Abstract
A 14-year-old girl with suicidal ideation was presented to the paediatric hospital about 2 h after ingestion of 21 long-acting methylphenidate (MPH) 54-mg tablets (1,134 mg Concerta®). At admission signs of sympathomimetic syndrome were observed like agitation, visual hallucinations, slight hypertension, and sinus tachycardia. Treatment included prevention of absorption (30 g activated charcoal orally) and careful observation related to the overstimulation of the sympathic system. Despite the intake of charcoal, the serum concentrations of MPH were 107 and 93 ng/ml 2.5 and 22 h after ingestion of MPH tablets. No support of vital functions was necessary. The girl made a full recovery and was discharged after 3 days of care at the paediatric clinic and referred to the child and adolescent psychiatric department. Exposure to a huge overdose of long-acting MPH exhibited acute sympathomimetic toxicity but no life-threatening symptoms in this patient. Thus this case report suggests that patients intoxicated with high dose long-acting MPH formulations can recover without sequelae when managed properly.
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References
Fachinformation Concerta (2009) 18 mg/36 mg/54 mg Retardtabletten Rote Liste Service GmbH- Fachinfo- Service Janssen-Cilag
Foley R, Mrvos R, Krenzelok EP (2000) A profile of methylphenidate exposures. Clin Tox 38:625–630
Klein-Schwartz W (2002) Abuse and toxicity of methylphenidate. Curr Opin Pediatr 14(2):219–223
Klein-Schwartz W, McGrath J (2003) Poison centers’ experience with methylphenidate abuse in pre-teens and adolescents. J Am Acad Child Adolesc Psychiatry 42(3):288–294
Levine B, Caplan YH, Kauffman G (1986) Fatality resulting from methylphenidate overdose. J Anal Toxicol 10(5):209–210
Markowitz JS, Straughn AB, Patrick KS, DeVane CL, Pestreich L, Lee J, Wang Y, Muniz R (2003) Pharmacokinetics of methylphenidate after oral administration of two modified-release formulations in healthy adults. Clin Pharmacokinet 42(4):393–401
National Institute for Health and Clinical Excellence: British Psychological Society, Royal College of Psychiatrists (eds) (2009) Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. National Clinical Practice Guideline 72
Ozdemir E, Karaman M, Yurteri N, Erdogan A (2010) A case of suicide attempt with long acting methylphenidate (Concerta). ADHD Attention Deficit and Hyperacitivity disorders. Springer Wien, Epub ahead of print
Scharman EJ, Erdman AR, Cobaugh DJ, Olson KR, Woolf AD, Caravati EM, Chyka PA, Booze LL, Manoguerra AS, Nelson LS, Christianson G, Troutman WG (2007) American association of poison control centers. Methylphenidate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 45(7):737–752
Van Vulpen LF, Malingré MM, Lange R, Bartelink AK (2006) Sympathomimetic syndrome caused by autointoxication with methylphenidate. Ned Tijdschr Geneeskd 150(48):2661–2664
Walitza S, Romanos R, Seifert J, Warnke A, Gerlach M (2009) Psychostimulantien. In: Warnke A, Wewetzer Ch, Gerlach M, Gerlach M, Mehler-Wex C, Walitza S, Walitza S (eds) Neuro-Psychopharmaka im Kindes- und Jugendalter. 2 Auflage, Springer, Wien, pp 289–330
White SR, Yadao CM (2000) Characterization of methylphenidate exposures reported to a regional poison control centre. Arch Pediatr Adolesc Med 154(12):1199–1203
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Klampfl, K., Quattländer, A., Burger, R. et al. Case report: intoxication with high dose of long-acting methylphenidate (Concerta®) in a suicidal 14-year-old girl. ADHD Atten Def Hyp Disord 2, 221–224 (2010). https://doi.org/10.1007/s12402-010-0032-0
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DOI: https://doi.org/10.1007/s12402-010-0032-0