A cannabinoid-intoxicated child treated with dexmedetomidine: a case report

Journal of Medical Case Reports

Giorgio Conti¹  Marco Piastra¹  Silvia Maria Pulitanò¹  Aldo Mancino¹  Flora Cipriani¹ 

[1] Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, Rome, 00168, Italy

关键词: Pediatric intensive care;    Dexmedetomidine;    Cannabinoids;   

Others  :  1231442
DOI  :  10.1186/s13256-015-0636-2

 received in 2015-02-02, accepted in 2015-06-15,  发布年份 2015

【 摘 要 】

Introduction

In the last 20 years, the rate of exposure to marijuana has increased dramatically, even in the pediatric population. Effects of intoxication are variable, more severe neurological symptoms can be observed following ingestion, thus hospital or intensive care unit admission is often required. Usually cannabinoids intoxicated patients are treated with administration of benzodiazepines or opioids, accepting the related risk of intubation and mechanical ventilation. Dexmedetomidine is a highly selective α ₂ -adrenergic receptor agonist, with no effect on the respiratory drive and pattern and produces a good level of sedation, allowing to avoid the administration of other sedatives. To our knowledge, this is the first reported case of dexmedetomidine use to support a cannabis intoxicated patient.

Case presentation

A 19-month-old Caucasian boy was presented to our emergency department. At the time of his arrival, he was somnolent with paroxysms of agitation, breathing spontaneously and hemodynamically stable. The results of all investigations were negative, but the result of the immunochemical screening of his urine was positive for Δ ⁹ -tetrahydrocannabinol. The patient was admitted to the pediatric intensive care unit and treated with a continuous infusion of dexmedetomidine.

Conclusions

Dexmedetomidine is a fairly safe and effective antidote for pediatric marijuana or natural cannabinoid exposures. Its properties and potential to allow for “cooperative” sedation make it a more attractive choice with fewer side effects than benzodiazepines or opioids.

【 授权许可】

   
2015 Cipriani et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Appelboam A, Oades PJ. Coma due to cannabis toxicity in an infant. Eur J Emerg Med. 2006; 13:177-9.
• [2]Carstairs SD, Fujinaka MK, Keeneo GE, Ly BT. Prolonged coma in a child due to hashish ingestion with quantitation of the metabolites in urine. J Emerg Med. 2011; 41(3):e69-71.
• [3]Marcou A, Paon JC, Dufour D, Belgaïd A, Goullé JP, Le Roux P. [Cannabis-induced toxicity in an 11-month-old child]. Presse Med. 2004; 33:940.
• [4]Croche Santander B, Alonso Salas MT, Loscertales Abril M. [Accidental cannabis poisoning in children: report of four cases in a tertiary care center from southern Spain]. Arch Argent Pediatr. 2011; 109:4-7.
• [5]Effects of marihuana on man. Pediatrics. 1975; 56:134-43.
• [6]Mowry JB, Spyker DA, Cantilena LR, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st annual report. Clin Toxicol (Phila). 2014; 52(10):1032-283.
• [7]Wang GS, Roosevelt G, Heard K. Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatr. 2013; 167(7):630-3.
• [8]Adams IB, Martin BR. Cannabis: pharmacology and toxicology in animals and humans. Addiction. 1996; 91(11):1585-614.
• [9]Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent). 2001; 14(1):13-21.
• [10]Afonso J, Reis F. Dexmedetomidine: current role in anesthesia and intensive care. Rev Bras Anestesiol. 2012; 62:118-33.
• [11]Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Crit Care Clin. 2009; 25:451-69.
• [12]Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M. The α 2 -adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology. 2003; 98(2):428-36.
• [13]Gravel NR, Searle NR, Sahab PG, Carrier M. Sedation in critically ill patients: practical recommendation. CNS Drugs. 1999; 11:9-22.
• [14]Su F, Hammer GB. Dexmedetomidine: pediatric pharmacology, clinical uses and safety. Expert Opin Drug Saf. 2011; 10:55-66.
• [15]Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ et al.. Dexmedetomidine for Long-Term Sedation Investigators. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012; 307(11):1151-60.