543: CEREBRAL EDEMA IN PEDIATRIC MARIJUANA INGESTION

Abstract

Introduction: Altered mentation in children while less common than in adult patients, continue to be a common indication for admission to the Pediatric Intensive Care Unit (PICU). Toxic ingestions such are an important consideration in the investigation of an altered pediatric patient. Unintentional pediatric ingestions of marijuana and edible cannabis-derived products are becoming more common. Marijuana ingestion in the pediatric population can have a wide-ranging presentation from mild lethargy and anxiety to acute encephalopathy. The case we present is of a 16-month-old male with an unintentional ingestion of THC oil who developed severe encephalopathy and cerebral edema. The development of cerebral edema due to THC toxicity has not been reported before. Description: A 16-month-old male presented to the emergency department for evaluation of altered mentation and concern for toxic ingestion. The history was significant for potential ingestion of mixed essential oils and/or cannabinoids oil. Initially upon arrival at the emergency department, the patient was somnolent but responsive to painful stimuli and was able to protect his airway. He deteriorated quickly over the first few hours and required intubation for worsening mental status and respiratory drive. Urgent CT head was showed significant cerebral edema and slit-like ventricles (figure 1). Hematologic, chemistry and toxicology laboratory tests were within normal limits except for positive urine drug screen for cannabinoids. Extensive neurological, infectious disease and metabolic workup was normal. With supportive are, the cerebral edema and so the encephalopathy improved over 3 weeks and the discharged home with no focal deficit. Discussion: While encephalopathy, coma, and respiratory depression are well-documented effects of acute marijuana toxicity, the observed cerebral edema seen in this patient has not been reported before. The long-term sequela of marijuana ingestion on children is still unknown, this case raises the concern for potentially significant long term sequel. The pediatric ingestions of marijuana are increasing in frequency and severity.