Opposing Digits

Texas. In February 2005, a girl aged 2 years who was tested for blood lead during routine health surveillance had a capillary BLL of 47 µg/dL. A venous BLL of 48 µg/dL obtained 12 days later confirmed the elevated BLL. A complete blood count and iron study conducted concurrently revealed low serum iron levels and borderline anemia. On February 28, 2005, the girl was admitted to a local medical center for combined oral and IV chelation therapy.

The patient's blood electrolytes at admission were within normal limits. Initial medication orders included IV Na2EDTA and oral succimer (an agent primarily used for treatment of lead poisoning). The medication order subsequently was corrected by the pediatric resident to IV CaEDTA. At 4:00 p.m. on the day of admission, the patient received her first dose of IV CaEDTA (300 mg in 100 mL normal saline at 25 mL/hr). At 4:35 p.m., she was administered 200 mg of oral succimer. Her vital signs remained normal throughout the night. At 4:00 a.m. the next day, a dose of IV Na2EDTA (instead of IV CaEDTA) was administered. An hour later, the patient's serum calcium had decreased to 5.2 mg/dL (normal value for pediatric patients: 8.5--10.5 mg/dL). At 7:05 a.m., the child's mother noticed that the child was limp and not breathing. Bedside procedures did not restore a normal cardiac rhythm, and a cardiac resuscitation code was called at 7:25 a.m. The child had no palpable pulse or audible heartbeat. Repeat laboratory values for serum drawn at 7:55 a.m. indicated that the serum calcium level was <5.0 mg/dL despite repeated doses of calcium chloride. All attempts at resuscitation failed, and the girl was pronounced dead at 8:12 a.m.

# posted by madthumbs @ 12:51 PM