The Poison Review

Coma in a 20-Month-Old Child From an Ingestion of a Toy Containing 1,4-Butanediol, A Precursor of γ-Hydroxybutyrate. Ortmann LA et al.  Pediatr Emer Care 2009;25:758-760.

Abstract

This is a very interesting case report describing a child who became comatose after ingesting plastic Aqua Dot beads. As has been well-publicized, the manufacturer of this toy in China substituted 1,4-butanediol (1,4-BD) for the more costly 1,5-pentanediol. In the body, 1,4-BD is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase to γ-hydroxybutyrate (GHB).  This child became comatose (GCS = shortly after ingesting the beads, did not require intubation, and awoke suddenly about 5 hours after presentation.  The authors’ conclusion: “Health care providers should suspect the possibility of a toxic component when an otherwise presumed nontoxic object (such as a plastic toy) causes unusual symptoms and consider consultation with a toxicologist.”

To read my column on Aqua Dots in Emergency Medicine News, click here.