Abstract
An 18-month-old previously healthy male presented unresponsive with generalized tonic-clonic activity. Seizures recurred despite multiple benzodiazepine doses, requiring intubation and mechanical ventilation. Extensive workup, including CT, MRI, lumbar puncture, respiratory panel, and blood cultures, failed to find an alternative cause for status epilepticus. Toxicologic testing confirmed a urine 11-nor-9-carboxy-tetrahydrocannabinol (THC-COOH) concentration >500 ng/mL and serum THC-COOH concentration of 256 ng/mL. Urine benzoylecgonine was also present at 74 ng/mL; no serum cocaine concentration was obtained. The patient returned to his neurologic baseline and was discharged after five days. To our knowledge, this is the first reported case of status epilepticus associated with laboratory-confirmed cannabis exposure in a toddler. Clinicians should consider THC toxicity in pediatric patients presenting with refractory seizures. Early recognition may guide acute management, targeted toxicologic testing, and child safety interventions.