ABSTRACT

A child died in the emergency room of a local hospital a few hours after ingesting a substance the color of cork and the consistency of earth. At home, a modest amount of resinous substance was found. At the hospital, the child exhibited alterations in walking, balance, and consciousness. Intubation was needed for the onset of dyspnea, so fentanyl and ketamine were administered during the procedure. A sample of blood was also collected for clinical investigation. During the autopsy, cadaveric samples were collected. Autopsy evaluation revealed multiorgan congestion in the brain, lung, liver, and kidney. Histological investigations were inconclusive. A thorough toxicological investigation was undertaken by immunochemical technique, gas chromatography–mass spectrometry (GC–MS), and liquid chromatography–tandem mass spectrometry (UPLC–MS/MS) on samples of blood, bile, urine, organs, gastric content, and head hair. Toxicological analysis detected cannabinoids, ketamine, norketamine, and fentanyl in blood drawn from the emergency room. Cannabinoids were also observed in postmortem central blood, peripheral blood, urine, bile, brain, lung, and liver samples. Hair analysis showed tetrahydrocannabinol, cannabidiol, cannabinol, methadone and metabolites, cocaine and metabolites, ketamine, morphine, 6-monoacetylmorphine, and fentanyl. Gastric content revealed traces of cannabis products. Acute cannabis intoxication in the context of chronic exposure to numerous drugs has been considered responsible for the death. An increasing number of intoxication cases are being reported worldwide due to the legalization of cannabis. In most cases, these are adults suffering from preexisting conditions, whereas data on younger individuals are still scarce. In this paper, the case of a child who died from acute intoxication due to ingestion of hashish is presented.