Cocaine pediatric poisoning: A case series

Abstract

To present a case series of cocaine pediatric poisoning. Cocaine pediatric poisonings are rare but lead to the most serious clinical pictures among the pediatric poisonings (Armenian, J Emerge Med, 2007, 52, 825–32). The most frequently described symptoms are tachycardia, convulsions and loss of consciousness (Dinnies, Am J Dis Child, 1990, 144, 743–4). A retrospective study of cocaine intoxications documented in the laboratory between 01/01/2019 and 12/31/2021 was conducted. Inclusion criteria were: age between 1 month and 12 years, a positive urine screening (immunoassay), followed by a confirmatory analysis with liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Children under 1 month and over 12 years old were excluded in order to exclude in utero exposure and voluntary poisoning among teenagers. Patients’ clinical information were collected from the computerized medical record. During the study period, 7 immunoassays screenings out of 1219 found a positive result and 5 were confirmed by LC-MS/MS. Exposure to cocaine was not considered by clinicians before the screening result for all 5. Urinary concentrations were documentated for 4 patients: cocaine 13-50 ng/mL; BE 276–654 ng/mL; EME 75–278 ng/mL. Plasma concentrations were documentated for 3 patients: cocaine 0–7 ng/mL; BE 10–13 ng/mL; EME 0–76 ng/mL. The clinical picture was provided for 4 patients. They all presented neurological symptoms of varying severity including faintness, loss of consciousness, hypotonia, convulsions and coma. Three patients presented cardio-respiratory disorders including polypnea; intermittent bradycardia and hypoventilation; cyanosis and disturbed cardiac biological analyses (troponinemia at 151 ng/L and BNP at 7180 ng/L). These symptoms are consistent with those described in the current literature (Armeninan, J Emerge Med, 2007, 52, 825–32) (Ernst, Ann Emerg Med, 1989, 774–7) (Galard, Pediatr Emerg Care, 1989, 5, 245–7). Thanks to an optimal medical care, the outcome was favorable for all. In 4 cases, cocaine poisonings were probably consecutive to an accidental exposure following care-givers negligence, in one case the cocaine exposure was due to a deliberate administration by the mother in the context of Münchhausen syndrome by proxy but the route of exposure was not known in any case. Cocaine pediatric intoxications are rare, however somatic consequences can be serious. Following unexplained neurological or cardiovascular disorders in a child, the differential diagnosis of intoxication by a psychoactive substance should be considered and documented to optimize patient management.