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> | *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> | *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 | |||
* Long term cannabis use (typically > | |||
Major Features | ===Essential Features=== | ||
* | |||
* | *Long term cannabis use (typically > 2 years) | ||
* | |||
* | |||
* | ===Major Features=== | ||
Supportive Features | |||
* Age < 50y | *Severe cyclical [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting |vomiting ]] | ||
* Weight loss > 5kg | *Weekly use of [[Special:MyLanguage/marijuana|marijuana]] | ||
* Symptoms greater in morning | *Relief of symptoms with hot showers or baths | ||
* Normal bowel habits | *[[Special:MyLanguage/Abdominal pain|Abdominal pain]]: epigastric or periumbilical | ||
* Negative labs, imaging and endoscopy | *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== | ==Differential Diagnosis== | ||
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{{Nausea and vomiting DDX}} | {{Nausea and vomiting DDX}} | ||
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==Evaluation== | |||
*Generally considered a diagnosis of exclusion after evaluating for other causes of [[Special:MyLanguage/nausea and vomiting|nausea and vomiting]] | |||
==Management== | ==Management== | ||
*Symptomatic treatment ([[Antiemetics]], anxiolytics, and hydration) | |||
* | *Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses | ||
*Capsaicin | *Symptomatic treatment ([[Special:MyLanguage/Antiemetics|Antiemetics]], anxiolytics, and hydration) | ||
**[[Special:MyLanguage/Haloperidol|Haloperidol]] 5 mg IV/IM and [[Special:MyLanguage/diphenhydramine|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> | |||
**[[Special:MyLanguage/Capsaicin|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> | |||
**[[Special:MyLanguage/Lorazepam|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== | ||
*Discharge once tolerating PO | *Discharge once tolerating PO | ||
==See Also== | |||
*[[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]] | |||
*[[Special:MyLanguage/Marijuana|Marijuana]] | |||
==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] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Toxicology]] | ||
[[Category:GI]] | [[Category:GI]] | ||
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Latest revision as of 21:46, 4 January 2026
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
- 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
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)
- Haloperidol 5 mg IV/IM and diphenhydramine 50 mg IV[4]
- Hot shower (>109°F), though short-lived[5]
- Capsaicin cream 0.025-0.075% across abdomen/arms/back, with symptoms diminishing within 30 min[6]
- Lorazepam 1-2 mg IV [7]
Disposition
- Discharge once tolerating PO
See Also
External Links
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
- ↑ Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6.
- ↑ Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.
- ↑ Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.
- ↑ Smith TN, et al. Cannabinoid hyperemesis syndrome: an unrecognized cause of nausea and vomiting. JAAPA. 2019. Apr;32(4):1-5