Sanders Taylor, Hymowitz Mitchell, Murphy Christine
Atrium Health's Carolinas Medical Center, Department of Emergency Medicine, Division of Medical Toxicology, Charlotte, North Carolina.
Louisiana State University Health Sciences Center, School of Medicine, Emergency Medicine Residency Program, Baton Rouge Campus, Baton Rouge, Louisiana.
Clin Pract Cases Emerg Med. 2024 Nov;8(4):332-335. doi: 10.5811/cpcem.7220.
Metallic luster dusts are decorative agents for cakes and other confections. While some powders are labeled "non-edible," they are also marketed as "non-toxic." We present a case of a child who developed acute metal pneumonitis after accidental aspiration of metallic luster dust.
A four-year-old presented to the emergency department (ED) in respiratory distress after attempting to ingest gold decorative metallic luster dust. In the ED she was placed on supplemental oxygen. Her initial chest radiograph (CXR) was unremarkable. Her condition worsened despite high-flow nasal cannula oxygen, and she was intubated. A repeat CXR revealed patchy perihilar and peribronchial opacities. While receiving aggressive ventilatory support, her CXR worsened over the next 48 hours as bilateral interstitial and alveolar opacities progressed, likely representing acute metal pneumonitis with acute respiratory distress syndrome (ARDS). She remained intubated until hospital day (HD) 5, requiring supplemental oxygen until HD 9. She was discharged home on HD 10. A CXR obtained four months later demonstrated increased interstitial markings throughout both lungs with overinflation and subsegmental atelectasis. The patient had persistent dyspnea upon exertion, with pulmonology documenting that her symptoms were likely sequelae from inhalation of the cake luster dust.
Non-edible metallic cake dusts are toxic. "Non-edible" labeling does not convey the health risks associated with handling by children, as evidenced by this case of metal pneumonitis with associated ARDS and chronic pulmonary disease. Accordingly, this descriptor should be abandoned for these products, and physicians should be aware of this potential complication.
金属光泽粉尘是用于蛋糕及其他糖果的装饰剂。虽然有些粉末标有“不可食用”，但它们也被宣传为“无毒”。我们报告一例儿童意外吸入金属光泽粉尘后发生急性金属性肺炎的病例。
一名4岁儿童在试图摄入金色装饰性金属光泽粉尘后因呼吸窘迫被送往急诊科。在急诊科，她接受了补充氧气治疗。她最初的胸部X线片（CXR）未见异常。尽管使用了高流量鼻导管吸氧，她的病情仍恶化，随后进行了气管插管。复查胸部X线片显示肺门周围和支气管周围有斑片状模糊影。在接受积极的通气支持治疗过程中，在接下来的48小时内她的胸部X线片病情恶化，双侧间质和肺泡模糊影进展，可能代表急性金属性肺炎合并急性呼吸窘迫综合征（ARDS）。她一直插管至住院第5天，直到住院第9天仍需要补充氧气。她于住院第10天出院。4个月后获得的胸部X线片显示双肺间质纹理增多，伴有过度充气和亚段肺不张。患者运动后仍持续呼吸困难，肺科医生记录其症状可能是吸入蛋糕光泽粉尘的后遗症。
不可食用的金属蛋糕粉尘是有毒的。“不可食用”标签并未传达与儿童接触相关的健康风险，本例金属性肺炎合并ARDS及慢性肺部疾病即为证明。因此，这些产品应摒弃该描述符，医生应意识到这种潜在并发症。
