An Infant with a Prolonged Sympathomimetic Toxidrome after Lisdexamfetamine Dimesylate Ingestion

Kelly E Wood; Matthew D Krasowski

doi:10.1007/s13181-016-0560-x

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An Infant with a Prolonged Sympathomimetic Toxidrome after Lisdexamfetamine Dimesylate Ingestion

Journal article

Open access

Peer reviewed

An Infant with a Prolonged Sympathomimetic Toxidrome after Lisdexamfetamine Dimesylate Ingestion

Kelly E Wood and Matthew D Krasowski

Journal of medical toxicology, Vol.12(4), pp.402-405

12/2016

DOI: 10.1007/s13181-016-0560-x

PMCID: PMC5135673

PMID: 27277955

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https://doi.org/10.1007/s13181-016-0560-xView

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Abstract

Stimulant medications are approved to treat attention deficit hyperactivity disorder (ADHD) in children over the age of 6 years. Fatal ingestion of stimulants by children has been reported, although most ingestions do not result in severe toxicity. Lisdexamfetamine dimesylate, a once daily long-acting stimulant, is a prodrug requiring conversion to its active form, dextroamphetamine, in the bloodstream. Based on its unique pharmacokinetics, peak levels of d-amphetamine are delayed. We describe a case of accidental ingestion of lisdexamfetamine dimesylate in an infant. A previously healthy 10-month-old infant was admitted to the hospital with a 5-h history of tachycardia, hypertension, dyskinesia, and altered mental status of unknown etiology. Confirmatory urine testing, from a specimen collected approximately 16 h after the onset of symptoms, revealed an urine amphetamine concentration of 22,312 ng/mL (positive cutoff 200 ng/mL). The serum amphetamine concentration, from a specimen collected approximately 37 h after the onset of symptoms, was 68 ng/mL (positive cutoff 20 ng/mL). Urine and serum were both negative for methamphetamine, methylenedioxyamphetamine (MDA), methylenedioxymethamphetamine (MDMA, Ecstasy), and methylenedioxyethamphetamine (MDEA). During the hospitalization, it was discovered that the infant had access to lisdexamfetamine dimesylate prior to the onset of symptoms. Amphetamine ingestions in young children are uncommon but do occur. Clinicians should be aware of signs and symptoms of amphetamine toxicity and consider ingestion when a pediatric patient presents with symptoms of a sympathetic toxidrome even when ingestion is denied.

Dioxoles - urine

Tachycardia - chemically induced

Humans

Sympathomimetics - urine

Hypertension - drug therapy

Infant

Tandem Mass Spectrometry

Dyskinesia, Drug-Induced - drug therapy

Lisdexamfetamine Dimesylate - toxicity

Hypertension - chemically induced

Chromatography, Liquid

Female

Adrenergic Uptake Inhibitors - blood

Acetaminophen - therapeutic use

Dioxoles - blood

Lisdexamfetamine Dimesylate - urine

Sympathomimetics - blood

Dyskinesia, Drug-Induced - etiology

Tachycardia - drug therapy

Lisdexamfetamine Dimesylate - blood

Analgesics, Non-Narcotic - therapeutic use

Adrenergic Uptake Inhibitors - urine

Central Nervous System Stimulants - toxicity

Metabolome - drug effects

Sympathomimetics - toxicity

Central Nervous System Stimulants - urine

Central Nervous System Stimulants - blood

Accidents, Home

Details

Title: Subtitle: An Infant with a Prolonged Sympathomimetic Toxidrome after Lisdexamfetamine Dimesylate Ingestion
Creators: Kelly E Wood - Stead Family Department of Pediatrics, University of Iowa Children's Hospital, 200 Hawkins Dr, Iowa City, IA, 52242, USA. Kelly-wood@uiowa.edu
Matthew D Krasowski - Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
Resource Type: Journal article
Publication Details: Journal of medical toxicology, Vol.12(4), pp.402-405
Publisher: United States
DOI: 10.1007/s13181-016-0560-x
PMID: 27277955
PMCID: PMC5135673
ISSN: 1556-9039
eISSN: 1937-6995
Language: English
Date published: 12/2016
Academic Unit: Stead Family Department of Pediatrics; Pathology; Hospital Medicine
Record Identifier: 9984046933202771

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