A two-year-old girl is brought to the emergency department by ambulance for acute somnolence and disorientation. The patient was being cared for by her elderly aunt when she was found lying in the hallway. Vital signs are temperature 37°C (98°F), heart rate 90 beats/minute, blood pressure 72/37 mmHg, and respirations 12/minute and shallow. On physical examination, the patient is obtunded with minimal responses to painful stimuli. Pupils are equal, round, reactive to light, and constricted bilaterally. Skin is warm and dry with no signs of bruising, rash, or other lesions.
E) Naloxone
Naloxone is an opioid antagonist used in the emergency treatment of opioid overdose/intoxication. In this case, the patient is showing signs of opioid intoxication. Rates of accidental opioid intoxication are increasing. Key findings in this case somnolence, constricted pupils, and decreased respirations.
Answer choice A: Cyproheptadine, is incorrect. Cyproheptadine is a first-generation antihistamine that can be used for the treatment of serotonin syndrome. Serotonin syndrome may result from intoxication from serotonergic medications and can present with agitation, disorientation, clonus, diaphoresis, tachycardia, hyperthermia, and hypertension.
Answer choice B: Dantroline, is incorrect.Dantroline is a post-synaptic muscle relaxant used for the treatment of neuroleptic malignant syndrome (NMS). NMS can present with altered mental status, cardiac arrythmias, tachycardia, tachypnea, muscle rigidity, diaphoresis and high or low blood pressure. NMS can result from intoxication from antipsychotic medications.
Answer choice C: Flumazenil, is incorrect. Flumazenil is a GABA receptor antagonist used for reversal of benzodiazepine intoxication. Benzodiazepine intoxication would present with altered metal status, somnolence, and ataxia.
Answer choice D: Fomepizole, is incorrect. Fomepizole is an alcohol dehydrogenase inhibitor indicated for treatment of ethylene glycol ingestion. While the initial signs of ethylene glycol appear similar to this case (ataxia, slurred speech, drowsiness, irritation, restlessness and disorientation), ethylene glycol intoxication does not present with constricted pupils. With ethylene glycol intoxication, the patient would present with tachypnea (in later presentations) as a compensation for metabolic acidosis.
Key Learning Point
Naloxone is a medication used to treat opioid overdose.
