Pediatric Edible Cannabis Exposures and Acute Toxicity: 2017-2021.

OBJECTIVES: This study evaluates trends in pediatric cannabis edible ingestions in children younger than age 6 years with regard to toxicity, medical outcome, and health care utilization for the years 2017-2021. METHODS: We performed retrospective analysis of the National Poison Data System data for pediatric exposures to edible cannabis products in children <6 years from 2017 to 2021. Data were analyzed quantitatively with a focus on incidence, common clinical effects, medical outcomes, health care utilization, and changes in acute toxicity between the pre-COVID years (2017-2019) to the COVID years (2020-2021). RESULTS: There were 7043 exposures reported during 2017-2021. In 2017, there were 207 reported cases, and in 2021 there were 3054 cases, an increase of 1375.0%. Most exposures (97.7%) occurred in a residential setting. Seventy percent of cases followed to a known outcome were reported to have central nervous system depression. Of all reported cases, 22.7% of patients were admitted to the hospital. There was a significant increase in both ICU and non-ICU admissions, whereas the number of patients treated and released decreased when comparing the pre-COVID years (2017-2019) to the COVID years (2020-2021) (P < .05). Major and moderate effects also significantly increased during the prepandemic years compared with the 2 years during the pandemic (P < .05). CONCLUSIONS: There has been a consistent increase in pediatric edible cannabis exposures over the past 5 years, with the potential for significant toxicity. It is important for providers to be aware of this in their practice and it presents an important opportunity for education and prevention.

Increased rates of diphenhydramine overdose, abuse, and misuse in the United States, 2005-2016.

OBJECTIVES: To describe trends in abuse, misuse, and suicide attempts involving diphenhydramine (DPH). METHODS: We analyzed intentional DPH exposures of individuals ≥10 years old reported to U.S. Poison Control Centers using data from the National Poison Data System, 2005-2016. RESULTS: There were 158,774 intentional DPH exposures in our dataset. The rate of intentional exposures increased 63% over the 12-year study period for all ages combined. Suicide attempts involving DPH showed a bimodal distribution-increasing 263% among children 10-14 years of age, and 126 and 143% among those 55-64 and ≥65 years of age, respectively. Older adults in both the 55-64 and ≥65-year-old age groups had about a 230% increase in rates of misuse. Major adverse clinical effects increased by 91%. There were 745 total reported deaths with a 3.6% increase across all age groups. CONCLUSIONS: Intentional DPH exposures among individuals ≥10 years old have been increasing since 2005. Increasing rates of suicide attempts among children ages 10-14 and increasing misuse among individuals ≥65, coupled with a trend toward greater severity of overdoses, highlight the significant public health impact of this commonly available over-the-counter drug.

Toxic boost: Acute, reversible neurotoxicity after ingestion of methylcyclopentadienyl manganese tricarbonyl (MMT) mistaken for an energy drink.

Methylcyclopentadienyl manganese tricarbonyl (MMT) is an organometallic compound used as a gasoline additive for its antiknock properties. Human ingestion of MMT has not previously been reported. We present the case of a 54-year-old man who developed seizures and altered mental status after drinking 12 oz. of MMT-containing NOS Octane Booster Racing Formula. Due to label similarities, he mistook this for the NOS High Performance energy drink. The patient was intubated due to persistent seizures despite benzodiazepine treatment and admitted to the intensive care unit. He had two further seizures while intubated, but he was successfully extubated on the 4th day post-ingestion. He was confused and ataxic following extubation, but one day later his symptoms resolved and he was discharged without further incident. This case highlights the importance of responsible labeling of consumables. It is important for clinicians and poison centers to report any such instances to the United States Food and Drug Administration.