Patient Presentation
A pediatrician received a telephone call from the local director of the emergency child care center in the community. A toddler was being placed with them that afternoon that had been taken from a home that was running a clandestine methamphetamine manufacturing laboratory. In her professional training she had learned that usually there were numerous chemicals in the laboratory environment, that hazardous materials cleanup is necessary and that people living in these environments usually need to leave clothing and belongings behind because of the contamination. However, her training did not cover decontamination of people and if the child could potentially pose a risk to others such as her child care professionals.
The diagnosis of a child with methamphetamine exposure and possible other chemical contamination was made. The pediatrician said that he did not know the exact answer but would check with the local child protection team. From other safety training about biological and radiation hazards he said that the child care providers should follow universal precautions as they always did, and thought that the child would probably not pose a risk as the child should have been bathed thoroughly already which is usually the second step for any decontamination process after removal from the environment. Additionally, the pediatrician felt it was unlikely that the child would have contaminated sweat, tears or other body fluids that would pose a risk to the child care provider. He recommended contacting the fire department’s hazardous materials division for more information if needed. Later, the child protection team confirmed that the child should be bathed with regular soap and water and should not pose additional risk to his/herself or others because of the clandestine laboratory exposure.
Discussion
Methamphetamine is an illegal, man-made, powerful central nervous system drug that gives the user an intense pleasurable feeling that is longer lasting than cocaine which it is similar to. Methamphetamine is highly addictive when used by smoking, inhaling, injecting or being swallowed. Because of unregulated manufacturing, numerous known and unknown chemical contaminants are possible in the manufacturing environment. Areas of highest contamination are in the area of direct manufacturing and chemical discharge such as drains and soil, but other locations where the chemicals can be tracked into such as wall and floors can be contaminated. Clean-up involves properly trained and protected workers using hazardous materials procedures including removal and proper disposal of contaminated materials (i.e. heavily soiled materials such as manufacturing equipment, tables, floor coverings), washing with water and/or plain soap (i.e. mopping of non-directly contaminated areas such as linoleum, clothing, persons, etc.), and containment (i.e. using permeable barrier to contain the chemical such as epoxy paint over walls). Clean-up is regulated by local and state regulations.
Learning Point
Chemical contaminants from methamphetamine manufacturing include, but are not limited to methamphetamine, 1,2-dimethyl-phenyl-aziridine, phenyl-2-propanone, 1-benzyl-methylnaphthalene, 1,3-dimethyl-2-phenylnaphthalene, iodine, hydrochloric acid, and hydriodic acid. While these chemicals can be dangerous, the greatest risk is the behavior of the persons making and using the drug. Children in the environment are often exposed to fires and explosions, numerous safety problems, abuse and neglect, and multitudes of social problems. The United State Justice Department’s Office of Victims of Crimes has a brief yet detailed overview of these potential exposures (see To Learn More below).
Questions for Further Discussion
1. What local resources are available to clean up potentially hazardous materials in your local environment?
2. What are the procedures for medical evaluations of children being placed into the foster care system locally?
3. What problems can infants born to mothers using methamphetamine during pregnancy have?
Related Cases
- Disease: Methamphetamine
- Symptom/Presentation: Child Abuse and Neglect and Sexual Abuse | <a Health Maintenance and Disease Prevention
- Specialty:
Child Abuse and Neglect | Pharmacology / Toxicology | Social Services
- Age: Toddler
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: Methamphetamine
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
Office for Victims of Crimes. U.S. Justice Department. Dangers to Children Living at Meth Labs. Available from the Internet at:http://www.ovc.gov/publications/bulletins/children/pg5.html (rev. 6/2003, cited 2/28/2011)
California Department of Toxic Substances Control. Initial Evaluation of Emission from Methamphetamine Manufacuring Via the Ephedrine/Red Phosphorus/Hydriodic Acid Method.
Available from the Internet at http://www.dtsc.ca.gov/sitecleanup/erp/upload/smbrb_memo_initial-eval.pdf (rev. 6/23/2003, cited 2/28/2011).
Illinois Department of Public Health. Methamphetamine Laboratories.
Available from the Internet at http://www.idph.state.il.us/envhealth/factsheets/meth-labs.htm (cited 2/28/2011).
ACGME Competencies Highlighted by Case
8. Health care services aimed at preventing health problems or maintaining health are provided.
9. Patient-focused care is provided by working with health care professionals, including those from other disciplines.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
14. Knowledge of study designs and statistical methods to appraisal clinical studies and other information on diagnostic and therapeutic effectiveness is applied.
20. Respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development are demonstrated.
23. Differing types of medical practice and delivery systems including methods of controlling health care costs and allocating resources are known.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital
Pediatric Education 