An 18-month-old, previously healthy boy presented to the emergency department with progressive lethargy and protracted emesis approximately 18 hours after ingestion of an unknown medication.
His mother had seen pills in his hands the previous night, but thinking the medication was harmless, did not seek medical attention. The child was asymptomatic at that time. He awoke 8 hours before admission with emesis and nonbloody diarrhea and became progressively lethargic. Pills and pill fragments were in his stool.
On physical examination, he was afebrile and had a pulse of 122 beats per minute. His respiratory rate was 32 breaths per minute. Blood pressure was 108/69 mm Hg. He was lethargic, but could be aroused, and had cool extremities. Examination of the abdomen revealed active bowel sounds and diffuse tenderness to palpation. Results of a test to detect occult blood in stool were negative. Except for changes in mental status, results of