An 8-year-old girl arrived in the Emergency Department presenting with sudden unilateral right trismus, deviation of the jaw, burning pain in the neck with dystonic deviation of the same backwards and dyskinesia. The mother reported that the child started vomiting and that three days before she had started therapy with metoclopramide 0.5 mg/kg/day IM following her paediatrician’s indication. In the suspicion of metoclopramide-induced extrapyramidal symptoms, blood chemistry tests were performed showing normal results and midazolam 0.2 mg/kg was administered leading to regression of symptoms. After twenty minutes symptoms recurred with pain-induced sinus tachycardia (HR 180 BPM). Therefore, she was administered a second dose of midazolam EV at 0.15 mg/kg that led to a complete and definitive regression of symptoms. Metoclopramide is a neuroleptic drug indicated only for the treatment of post-operative vomiting or chemotherapy in children over one year. The most common adverse reaction is the onset of extrapyramidal symptoms. A careful risk-benefit balance must always be performed before deciding whether to administer an antiemetic drug.

The paper describes a case of intoxication from vitamin D in a 35-day infant of exclusive breastfeeding life who was administered 8000 IU of vitamin D per day over 4 weeks. There was an important linguistic barrier with her mother. The clinical picture was exclusively characterized by constipation, with adequate growth. Laboratory investigations showed calcemia at upper limits (11.1 mg/dl), elevated levels of 25-OH vitamin D3 (25-OH), equal to 375 µg/l, and renal ultrasound finding compatible with microlithiasis. The clinical picture was resolved with an intravenous hydration and suspension of vitamin supplementation. The case shows that in a situation in which there is a condition of family vulnerability it is necessary to make sure that any prescription has been correctly understood.

Hematocolpos is a term given to a blood-filled dilated vagina due to menstrual blood. When there is concurrent uterine distention, the term hematometrocolpos is used. These conditions are mostly in the setting of an anatomical obstruction, usually an imperforate hymen. Usually, clinical presentation may be characterized by primary amenhorrea, recurrent abdominal or pelvic pain, urinary retention and dys-uria or constipation. Imaging techniques such as trans-abdominal ultrasound and nuclear magnetic res-onance are respectively the exam of choice and the “gold standard” exam for diagnosing hematocolpos. The paper reports the case of a 12-year-old girl with a sacral pain present for a month, not associated with other symptoms with a diagnosis of hematocolpos that became evident to the magnetic resonance.