Respiratory depression following an accidental overdose of a CBD-labeled product: A pediatric case report.

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OBJECTIVE:

To report a case of accidental cannabidiol (CBD) oil overdose in a pediatric patient.

BACKGROUND:

CBD is one of over 100 pharmacologically active compounds in the marijuana plant (Cannabis sativa). Its absence of psychoactive effects and the abundance of anecdotal claims of effectiveness across a wide variety of conditions in both mainstream and social media have created an incredible amount of public interest in CBD oil in recent years. Such interest has led to increased consumer availability. Despite this increased access, such sales remain illegal at the federal level. While sales of CBD products not approved by the Food and Drug Administration continue to rise, purity, potency, labeling, and delivery devices remain inconsistent. This may lead to an increased risk of adverse events. The following report describes a case of accidental CBD overdose in a pediatric patient leading to a stay in the pediatric intensive care unit.

CASE SUMMARY:

The patient initially presented to the urgent care and was quickly transferred to the emergency department after being found unresponsive after administration of a dose of CBD oil earlier in the day. After arrival, his mental status and respiratory drive continued to deteriorate, and he was ultimately intubated. He was eventually extubated and transferred out of the pediatric intensive care unit after 48 hours and discharged after 72 hours. This patient was found to have a urine 9-carboxy-11-nor-Δ-9-tetrahydrocannabinol concentration of 123 ng/mL, suggestive of consumption of a substantial amount of tetrahydrocannabinol. However, samples from the same batch ingested by the patient were tested by both the manufacturer and the Food and Drug Administration and contained only trace amounts of THC.

PRACTICE IMPLICATIONS:

As CBD oil use continues to rise, health care professionals should have an adequate understanding of current clinical evidence and state and federal legislation to counsel patients on CBD use in a practical and compassionate manner.

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