Case presentation: A previously stable two-year-old boy was taken to the pediatric emergency department with an altered mental state. Around an hour after his lunch, his mother laid him down for a nap. Two hours later, when she went to check on him, he lay on the floor and could not be awakened from sleep. Medication history: Medication history reveals the administration of morphine for pain management. Investigations His vitals on arrival were as follows - Heart rate: 120 beats/min Blood pressure: 90/60 mmHg Oxygen saturation: 98% Respiratory rate: 24 Glucose: 16 mg/dl Physical examination revealed the following - Responsive only to painful stimuli.
Occasional moaning without any verbal communication. Eyes remain closed to tactile and verbal stimuli. The pupils were 3 mm, identical, and bilaterally receptive to light when opened manually. Reduced muscle tone. No skin infections,…