Table.
Summary of case reports of 11 patients presenting to the emergency department with life-threatening toxicity after exposure to synthetic cannabinoids.
| Case | Hospital day | Clinical presentation | Intubated | Outcome | Vital signs | Qualitative serum level, SC screen* | Comprehensive urine drug screen findings (LC/MS) |
|---|---|---|---|---|---|---|---|
| #1. 18yo male | Day 1 | Altered mental status, combative, agitated | No | Discharged same day. | HR 113bpm, BP 95/53mmHg, temp 99.9°F, RR 20rpm, pulse ox 100%, room air | X1 | Caffeine |
| #2. 28yo male | Day 3 | Combative and hallucinating | Yes | Developed aspiration pneumonia. Discharged hospital day 6. | HR 102bpm, BP 119/88mmHg, temp 96°F, RR 15rpm, pulse ox 100%, vent | X10 | Caffeine, morphine, midazolam, lorazepam |
| #3. 17yo female | Day 2 | Agitated and delirious | No | Discharged following day. | HR 110bpm, BP 112/63mmHg, temp 97.3°F, RR 16rpm, pulse ox 98%, room air | X8 | Lorazepam |
| #4. 14yo male | Day 2 | Intermittent unresponsiveness followed by agitation | Yes | Discharged following day. | HR 96bpm, BP 123/58mmHg, temp 96.7°F, RR 19rpm, pulse ox 98%, vent | X45 | Norfentanyl |
| #5. 13yo female | Day 2 | Altered mental status with unresponsiveness | Yes | Discharged hospital day 2. | HR 115bpm, BP 98/46mmHg, temp 98.9°F, RR 17rpm, Ppulse ox 100%, vent | X20 | Phenylephrine, midazolam, fentanyl, norfentanyl, diphenhydramine, cotinine |
| #6. 13yo male | Day 0 | Found unresponsive | Yes | Developed aspiration pneumonia. Discharged on hospital day 3. | HR 81bpm, BP 131/80mmHg, temp 97.1°F, RR 16rpm, pulse ox 99%, room air | X30 | Lorazapam, hydroxymidazolam |
| #7. 50yo male | Day 1 | Found unresponsive | Yes | Discharged to inpatient drug rehabilitation facility. | HR 59bpm, BP 93/57mmHg (patient prescribed Lopressor), temp 98.7°F, RR 14rpm, pulse ox 95%, vent | X36 | Ethanol, naloxone, metoprolol, caffeine |
| #8. 40yo female | Day 1 | Combative, delirious, seizures | Yes | Discharged hospital day 2. | HR 114bpm, BP 120/62mmHg, temp 99.4°F, RR 18rpm, pulse ox 84%, room air (improved after intubation) | X32 | Acetaminophen |
| #9. 19yo female | Day 3 | Found unresponsive; seizure-like activity | Yes | Treated for infected right forearm wound secondary to IV drug use. Discharged hospital day 4. | HR 74bpm, BP 118/85mmHg, temp 97.6°F, RR 14rpm, pulse ox 100%, 40% oxygen | X55 | Morphine, norfentanyl, cocaine, amphetamine, methamphetamine, codeine, midazolam, lorazepam |
| #10. 14yo male | Day 2 | Agitated and combative | Yes | Discharged following day. | HR 95bpm, BP 114/66mmHg, temp 99.9°F, RR 22rpm, pulse ox 100% vent | X13 | Sertraline |
| #11. 20yo male | Day 3 | Found unresponsive and posturing; approximate down-time was 24–36 hours | Yes | Expired. Anoxic brain injury. Family withdrew care on hospital day 7 | HR 146bpm, BP 200/74mmHg, temp 104.1°F, RR 33rpm, pulse ox 100%, vent (outside facility) HR 75bpm, BP 138/55mmHg, temp 99.5°F, RR 17rpm, pulse ox 100%, vent (upon ICU arrival) |
X1.5 | Sertraline |
SC, synthetic cannabinoids; LC, liquid chromatography; MS, mass spectroscopy; HR, heart rate; BP, blood pressure; RR, respiratory rate; RPM, respirations per minute; yo, year old
*
Value represents the number of times higher each case was in comparison to Case #1, which had the lowest relative concentration.
SC, synthetic cannabinoids; LC, liquid chromatography; MS, mass spectroscopy; IV, intravenous; HR, heart rate; BP, blood pressure; RR, respiratory rate; RPM, respirations per minute; ICU, intensive care unit