title: Sudden onset unexplained encephalopathy in infants: think of cannabis intoxication.
abstract: The use of cannabis as both a therapeutic agent and recreational drug is common, and its availability is increasing as a result of legalization in many countries. Among older children, the manifestations of cannabis intoxication are numerous and include both neurological and systemic manifestations that are frequently non-specific. There have been only a few reports detailing cannabis intoxication in infants and toddlers. We describe three infants who presented to the emergency department with encephalopathic signs without prominent systemic manifestations. During the initial interview of caregivers, no history of exposure to neurotoxic agents was obtained. All three patients were subsequently diagnosed with cannabis intoxication based on urine toxic screens for delta-9-tetrahydrocannabinol (THC). The infants recovered with supportive care that included fluids and monitoring. The non-specific symptomatology of cannabis intoxication in infants together with the wide differential for unexplained acute onset encephalopathy may delay diagnosis and lead to inappropriate procedures and interventions such as antimicrobial treatments and imaging studies.
  
  
  CONCLUSIONS
  Healthcare personnel of emergency rooms, urgent care centers, and general clinics should be aware of the potential risk of cannabis ingestion in young infants. A thorough medical history and toxic screen are warranted in all infants with unexplained decreased sensorium.
authors.affiliation: Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, POB 24035, 91240, Jerusalem, Israel. leran@hadassah.org.il.
authors.forename: Eran
authors.initials: E
authors.lastname: Lavi
authors.affiliation: Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, POB 24035, 91240, Jerusalem, Israel. Rdavidr@hadassah.org.il.
authors.forename: David
authors.initials: D
authors.lastname: Rekhtman
authors.affiliation: Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, POB 24035, 91240, Jerusalem, Israel. berkun@hadassah.org.il.
authors.forename: Yackov
authors.initials: Y
authors.lastname: Berkun
authors.affiliation: Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, POB 24035, 91240, Jerusalem, Israel. shwexler@hadassah.org.il.
authors.forename: Isaiah
authors.initials: I
authors.lastname: Wexler
mesh_terms: D001927:Brain Diseases / Q000139:chemically induced* / Q000628:therapy; D002188:Cannabis / Q000633:toxicity*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D002189:Marijuana Abuse / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
keywords: Cannabis; Children; Encephalopathy; Intoxication