Marijuana Misadventures in Children

Heizer, Justin W.; Borgelt, Laura M.; Bashqoy, Ferras; Wang, George S.; Reiter, Pamela D.

doi:10.1097/pec.0000000000000770

Cited by 20 publications

(8 citation statements)

References 18 publications

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“…In a retrospective review study comparing first-time cannabis users with cannabis experienced children aged 1 month to 20 years old who were treated for acute cannabis toxicity, the authors found that patients who had never used cannabis before were more likely to feel lethargic or somnolent, have longer-lasting symptoms, and required longer hospital stays [83]. They report patients were more likely to need hospital admission with > 5 mg THC/kg and were more likely to be observed and discharged from the ED with 3 mg THC/kg or less.…”

Section: Pediatric Exposurementioning

confidence: 99%

The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review

Takakuwa¹,

Schears

2021

Int J Emerg Med

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Background Cannabis is the most prevalent illegal drug used and the second most common cause of ED drug-related complaints in the USA. Recently, newer more potent strains, concentrated THC products, and consumption methods have become available. Objective Our first objective was to define cannabis use in the USA and provide a summary background on its current preparations, pharmacokinetics, vital sign and physical exam findings, adverse effects, and laboratory testing. Our second objective, using the aforementioned summary as relevant background information, was to present and summarize the care and treatment of the most commonly reported cannabis-related topics relevant to ED physicians. Methods We first performed an extensive literature search of peer-reviewed publications using New PubMed and Cochrane Central Register of Controlled Trials to identify the most commonly reported cannabis-related topics in emergency care. Once the six topic areas were identified, we undertook an extensive narrative literature review for each section of this paper using New PubMed and Cochrane Central Register of Controlled Trials from the inception of the databases to September 30, 2020. Results The six subject areas that were most frequently reported in the medical literature relevant to cannabis-related ED care were acute intoxication/overdose, pediatric exposure, cannabinoid hyperemesis syndrome, cannabis withdrawal, e-cigarette or vaping product use-associated lung injury (EVALI), and synthetic cannabinoids. Conclusion As cannabis becomes more widely available with the adoption of state medical cannabis laws, ED-related cannabis visits will likely rise. While cannabis has historically been considered a relatively safe drug, increased legal and illegal access to newer formulations of higher potency products and consumption methods have altered the management and approach to ED patient care and forced physicians to become more vigilant about recognizing and treating some new cannabis-related life-threatening conditions.

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Section: Pediatric Exposurementioning

confidence: 99%

The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review

Takakuwa¹,

Schears

2021

Int J Emerg Med

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“…11 Younger pediatric patients may present with signs of CNS depression, such as lethargy or somnolence, with the most serious effect being respiratory insufficiency and coma. 8,12–17…”

Section: Introductionmentioning

confidence: 99%

“…Depending on the effective dose, the child may recover after several hours of observation or require admission to the hospital wards or intensive care unit for persistent AMS and/or respiratory insufficiency. 12 Cases of unintentional marijuana ingestion should be reported to the local poison control center for epidemiologic tracking. Depending on the social and family situations, providers may need to engage additional social support or child protective services.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Emergency Medicine Simulation Curriculum: Marijuana Ingestion

Burns

Sanseau

et al. 2018

MedEdPORTAL

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IntroductionAltered mental status can be a challenging presenting symptom in children due to the wide differential diagnosis, which ranges from the relatively benign to the life threatening. Marijuana ingestion and unintentional intoxication are becoming an increasingly common cause of altered mental status in children as marijuana use and availability of enticing marijuana edibles increase in the United States. Because children present with altered mental status rather than the typical marijuana toxidrome, appropriately managing these patients in emergency settings can be particularly challenging.MethodsThis simulation-based curriculum involved the evaluation and management of a 6-year-old boy who presented with altered mental status from acute marijuana intoxication unbeknownst to his parents. Participants systematically evaluated a pediatric patient with a broad differential diagnosis of altered mental status and managed the patient with acute marijuana intoxication. This scenario may be modified based on trainee level (medical student vs. resident vs. fellow).ResultsA total of 20 trainees comprising six emergency medicine fellows and 14 pediatric residents and medical students participated in this simulation curriculum over three iterations. Trainees consistently rated it as an overall positive learning experience for pediatric altered mental status and toxidrome education.DiscussionLow-frequency, high-risk illnesses such as altered mental status due to marijuana intoxication require providers to be familiar with their evaluation and management. This curriculum provides instructors with the materials to successfully implement and improve the simulation over time.

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“…6 Exposure to marijuana can cause significant clinical consequences such as euphoria, impaired motor skills, altered mental status, tachycardia, lethargy, somnolence, and in cases of acute toxicity, respiratory depression. [5][6][7][8][9][10][11][12] Newer articles describe younger pediatric patients who may present with encephalopathic signs and symptoms and some require intubation. 9,13,14 To the unsuspecting medical provider, clinical symptoms of marijuana intoxication can present like many other serious conditions.…”

mentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12] Newer articles describe younger pediatric patients who may present with encephalopathic signs and symptoms and some require intubation. 9,13,14 To the unsuspecting medical provider, clinical symptoms of marijuana intoxication can present like many other serious conditions. Without disclosure of marijuana exposure, the clinical constellation of marijuana toxicity may lead the treating medical provider to consider potentially avoidable diagnostic studies.…”

mentioning

confidence: 99%

Increased Testing and Health Care Costs for Pediatric Cannabis Exposures

et al. 2019

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Objectives: This study aimed to evaluate the process of identifying marijuana exposure in a children's hospital emergency department and compare the cost of diagnostic testing and procedures.Methods: A retrospective chart review was performed on patients 31 days to 20 years old with a positive marijuana toxicology screen result between November 2009 and December 2014. Primary outcomes included time to provider recognition of marijuana exposure, number of diagnostic tests and procedures performed, and length of hospital stay. Patients were analyzed based on time of exposure recognition (forthcoming compared with not forthcoming of marijuana exposure) and age (children <12 years compared with adolescents >12 years).Results: There were 37 children and 38 adolescents included. Mean time to exposure recognition was 2.3 ± 4.3 hours in children compared with 0.4 ± 0.9 hours in adolescents (P = 0.02). Patients who were not forthcoming of marijuana exposure experienced more than twice as many diagnostic tests or procedures compared with children who were forthcoming of marijuana exposure (mean, 8.91 vs 4 tests, P < 0.0001) and more than a 4-fold higher cost of potentially avoidable diagnostic tests/procedures. Length of hospital stay was significantly longer in children (18.34 ± 2.39 hours) compared with adolescents (4.22 ± 0.52 hours; P ≤ 0.0001). Few parents or guardians were able to disclose characteristics of the marijuana product. Conclusion:Delay in recognition of marijuana exposure is associated with high resource utilization, unnecessary medical costs, and prolonged length of stay.

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Marijuana Misadventures in Children

Cited by 20 publications

References 18 publications

The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review

The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review

Pediatric Emergency Medicine Simulation Curriculum: Marijuana Ingestion

Increased Testing and Health Care Costs for Pediatric Cannabis Exposures

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