患儿男,10个月。腹泻、水样便。T 36.5℃(腋),P105次/分,律整无杂音,R32次/分,肠鸣音亢进。血自细胞总数7.5×10~9/L,分类:中性0.70,淋巴0.25,嗜酸粒细胞0.03,大便常规检查正常。诊断为婴幼儿腹泻。给5%葡萄糖盐水200ml、5%碳酸氢钠20ml、庆大霉素3万 u、10%氯化钾5ml 静滴。因夜间静脉穿刺困难,拟用5%碳酸氢钠以注射器连接头皮针静脉穿刺,在穿刺时误用了10%氯化钾10ml。2分钟注完时患儿口唇紫绀,自主呼吸停止,双侧瞳孔散大,大动脉搏动 Children male, 10 months. Diarrhea, watery stools. T 36.5 ℃ (axillary), P105 times / min, the whole law without noise, R32 beats / min, bowel sounds hyperthyroidism. Blood from the total number of cells 7.5 × 10 ~ 9 / L, classification: neutral 0.70, lymph 0.25, eosinophil 0.03, stool routine examination was normal. Diagnosis of infant diarrhea. Give 5% glucose saline 200ml, 5% sodium bicarbonate 20ml, gentamicin 30,000 u, 10% potassium chloride 5ml intravenous infusion. Difficult to puncture the night due to venous, intended to use 5% sodium bicarbonate syringe to connect the scalp needle venous puncture misuse of 10% potassium chloride 10ml. 2 minutes note children with cyanosis lips, spontaneous breathing stopped, bilateral mydriasis, aortic pulse