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A pseudoencephalitis presentation of a pediatric non-intentional intoxication
C Bréhin1, C Cessans1, C Monchaud2
1Pediatric Emergency Unit, Children Hospital, CHU Toulouse, France.
Summary
Pediatric patients experiencing hallucinations may have anticholinergic syndrome from promethazine in over-the-counter cough medicines. This intoxication can mimic serious conditions like encephalitis.
Area of Science:
- Pediatric Toxicology
- Neuroscience
- Pharmacology
Background:
- Anticholinergic syndrome is often unrecognized in children presenting with hallucinations.
- Promethazine is a common ingredient in over-the-counter cough and cold medications.
Observation:
- A 7-year-old girl presented with acute agitation, visual, and tactile hallucinations, mimicking encephalitis.
- Initial investigations, including drug screening, were negative, but an EEG suggested benzodiazepine intoxication.
- Advanced toxicological analysis identified promethazine as the causative agent.
Findings:
- Promethazine intoxication can present as pseudoencephalitis in children.
- Symptoms included fever, tachycardia, and significant neurological disturbances.
- The child recovered fully after 20 hours.
Implications:
- Healthcare providers should consider anticholinergic toxicity in pediatric patients with unexplained neurological symptoms.
- Over-the-counter medications containing promethazine should be used with caution in children.
- Increased awareness and diagnostic vigilance are crucial for managing such cases.
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