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Unintentional Cannabis Ingestion in Children: A Systematic Review - 01/11/17

Doi : 10.1016/j.jpeds.2017.07.005 
John R. Richards, MD * , Nishelle E. Smith, MS, Aimee K. Moulin, MD
 Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA 

*Reprint requests: John R. Richards, MD, Department of Emergency Medicine PSSB 2100, U.C. Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817.Department of Emergency Medicine PSSB 2100U.C. Davis Medical Center2315 Stockton BlvdSacramentoCA95817

Abstract

Objective

To analyze published reports of unintentional cannabis ingestions in children to determine presenting signs and symptoms, route of exposure, treatment, and outcome.

Study design

PubMed, OpenGrey, and Google Scholar were systematically searched. Articles were selected, reviewed, and graded using Oxford Center for Evidence-Based Medicine guidelines.

Results

Of 3316 articles, 44 were included (3582 children age ≤12 years). We found no high quality (Oxford Center for Evidence-Based Medicine level I or II) studies and 10 level III studies documenting lethargy as the most common presenting sign and confirming increasing incidence of unintentional ingestion in states having decriminalized medical and recreational cannabis. We identified 16 level IV case series, and 28 level V case reports with 114 children, mean age 25.2 ± 18.7 months, range 8 months to 12 years, and 50 female children (44%). The most common ingestion (n = 43, 38%) was cannabis resin, followed by cookies and joints (both n = 15, 13%). Other exposures included passive smoke, medical cannabis, candies, beverages, and hemp oil. Lethargy was the most common presenting sign (n = 81, 71%) followed by ataxia (n = 16, 14%). Tachycardia, mydriasis, and hypotonia were also commonly observed. All cases were cared for in the emergency department or admitted, and mean length of stay was 27.1 ± 27.0 hours. Twenty (18%) were admitted to the pediatric intensive care unit, and 7 (6%) were intubated.

Conclusions

Unintentional cannabis ingestion by children is a serious public health concern and is well-documented in numerous studies and case reports. Clinicians should consider cannabis toxicity in any child with sudden onset of lethargy or ataxia.

El texto completo de este artículo está disponible en PDF.

Keywords : cannabis, marijuana, edible, cannabinoid, children, toxicology, ingestion

Abbreviations : PICU, THC, TW


Esquema


 A.K.M. is supported by a postdoctoral training grant in health services research from the Agency for Healthcare Research and Quality (T32 HS022236). The other authors declare no conflicts of interest.


© 2017  Elsevier Inc. Reservados todos los derechos.
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Vol 190

P. 142-152 - novembre 2017 Regresar al número
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