A threshold of 1.7 mg/kg of tetrahydrocannabinol (THC) in children younger than 6 years of age “may guide medical management and preventive regulations,” investigators conclude based on the experiences of 80 patients. The THC dose of edible cannabis correlated with the degree of toxicity.
Children younger than 6 years who presented in 2015-2022 in a pediatric hospital network were reviewed retrospectively. Severe cannabis toxicity was defined as severe cardiovascular (bradycardia, tachycardia/hypotension requiring vasopressors or intravenous fluids, other dysrhythmias), respiratory (respiratory failure, apnea, requiring oxygen supplementation), or neurologic (seizure, myoclonus, unresponsiveness, responsiveness to painful stimulation only, requiring intubation or sedation) effects. Those requiring more than 6 hours to reach baseline levels were considered to have prolonged cannabis toxicity.
“The median age [of 80 patients meeting inclusion criteria] was 2.9 years,” write the authors. “The median THC ingestion was 2.1 mg/kg. Severe and prolonged toxicity was present in 46% and 74%, respectively. THC dose was a significant predictor of severe (adjusted odds ratio 2.9, 95% confidence interval: 1.8–4.7) and prolonged toxicity (adjusted odds ratio 3.2, 95% confidence interval: 1.6–6.5), whereas age and sex were not. Area under the curve was 92.9% for severe and 87.3% for prolonged toxicity. THC ingestions of ≥1.7 mg/kg can predict severe (sensitivity 97.3%) and prolonged toxicity (sensitivity 75.4%).”