Journal of Clinical Toxicology has recently launched a paediatric case report which is related to methadone toxicity in paediatrics.

This case study focuses on the methadone toxicity observed in a 4 year old male patient who has been admitted to paediatric intensive care unit. The abstract of the case study was shown below:

Pediatric morbidity and mortality from methadone toxicity has increased in recent years. Multiple publicationsserve to highlight the danger of methadone ingestion for pediatric patients as there is notable overlap between toxicand fatal levels of methadone for children. This case report presents a 4-year-old male who was admitted to thepediatric  intensive  care  unit  due  to  emesis,  altered  mental  status  and  acute  hypoxemic  respiratory  failure.Methadone was identified on serum drug screening and no alternative explanation for patient’s clinical presentationwas found. This case report highlights importance of additional drug testing and consideration of methadone toxicitywhenever a patient presents with miosis, central nervous system depression and respiratory depression as it mayrequire testing beyond the standard urine drug screen to identify the correct drug exposure.

Author has discussed about the case in a well professional manner. The case presentation was like: A previously healthy 4-year old male presented to the localemergency room with acute onset of non-bilious emesis and lethargy. His initialvital signs were notable for being afebrile, tachycardic (HR 131),tachypneic (RR 30) with normal BP and SpO2 of 91% on room air.  he  was  placed  on  continuous  EEGmonitoring  which  was  normal.  A  repeat  urine  drug  screen  wasobtained at the time of admission to the PICU and resulted negativeapproximately 9 hours after the original positive urine test. A plasmadrugs of abuse screen was sent approximately 12 hours after admissionto  the  PICU  and  resulted  positive  for  methadone  and  negative  foramphetamine, barbiturates, benzodiazepines, buprenorphine, cocaine,opiates,   phencyclidine,   cannabinoids,   oxycodone   andmethamphetamine.  Subsequent  testing  via  Quantitative  LiquidChromatography-Tandem Mass Spectrometry confirmed the presenceof both methadone and its metabolite, ethylidine -1,5-dimethyl -3,3-diphenylpyrrolidine (EDDP). A DHS report was filed. He spiked anisolated fever to 38.8 degrees Celsius after admission and underwentan infectious work-up consisting of blood, urine and CSF cultures andwas started on empiric antibiotics of vancomycin and ceftriaxone.

Conclusion:

Pediatric morbidity and mortality related to methadone toxicity hasincreased  over  time.  Children  are  at  especially  high  risk  forcomplications  from  methadone  ingestion  given  that  a  very  smallamount  of  methadone  may  be  fatal  as  there  is significant  overlapbetween toxic and fatal levels of methadone for children. Methadonetoxicity should be considered whenever a pediatric patient presentswith the combination of miosis, central nervous system depression andrespiratory depression as it may require testing beyond the standardurine drug screen to identify the correct drug exposure.

For complete information, please follow the below link: https://www.omicsonline.org/open-access/methadone-toxicity-a-pediatric-case-report.pdf

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Journal of Clinical Toxicology
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