الفهرس 
Historical Review & LawOnly 14 pages are availabe for public view
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Abstract
Cannabis use has increased sharply all around the
world. Widespread use of cannabis translates to greater
access for children. Acute cannabis intoxication in children
typically occurs after exploratory ingestion of cannabis
intended for adult use. The most common serious cases
involve children swallowing hashish resin, which confused
with chocolate or something else that is edible. There are
no validated scoring systems for categorizing severity or
predicting the outcome of acute cannabis intoxication in
children. This makes predicting outcome of acute cannabis
intoxication in children inaccurate and hazardous.
The current study was a cross-sectional study, carried
on pre-school children of both sexes who admitted to PCCASUH, during the period from March 2019 to December
2019, with history of acute cannabis toxicity and confirmed
by cannabis positive screen test.
The study aimed to assess the prevalence of acute
cannabis intoxication in pre-school children in Egypt,
analysis of different factors related to the problem, clinical
picture, management & assessment of outcome and severity
of the problem by poison severity score (PSS).
For each patient, socio-demographic and intoxication
data were obtained. In addition, detailed clinical evaluation
and laboratory investigations were recorded including random blood glucose level, arterial blood gas analysis,
electrocardiographic findings, duration of hospital
admission and causes of ICU admission were also
recorded. Evaluation of severity of poisoning was assessed
at the time of peak manifestations using PSS of European
Association of Poisons Centers and Clinical Toxicologists
(EAPCCT) and finally, the PSS was correlated with the
patients’ data to highlight various risk factors affecting the
severity of poisoning in acute cannabis intoxication.
Prevalence of acute cannabis intoxication in pre-school
children:
The number of acutely intoxicated cannabis preschool children admitted to PCC-ASUH during the study
period was 227 patients. Four children were excluded from
the study, two of them had history of co- ingestion of mixed
drugs with cannabis and the other two patients had past
history of cardiovascular and/or neurological diseases, so
the number of acutely intoxicated cannabis cases in this
study was 223 patients.
During the study period, the percentage of acute
cannabis intoxicated children (under 18 years) was
92.5%. The number of acute cannabis intoxicated preschool children was 223 (89.9%) out of 248 acute cannabis
intoxicated children admitted to PCC-ASUH. This showed
that the most affected age group of the problem is the preschool children.During the study period, the number of acute
cannabis intoxicated pre-school children was 223 (24%)
from total number of 930 acutely intoxicated pre-school
children admitted to PCC-ASUH. This showed the size of
the problem that acute cannabis intoxicated pre-school
children are considered significant health problem.
Severity of acute cannabis intoxication in pre-school
children in Egypt:
The number of acutely intoxicated cannabis cases in
this study was 223 patients who classified into three groups
according to PSS, the majority of patients (55.1%) were of
group II (moderate group), while (31.4%) were of group I
(minor group) & (13.5%) were of group III (severe group).
Socio-demographic data:
The mean age of the studied acute cannabis
intoxicated pre-school children was (17.38 month±8.75).
Mostly were male and the majority of cases came from
urban areas. There was no previous child social &
psychological problems and there was no significant
statistical difference observed between socio-demographic
data and severity of poisoning.Intoxication data:
Most of cannabis intoxicated pre-school children
were accidental exposed mainly via ingestion route. The
main source of exposure was father in (18.4%) of patients
who is a cannabis addict and the majority of exposure of
cannabis intoxicated pre-school children occurred at their
home (91.5%). The mean delay time was (6.2 ± 3.3) hours
and activated charcoal was given in (1.3%) as a preconsultation management.
There was a significant difference as regard the
place of exposure between group I & II of PSS being
higher in group II than group I.
General examination:
Regarding the vital data in the present study, normal
sinus rhythm was observed in the majority of patients
(93.3%), while tachycardia was observed in (5.8%) of the
studied group. As regard of blood pressure, normal blood
pressure was observed in most of cases (86%), while
hypertension was observed in only (13.5%) in the present
study. As regard of respiratory rate, tachypnea was found in
(18%) of patients & two patients needed mechanical
ventilation in the present study. Regarding body
temperature, most of patients (68%) had normal body
temperature, while minor percentage (31.8%) had
hyperthermia in the present study.There was a highly significant difference as regards
respiratory rate among three groups being higher in group
III than I & II.
Systemic examination:
Regarding clinical manifestations, neurological
symptoms predominated in the studied cannabis intoxicated
patients. The most common CNS manifestations in the
present study were drowsiness (31.4%), muscle rigidity
(21.5%) & extra-pyramidal manifestations (21.5%). In the
present study, according to REED’s coma scale, (67.7%)
were in coma grade I, (0.9%) were in coma grade II,
however ataxia was observed in (2.7%) of patients.
There was a highly significant differences among
three groups (group I, II & III) of PSS as regard of
(conscious level - seizures - muscle rigidity & ataxia).
Coma grade I/II & other neurological findings showed high
significant increase in group III than groups I & II.
Furthermore, coma grade I showed high significant
increase in group II compared to group I.
Regarding respiratory symptoms, respiratory distress
was observed in (1.8%) of patients, while respiratory
failure was found in (0.9%).
There was a highly significant differences among
three groups (group I, II & III of PSS as regards respiratory findings (wheezes / crepitation - respiratory
distress & failure) shows highly significant increase in
group III when compared with groups I & II, also wheezes
/crepitation were significantly higher in group II when
compared with group I.
As regard the gastrointestinal symptoms, 17.9% of
patients complained of vomiting & 18.4% of patients had
abdominal distension.
There was a highly significant differences among
three groups (groups I, II & III) of PSS as regards
gastrointestinal findings (abdominal distension- vomiting)
showing highly significant increase in group III than I &
II, also abdominal distension were highly significantly
increased in group II when compared with group I.
As regard the eye findings, mydriasis was observed
in (13%) of patients, while miosis was observed in (18.8%)
& eye redness was observed in (9.9%). Regarding skin
findings in the present study, flushed skin was observed in
(12.1%) of patients.
There was a highly significant differences among
three groups (groups I, II & III) of PSS as regards eye
findings (eye miosis - mydrasis & redness) show high
significant increase in group III when compared with
groups I & II. table (20).There was a highly significant
increase in number of cases with skin findings in group III
when compared with groups I & II.Laboratory findings:
Regarding arterial blood gas analysis, most of patients
(59%) in this study had normal ABG. Respiratory acidosis
was the most prominent acid-base disturbance affecting
26.5% of the total number of studied acute cannabis
intoxicated pre-school children. However, metabolic
acidosis was recorded in (9.9%), while respiratory alkalosis
appeared in (3.6%) of patients. The severity of poisoning
affected the ABG findings as clarified by presence of a
highly statistical significant difference on comparing three
groups under study.
Regarding blood glucose level & electrolytes in the
present study, the majority of cases had normal random
blood sugar, normal sodium and potassium levels.
Regarding ECG findings, the majority of cases had normal
ECG findings.
There was a highly significant difference in ABG &
PH. Percentage of patients presented with respiratory and
metabolic alkalosis shows high significant increase in
group II when compared with group I. Percentages of
patients presented with respiratory and metabolic acidosis
show high significant increase in group III & group II
when compared with group I. pH shows high significant
decrease in group III when compare with groups I & II. A significant decrease regarding HCO3 is noticed in group
III when compared with group I&II. In addition to, there
was a significant difference regarding mean levels of
random blood sugar being a significant increase in group
III when compare with groups I & II.
Treatment of acute cannabis intoxication in pre-school
children in Egypt:
In the present study, there was a highly significant
difference as regard percentages of patients who received
(anti convulsant drugs - nasal O2 & mechanical
ventilation) among the three groups (group I, II & III) of
PSS. Percentage of patients who received anti convulsant
drugs was significantly higher in group III when
compared with group II.
In the present study, in-patient admission occurred in
(31.3%) of patients, while ICU admission occurred in
(68,7%) of patients. There was a highly significant
difference regarding place of admission among three
groups (groups I, II & III) of PSS in acute cannabis
intoxicated pre-school children ICU admission percentage
was significantly high in group III and group II when
compared with group I.Outcome data:
The majority of acute cannabis intoxicated preschool children were admitted ≥24 hours (65.9%), while
(34.1%) were admitted <24 hours at PCC ASU. Coma was
the commonest cause of ICU admission either alone or in
combination with extra-pyramidal manifestations or
respiratory complications. Most of patients recovered
without any complication during hospital stay (99.6%)
while only one patient recovered with visual impairment
due to prolonged hypoxia with need of pediatric follow up
with no recorded dead cases.
There was a highly significant difference regarding
duration of hospital stay among three groups (group I, II
& III) of PSS in acute cannabis intoxicated preschool
children being it was higher at group III than group II & I,
also it was higher at group II than group I.