Cannabinoid hyperemesis syndrome

2016 ◽  
Vol 33 (S1) ◽  
pp. S306-S307 ◽  
Author(s):  
S. López-Romeo ◽  
G. Ledesma-Iparraguirre
Keyword(s):  
Abdominal Pain ◽  
Outpatient Service ◽  
Somatoform Disorder ◽  
Cannabis Use ◽  
Abdominal Ultrasonography ◽  
Cannabinoid Hyperemesis Syndrome ◽  
History Of ◽  
Disorder Treatment ◽  
Competing Interest

Case reportA 25-year-old man was attended in multiple times at Emergency Department by referring abdominal pain and vomiting. No organic disease was found and he was referred to Psychiatric Emergency to assess him. He had history of cannabis use (4–5 times/day) during last 5 years. He referred recurrent episodes of abdominal pain and vomiting since 4 years ago, he had found that having hot showers alleviate his symptoms. Urine screening was positive for THC and negative for other drugs. In results of blood tests, abdominal X-ray, abdominal ultrasonography, abdominal tomography and fibrogastroscopy didn’t find any abnormality. He was diagnosed from suffering a somatoform disorder. Treatment with Setraline 50 mg/day was prescribed and cannabis abstinence was recommended. He was referred to Mental Health outpatient service. He maintained cannabis abstinence for 1 month and some symptoms disappeared. However, 2 months later, he relapsed in cannabis use and all symptoms reappeared. Later he achieved cannabis abstinence again and he got full recovery, then he was diagnosed from cannabinoid hyperemesis syndrome.ConclusionCannabinoid hyperemesis syndrome is characterized by recurrent nausea, vomiting and colicky abdominal pain in patients with long-term cannabis use. These symptoms have been reported to be alleviated temporarily by taking a hot shower or more permanently by abstaining from the use of cannabis. The phenomenon of cannabinoid hyperemesis and clinical diagnosis remained obscure until recently. For this reason, it is necessary to take it into account in order to recognize it and help provide these patients early and better approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Cannabinoid Hyperemesis Syndrome: A Case Report of Cyclic Severe Hyperemesis and Abdominal Pain with Long-Term Cannabis Use

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Julia Hermes-Laufer ◽  
Lola Del Puppo ◽  
Ihsan Inan ◽  
François-Xavier Troillet ◽  
Omar Kherad
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
D2 Receptor ◽  
Rare Condition ◽  
Final Diagnosis ◽  
Cannabis Use ◽  
Severe Nausea ◽  
Cannabis Consumption ◽  
Cannabinoid Hyperemesis Syndrome

Introduction.Cannabinoid Hyperemesis Syndrome (CHS) is a rare condition that includes cyclic severe vomiting in subjects who have been consuming large doses of cannabis for several years. One of the major diagnostic criteria is the alleviation of symptoms by hot showers. The syndrome was first described in 2004 and is so far neither completely understood nor well known. The latter leads to continued morbidity in concerned subjects and unnecessary expenses for futile investigations. Standard treatments of vomiting as 5-HT3 or D2-receptor antagonists have been shown to be ineffective in alleviating the symptoms. The only long-term satisfying treatment option is the complete abstinence from cannabis consumption.Case Summary.In this case report we describe a 26-year-old male Caucasian long-term cannabis consumer who repeatedly presented in our emergency room with cyclic severe nausea and vomiting ceased by hot showers and resistant to all other treatments. The final diagnosis was not established until his third visit to the ER.Conclusion.CHS is an important differential diagnosis in patients who present with cyclic vomiting and abdominal pain with a history of long-term cannabis use. Recognition of this syndrome is important in order to avoid unnecessary clinical testing and to help the patients break the cycle of drug use.

scholarly journals Cannabinoid Hyperemesis Syndrome: Case Report of a Paradoxical Reaction with Heavy Marijuana Use

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Benjamin Cox ◽  
Akansha Chhabra ◽  
Michael Adler ◽  
Justin Simmons ◽  
Diana Randlett
Keyword(s):  
Abdominal Pain ◽  
Marijuana Use ◽  
Symptomatic Treatment ◽  
Clinical Findings ◽  
Term Treatment ◽  
Paradoxical Reaction ◽  
Long Term Treatment ◽  
Cannabinoid Hyperemesis Syndrome ◽  
History Of

Cannabinoid hyperemesis syndrome (CHS) is a rare constellation of clinical findings that includes a history of chronic heavy marijuana use, severe abdominal pain, unrelenting nausea, and intractable vomiting. A striking component of this history includes the use of hot showers or long baths that help to alleviate these symptoms. This is an underrecognized syndrome that can lead to expensive and unrevealing workups and can leave patients self-medicating their nausea and vomiting with the very substance that is causing their symptoms. Long-term treatment of CHS is abstinence from marijuana use—but the acute symptomatic treatment of CHS has been a struggle for many clinicians. Many standard medications used for the symptomatic treatment of CHS (including ondansetron, promethazine, and morphine) have repeatedly been shown to be ineffective. Here we present the use of lorazepam as an agent that successfully and safely treats the tenacious symptoms of CHS. Additionally, we build upon existing hypotheses for the pathogenesis of CHS to try to explain why a substance that has been used for thousands of years is only now beginning to cause this paradoxical hyperemesis syndrome.

scholarly journals LO48: Pediatric cannabinoid hyperemesis syndrome in the emergency department: a 5-year retrospective review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S24-S24
Author(s):  
D. Foster ◽  
K. Van Aarsen ◽  
J. Yan ◽  
J. Teefy ◽  
T. Lynch
Keyword(s):  
Emergency Department ◽  
Weight Loss ◽  
Abdominal Pain ◽  
Pediatric Patients ◽  
Venous Blood ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Cannabis Use ◽  
Discharge Diagnosis ◽  
Cannabinoid Hyperemesis Syndrome

Introduction: Cannabinoid Hyperemesis Syndrome (CHS) in pediatric patients is poorly characterized. Literature is scarce, making identification and treatment challenging. This study's objective was to describe demographics and visit data of pediatric patients presenting to the emergency department (ED) with suspected CHS, in order to improve understanding of the disorder. Methods: A retrospective chart review was conducted of pediatric patients (12-17 years) with suspected CHS presenting to one of two tertiary-care EDs; one pediatric and one pediatric/adult (combined annual pediatric census 40,550) between April 2014-March 2019. Charts were selected based on discharge diagnosis of abdominal pain or nausea/vomiting with positive cannabis urine screen, or discharge diagnosis of cannabis use, using ICD-10 codes. Patients with confirmed or likely diagnosis of CHS were identified and data including demographics, clinical history, and ED investigations/treatments were recorded by a trained research assistant. Results: 242 patients met criteria for review. 39 were identified as having a confirmed or likely diagnosis of CHS (mean age 16.2, SD 0.85 years with 64% female). 87% were triaged as either CTAS-2 or CTAS-3. 80% of patients had cannabis use frequency/duration documented. Of these, 89% reported at least daily use, the mean consumption was 1.30g/day (SD 1.13g/day), and all reported ≥6 months of heavy use. 69% of patients had at least one psychiatric comorbidity. When presenting to the ED, all had vomiting, 81% had nausea, 81% had abdominal pain, and 30% reported weight loss. Investigations done included venous blood gas (30%), pregnancy test in females (84%), liver enzymes (57%), pelvic or abdominal ultrasound (19%), abdominal X-ray (19%), and CT head (5%). 89% of patients received treatment in the ED with 81% receiving anti-emetics, 68% receiving intravenous (IV) fluids, and 22% receiving analgesics. Normal saline was the most used IV fluid (80%) and ondansetron was the most used anti-emetic (90%). Cannabis was suspected to account for symptoms in 74%, with 31% of these given the formal diagnosis of CHS. 62% of patients had another visit to the ED within 30 days (prior to or post sentinel visit), 59% of these for similar symptoms. Conclusion: This study of pediatric CHS reveals unique findings including a preponderance of female patients, a majority that consume cannabis daily, and weight loss reported in nearly one third. Many received extensive workups and most had multiple clustered visits to the ED.

scholarly journals Primary portal vein hypoplasia with portal hypertension in a young dog

2017 ◽  
Vol 65 (4) ◽  
pp. 257
Author(s):  
D. KASABALIS (Δ. ΚΑΣΑΜΠΑΛΗΣ) ◽  
D. ALATZAS (Δ. ΑΛΑΤΖΑΣ) ◽  
D. ALATZA (Δ. ΑΛΑΤΖΑ) ◽  
T. A. PETANIDES (Θ. ΠΕΤΑΝΙΔΗΣ) ◽  
G. ALATZAS (Γ. ΑΛΑΤΖΑΣ) ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Exploratory Laparotomy ◽  
Abdominal Ultrasonography ◽  
Liver Histopathology ◽  
Low Protein ◽  
Portosystemic Collateral ◽  
History Of ◽  
Collateral Vessels

A 5-month old Caucasian dog was presented with a 20-day history of abdominal distention along with inappetance, depression and vomiting of 24-hour duration. Physical examination findings included depression, ascites, mild inspiratory dyspnea and dehydration. Clinicopathological evaluation revealed hyperammonemia, hypoalbuminemia, hyperbilirubinemia, hypoglycemia and hyponatremia. Μicrohepatia and free abdominal fluid was detected with abdominal ultrasonography. During exploratory laparotomy, multiple acquired portosystemic collateral vessels were found, indicative of portal hypertension, along with a small liver of normal color and texture. Liver histopathology included features consistent with liver hypoperfusion. These findings supported the diagnosis of primary portal vein hypoplasia with portal hypertension. The animal recovered uneventfully postoperatively and was discharged with diuretics, hepatoprotectants and a low-protein diet and remains healthy two years after diagnosis. This case underscores that a favorable prognosis may be anticipated in cases of primary portal vein hypoplasia with portal hypertension, thus, justifying the long-term conservative management instead of considering euthanasia.

Post-traumatic Mania Symptoms: About One Case

2017 ◽  
Vol 41 (S1) ◽  
pp. S724-S725
Author(s):  
H. El Kefi ◽  
I. Beldi ◽  
W. Krir ◽  
C. Benchikh Brahim ◽  
S. Eddif ◽  
...  
Keyword(s):  
Terrorist Attack ◽  
Post Traumatic Stress ◽  
Psychological Reactions ◽  
Manic Symptoms ◽  
Induced Mood ◽  
History Of ◽  
Post Traumatic ◽  
Competing Interest ◽  
Significant Regression

IntroductionPsychotraumatism can constitute for some people a real existential fracture, a real upheaval of the psychic organization.Immediate psychological reactions can vary from one-off and temporary reactions to far more severe and sometimes enduring reactions.Material and methodsWe collected the case of a patient who was hospitalised in April 2015 for manic symptoms in the immediate aftermath of a terrorist attack, with a review of the literature.Clinical caseThis is Mr. A. F., aged 38, with a personal history of AVP and a shooting wound following a terrorist attack. He had presented a psychomotor instability and an exaltation of the mood in the immediate aftermath of an ambush.Behavioural problems were identified by the psychiatric team during the group debriefing conducted at the HMPIT emergency room. During his hospitalisation, a chemotherapy based on thymoregulators, neuroleptics and anxiolytics was introduced.The evolution was marked by a significant regression of the manic syndrome after ten days, and the installation of a post-traumatic stress condition (PTSD). At the end of eight months, the patient was able to resume his work with long-term thymoregulatory treatment, a ban on weapons and safety posts.ConclusionManic episodes are rarely observed as an immediate post-traumatic reaction. Their occurrence does not prevent the subsequent installation of PTSD. Has psychic trauma revealed a latent psychosis? Is it a trauma-induced mood disorder?Disclosure of interestThe authors have not supplied their declaration of competing interest.

Management of Cannabinoid Hyperemesis Syndrome: Focus on Capsaicin

2020 ◽  
pp. 089719002093428
Author(s):  
Janice L. Stumpf ◽  
Lauren D. Williams
Keyword(s):  
Abdominal Pain ◽  
Clinical Presentation ◽  
Marijuana Use ◽  
Hot Water ◽  
Severe Nausea ◽  
Trpv1 Receptors ◽  
Cannabinoid Hyperemesis Syndrome ◽  
Topical Capsaicin

Cannabinoid hyperemesis syndrome is a condition characterized by cyclic severe nausea, vomiting, and abdominal pain associated with frequent, long-term marijuana use. The condition resolves with cessation of cannabis but may be temporarily relieved by bathing in hot water. Topical capsaicin cream may also alleviate symptoms, perhaps through antiemetic effects produced by activation of TRPV1 receptors, similar to that of hot water bathing. This review summarizes the epidemiology, clinical presentation, diagnosis, pathophysiology, and management of cannabinoid hyperemesis syndrome, focusing on treatment with topical capsaicin.

scholarly journals Cannabinoid Hyperemesis Syndrome: The Missed Diagnosis

2020 ◽  
Vol 6 (3) ◽  
pp. 127-130
Author(s):  
João B. Fonseca ◽  
Daniela Vilaverde ◽  
Rosa Rodrigues ◽  
Pedro Morgado
Keyword(s):  
Illicit Drug ◽  
Cannabis User ◽  
Cannabinoid Hyperemesis Syndrome ◽  
History Of ◽  
Missed Diagnosis ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Cyclic Vomiting

Cannabis is the most cultivated and abused illicit drug worldwide. Paradoxically to the antiemetic properties attributed to cannabis, a relatively new cannabinoid hyperemesis syndrome (CHS) started to be recognized and is characterized by cyclic vomiting that are interspaced by asymptomatic phases. We present a case of a 36‑year‑old woman who repeatedly presented to the emergency room with cyclic vomiting that alleviated with hot showers. She was a long‑term cannabis user and the diagnosis was only established several years later after the onset of symptoms. The diagnostic work up was unremarkable, and the only effective treatment was cannabis cessation. Hot bathing behavior is a key characteristic of this syndrome. CHS is a new clinical condition that should be considered in a setting of recurrent and intractable vomiting in patients with a history of cannabis use.

scholarly journals Cannabis hyperemesis syndrome

2018 ◽  
pp. bcr-2018-226524 ◽  
Author(s):  
Umesh Sharma
Keyword(s):  
Abdominal Pain ◽  
Side Effects ◽  
Young Woman ◽  
Cannabis Use ◽  
Laboratory Examination ◽  
History Of ◽  
Topical Capsaicin ◽  
Cannabis Hyperemesis Syndrome

A young woman with chronic cannabis use presents with 2-day history of cyclical nausea, vomiting and abdominal pain. Clinical and laboratory examination excluded other causes. Patient’s symptoms improved with topical capsaicin, hot showers, antiemetics and she was subsequently discharged home 4 days later. The patient was educated on side effects of cannabis use and chose to stop cannabis use completely.

scholarly journals Pediatric Mania: The Controversy Between Euphoria and Irritability

2017 ◽  
Vol 41 (S1) ◽  
pp. S224-S225 ◽  
Author(s):  
G. Serra ◽  
M. Uchida ◽  
C. Battaglia ◽  
M.P. Casini ◽  
L. De Chiara ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Disease ◽  
Clinical Feature ◽  
Pediatric Bipolar Disorder ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Adult Age ◽  
History Of ◽  
Competing Interest

IntroductionPediatric bipolar disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders, with high levels of morbidity and disability and with a great risk of suicide.ObjectivesWhile there is a general consensus on the symptomatology of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course and long-term outcome of pediatric BD still need to be clarified.AimsTo assess the prevalence, demographics, clinical correlates and course of these euphoric versus irritable pediatric mania.MethodsSystematic review of the available studies assessing the phenomenology, course and outcome of pediatric mania.ResultsEighteen studies reported the number of subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be the most frequent clinical feature of pediatric mania reaching a sensitivity of 95–100% in several samples. Only half the studies reviewed reported on number of episodes or cycling patterns and the described course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common. Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young adult age.ConclusionsSevere irritability is the most common presentation of abnormal mood described in children with bipolar disorder. Longitudinal studies of samples with irritable versus elated mood presentation and chronic versus episodic course may help clarify whether these are factors predicting different long-term course, treatment-response and outcome of pediatric onset bipolar disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ECT in major recurrent depressive syndrome with Parkinsonism syndrome

2017 ◽  
Vol 41 (S1) ◽  
pp. S769-S769
Author(s):  
T. Gómez Alemany ◽  
J. Soler Vidal ◽  
I. Targa ◽  
B. Garcia Alarcon ◽  
A. Santoro ◽  
...  
Keyword(s):  
Medical Records ◽  
Depressive Syndrome ◽  
Recurrent Depression ◽  
Pharmacological Management ◽  
History Of ◽  
Competing Interest ◽  
One Year ◽  
Different Levels ◽  
Progressive Cognitive Impairment

A 71-year-old woman with history of major recurrent depressive syndrome responsive to clomipramine (last episode at 50-year-old) with the following medical records: ischaemic stroke with progressive cognitive impairment to the extent of requiring wheelchair.Current episodeDepressive symptoms, with suicidal thoughts, anxiety, tremor and low food intake in the last month (due to choke phobia) with up to 10 kg of weight loss.DiagnosisMajor recurrent depressive syndrome resistant to treatment with Parkinson syndrome.TreatmentLorazepam 10 mg/day levodopa 150/carbidopa 37.5 mg/day, LART Electroconvulsive therapy (Thymatron SYSTEM IV) was also carried out 3 times a week until 15 sessions were reached.DiscussionThis case illustrates the successful response with LART ECT towards major recurrent depression syndrome associated with a pharmacological parkinsonism maintained over the long-term (one year with ECT). There are sufficient evidences showing that the ECT has an effect in the dopaminergic system at different levels: dopamine release, dopamine neurotransmission and linkage with its receptor, and these effects differ between an acute stimulation and when repeated stimulation is carried out. It must be taken into consideration the fact that concomitant existence of depression and parkinsonism could represent another indication for ECT, since the pharmacological management of these patients is highly complex and could even more if we bear in mind that one of the therapeutical options towards the antidepressant potentiation (atypical anti-psychotics) can worsen the symptomatology.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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