儿科人群中的急性大麻中毒。

IF 3.6 Q2 TOXICOLOGY
Frontiers in toxicology Pub Date : 2025-04-14 eCollection Date: 2025-01-01 DOI:10.3389/ftox.2025.1558721
Ginevra Malta, Giuseppe Davide Albano, Gianluca Lavanco, Anna Brancato, Carla Cannizzaro, Antonina Argo, Simona Contorno, Fulvio Plescia, Stefania Zerbo
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引用次数: 0

摘要

本叙述性审查综合了儿科大麻中毒的毒理学、临床和医学法律方面。通过提供全面的概述,它旨在为未来的研究提供信息,指导政策制定,并加强临床和毒理学实践,以解决这一日益严重的公共卫生问题。儿童摄取大麻素的药代动力学受到其胃肠道和代谢酶系统不成熟的显著影响,导致口服生物利用度改变。临床数据表明,儿童患者的Δ9-tetrahydrocannabinol (THC)相关效应通常在摄入后2小时内出现,更严重的症状在4小时内出现。内源性大麻素系统(ECS)经历了显著的发育变化,大麻素受体在胎儿、新生儿和成人大脑中的表达和分布存在显著差异。在神经发育过程中,CB1受体表现出独特的表达模式,包括短暂定位于对神经营养功能至关重要的脑干区域。这些发育动态可能解释了儿童对四氢大麻酚神经和神经植物效应的高度敏感性,往往导致比成人更严重的后果。大麻素的可靠检测包括将筛选方法与验证性分析技术相结合。尿免疫分析测试被广泛认为是评估以前接触的有用工具,在摄入后3-4小时内呈阳性。然而,这种方法容易产生误报。当接近事件测量血浆THC浓度时,可以提供有价值的见解,了解摄入的量以及暴露与损伤窗口临床结果之间的相关性。毛发分析虽然有助于区分急性和慢性使用,但容易受到各种偏差的影响。儿童急性大麻中毒的发病率不断上升,这突出表明迫切需要有针对性的公共卫生干预措施和更严格的监管框架。预防措施,如防儿童包装、公共教育运动和怀孕期间大麻使用筛查,对于减轻风险至关重要。临床医生在鉴别诊断出现不明原因的神经、免疫或代谢症状的儿童时应考虑四氢大麻酚暴露。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute cannabis intoxication among the paediatric population.

This narrative review synthesizes the toxicological, clinical and medico-legal aspects of paediatric cannabis intoxication. By providing a comprehensive overview, it aims to inform future research, guide policymaking, and enhance clinical and toxicological practice in addressing this growing public health concern. The pharmacokinetics of cannabinoid ingestion in children are significantly influenced by the immaturity of their gastrointestinal tract and metabolic enzyme systems, resulting in altered oral bioavailability. Clinical data indicate that Δ9-tetrahydrocannabinol (THC)-related effects in paediatricpaediatric patients typically emerge within 2 hours of ingestion, with more severe symptoms developing within 4 hours. The endocannabinoid system (ECS) undergoes significant developmental changes, with marked differences in cannabinoid receptor expression and distribution across fetal, neonatal, and adult brains. During neurodevelopment, CB1 receptors exhibit unique expression patterns, including transient localization in brainstem regions critical for neurovegetative functions. These developmental dynamics likely explain children's heightened sensitivity to THC's neurological and neurovegetative effects, often resulting in more severe outcomes compared to adults. The reliable detection of cannabinoids involves integrating screening methods with confirmatory analytical techniques. Urine immunoassay testing is widely considered an helpful toolto assess a previous exposure, becoming positive within 3-4 h of ingestion. However, this method is prone to false positives. Plasma THC concentration, when measured close to the event, offers valuable insights into the quantity ingested and the correlation between exposure and clinical outcomes in the impairment window. Hair analysis, while useful for distinguishing between acute and chronic use, is susceptible to various biases. The rising incidence of acute cannabis intoxication in children underscores the urgent need for targeted public health interventions and stricter regulatory frameworks. Preventive measures such as child-resistant packaging, public education campaigns, and cannabis use screening during pregnancy are essential to mitigate risks. Clinicians should consider THC exposure in the differential diagnosis of children presenting with unexplained neurological, immune, or metabolic symptoms.

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CiteScore
3.80
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