title: Hypovolemic shock due to severe gastrointestinal bleeding in a child taking an herbal syrup.
abstract: We report the case of a 4-years-old boy who was admitted with hypovolemic shock due to a severe gastrointestinal bleeding. The esophagogastroduodenoscopy (EGDS) showed hiatus hernia, erosions and ulcerations of the lower esophagus, possibly due to a gastroesophageal reflux, and a small duodenal erosion. The child was previously healthy and he had never shown any symptoms related to this condition. The only product taken by the child in the previous days was a syrup containing several herbs, among which Filipendula ulmaria (L.) Maxim. and Salix spp. (known to contain salicylates), marketed as food and prescribed by his paediatrician to treat a mild cold accompanied by fever. Quali-quantitative analysis confirmed the presence of salicylates in the syrup. Naranjo algorithm showed a probable correlation between the onset of symptoms and the consumption of the herbal remedy. The child recovered after receiving intensive care. The product was withdrawn from Italian market.
authors.affiliation: Centro Antiveleni, Ospedale Niguarda Ca' Granda, Milan, Italy. paola.moro@ospedaleniguarda.it
authors.forename: Paola Angela
authors.initials: PA
authors.lastname: Moro
authors.forename: Valerio
authors.initials: V
authors.lastname: Flacco
authors.forename: Federica
authors.initials: F
authors.lastname: Cassetti
authors.forename: Valentina
authors.initials: V
authors.lastname: Clementi
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Colombo
authors.forename: Giulia Maria
authors.initials: GM
authors.lastname: Chiesa
authors.forename: Francesca
authors.initials: F
authors.lastname: Menniti-Ippolito
authors.forename: Roberto
authors.initials: R
authors.lastname: Raschetti
authors.forename: Carmela
authors.initials: C
authors.lastname: Santuccio
mesh_terms: D002675:Child, Preschool; D002851:Chromatography, High Pressure Liquid; D003139:Common Cold / Q000150:complications / Q000188:drug therapy; D003422:Critical Care; D056736:Drug Recalls; D016145:Endoscopy, Digestive System; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000150:complications*; D006551:Hernia, Hiatal / Q000150:complications / Q000473:pathology; D006801:Humans; D007558:Italy; D008297:Male; D028321:Plant Preparations / Q000009:adverse effects*; D012015:Reference Standards; D012459:Salicylates / Q000009:adverse effects / Q000032:analysis; D012769:Shock / Q000209:etiology* / Q000473:pathology
chemical_list: D028321:Plant Preparations; D012459:Salicylates