Cannabinoid hyperemesis syndrome: Difference between revisions
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==Background== | ==Background== | ||
Cannabis is the most widely used drug in the US and the world. | *Cannabis is the most widely used drug in the US and the world. | ||
*Cannabinoid hyperemesis syndrome, first described by Allen et al. in 2004 consists of nausea, vomiting, and abdominal pain in a patient with no other organic cause who frequently uses marijuana and has relief of symptoms with hot showers<ref> Allen, J H; De Moore, GM; Heddle, R; Twartz, JC (2004). "Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse". Gut 53 (11): 1566–70. doi:10.1136/gut.2003.036350. PMC 1774264</ref> | |||
*Pathophysiology not yet well understood<ref>Byrne, A; Hallinan, R; Wodak, A (2006). "'Cannabis hyperemesis' causation questioned". Gut 55 (1): 132; author reply 132. PMC 1856368</ref> | |||
* | |||
==Clinical Features<ref>Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). "Cannabinoid Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings 87 (2): 114–9. doi:10.1016/j.mayocp.2011.10.005. PMID 22305024</ref>== | ==Clinical Features<ref>Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). "Cannabinoid Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings 87 (2): 114–9. doi:10.1016/j.mayocp.2011.10.005. PMID 22305024</ref>== | ||
Essential Features | Essential Features | ||
* Long term cannabis use (typically > 2years) | * Long term cannabis use (typically > 2years) | ||
Major Features | Major Features | ||
* severe cyclical nausea, vomiting | * severe cyclical nausea, vomiting | ||
* weekly use of marijuana | * weekly use of marijuana | ||
| Line 25: | Line 24: | ||
==Diagnosis== | ==Diagnosis== | ||
*Generally considered a diagnosis of exclusion after evaluating for other causes of [[Nausea and Vomiting]] | |||
==Management== | ==Management== | ||
*Symptomatic treatment | *Symptomatic treatment ([[Antiemetics]], anxiolytics, and hydration) | ||
*Cessation of marijuana use | *Cessation of marijuana use | ||
*Capsaicin Cream | *Capsaicin Cream | ||
==Disposition== | ==Disposition== | ||
*Discharge once tolerating PO | |||
==External Links== | ==External Links== | ||
*[http://lifeinthefastlane.com/therapeutic-showering/ LITFL: Therapeutic Showering] | *[http://lifeinthefastlane.com/therapeutic-showering/ LITFL:Therapeutic Showering] | ||
*[http://www.thepoisonreview.com/2014/07/16/review-of-cannabinoid-hyperemesis-syndrome/ The Poison Review: Review of cannabinoid hyperemesis syndrome] | *[http://www.thepoisonreview.com/2014/07/16/review-of-cannabinoid-hyperemesis-syndrome/ The Poison Review: Review of cannabinoid hyperemesis syndrome] | ||
==See Also== | ==See Also== | ||
[[Nausea and Vomiting]] | *[[Nausea and Vomiting]] | ||
*[[Marijuana]] | |||
==References== | ==References== | ||
Revision as of 09:23, 27 February 2016
Background
- Cannabis is the most widely used drug in the US and the world.
- Cannabinoid hyperemesis syndrome, first described by Allen et al. in 2004 consists of nausea, vomiting, and abdominal pain in a patient with no other organic cause who frequently uses marijuana and has relief of symptoms with hot showers[1]
- Pathophysiology not yet well understood[2]
Clinical Features[3]
Essential Features
- Long term cannabis use (typically > 2years)
Major Features
- severe cyclical nausea, vomiting
- weekly use of marijuana
- relief of symptoms with hot showers or baths
- abdominal pain: epigastric or periumbilical
- resolution of symptoms with cannabis cessation
Supportive Features
- Age < 50y
- Weight loss > 5kg
- Symptoms greater in morning
- Normal bowel habits
- Negative labs, imaging and endoscopy
Differential Diagnosis
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
Diagnosis
- Generally considered a diagnosis of exclusion after evaluating for other causes of Nausea and Vomiting
Management
- Symptomatic treatment (Antiemetics, anxiolytics, and hydration)
- Cessation of marijuana use
- Capsaicin Cream
Disposition
- Discharge once tolerating PO
External Links
See Also
References
- ↑ Allen, J H; De Moore, GM; Heddle, R; Twartz, JC (2004). "Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse". Gut 53 (11): 1566–70. doi:10.1136/gut.2003.036350. PMC 1774264
- ↑ Byrne, A; Hallinan, R; Wodak, A (2006). "'Cannabis hyperemesis' causation questioned". Gut 55 (1): 132; author reply 132. PMC 1856368
- ↑ Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). "Cannabinoid Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings 87 (2): 114–9. doi:10.1016/j.mayocp.2011.10.005. PMID 22305024