TY - JOUR T1 - Abnormal movements and diaphragmatic flutter in a case of suspected induced illness JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2020-236962 VL - 14 IS - 4 SP - e236962 AU - Rebecca Arvier AU - Thomas Clayton AU - Monique Dade AU - Rahul S Joshi Y1 - 2021/04/01 UR - http://casereports.bmj.com/content/14/4/e236962.abstract N2 - A 6-month-old girl presented to hospital via ambulance with a decreased conscious level (initial Glasgow Coma Scale of 3) and an abnormal breathing pattern described as diaphragmatic flutter. She then developed abnormal movements and continued to have episodes of fluctuating conscious levels so was transferred to a tertiary hospital paediatric intensive care unit for further investigation. During her 16-day stay in hospital, she continued to experience discrete episodes of drowsiness, bradycardia, unusual breathing patterns and abnormal movements which were associated with agitation, tachycardia, hypertension and insomnia. The patient underwent extensive investigation for her symptoms and, after some delay in waiting for initial results before considering a urine drug screen, she was ultimately found to have lisdexamfetamine and clonidine in her urine drug screen. Her symptoms subsequently resolved after her mother’s visits were restricted. ER -