Accidental ecstasy intoxication in an 8-month-old infant

Excerpt

Sir: Accidental ecstasy (XTC-3,4-methylenedioxymethamphetamin) intoxication in infants may present with life-threatening symptoms. An 8-month-old infant was found by his mother after a probable ingestion of two or three XTC pills. Within 30 min a tachypneic infant (40 breaths/min) was seen with a blood pressure of 130/80 mmHg and a heart rate of 140–180/min. He had hyperhydrosis with a rectal temperature of 38.6°C. Neurological examination revealed a hypertonic, anxious, and agitated child with light-responsive dilated pupils. The infant was intubated because of persistent adrenergic symptoms, risk of malignant hyperthermia, and altered consciousness. Upon admission to the pediatric intensive care unit approx. 4 h after ingestion the infant had stable respiratory but remained hypertensive with tachycardia. The body temperature had normalized. Neurological examination yielded dilated pupils that were unresponsive to light. Emergency cerebral computed tomography showed no abnormalities. His serum creatinine kinase was 4014 U/l, suggestive for rhabdomyolysis. The child was ventilated for 12 h and the rhabdomyolysis was treated with hyperhydration (3 l/m²) and sodium bicarbonate. The next day his creatine kinase level increased to 12136 U/l, after which it gradually decreased. Liver and kidney function remained normal. The serum concentration of XTC was less than 50 μg/l and urine concentration less than 8000 μg/l (cutoff point 1000 μg/l). …