Acute cannabis toxicity

Q: 22 years old male, visiting friends and family on Thanksgiving weekend from college, and 'chilling' at a Hookah bar is brought to the emergency room (ER) with chest pain, hyperemesis, and decreased breath sound on the right side. The probable diagnosis of acute cannabis intoxication is made. Which is more common in such clinical presentations? (select one)

A) Hyperventilation

B) Hypoventilation

Answer: A

In recent years with more acceptance of marijuana in the society and epidemic of sheesha/hookah in urban areas, inpatient physicians need to be always ready with young men presenting with acute cannabis intoxication.

The most common presenting symptom is hyperemesis, dysphoria, and/or agitation. Young men tend to inhale and hold their breath during hookah inhalation. Pneumomediastinum and pneumothorax are very common. Myocardial infarction in young adults without any prior history of heart disease is also reported.

Although in massive overdose hypoventilation/apnea may occur but is rare. By default tachypnea and hyperventilation are the norm. Other clinical symptoms are tachycardia, hypertension, dry mouth, red eye, nystagmus, ataxia, and slurred speech.

#toxicology

References:

1. Ashton CH. Pharmacology and effects of cannabis: a brief review. Br J Psychiatry 2001; 178:101.

2. Tashkin DP. Effects of marijuana smoking on the lung. Ann Am Thorac Soc 2013; 10:239.

3. Noble MJ, Hedberg K, Hendrickson RG. Acute cannabis toxicity. Clin Toxicol (Phila). 2019 Aug;57(8):735-742. doi: 10.1080/15563650.2018.1548708. Epub 2019 Jan 24. PMID: 30676820.