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

Abstract

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 α2-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.

Fig. 1

Variation of heart rate (HR), systolic blood pressure (SBP) and Objective Pain Scale (OPS) score over time. The figure shows the trend of the patient’s vital signs (HR and SBP), which decreased after the start of the dexmedetomidine (Dex) continuous infusion (at 12 p.m.) and later remained stable. The graph also shows a zeroing of the OPS score because the child stayed quiet a few hours after the beginning of dexmedetomidine treatment. bpm, Beats per minute