Massive hepatic gas embolism from a health food additive

Abstract

A 6-year-old boy was at his grandmother's house and went into the refrigerator to get a glass of water. After drinking a glass full of a clear liquid, the child immediately began vomiting clear foamy liquid. After several bouts of vomiting, a small amount of blood was seen in the vomitus. The grandparents brought the child to the Emergency Department. On evaluation the child was in moderate distress from retching, but he was otherwise alert and cooperative. He was afebrile with a pulse of 92 beats/min, blood pressure of 94/60 mm Hg, and respiratory rate of 36 breaths/min. He had a red tympanic membrane on the right, but the remainder of the ENT examination was normal. The airway was patent and well maintained, the lungs were clear to auscultation, but the abdominal examination was tender in the epigastric area. Promethazine (Phenergan) was given intravenously for vomiting with resolution of symptoms. The laboratory tests were unremarkable. (Na 142 umol/L, K 4.1 umol/L, CL 106 umol/L, CO2 26 umol/L, BUN 12 mg/dL, Creatinine 0.5 mg/dL, Glucose 83 mg/dL, AST 25 U/L, Alkaline phosphatase 194 U/L, Bilirubin 1.1 U/L, WBC 6.7, Hematocrit 38.8 %).