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Dtsch Med Wochenschr. 2007 Mar 16;132(11):560-2.

["Usual" cannabis abuse producing an unusual incident].

[Article in German]

Author information

1
Klinikum Nürnberg Nord, Medizinische Klinik 2, Intensivmedizin-Toxikologie, Lehrstuhl Innere Medizin V-Geriatrie, FAU Erlangen-Nürnberg. heppner@klinikum-nuernberg.de

Abstract

CASE HISTORY:

A 17-year-old male presented in an agitated, deranged state with rapidly increasing swelling of the neck. Except for regular abuse of cannabis there was no medical history of note. He had a sinus tachycardia (130 bpm), a slow pupillary reflex, bilateral hyposphagma and subcutaneous emphysema around the neck and shoulders.

INVESTIGATIONS AND DIAGNOSIS:

Laboratory tests showed elevated inflammatory markers. The chest X-ray demonstrated a bilateral pneumothorax and large subcutaneous emphysema. Subsequent computed tomography of neck and thorax showed an extensive pneumomediastinum and the described subcutaneous emphysema. There was no evidence of a ruptured trachea or esophageal perforation. The underlying cause was presumed to have been a Valsalva maneuver during marijuana smoking.

TREATMENT AND COURSE:

As the pneumothorax was completely reabsorbed, no chest drains were inserted and the patient was transferred to our toxicological intensive care unit. Recurring drug-induced psychosis had to be treated with repeated doses of haloperidol. The emphysema was slowly reabsorbed without any further complication. The patient was transferred back to a psychiatric ward after five days.

CONCLUSION:

Although cannabis is thought to be one of the "safe" drugs, its abuse can have life-threatening effects. One complication is the occurrence of a pneumothorax after a Valsalva maneuver. As the rate of cannabis abuse has been increasing during the last few years, the risk of life-threatening complications should be mentioned in relevant publications and as part of drug education. Patients presenting with dyspnea should always be carefully questioned about possible drug abuse.

PMID:
17342632
DOI:
10.1055/s-2007-970377
[Indexed for MEDLINE]

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