Delirium following ingestion of marijuana present in chocolate cookies

Objective: To describe a case of marijuana-induced delirium and the techniques used to detect psychoactive agents and metabolites in urine. Methods: A case of delirium following involuntary ingestion of cannabis is described. A urine sample was analyzed applying various chemical procedures, using high-resolution gas chromatography coupled with mass spectrometry technique. 11-nor-Delta 9-tetrahydrocannabinol-9-carboxylic acid was quantified by the methodology for steroids and cannabis. Results: A 26-year-old man was hospitalized with severe agitation and psychotic behavior 36 hours after suspected involuntary ingestion of cannabis contained in a brigadeiro, a typical Brazilian cookie, consumed during a party. Treatment with neuroleptics resulted in complete regression of the symptoms over 2 weeks. The urine sample revealed marijuana ingestion, demonstrated by the presence of its metabolite, 11-nor-Delta 9-tetrahydrocannabinol-9-carboxylic acid in high concentration. No other investigated substance was found in the patient's urine. Conclusion: Severe delirium can follow oral ingestion of cannabis integrated into homemade cookies.