Critical Care: Global Case Report Poster - Miscellaneous |

New Generation Cannabinoids and Lung FREE TO VIEW

Coskun Dogan, MD; Sevda Sener Comert, MD; Benan Caglayan, MD; Ali Fidan, MD; Elif Torun Parmaksiz, MD; Banu Salepci, MD; Nesrin Kiral, MD
Author and Funding Information

Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):281A. doi:10.1016/j.chest.2016.08.294
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SESSION TITLE: Global Case Report Poster - Miscellaneous

SESSION TYPE: Global Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Nowadays, new jeneration synthetic cannabinoids (SC) are widely used psychoactive substances and they are getting more frequently used day by day. The possible reasons for this increase in usage are that they can easly be found, they are cheaper,as potent as non-synthetic equivalents and can be escaped from the legal check. These two cases are being presented to remark the lung toxicitiy of this potent synthetic cannabinoid.

CASE PRESENTATION: Case 1: A 18 yr old young male was admitted to emergency room with agitation, confusion and high fever. His relatives mentioned that he was using bonsai for last week. On admission, blood pressure:125/75 mmHg, RR: 25/min, body temperature: 39 °C, PR: 100/min and Glasgow Coma Scale:9. On physicial exam crackles were heard bilaterlly. Chest x-ray was showing infiltrates on both lower zones. Routine laboratory results were normal except for elevated CRP: 118 mg/L. Blood gases revealed pH:7.22 pCO2: 69.8 mmHg pO2:66.9 HCO3:21.8 mmol/L SO2: 89.8% consistant with respiratory acidosis. On 5th day of treatment, chest x-ray has turned to normal. Case 2: A 21 yr old young male was admitted to emergency room with loss of consciousness. On admission, blood pressure: 140/90 mmHg, RR: 35/min, body temperature: 36.1 °C PR: 115/min and Glasgow Coma Scale:10. Physicial exam demontrated rales on right hemithorax. He was using syntetic cannabinoids for a while. On chest x-ray, heterogenous infiltrates was seen on right middle and lower zones. Blood gases showed pH:7.36 pCO2: 33.7 mmHg pO2:63.6 HCO3:19.5 mmol/L SO2: 93.7%. On 3rd day of treatment, chest x-ray has turned to near-normal (Image).

DISCUSSION: Bonsai as a SC has many side effects on different organs and systems but lung toxicity is rarely seen. The lung toxicity may be seen as respiratory depression / respiratory asidosis as well as pulmonary infiltrates of unknown mechanism that resolves rapidly on radigraphic investigations. Synthetic cannabinoids make their effects via cannabinoid reseptor 1 (CR1) and CR2. With CR1 resepror effect, they cause central nervous system depression including respiratory failure. Tachycardia, hypoxemia, asidosis with respiratory failure were seen in our both cases consistent with the literature.

CONCLUSIONS: Psychotropic substances are widely used because of their receptor madiated capability of affecting the mind, emotions, and behavior. Although they may cause many well known toxicities on different systems of human organism, acute lung injury and respiraory failure are rare conditions as presented with these two cases.

Reference #1: Ashton CH, Pahrmacology and effects of cannabis: A brief review. Br J Psychiatry 2001; 178 (2): 101-106

Reference #2: Seely KA, Lapoint J, Moran JH, Fattore L. Spice drugs are more than harmless herbal blends: A reviev of the pharmacology and toxicology of synthetic cannabinoids. Prog Neuropsychopharmacol Biol Psychiatry. 2012; 39(2): 234-43

Reference #3: Schmid K, Niederhofder N, Szabo B. Analysis of the respiratory of effects of cannabinoids in rats. Naunyn Schmiedebergs Arch Pharmacol 2003; 368 (4): 301-8

DISCLOSURE: The following authors have nothing to disclose: Coskun Dogan, Sevda Sener Comert, Benan Caglayan, Ali Fidan, Elif Torun Parmaksiz, Banu Salepci, Nesrin Kiral

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