A dire condition and a call to poison control

At first, nothing seemed too unusual about the call I received one day last year from the Philadelphia Poison Control Center. As a toxicology fellow at Einstein Healthcare Network, I'm on call to help manage drug overdoses, interpret drug toxicities, and solve puzzles involving unusual reactions to medications.

A 3-year-old boy was in intensive care at another hospital with symptoms his doctors considered life-threatening, including a low heart rate, low blood pressure, lethargy, and a depressed mental state.

Earlier in the week, the boy's mother had taken him to the hospital and told the staff the child's grandmother had given him gelsemium, a homeopathic remedy for fever. He soon recovered and was sent home from the hospital.

Two days later, however, the child was readmitted with similar symptoms, including hypotension and small pupils. His mother gave the same explanation. As the day progressed, the boy got better. But after he had dinner with his mother, he was worse.

That's when the hospital called poison control.

Part of my training is to identify a toxidrome - a constellation of signs and symptoms that suggest a certain poison. When we don't know what a patient might have ingested, we look for symptoms that fit a toxidrome to guide us independent of the oral history we have been given, which can be unreliable. This is especially important when we're working over the phone and can't physically examine the patient.

The child's symptoms suggested he somehow was receiving an opiate or a class of medications that include agents that treat blood pressure in adults and ADHD in kids, and that are the active ingredient in over-the-counter eyedrops. I suggested the medical team determine whether the boy's mother had any such medications in her possession.

Hospital staffers believed the mother's version of events, especially because she seemed a caring, concerned parent. But they did as I asked and learned she was carrying Visine in her purse.

Once I heard about the eyedrops, I suggested it was time to call the police and report a suspected case of medical child abuse.

Not surprisingly, hospital staffers were skeptical. I hadn't even seen the child, and I was telling them I suspected his mother was poisoning him.

But as they talked more to the mother and heard about her hostilities with the grandmother, they agreed to call the authorities.

With help from Heather Borek, M.D., my attending physician at Einstein, and the Poison Control Center at Children's Hospital of Philadelphia, I sent the police numerous articles and resources and guided their forensic testing.

They confirmed that tetrahydrozoline, the active ingredient in Visine, was in the boy's urine, in his sippy cup, and in other bottles at home.

Ultimately, the mother, 23, of Franklin Township, Adams County, was arrested on charges of attempting to poison both of her children. The 1-year-old got sick after drinking a bottle she had prepared for his older brother.

Samantha Elizabeth Unger admitted she put Visine in her child's water and juice in an effort to incriminate her mother, according to media reports. She pleaded guilty and was sent to prison.

As a consultant with the Poison Control Center, I don't always find out how cases come out, whether my suggestions are followed, or whether my suspicions are proved. So it was especially gratifying to know I helped save this child's life, and possibly that of his brother, all through a telephone consultation.

The story also shows that the Poison Control Center is much more than just a hotline for parents to call when their child ate something he or she shouldn't have. The center helps people of all ages and backgrounds with potential poisoning-related events - including helping doctors with complicated cases such as this one. Contact the center toll-free at 1-800-222-1222.