Diferencia entre revisiones de «Cannabinoid hyperemesis syndrome»
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==Background== | ==Background== <!--T:1--> | ||
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*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> | ||
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==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>== <!--T:3--> | ||
===Essential Features=== | ===Essential Features=== <!--T:4--> | ||
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*Long term cannabis use (typically > 2 years) | *Long term cannabis use (typically > 2 years) | ||
===Major Features=== | ===Major Features=== <!--T:6--> | ||
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*Severe cyclical [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting |vomiting ]] | *Severe cyclical [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting |vomiting ]] | ||
*Weekly use of [[Special:MyLanguage/marijuana|marijuana]] | *Weekly use of [[Special:MyLanguage/marijuana|marijuana]] | ||
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===Supportive Features=== | ===Supportive Features=== <!--T:8--> | ||
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*Age < 50y | *Age < 50y | ||
*Weight loss > 5kg | *Weight loss > 5kg | ||
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==Differential Diagnosis== | ==Differential Diagnosis== <!--T:10--> | ||
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==Evaluation== | ==Evaluation== <!--T:11--> | ||
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*Generally considered a diagnosis of exclusion after evaluating for other causes of [[Special:MyLanguage/nausea and vomiting|nausea and vomiting]] | *Generally considered a diagnosis of exclusion after evaluating for other causes of [[Special:MyLanguage/nausea and vomiting|nausea and vomiting]] | ||
==Management== | ==Management== <!--T:13--> | ||
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*Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses | *Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses | ||
*Symptomatic treatment ([[Special:MyLanguage/Antiemetics|Antiemetics]], anxiolytics, and hydration) | *Symptomatic treatment ([[Special:MyLanguage/Antiemetics|Antiemetics]], anxiolytics, and hydration) | ||
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==Disposition== | ==Disposition== <!--T:15--> | ||
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*Discharge once tolerating PO | *Discharge once tolerating PO | ||
==See Also== | ==See Also== <!--T:17--> | ||
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*[[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]] | *[[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]] | ||
*[[Special:MyLanguage/Marijuana|Marijuana]] | *[[Special:MyLanguage/Marijuana|Marijuana]] | ||
==External Links== | ==External Links== <!--T:19--> | ||
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*[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== <!--T:21--> | ||
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<references/> | <references/> | ||
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[[Category:Toxicology]] | [[Category:Toxicology]] | ||
[[Category:GI]] | [[Category:GI]] | ||
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Revisión del 12:26 7 ene 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