Question

Marie Case study

One day prior to admission, Marie, who is 7-years-old, began to complain of abdominal pain associated with vomiting. The child also had loss of control of her legs, being unable to walk. Up to this point her health had been excellent with visits to the physician being limited to pre-school exams. At the local Emergency Room (ER), symptoms were consistent with gastroenteritis, although she was afebrile. One teaspoon of Donnatal elixir was given and she was discharged home. Throughout the evening, she was extremely restless complaining of pain wherever she was touched. Vomiting continued and diarrhea began. Because of increasing GIT problems and progressive weakness with irritability, she was returned the ER. On the way she became incontinent of urine. At the ER, Marie was flaccid with difficult breathing. She complained she could not see. She required intubation and oxygen. Blood gases showed pCO2=41.7, pO2=77.5 and pH=7.29. She began to have generalized twitching and was immediately referred to a large medical center. On arrival, she was admitted directly to the pediatrician intensive care unit (ICU). Without doing a physical examination, the resident was immediately impressed with her pinpoint pupil, weakness and the fact she was drooling despite a history of vomiting and diarrhea, might possibly result in dehydration. He thought that taking a history was important. Marie’s family was living in a farm and stated that the family’ pet had died some hours before Marie had become ill and he had foamed at the mouth and was weak shortly before death.

Q7: Which of the following is/ are considered specific antidote for Marie case ?, you can choose two: (0.5 mark)

1. N acetyl cysteine
2. Atropine
3. Pralidoxime
4. Malathion

8QExplain the mechanism by which each choice works? (1mark)

9QWhich of these agents is considered a lifesaving drug for Marie?