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

A 3-year-old boy is brought to the emergency department for evaluation after being found with an open, unmarked bottle of liquid in the living room. The child is otherwise healthy and does not take any medications daily. Temperature is 37°C (98.6°F), heart rate is 108/min, blood pressure is 105/67 mmHg, respiratory rate is 27/min, and oxygen saturation is 99% on room air. On physical examination, the child appears fatigued. Cardiopulmonary and abdominal examinations are within normal limits. A venous blood gas reveals a pH of 7.42. Additional laboratory findings are obtained and detailed below. Which of the following is the most likely diagnosis?

Laboratory Value	Result	Reference Range
Serum Chemistry
Sodium	142 mEq/L	138-145 mEq/L
Potassium	4.2 mEq/L	4.1-5.8 mEq/L
Chloride	107 mEq/L	96-106 mEq/L
Bicarbonate	28 mEq/L	22-28 mEq/L
Blood urea nitrogen (BUN)	18 mg/dL	5-17 mg/dL
Creatinine	0.5 mg/dL	0.1-0.4 mg/dL
Glucose	90 mg/dL	74-127 mg/dL
Albumin	3.2 g/dL	3.5-4.6 g/dL
Serum osmolality	328 mOsm/kg	275-296 mOsm/kg

Urinalysis
Color	Clear	Clear to light yellow
Specific gravity	1.013	1.003-1.035
Glucose	Negative	Negative
Blood	Negative	Negative
Leukocyte esterase	Negative	Negative
Nitrites	Negative	Negative
Leukocytes	1-2/hpf	Negative
Erythrocytes	1-2/hpf	Negative
Dysmorphic RBCs	Absent	Absent
Ketones	Large	Negative