An 8-year-old boy is brought to the emergency room by paramedics with a reported ingestion about four hours ago. The patient had an accidental ingestion of "antifreeze" after mistaking it for a beverage in the garage.
Item 1 of 2
Which of the following physical signs would be consistent with the history of "antifreeze" ingestion?

Question

Quizplus · Accepted Answer

Explanation: Ethylene glycol is one of the components of antifreeze and other solvents. It is one of the alcohols (along with ethanol, methanol and isopropanol) with fatal intoxications. It is important to recognize its toxicity early for instituting quick and definitive therapy. Ethylene glycol gets metabolized in the body by an enzyme, alcohol dehydrogenase (ADH), into a variety of toxic metabolites, including glycolic acid, glyoxylic acid, and oxalic acid. These toxic metabolites are responsible for most of the clinical symptoms and organ damage seen with antifreeze ingestion. Ethylene glycol ingestion leads to a severe anion gap metabolic acidosis. This causes a typical rapid and deep breathing pattern known as Kussmaul's respiration. Some of the other early signs include nausea, vomiting, slurred speech, ataxia, nystagmus, and lethargy. Further toxicity may lead to tachypnea, agitation, confusion, flank pain, renal failure, pulmonary edema, changes in mental status, and eventually, progression to a coma. (Choices A and D) Dry skin and mucosal surfaces, as well as dilated pupils, are seen in overdoses of anticholinergic agents. The common agents implicated are tricyclic antidepressants, certain plants (Datura stramonium), and mushrooms. (Choice B) Ventricular tachyarrhythmias are seen with overdoses of tricyclic antidepressants and second-generation antihistamines such as astemizole or terfenadine. (Choice C) Excessive salivation is classically seen with organophosphate or carbamate poisoning. These are commonly the agents used in pesticides and insecticides. Educational Objective: Ethylene glycol ingestion leads to a severe anion gap metabolic acidosis. This causes a typical rapid and deep breathing pattern known as Kussmaul's respiration.

An 8-Year-Old Boy Is Brought to the Emergency Room by Paramedics