Cannabinoids acute intoxication in Paediatrics

Key words: Paediatric cannabinoids intoxication, Cannabis sativa, Marijuana, Hashish

Background - Data available in the literature indicate that cannabis consumption has greatly increased in the USA and in some European countries over the last years, parallel to an increased accidental exposure of children. Similar data from Italy are lacking.
Objective - The aim of the study was to carry out an epidemiological investigation on acute cannabinoids intoxication in patients attending a city paediatric Emergency Room.
Materials and Methods - Clinical records of all patients who came to the Emergency Room (Naples, Italy) from April 2016 to November 2017 were retrospectively reviewed and then the diagnosis of cannabinoid intoxication were selected and evaluated.
Results - 111,989 visits were registered, and 436 cases (0.6%) were acute intoxications. Mean age was 3 ± 2.5 years. Ten of these (1.15%) were cannabinoid intoxication occurred for accidental ingestion in 7 subjects (mean age 2.15 ± 2.17 years) and for intentional inhalation in 3 (mean age 11.3 ± 1.5); p ≤ 0.0001. Diagnosis was always confirmed by the toxicological screening performed on a urine sample. Six of seven patients with accidental ingestion had a reduced state of consciousness, 3 of these had a severe clinical presentation. Two cases of 3 by intentional inhalation had mild symptoms, only one moderate showing visual hallucinations. Conjunctival hyperaemia was the most frequent associated symptom. Six of the 10 patients needed to receive supportive drug treatment, mainly saline infusion and/or oxygen therapy. The length of hospital stay was 12 hours for the cases of intentional intoxication and varied from 12 hours to 12 days (mean 88.6 hours, SD 103.6) for inadvertent intoxications (p: 0.25) with 1 patient admitted to the paediatric Intensive Care Unit.
Conclusions - Cannabinoid intoxication should be always suspected when clinical presentation is not specific and/or is equivocal and when psychiatric manifestations are present. Moreover, the rapid urine toxicology test should become part of the routine screening in the Emergency Room.