A 3-year-old child sleeping in a hut woke up in the middle of the night screaming. Her mother thought the child had a nightmare and tried to pacify her. After sometime, she noticed that the child was sweating profusely and the hands were becoming cold. She vomited a couple of times. The mother immediately rushed her to the emergency services. Her pulse was 150/minute and her BP 90/60 mmHg. This child is likely to have: COMEDK 14

Okay, let's tackle this question. The scenario is a 3-year-old child who woke up screaming, had sweating, cold hands, vomiting, tachycardia, and hypotension. The key here is to figure out the most likely cause. The mother thought it was a nightmare, but the symptoms are more severe.

First, the symptoms: sudden onset during sleep, screaming, profuse sweating, cold extremities, vomiting, and vital signs showing tachycardia and low BP. These are signs of a possible acute condition. The age is important here. At 3 years old, common issues might include infections, metabolic disorders, or neurological events.

Sweating and cold hands could point to hypoglycemia, especially if it's a young child. Hypoglycemia can cause autonomic symptoms like sweating, tachycardia, and if severe, altered mental status. Vomiting might be a result of the body's response to low glucose or another underlying cause. The tachycardia and hypotension suggest a compensatory response to hypoperfusion, which can occur in hypoglycemia if it's severe enough.

Another possibility is a seizure or a postictal state, but the mother would likely have noticed convulsions. Nightmares usually don't cause such physical symptoms. Meningitis could present with fever, but there's no mention of fever here. Also, the rapid onset and symptoms point more towards an acute metabolic issue rather than an infection.

Hypoglycemia in children can be due to various causes like fasting, certain medications, or underlying metabolic disorders. The child was sleeping, so maybe she hadn't eaten in a while, leading to hypoglycemia. The sweating and tachycardia are classic signs of the body trying to compensate for low glucose levels. Vomiting could be a result of the body's stress response or the hypoglycemia itself affecting the central nervous system.

Now, looking at the answer choices. The correct answer is likely hypoglycemia. The other options like meningitis, seizures, or poisoning would have different presentations. Meningitis would have fever and neck stiffness; seizures would have convulsions. Poisoning might be possible if there's a known exposure, but the question doesn't mention that. The cold hands and hypotension are more consistent with hypoglycemia leading to shock.

So, the core concept here is recognizing hypoglycemia in children based on symptoms and signs. The key is the acute presentation with autonomic symptoms and cardiovascular signs. The clinical pearl is to consider hypoglycemia in a child with sudden onset of sweating, tachycardia, and hypotension, especially if they're not eating well or have a history of fasting.

**Core Concept**
This question tests recognition of acute hypoglycemia in a pediatric patient. Hypoglycemia in children can lead to autonomic symptoms (sweating, tachycardia), neuroglycopenic symptoms (confusion, vomiting), and cardiovascular instability (hypotension) due to impaired glucose delivery to the brain and compensatory adrenergic responses.

**Why the Correct Answer is Right**
The child’s presentation—sudden nighttime awakening, sweating, tachycardia (150 bpm), hypot

✓ Correct Answer: B. Scorpion bite