The child died after oral administration of "diarrhea medicine" because of ignoring this item in the instructions!

Only for medical professionals to read for reference.
Is the medicine for diarrhea deadly? Compound diphenoxylate is a non-specific drug for the treatment of diarrhea.
It is used for acute and chronic functional diarrhea and chronic enteritis, and is widely used in primary hospitals
.

However, non-standard medication may cause serious consequences and even lead to death of the patient! The following case [1] is a bloody lesson, let’s charge it together
.

 Case review: A male admitted to the hospital, 8 months old, had no obvious cause of diarrhea 7 days before admission, and had a small amount of yellow loose stools, ranging from 3 to 4 times a day, accompanied by vomiting and fever.
The vomit was stomach contents.
Contains bile, non-spray, and measures body temperature of 38.
5℃
.

I once visited a local private clinic.
The doctor gave oral white tablets (later confirmed to be compound diphenoxylate tablets) for 7 days.
The specific dosage was unknown.
The patient's vomiting was relieved, but the diarrhea and fever were not significantly improved
.

Later, he was transferred to the local county hospital of traditional Chinese medicine.
A plain radiograph of the chest and abdomen showed that the lungs had increased weight, a large amount of flatulence in the abdomen, and incomplete intestinal obstruction was not ruled out
.

At this time, the child gradually developed poor spirit and decreased urine output
.

He was then transferred to the local county people's hospital for treatment
.

Check T35.
5℃, P156 times/min, R36 times/min, BP84/44mmHg
.

CT examination of the head and chest revealed: ① Cerebral hypoxia and edema, a small amount of hemorrhage in the subarachnoid space; ② Multiple infections and exudative lesions in both lungs
.

Blood routine: WBC5.
9×109/L, NE%21.
4%; Procalcitonin: 1.
2ng/ml; Serum potassium: 2.
6mmol/L; Alanine aminotransferase (ALT) 203.
6U/L, Aspartate aminotransferase (AST) 321.
0U/L, alkaline phosphatase (ALP) 231.
5U/L, total protein 50.
7g/L, creatine kinase (CK) 3646.
0U/L, creatine kinase isoenzyme (CKMB) 287.
0U/L, lactic acid Dehydrogenase 2471.
0U/L, hydroxybutyrate dehydrogenase 2401.
0U/L
.

Diagnosis ①Compound diphenoxylate poisoning; ②Respiratory failure; ③Toxic encephalopathy; ④Myocardial damage; ⑤Severe dehydration; ⑥Incomplete intestinal obstruction
.

On sudden admission, he was given gastric lavage immediately, and a small amount of brown stomach contents were washed out
.

One hour later, the child had a sudden facial cyanosis, followed by respiratory and cardiac arrest.
He immediately chest compressions, intravenous injection of epinephrine and naloxone, and tracheal intubation.
The child’s heart rate returned to 84 beats/min, but he did not breathe spontaneously.
Recovery, assisted breathing by ventilator, deep coma on physical examination, equal circle of bilateral pupils, diameter of about 5mm, no light reflection
.

Drug therapy is given to rehydration, mannitol assisted furosemide to alternately lower intracranial pressure, intravenous administration of naloxone to antagonize the toxicity of diphenoxylate, meropenem to fight infection, cimetidine to prevent gastrointestinal bleeding and other treatments, gangliosides Lipid promotes brain function recovery, liver protection and other drug treatments: the child’s condition does not improve significantly and continues to aggravate.
During the treatment, the child’s spontaneous breathing has never recovered.
On the 21st day of hospitalization, the child has a gradual decrease in heart rate and the extremities are cold.
, After the rescue was invalid, declared clinical death
.

Cause of death analysis 1.
Drug selection error According to the compound diphenoxylate instruction [2]: newborns and infants can cause respiratory depression, so children under 2 years old are disabled, and this patient is 8 months old and does not belong to compound diphenoxylate The drug crowd of tablets
.

In addition, acute diarrhea is generally improved 48 hours after treatment.
If it does not improve, the drug should be stopped in time [3].
In this case, the patient has been used for 7 consecutive days, and the diarrhea and fever have not improved.
It should be considered that the treatment is ineffective and the drug should be stopped in time. .

5w+ medicines are free to check the screenshots of the doctor’s station App medication query 2.
The rescue measures are unreasonable.
First, for compound diphenoxylate poisoning, the first is to remove the poison in the stomach and repeatedly inject and wash until the gastric lavage is colorless and tasteless.
The patient's case only showed that a small amount of brown stomach contents were washed out, and it is impossible to know whether the poison was completely washed out; second, large doses of compound diphenoxylate can cause respiratory depression, and naloxone should be used for detoxification as soon as possible
.

Studies have shown that children with respiratory depression (10 breaths/min) will improve their breathing within 5-10 minutes after medication
.

 Critically ill patients can be used repeatedly within 30-60 minutes until breathing is stable
.

In this case, the patient started naloxone treatment only 1 hour after admission, and the optimal treatment time had been missed.
The patient's spontaneous breathing has never recovered, which led to the patient's death
.

In order to prevent the occurrence of the above serious adverse reactions, Jie Xiaoyao summarized the correct use method of compound diphenoxylate and the principle of rescue of poisoning for clinical medication reference
.

 Correct use of compound diphenoxylate tablets [2] Principles of rescue of compound diphenoxylate poisoning[3-5] 1.
Immediately remove the drugs in the stomach, quickly establish intravenous access and place the child in a supine position with his head tilted to one side.
The awake person takes the left side decubitus position
.

Choose the appropriate type of gastric tube according to different ages, generally choose No.
8-12, use a 50ml syringe to draw out the stomach content, and then draw 50-100ml of 0.
9% sodium chloride solution into the stomach, and inject it for 2-4 times.
Extract the contents of the stomach and repeatedly infuse and wash until the gastric lavage fluid is colorless and tasteless.
The amount of perfusion should not be too much, so as not to cause the stomach to expand and increase the absorption of toxicants
.

Strictly record the amount of gastric lavage liquid, and the amount into the stomach is roughly equal to the amount out of the stomach
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During gastric lavage, closely observe the patient's complexion, lips, pulse, breathing, and the amount, color, taste, and properties of the lavage fluid
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 2.
Keep the airway unobstructed and use naloxone to detoxify as soon as possible.
Large doses of compound diphenoxylate can cause respiratory depression.
Keeping the airway unobstructed has become the focus of emergency care
.

Tilt the child's head back and tilt his head to one side, clear the child's mouth and nasal secretions in time, and use negative pressure to suck sputum if necessary
.

Children are given nasal cannula for oxygen inhalation with a flow rate of 2-3L/min, and infants can use a hood to inhale oxygen with a flow rate of 5L/min
.

The first dose of naloxone is 0.
01～0.
04mg·kg/h intravenously, and then 0.
05mg·kg/h to maintain pumping
.

 3.
Ensure that the urine is unblocked.
The use of compound diphenoxylate tablets will cause the patient's bladder to expand and form urinary retention
.

The specific method: first put a hot and humid towel or a hot water bottle wrapped with a dry towel in the swollen bladder area of ​​the lower abdomen of the child for 2-3 minutes.
After removing the hot and humid towel or hot water bottle, use the four fingers of the right hand to place it on the swollen bladder area.
Use your four finger pads to massage the bladder in a clockwise direction for 1-2 minutes, and then gently press the bladder from top to bottom.
If no urine is discharged, repeat the above method once again
.

 4.
Closely observe changes in the condition and provide special personnel to guard, closely observe the child's vital signs, complexion, consciousness, urine output, etc.
, and provide ECG monitoring and blood oxygen saturation monitoring.
If abnormalities are found, they will promptly cooperate with the physician to actively deal with them
.

References: [1] Wang Qinxue, Li Wanzhi, Nan Wenqing, et al.
One case of death caused by oral compound diphenoxylate tablets poisoning[J].
Chinese Journal of Drug Abuse Prevention and Treatment, 2020, v.
26(01):49- 52.
[2]Instructions for compound diphenoxylate tablets.
[3]Sun Jing, Qin Kan.
Safety problems of children's medication caused by adverse reactions of compound diphenoxylate and literature analysis[J].
Strait Pharmacy, 2016, 28( 006):131-134.
[4]Zhou Peifen.
First aid and nursing care of children with compound diphenoxylate poisoning[J].
Journal of Clinical Nursing, 2011,10(006):37-38.
[5]Yuan Min, Jiang Chunlin.
First aid and nursing care of children poisoned by mistakenly taking compound diphenoxylate[J].
Journal of Medical Theory and Practice, 2011(15):109-110.