Phenergan Supp given to toddler; child dies

I WAS an RN in NICU (taking some time off to raise a family). I am unfamiliar with Phenergan. Obviously we did not use it in my area.

I have a very tragic situation....A very good friend of mine brought her toddler to our local ER for vomitting and dehydration from viral Gastroenteritis. The child was under two and small for her age (9.5 kg). After waiting more than two hours with symptoms worsening (vomitting blood), her child was given a Phenergan suppository 12.5. No IV was given. No exam was performed. My friend think it was actually the 50 dose based on the color of the packaging and size of the supp. Later, when her daughter coded, the child was given Epinephrine (excessive dose). I have been able to find out that Epi contraindicates with the Phenergan (Lippincott). Her child died. She had me look over the records and the Phenergan stuck out.

What has been your experience with Phenergan supp in pediatric patients? Thanks for your input.....Mom23

This toddler came into the ER at approx. 1630, with vomiting since o600. Was lethargic and dehydrated. How is triaging handled in the ER? Why would they withold IV fluids for so long? Heplock started at 1830 but no fluids? Doesn't this sound negligent from the beginning with no complete assessment? The questions about the phenergan are just one issue in this case.

Yep, yep, yep. When learning the emergency care of children, that is one of the things they drill into your head. Kid's vital signs can be completely normal for a very long time as their bodies compensate for things like hypovolemia. Then they get to a point where they can't compensate anymore...and they just crash. So I agree, any child that has been vomiting that much (to the point of vomiting blood) and had a heplock already in place should have gotten some IV fluids. A bolus, a running line, something, anything. Dehydration is deadly in children, and the smaller they are, the harder it can hit them. This stands out to me much more than the phenergan suppository.

My 10 month old grandson went in to the ER with N&V, and was diagnosed with gastroenteritis. Got very lethargic after we finally got him back to a room. After reading these posts, it makes me realize how lucky we were that they started fluids on him right away and gave him a Phenergan supp. about an hour later with no ill affects.

This is such a devastating situation for your friend. My heart goes out to her. The loss of a child is overwhelming, to say the least.

even if there was an error in the dosage of phenergan, whether it was the order itself, or the nurse's error, i truly believe this child's demise was a result of lack of fluids. dehydration kills children. they simply can not handle a lot of volume loss bc of their size. the child should have received iv fluids promptly and before any other intervention.

it is the pals standard of care.

my sympathy to you, your friend and her family.

trish
pals cert

My condolences to you and your friend for the loss of a child. I had a somewhat similar experience. My toddler who was 2 1/2 was vomitting in the morning on and off for weeks and we were told by the pediatrician that it was most likely Motrin induced gastritis. I had been giving him motrin and tylenol on and off because he had been cutting molars and kept complaining that his "mouth hurts." After a few more weeks of vomiting we went back to the pediatrician and he gave my son a phenergan injection for the vomiting. He told me it would make him very drowsy for several hours. My son indeed was very drowsy all afternoon and barely woke up to get into pjs for the night and take little fluids so as not to dehydrate. I fully expected him to wake up in the middle of the night ready to go for the day. He did not. At 6:30am when his twin woke up we could not wake the other toddler. He was completely unresponsive. We called the doctors office and 911 and began CPR as he started to turn blue in our arms. He went into respiratory depression and into a coma. We also found out at the same time that he had a brain tumor as well. He went into multiple cardia arrests and respiratory arrests all day long. We took him off of life support two days after. The pediatrician at the childrens hospital was very upset that the pediatrician had given my son phenergan as she said it was contraindicated for a child that small. I realize my child had a terminal illess that we did not know about, but I do believe the respiratory arrest led to his immediate death.

I understand and can sympathize with loss of a child so unexpectedly. Its been very difficult for our family.

God Bless.

So it sounds like the Triage nurse is at fault for not recognizing that the child should have been bolused quickly and been evaluated more quickly. Very sad, very scary. I'm so sorry for the pain and sadness and I hope they will take legal action because this was a preventable death and calling attention to it will help prevent similar events in the future, I hope.

no, not the triage nurse, the ER PHYSICIAN.

But wasn't it up to the nurse to get the doc to attend to the child?

Blame does no real good but I'm trying to analyze where the fatal error really occurred.