Hypovolemic shock due to severe gastrointestinal bleeding in a child taking an herbal syrup

Area of Science:

• Pediatrics
• Gastroenterology
• Clinical Toxicology

Background:

• Herbal remedies are widely used for common ailments, but their safety profiles, especially in children, require thorough investigation.
• Salicylates, commonly found in plants like Salix spp. and Filipendula ulmaria, are known for their anti-inflammatory and analgesic properties but can cause adverse effects.

Observation:

• A previously healthy 4-year-old boy presented with hypovolemic shock secondary to severe gastrointestinal bleeding.
• Endoscopic examination revealed esophageal erosions, ulcerations, and a duodenal erosion.
• The child had recently consumed a herbal syrup containing Filipendula ulmaria and Salix spp. for a mild cold.

Findings:

• Qualitative and quantitative analysis confirmed the presence of salicylates in the consumed herbal syrup.
• The Naranjo algorithm indicated a probable correlation between the herbal syrup ingestion and the onset of gastrointestinal bleeding.
• The child recovered fully after intensive care management.

Implications:

• This case underscores the potential for serious adverse events, including severe gastrointestinal bleeding, from over-the-counter or prescribed herbal products containing salicylates in pediatric patients.
• It emphasizes the need for increased awareness and caution among healthcare providers and parents regarding the safety of herbal remedies.
• Regulatory bodies should ensure rigorous safety assessments for herbal products marketed for children.