Ir Med J. 2009 Feb;102(2):62.
Sir,

We read with interest the case report by Akinlabi et al¹ concerning accidental Ecstasy ingestion in 2-year old. In the period 2004- 2007 the National Poisons Information centre (NPIC) received 286 enquiries regarding Ecstasy poisoning. Six of these enquiries concerned suspected Ecstasy ingestion in children aged 3 years or less (including the case reported by Akinlabi et al.). Four of these children were asymptomatic on presentation to the hospital emergency department while 2 presented with symptoms of moderate toxicity. During the same 3 year period, there were a number of published case reports of accidental Ecstasy poisoning in young children.^2-5 In all of these cases, the children presented to hospital with seizures, tachycardia, hypertension, and hyperthermia. All were successfully managed with supportive therapy including cooling and hydration.

Gastric lavage is no longer routinely indicated in the management of poisoning, as the evidence of improved outcome is lacking and its use is associated with increased morbidity e.g. aspiration pneumonia, laryngospasm, mechanical injury, and hypernatraemia following lavage with large volumes of saline.⁶ In the case reported, the authors used gastric lavage although, they did not disclose if any tablets or fragments were recovered. In paediatric cases, the most appropriate gastrointestinal decontamination procedure is activated charcoal, if it can be given within 1-hour.^7,8 As seizure activity can occur in children soon after Ecstasy ingestion,^2-5 gastric decontamination procedures should be undertaken with caution.

Airway protection, seizure-control, correction of metabolic disturbances, and cooling measures are the mainstay of treatment following Ecstasy overdose. Urine toxicology should be considered along with standard biochemistry investigations. The child in this case report never exhibited the signs of severe toxicity (hyperthermia, convulsions) and the authors did not report whether or not he was hypertensive. Confirmatory urine toxicology results were not discussed in the article. This case report poses the question whether the use of gastric decontamination procedures at 1-hour post ingestion, as opposed to supportive therapy alone, resulted in a good outcome.

N Cassidy, PB Casey, JA Tracey
The National Poisons Information Centre, Beaumont Hospital, Beaumont, Dublin 9
Tel: +353 1 809 2566
Fax: +353 1 836 8476
Email: [email protected]

References

1. Akinlabi LO, Al-Assaf N, Donnelly J, Nicholson AJ. Accidental Ecstasy ingestion in a two year old. IMJ 2008;101:156-157
2. Melian AM, Burillo-Putze G, Campo CG, Padron AG, Ramos CO. Accidental Ecstasy poisoning in a toddler. Pediatr Emerg Care 2004;20:534-535
3. Chang YJ, Lai MW, Kong MS, Chao HC. Accidental ingestion of Ecstasy in a toddler. J Formos Med Assoc 2005;104:946-947
4. Duffy MR, Swart M. Severe Ecstasy poisoning in a toddler. Anaesthesia 2006 61:498-501
5. Eifinger F, Roth B, Kröner L, Rothschild MA. Severe Ecstasy poisoning in an 8-month-old infant. Eur J Pediatr 2008;167:1067-1070
6. Position Statement: Gastric Lavage. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Clinical Toxicology 1997;35:711-719
7. Position Statement: Single-dose activated charcoal. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. Clinical Toxicology 1997;35:721-741
8. POISINDEX® System: Klasco RK (Ed): POISINDEX® System (electronic version). Thomson Micromedex, Greenwood Village, Colorado, USA. Available at: http://www.thomsonhc.com (cited: 25/7/2008).