Original Article   

Minerva Pediatrics 2022 Nov 02

DOI: 10.23736/S2724-5276.22.06991-9

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Unintentional cannabis intoxication in infants and toddlers presenting with neurological impairment in a Pediatric Emergency Department

Cristina MASCOLO ¹, Mara PISANI ², Marco MARANO ^{2, 3}, Pierfrancesco BERTUCCI ⁴, Elena BELLELLI ², Flavia SEVERINI ¹, Antonino REALE ², Alberto VILLANI ², Umberto RAUCCI ² ✉

¹ Department of Pediatrics, Bambino Gesù Children’s Hospital, Tor Vergata University, Rome, Italy; ² Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, Rome, Italy; ³ Paediatric Clinical Toxicology Center, Bambino Gesù Children’s Hospital, Rome, Italy; ⁴ Department of Laboratory Medicine, Tor Vergata University, Rome, Italy

BACKGROUND: Recent data show that the rising consumption of cannabis has increased the rate of acute intoxication in pediatric age. Common patterns of pediatric poisoning consist of exploratory ingestions in younger children. A history of poisoning is often not provided; therefore, it could be advisable to use an objective biological marker. The clinical presentation of occult ingestion can range from asymptomatic to critically ill. Neurological involvement is one of the most described presentations. The goal of our study was to examine the presentation of acute cannabis intoxication in a sample of 13 pediatric patients under 3 years.
METHODS: A retrospective epidemiological investigation on acute cannabinoid intoxication was conducted on children under 3 years, recruited between 2016 and 2020. All patients were tested for urine drug screening suspecting poisoning as reason for Emergency Department (ED) admission.
RESULTS: Thirteen of forty-eight patients tested (27%) were positive for Tetrahydrocannabinol (THC). Ingestion was the route of intoxication in all of them. Only in five cases the possible accidental intake of cannabinoids was promptly declared. Twelve children accessed on ED due to a neurological symptomatology not attributable to known causes in the medical history.
CONCLUSIONS: Differential diagnosis for abuse drugs exposure in young children is broad: the urine drug screening plays a central role for confirmation of the diagnostic suspicion and identification of the specific substance. A positive result combined with a history of potential access to cannabis could prevent unnecessary, invasive, expensive procedures. When identified, the management is predominantly supportive. In this article, we want to emphasize the importance of always considering drug intoxication in children with acute neurological symptoms especially in cases of ambiguous familiar or social context. Further studies will be needed to better characterize the alarm bells for intoxication and to identify a strategy for the prevention of unintentional cannabinoid intoxication.

KEY WORDS: Cannabis; Children; Emergency department; Neurological impairment; Unintentional ingestion