Approach to household substance exposure (pediatrics) Quiz: Ace Your Exams
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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 |
| Serum chemistry | |
| Sodium | 142 mEq/L |
| Potassium | 4.2 mEq/L |
| Chloride | 107 mEq/L |
| Bicarbonate | 28 mEq/L |
| Blood urea nitrogen (BUN) | 18 |
| Creatinine | 0.5 mg/dL |
| Glucose | 90 |
| Albumin | 3.2 g/dL |
| Serum osmolality | 328 mOsm/kg |
| Urinalysis | |
| Color | Clear |
| Specific gravity | 1.013 |
| Glucose | Negative |
| Blood | Negative |
| Leukocyte esterase | Negative |
| Nitrites | Negative |
| Leukocytes | 1-2/hpf |
| Erythrocytes | 1-2/hpf |
| Dysmorphic RBCs | Absent |
| Ketones | Large |
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