Emergent Care / Stabilization:
Patients with severe symptoms from a suspected cannabis ingestion should have rapid assessment addressing and stabilizing the airway, assisting respiration, and providing supplemental oxygen as needed, as well as insertion of an intravenous (IV) line to administer IV fluids. Benzodiazepines may be needed if the patient has seizure activity. Naloxone is sometimes given to treat possible coingestion of opioids if this is suspected.

Diagnosis Overview:
The availability and popularity of edible cannabis products has soared as many US states have legalized recreational and medical cannabis use. While these products are intended exclusively for adult use, the incidence of accidental ingestion by young children and toddlers has increased 1375% from 2017 to 2021. Most ingestions occur in private residences where an adult user resides. (See acute cannabis intoxication for toxicity, including from edibles, in adults.)

Many of the edible products are familiar and appealing to toddlers and children as they resemble commonly consumed treats such as baked goods (eg, brownies and cookies) and candies (eg, chocolates and gummies). Most states do not have regulations requiring child-resistant packaging and allow edible products to have brightly colored labels that attract the interest of toddlers and children.

Edible cannabis product packages often contain multiple servings in a single package (each serving usually contains 2.5-10 mg of delta-9-tetrahydrocannabinol [THC] but may contain significantly more). Toddlers often ingest multiple servings at once, leading to a very high dose of THC ingested; this coupled with a lower body weight leads to more severe toxicity. Toddlers may also consume cannabis resins or joints. Occasionally, toddlers may be exposed to THC if they consume the fluid from a vape cartridge containing THC.

Clinical effects of THC ingestion in toddlers can range from mild to severe, with more severe presentations occurring in younger patients with higher THC ingestions. Symptoms can begin as soon as 30 minutes post ingestion and can last for over 10 hours. The most common symptom is altered mental status, ranging from mild sedation / lethargy to complete obtundation. Other neurologic symptoms can include ataxia, agitation, hyperkinesis, confusion, tremor, hallucinations, headache, and slurred speech. Cardiac effects are seen in just over 10% of patients and are variable, including tachycardia, bradycardia, hypertension, and hypotension. Patients may display vomiting and occasionally report nausea or abdominal pain. Ocular manifestations are less common and include mydriasis or rarely meiosis, as well as occasional nystagmus and red injection. Other symptoms reported in less than 1% of patients include fevers or hypothermia, pallor, and weakness. Severe intoxication may also involve apnea and coma.

Treatment is mainly supportive, initially addressing the ABCs (airway, breathing, circulation), and includes respiratory support and IV fluids.