Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 208. Guest post by Dr Mark Corden – paediatric fellow in Melbourne
- Grevillea species; specifically Grevillea Robyn Gordon.
- An Australian native species common in domestic gardens across the country due to its striking colour. It is the most common botanical cause of contact dermatitis and bullous eruptions in Australia. [Reference]
A teenage girl is brought in via ambulance with vomiting and severe abdominal pain after eating some leaves and flowers from this plant. What is it? What toxic effects is she at risk of?
- Oleander trees are equally ubiquitous in gardens in Australia. Each part of the plant, flowers, leaves and stems, contain poisonous cardiac glycosides; similar to digitalis.
- Early effects are gastrointestinal: nausea, vomiting, abdominal pain and diarrhoea. Cardiac involvement is common, varying from ST and T changes up to 3rd degree heart block, VF and cardiac death. Weakness, dizziness, confusion and coma have been reported amongst other features. (see our tox page)
- Any of the sympathomimetic diet agents would give a similar presentation. The child was admitted given the potential risk of seizures and choreiform movements. Unsurprisingly her lack of appetite necessitated an NG for hydration support!
- Risk of Reye’s Syndrome.
- First described by Dr Douglas Reye in a report published in the Lancet in 1963 on a series of 21 children admitted to the Royal Alexandra Hospital for Children in New South Wales between 1951 and 1962 with acute encephalopathy and fatty changes in the liver.
- Although the original report did not mention salicylates, and that multiple subsequent studies have attempted to investigate a causal link between aspirin and encephalopathy in children with debateable findings, it is now culturally not appropriate to give aspirin to children.
- What is certain is that the incidence of Reye’s syndrome has decreased since the 1970s and 80s. Whether this is due to a reduction in the use of aspirin to treat fever in children with viral illnesses, or to an increase in earlier diagnosis of other inborn errors of metabolism is uncertain. However, now the only disease whereby aspirin is given to children is Kawasaki’s. [Reference]
- Slipped upper femoral epiphyses. [Reference]