J Pediatr Intensive Care 2019; 08(03): 175-177
DOI: 10.1055/s-0039-1677815
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Dexmedetomidine to Treat 3, 4-Methylenedioxymethamphetamine-Induced Agitation in a 13-Month-Old Infant: A Case Report and Literature Review

Patricia J. L. T. Sanders
1   Section of Pediatric Intensive Care, Department of Pediatrics, Maastricht University Medical Center (MUMC + ), Maastricht, The Netherlands
,
Jan Hanot
1   Section of Pediatric Intensive Care, Department of Pediatrics, Maastricht University Medical Center (MUMC + ), Maastricht, The Netherlands
› Author Affiliations
Further Information

Publication History

04 October 2018

01 January 2019

Publication Date:
13 February 2019 (online)

Abstract

We report a 13-month-old infant who accidentally ingested a tablet of 3, 4-methylenedioxymethamphetamine (MDMA) and was brought to the emergency department with tachycardia, seizures, mydriasis, and altered mental status. The patient received multiple doses of benzodiazepines to treat the seizures and developed respiratory insufficiency needing intubation. After extubation, the patient developed hyperactivity, myoclonic, and choreoathetoid movements which were unresponsive to benzodiazepines. Dexmedetomidine was started with good response. The patient made a full clinical recovery. This is the first case that illustrates the possibility to treat MDMA-induced agitation with dexmedetomidine in a 13-month-old infant.

 
  • References

  • 1 Akingbola OA, Singh D. Dexmedetomidine to treat lisdexamfetamine overdose and serotonin toxidrome in a 6-year-old girl. Am J Crit Care 2012; 21 (06) 456-459
  • 2 Bagdure DN, Bhoite GR, Reiter PD, Dobyns EL. Dexmedetomidine in a child with methylphenidate intoxication. Indian J Pediatr 2013; 80 (04) 343-344
  • 3 Chiang WK. Amphetamines. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Howland MA, Hoffman RS, Nelson LS. Goldfrank's Toxicologic Emergencies. 7th ed. New York, NY: McGraw-Hill; 2002. :1020–1033
  • 4 Westfall TC, Macarthur H, Westfall DP. Adrenergic agonists and antagonists. In: Brunton LL, Hilal-Dandan R, Knollmann BC. Goodman & Gilman's: The Pharmacological Basis of Therapeutics. 13th ed. New York, NY: McGraw-Hill; 2017: 191-224
  • 5 Derlet RW, Rice P, Horowitz BZ, Lord RV. Amphetamine toxicity: experience with 127 cases. J Emerg Med 1989; 7 (02) 157-161
  • 6 Henry JA, Jeffreys KJ, Dawling S. Toxicity and deaths from 3,4-methylenedioxymethamphetamine (“ecstasy”). Lancet 1992; 340 (8816): 384-387
  • 7 Rhee KJ, Albertson TE, Douglas JC. Choreoathetoid disorder associated with amphetamine-like drugs. Am J Emerg Med 1988; 6 (02) 131-133
  • 8 Richards JR, Albertson TE, Derlet RW, Lange RA, Olson KR, Horowitz BZ. Treatment of toxicity from amphetamines, related derivatives, and analogues: a systematic clinical review. Drug Alcohol Depend 2015; 150: 1-13
  • 9 Hysek CM, Brugger R, Simmler LD. , et al. Effects of the α2-adrenergic agonist clonidine on the pharmacodynamics and pharmacokinetics of 3,4-methylenedioxymethamphetamine in healthy volunteers. J Pharmacol Exp Ther 2012; 340 (02) 286-294
  • 10 Cipriani F, Mancino A, Pulitanò SM, Piastra M, Conti G. A cannabinoid-intoxicated child treated with dexmedetomidine: a case report. J Med Case Reports 2015; 9: 152
  • 11 Finkel JC, Elrefai A. The use of dexmedetomidine to facilitate opioid and benzodiazepine detoxification in an infant. Anesth Analg 2004; 98 (06) 1658-1659
  • 12 Oschman A, McCabe T, Kuhn RJ. Dexmedetomidine for opioid and benzodiazepine withdrawal in pediatric patients. Am J Health Syst Pharm 2011; 68 (13) 1233-1238
  • 13 Seyit M, Erdur B, Kortunay S. , et al. A comparison of dexmedetomidine, moxonidine and alpha-methyldopa effects on acute, lethal cocaine toxicity. Iran Red Crescent Med J 2015; 17 (06) e18780
  • 14 Lam RPK, Yip WL, Wan CK, Tsui MSH. Dexmedetomidine use in the ED for control of methamphetamine-induced agitation. Am J Emerg Med 2017; 35 (04) 665.e1-665.e4
  • 15 Sallinen J, Haapalinna A, Viitamaa T, Kobilka BK, Scheinin M. D-amphetamine and L-5-hydroxytryptophan-induced behaviours in mice with genetically-altered expression of the alpha2C-adrenergic receptor subtype. Neuroscience 1998; 86 (03) 959-965