Synthetic cannabinoids

Signs and symptoms

 * Neurological
 * Coma / CNS depression
 * Seizures
 * Agitation (primarily when used with additional drugs)
 * Rhabdomyolysis
 * Transient cerebral edema: occurred in one case in a series of 30 patients, and was reversible.
 * Systemic
 * Acute respiratory failure: 70% of patients in one series required endotracheal intubation, but some were for hypoxia and ARDS.
 * Cardiac
 * Acute MI
 * Bradycardia
 * QT prolongation
 * Hypertensive emergency
 * Acute renal failure: may be related to rhabdomyolysis

One 30-year old patient was reported who was found unresponsive with absent brainstem reflexes and decerebrate posturing, hypothermic, and with hypoxia. NCHCT showed global cerebral edema and lost grey-white differentiation. He was treated with mannitol and hypertonic saline and had neurological recovery, after which he was extubated 40 hours later.

In adolescents, synthetic cannabinoids are associated with higher odds of coma or CNS depression (OR 3.42, 95% CI 1.51-7.75) and a higher odds of seizures (OR 3.89, 95% CI 1.39-10.94) with less agitation (OR 0.18, 95% CI 0.10-0.34) compared with cannabis alone. However, agitation became more likely when synthetic cannabinoids were used with additional drugs.