There’s a popular belief that weed can’t kill you.
asserted
weed → ’ → you
While it’s almost impossible to overdose on weed by itself, marijuana use can indirectly cause life-threatening complications.
asserted
use → ’ → complications
A 15-year-old learned this the hard way, a new case study reveals.
asserted
study → learn → this
His is one of only two recorded cases in teens in which “scromitting,” slang for cannabinoid hyperemesis syndrome (CHS), led to a critical and life-threatening thiamine (vitamin B1) deficiency that affected the brain.
asserted
that → record → brain
Before doctors identified the cause, he’d lost 25 to 30 pounds from vomiting, a hallmark of CHS.
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he → identify → CHS
He also developed serious issues with cognition and movement.
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He → develop → cognition
With increased access to the marijuana, more teens are using it in various forms, which can lead to problems in school and with friends and psychiatric conditions.
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which → increase → friends
In the 15-year-old’s case, he developed a brain condition that is notoriously hard to identify and diagnose.
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that → develop → condition
Here’s how doctors figured it out and saved his life.
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doctors → ’ → life
What happened to the teen
The teen originally went to the emergency room after spending several days feeling nauseous, with a headache and vomiting.
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teen → happen → headache
He said he’d been using cannabis for the past three months, but otherwise didn’t say he had used any other drugs and didn’t have any significant past medical history.
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he → say → history
He was given anti-nausea drugs, IV fluids, and told to stop using weed — then was sent on his way.
asserted
He → give → way
Three weeks later, he went to his primary care doctor with the same symptoms.
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he → go → symptoms
He had a series of tests and imaging done, including a CT scan, which didn’t reveal anything remarkable.
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which → have → anything
Another week went by, and his mom took him back to the ER, a month after his initial visit.
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mom → go → visit
She said he’d lost 25-30 pounds by this point.
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he → say → point
A urine test showed he was still using marijuana.
asserted
he → show → marijuana
During the assessment, doctors noted he was confused, had slowed speech, and would be unresponsive for a few moments when asked a question.
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he → note → question
Doctors scrambled, looking at his digestive system and kidneys, and they gave him something to raise his dangerously low sodium levels.
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they → scramble → levels
It helped his blood sodium levels return to normal, but his cognition remained impaired.
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cognition → help → ?
By the fourth day in the hospital, the teen was still bed-bound.
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teen → bind → hospital
His eyes started moving rapidly and uncontrollably and he was sensitive to light and had trouble walking to the bathroom.
asserted
he → start → bathroom
Doctors ordered an MRI, which didn’t reveal a cause.
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which → order → cause
How his condition was identified
A condition known as Wernicke encephalopathy (WE) is associated with three hallmarks: rapid eye movement (nystagmus), ataxia (loss of coordination) and mental changes.
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condition → identify → coordination
However, this triad of symptoms only appears in a minority of patients with the disorder — making it notoriously hard to diagnose.
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it → appear → disorder
Most cases are only identified after death, during an autopsy.
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cases → identify → autopsy
WE is caused by dangerously low levels of thiamine (vitamin B1) in the brain.
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WE → cause → brain
In this teen’s case, the deficiency was caused by the prolonged, excessive vomiting associated with CHS.
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deficiency → cause → CHS
The leading cause for WE is chronic alcohol use, but malnutrition from things like an eating disorder or cancer can also lead to this deficiency.
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malnutrition → lead → deficiency
It often progresses to Korsakoff syndrome, which causes permanent losses to memory and learning.
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which → progress → memory
This develops in up to 85% of survivors.
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This → develop → survivors
Wernicke-Korskoff syndrome kills 20% of patients.
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syndrome → kill → patients
In the only other teen case of CHS leading to WE, it was caught via MRI.
asserted
it → lead → MRI
In the 15-year-old’s case, the MRI missed it.
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MRI → miss → it
Doctors didn’t know it was WE for sure.
asserted
it → know → ?
A test to confirm thiamine deficiency would take days to return.
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test → confirm → days
But they suspected it, based on the teen’s symptoms, and said that giving him supplemental thiamine was “low risk.”
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giving → suspect → thiamine
The teen got thiamine through an IV every eight hours for two days, plus a thiamine pill for four days.
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teen → get → days
Within a day, his eye movements and cognition improved.
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movements → improve → day
With his improvement, he was sent home.
asserted
he → send → improvement
…and 2 more, not listed.
The Aporia
