Cates Alexis L, Wheatley Scott M, Katz Kenneth D
Pediatr Emerg Care. 2018 Apr;34(4):e79-e81. doi: 10.1097/PEC.0000000000000790.
A 22-month-old girl without any significant medical history accidentally consumed a small amount of a therapeutic compounding cream that contained camphor, gabapentin, clonidine, ketoprofen, and lidocaine. Upon presentation to the emergency department, the child exhibited immediate onset of altered mental status with wide fluctuation in her vital signs, which included intermittent apnea requiring bag-valve mask assistance and endotracheal intubation. Serum laboratory analysis measured a clonidine level of 2.6 ng/mL and undetectable camphor, gabapentin, and ketoprofen levels. While on mechanical ventilation, the patient exhibited hypothermia, bradycardia, and hypotension; all of which responded to supportive care. After approximately 12 hours in the intensive care unit, the patient was successfully extubated and remained asymptomatic. This unique case of a patient with brief, unintentional oral exposure to a compounding cream, who demonstrated severe toxicity despite only a measured, supratherapeutic clonidine concentration, is discussed. Emergency physicians and pediatricians should be alert to the potential for exposure of pediatric patients to these medicinal compounds. Furthermore, parents must be made aware of the potential dangers of compounded medications and ensure their proper usage and storage.
一名22个月大、无重大病史的女童意外摄入了少量含有樟脑、加巴喷丁、可乐定、酮洛芬和利多卡因的治疗性复方乳膏。到急诊科就诊时，患儿立即出现精神状态改变，生命体征波动较大，包括间歇性呼吸暂停，需要使用袋阀面罩辅助通气和气管插管。血清实验室分析测得可乐定水平为2.6 ng/mL，樟脑、加巴喷丁和酮洛芬水平未检测到。在机械通气期间，患者出现体温过低、心动过缓和低血压；所有这些情况对支持治疗均有反应。在重症监护病房大约12小时后，患者成功拔管且仍无症状。本文讨论了这一独特病例，该患者意外经口短暂接触复方乳膏，尽管测得的可乐定浓度仅高于治疗浓度，但仍表现出严重毒性。急诊医生和儿科医生应警惕儿科患者接触这些药物化合物的可能性。此外，必须让家长意识到复方药物的潜在危险，并确保其正确使用和储存。
