Author: Sarat Naidu, Fatima Seedat, Shanthi Siva / Editor: Jessie Lynch / Codes: / Published: 07/05/2025
A 14-year-old boy is brought to the Emergency Department (ED) by his mother with a history of abdominal pain, nausea and multiple episodes of vomiting for the past two hours. He has no fever or diarrhoea.
He was feeling unwell in school and vomited in class. The teachers noticed some fresh green leaves in the vomitus.
He admits that he is under lot of pressure at the moment due to his ongoing exams, and that he had an argument with his parents this morning before school; on the way to school he intentionally consumed some foxglove plant leaves to harm himself. He was fully aware that the foxglove plant is poisonous. He did not take any other substances or alcohol.
He has no significant medical history and is not on any regular medications.
On examination, he is quiet and withdrawn, with a Glasgow coma score of 15/15 and no neurological deficit. His abdomen is soft & non-tender but he is continuously empty retching. His cardiorespiratory examination is normal.
His vital signs are:
- Heart rate 83 beats per minute
- Blood pressure 122/86mmHg
- Respiratory rate 20 breaths per minute
- Oxygen saturations 98% on air
- Temperature 36.7 C
His initial ECG shows sinus arrhythmia, and he has a minimally raised troponin level of 0.20ng/ml (normal is < 0.01 ng/ml).
At 6 hours post ingestion, he has multiple further episodes of vomiting in the ED and becomes bradycardic with a heart rate of 52 beats per minute. His repeat ECG shows junctional bradycardia.
