Pediatr Emerg Med J.  2023 Oct;10(4):175-181. 10.22470/pemj.2023.00808.

A 35-month-old boy who ingested laundry detergent pods and underwent veno-pulmonary extracorporeal membrane oxygenation support

• Han Hj
• Lee B
• Jang WJ
• Lee JW
• Kim JH
• Cho S
• Park JD

• KMID: 2546294
• DOI: http://doi.org/10.22470/pemj.2023.00808

Abstract

Laundry detergent pod (LDP) exposure has been reported to be fatal in children younger than 2 years, leading to respiratory or central nervous system depression. While gastrointestinal irritation is the most common symptom, there are reported cases of severe acidosis with respiratory depression or pneumonia, resulting in mortality. To our best knowledge, there is no report on a case of LDP exposure presenting with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation support. Here, we present a case of a child with severe acute respiratory distress syndrome following LDP exposure, who was successfully treated with veno-pulmonary extracorporeal membrane oxygenation and steroids.

Keyword

Acidosis; Detergents; Extracorporeal Membrane Oxygenation; Pneumonia, Aspiration; Respiratory Distress Syndrome

Figure

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  Fig. 1. Serial plain radiographs. (A) The initial radiograph shows a diffuse haziness and ground glass opacities, which are more remarkable on the right lung field, suggesting pneumonitis (day 1). (B) The right pulmonary lesion progressed to white-out (day 1). (C) Right pneumothorax (arrows) developed (day 3), and a chest tube (asterisk) was inserted (day 4). (D) Veno-arterial ECMO was implemented by draining the cannula into the inferior vena cava and returning the cannula into the ascending aorta (arrowheads) because of severe acute respiratory distress syndrome with recurrent pneumothorax (day 4). (E) After transfer to our hospital, steroid therapy was initiated for hypersensitivity pneumonitis, and cannulas for veno-pulmonary ECMO were inserted (arrowheads). (F) ECMO was successfully stopped 17 days after the transfer. ECMO: extracorporeal membrane oxygenation.

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  Fig. 2. Multifocal infarcted lesions on computed tomography scans (after transfer). (A) Symmetrical wedge-shaped, hypodense lesions with internal hemorrhagic changes (asterisks) are found in bilateral watershed areas, with ventricles collapsed by the edematous brain. (B-D) Multifocal hypodense lesions are observed on the scans, which are consistent with probable infarctions in the right kidney and spleen (arrows).

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  Fig. 3. Trends of OI (line graph) and therapeutic interventions (bars with letters) for acute respiratory distress syndrome. Because OI (= [FiO2 × mean airway pressure] ÷ PaO2) represents the degree of ventilator support needed to maintain oxygenation, change in OI after transfer to our hospital is plotted sequentially. OI: oxygenation index, NO: nitric oxide, VA ECMO: veno-arterial extracorporeal membrane oxygenation, ECMO: extracorporeal membrane oxygenation, HP: hypersensitivity pneumonitis.

Reference

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