Marijuana toxicity
Background
- Marijuana is the most commonly used illegal substance in the world[1]
- THC concentrations have been steadily increasing in multiple formulations due to strain engineering
- Pediatric overdoses increasing, though unintentional, due to increased legalization and access
Clinical Features
- Excessive and purposeless motor activity of the extremities (hyperkinesis)
- Lethargy
- Tachycardia
- Hypertension or orthostatic hypotension
- Tachypnea
- Conjunctival injection
- Dry mouth
- Increased appetite
- Nystagmus
- Ataxia
- Slurred speech
Differential Diagnosis
- Hypoglycemia
- Meningitis]/Encephalitis
- TBI
- Drugs - Opioids, Antihistamines, Anticholinergics, Antipsychotics
- CO poisoning
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
Evaluation
- Clinical Diagnosis
- Urine toxicology screen helpful, but can be negative with synthetic cannabis
Peak Plasma Concentration Time[2]
- Inhalation: 3-10 minutes
- Ingestion/oral: 1-6 hours
- Intravenous: 10 minutes
- Rectal: 2-8 hours
Management
- Supportive care, if concerned for mixed ingestion, try other reversal agents
Disposition
- Discharge when clinically sober
External Links
References
- Leggett T, United Nations Office on Drugs and Crime. A review of the world cannabis situation. Bull Narc 2006; 58:1.
- Kim HS, Monte AA. Colorado cannabis legalization and its effect on emergency care. Ann Emerg Med. 2016;68(1):71-75
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