Six-Year-Old With Altered Mental Status: No "LACk" of Clues

Area of Science:

• Pediatric Emergency Medicine
• Toxicology
• Metabolic Disorders

Background:

• Hypoglycemia and seizures in children warrant a thorough diagnostic evaluation.
• Alcohol ingestion is a known cause of hypoglycemia and seizures in pediatric patients.
• Altered mental status in children necessitates consideration of toxic ingestions.

Observation:

• A previously healthy 6-year-old presented with seizure and hypoglycemia.
• Initial ethanol levels were normal, complicating the diagnosis.
• The patient exhibited mild metabolic ketoacidosis and transient lactic acidemia.

Findings:

• Despite normal initial ethanol levels, ethanol toxicity was suspected.
• Subsequent history confirmed ethanol ingestion as the cause.
• Metabolic derangements included hypoglycemia, ketoacidosis, and lactic acidemia.

Implications:

• This case highlights the importance of suspecting ethanol toxicity in pediatric hypoglycemia and altered mental status, even with normal initial ethanol levels.
• It underscores the need for comprehensive history taking in diagnosing toxic ingestions.
• Clinicians should consider ethanol toxicity in the differential diagnosis of pediatric seizures associated with metabolic disturbances.