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The Double Edged Sword

My son accidentally ingested peanut butter yesterday.  He’s allergic.

He’s done this once before, which is when we found out about the allergy.  He had some really awful hives 3 hours after he ate that small bite of peanut butter sandwich but that was all.  His allergist told me that it would most likely never get worse than that.

He managed to eat some more yesterday.  I braced myself for the hives to come, and we dosed him with Benadryl.  An hour later he vomited.  The pediatrician’s advice nurse advised me to take him to the ER.  At the time I thought it was overkill.  He wasn’t having any breathing difficulties beyond the cough he already had (he has a cold).  He definitely wasn’t acting quite right, though, so off we went.

I barely made it down the street before he started having very long coughing fits.  He was breathing okay in between, but he just kept coughing so much.  He couldn’t go more than 10 seconds without coughing.  About a mile from the hospital (this is probably 1 1/2 hours after ingestion) he started putting his fingers in his mouth but wouldn’t tell me why.  Itchy tongue?

It was the longest ride of my life.  Traffic, red lights.  Imagine being the 13th car at a red light when you have an emergency!  Of course there was no parking when I got to our nearest ER.  I hastily parked in a “reserved” space (sorry, director of geriatric services) and ran in.  Although the waiting room appeared to be full, there was no line at registration.  When I put him on the counter, I noticed that his lips were bluish.  I told the lady at registration and he was in triage within about 30 seconds.

I was a little hesitant to come to this hospital.  About a year ago I had a panic attack, which I had never had before.   I had been hyperventilating for a couple of hours (due to a reason not related to the panic attack) and then it occurred to my CCU trained brain that hyperventilating for a few hours might be Very Bad for my serum pH level.  This made everything exponentially worse and I was immediately convinced that I was going to die.  Convinced. It didn’t occur to me that debating whether my pH was above or below 7.1 might be indicative of the fact that I was most likely just fine.  I think if one’s pH is really 7.1 they aren’t debating much at all!

So we went to the nearest ER late at night.  I was doubtful that I’d make it there alive, visions of ABG’s being drawn and intubations happening… I was really scared and really quite irrational.  But my CCU brain was still there, feeding into it all, convincing me of all the bad things that could happen.

When I got to triage, they could not have been less impressed with me.  A ho and a hum and a normal pulse ox later, I was thrown to the waiting room.  I’ll admit that the normal oxygen level calmed me a bit but I was still hyperventilating for some reason and could not stop.  Already long story short:  Panic attack caused by hyperventilating caused by a probable reaction between two commonly prescribed drugs that I’d taken earlier for The Worst Headache Ever.  Whatever it was wore off, I calmed down, we went home.

So I wasn’t sure, running into that same ER with my son, how responsive they’d be.  I had nothing to worry about.  The triage nurse exuded a level of calm that blanketed over everything.  It wasn’t an unconcerned or disinterested calm.  It was a “I’ve seen this before and know exactly what to do” calm. She handled my son (and me!) perfectly.  She wanted to put the pulse ox probe on his finger and told him that Elmo had been there the day before and had had the same sticker put on.  My son doesn’t know very many cartoon characters, but he knows Elmo very well.  If she’d said Dora or Mickey Mouse or Barney, he wouldn’t have had a clue what she was talking about.  But because Elmo had had it the day before, he finally reluctantly let me put his finger out.

His pulse ox was 90, which is not very good.  Normal is about 95-100 on room air for a reasonably healthy person.  I told them it was an allergic reaction to peanuts and they got us back to a room so fast our heads spun.  When his oxygen level dropped to 85, once again my CCU trained brain had visions of Horrible Things happening, but it never came to that.  After some oxygen, Benadryl and IV steroids, he was back to almost normal.  The hives did show up 3 hours after ingestion on the dot, and they were uncomfortable but not as severe due to the meds he’d received.

So being a highly trained RN is a bit of a double-edged sword when healthcare becomes personal.  On one hand I never needed to ask for clarification about what anyone was saying, and I had no trouble understanding the conversation between the doctor and nurse.  I knew the reason for and possible side effects of every medication they talked about giving him.  I knew what all the equipment was for and what the normal numbers were supposed to be.

On the other hand, I knew exactly what they were talking about, I knew what everything was for and what normal numbers were supposed to be.  When I realized they weren’t normal, I was pretty freaked out.

I intuitively knew why we had to put an IV in, but couldn’t help thinking about possible infection of the site and infiltration.  I wasn’t worried about giving the Benadryl as he’s had that several times in his life for various reasons, but the Solumedrol he needed?  That’s a drug I’ve probably given a thousand times, and never have I seen a reaction from it.  But this was my son, and how was it going to affect him?  Did they know how to calcuate the dosage based on his weight?  Would there be a miscalculation while drawing it up?

Everything turned out fine.  Everyone was professional and competent and knew just how to deal with a sick kid and his anxious mother.  Kiddo is completely back to normal today and is no worse for the wear from the whole experience.

But now my complacency about peanut butter is gone.  The hives were certainly awful but not life threatening, so I hadn’t really been overly concerned.  I’ve been careful, of course, as have those who watch him, but 3 year olds are 3 year olds and they are amazingly fast.  Now that I know it can affect his airway, I’m even more concerned about the times that he won’t be in my direct control, especially when he starts to go to school.  I feel like I’m going to need to tattoo it on his forehead.  I think the public in general (and schools in particular) are more aware of allergies, which is a tiny bit comforting.

He’s also allergic to eggs, which I used to think was the bigger pain in the butt.  There’s a lot more that he can’t eat due to eggs than peanut butter, but his reaction to eggs is very minor comparatively.  I used to even think that if I had a choice, I’d rather he not be allergic to eggs.

I’ve changed my mind.

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Oh my goodness. That sounds scary. I am glad that everything turned out ok!

It sure is spooky! I have two sons, and my eldest had a similar situation to penicillin – scared me to death, but like you, everything turned out just fine. Stephanie

Although it’s never pleasant to use, your son should probably have an epi-pen with him, in the car, and at home – just in case.

Just my $0.02-

Wow, what a story. So glad everything is OK with your son. I can totally see how knowing more than most patients could make the situation even scarier, I suddenly realize that all those medical code words are there for a reason!

Loved your honesty about the balance between being a medical professional and being a parent. On allergic reactions–I have always taken them seriously since hearing that a 40 y/o male walked into the ER with allergic symptoms and died.

Your story was well written–have you done creative writing? I’ve written a manuscript about the stories of 30 patients that stood out over my nursing career, and the next book will be a compilation of other nurses stories. Part of the proceeds will go for charities like Doctor’s WithOut Boarders.

I second the motion about carrying an EPI pen. I hope your son never needs it though.

My daughter has a severe peanut allergy also. I scares me more than any thing! I always imagine her eating from a peanut butter jar when she is away from me! The best thing to do is educate your son. My daughter is almost ritualistic in monitoring her allergy. She asks “does this have peanuts in it” to anyone and everyone who offers her food. Sometimes she asks me! She also has practiced using her epi pen and can show adults how to use it. With something so dangerous to our beautiful children I think education is the best tool to help avoid contact! SO GLAD YOUR SON IS SAFE :)

So, if you haven’t already gotten an Epi-pen DO IT TODAY! Get all things peanut out of your house. In my experience, the next allergic reaction will be worse. And please be very hesitant about eating in restaurants AT ALL. Things tend to cross-contaminate in busy kitchens and servers don’t always know every ingredient. Good luck and may you never have to come to the ER again – but we’ll be there if you need us!

This reminded me of when my toddler son pushed his plastic mower through a fire ant hill. He always had severe local reactions and given the multitude of bites, I wondered if we should go to the ER. I immediately removed the ants in the wading pool and dosed him with anti histamines. I had just started working ER and knew my colleagues would rag me for bringing my son in for ant bites if he had no reaction but was afraid of the consequences if I did not. I decided to drive there and wait. If he had no reaction I would simply come home and if he did we would be there. On the way he started coughing and I advised my husband to make haste. He was taken back immediately and given susphrine. I often wonder how children who don’t have nurse moms survive! :)

I do have an epi-pen that I’ve been carrying around for over a year. Unfortunately in my haste I left it here at home! I would have felt much better about having it with me on the way to the ER.

Its been a while since I’ve been to your blog. As always another great post. I really enjoy your perspective. It’s funny. an Epi-Pen is like a real pen. There is never one at hand when you need one LOL.

Your hyperventilating would have made your ph alkalotic (>7.45) not acidotic. Anyway, you should have your son tested to see if it is a true nut allergy or just peanuts, that way you can be “in the know” and protect as necessary.

mothers panic when something happens to their kids. no matter what. we all suffer the same things when it comes to our children :)

I feel like nut-related allergies are growing like an epidemic. I don’t think I met one person with a nut allergy before 2005, but now I hear of them all the time! Glad to hear everything worked out.

Hi I really enjoy your perspective. Thanks for your post. I really not know that anyone has allergy through eggs.

I’m so glad everything turned out ok with your son. I feel your pain with being in the know as a nurse. It can be a blessing and a curse.

Hey very nice site!! Man .. Beautiful .. Amazing .. I will bookmark your blog and take the feeds alsoI am happy to find a lot of useful info here in the post, we need work out more techniques in this regard, thanks for sharing. . . . . . efekgeacadee

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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