Molly is a 5 year-old girl who is brought by her parents to the pediatric emergency room with severe nausea, hematemesis, and abdominal pain. She had been playing “candy maker” in her parents’ room and an open medication bottle was found on the floor. The child is otherwise healthy. The parents, in their excitement forgot to bring the bottle.

Physical Exam:

Vital signs show a marked increase in respiratory frequency (hyperventilation), fever, but normal blood pressure. The remaining physical exam reveals a normal appearing 5 year-old girl with a flushed face, lethargy, dizziness, disorientation, dehydration, generalized petechiae, and abdominal pain.

Lab and X-ray

• Electrolytes: normal
• Arterial Blood Gases: respiratory alkalosis and metabolic acidosis
• Chest X-ray: normal

Molly seems like a pretty sick little girl.

• If you were the doctor what would you do next?
• Does Molly need more testing performed?
• What do you think is wrong with Molly?