Fatal pediatric polypharmacy ingestion: A case of refractory hypotension and multiorgan failure

ABSTRACT Acute poisoning in children continues to be a significant global health concern, frequently resulting in emergency department (ED) visits and posing risks of morbidity and mortality. Fatality in children is still low, but unfortunately, our case had resulted in death. A 16-month-old previously healthy male presented 10 h after the accidental ingestion of multiple medications: including antihypertensives (lisinopril, bisoprolol, and amlodipine), aspirin, and lipid-lowering agents (ezetimibe and atorvastatin) and initially exhibited only mild symptoms. However, within 1 h of observation in the ED, his clinical condition deteriorated rapidly, progressing to severe hypotension, metabolic acidosis, and multiorgan dysfunction despite aggressive fluid resuscitation, escalating vasopressor support, high-dose insulin euglycemia therapy, and lipid emulsion therapy. The patient ultimately passed away on Day 6 postingestion. This case underscores the complexity of managing pediatric polypharmacy poisoning and emphasizes the critical need for early presentation and recognition, prompt aggressive management, and preventive measures to avert such fatal outcomes.