Pediatric cocaine poisoning: A case series

The authors present a case series of pediatric cocaine poisoning. These poisonings are rare but lead to the most serious clinical pictures among pediatric poisonings. The most frequently described symptoms are tachycardia, convulsions and loss of consciousness. A retrospective study of cocaine intoxications documented in the pharmacokinetics and toxicology laboratory of the Marseille University Hospital from 01/01/2019 to 12/31/2021 was carried out. The inclusion criteria were: age between 1 month and 12 years, positive urinary screening (immunoanalysis) followed by a quantitative confirmatory analysis by LC-MS/MS. During the study period, 7 out of 1219 urine tests were positive and 4 were confirmed by LC-MS/MS. Cocaine exposure was not considered by clinicians prior to the screening result for 4. Urinary concentrations were documented for 4 patients: cocaine < 5-50 ng/mL; benzoylecgonine > 100-654 ng/mL; ecgonine methylester ND-278 ng/mL. Plasma concentrations for 2 patients: cocaine < 5-7 ng/mL; benzoylecgonine 10-13 ng/mL; ecgonine methylester < 5-76 ng/mL. The clinical picture was completed for 3 patients. All the children presented neurological and cardiorespiratory disorders of varying severity. Thanks to optimal medical care, the outcome was favorable for all. The cocaine poisonings were probably secondary to accidental exposure. Finally, the route of exposure was supposed for one case. This series makes it possible to recommend in the face of unexplained neurological or cardiovascular disorders in a child, to consider the differential diagnosis of intoxication by a psychoactive substance and to document it biologically. (c) 2023 Societe Francaise de Toxicologie Analytique. Published by Elsevier Masson SAS. All rights reserved.