Accidental ecstasy poisoning in a toddler

Abstract

A child of 14 months accidentally swallowed a portion of an Ecstasy pill. Forty minutes after ingestion, he started a generalized convulsion. He also presented hyperthermia (38 degrees C), hypertension, tachycardia (130 bpm), ventricular extrasystoles, tachypnea (50 rpm), and mydriasis. At the hospital 5 hours later, the urine levels of amphetamine/metamphetamine were >16 mg/L. He was treated with general support measures and benzodiazepines intravenously and admitted to the pediatric intensive care unit. During the first 12 hours, he continued with hypertension, tachycardia, and long periods of trigeminy, without hemodynamic repercussion. He was discharged fully recovered. Gas chromatography/mass spectrometry analysis (8 hours after ingestion) showed a serum level of 3,4 methylenedioximethylamphetamine (MDMA) of 0.591 mg/L. The 3 cases described in the literature have shown a good evolution of Ecstasy poisoning in toddlers and infants, despite an initial critical situation. Regarding adults, the toddler intoxication seems to present symptoms sooner (20 to 30 minutes), having as an initial manifestation convulsions. However, great care must be taken on accidental ingestion of these attractive design pills.