Magnum, P.I.

​An 11-year-old boy with cerebral palsy presented to the emergency department unresponsive. His mother said the child was in his normal state earlier that morning, but was blue and unresponsive when she tried to wake him from his morning nap. A home pulse oximeter reported an oxygen level of 55%.The mother placed the child on oxygen and called 911. He was still unresponsive on arrival, and his physical examination demonstrated flaccid paralysis and a GCS score of 3 with fixed dilated pupils. He was tachycardic with shallow respirations. His initial vital signs were a temperature of 36.9°C, a heart rate of 136 bpm, a respiratory rate of 16 bpm, and a blood pressure of 89/38 mm Hg.The boy was G-tube dependent, and his mother stated that he also had chronic GI bleeding and was supposed to see the gastroenterologist the next day. His medication list included valproic acid, felbamate, topiramate, and baclofen. His initial VBG showed a pH of 7.01, a CO2 of 126.02, and an HCO3 of 31.1, with a lactic acid of 2.8. He was intubated because of his mental status and admitted to the PICU, where the mother reported that she had also given him 240 mL of magnesium citrate to prep him for a colonoscopy he was due to have the following day.What Is the Differential?Brain stem herniationSepsisBaclofen, topiramate, or valproic acid overdoseHyperammonemia secondary to valproic acidHypermagnesemia The Clinical Effects of HypermagnesemiaNormal serum levels range from 1.3 to 2.2 mEq/L. Only o...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs