Severe liver dysfunction in a toddler receiving nonprescription phytocannabinoid

Area of Science:

• Hepatology
• Pediatric Gastroenterology
• Pharmacovigilance

Background:

• Nonprescription cannabis products, including hemp extract, are increasingly accessible for various health concerns.
• The safety profile of these products, particularly non-psychoactive phytocannabinoids, beyond their psychoactive effects, remains under-researched.
• While high doses of recreational tetrahydrocannabinol (THC) and cannabidiol (CBD) are linked to liver issues, data on nonprescription phytocannabinoids is limited.

Observation:

• A 2-year-old unimmunized male with refractory epilepsy was incidentally diagnosed with severe liver dysfunction and elevated coagulation markers.
• The child's parents were administering nonprescription phytocannabinoids (hemp extract) for his neurological condition.
• Liver enzymes normalized after discontinuing the phytocannabinoid product, with the World Health Organization-Uppsala Monitoring Centre classifying the event as a probable adverse reaction.

Findings:

• This case suggests a potential link between nonprescription phytocannabinoid ingestion and severe liver dysfunction in pediatric patients.
• Phytocannabinoids may play a role in the pathophysiology of drug-induced liver injury, even in nonprescription formulations.
• The absence of clinical signs of liver failure despite severe laboratory abnormalities highlights the insidious nature of this adverse reaction.

Implications:

• Increased awareness among healthcare providers and caregivers regarding the potential for life-threatening liver injury from over-the-counter phytocannabinoid products is crucial.
• Routine monitoring of liver enzymes is recommended for pediatric patients using hemp-derived products.
• Further research is urgently needed to elucidate the safety profile of various phytocannabinoids and their impact on different organ systems.