Tuesday, September 8, 2009

Cash Baby


A mother brought in her 8 month old baby today for "breathing difficulty." She stated that for the last 2 months her child had been breathing worse and worse. He had a non productive cough and no fever. They had been to her pediatrician multiple times. Despite treatment with medicines, including breathing treatments, the child was getting worse. When she went to see her doctor today...she realized the baby had lost 4 pounds in the last 2 months...so she decided to come to the ER for a second opinion.

Up until his presentation today, no one had ordered a chest x ray. A similar CXR to my patients is pasted above.

So the diagnosis was easy. Swallowed a coin. Consult for endoscopy....


But if ya think of it....this doesn't really make sense. The kid has been losing weight so I am confident that the coin was probably the culprit. But how does a baby that small swallow a coin? We are taught that a coin that is swallowed but doesn't make it to the stomach is a surgical emergency. But presumably the child swallowed this coin 2 months ago?!?! That means by now the child would have been septic, had a perforated or eroded his esophagus, the list could go on and on.


So....I'm stumped. Don't know if the swallow was recent and a red herring to what was really going on, or if he swallowed it 2 months ago and is some kind of miracle baby. He was admitted to the hospital to have the coin removed and further workup. I'll have to follow up and see what comes out of it.


-ER Doc


9 comments:

Anonymous said...

As a grandmother and old peds nurse, I can assure you that from about five-six months when the little booger can pick up small items with their little hands, EVERYTHING goes into the mouth to be explored.....Trisha

Bronco said...

If he has breathing difficulty then the coin is probably in his trachea and not the esophagus. Would also explain the productive cough and the reason why he is not septic or has perforated his esophagus yet.

ERP said...

Right - I bet it is in the trachea.

Can'tSpell, DVM said...

If it is a penny or nickel minted before a certain year they can get zinc toxicosis... might explain your weight loss.

Anonymous said...

Just working on the President's ideas of hope and CHANGE!

numskull said...

Tell the Kid to put his arm up then quickly pull it down. If you're lucky the change might come out.

cynic said...

There is plenty of literature on this, feel free to continue on if you are bored.

http://emedicine.medscape.com/article/1001253-overview

http://emedicine.medscape.com/article/405994-overview

retdlawdoc said...

Picture is most consistent with esophageal coin, but this illustrates why laterals should be done. That would answer the question definitively. Coin in esophagus is an emergency because of the risks of aspiration and inanition. Your patient illustrates the well known adage that each patient is different and rules of thumb are just guidelines. I assume the child had an uneventful course after the coin was removed.

Anonymous said...

So what became of the baby???? Inquiring minds need to know. (As a mom, I can totally relate. You can't watch them every second. Even if you wanted to do so, it's impossible. This is especially true if you have a toddler and a baby. Babies demand and toddlers wander. Bad combo. I know. My toddler gobbled nightshade berries.)