RESUMO
EN: The increased use of cannabis among adults and the general perception that cannabis is harmless has been accompanied by a rise in the number of acute poisoning cases among children. We present a retrospective, descriptive study of patients aged 3 years or younger who were treated for cannabis poisoning in a pediatric emergency department between 2012 and 2017. Epidemiologic and clinical data as well as toxicologic findings are reported. We found 10 cases of cannabis poisoning in our records. Nine of the patients had diminished consciousness. Only 2 families initially reported exposure to cannabis when interviewed. Repeated exposure was demonstrated by analysis of hair from 2 patients. We conclude that cannabis poisoning should be included in the differential diagnosis of young children with acute neurologic symptoms of unknown origin. When cannabis is detected in urine samples collected in the pediatric emergency department, more specific diagnostic techniques should be used to assess the possibility of repeated exposure.
ES: El aumento en el consumo de cannabis y su trivialización por la población adulta se han traducido en un aumento de los casos de intoxicaciones agudas en niños. Se presenta un estudio observacional retrospectivo de los pacientes menores de 3 años intoxicados por cannabis entre 2012 y 2017 en un servicio de urgencias pediátricas (SUP). Se recogieron datos epidemiológicos, clínicos y toxicológicos. Se detectaron 10 intoxicaciones por cannabis. Nueve pacientes presentaron alteración en el nivel de conciencia. Solo en 2 casos la familia refirió la exposición al tóxico en la anamnesis inicial. La detección en cabello demostró exposición repetida en 2 pacientes. En conclusión, es necesario incluir la intoxicación por cannabis dentro del diagnóstico diferencial de los niños con clínica neurológica aguda no filiada. Ante la detección de cannabis en orina en el SUP, se debe solicitar la confirmación mediante técnicas específicas y valorar la posibilidad de exposiciones repetidas.
Assuntos
Cannabis/intoxicação , Intoxicação/diagnóstico , Intoxicação/epidemiologia , Fatores Etários , Pré-Escolar , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
The reliability of procalcitonin as a predictor of invasive infection in infants <36 months of age with fever and nontoxic appearance was assessed in 868 patients, 15 (1.7%) of whom had invasive infection. The area under the receiver operating characteristic curve for procalcitonin was 0.87 (optimum cutoff 0.9 ng/mL, sensitivity 86.7%, specificity 90.5%), whereas for C-reactive protein it was 0.79 (optimum cutoff 91 mg/L, sensitivity 33.3%, specificity 95.9%). In infants with fever of <8 hours duration, the area under the receiver operating characteristic curve was 0.97 for procalcitonin and 0.76 for C-reactive protein. Procalcitonin was a useful biomarker to predict invasive infection in non-toxic-appearing infants with fever without apparent focus, particularly in febrile episodes of <8 hours duration.