Written by Aaron Lacy
Spoon Feed
Given a substantial increase in the number of children who have accidental ingestion of THC-based products, these authors advocate for consideration of early urine drug screen testing on children who present with altered mental status or neurological symptoms.
Side effects include the munchies, red eyes, and coma
The number of children with unintentional ingestion of THC who have presented to the ED has increased >1000%. Children are not just small adults, particularly when it comes to cannabis ingestion. THC can cause significant alteration in mental status and neurological findings, and they often are under the influence of the drug for much longer than adults. This article highlights 5 cases of children who presented with altered mental status that ultimately had THC confirmed on urine drug screen as the culprit. Four of these cases got significant medical workups, including CT of the head, before a diagnosis was made on drug screening. The authors highlight in one of the cases, early UDS findings of THC prevented further invasive testing or imaging. This case series was used by the authors to advocate for early THC screening in children with undifferentiated abnormal neurological findings and altered mental status to try and reduce invasive testing and radiation exposure in this young population.
How will this change my practice?
Regardless of how you feel about the legalization and commercialization of cannabis, there have been significant downstream effects on the healthcare system. Packaging of THC edibles can be indiscernible from other candies for most young children, and clinicians must add THC ingestion to the differential in children with altered mental status. I will probably not start blanket adding a UDS to the workup of all children I see with AMS, but I need to be asking about the possibility or presence of edibles in the home. If there is high suspicion and association with clinical stability, I may defer further significant testing until a UDS results (i.e. lumbar puncture, head CT) depending on my work location. I can get rapid UDS results in a tertiary care pediatric ED, but when I am working in my other location, a 10-bed ED, the UDS is a send-out that will not result in a reasonable enough time to clinch the diagnosis.
If you are looking for THC on a UDS in your patients, a few key points from the article:
- Secondhand smoke rarely causes results in a positive UDS, so if you see THC on one, it was likely smoked or ingested by that patient.
- THC can be detected on most standard UDS testing, but other cannabinoids or synthetics often cannot be detected, so a negative test does not preclude some form of cannabis as the culprit.
Source
Urine Toxicology Test for Children With Altered Mental Status. Pediatrics. 2023. Nov 1;152(5):e2022060861Doi: 10.1542/peds.
uds should be on all workups of ams. however, difficult to say if to withhold ct imaging while we wait for the uds. additionally, our uds testing is not a quantitative but rather a qualitative test.