Sedation and Acute Encephalopathy in a Pediatric Patient Following Ingestion of Delta-8-Tetrahydrocannabinol Gummies

Abstract

Patient: Female, 2-year-old Final Diagnosis: Acute encephalopathy, resolved • poisoning by delta-8-THC symptoms • altered mental status • respiratory failure Symptoms: Acute encephalopathy • altered mental status • respiratory failure Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology • Toxicology Objective: Unusual clinical course Background: Delta-8 tetrahydrocannabinol (delta-8 THC) is an isomer of delta-9-tetrahydrocannabinol (delta-9 THC), the primary psychoactive cannabinoid in the marijuana plant. Typically found at lower concentrations in marijuana, delta-8 THC exhibits psychoactive properties similar to delta-9 THC. Products containing delta-8 THC are readily available across the US and currently there is a lack of available confirmatory testing specific to delta-8 THC as there is cross-reactivity to other naturally occurring cannabinoids in standard immunoassays. Pediatric exposures to this substance are on the rise. Case Report: We present a case with laboratory confirmation of a previously healthy 2-year-old girl ingesting approximately 15 mg/kg of delta-8 THC gummies. The patient arrived minimally responsive and requiring intubation for encephalopathy. Laboratory confirmation of delta-8 THC exposure is not routinely available with common testing modalities. A urine drug screen preformed in the hospital was positive for delta-9 THC. With the collaboration of the Drug Enforcement Administration’s Toxicology Testing Program, detection and confirmation of delta-8 THC was performed in the serum and urine using liquid chromatography-quadrupole time-of-flight mass spectrometry. Conclusions: The prevalence of delta-8 THC-containing products in the illicit drug market is increasing rapidly. Delta-8 THC products are now available in gas stations and in headshops. The clinical presentation of delta-8 THC exposure is similar to known effects of delta-9 THC exposure. These similarities limit the clinicians’ abilities to determine the specific substance ingested. Symptomatic and supportive care remains an effective treatment for cannabinoid toxicity.

Delta-8-THC association with psychosis: A case report with literature review

“…However, anecdotally, there has been an increase in the use of 8 -THC within our patient population, and the large body of evidence on cannabis ( 9 -THC) association with psychosis and schizophrenia cannot be ignored. Furthermore, other cases exist documenting similar presentations of patients using 8 -THC (21,22). A recognized limitation of 8 -THC reporting is that a UDS cannot distinguish 8 -THC from 9 -THC.…”

“…Thus far, there are two published case reports documenting Δ 8 -THC intoxication. The first case describes acute encephalopathy in a pediatric patient following accidental ingestion of Δ 8 -THC gummies ( 21 ). The second case report documents a 23-year-old male and a 35-year-old female who self-reported Δ 8 -THC use before presenting with delusions and suicidal ideation that was persistent and resistant to conventional treatment ( 22 ).…”

Delta-8, a Cannabis-Derived Tetrahydrocannabinol Isomer: Evaluating Case Report Data in the Food and Drug Administration Adverse Event Reporting System (FAERS) Database

“…The first case report is that of acute encephalopathy in a 2-year-old-female in Kentucky ingesting approximately 15mg/kg of D8-THC gummies. 27 The patient was minimally responsive with a noted Glasgow Coma scale (GCS) of three and a heart rate of 136 beats per minute; the patient was intubated using fentanyl and ketamine. Since D8-THC is not included in the typical drug screen, the hospital collaborated with the DEA toxicology division to confirm the presence of D8-THC.…”

The Dark Side of Cannabidiol: The Unanticipated Social and Clinical Implications of Synthetic Δ8-THC

“…Eighteen percent of these patients required hospitalization, including several children who required intensive care unit admission following exposure to these products, and one required emergency intubation and ventilatory support. 61 …”