We are reporting an unusual case of accidental amphetamine ingestion in a 2 year 8 month old child, presenting with acute confusion.

Her father brought this female child to the Accident and Emergency Department with history of acute confusion for paediatric assessment. The child had been agitated for the last 12 hours, was difficult to settle and kept saying, “don’t want it”. She had previously been well. On examination she was agitated, apyrexial and constantly talking with heart rate of 148/min. Her pupils were dilated but equal and sluggishly reactive. She had no neck stiffness and rest of the systemic examination was unremarkable. The main differential diagnoses at this stage were probable encephalitis and acute poisoning. Her full blood count, urea and electrolytes, liver function tests, coagulation screen, paracetamol and salicylate levels, and venous gas were all normal.

After initial denial, father revealed that the child’s mother had been using amphetamine for years. Mother confessed that she had a paste of amphetamine powder in the orange juice around 2-3 hours before the child started to behave unusually. Mother had left the child alone in the room with the orange juice and went to the kitchen for 5 minutes. Mother was not sure how much orange juice the child could have drunk. The child was monitored closely. Urine was sent for toxicology. After 17 hours of admission, the child started to interact normally, talk appropriately, pupils were reacting normally and heart rate settled. Next day, the child was back to normal and was discharged to foster care. The urine came back positive for amphetamine. The child has been reported to be doing well on follow -up.

Amphetamine ingestion in a child of <5 years of age has not been previously reported. There is only a small selection of articles which focus on adolescents [1-3]/adults and methamphetamine. The main intention to report this the case is to raise the awareness of acute intoxication as a differential diagnosis in a child who presents with acute confusion.

References

1. Hawke JM, Jainchill N, De Leon G. Adolescent amphetamine users in treatment: client profiles and treatment outcomes. J Psychoactive Drugs. 2000;32:95-105.

2. Westover AN, Nakonezny PA. Aortic dissection in young adults who abuse amphetamines. Am Heart J. 2010;160:315-21.

3. King G, Alicata D, Cloak C. Neuropsychological deficits in adolescent methamphetamine abusers. Psychopharmaco-logy (Berl). 2010;212:243-9.