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Severe respiratory failure following charcoal application in a toddler
1Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Vienna, Austria. Johann.Golej@akh-wien.ac.at
Insights
Enteral detoxification with charcoal via gastric tubes in toddlers is generally safe, but aspiration is a rare risk. This case highlights the potential for severe respiratory failure from endobronchial charcoal contamination.
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Toxicology
Background:
- Activated charcoal is frequently used for enteral detoxification in pediatric patients.
- Gastric tube administration is a common method for delivering charcoal, especially in toddlers.
- Aspiration of charcoal is considered a rare complication.
Observation:
- A 19-month-old boy experienced endobronchial charcoal contamination after gastric tube administration.
- This led to acute airway obstruction and severe respiratory failure, despite standard tube placement verification.
- Initial chest X-rays did not accurately represent the extent of endobronchial charcoal deposition.
Findings:
- The patient required immediate intubation, tracheal suctioning, bronchodilators, and high-frequency oscillatory ventilation (HFOV) to manage hypoxia and hypercarbia.
- Successful removal of charcoal was achieved through bronchoscopy.
- Gastric tube administration of charcoal in children poses a significant risk of aspiration.
Implications:
- Pediatric patients receiving charcoal via gastric tubes are at risk for life-threatening respiratory complications.
- Prompt medical intervention, including artificial ventilation and bronchial lavage, may be necessary.
- Standard tube verification techniques may not always prevent aspiration events.
Abstract:
Charcoal has been commonly used for enteral detoxication with few adverse effects. In toddlers charcoal can often be simply applied via a gastric tube. Regurgitation and aspiration is considered a rare event. We report the case of a 19-month-old boy who suffered endobronchial charcoal contamination followed by acute airway obstruction and severe respiratory failure despite a commonly used tube placement verification technique. Immediate intubation, tracheal suctioning, intravenous bronchodilators, and high frequency oscillatory ventilation (HFOV) were used to control hypercarbia and hypoxia. Eventually charcoal removal by bronchoscopy was successful. Chest X-ray investigation did not reflect the true amount of charcoal deposited endobronchially at any time. We conclude that gastric tube application of charcoal in children carries a risk of aspiration. This may lead to life-threatening respiratory failure with the need to provide artificial ventilation and bronchial lavage.