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2009 Southern Regional Meeting Abstracts
Session: Pediatric Clinical Symposium
COMA IN A 20-MONTH OLD CHILD FROM AN INGESTION OF A TOY CONTAINING 1,4-BUTANEDIOL, A PRECURSOR OF γ-HYDROXYBUTYRATE
Jaeger MW, Ortmann L, James L, Schexnayder S. University of Arkansas for Medical Sciences, Little Rock, AR.
Case Report: 1,4-butanediol (1,4-BD) is an industrial solvent as well as a substance of abuse as it is metabolized to γ-hydroxybutyrate (GHB). We report a case of coma in a 20-month old boy from an ingestion of Aqua Dots, a toy containing 1,4-BD.
He was found by his mother at home staggering “as if he was drunk”. He proceeded to vomit colored beads found in his sister’s Aqua Dots craft set. Upon presentation to the ED he was awake and crying, but quickly became somnolent and responsive only to painful stimuli. He had no respiratory distress or depression. The remainder of his physical exam was normal. His vital signs and oxygen saturation were normal. Initial lab values including a CBC, ABG and metabolic panel were also normal as was his CXR.
He was transferred to the regional children’s hospital and admitted to the pediatric intensive care unit where his GCS was 8. The remainder of his physical exam, vitals and and sats remained normal. One dose of naloxone was given with no change in his mental status. The toxicology service was consulted. All labs including bedside glucose, basic metabolic panel, serum osmolality, urine screen for common drugs of abuse, acetaminophen and tricyclic antidepressant levels, RBC and plasma cholinesterase levels were normal as was his head CT. Initial investigations regarding the toxicity of Aqua Dots via the internet, poison control center, and product label revealed no published information.
His GCS remained 8 until 5 hours into the course of his illness when the patient suddenly awakened and began speaking and playing with his family. His mental status remained normal and he was discharged home 23 hours after the ingestion with no further symptoms.
After discharge from the hospital the patient’s parents obtained a list of ingredients for Aqua Dots from the manufacturer. This list was reviewed by our toxicolgy service and included 1,4-BD, a known precursor to GHB. The family contacted the media and consumer safety advocates which sparked national media coverage and an immediate toy recall by the Consumer Product Safety Commission (CPSC).
This case proved the need for tighter regulation and safety testing. The CPSC has since helped pass legislation in August 2008 to improve toy safety.
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