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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. |