Introduction: Metallic luster dusts are decorative agents for cakes and other confections. While some powders are labeled “non-edible,” they are also marketed as “non-toxic.” We present a case of a child who developed acute metal pneumonitis after accidental aspiration of metallic luster dust.
\nCase Report: A four-year-old presented to the emergency department (ED) in respiratory
distress after attempting to ingest gold decorative metallic luster dust. In the ED she was placed on supplemental oxygen. Her initial chest radiograph (CXR) was unremarkable. Her condition worsened despite high-flow nasal cannula oxygen, and she was intubated. A repeat CXR revealed patchy perihilar and peribronchial opacities. While receiving aggressive ventilatory support, her CXR worsened over the next 48 hours as bilateral interstitial and alveolar opacities progressed, likely representing acute metal pneumonitis with acute respiratory distress syndrome (ARDS). She remained intubated until hospital day (HD) 5, requiring supplemental oxygen until HD 9. She was discharged home on HD 10. A CXR obtained four months later demonstrated increased interstitial markings throughout both lungs with overinflation and subsegmental atelectasis. The patient had persistent dyspnea upon exertion, with pulmonology documenting that her symptoms were likely sequelae from inhalation of the cake luster dust.
Conclusion: Non-edible metallic cake dusts are toxic. “Non-edible” labeling does not convey the health risks associated with handling by children, as evidenced by this case of metal pneumonitis with associated ARDS and chronic pulmonary disease. Accordingly, this descriptor should be abandoned for these products, and physicians should be aware of this potential complication.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"case report"},{"word":"cake dust"},{"word":"bronze"},{"word":"metal pneumonitis"},{"word":"pediatric"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7xg3t40d","frozenauthors":[{"first_name":"Taylor","middle_name":"","last_name":"Sanders","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Emergency Medicine, Division of Medical Toxicology, Charlotte, North Carolina; Louisiana State University Health Sciences Center, School of Medicine, Emergency Medicine Residency Program, Baton Rouge Campus, Baton Rouge, Louisiana","department":""},{"first_name":"Mitchell","middle_name":"","last_name":"Hymowitz","name_suffix":"","institution":"Louisiana State University Health Sciences Center, School of Medicine, Emergency Medicine Residency Program, Baton Rouge Campus, Baton Rouge, Louisiana","department":""},{"first_name":"Christine","middle_name":"","last_name":"Murphy","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Emergency Medicine, Division of Medical Toxicology, Charlotte, North Carolina","department":""}],"date_submitted":"2024-01-20T21:31:20.573000Z","date_accepted":"2024-05-15T17:58:11.717000Z","date_published":"2024-07-28T16:30:00Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/7220/galley/30153/download/"}]}