Approach to household substance exposure (pediatrics) Quiz: Ace Your Exams

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A 3-year-old girl presents to the emergency department for evaluation following concern for a household ingestion. The child was found by a caregiver in the bathroom with several open containers of cleaning solutions. The caregiver reports that the patient was initially asymptomatic but has become stuporous over the past hour. The child is otherwise healthy and does not take any daily medications. Temperature is 36.7°C (98.1°F), heart rate is 110/min, blood pressure is 100/60 mmHg, respiratory rate is 25/min, and oxygen saturation is 99% on room air. On physical examination, the patient appears fatigued and has a fruity odor on the breath. Cardiopulmonary and abdominal examinations are within normal limits. A point-of-care blood glucose test is normal. Which of the following additional findings is most likely to be present on further workup?

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