Child reaching for pills on a high shelf, symbolizing the dangers of accidental medication ingestion.

When Medicine Becomes Misadventure: A Toddler's Accidental Overdose

Reese Marlowe in Health & Wellness August 2025 • 3 min read.

"A Case Report on Cholinergic Crisis and Tetraplegia Following Pyridostigmine Intoxication"

Medication safety is paramount, especially in households with young children. While medications are intended to heal and improve quality of life, accidental ingestion can lead to severe and life-threatening consequences. This article explores a case report that highlights the dangers of accidental pyridostigmine overdose in a toddler, shedding light on the rapid onset of cholinergic crisis and the importance of immediate medical intervention.

Pyridostigmine is a medication commonly prescribed to treat myasthenia gravis, an autoimmune disorder that causes muscle weakness. It works by preventing the breakdown of acetylcholine, a neurotransmitter that helps muscles contract. While it's a crucial medication for those who need it, pyridostigmine can be extremely dangerous if ingested accidentally, particularly by children.

In this article, we will delve into a case where a 2.5-year-old boy experienced a severe reaction after ingesting his mother's pyridostigmine medication, which lead to cholinergic crisis and tetraplegia.

The Case: A Toddler's Unexpected Crisis

Child reaching for pills on a high shelf, symbolizing the dangers of accidental medication ingestion.

The case report details how a 2.5-year-old boy accidentally ingested his mother's pyridostigmine, a medication she took for myasthenia gravis. At the time of discovery, 19 tablets (totaling 1140mg) were missing, and the child admitted to ingesting them. Within an hour, the toddler's condition rapidly deteriorated.

The symptoms progressed quickly, leading to:

Vomiting and loss of muscle tone
Presentation to the hospital in a tetraplegic condition (paralysis of all four limbs)
Drooling and increased bronchial secretions
Miosis (excessive constriction of the pupils)

Despite these alarming symptoms, the toddler's respiratory muscle function and circulatory functions remained stable, which was a crucial factor in his eventual recovery.

Key Takeaways: Prevention and Vigilance

This case underscores the critical importance of safe medication storage and handling, especially in households with young children. Medications should always be stored out of reach and sight of children, preferably in locked cabinets or containers.

Parents and caregivers should be educated about the potential dangers of accidental ingestion and the importance of seeking immediate medical attention if it occurs.

While this case had a positive outcome, the rapid onset of severe symptoms highlights the need for vigilance and proactive measures to prevent accidental medication overdoses in children. Raising awareness and promoting safe medication practices are essential steps in protecting our youngest and most vulnerable populations.

About this Article -

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Everything You Need To Know

What is Pyridostigmine and what is its purpose?

Pyridostigmine is a medication primarily used to treat myasthenia gravis, an autoimmune disorder that causes muscle weakness. It works by inhibiting the breakdown of acetylcholine, a neurotransmitter essential for muscle contraction. In the context of this case, the accidental ingestion of pyridostigmine by a toddler resulted in a severe reaction because the medication, while beneficial for those with myasthenia gravis, is toxic at high doses, leading to a cholinergic crisis and tetraplegia.

What is a cholinergic crisis, and what were the signs of it in the toddler?

A cholinergic crisis is a severe overstimulation of the cholinergic system, typically caused by an overdose of medications like pyridostigmine that increase acetylcholine levels. The toddler's symptoms, including vomiting, loss of muscle tone, tetraplegia (paralysis of all four limbs), drooling, increased bronchial secretions, and miosis (constriction of the pupils), are all indicative of this crisis. The severity of the cholinergic crisis in this case highlights the dangers of medication safety and the rapid impact of pyridostigmine overdose in young children.

What is tetraplegia, and how did it relate to the toddler's condition?

Tetraplegia, also known as quadriplegia, is the paralysis of all four limbs. In this case, the toddler developed tetraplegia as a direct result of the cholinergic crisis caused by pyridostigmine overdose. The paralysis underscores the dangerous effects that can result from accidental ingestion of this medication. The fact that his respiratory and circulatory functions remained stable was crucial for his survival and recovery.

What is the key takeaway about medication safety from this case?

The case highlights the critical importance of medication safety, especially in households with young children. It is vital to store medications, such as pyridostigmine, out of sight and reach of children, ideally in locked cabinets or containers. This will help prevent accidental ingestion and the severe health consequences that can follow, like the cholinergic crisis and tetraplegia seen in the toddler. Careful medication storage is a crucial step in protecting children from potentially life-threatening situations.

Why was immediate medical intervention so important in this situation?

The immediate medical intervention was vital for the toddler's eventual recovery. While the article doesn't explicitly detail the treatment, the fact that the child's respiratory muscle and circulatory functions remained stable played a key role in his recovery. Prompt medical attention and supportive care are essential when dealing with pyridostigmine overdose, as it can lead to severe complications, including the cholinergic crisis and subsequent tetraplegia. This case underscores the importance of seeking immediate medical help if accidental ingestion is suspected.