Cannabinoid hyperemesis syndrome: Difference between revisions
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* relief of symptoms with hot showers or baths | * relief of symptoms with hot showers or baths | ||
* abdominal pain: epigastric or periumbilical | * abdominal pain: epigastric or periumbilical | ||
* resolution of cannabis cessation | * resolution of symptoms with cannabis cessation | ||
Supportive Features | Supportive Features | ||
* Age < 50y | * Age < 50y | ||
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* Symptoms greater in morning | * Symptoms greater in morning | ||
* Normal bowel habits | * Normal bowel habits | ||
* | * Negative labs, imaging and endoscopy | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 14:37, 25 August 2015
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[1]
Current Controversies
- The pathophysiology and exact cause of the syndrome remains under question, especially since cannabis acts as an antiemetic [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
Diagnosis of exclusion after complete workup for Nausea and Vomiting
Management
- Symptomatic treatment: Antiemetics, Anxiolytics, and Hydration
- Cessation of marijuana use
- Capsaicin Cream
Disposition
Home once nausea and vomiting is controlled
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