Ir Med J. 2008 May;101(5):156-7.
Sir
A previously healthy 2 year old boy presented to our hospital with unusual, irrational behaviour, facial flushing and stiffness of the extremities. His examination revealed dilated pupils, a normal temperature and a significant tachycardia of 190 beats per minute. Chest examination revealed scattered rales. One hour prior to admission he, according to his parents, had ingested an unknown number of ectasy tablets found at home.

Emergency treatment consisted of gastric lavage with normal saline, installation of activated charcoal, a nomal saline bolus and diazepam were administered intraenously. Oral chloral hydrate was later given for sedation. Blood chemistry was normal and initial metabolic acidosis corrected quickly. The following day he was still tachycardic but was then interactive and playful. He was discharged home 3 days post-admission following detailed social worker input.

Discussion
Ecstasy or 3,4-methylenedioxy-methamphetamine (MDMA)¹ is commonly used as a recreational drug. The typical dosage range of MDMA for recreational use varies from 50 mg to 150 mg^2,3 but the amount per tablet in different batches of tablets may vary 70- fold or more, from almost zero to well over 100 mg.^4,5

Ecstasy is often taken in Britain⁶ and Ireland as a “dance drug” at “rave” parties where its use is associated with extreme physical activity which may compound the toxic effects of the drug. In Ireland, ecstasy abuse became a problem in the early 1990s. Reports of ecstasy ingestion to the National Poisons Information Centre increased dramatically from zero in January 1991 to thirty seven in June 1992⁷. The patients involved were predominantly male (80%) and aged 10-30 years, the highest incidence being in the 16-25 year old age group. Thirty two (86%) patients were symptomatic⁷.

An ecstasy overdose is characterized by high blood pressure, faintness, panic attacks, and, in more severe cases, loss of consciousness, seizures, and a drastic rise in body temperature. Ecstasy overdoses can be fatal, as they may result in heart failure or extreme heat stroke.

Our case illustrates the risks posed to young children from accidental ingestion of ecstasy by careless handling of the drug by adults and has child protection implications.

The effects from an orally ingested pill have an onset of 20-60 minutes and last 2-6 hours⁸. This patient presenting within one hour of ingestion could be responsible for the amount of intervention required and the early turn around. To our knowledge, there have been no prior reports of ecstasy ingestion or overdose in children of this age group.

LO Akinlabi, N Al-Assaf, J Donnelly, AJ Nicholson
Department of Paediatrics, Our Lady of Lourdes Hospital,
Drogheda, Co. Louth
Email: [email protected]

References

1. Harold Kalant: The pharmacology and toxicology of “ecstasy” (MDMA) and related drugs.
2. Theune M, Esser W, Druschky KF, Interschick E, Patscheke H. Grandmal- Serie nach Ecstasy-Einnahme. Nervenarzt 1999;70:1094-7.
3. Kirsch MM. “Ecstasy”. In: Designer drugs. Minneapolis (Minn): CompCare Publications; 1986. 75-97.
4. Milroy CM, Clark JC, Forrest ARW. Pathology of deaths associated with “ecstasy” and “eve” misuse. J Clin Pathol 1996;49:149-53.
5. Sherlock K, Wolff K, Hay AW, Conner M. Analysis of illicit ecstasy tablets: implications for clinical management in the accident and emergency department. J Accid Emerg Med 1999;16:194-7.
6. Henry J.A. Ecstasy and the dance of death. BMJ 1992; 305: 5.
7. Cregg, MT, TRACEY JA: Ecstasy abuse in Ireland Irish Medical Journal, 86, July 1993, 118-120.
8. Ecstasy.org. Questions and answers. Available from www.ecstasy.org. Accessed May 9, 2001. MEDICAL