Happy New Year!
A 17-month-old boy is brought in by his mother approximately 20 minutes after getting into her “beauty cream”.  Mother reports that the child was found with an open tube of skin cream, smeared on his face and mouth; according to mother, approximately one-quarter to one-half of the tube could have been ingested.  He vomited once “with all of the excitement”, but has not vomited since.
You see a happy, drooling, active toddler with normal vital signs and a normal general exam.  He has some mild erythema and irritation of the lips and buccal mucosa, but is tolerating his secretions, and drinking juice in the ED.  
On further questioning, the family is originally from Nigeria, and she uses the cream from back home as a skin lightener.
Regarding this child’s assessment and management, which of the following is the BEST answer:

A.    After NS bolus, give 1mEq/kg sodium bicarbonate IV followed by 1.5 maintenance of sodium bicarbonate infusion
B.    Start DMSA 10 mg/kg PO
C.    Observe the child for four hours and if asymptomatic, discharge home
D.    Admit for upper endoscopy

In the meantime, a quote –
“All who drink of this remedy recover in a short time, except those whom it does not help, who all die.  Therefore, it is obvious that it fails only in the incurable cases.”
-- Galen, Roman physician (AD 130-200)


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