To report a case of fentanyl intoxication in a 13-year-old male with marijuana use. It highlights the dangers of unintentional fentanyl exposure in adolescents and underscores the importance of early diagnosis, intervention, and multidisciplinary treatment.

Fentanyl intoxication is a rapidly escalating crisis, with adolescents increasingly at risk due to its potent and widespread use in illicit drug markets. Fentanyl, 100 times more potent than morphine, is frequently mixed with drugs like marijuana, leading to unintended overdoses. Respiratory depression and cerebral hypoxia are the most dangerous complications of fentanyl toxicity, requiring urgent intervention. This case highlights the unique challenges of diagnosing and treating fentanyl overdose in an adolescent.

A 13-year-old male was brought to the emergency department with altered mental status, seizures, and agitation after suspected marijuana use. Initial lab work revealed rhabdomyolysis, acute kidney injury, and elevated liver enzymes. A urine toxicology screen was positive for fentanyl and THC. Brain MRI showed hypoxic injury in the cerebellum, and EEG indicated severe encephalopathy. The patient was treated with naloxone, intubated for respiratory failure, and managed for rhabdomyolysis and compartment syndrome with aggressive hydration and surgical intervention.

Following naloxone administration, the patient showed marked neurological improvement. He was extubated after eight days, and his cognitive and motor functions improved with physical therapy. MRI findings confirmed cerebellar damage due to hypoxia, and he was discharged with a plan for ongoing neurological and physical rehabilitation.

This case highlights the critical need for early detection and treatment of fentanyl overdose in adolescents. Public health efforts must focus on education about the dangers of fentanyl-laced drugs, particularly marijuana. A multidisciplinary approach, including the use of naloxone, can significantly improve outcomes. Further studies are required to develop preventive strategies and improve adolescent safety.