A candy catastrophe: Case report on methamphetamine poisoning in a child

Methamphetamine, a potent amphetamine derivative, is increasingly implicated in pediatric poisonings and can present with severe neurological, cardiovascular, or behavioural disturbances. Clinicians must remain vigilant when managing undifferentiated status epilepticus, as toxic etiologies may masquerade as primary medical causes. A previously healthy 3-year-old boy was found convulsing at home and received rectal diazepam without improvement. On arrival at the emergency department, he exhibited generalised tonic-clonic seizures, tachycardia, and dilated pupils despite intravenous benzodiazepines and levetiracetam. Suspicion arose when inconsistent caregiver accounts and mention of “candy” ingestion led the team to perform toxicology screening, which revealed methamphetamine as the offending agent. The child required endotracheal intubation and continuous midazolam infusion to control his refractory seizures. Subsequent investigations showed lactic acidosis but no intracranial pathology. Both parents later admitted to methamphetamine use prompting urgent child-protection involvement. The boy was successfully extubated after two days, recovered without neurological deficits, and was discharged on hospital day eight. This case underscores the importance of maintaining a high index of suspicion for toxic etiologies in unexplained pediatric seizures. Early recognition, prompt seizure management, and vigilant social assessment are critical to achieving favourable outcomes and ensuring child safety.