title: Stimulant Toxicity in Children: A Retrospective Study on 147 Patients.
abstract: OBJECTIVE
  To evaluate the signs/symptoms of different stimulant toxicities in children to determine differences among them.
  
  
  METHODS
  Observational, retrospective, single-center case-series.
  
  
  METHODS
  The only referral hospital for pediatric poisoned patients in Tehran, Iran, covering 12.5 million permanent and 6.5 million temporary residents.
  
  
  METHODS
  All children between 2007 and 2012 were evaluated. Their clinical findings, laboratory tests, electrocardiogram, and outcome were evaluated.
  
  
  METHODS
  None.
  
  
  RESULTS
  A total of 147 patients were enrolled (115, 24, three, and five with methamphetamine, methylphenidate, ecstasy, and unknown stimulant toxicities, respectively). Median (interquartile range) age of the methamphetamine- intoxicated children (16 mo [22-42 mo]) was significantly less than those with methylphenidate toxicity (66 mo [33-105 mo]). Almost 79% of the patients had ingested the stimulant, whereas 9% had passively been exposed to the methamphetamine smoke. The frequency of stimulant toxicity had significantly increased during the 5-year period of the study. Restlessness, mydriasis, stereotypic movements, and talkativeness were the most common signs and symptoms. Whereas bruxism only seen in 66.7% (95% CI, 21-94%) of ecstasy users, the prevalence of restlessness, sweating, and tremor was also more in this group of children. On the other hand, mydriasis and stereotypic movements were more common in crystal-meth patients by 76.5% (95% CI, 68-83%) and 53% (95% CI, 44-62%), respectively. A comparison between different routes of crystal-meth intoxication showed that flushing was more common in those who had passively/actively smoked/inhaled methamphetamine (odds ratio, 6.3 [95% CI, 1.5-26]). Palpitation was more seen in methylphenidate toxicity by 12.5% (95% CI, 4-31%). Restlessness was more detected in toddlers, whereas talkativeness and ataxia were more common in older children. Nineteen children (21%) had prolonged QTc according to normal values in different ages. None of them died.
  
  
  CONCLUSIONS
  More studies are warranted to evaluate the frequency and outcome of this poisoning in children. Educational preventive programs are also recommended.
authors.affiliation: 1Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2Excellence Center of Clinical Toxicology, Iranian Ministry of Health, Tehran, Iran. 3Loghman-Hakim Clinical Research Development Center, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 4Department of Cardiology, Babol University of Medical Sciences, Babol, Iran. 5Department of Pediatrics, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Iran. 6Department of Bone Marrow Transplantation, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 7Private Clinic, Child and Adolescent Psychiatrist, Tehran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Hassanian-Moghaddam
authors.forename: Maryam
authors.initials: M
authors.lastname: Ranjbar
authors.forename: Fariba
authors.initials: F
authors.lastname: Farnaghi
authors.forename: Nasim
authors.initials: N
authors.lastname: Zamani
authors.forename: Afshin Mohammad
authors.initials: AM
authors.lastname: Alizadeh
authors.forename: Saeedeh
authors.initials: S
authors.lastname: Sarjami
mesh_terms: D000697:Central Nervous System Stimulants / Q000633:toxicity*; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007223:Infant; D007492:Iran / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies
chemical_list: D000697:Central Nervous System Stimulants