Marijuana toxicity: Difference between revisions
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==Background== | ==Background== | ||
*Marijuana is the most commonly used illegal substance in the world<ref>Leggett T, United Nations Office on Drugs and Crime. A review of the world cannabis situation. Bull Narc 2006; 58:1.</ref> | *Marijuana is the most commonly used illegal substance in the world<ref>Leggett T, United Nations Office on Drugs and Crime. A review of the world cannabis situation. Bull Narc 2006; 58:1.</ref> | ||
*THC concentrations have been steadily increasing in multiple formulations due to strain engineering | |||
*Pediatric overdoses increasing, though unintentional, due to increased legalization and access | |||
==Clinical Features== | ==Clinical Features== | ||
*Excessive and purposeless motor activity of the extremities (hyperkinesis) | *Excessive and purposeless motor activity of the extremities (hyperkinesis) | ||
*Lethargy | *[[Lethargy]] | ||
*Tachycardia | *[[Tachycardia]] | ||
* | *[[Hypertension]] or orthostatic [[hypotension]] | ||
*Tachypnea | *[[Tachypnea]] | ||
*Conjunctival injection | *Conjunctival injection | ||
*Dry mouth | *Dry mouth | ||
*Increased appetite | *Increased appetite | ||
*Nystagmus | *[[Nystagmus]] | ||
*Ataxia | *[[Ataxia]] | ||
*Slurred speech | *[[Dysarthria|Slurred speech]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Hypoglycemia]] | |||
*[[Meningitis]]]/[[Encephalitis]] | |||
*[[TBI]] | |||
*Drugs - [[Opioid toxicity|Opioids]], [[Antihistamines]], [[Anticholinergic toxicity|Anticholinergics]], [[Antipsychotics]] | |||
*[[CO poisoning]] | |||
{{Drugs of abuse types}} | |||
== | ==Evaluation== | ||
*Clinical Diagnosis | *Clinical Diagnosis | ||
* | *[[Urine toxicology screen]] helpful, but can be negative with synthetic cannabis | ||
===Peak Plasma Concentration Time<ref>Kim HS, Monte AA. Colorado cannabis legalization and its effect on emergency care. Ann Emerg Med. 2016;68(1):71-75</ref>=== | |||
*Inhalation: 3-10 minutes | |||
*Ingestion/oral: 1-6 hours | |||
*Intravenous: 10 minutes | |||
*Rectal: 2-8 hours | |||
==Management== | ==Management== | ||
*Supportive care, if concerned for mixed ingestion, try other reversal agents | |||
==Disposition== | ==Disposition== | ||
*Discharge when clinically sober | |||
==See Also== | ==See Also== | ||
*[[Cannabinoid hyperemesis syndrome]] | *[[Cannabinoid hyperemesis syndrome]] | ||
*[[Synthetic cannabinoids]] | |||
==External Links== | ==External Links== | ||
Latest revision as of 23:08, 22 September 2019
Background
- Marijuana is the most commonly used illegal substance in the world[1]
- THC concentrations have been steadily increasing in multiple formulations due to strain engineering
- Pediatric overdoses increasing, though unintentional, due to increased legalization and access
Clinical Features
- Excessive and purposeless motor activity of the extremities (hyperkinesis)
- Lethargy
- Tachycardia
- Hypertension or orthostatic hypotension
- Tachypnea
- Conjunctival injection
- Dry mouth
- Increased appetite
- Nystagmus
- Ataxia
- Slurred speech
Differential Diagnosis
- Hypoglycemia
- Meningitis]/Encephalitis
- TBI
- Drugs - Opioids, Antihistamines, Anticholinergics, Antipsychotics
- CO poisoning
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Kratom
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
- Chloral hydrate
- Body packing
Evaluation
- Clinical Diagnosis
- Urine toxicology screen helpful, but can be negative with synthetic cannabis
Peak Plasma Concentration Time[2]
- Inhalation: 3-10 minutes
- Ingestion/oral: 1-6 hours
- Intravenous: 10 minutes
- Rectal: 2-8 hours
Management
- Supportive care, if concerned for mixed ingestion, try other reversal agents
Disposition
- Discharge when clinically sober