An Infant with a Prolonged Sympathomimetic Toxidrome after Lisdexamfetamine Dimesylate Ingestion.
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.
Stead Family Department of Pediatrics, University of Iowa Children's Hospital, 200 Hawkins Dr, Iowa City, IA, 52242, USA. Kelly-wood@uiowa.edu.
Kelly E
KE
Wood
Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
Matthew D
MD
Krasowski
D000061:Accidents, Home; D000082:Acetaminophen / Q000627:therapeutic use; D018759:Adrenergic Uptake Inhibitors / Q000097:blood / Q000652:urine; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000097:blood / Q000633:toxicity* / Q000652:urine; D002853:Chromatography, Liquid; D004149:Dioxoles / Q000097:blood / Q000652:urine; D004409:Dyskinesia, Drug-Induced / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000188:drug therapy; D007223:Infant; D000069478:Lisdexamfetamine Dimesylate / Q000097:blood / Q000633:toxicity* / Q000652:urine; D055442:Metabolome / Q000187:drug effects; D013566:Sympathomimetics / Q000097:blood / Q000633:toxicity* / Q000652:urine; D013610:Tachycardia / Q000139:chemically induced / Q000188:drug therapy; D053719:Tandem Mass Spectrometry
D018759:Adrenergic Uptake Inhibitors; D018712:Analgesics, Non-Narcotic; D000697:Central Nervous System Stimulants; D004149:Dioxoles; D013566:Sympathomimetics; D000082:Acetaminophen; C040539:1,3-benzodioxole; D000069478:Lisdexamfetamine Dimesylate
Attention deficit disorder with hyperactivity; Dextroamphetamine; Lisdexamfetamine dimesylate