Shake It Up! What's Going On?

This is the case of a 4-year-old girl who presented to the emergency department with acute development of seizures and respiratory failure. The patient had sustained full thickness burns a few days prior covering 20% total body surface area. She was treated with home topical therapies including a lidocaine containing gel. She had resultant lidocaine toxicity and hyponatremic, hypochloremic dehydration. This case report reviews the differential diagnosis of decreased mental status and seizures. The patient's diagnoses of lidocaine toxicity, full thickness burns, dehydration, and child abuse are discussed. Lidocaine toxicity is reviewed including mechanism of action, signs and symptoms, and treatment.