EGD for Refractory Toxidromes: Is It Time to Add to the Algorithm?
Kelsey Allen1, Ian Kane1, Nicholas Connors2
1Medical University of South Carolina, Charleston, USA.
Summary
Refractory serotonin toxicity in an adolescent was successfully treated with endoscopic removal of medication remnants. This case highlights esophagogastroduodenoscopy (EGD) as a valuable tool for persistent toxic ingestions.
Area of Science:
- Toxicology
- Pediatric Emergency Medicine
- Gastroenterology
Background:
- Toxic ingestions pose a growing challenge in pediatric care, with some cases exhibiting persistent symptoms despite standard interventions.
- Serotonin toxicity, a potentially life-threatening condition, requires prompt and effective management.
Observation:
- A 14-year-old male with anxiety and depression presented with seizures and altered mental status, suspected to be serotonin toxicity from escitalopram and clonidine.
- Despite initial stabilization, seizure control, and medication (midazolam, cyproheptadine), the patient's condition deteriorated, necessitating intubation for respiratory failure.
Findings:
- Esophagogastroduodenoscopy (EGD) revealed partially digested medication fragments adhered to the gastric mucosa.
- Endoscopic removal of these remnants, followed by whole bowel irrigation, led to rapid clinical improvement and extubation within 24 hours.
Implications:
- Esophagogastroduodenoscopy (EGD) can serve as a crucial diagnostic and therapeutic decontamination method in severe, refractory toxic ingestions.
- This case underscores the importance of considering endoscopic interventions when conventional treatments fail in pediatric toxicological emergencies.
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