Metoclopramide is a widely used antiemetic, which carries a significant risk of acute extrapyramidal reactions, particularly in children. This case report describes a severe case of overdose following self-medication.

A previously healthy 12-year-old boy presented with acute dystonic syndrome (oromandibular and cervical dystonia, and abdominal spasms) 12 hours after ingesting 90 mg of metoclopramide to treat gastroenteritis. Neurological examination revealed no abnormalities, and a brain MRI scan showed no structural abnormalities. Management in the intensive care unit included discontinuing the drug immediately, intravenous rehydration and administering biperiden (5 mg IV), alongside light sedation using midazolam. The symptoms resolved completely within six hours. The patient was discharged after 48 hours without sequelae.

This case highlights the severe and potentially serious neurotoxicity of metoclopramide in children. It warns against the dangers of self-medication and non-compliance with paediatric dosages and calls for stronger preventive measures and information for healthcare professionals and the public.