Posted: July 4th, 2024

A 13-year-old female presents to your emergency department with her parents – potential substance ingestion

This case study presents a challenging scenario in paediatric emergency medicine. The patient’s symptoms and clinical presentation suggest potential substance ingestion, necessitating a thorough evaluation and appropriate management.

Effects of Marijuana

Marijuana, or cannabis, can produce various acute effects when consumed. These effects stem from the action of cannabinoids, primarily delta-9-tetrahydrocannabinol (THC), on the endocannabinoid system. Common acute effects include tachycardia, hypertension, conjunctival injection, and dry mouth. Psychoactive effects may include euphoria, relaxation, altered time perception, and impaired memory and concentration. In some cases, particularly with high doses or in susceptible individuals, marijuana can induce anxiety, paranoia, and panic attacks (Huestis et al., 2019).

The patient’s presentation aligns with several known effects of marijuana intoxication, including tachycardia, hypertension, anxiety, and gastrointestinal symptoms. However, it is crucial to consider other potential causes and conduct a comprehensive evaluation.

Patient Management

The management of this patient should follow a structured approach:

1. Stabilisation: Ensure the patient’s airway, breathing, and circulation are stable. Monitor vital signs continuously.

2. History and physical examination: Obtain a detailed history from the patient and parents, focusing on the events at the party, potential substance exposure, and any pre-existing medical conditions. Conduct a thorough physical examination, including neurological assessment.

3. Diagnostic tests: Perform a urine drug screen to detect cannabinoids and other substances. Consider blood tests, including electrolytes, glucose, and liver function tests. An electrocardiogram may be warranted given the patient’s tachycardia and chest tightness.

4. Supportive care: Provide intravenous fluids if needed. Treat symptoms as they arise, such as antiemetics for nausea and vomiting.

5. Observation: Monitor the patient closely for several hours to ensure symptom resolution and rule out any complications.

6. Psychiatric evaluation: Given the patient’s anxiety and agitation, a mental health assessment may be beneficial to address any underlying issues and provide appropriate support (Stellefson et al., 2021).

7. Education and counselling: Once the patient is stable, provide education on the risks of substance use and offer resources for further support if needed.

Other Agents to Consider

While the patient’s symptoms are consistent with marijuana intoxication, it is essential to consider other potential agents:

1. Synthetic cannabinoids: These substances can produce more severe symptoms than marijuana, including agitation, psychosis, and seizures.

2. Stimulants: Drugs such as cocaine, amphetamines, or MDMA can cause similar cardiovascular and neurological symptoms.

3. Hallucinogens: Substances like LSD or psilocybin mushrooms can induce anxiety, altered perceptions, and physiological changes.

4. Alcohol: Ethanol intoxication can present with similar symptoms, especially in adolescents with limited alcohol exposure.

5. Food contaminants: Consider the possibility of accidental ingestion of contaminated food or drinks at the party.

A comprehensive toxicology screen and thorough history-taking are crucial to identify potential exposure to these agents (Chung et al., 2022). The management approach should be tailored based on the identified substance and the patient’s clinical status.

In conclusion, this case highlights the importance of maintaining a high index of suspicion for substance use in adolescents presenting with unexplained symptoms. A systematic approach to evaluation and management, coupled with appropriate support and education, is essential for optimal patient outcomes (Hadland et al., 2023).

References

Chung, C., Dong, Z. and Meehan, T.J., 2022. Acute Pediatric Cannabis Toxicity. Pediatric Emergency Care, 38(1), pp.e372-e376.

Hadland, S.E., Levy, S.J. and Trent, S.A., 2023. Adolescent Substance Use Disorders: Screening, Brief Intervention, and Referral to Treatment. Pediatrics, 151(4), p.e2023061764.

Huestis, M.A., Solimini, R., Pichini, S., Pacifici, R. and Carlier, J., 2019. Cannabidiol adverse effects and toxicity. Current Neuropharmacology, 17(10), pp.974-989.

Stellefson, M., Paige, S.R., Barry, A.E., Wang, M.Q. and Liu, Y., 2021. Cannabis health knowledge and risk perceptions among Canadian youth and young adults. Addiction Research & Theory, 29(3), pp.223-231.

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History: A 13-year-old female presents to your emergency department with her
parents. She returned home after a party and has been complaining of
dizziness, headache, palpitations and a feeling of chest tightness. She
claims to have taken no drugs, but says that she ate at the party. She
vomited twice at home and now feels very hungry.

PMH: None.
Physical Examination:
T: 99.4°F HR: 110 bpm RR: 19 breaths per minute BP: 153/86 mm Hg
General: Pale, agitated and crying. She is very anxious.
HEENT: Examination is normal.
Pulmonary: Clear to auscultation.
CV: Tachycardic without murmur.
Abdomen: Soft and nontender.
Neurologic: GCS 15. Ccranial nerves II-XII intact.
QUESTIONS CASE STUDY #12
1. What are the effects of marijuana?
2. How should this patient be managed?
3. What other agents should be considered?

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