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
==Clinical Features==
*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>
Essential Features<br />
*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>
* Long term cannabis use (typically > 2years)<br />
Major Features<br />
* severe cyclical nausea, vomiting  
* weekly use of marijuana
* relief of symptoms with hot showers or baths
* abdominal pain: epigastric or periumbilical
* resolution of cannabis cessation<br />
Supportive Features
* Age < 50y
* Weight loss > 5kg
* Symptoms greater in morning
* Normal bowel habits
* Neg lab, imaging and endoscopy


==Differential Diagnosis==
==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>==
[[Vomiting]]
===Essential Features===
*Long term cannabis use (typically > 2 years)


==Workup==
===Major Features===
Diagnosis of exclusion after complete workup for [[Vomitting]]
*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


'''Modified criteria for the diagnosis of "cannabinoid hyperemesis syndrome"'''<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>
===Supportive Features===
{| class="wikitable"
*Age < 50y
|-
*Weight loss > 5kg
! Essential
*Symptoms greater in morning
| Long-term cannabis use
*Normal bowel habits
|-
*Negative labs, imaging and endoscopy
! Major
| Severe cyclic nausea and vomiting
Resolution with cannabis cessation


Relief of symptoms with hot showers or baths
==Differential Diagnosis==
{{Nausea and vomiting DDX}}


Abdominal pain, epigastric or periumbilical
==Evaluation==
 
*Generally considered a diagnosis of exclusion after evaluating for other causes of [[nausea and vomiting]]
Weekly use of marijuana.
|-
! Supportive
|Age less than 50 y
 
Weight loss of >5 kg
 
Morning predominance of symptoms
 
Normal bowel habits
 
Negative laboratory, radiographic, and endoscopic test results
|}


==Management==
==Management==
Symptomatic treatment: antiemetics, IV/PO hydration<br />
*Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses
Cessation of marijuana use
*Symptomatic treatment ([[Antiemetics]], anxiolytics, and hydration)
**[[Haloperidol]] 5 mg IV/IM and [[diphenhydramine]] 50 mg IV<ref>Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6.</ref>
**Hot shower (>109°F), though short-lived<ref>Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.</ref>
**[[Capsaicin]] cream 0.025-0.075% across abdomen/arms/back, with symptoms diminishing within 30 min<ref>Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.</ref>
**[[Lorazepam]] 1-2 mg IV <ref>Smith TN, et al. Cannabinoid hyperemesis syndrome: an unrecognized cause of nausea and vomiting. JAAPA. 2019.  Apr;32(4):1-5 </ref>


==Disposition==
==Disposition==
Home
*Discharge once tolerating PO


==See Also==
==See Also==
*[[Nausea and vomiting]]
*[[Marijuana]]
==External Links==
*[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]
==References==
<references/>


==Sources==
[[Category:Toxicology]]
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.
[[Category:GI]]

Latest revision as of 21:43, 24 November 2019

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 > 2 years)

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

Nonemergent

Evaluation

  • Generally considered a diagnosis of exclusion after evaluating for other causes of nausea and vomiting

Management

  • Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses
  • Symptomatic treatment (Antiemetics, anxiolytics, and hydration)

Disposition

  • Discharge once tolerating PO

See Also

External Links

References

  1. ↑ 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
  2. ↑ Byrne, A; Hallinan, R; Wodak, A (2006). "'Cannabis hyperemesis' causation questioned". Gut 55 (1): 132; author reply 132. PMC 1856368
  3. ↑ 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
  4. ↑ Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6.
  5. ↑ Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.
  6. ↑ Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.
  7. ↑ Smith TN, et al. Cannabinoid hyperemesis syndrome: an unrecognized cause of nausea and vomiting. JAAPA. 2019. Apr;32(4):1-5
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