Heartbroken, 2-year-old children mistakenly eat metformin after causing serious brain damage! How to prevent it?

For medical professionals only

No matter what medicine, no matter who takes the medicine, children can not get it at will.

In the past few days, the parents of a 2-year-old child with a thick stack of medical records have told me in the clinic that "the child's accidental eating of metformin has caused serious brain damage" which makes me sad and unforgettable, and it is another serious case of accidental injury to children!

In the pediatric outpatient emergency department, it is often seen that children whose lives are endangered due to accidental injuries such as taking drugs by mistake are sent by hurried parents and 120 ambulances!

Unintentional injuries in children are more common in children aged 1-5 years, about 90% occur at home, and have become one of the leading causes of disability and death in children under 5 years of age. Especially in the recent epidemic prevention and control, children's time at home has increased, in order to protect children's health and life safety, we must draw everyone's attention to prevention.

Case profile

This serious brain damage caused by mistakenly eating metformin is a lively, cute, smart and clever 2-year-old boy.

More than a month ago, the boy took a nap in his grandmother's bedroom as usual, and the parents left him in the bedroom. 2 hours later, when the parents went to the bedroom to see the child, they found that he was lying on the floor with a soft body, foam in his mouth, and a blue face, with a large amount of white powder in his mouth, and an open bottle of metformin extended-release tablets next to him.

Grandma quickly came over to check, less than 10 tablets, the child may eat 10 tablets of metformin at a time!

After finding out that the child took the wrong medicine, the family immediately called 120 emergency to XX Children's Hospital, and when they arrived at the hospital, they found that the child's blood glucose could not be detected, and the test results showed 0, and the doctor said that it was severe hypoglycemia caused by metformin, and hypoglycemia caused brain damage.

The boy's aunt said bitterly: "The doctor said that it was late to find out, the treatment was late, the brain damage was serious, and it was difficult to return to normal." The child who was originally alive and jumping and loved by everyone was treated in the children's hospital for more than 1 month, and now his life is saved, but he will not know anything, no one knows, he cannot speak, he will not turn over and exercise, and he will not know what to eat and drink. However, feeding him porridge will swallow. ”

The little aunt also said that their whole family also knew that children should not be exposed to drugs and the like, and the drugs and pesticides at home were hidden and placed in places where the children could not see or get them. No one expected this metformin, many elderly people to eat drugs that have not had side effects for many years, and even poisoned children so badly!

As a pediatrician, while listening to her story, I looked through this thick medical record information and said with a heavy heart: "Metformin is a hypoglycemic drug, although there is no direct liver and kidney brain toxicity, but the hypoglycemia it causes can seriously damage various organs of the body, especially the brain damage to children, the smaller the child, the more serious, and irreversible, children under 10 years of age are not used." ”

Metformin this medicine, adults 1 time is the amount of 1 tablet, this 2-year-old child, 1 time to eat 10 tablets, super large dose! Even with the medications/foods that your child can take on his own, very large doses can be dangerous. Therefore, no matter what medicine, no matter who takes the medicine, the child can not eat it himself!

Case solving

1

Metformin overdose can cause severe hypoglycemia

Metformin tablets are often used for type 2 diabetes mellitus that does not respond to diet control and physical exercise alone, especially in obese patients. Children over 10 years old with type 2 diabetes can use this product, in strict compliance with the doctor's advice on the correct dosage, the main side effects are nausea, vomiting, diarrhea, abdominal pain and loss of appetite, gastrointestinal discomfort, in the overly large dose of consumption, will excessively reduce the body's blood glucose levels.

2

What are the harmful damages of hypoglycemia in children? How to detect it early?

Hypoglycemia is the most common metabolic disorder in children, especially in newborns and infants, and recurrent episodes or persistent hypoglycemia can lead to irreversible brain function damage in children, which in turn causes children's growth retardation, severe low IQ, and even death.

Although hypoglycemia is harmful in children, infants and newborns do not have any clinical signs and symptoms and require careful observation and assessment of changes in children by guardians before they can be detected.

Diagnostic criteria for hypoglycemia:

Newborns within 28 days of birth: blood glucose levels < 2.2 mmol/L;

Children of other ages: fasting blood glucose concentration < 2.8 mmol/L;

Children with diabetes mellitus: blood glucose < 3.9 mmol/L.

The extent to which hypoglycemia leads to brain damage depends on the cause, level and duration of hypoglycemia, which occurs acutely, lasts longer, and the lower the blood glucose level, the more severe the brain injury. When severe hypoglycemia occurs, the metabolism of the human brain will stagnate like asphyxia and lack of oxygen, lasting 8 minutes to cause severe irreversible brain damage. Hypoglycemia is more damaging to children, especially infants and young children than adults, and clinical timely diagnosis and treatment are extremely important.

If the child is found to have feeding difficulties, drowsiness, bruising, crying abnormalities, pallor, trembling, tremor, and even convulsions and other clinical manifestations of hypoglycemia, within 5 minutes, oral candy, sugar water or foods with more sugar should be given, if eating difficulties, immediately give intravenous bolus or glucose infusion, most children's blood sugar will quickly rise, can avoid brain damage and other serious consequences.

The 2-year-old boy in this article, who was found in 2 hours, has developed severe brain damage, and his blood sugar is so low that he cannot detect the number in the hospital, so the prognosis will be very painful!

3

What should parents do if they find that their children have mistakenly taken drugs and other harmful substances?

1. When it is found that the child has mistakenly taken drugs and other harmful substances, parents first stop the child's further consumption, judge the child's general condition, whether it is sober, and dial the 120 emergency number at the same time.

2. Inducing vomiting, gastric lavage, diarrhea, and enema are several sequential measures to deal with harmful substances such as drugs that have been mistakenly taken, but each step and each measure has indications and contraindications.

3. Contraindications to vomiting

Children with altered consciousness, active convulsions, or bleeding tendencies;

Mistakenly ingesting corrosive poisons: such as acidic or alkaline substances;

Mistakenly ingesting chemicals such as gasoline and kerosene;

Mistakenly taking drugs that act rapidly on the central nervous system;

Children with severe heart disease;

Small infants under 6 months of age with an unsound swallowing and vomiting reflex.

4. Methods of inducing vomiting

Contraindications are ruled out, and the sooner the vomiting is induced, the better. Direct stimulation of the posterior pharyngeal wall of the child may be stimulated by a tongue depressor or a finger. During the vomiting process, be sure to observe the child's reaction to avoid vomiting and aspiration.

Expert Profiles

Xu Lingmin

Chief Physician of pediatrics and director of the Teaching and Research Department of Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Doctor of Medicine; Member of Pediatric Branch of Shanghai Medical Association and Medical Association, Member of Science Popularization Branch, Member of Pediatric Cardiovascular Group, Scientific Debunking Expert of China Association for Science and Technology; Original Popular Science Books "Solution to Common Pediatric Diseases" and "Pediatric Emergency Emergency Problem Solving", answering public parenting confusion. He has won the second prize of the Shanghai Science Popularization Education Innovation Award, the Nomination Award of the Popular Science Award, the Outstanding Popular Science Writer Award and the Excellent Popular Science Book Award, and many other popular science awards, and the 2nd Annual Good Doctor of "Good Doctor Online" and the outstanding author of "Medical Field" for many years.

bibliography:

Wang Weiping,Sun Kun,Chang Liwen. Pediatrics[M].Beijing:People's Medical Publishing House,2018.]

Xu Lingmin. Solutions to common pediatric diseases[M].Shanghai:Shanghai Science and Technology Education Press,2018.

Xu Lingmin. Pediatric Emergency Emergency Diagnosis[M].Shanghai:Shanghai Science and Technology Education Press,2020.

Jiang Zaifang, Shen Kunling, Shen Ying. Zhu Futang Practical Pediatrics (8th Edition)[M].Beijing: People's Medical Publishing House, 2015.

Liu Xiangyun,Chen Ronghua,Zhao Zhengyan. Child Health Care (4th Edition).Nanjing:Jiangsu Science and Technology Press,2016.]

Source of this article: Pediatrics Channel of the Medical Community

The author of this article: Xu Lingmin, chief physician of the Department of Pediatrics, Qingpu Branch, Zhongshan Hospital, Fudan University

Editor-in-Charge: CiCi

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