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Introduction
Aspiration is defined as an accidental entry of a foreign substance into the respiratory tract.1 Foreign body aspiration in children carries a high risk of morbidity and mortality; 5% of unintentional deaths among children younger than 4 years of age are due to mechanical suffocation,2 The aspirated material consists of either organic substances such as peanuts, popcorn, hot dogs, or vegetables, or nonfood materials such as balloons, coins, pen tops, and pins.3-5 We report a case of aspiration of cocoa powder by a 4-year-old that resulted in reactive airway disease leading to acute respiratory failure.
Patient Report
The patient was a previously healthy 4-year-old male who attempted to swallow a teaspoon heap full of chocolate powder that his mother was using to prepare brownies. The child started to choke and gag immediately. He developed cyanotic lips and difficulty in breathing. His mother activated emergency medical service who took him to a nearby emergency room. The child was born 5 weeks early but was not intubated nor received supplemental oxygen in the newborn period. Significant past medical history included an episode of respiratory syncytial virus (RSV) bronchiolitis as an infant for which he was hospitalized for supportive care and close monitoring. RSV bronchiolitis was followed by a few episodes of reactive airway disease that were treated with nebulized albuterol. However, the patient had not required bronchodilator treatment for the past 2 years. The patient was not receiving any medications and had no known drug, food, or environmental allergies. His development was appropriate for age. He lived at home with his parents and 3 siblings aged 8 years, 2 years, and 5 months, respectively. The family history was unremarkable.
The child was noted to be in respiratory distress with hypoxemia in the outside emergency room. A chest radiograph was unremarkable. he was given 2 nebulized Xopenex treatments, decadron IV, and oxygen by face mask without much improvement and was subsequently transferred to our Pediatric Critical Care Unit. Arterial blood gas values before transfer were as follows: fraction of inspired oxygen (FIO^sub 2^) 1.00, pH 7.26, partial pressure...