Diagnóstico, Manejo y Seguimiento de los Pacientes Intoxicados con derivados de Cannabis: una revisión narrativa

Contenido principal del artículo

MD Juan Jose Cordero-Solís
Bach Diego Delgado-Gómez
Bach Juan Santillán-Zúñiga

Keywords

cannabis, intoxicación, toxicología

Resumen

El uso de cannabis a nivel mundial ha tenido un auge en los últimos años, según datos de la Organización Mundial de la Salud, tendencia que de igual manera se ha manifestado en Costa Rica. Además, los diferentes componentes químicos de la marihuana se asocian a un uso variado de la misma tal como recreacional, medicinal, o cosméticamente. Lo anterior va a incidir directamente en que exista una mayor posibilidad de que los usuarios presenten un cuadro de intoxicación de marihuana por su uso inadecuado, por lo cual es primordial que los médicos y demás personal de salud logren identificar el cuadro clínico de un paciente intoxicado con cannabis, así como saber realizar un manejo integral y brindar el seguimiento adecuado de estas personas, para así minimizar el riesgo de posibles consecuencias nocivas atribuibles al consumo de cannabis.

Abstract 1084 | PDF Downloads 1692

Citas

1. United Nations. World Drug Report 2020. 2020;11–2. Disponible en: https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

2. Grof C. Cannabis, from plant to pill. Br J Clin Pharmacol. 2018;1–15.

3. Wilkinson S, Yarnel S, Radhakrishnan R, Ball S, Cyril D. Marijuana Legalization: Impact on Physicians and Public Health. Annu Rev Med. 2016;67(1):453–66.

4. Comisión Interamericana Abuso De Drogas Control del. Informe sobre el consumo de drogas en las Américas, 2019. 2019;67–75.

5. Chandra S, Radwan M, Majumbar C, Church J, Freeman T, ElSohly M. New trends in cannabis potency in USA and Europe during the last decade (2008–2017). Eur Arch Psychiatry Clin Neurosci. 2019;1–11.

6. Naciones Unidas. Informe Mundial sobre las Drogas [Internet]. 2019. Disponible en: https://wdr.unodc.org/wdr2019/field/B2_S.pdf

7. Zeledón G. PERFIL EPIDEMIOLÓGICO DE INTOXICACIONES EN COSTA RICA, 2017 [Internet]. San Jose; 2018. Disponible en: https://www.redciatox.org/sites/default/files/webfiles/2018/datos_toxico_cor_2017.pdf

8. Instituto sobre Alcoholismo y Farmacodependencia [Internet]. 2020. Disponible en: https://www.iafa.go.cr/

9. Lewis B, Fleeger T, Judge B, Riley B, Jones J. Acute toxicity associated with cannabis edibles following decriminalization of marijuana in Michigan. Am J Emerg Med. 2020;

10. Grimaldi A, Giglio L, Haggiag S, Bianco A, Cortese A, Giuseppe S, et al. The influence of physiotherapy intervention on patients with multiple sclerosis–related spasticity treated with nabiximols (THC:CBD oromucosal spray). PLoS One. 2019;14(7):1–10.

11. Lim M, Kirchhof M. Dermatology-Related Uses of Medical Cannabis Promoted by Dispensaries in Canada, Europe, and the United States. J Cutan Med Surg. 2018;

12. Kleine-Brueggeney M, Greif R, Brenneisen R, Urwyler N, Stueber F, Theiler L. Intravenous Delta-9 Tetrahydrocannabinol to Prevent Postoperative Nausea and Vomiting: A Randomized Controlled Trial. Anesth Analg. 2015;121(5):1157–64.

13. Huestis MA, Solimini R, Pichini S, Pacifici R, Carlier J, Busardò FP. Cannabidiol Adverse Effects and Toxicity. Curr Neuropharmacol. 2019;17(10):974–89.

14. Pagano S, Coniglio M, Valenti C, Federici MI, Lombardo G, Cianetti S, et al. Biological effects of Cannabidiol on normal human healthy cell populations: Systematic review of the literature. Biomed Pharmacother [Internet]. 2020;132:110728. Disponible en: https://doi.org/10.1016/j.biopha.2020.110728

15. Amin MR, Ali DW. Pharmacology of Medical Cannabis. Adv Exp Med Biol. 2019;1162:151–65.

16. Lucas CJ, Galettis P, Schneider J. The pharmacokinetics and the pharmacodynamics of cannabinoids. Br J Clin Pharmacol. 2018;84(11):2477–82.

17. Bellocchio L, Inchingolo AD, Inchingolo AM, Lorusso F, Malcangi G, Santacroce L, et al. Cannabinoids drugs and oral health—from recreational side-effects to medicinal purposes: A systematic review. Int J Mol Sci. 2021;22(15).

18. Weier A, Kleinschmidt K. How Are Patients Who Are Admitted to the Intensive Care Unit after Common Poisonings Diagnosed and Managed? [Internet]. Evidence-Based Practice of Critical Care. Elsevier Inc.; 2006. 632–636 p. Disponible en: http://dx.doi.org/10.1016/B978-1-4160-5476-4.00090-0

19. Noble MJ, Hedberg K, Hendrickson RG. Acute cannabis toxicity. Clin Toxicol [Internet]. 2019 [cited 2021 May 9];57(8):735–42. Disponible en: https://www.tandfonline.com/doi/full/10.1080/15563650.2018.1548708

20. Chen Y, Klig J. Cannabis-related emergencies in children and teens. Curr Opin Pediatr. 2019;31(3):291–6.

21. Claudet I, Le Breton M, Bréhin C, Franchitto N. A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach? Eur J Pediatr [Internet]. 2017 [cited 2021 May 9];176(4):553–6. Available from: http://link.springer.com/10.1007/s00431-017-2872-5

22. Emoto J, Weeks K, Kallail KJ. Accidental Acute Cannabis Intoxication Presenting as Seizure in Pediatrics Patients. Kansas J Med. 2020;13:129–30.

23. Richards JR, Smith NE, Moulin AK. Unintentional Cannabis Ingestion in Children: A Systematic Review. J Pediatr [Internet]. 2017;190:142–52. Disponible en: https://doi.org/10.1016/j.jpeds.2017.07.005

24. Onders B, Casavant MJ, Spiller HA, Chounthirath T, Smith GA. Marijuana Exposure Among Children Younger Than Six Years in the United States. Clin Pediatr (Phila) [Internet]. 2016 May [cited 2021 May 9];55(5):428–36. Disponible en: http://journals.sagepub.com/doi/10.1177/0009922815589912

25. Schmid Y, Scholz I, Mueller L, Exadaktylos AK, Ceschi A, Liechti ME, et al. Emergency department presentations related to acute toxicity following recreational use of cannabis products in {Switzerland}. Drug Alcohol Depend [Internet]. 2020 [cited 2021 May 9];206:107726. Disponible en:https://linkinghub.elsevier.com/retrieve/pii/S0376871619305034

26. Boadu O, Gombolay GY, Caviness VS, El Saleeby CM. Intoxication From Accidental Marijuana Ingestion in Pediatric Patients: What May Lie Ahead. Pediatr Emerg Care. 2020;36(6):e349--e354.

27. Khatri U, Jang DH. Hallucinogens. In: Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, et al., editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e [Internet]. New York, NY: McGraw-Hill Education; 2020 [cited 2021 May 10]. Disponible en: accessmedicine.mhmedical.com/content.aspx?aid=1166600412

28. Cooper Z, Williams A. Cannabis and Cannabinoid Intoxication and Toxicity. Div Subst Use Disord New York State Psychiatr Inst Dep Psychiatry. 2019;

29. Gage SH. Cannabis and psychosis: triangulating the evidence. The Lancet Psychiatry [Internet]. 2019 May [cited 2021 May 9];6(5):364–5. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S2215036619300860

30. Hall KE, Monte AA, Chang T, Fox J, Brevik C, Vigil DI, et al. Mental Health–related Emergency Department Visits Associated With Cannabis in Colorado. Bird SB, editor. Acad Emerg Med [Internet]. 2018 May [cited 2021 May 9];25(5):526–37. Disponible en:
https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.13393

31. Monte AA, Shelton SK, Mills E, Saben J, Hopkinson A, Sonn B, et al. Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study. Ann Intern Med [Internet]. 2019 [cited 2021 May 9];170(8):531.

United Nations. World Drug Report 2020. 2020;11–2. Disponible en:
https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf
2. Grof C. Cannabis, from plant to pill. Br J Clin Pharmacol. 2018;1–15.





3. Wilkinson S, Yarnel S, Radhakrishnan R, Ball S, Cyril D. Marijuana Legalization: Impact on Physicians and Public Health. Annu Rev Med. 2016;67(1):453–66.
4. Comisión Interamericana Abuso De Drogas Control del. Informe sobre el consumo de drogas en las Américas, 2019. 2019;67–75.
5. Chandra S, Radwan M, Majumbar C, Church J, Freeman T, ElSohly M. New trends in cannabis potency in USA and Europe during the last decade (2008–2017). Eur Arch Psychiatry Clin Neurosci. 2019;1–11.
6. Naciones Unidas. Informe Mundial sobre las Drogas [Internet]. 2019. Disponible en: https://wdr.unodc.org/wdr2019/field/B2_S.pdf
7. Zeledón G. PERFIL EPIDEMIOLÓGICO DE INTOXICACIONES EN COSTA RICA, 2017 [Internet]. San Jose; 2018. Disponible en: https://www.redciatox.org/sites/default/files/webfiles/2018/datos_toxico_cor_2017.pdf
8. Instituto sobre Alcoholismo y Farmacodependencia [Internet]. 2020. Disponible en: https://www.iafa.go.cr/
9. Lewis B, Fleeger T, Judge B, Riley B, Jones J. Acute toxicity associated with cannabis edibles following decriminalization of marijuana in Michigan. Am J Emerg Med. 2020;
10. Grimaldi A, Giglio L, Haggiag S, Bianco A, Cortese A, Giuseppe S, et al. The influence of physiotherapy intervention on patients with multiple sclerosis–related spasticity treated with nabiximols (THC:CBD oromucosal spray). PLoS One. 2019;14(7):1–10.
11. Lim M, Kirchhof M. Dermatology-Related Uses of Medical Cannabis Promoted by Dispensaries in Canada, Europe, and the United States. J Cutan Med Surg. 2018;




12. Kleine-Brueggeney M, Greif R, Brenneisen R, Urwyler N, Stueber F, Theiler L. Intravenous Delta-9 Tetrahydrocannabinol to Prevent Postoperative Nausea and Vomiting: A Randomized Controlled Trial. Anesth Analg. 2015;121(5):1157–64.
13. Huestis MA, Solimini R, Pichini S, Pacifici R, Carlier J, Busardò FP. Cannabidiol Adverse Effects and Toxicity. Curr Neuropharmacol. 2019;17(10):974–89.
14. Pagano S, Coniglio M, Valenti C, Federici MI, Lombardo G, Cianetti S, et al. Biological effects of Cannabidiol on normal human healthy cell populations: Systematic review of the literature. Biomed Pharmacother [Internet]. 2020;132:110728. Disponible en: https://doi.org/10.1016/j.biopha.2020.110728
15. Amin MR, Ali DW. Pharmacology of Medical Cannabis. Adv Exp Med Biol. 2019;1162:151–65.
16. Lucas CJ, Galettis P, Schneider J. The pharmacokinetics and the pharmacodynamics of cannabinoids. Br J Clin Pharmacol. 2018;84(11):2477–82.
17. Bellocchio L, Inchingolo AD, Inchingolo AM, Lorusso F, Malcangi G, Santacroce L, et al. Cannabinoids drugs and oral health—from recreational side-effects to medicinal purposes: A systematic review. Int J Mol Sci. 2021;22(15).
18. Weier A, Kleinschmidt K. How Are Patients Who Are Admitted to the Intensive Care Unit after Common Poisonings Diagnosed and Managed? [Internet]. Evidence-Based Practice of Critical Care. Elsevier Inc.; 2006. 632–636 p. Disponible en: http://dx.doi.org/10.1016/B978-1-4160-5476-4.00090-0
19. Noble MJ, Hedberg K, Hendrickson RG. Acute cannabis toxicity. Clin Toxicol [Internet]. 2019 [cited 2021 May 9];57(8):735–42. Disponible en:





https://www.tandfonline.com/doi/full/10.1080/15563650.2018.1548708
20. Chen Y, Klig J. Cannabis-related emergencies in children and teens. Curr Opin Pediatr. 2019;31(3):291–6.
21. Claudet I, Le Breton M, Bréhin C, Franchitto N. A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach? Eur J Pediatr [Internet]. 2017 [cited 2021 May 9];176(4):553–6. Available from: http://link.springer.com/10.1007/s00431-017-2872-5
22. Emoto J, Weeks K, Kallail KJ. Accidental Acute Cannabis Intoxication Presenting as Seizure in Pediatrics Patients. Kansas J Med. 2020;13:129–30.
23. Richards JR, Smith NE, Moulin AK. Unintentional Cannabis Ingestion in Children: A Systematic Review. J Pediatr [Internet]. 2017;190:142–52. Disponible en: https://doi.org/10.1016/j.jpeds.2017.07.005
24. Onders B, Casavant MJ, Spiller HA, Chounthirath T, Smith GA. Marijuana Exposure Among Children Younger Than Six Years in the United States. Clin Pediatr (Phila) [Internet]. 2016 May [cited 2021 May 9];55(5):428–36. Disponible en: http://journals.sagepub.com/doi/10.1177/0009922815589912
25. Schmid Y, Scholz I, Mueller L, Exadaktylos AK, Ceschi A, Liechti ME, et al. Emergency department presentations related to acute toxicity following recreational use of cannabis products in {Switzerland}. Drug Alcohol Depend [Internet]. 2020 [cited 2021 May 9];206:107726. Disponible en:https://linkinghub.elsevier.com/retrieve/pii/S0376871619305034






26. Boadu O, Gombolay GY, Caviness VS, El Saleeby CM. Intoxication From Accidental Marijuana Ingestion in Pediatric Patients: What May Lie Ahead. Pediatr Emerg Care. 2020;36(6):e349--e354.
27. Khatri U, Jang DH. Hallucinogens. In: Tintinalli JE, Ma OJ, Yealy DM, Meckler GD, Stapczynski JS, Cline DM, et al., editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e [Internet]. New York, NY: McGraw-Hill Education; 2020 [cited 2021 May 10]. Disponible en: accessmedicine.mhmedical.com/content.aspx?aid=1166600412
28. Cooper Z, Williams A. Cannabis and Cannabinoid Intoxication and Toxicity. Div Subst Use Disord New York State Psychiatr Inst Dep Psychiatry. 2019;
29. Gage SH. Cannabis and psychosis: triangulating the evidence. The Lancet Psychiatry [Internet]. 2019 May [cited 2021 May 9];6(5):364–5. Disponible en:
https://linkinghub.elsevier.com/retrieve/pii/S2215036619300860
30. Hall KE, Monte AA, Chang T, Fox J, Brevik C, Vigil DI, et al. Mental Health–related Emergency Department Visits Associated With Cannabis in Colorado. Bird SB, editor. Acad Emerg Med [Internet]. 2018 May [cited 2021 May 9];25(5):526–37. Disponible en:
https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.13393
31. Monte AA, Shelton SK, Mills E, Saben J, Hopkinson A, Sonn B, et al. Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study. Ann Intern Med [Internet]. 2019 [cited 2021 May 9];170(8):531. Disponible en: http://annals.org/article.aspx?doi=10.7326/M18-2809

32. Shelton SK, Mills E, Saben JL, Devivo M, Williamson K, Abbott D, et al. Why do patients come to the emergency department after using cannabis? Clin Toxicol [Internet]. 2020 [cited 2021 May 9];58(6):453–9. Disponible en: https://www.tandfonline.com/doi/full/10.1080/15563650.2019.1657582

33. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering Myocardial Infarction by Marijuana. Circulation [Internet]. 2001 [cited 2021 May 8];103(23):2805–9. Disponible en: https://www.ahajournals.org/doi/10.1161/01.CIR.103.23.2805

34. Richards JR, Bing ML, Moulin AK, Elder JW, Rominski RT, Summers PJ, et al. Cannabis use and acute coronary syndrome. Clin Toxicol [Internet]. 2019 [cited 2021 May 9];57(10):831–41. Disponible en:
https://www.tandfonline.com/doi/full/10.1080/15563650.2019.1601735

35. Richards JR. Mechanisms for the Risk of Acute Coronary Syndrome and Arrhythmia Associated With Phytogenic and Synthetic Cannabinoid Use. J Cardiovasc Pharmacol Ther [Internet]. 2020 [cited 2021 May 8];25(6):508–22. Disponible en: http://journals.sagepub.com/doi/10.1177/1074248420935743

36. Toce MS, Farias M, Powell AJ, Daly KP, Vargas SO, Burns MM. Myocardial Infarct After Marijuana Inhalation in a 16-year-old Adolescentn Boy. Pediatr Dev Pathol [Internet]. 2019 [cited 2021 May 9];22(1):80–6. Disponible en: http://journals.sagepub.com/doi/10.1177/1093526618785552

37. Lapoint J, Meyer S, Yu C, Koenig K, Lev R, Thihalolipavan S, et al. Cannabinoid Hyperemesis Syndrome: Public Health Implications and a Novel Model Treatment Guideline. West J Emerg Med [Internet]. 2018 [cited 2021 May 9];19(2):380–6. Disponible en:
https://escholarship.org/uc/item/59z5q826

38. Nourbakhsh M, Miller A, Gofton J, Jones G, Adeagbo B. Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases. J Forensic Sci. 2019;64(1):270–4.

39. Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review. J Med Toxicol. 2017;13(1):71–87.

40. Grotenhermen F. Pharmacokinetics and Pharmacodynamics of Cannabinoids. Clin Pharmacokinet [Internet]. 2003 [cited 2021 May 8];42(4):327–60. Disponible en: http://link.springer.com/10.2165/00003088-200342040-00003

41. Cao D, Srisuma S, Bronstein AC, Hoyte CO. Characterization of edible marijuana product exposures reported to United States poison centers. Clin Toxicol [Internet]. 2016 [cited 2021 Apr 25];54(9):840–6. Disponible en: https://www.tandfonline.com/doi/full/10.1080/15563650.2016.1209761

42. Iwanicki J. Hallucinogens. In: Rosen’s Emergency Medicine: Concepts and Clinical Practice [Internet]. Ninth edit. Philadelphia, PA: Elsevier; 2018 [cited 2021 May 10]. Disponibilidad en: https://bit.ly/3wz7Yqo

43. Fouad H, Haron M, Halawa EF, Nada M. Nontraumatic coma in a tertiary pediatric emergency department in Egypt: Etiology and outcome. J Child Neurol. 2011;26(2):136–41.

44. Olson K. Intoxicaciones. In: Papadakis MA, McPhee SJ, Rabow MW, editors. Diagnóstico clínico y tratamiento [Internet]. New York, NY: McGraw-Hill Education; 2017. Available from: accessmedicina.mhmedical.com/content.aspx?aid=1148089690

45. Randall K, Hayward K. Emergent Medical Illnesses Related to Cannabis Use. Mo Med. 2019;116(3):226–8.

46. Richard J. Cannabinoid Hyperemesis Syndrome: Pathophysiology and Treatment in the Emergency Department. J Emerg Med. 2017;54(3):354–63.

47. Richards J, Gordon B, Danielson A, Moulin A. Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review. J Hum Pharmacol Drug Ther. 2017;37(6):725–34.

48. Wong K, Baum C. Acute Cannabis Toxicity. Pediatr Emerg Care. 2019;35(11):799–804.

49. Baldwin DS, Waldman S, Allgulander C. Evidence-based pharmacological treatment of generalized anxiety disorder. Int J Neuropsychopharmacol. 2011;14(5):697–710.

50. Li C, Xia J, Wang J. Risperidone dose for schizophrenia. Cochrane Database Syst Rev. 2009;4.

51. Richards JR, Schandera V, Elder JW. Treatment of acute cannabinoid overdose with naloxone infusion. Toxicol Commun [Internet]. 2017 [cited 2021 May 9];1(1):29–33. Disponible en: https://www.tandfonline.com/doi/full/10.1080/24734306.2017.1392715

52. Smith PEM. Initial Management of Seizure in Adults. N Engl J Med. 2021;385(3):251–63.

53. Gates PJ, Sabioni P, Copeland J, Le Foll B, Gowing L. Psychosocial interventions for cannabis use disorder. Cochrane Database Syst Rev. 2016;

54. Simpson A, Magid V. Cannabis Use Disorder in Adolescence. Child Adolesc Psychiatry Clin North Am [Internet]. 2016;25(3):431–43. Disponible en: http://dx.doi.org/10.1016/j.chc.2016.03.003

55. Williams A, Hill K. Care of the Patient Using Cannabis. Ann Intern Med. 2020;173(9).

56. Claudet I, Mouvier S, Labadie M, Manin C, Michard-Lenoir A, Eyer D, et al. Unintentional Cannabis Intoxication in Toddlers. Pediatrics,. 2017;140(3).

Artículos más leídos del mismo autor/a