A candy catastrophe: Case report on methamphetamine poisoning in a child

Abstract

Methamphetamine, a potent amphetamine derivative, is increasingly implicated in pediatric poisonings and can present with severe neurological, cardiovascular, or behavioural disturbances. Clinicians must remain vigilant when managing undifferentiated status epilepticus, as toxic etiologies may masquerade as primary medical causes. A previously healthy 3-year-old boy was found convulsing at home and received rectal diazepam without improvement. On arrival at the emergency department, he exhibited generalised tonic-clonic seizures, tachycardia, and dilated pupils despite intravenous benzodiazepines and levetiracetam. Suspicion arose when inconsistent caregiver accounts and mention of “candy” ingestion led the team to perform toxicology screening, which revealed methamphetamine as the offending agent. The child required endotracheal intubation and continuous midazolam infusion to control his refractory seizures. Subsequent investigations showed lactic acidosis but no intracranial pathology. Both parents later admitted to methamphetamine use prompting urgent child-protection involvement. The boy was successfully extubated after two days, recovered without neurological deficits, and was discharged on hospital day eight. This case underscores the importance of maintaining a high index of suspicion for toxic etiologies in unexplained pediatric seizures. Early recognition, prompt seizure management, and vigilant social assessment are critical to achieving favourable outcomes and ensuring child safety.

Keywords

• Methamphetamine poisoning
• Methamphetamine toxicity
• Methamphetamine induced seizure
• child abuse
• child neglect

References

1. 1. United Nations. World Drug Report [Internet]. 2015. Available from: https://www.unodc.org/documents/wdr2015/World_Drug_Report_2015.pdf
2. 2. Cruickshank CC, Dyer KR. A review of the clinical pharmacology of methamphetamine. Addiction. 2009;104:1085–99.
3. 3. Alwan IA, Brhaish AS, Awadh AI, Misnan A, Rahim NA, Tangiisuran B, et al. Poisoning among children in Malaysia: a 10-years retrospective study. PLoS One. 2022;17(0).
4. 4. Malashock HR, Yeung C, Roberts AR, Snow JW, Gerkin RD, O’Connor AD. Pediatric Methamphetamine Toxicity: Clinical Manifestations and Therapeutic Use of Antipsychotics-One Institution’s Experience. J Med Toxicol. 2021;Apr;17(2):168-175. doi.
5. 5. Miller DR, Bu M, Gopinath A, Martinez LR, Khoshbouei H. Methamphetamine Dysregulation of the Central Nervous System and Peripheral Immunity. J Pharmacol Exp Ther. 2021;Dec;379(3):372-385. doi.
6. 6. Coralic Z. Treatment of Toxin-Related Status Epilepticus With Levetiracetam, Fosphenytoin, or Valproate in Patients Enrolled in the Established Status Epilepticus Treatment Trial. Annals of Emergency Medicine. 80(ue 3):194–202.
7. 7. Chen HY, Albertson TE, Olson KR. Treatment of drug-induced seizures. Br J Clin Pharmacol. 2016;81:412–9.
8. 8. Shah AS, Eddleston M. Should phenytoin or barbiturates beused as second-line anticonvulsant therapy for toxicologicalseizures? Clin Toxicol. 2010;48:800–5.

9. 9. Interpersonal violence and illicit drugs [Internet]. [cited 2025 Mar 1]. Available from: https://www.who.int/publications/m/item/interpersonal-violence-and-illicit-drugs