Delirium following ingestion of marijuana present in chocolate cookies.
OBJECTIVE
To describe a case of marijuana-induced delirium and the techniques used to detect psychoactive agents and metabolites in urine.


METHODS
A case of delirium following involuntary ingestion of cannabis is described. A urine sample was analyzed applying various chemical procedures, using high-resolution gas chromatography coupled with mass spectrometry technique. 11-Nor-delta9-tetrahydrocannabinol-9-carboxylic acid was quantified by the methodology for steroids and cannabis.


RESULTS
A 26-year-old man was hospitalized with severe agitation and psychotic behavior 36 hours after suspected involuntary ingestion of cannabis contained in a brigadeiro, a typical Brazilian cookie, consumed during a party. Treatment with neuroleptics resulted in complete regression of the symptoms over 2 weeks. The urine sample revealed marijuana ingestion, demonstrated by the presence of its metabolite, 11-nor-delta9-tetrahydrocannabinol-9-carboxylic acid in high concentration. No other investigated substance was found in the patient's urine.


CONCLUSIONS
Severe delirium can follow oral ingestion of cannabis integrated into homemade cookies.
André
Charles
C
Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. andrecmd@unisys.com.br
Jaber-Filho
Jorge A
JA
Bento
Rafael M A
RM
Damasceno
Lúcia M P
LM
Aquino-Neto
Francisco R
FR
D000328:Adult; D002099:Cacao; D002188:Cannabis / Q000633:toxicity*; D003693:Delirium / Q000139:chemically induced* / Q000175:diagnosis; D003937:Diagnosis, Differential; D013759:Dronabinol / Q000031:analogs & derivatives / Q000652:urine; D005506:Food Contamination / Q000032:analysis; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate / Q000502:physiology; D011605:Psychoses, Substance-Induced / Q000175:diagnosis / Q000209:etiology*
C016780:11-nor-delta(9)-tetrahydrocannabinol-9-carboxylic acid; D013759:Dronabinol