassurance that appropriate care was given. Failure to perform a postmortem examination denies the family and the clinician knowledge regarding mechanisms of disease, confirmation or inclusion of unsuspected diagnoses, and the presence of iatrogenic complications. This missed information can be both informative to the current family's situation and potentially therapeutic in future cases. If death is the final chapter of life, then the physician's responsible relationship with the parents of the deceased patient should not end until a conference takes place several weeks or months after the child's death. The results of the postmortem examination provide a beginning point for discussion regarding the child's illness and death, the parents responses and coping, and the opportunity to help the family make sense of and bring closure to one of life's greatest crises.

Life-threatening Pyridium Plus intoxication: a case report.

A 16-month-old male presented with an overdose of Pyridium Plus--a combination anticholinergic, azo dye, and barbiturate--resulting in seizures, coma, and methemoglobinemia. This case report reviews the treatment of methemoglobinemia with methylene blue, activated charcoal, and exchange transfusion. Additionally, the role of the pulse oximeter is addressed when methemoglobinemia exists and is treated with methylene blue.

Sertraline intoxication in a child.

We describe severe sertraline intoxication in a child after accidental ingestion. Sertraline is a new antidepressant that has potent and selective inhibition of neuronal serotonin reuptake. Drug company-sponsored research has suggested little toxicity for this compound. Our patient exhibited prolonged tachycardia, hypertension, hallucinations, coma, hyperthermia, tremors of all extremities, and skin flushing. Clinicians should consider the possibility of serotonin syndrome among patients with similar clinical features and a recent history of sertraline or other serotonergic agent ingestion.

New onset childhood seizures. Emergency department experience.

Fifty-six cases of new onset seizures evaluated in a pediatric emergency department (ED) during a one-year period were assessed retrospectively for efficiency of diagnosis and workup. The majority of patients (69%) were less than two years of age. Based on etiology, the most common seizure type was febrile (71%) followed by idiopathic (21%) and symptomatic (7%). Significant laboratory abnormalities were found in four (7%) patients; two had hyponatremia, one carbamazepine overdose and one bacterial meningitis. Screening laboratory tests including brain CT scans were generally not helpful. A thorough history including specific details regarding the seizure and a complete physical examination should eliminate the need for major laboratory and radiologic workup in the emergency department.

Sudden infant death syndrome. Comparison of incidence in four urban Florida counties.

The observed incidence of sudden infant death syndrome (SIDS) in Hillsborough County is significantly higher than corrected rates in three other metropolitan areas of the state which have common demographic features. An eight year analysis of data (1979-1986) demonstrates the consistency of the observation. Since SIDS is a postmortem diagnosis of exclusion utilized for deaths of infants for whom no anatomic or biochemical cause can be determined and represents a large segment of deaths between 28 days and one year of age, there is a need to assure that all areas of the state utilize similar criteria for assignment of the diagnosis.

Acute hemorrhagic diarrhea and cardiovascular collapse in a young child owing to environmentally acquired cocaine.

Acute crack cocaine intoxication has become a significant problem in both adolescent and adult patients. Recently, cases of cocaine toxicity in infants and toddlers have been described. We report a four-year-old child with acute hemorrhagic diarrhea and shock after intoxication by crack cocaine. Acute cocaine intoxication should be considered in the differential for hemorrhagic diarrhea and shock. The gastrointestinal decontamination following cocaine ingestion is discussed.

Acute toxicity from oral ingestion of crack cocaine: a report of four cases.

We report the symptomatology, clinical, and laboratory findings in four patients following oral ingestion of crack cocaine. All of the patients had a positive urine test for cocaine metabolites measured by gas chromatography-mass spectroscopy. Retrospective analysis of the four patients revealed alterations in function of the cardiovascular system (4), the autonomic nervous system (4), the central nervous system (3), and the gastrointestinal system (1). Three patients ingested crack cocaine as a direct result of confrontation with law enforcement officers. The symptomatologies of acute toxicity from oral ingestion of crack cocaine are related to its effect on the cardiovascular system and the brain. Cocaine toxicity should be considered in patients with acute and unexplained cardiovascular, central nervous system, or gastrointestinal complaints. Law enforcement personnel should be made aware of the signs and symptoms of cocaine intoxication and be made aware of the propensity to ingest the evidence.

Evaluation of an improved sampling method for blood gas analysis from indwelling arterial catheters.

Embolic complications of indwelling arterial lines are well documented. We evaluated a method of blood sampling from indwelling arterial lines that minimizes blood loss and eliminates the embolic risks associated with retrograde flushing. The values for PaO2, PaCO2, and pH obtained by the conventional sampling technique were compared to those obtained by a technique termed the "three drop" method. Thirty-five paired samples were obtained from patients in the pediatric ICU. Meaningful statistical and clinical correlations were observed for PaO2 (r = .97, p less than 10(-6], PaCO2 (r = .97, p less than 10(-6], and pH (r = .98, p less than 10(-6]. Evaluation for the slope of the regression line for each pair of variables was also significant (p less than 10(-6]. The means for each variable were also assessed. Only the PaCO2 values were different (t = 2.49, p less than .002). As the absolute value was 2 torr, we feel that there is no clinical significance to this finding. These data confirm that the three drop technique of sampling for arterial blood gas analysis is reliable. It also removes the risks of retrograde flushing and minimizes blood loss.

Pulmonary artery catheterization in pediatric intensive care.

Pulmonary artery catheterization has become a routine part of pediatric intensive care even for small infants. Measured and derived variables provide clinicians with better understanding of the patient's cardiovascular and pulmonary systems and provide the means by which the results and complications of therapy may be monitored. While significant complications from pulmonary artery catheterization do occur, the risks are acceptable and warranted. Proper patient selection, strict attention to detail in all aspects of catheter use, and prompt removal will help to minimize complications.