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Cannabis is becoming more available as it is legalized across the country.1 There has been a rise in accidental pediatric cannabis poisoning in Colorado since its legalization.2 While recreational use of cannabis has not been legalized in the state of Kansas, its proximity to Colorado makes cannabis easily available. Children aged one to four years of age are especially at risk for accidental poisoning due to exploratory ingestion.3 With cannabis’s growing popularity, its modes of delivery have evolved to include vaping, dabbing (inhaling small quantities of a concentrated or vaporized drug), topical applications, and oral ingestion through baked goods and candies.4 Oral ingestion puts children particularly at risk of acute intoxication due to the appealing nature of edibles and its easy consumption. Furthermore, delta-9-tetrahydrocannabinol (THC) often is highly concentrated in edibles. When smoked, the maximum plasma concentration of THC is achieved within 0.02-0.5 hours versus 1-3.4 hours with oral consumption.5 THC is the main psychoactive ingredient in cannabis that contributes to its CNS toxicities.6 Cannabidiol (CBD) is the main non-psychoactive ingredient in cannabis that is being studied for its effectiveness in treating epilepsy. Through selective breeding of the hemp plant Cannabis sativa, the THC to cannabidiol content in cannabis has increased from 14 times in 1995 to about 80 times in 2014.7 The adverse effects of cannabis intoxication in adults has been well-defined,8 but less is known about how it presents in children. There have been different case reports of acute cannabis intoxication in children presenting with ataxia, lethargy, tremors, coma, and seizures.8,9 Neurological impairment is the main manifestation of cannabis intoxication in children under 3-years-old.10 However, the pharmacokinetics of cannabis in children is still unknown.11 Case reports depicting these side effects have dated back to 1983 in Italy12 and 2005 in the United States.2 We report two cases of children presenting with new-onset seizures precipitated by acute cannabis intoxication. Physicians should consider cannabis ingestion in their differential diagnosis when a child presents with seizures and other neurological impairments.

Accidental Acute Cannabis Intoxication Presenting as Seizure in Pediatrics Patients