G457(P) Acute cannabis intoxication in an infant. (May 2019)

• Record Type: Journal Article
• Authors: Morgan, I; Abernethy, S
• Is Part Of: Archives of disease in childhood. Volume 104:(2019)Supplement 2
• Page Start: A185
• Page End: A185
• Publication Date: 2019-05
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-rcpch.442
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Objective: To describe an unusual presentation of cannabis intoxication with encephalopathy and markedly abnormal respiration in a previously well child, and to highlight the importance of awareness of the potential toxicity of this drug. Method/case history: A previously fit and well 13 month old presented to a District General Hospital with pallor and poor balance after waking from a nap. She went on to develop gasping respiration over the next few hours in association with worsening encephalopathy requiring transfer to a tertiary paediatric centre for specialist opinion. Clinical examination showed global hypotonia, conscious level varying between unresponsive and response to pain, and gasping respiration. The child was intubated, but improved over 24 hours. Results: Initial investigations in the local DGH including inflammatory markers and LP for microscopy were normal. CT brain and MRI brain with contrast were normal. EEG showed general changes in keeping with encephalopathy. Further blood and CSF tests were undertaken for neuroimmunological and metabolic causes which were all normal. Urine toxicology was positive for cannabinoids. Conclusions: In older children and adults acute cannabinoid intoxication is associated with psychosis, changes in observations and clinical signs. This case demonstrates that in infants a pattern of encephalopathy without other focal signs can be the only presenting feature. In this case, the child also had a markedly abnormal breathing pattern, which has rarely been reported in the literature. In addition she had marked EEG change which recovered to baseline. Intoxication with cannabinoids should be suspected in cases of unexplained encephalopathy in infants and young children, and if results are available early may prevent invasive investigations. This is a time of intense interest in the use of cannabinoids, both in the medical fraternity and in the general public, but this case highlights that they are not without risk.