Management of Gummy Edible Overdose in Children
No Specific Antidote Exists
There is no specific antidote for THC, CBD, or vitamin gummy overdose in children—management is entirely supportive care focused on maintaining vital functions and treating symptoms as they arise. 1, 2
Immediate Assessment and Stabilization
Airway and Breathing Priority
- Establish and maintain an open airway as the absolute first priority, providing bag-mask ventilation for respiratory depression, followed by endotracheal intubation when clinically indicated. 3
- Monitor continuously for hypoxemia and hypercarbia, which are the primary causes of tissue injury and death in cannabinoid overdose. 3
Vital Sign Monitoring
- Continuously monitor temperature, heart rate, and cardiac rhythm, as THC toxicity can cause both bradycardia (uncommon but reported) and tachycardia depending on dose and timing. 4, 5
- Be alert for hypertension, tachycardia, and unexplained lactic acidosis—cannabis toxicity can cause acute lactic acidosis in some patients. 4
Supportive Care by Substance Type
THC/Cannabis Gummy Overdose
Clinical Presentation:
- Neurologic symptoms predominate: lethargy, agitation, ataxia, mydriasis, hypersalivation, urinary incontinence, tremors, and at higher doses—hyperexcitability or seizures. 2
- Cardiovascular: bradycardia (including first-degree AV block), tachycardia, or hypertension depending on dose. 4, 5
- Gastrointestinal: vomiting is common. 4, 2
- Respiratory: tachypnea or respiratory depression at toxic doses. 2
Management:
- Provide respiratory support as the cornerstone of management—this is the single most important intervention. 3
- Administer intravenous fluids to counter vomiting and help control body temperature (hypothermia or hyperthermia may occur). 2
- For severe agitation or hyperexcitability, sedate with benzodiazepines (e.g., lorazepam 0.5-2 mg IV titrated to effect). 6, 2
- Consider activated charcoal (1 g/kg orally) if presentation occurs within 1-3 hours of ingestion, though efficacy diminishes rapidly after this window. 6
- Intralipid therapy has been used anecdotally to bind highly lipophilic THC and reduce clinical signs, though evidence is limited to case reports. 2
Diagnostic Testing:
- Urine drug screening for cannabinoids can be performed, but human urine tests are unreliable in children due to metabolite interference and timing issues—false negatives are common if testing occurs too soon after ingestion. 2
- Basic laboratory workup should include CBC, electrolytes, glucose, and lactate if the patient appears severely ill. 4
Vitamin Gummy Overdose
Clinical Presentation Varies by Vitamin Type:
Fat-Soluble Vitamins (A, D, E, K):
- Vitamin D toxicity presents with hypercalcemia causing anorexia, weakness, lethargy, vomiting, and in severe cases—refractory hypercalcemia requiring ICU admission. 7
- Symptoms may develop over days to weeks with chronic ingestion. 7
Water-Soluble Vitamins (B-complex, C):
- Generally cause only mild gastrointestinal upset (nausea, vomiting, diarrhea) as excess is rapidly excreted. 8
Iron-Containing Gummies:
- Can cause severe toxicity with gastrointestinal hemorrhage, metabolic acidosis, and hepatotoxicity—this is a true emergency requiring aggressive management and potential chelation therapy (though this falls outside the scope of "gummy vitamins" typically).
Management:
- For hypercalcemia from vitamin D toxicity: aggressive IV fluid resuscitation, prednisone, calcitonin, and in refractory cases—bisphosphonates (zoledronic acid). 7
- Monitor calcium, phosphate, magnesium, and vitamin D levels serially. 7
- Activated charcoal is generally not helpful for vitamin overdoses as most are already absorbed by presentation time. 6
Melatonin Gummy Overdose
Clinical Presentation:
- Drowsiness is the predominant symptom, along with gastrointestinal upset and paradoxical hyperactivity in some children. 8
- Children who ingest melatonin gummies have 8.4 times higher odds of being symptomatic and 4.8 times higher odds of requiring ED evaluation compared to other gummy exposures. 8
Management:
- Supportive care only—maintain airway, monitor vital signs, and observe for resolution of sedation (typically within 6-12 hours). 8
- No specific antidote exists; symptoms resolve spontaneously. 8
Critical Pitfalls to Avoid
- Never administer flumazenil for suspected cannabinoid toxicity—it has no role and may precipitate seizures if co-ingestion with other substances has occurred. 3
- Never use opioids for symptom management—they worsen nausea, carry high addiction risk, and do not address underlying pathophysiology. 6, 9
- Do not assume "gummy vitamins are harmless"—fat-soluble vitamin toxicity (especially vitamin D) can cause severe, prolonged hypercalcemia requiring intensive care. 7
- Do not rely on urine drug screens to rule out THC toxicity in children—false negatives are common and clinical diagnosis should guide management. 2
- Never delay respiratory support while pursuing diagnostic testing—airway management takes absolute priority. 3
Disposition and Follow-Up
- Most children with THC gummy ingestion recover completely within 24 hours with supportive care alone. 2
- Admit to ICU if respiratory depression, severe agitation requiring sedation, persistent tachycardia/bradycardia, or lactic acidosis is present. 4
- For vitamin D toxicity with hypercalcemia, prolonged hospitalization (days to weeks) may be required until calcium normalizes. 7
- Mandatory social work evaluation and parental education regarding safe storage of all medications and edibles—these ingestions represent a preventable exposure. 8, 7, 5