PW Health Clinic

[axe.effect]

Hey docs, need urgent advice...

my 4 year old son eaten up some of the AA battery cell as he chewed it in mouth... when i noticed i immediately cleaned his mouth, tongue and face. Still I suspect he ingested some of the carbon of the cell.... any idea what to do next to prevent any harm.. should i get him checked by a doctor or some thing to do at home?

Thanks.

Was it AA rechargeable or normal?. Both have several types and compositions.

Its written on cell about its composition (alkaline, lithium, NiMh etc). I think, by knowing the exact thing that he took will help doctors to give better advice.

[Glioblastoma]

Well. If it would have been liquid alkali ingestion I would have taken it seriously and in that case as well we dont go for EGD stat so as to avoid perforation. And the patient is usually kept under observation with respiratory support etc.

However in this special scenario, the cylindrical AA cells with powder alkali was swallowed with just the powder stuff taken in and nothing else. So it wouldnt matter much. And going for an USG or EGD in this case would be over treatment. So just keep in observation. Thats all.
If oral ulcers or irritation does happen let me know. Will treat that symptomatically.

Hope it helps.

Sorry to disagree with you here brother but only way to specifically tell the extent of any caustic ingestion is doing an EGD specially within 24hrs, gastrografin can be used but is not that much sensitive. The fear of perforation is only within the first few hours. So as the patient has made it so no problem of perforation and CXR and AXR will tell if its perforated already or not.

Yes in this case as patient is doing fine a lot of oral hydration is the way to go.

[Glioblastoma]

Was it AA rechargeable or normal?. Both have several types and compositions.

Its written on cell about its composition (alkaline, lithium, NiMh etc). I think, by knowing the exact thing that he took will help doctors to give better advice.

Either its acid or alkali ingestion treatment is the same therefore doesn't matter whether its rechargeable or not and what it contained.

You might be thinking if its an acid give alkali to neutralize it and vice versa as we learned in chemistry but NEVER EVER try it as it sets up an exothermic reaction further worsening the injuries.

[Glioblastoma]

Doctors input required...Is Uterine artery embolization treatment of uterine fibriods available in faisalabad??

Well I don't know if its available in Faislabad or not this requires high amount of expertise and specifically requires an interventional radiologist, which is hard to find and expensive even in Karachi.

My question is why do you specifically want to get a uterine artery embolization done? What is the age of patient? If she is past her child bearing age go for hysterectomy because it nullifies the chances of endometrial cancer.

[invincible_doc]

Sorry to disagree with you here brother but only way to specifically tell the extent of any caustic ingestion is doing an EGD specially within 24hrs, gastrografin can be used but is not that much sensitive. The fear of perforation is only within the first few hours. So as the patient has made it so no problem of perforation and CXR and AXR will tell if its perforated already or not.

Yes in this case as patient is doing fine a lot of oral hydration is the way to go.

Relax man. I never said EGD is not done. I just said its not done stat.
And perf can be judged more with clinical assessment as well. Anyways rx options and approaches vary. Hope the kid is fine hehe.

[nasirjavaid]

Well. If it would have been liquid alkali ingestion I would have taken it seriously and in that case as well we dont go for EGD stat so as to avoid perforation. And the patient is usually kept under observation with respiratory support etc.

However in this special scenario, the cylindrical AA cells with powder alkali was swallowed with just the powder stuff taken in and nothing else. So it wouldnt matter much. And going for an USG or EGD in this case would be over treatment. So just keep in observation. Thats all.
If oral ulcers or irritation does happen let me know. Will treat that symptomatically.

Hope it helps.

Was it AA rechargeable or normal?. Both have several types and compositions.

Its written on cell about its composition (alkaline, lithium, NiMh etc). I think, by knowing the exact thing that he took will help doctors to give better advice.

Sorry to disagree with you here brother but only way to specifically tell the extent of any caustic ingestion is doing an EGD specially within 24hrs, gastrografin can be used but is not that much sensitive. The fear of perforation is only within the first few hours. So as the patient has made it so no problem of perforation and CXR and AXR will tell if its perforated already or not.

Yes in this case as patient is doing fine a lot of oral hydration is the way to go.

Either its acid or alkali ingestion treatment is the same therefore doesn't matter whether its rechargeable or not and what it contained.

You might be thinking if its an acid give alkali to neutralize it and vice versa as we learned in chemistry but NEVER EVER try it as it sets up an exothermic reaction further worsening the injuries.

Relax man. I never said EGD is not done. I just said its not done stat.
And perf can be judged more with clinical assessment as well. Anyways rx options and approaches vary. Hope the kid is fine hehe.

Thank you all for your input. The cell was normal AA cell used in remote controls. not rechargeable or nimh etc..
The kid was given ice cream and lots of liquid including milk. At night he was a bit uneasy sleeping (but that could be due to ice cream as he had a bit flu and cough already)..
At night he went to toilet and feces were little dark in color and bit hard. but overall no other major signs... he is sleeping and looks fine....

any further suggestions will be highly appreciated... do i still need to get him checked by some doc or hospital? any tests or its ok?

[Glioblastoma]

Relax man. I never said EGD is not done. I just said its not done stat.
And perf can be judged more with clinical assessment as well. Anyways rx options and approaches vary. Hope the kid is fine hehe.

Obviously bro there will sometimes be a difference of opinion and I respect your opinion as well, we are all here to help. Hope there are no hard feelings

[Glioblastoma]

Thank you all for your input. The cell was normal AA cell used in remote controls. not rechargeable or nimh etc..
The kid was given ice cream and lots of liquid including milk. At night he was a bit uneasy sleeping (but that could be due to ice cream as he had a bit flu and cough already)..
At night he went to toilet and feces were little dark in color and bit hard. but overall no other major signs... he is sleeping and looks fine....

any further suggestions will be highly appreciated... do i still need to get him checked by some doc or hospital? any tests or its ok?

Looks fine at the moment. Just be sure to observe for breathing difficulty any wheezing or abnormal breathing sounds, vomiting specially bloody, any belly pain and consistently passing dark stools.

[invincible_doc]

Obviously bro there will sometimes be a difference of opinion and I respect your opinion as well, we are all here to help. Hope there are no hard feelings

Oh nahin. Not at all. This is very normal in every profession. At least this discussion is of use and help for someone in need.

We posted such a long explanation regarding one raised prolactin query and it was removed. That surely hurt. Lol.

[Glioblastoma]

Oh nahin. Not at all. This is very normal in every profession. At least this discussion is of use and help for someone in need.

We posted such a long explanation regarding one raised prolactin query and it was removed. That surely hurt. Lol.

Thanks.

Agreed on that prolactin issue, but I think to be fair to the mod it was getting too public and patient privacy was being dented. But how can one help without knowing patient issues.

[invincible_doc]

Thanks.

Agreed on that prolactin issue, but I think to be fair to the mod it was getting too public and patient privacy was being dented. But how can one help without knowing patient issues.

No doubt. Thats why my initial reply was to PM me the details which the patient never bothered doing. Hehe

[nasirjavaid]

Looks fine at the moment. Just be sure to observe for breathing difficulty any wheezing or abnormal breathing sounds, vomiting specially bloody, any belly pain and consistently passing dark stools.

He is fine all day, no breathing issues, no wheezing or abnormal breathing, no vomiting and no pain ma sha Allah.... Stool is less dark than the previous and much close to normal...

He is alot active and remained fit all day... gave him ice cream last night and plenty of liquids.. He himself also, like a cat, keeps up his treatment by eating all sorts of stuff like fresh carrots, reddish and even onions and I heard onions are good for poisonous things

Also guava is also said to remove poisonous stuff out of belly so gave him a guava today ...

Cheers!

[Glioblastoma]

He is fine all day, no breathing issues, no wheezing or abnormal breathing, no vomiting and no pain ma sha Allah.... Stool is less dark than the previous and much close to normal...

He is alot active and remained fit all day... gave him ice cream last night and plenty of liquids.. He himself also, like a cat, keeps up his treatment by eating all sorts of stuff like fresh carrots, reddish and even onions and I heard onions are good for poisonous things

Also guava is also said to remove poisonous stuff out of belly so gave him a guava today ...

Cheers!

Good to know

[nasirjavaid]

Good to know

Thanks. But now he caught flu after eating ice cream ... @invincible_doc

[addikted]

Asalamualikum
can anyone tell me what medicine are available for ADHD/ADD in PAKISTAN
Jazaka Allah

[Glioblastoma]

Asalamualikum
can anyone tell me what medicine are available for ADHD/ADD in PAKISTAN
Jazaka Allah

1st line treatment Methylphenidate comes by name of ritalin, methril, phenida.

2nd line treatment Atomoxetine by name of Strattera, attentra.

These drugs are not available on small stores only on big stores and hospitals and are not given without prescription, that also from only psychiatrist or neurologist. General physician or child specialist prescription wouldn't work.

Do not diagnose ADHD without reffering to a child psychiatrist or a good psychiatrist if a child psychiatrist is not available in your area but you are in islamabad so it would be easy to find one. Most of neurologists, psychiatrists and child specialists in pakistan donot know how to diagnose ADHD and how to manage it.

[addikted]

1st line treatment Methylphenidate comes by name of ritalin, methril, phenida.

2nd line treatment Atomoxetine by name of Strattera, attentra.

These drugs are not available on small stores only on big stores and hospitals and are not given without prescription, that also from only psychiatrist or neurologist. General physician or child specialist prescription wouldn't work.

Do not diagnose ADHD without reffering to a child psychiatrist or a good psychiatrist if a child psychiatrist is not available in your area but you are in islamabad so it would be easy to find one. Most of neurologists, psychiatrists and child specialists in pakistan donot know how to diagnose ADHD and how to manage it.

thank you so much

[Vajih102]

I'll add to this discussion. @Vajih102, most drops basically have a diluted concentration of hydrogen peroxide. It creates a fun bubbling sensation as it dissolves the wax in your ear.

My personal favorite solution is to buy a wax removal syringe such as this: http://www.amazon.com/Health-Enterprises-Ear-Removal-Syringe/dp/B000SOJXGA/ref=sr_1_1?ie=UTF8&qid=1423048885&sr=8-1&keywords=ear+wax+syringe

Basically you squirt water into your ear to flush out whatever wax buildup you have. You can use peroxide to flush your ears, or even hot water.

Interesting. Thanks.

[addikted]

@Glioblastoma is Adderall also good for ADHD and is it available here?

[Glioblastoma]

@Glioblastoma is Adderall also good for ADHD and is it available here?

Yes its also the 1st line treatment like methylphenidate both come from the same drug that is amphetamine. But to my knowledge its not available here, ask the store or hospital that has the drugs for ADHD.

Problem is adderall(amphetamine and dextroamphetamine) as well as methylphenidate both are addictive substances and have high abuse potential therefore they are highly controlled substances in developed world. Atomoxetine however has very low abuse potential.

If the person who is suggesting you the drugs is living outside Pakistan then he will not know what is available here or not. As i previously mentioned better to show the patient to a good child or general psychiatrist.