Methamphetamine Intoxication in Children: A Single-Center Experience

Öz

Objective: Illicit substances, especially methamphetamine, are becoming increasingly popular with adolescents in Turkey as well as around the world. Most of the studies conducted for this purpose in Turkey are survey studies. Our study therefore aimed to evaluate the clinical features and laboratory parameters of patients who applied to our hospital and were found to have methamphetamine intoxication.

Materials and Methods: Patients under 18 who applied to the Ankara City Hospital Pediatric Emergency Department (PED) between August 2019 and December 2021 and were found to be positive for methamphetamine in the urine drug screening were included in the study,and their data were evaluated retrospectively.

Results: We reviewed 10 cases presenting to our PED with methamphetamine intoxication. The mean age was 16.3 ± 0.94 (14-17) and 80% of patients were male. Eight patients concealed substance use at admission. The most frequent complaints upon presentation were cardiovascular, neurological, and gastrointestinal system symptoms. Concomitant alcohol use was detected in four patients, multidrug use in one patient. No significant pathology was observed in the laboratory tests. Gastric perforation was detected in one patient with abdominal pain, and pneumomediastinum was detected in one patient with chest pain.

Conclusion: There are no specific clinical and laboratory indicators of methamphetamine intoxication, and substance abuse should be considered in all cases where a possible reason cannot explain the patient’s clinical findings. Children who use alcohol should be questioned about substance abuse, care should be taken in terms of multiple substance use, and follow-up and rehabilitation plans for patients should be made accordingly.

Anahtar Kelimeler

• methamphetamine
• children
• substances
• alcohol
• urine drug screening

Çocuklarda Metamfetamin İntoksikasyonu: Tek Merkez Deneyimi

Öz

Amaç: Yasadışı uyuşturucu maddeler, özellikle de metamfetamin, dünyada olduğu gibi Türkiye'de de ergenler arasında giderek daha popüler hale gelmektedir. Türkiye'de bu amaçla yapılan çalışmaların çoğu anket çalışmalarıdır. Çalışmamız ise hastanemize başvuran ve metamfetamin intoksikasyonu saptanan hastaların klinik özelliklerini ve laboratuvar parametrelerini değerlendirmeyi amaçlamıştır.

Gereç ve Yöntemler: Ağustos 2019-Aralık 2021 tarihleri arasında Ankara Şehir Hastanesi Çocuk Acil Servisi'ne başvuran ve idrar toksik madde taramasında metamfetamin pozitif saptanan 18 yaş altı hastalar çalışmaya dahil edildi ve verileri retrospektif olarak değerlendirildi.

Bulgular: Çalışmamızda metamfetamin intoksikasyonu saptanan 10 hastayı inceledik. Ortalama yaş 16.3 ± 0.94 (14-17) idi ve hastaların %80'i erkekti. Sekiz hasta başvuru sırasında madde kullanımını gizledi. Başvuru anında en sık kardiyovasküler, nörolojik ve gastrointestinal sistem semptomları görüldü. Dört hastada eşzamanlı alkol kullanımı, bir hastada çoklu uyuşturucu kullanımı saptandı. Laboratuar testlerinde önemli bir patoloji gözlenmedi. Karın ağrısı olan bir hastada mide perforasyonu, göğüs ağrısı olan bir hastada pnömomediastinum tespit edildi.

Sonuç: Metamfetamin intoksikasyonunun spesifik klinik ve laboratuvar göstergeleri yoktur ve olası bir nedenin hastanın klinik bulgularını açıklayamadığı tüm durumlarda madde kötüye kullanımı düşünülmelidir. Alkol kullanan çocuklarda madde kullanımı sorgulanmalı, çoklu madde kullanımı açısından dikkatli olunmalı, buna göre hasta takip ve rehabilitasyon planları yapılmalıdır.

Anahtar Kelimeler

• metamfetamin
• çocuk
• uyuşturucu maddeler
• alkol
• idrar uyuşturucu taraması

Kaynakça

1. (1) Güngör D. Sentetik Uyuşturucular: Amfetamin Örneği. Güvenlik Çalışmaları Derg 2018;20:105–12.
2. (2) Schep LJ, Slaughter RJ, Beasley DMG. The clinical toxicology of metamfetamine. Clin Toxicol (Phila) 2010;48:675–94.
3. (3) Vearrier D, Greenberg MI, Miller SN, Okaneku JT, Haggerty DA. Methamphetamine: history, pathophysiology, adverse health effects, current trends, and hazards associated with the clandestine manufacture of methamphetamine. Dis Mon 2012;58:38–89.
4. (4) Chomchai C, Chomchai S. Global patterns of methamphetamine use. Curr Opin Psychiatry 2015;28:269–74.
5. (5) Evren C, Bozkurt M. Update on Methamphetamine: an Old Problem that We have Recently Encountered. Dusunen Adam J Psychiatry Neurol Sci 2018;31:1.
6. (6) Karakükcü Ç, Zahit Çiraci M, Koçer D, Ertürk Zararsiz G, Reyhancan M, Altintop İ. Regional drug abuse prevalence depending on laboratory based urine illicit drug screening results. ANADOLU Psikiyatr DERGISI-ANATOLIAN J PSYCHIATRY 2018;19:169–76.
7. (7) De Matos EG, Hannemann TV, Atzendorf J, Kraus L, Piontek D. The Consumption of New Psychoactive Substances and Methamphetamine: Analysis of Data From 6 German Federal States. Dtsch Arztebl Int 2018;115:49.
8. (8) Kolecki P. Inadvertent methamphetamine poisoning in pediatric patients. Pediatr Emerg Care 1998;14:385–7.

9. (9) 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;17:168–75.
10. (10) Gordon S, Toepper WC, Blackman SC. Toxicology screening in adolescent trauma. Pediatr Emerg Care 1996;12:36–9.
11. (11) Yurtseven A, Turan C, Yuncu Z, Annette Akgur S, Saz EU. Substance use frequency and related characteristics among adolescents presenting to an emergency department in Turkey. Journal of Ethnicity in Substance Abuse, 20:4, 614-624.
12. (12) Kozer E, Bar-Hamburger R, Rosenfeld NY, Zdanovitch I, Bulkowstein M. Illicit Drug and Alcohol Users Admitted to the Pediatric Emergency Department. Isr Med Assoc J 2018:779–82.
13. (13) Jané-Llopis E, Matytsina I. Mental health and alcohol, drugs and tobacco: a review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug Alcohol Rev 2006;25:515–36.
14. (14) Boys A, Farrell M, Taylor C, Marsden J, Goodman R, Brugha T, et al. Psychiatric morbidity and substance use in young people aged 13–15 years: results from the Child and Adolescent Survey of Mental Health. Br J Psychiatry 2003;182:509–17.
15. (15) Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997;54:313–21.
16. (16) Gau SSF, Chong MY, Yang P, Yen CF, Liang KY, Cheng ATA. Psychiatric and psychosocial predictors of substance use disorders among adolescents: Longitudinal study. Br J Psychiatry 2007;190:42–8.
17. (17) Nelson ME, Bryant SM, Aks SE. Emerging drugs of abuse. Emerg Med Clin North Am 2014;32:1–28.
18. (18) Chen T, Spiller HA, Badeti J, Funk AR, Zhu M, Smith GA. Methamphetamine exposures reported to United States poison control centers, 2000-2019. Clin Toxicol (Phila) 2021;59:705–14.
19. (19) Richards JR, Johnson EB, Stark RW, Derlet RW. Methamphetamine abuse and rhabdomyolysis in the ED: a 5-year study. Am J Emerg Med 1999;17:681–5.
20. (20) Richards JR, Bretz SW, Johnson EB, Turnipseed SD, Brofeldt BT, Derlet RW. Methamphetamine abuse and emergency department utilization. West J Med 1999;170:198.