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Synthetic cannabinoid use, such as with "Bonsai" herbal incense, can trigger diabetic ketoacidosis (DKA) with prolonged acidosis and hypokalemia. This condition is difficult to detect with standard drug tests.

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Area of Science:

  • Toxicology
  • Endocrinology
  • Emergency Medicine

Background:

  • Diabetic ketoacidosis (DKA) is a severe diabetes complication characterized by hyperglycemia, acidosis, and ketonuria.
  • Synthetic cannabinoids, found in products like "Bonsai" herbal incense, are increasingly prevalent and pose diagnostic challenges due to their undetectability by conventional drug screens.
  • Synthetic cannabinoid abuse is linked to serious adverse effects, including tachycardia, hypertension, acidosis, sedation, and coma.

Purpose of the Study:

  • To investigate the association between synthetic cannabinoid consumption and atypical diabetic ketoacidosis presentation.
  • To highlight the diagnostic challenges posed by synthetic cannabinoid-induced DKA.

Main Methods:

  • Case report of a 17-year-old male presenting with dyspnea, hyperglycemia, acidosis, and ketonuria.
  • Patient admitted to ICU with a diagnosis of DKA.
  • Investigation into atypical DKA features including hypokalemia, persistent tachycardia, and bronchoscopic findings.
  • Patient history revealed recent cannabis and "Bonsai" (synthetic cannabinoid) use.

Main Results:

  • The patient exhibited symptoms consistent with DKA but presented with atypical features such as hypokalemia and persistent tachycardia.
  • Laboratory findings confirmed hyperglycemia, acidosis, and ketonuria.
  • The patient's condition improved with DKA treatment, and synthetic cannabinoid use was identified as a likely contributing factor.

Conclusions:

  • Synthetic cannabinoid consumption should be considered in cases of unexplained or atypical diabetic ketoacidosis, particularly those with prolonged acidosis and hypokalemia.
  • The study underscores the importance of comprehensive drug history in managing complex metabolic emergencies.
  • Early identification and management of synthetic cannabinoid abuse are crucial to prevent severe health consequences.