Critical care interventions in children aged 6 months to 12 years admitted to the pediatric intensive care unit after unintentional cannabis exposures

Leonard, James; Laudone, Thomas W; Hines, Elizabeth Quaal

doi:10.1080/15563650.2022.2059497

Cited by 8 publications

(4 citation statements)

References 15 publications

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“…Unfortunately, there has been an increase in the number of children with respiratory involvement and pediatric ICU admission for cannabis intoxication over the last decade [28 ▪ ,29 ▪▪ ,33,34 ▪ ]. This may be caused by increasing THC concentrations and availability of edibles.…”

Section: Clinical Presentation Morbidity and Treatment Of Cannabis To...mentioning

confidence: 99%

“…Treatment of cannabis intoxication is supportive, with many children requiring inpatient hospitalization and observation [10,28 Prompt recognition and removal of an esophageal button battery is imperative, as the longer the impaction, the higher the likelihood of a major adverse outcomes or death.…”

Section: Clinical Presentation Morbidity and Treatment Of Cannabis To...mentioning

confidence: 99%

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Evolving threat of pediatric ingestions: a discussion of cannabis and button batteries and their implications for children

Lorenzo

Beno

2023

Current Opinion in Pediatrics

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Purpose of ReviewPediatric button battery and cannabis ingestions are rising in incidence and have the potential for significant harm. This review will focus on the clinical presentation and complications of these two common inadvertent ingestions in children, as well as recent regulatory efforts and advocacy opportunities. Recent FindingsThe rising incidence of cannabis toxicity in children has corresponded with its legalization across several countries in the last decade. Inadvertent pediatric cannabis intoxication is most commonly due to the ingestion of edible forms discovered by children in their own home. The clinical presentation can be nonspecific, therefore clinicians should have a low threshold for including it on their differential diagnosis. Button battery ingestions are also increasing in incidence. While many children are asymptomatic at presentation, button battery ingestions can quickly cause esophageal injury and lead to several serious and potentially life-threatening complications. Prompt recognition and removal of esophageal button batteries is essential for reducing harm.

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Section: Clinical Presentation Morbidity and Treatment Of Cannabis To...mentioning

confidence: 99%

Section: Clinical Presentation Morbidity and Treatment Of Cannabis To...mentioning

confidence: 99%

Evolving threat of pediatric ingestions: a discussion of cannabis and button batteries and their implications for children

Lorenzo

Beno

2023

Current Opinion in Pediatrics

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“…The authors, in keeping with previous literature (7,11,12), reviewed the list of interventions in the ToxIC registry and arrived at a consensus list of interventions that could only reasonably be performed in an intensive care setting (eTable 1, http://links.lww.com/PCC/ C379). We then reviewed prior literature regarding pharmacologic and nonpharmacologic treatment of hemodynamic instability in cardiovascular medication poisoning (13)(14)(15), and through consensus, derived a list of interventions that could appropriately be characterized as intensive hemodynamic intervention (eTable 1, http://links.lww.com/PCC/C379).…”

Section: Primary and Secondary Outcomesmentioning

confidence: 99%

Intensive Care Interventions Among Children With Toxicologic Exposures to Cardiovascular Medications

Simpson

Watson

Whitledge

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES: Interventions requiring a PICU are rare in toxicologic exposures, but cardiovascular medications are high-risk exposures due to their hemodynamic effects. This study aimed to describe prevalence of and risk factors for PICU interventions among children exposed to cardiovascular medications. DESIGN: Secondary analysis of Toxicology Investigators Consortium Core Registry from January 2010 to March 2022. SETTING: International multicenter research network of 40 sites. PATIENTS: Patients 18 years old or younger with acute or acute-on-chronic toxicologic exposure to cardiovascular medications. Patients were excluded if exposed to noncardiovascular medications or if symptoms were documented as unlikely related to exposure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 1,091 patients in the final analysis, 195 (17.9%) received PICU intervention. One hundred fifty-seven (14.4%) received intensive hemodynamic interventions and 602 (55.2%) received intervention in general. Children less than 2 years old were less likely to receive PICU intervention (odds ratio [OR], 0.42; 95% CI, 0.20–0.86). Exposures to alpha-2 agonists (OR, 2.0; 95% CI, 1.11–3.72) and antiarrhythmics (OR, 4.26; 95% CI, 1.41–12.90) were associated with PICU intervention. In the sensitivity analysis removing atropine from the composite outcome PICU intervention, only exposures to calcium channel antagonists (OR, 2.12; 95% CI, 1.09–4.11) and antiarrhythmics (OR, 4.82; 95% CI, 1.57–14.81) were independently associated with PICU intervention. No independent association was identified between PICU intervention and gender, polypharmacy, intentionality or acuity of exposure, or the other medication classes studied. CONCLUSIONS: PICU interventions were uncommon but were associated with exposure to antiarrhythmic medications, calcium channel antagonists, and alpha-2 agonists. As demonstrated via sensitivity analysis, exact associations may depend on institutional definitions of PICU intervention. Children less than 2 years old are less likely to require PICU interventions. In equivocal cases, age and exposure to certain cardiovascular medication classes may be useful to guide appropriate disposition.

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“…Over the past 5 years, increased edible cannabis exposures in children have resulted in increased hospital visits and admission to pediatric intensive care units (PICUs) in the United States ( Leonard et al, 2022 ). Reviewing the National Poison Data System (NPDS) from 2000 to 2020, it was identified that the proportion of children in the registry with unintentional cannabis ingestion admitted to the PICU increased from 9.5% in 2000 to 14% in 2020 ( Leonard et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Asystole in a young child with tetrahydrocannabinol overdose: a case report and review of literature

Masilamani,

Leff,

Kawai

2024

Front. Toxicol.

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IntroductionThe association between Δ8-tetrahydrocannabinol (THC) and cardiac dysrhythmia has not been well described in children. Asystole, while consistent with reports of severe bradycardia and apnea in children, is uncommonly described in the current literature. We present the first pediatric case of asystole and apnea following THC ingestion.CaseA 7-year-old male presented to the emergency department (ED) after his mother noticed he was lethargic 3–4 h after accidental ingestion of five 15 mg (total of 75 mg) Δ8-THC gummies. Upon arrival, he was vitally stable and well-appearing. He received maintenance intravenous fluids. Approximately 7 h after initial ingestion, he experienced a >15-s episode of asystole and apnea on telemetry requiring sternal rub to awaken. This was followed by bradycardia (60 beats per minute range) which resolved with 0.1 mg glycopyrrolate. He was admitted to the PICU, drowsy but arousable with stable vitals. After an uneventful 24-h (post-ingestion) PICU observation, he was discharged home in stable condition.DiscussionTo our knowledge, this is the first reported pediatric case of THC-induced asystole. The etiology of asystole may be attributed to direct vagal stimulation of THC or respiratory depression. The typical recommended observation time after potential toxicity is 3–6 h after children have returned to their physiological and behavioral baseline. Our patient was clinically stable with no concern for respiratory depression or cardiac dysrhythmia yet experienced an asystolic pause with apnea 7 h after initial ingestion.ConclusionOur case demonstrates that asystole and apnea may occur in pediatric patients following large THC ingestions and those symptoms can appear late outside of the currently recommended observation period.

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Critical care interventions in children aged 6 months to 12 years admitted to the pediatric intensive care unit after unintentional cannabis exposures

Cited by 8 publications

References 15 publications

Evolving threat of pediatric ingestions: a discussion of cannabis and button batteries and their implications for children

Evolving threat of pediatric ingestions: a discussion of cannabis and button batteries and their implications for children

Intensive Care Interventions Among Children With Toxicologic Exposures to Cardiovascular Medications

Asystole in a young child with tetrahydrocannabinol overdose: a case report and review of literature

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