Differential diagnosis of cannabinoid intoxication

CASE STUDY: Differential diagnosis of cannabinoid intoxication

1. Patient Identification Data

Patient: M., 23 years old
Sex: Male
Marital status: Single
Education: Secondary vocational education
Employment: Temporarily unemployed

2. Complaints

The patient was brought to the emergency department with the following complaints:

• feeling of anxiety
• rapid heartbeat
• dry mouth
• feeling of unreality (derealization)
• dizziness

According to accompanying persons, the patient smoked an unknown substance several hours earlier.

3. Medical History

The patient has been using psychoactive substances occasionally for about 2 years. Alcohol consumption is rare. He has not previously sought narcological treatment.

Approximately 20–30 minutes after smoking, the following symptoms appeared:

• pronounced euphoria
• increased talkativeness
• inappropriate laughter

After some time, the condition changed to:

• anxiety
• suspiciousness
• feeling of fear

4. Objective Status

General condition: satisfactory.

Consciousness: clear.
Orientation: preserved.

Observed signs:

• conjunctival hyperemia (red eyes)
• dilated pupils
• dryness of mucous membranes
• tachycardia (100–110 beats/min)

Mental state:

• emotional lability
• periodic anxiety
• impaired concentration
• slowed thinking

5. Preliminary Diagnosis

Acute cannabinoid intoxication.

6. Differential Diagnosis

Cannabinoid intoxication should be differentiated from the following conditions:

1. Alcohol Intoxication

Distinctive features:

• smell of alcohol from the mouth
• impaired coordination of movements
• pronounced dysarthria
• more frequent depression of the central nervous system

2. Opioid Intoxication

Characteristic signs:

• constricted pupils (miosis)
• drowsiness
• respiratory depression
• pronounced euphoria followed by lethargy

3. Psychostimulant Intoxication (Amphetamine)

Characterized by:

• pronounced psychomotor agitation
• insomnia
• aggressiveness
• significant increase in blood pressure

4. Panic Attack

Differences:

• no evidence of substance use
• no conjunctival hyperemia
• symptoms occur without psychoactive substance intake

7. Additional Diagnostic Methods

• toxicological urine analysis
• blood test for psychoactive substances
• examination by a psychiatrist-narcologist
• ECG (in case of tachycardia)

8. Final Diagnosis

Acute cannabinoid intoxication.

9. Treatment

• observation in a hospital setting
• sedative medications (in case of anxiety)
• detoxification therapy
• psychological support

10. Questions for Discussion (for Students)

1. What clinical signs are characteristic of cannabinoid intoxication?
2. How does cannabinoid intoxication differ from alcohol intoxication?
3. What laboratory methods are used to detect cannabinoids?
4. What complications may occur after cannabis use?