Thomas Anita A, Mazor Suzan
Seattle Children's Hospital, Department of Pediatrics, Division of Emergency Medicine University of Washington School of Medicine, Seattle, Washington.
J Emerg Med. 2017 Dec;53(6):e119-e123. doi: 10.1016/j.jemermed.2017.08.007. Epub 2017 Oct 5.
Unintentional tetrahydrocannabinol (THC) exposure in pediatric patients can present as altered mental status. Altered mental status in a pediatric patient often leads to invasive diagnostic testing.
The following cases describe 3 pediatric patients in Washington state who presented to a tertiary care children's hospital emergency department (ED) with altered mental status, later found to have urine toxicology screening positive for inactive THC metabolite (positive THC toxicology screen). Case 1 is a 6-year-old boy who presented with vomiting, lethargy, and hallucinations. Case 2 is a 5-year-old girl who presented with nausea, slurred speech, ataxia, and lethargy in the setting of a minor head injury. Case 3 is a 7-month-old boy who presented with vomiting and lethargy in the setting of a minor fall the day prior to ED evaluation. All children had extensive work-ups before the diagnosis was made; 2 were discharged home and 1 was admitted to the pediatric intensive care unit. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As access to marijuana increases with growing legalization, it is important to be familiar with state marijuana legislation, to consider and ask families about access to marijuana products as a potential contributor to altered mental status, and to be aware of potential caretaker reluctance regarding disclosure of marijuana use secondary to perceived stigma. Maintaining awareness of the clinical effects of THC exposure in children may limit invasive testing in a hemodynamically stable child with altered mental status.
儿科患者意外接触四氢大麻酚（THC）可表现为精神状态改变。儿科患者的精神状态改变常导致进行侵入性诊断检查。
以下病例描述了华盛顿州的3名儿科患者，他们因精神状态改变被送往一家三级儿童专科医院急诊科（ED），后来尿液毒理学筛查显示四氢大麻酚代谢物呈阳性（THC毒理学筛查阳性）。病例1是一名6岁男孩，表现为呕吐、嗜睡和幻觉。病例2是一名5岁女孩，在轻度头部受伤的情况下出现恶心、言语不清、共济失调和嗜睡。病例3是一名7个月大的男孩，在急诊科评估前一天因轻度摔倒出现呕吐和嗜睡。所有儿童在确诊前都进行了全面检查；2名儿童出院回家，1名儿童被收入儿科重症监护病房。急诊医生为何应了解此事？：随着大麻合法化程度提高，获取大麻的机会增多，熟悉州大麻立法、考虑并询问家属接触大麻产品的情况作为精神状态改变的潜在原因、以及意识到照顾者因感知到的污名而不愿透露大麻使用情况，这些都很重要。了解儿童接触THC的临床影响可能会减少对血流动力学稳定但精神状态改变的儿童进行侵入性检查。
