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


==Differential Diagnosis==
==Differential Diagnosis==
[[Vomiting]]
{{Nausea and vomiting DDX}}


==Workup==
==Evaluation==
Diagnosis of exclusion after complete workup for [[Nausea_and_Vomiting]]
*Generally considered a diagnosis of exclusion after evaluating for other causes of [[nausea and vomiting]]


==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>


==Current Controversies==
*The pathophysiology and exact cause of the syndrome remains under question, especially since cannabis acts as an antiemetic <ref>Byrne, A; Hallinan, R; Wodak, A (2006). "'Cannabis hyperemesis' causation questioned". Gut 55 (1): 132; author reply 132. PMC 1856368</ref>
==Disposition==
==Disposition==
Home once Nausea and Vomiting is Controlled
*Discharge once tolerating PO


==See Also==
==See Also==
[[Nausea and Vomiting]]
*[[Nausea and vomiting]]
*[[Marijuana]]


==Sources==
==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/>
<references/>
[[Category:Toxicology]]
[[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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