Cannabis Intoxication in Children: About Three Cases

Introduction: Consultations for acute disorders of consciousness are relatively frequent pediatric emergencies. Among the most frequently mentioned causes in cases of apyrexia, metabolic causes and drug or other poisoning, illicit substances are however more and more involved in Pediatrics. We report three cases of cannabis intoxication that required hospitalization in a pediatric resuscitation unit.

Observations: We identified three cases of cannabis intoxication diagnosed in two female and one male infants aged respectively of 22 months, 18 months and 14 months, who consult for brutal apparition of consciousness disorders combining alternately drowsiness and agitation in a context of apyrexia. The clinical examination found apyrexia in all cases, Glasgow score at 11/15 for one patient and 13/15 for the other two infants. All the patients had intermediate pupils with a symmetrical and present photomotor reflex, axial and peripheral hypotonia, normal osteotendinous reflexes. Toxicological research confirmed a high level of cannabinoid derivatives at the urinary level (> 100ng / mL) in all cases. Blood levels of delta-9-tetrahydrocannabinol (THC) were also positive. During the evolution, only one infant had sinus tachycardia at 170batt / min and hypothermia at 35 °. Treatment was symptomatic, consisting of intravenous hydration. Activated charcoal was received in all cases. Treatment with Flumazenil at a dose of 10 gamma / kg was administered to all patients, twice in one infant and 3 times in the two others. The complete regression of the symptomatology was observed after 3 days on average (min 24 hours - max 5 days).

Conclusion: The distribution and use of cannabis has increased significantly in Tunisia. Accidental intoxications of children have become more and more frequent but they are poorly described. In addition, this unusual intoxication for Tunisian pediatricians is probably underestimated, given the lack of systematic screening of cannabis. Thus, cannabis intoxication should be mentioned first before any alteration of the unexplained state of consciousness. The search for cannabinoid derivatives in the urine must be requested.