RESUMEN
We report a case of mild cannabinoid poisoning in a preschool child, after 3-week ingestion of hemp seed oil prescribed by his pediatrician to strengthen his immune system. The patient presented neurological symptoms that disappeared after intravenous hydration. A possible mild withdrawal syndrome was reported after discharge. The main metabolite of Δ-tetrahydrocannabinol was detected in urine, and very low concentration of Δ-tetrahydrocannabinol was detected in the ingested product. This is, as far as we know, the first report of cannabinoid poisoning after medical prescription of hemp seed oil in a preschool child.
Asunto(s)
Cannabinoides/envenenamiento , Cannabis/efectos adversos , Dronabinol/orina , Aceites de Plantas/uso terapéutico , Intoxicación/diagnóstico , Semillas/efectos adversos , Síndrome de Abstinencia a Sustancias/diagnóstico , Preescolar , Citocromo P-450 CYP2C9/metabolismo , Citocromo P-450 CYP3A/metabolismo , Dronabinol/metabolismo , Humanos , Infusiones Intravenosas/métodos , Masculino , Aceites de Plantas/administración & dosificación , Aceites de Plantas/efectos adversos , Intoxicación/etiología , Intoxicación/terapia , Síndrome de Abstinencia a Sustancias/etiología , Resultado del TratamientoRESUMEN
PURPOSE: The aim of the present study was to investigate the genetic variability of VKORC1, CYP2C9 and CYP4F2 genes in patients who required a very low and high warfarin dose, in order to identify novel variants that could help to explain the particular extreme dose requirements. METHODS: Among patients followed and treated with warfarin at the Center of Haemostasis and Thrombosis of the PTV, we selected twelve patients showing a high divergence from warfarin standard doses required to achieve the therapeutic effect. All VKORC1, CYP2C9 and CYP4F2 coding regions, 3' and 5' UTR and exon/intron boundaries were analyzed by direct sequencing. RESULTS: The 1173T and -1639A allele variants in VKORC1 gene, associated with warfarin sensitivity, were present, as expected, mostly in low dose patients while 3730A allele, linked to warfarin resistance, has been found only in high dose patients. Interestingly, we found that three out of six low dose subjects presented CYP2C9*3/*3 homozygous genotype, very rare in Caucasians. Besides these common polymorphisms, we identified 5 SNPs in CYP2C9 gene and 19 SNPs in CYP4F2 gene. Among these, all polymorphisms identified in CYP2C9 gene were present only in low dose patients and three of them resulted in linkage with CYP2C9*2 and CYP2C9*3. Regarding CYP4F2 SNPs, we did not observe differences between the high and low dose patients. At the end, the whole sequencing did not reveal any novel polymorphism/mutation. CONCLUSION: Further studies are required to identify other genetic factors contributing to extreme warfarin requirement.