Pediatric emergency medicine trisk 3097 3097

FIGURE 102.5 Algorithmic approach to a toddler having ingested one to two doses (1 to 2
pills or 5- to 10-cc swallow) of a drug. a Medications notorious for their ability to have delayed
onset in toxicity, beyond 4 to 6 hours, include oral hypoglycemic agents, sustained-release
preparations, monoamine oxidase inhibitors, drugs taken concomitantly with anticholinergic
agents, and acetaminophen.

In any patient with coma and an unexplained osmolal gap (the difference
between calculated and observed osmolarity), a toxic alcohol should be strongly
considered. The presence of ketonuria in conjunction with the absence of
metabolic acidosis effectively makes the diagnosis of isopropyl intoxication.
Isopropyl alcohol is easily removed by hemodialysis. However, hemodialysis is
rarely necessary because life-threatening toxicity does not occur until serum