MedBugs: SAQ #69

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Case: Liquid paracetamol ingestion

A 3-year-old boy is brought in by his mother after ingesting an unknown quantity of liquid paracetamol. He had been playing quietly in his room for about 10 minutes and was found with the empty bo le that previously was around three quarters full. The time of ingestion was 30 minutes prior to presentation. The entire 200mL bottle of paracetamol contains 10g of paracetamol. The child weights 14kg.

1. What is your approach to decontamination of this child? 1 mark

As part of your risk assessment you calculate the possible dose of paracetamol ingested.

2. What is the threshold ingested dose of paracetamol (in mg/kg) at and above which a serum paracetamol level should be measured? 1 mark

You decide the child DOES need a paracetamol level to be check.

3. How long after ingestion will you check a paracetamol level in this child? 1 mark

The child’s parents are appropriately concerned for their child and want to ensure there is no further risk to the child from accidental inges ons in the home. They ask you more questions about dangerous ingestions in children.

4. List (4) medications which would be life-threatening if a small child ingested 1-2 pills. 4 marks

After completing the appropriate testing, you have decided this child needs treatment with N-acetyl-cysteine. Soon after commencing the appropriate first infusion, the child develop widespread erythematous flushing and wheeze.

5. Outline (5) steps in your immediate management. 5 marks

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