Cannabinoid Hyperemesis

Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months. Cannabinoids are often utilized for their antiemetic properties, so CHS can be a puzzling condition, and the diagnosis of CHS may be disputed by patients. Unlike other cyclic vomiting syndromes, CHS can be relieved by hot showers or topical capsaicin. Abstinence from cannabinoids causes CHS to resolve, sometimes in a matter of days or hours. Marijuana users as well as many clinicians are not aware of CHS, and patients may undergo unnecessary tests, scans, and other procedures to get an accurate diagnosis. Symptoms may be severe enough to require hospitalization. With liberalization of marijuana laws and favorable public opinion about the healing properties of cannabis, CHS may be more frequently observed in clinical practice.

Download Full-text

Cannabinoid Hyperemesis Syndrome: The Missed Diagnosis

Revista Portuguesa de Psiquiatria e Saúde Mental ◽

10.51338/rppsm.2020.v6.i3.133 ◽

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.

Download Full-text

Cannabinoid hyperemesis syndrome: definition, pathophysiology, clinical spectrum, insights into acute and long-term management

Journal of Investigative Medicine ◽

10.1136/jim-2020-001564 ◽

2020 ◽

Vol 68 (8) ◽

pp. 1309-1316

Author(s):

Mahesh Gajendran ◽

Joshua Sifuentes ◽

Mohammad Bashashati ◽

Richard McCallum

Keyword(s):

Symptom Control ◽

Well Being ◽

Clinical Entity ◽

Cyclic Vomiting Syndrome ◽

Cannabinoid Hyperemesis Syndrome ◽

Acute Attacks ◽

Hot Baths ◽

Term Management ◽

Cyclic Vomiting

Although cannabinoid hyperemesis syndrome (CHS) was first reported more than 15 years ago, it still remains an unfamiliar clinical entity among physicians worldwide. CHS is categorized by Rome IV classification as a functional gastroduodenal disorder. It is characterized by stereotypical episodic vomiting in the setting of chronic, daily cannabis use, with cycles decreasing by the cessation of cannabis. CHS is also associated with abdominal pain reduced by hot baths and showers with comparative well-being between attacks. Thus, its clinical presentation resembles ‘classic’ cyclic vomiting syndrome, but eliciting a cannabis history is crucial in diagnosing this entity. In acute attacks, parenteral benzodiazepines are very effective. For prevention and long-term management, tricyclic antidepressants such as amitriptyline are the mainstay of therapy requiring doses in the range of 50–200 mg/d to achieve symptom control. In addition, counseling to achieve marijuana cessation, accompanied by antianxiety medications, is necessary for sustaining clinical outcomes. Once the patient is in remission and off marijuana for a period of 6–12 months, then tapering the dose of amitriptyline can be implemented, with the goal of no therapy being achieved in the majority of patients over time. With the legalization of marijuana in many states, CHS will become an increasingly prevalent clinical entity, so educating about CHS is an important goal, particularly for emergency department physicians who generally first encounter these patients.

Download Full-text

Management of Cannabinoid Hyperemesis Syndrome: Focus on Capsaicin

Journal of Pharmacy Practice ◽

10.1177/0897190020934289 ◽

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.

Download Full-text

First clinical experience with the wearable cardiac rhythm long-term monitoring cardioskin device

European Heart Journal ◽

10.1093/ehjci/ehaa946.3464 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Guedeney ◽

J Silvain ◽

F Hidden-Lucet ◽

C Maupain ◽

S Dinanian ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Cardiac Rhythm ◽

Cardiac Monitoring ◽

Funding Source ◽

Single Center ◽

Long Term Monitoring ◽

Monitoring Devices ◽

Term Monitoring

Abstract Background There are only limited options for long-term cardiac monitoring devices readily available in clinical practice for outpatients. Holter monitoring devices are limited by the uncomfort of wires and patches, the small number of leads for analysis, the quality of recordings or the monitoring duration while insertable cardiac monitors are costly and exposed to potential local complication. Purpose To describe a single center experience with a novel wearable device for cardiac rhythm monitoring. Methods The Cardioskin™ system is a patch-free, wire-free, wearable device with rechargeable batteries that provides a high quality 15-lead electrocardiogram monitoring over 1 month (Figure 1). Data are sent using a mobile application downloaded in the patient smartphone to a central Corelab where they can be interpreted by an expert and/or the prescribing physician. An alarm signal is readily available within the Cardioskin™ device, to allow patients to indicate the presence of symptoms. In this single center retrospective registry, we provide a first report of the use of this novel device in real world practice, with indication and duration of cardiac monitoring left at the physicans “discretion”. Results From January 2019 to December 2019, the Cardioskin™ system was prescribed in 60 patients for an overall median duration of 26.5 (14–32) days. The mean age of the patients was 45±12.2 years and 24 (40%) were male. Indications for cardiac monitoring were post-Stroke, palpitation, syncope and cardiomyopathy assessment in 56%, 30%, 7% and 7% of the cases, respectively. A sustained (>30 seconds) supraventricular tachycardia was detected in 4 cases, including one case of atrial fibrillation, two case of atrial tachycardia and on case of junctional tachycardia. Unsustained ventricular tachycardia and atrial fibrillation burst were detected in another 2 cases (Figure 1). There was no reported case of skin irritation by the Cardioskin™ system or abrupt interruption of the monitoring by the patients. Conclusion The Cardioskin™ system is a novel, discreet and comfortable cardiac rhythm wearable long-term monitoring device which can be used in clinical practice for broad diagnostic indications. Figure 1. Cardioskin system Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): ACTION coeur

Download Full-text

Pharmacological and clinical evaluation of deferasirox formulations for treatment tailoring

Scientific Reports ◽

10.1038/s41598-021-91983-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Andrea Piolatto ◽

Paola Berchialla ◽

Sarah Allegra ◽

Silvia De Francia ◽

Giovanni Battista Ferrero ◽

...

Keyword(s):

Clinical Practice ◽

Renal Impairment ◽

Observational Study ◽

Iron Overload ◽

Iron Loading ◽

Comprehensive Comparison ◽

Dispersible Tablets ◽

One Year ◽

Safety Features

AbstractDeferasirox (DFX) is the newest among three different chelators available to treat iron overload in iron-loading anaemias, firstly released as Dispersible Tablets (DT) and more recently replaced by Film-Coated Tablets (FCT). In this retrospective observational study, pharmacokinetics, pharmacodynamics, and safety features of DFX treatment were analyzed in 74 patients that took both formulations subsequently under clinical practice conditions. Bioavailability of DFX FCT compared to DT resulted higher than expected [Cmax: 99.5 (FCT) and 69.7 (DT) μMol/L; AUC: 1278 (FCT) and 846 (DT), P < 0.0001]. DFX FCT was also superior in scalability among doses. After one year of treatment for each formulation, no differences were observed between the treatments in the overall iron overload levels; however, DFX FCT but not DT showed a significant dose–response correlation [Spearman r (dose-serum ferritin variation): − 0.54, P < 0.0001]. Despite being administered at different dosages, the long-term safety profile was not different between formulations: a significant increase in renal impairment risk was observed for both treatments and it was reversible under strict monitoring (P < 0.002). Altogether, these data constitute a comprehensive comparison of DFX formulations in thalassaemia and other iron-loading anaemias, confirming the effectiveness and safety characteristics of DFX and its applicability for treatment tailoring.

Download Full-text

Efficacy and safety of long term entecavir in chronic hepatitis B treatment naïve patients in clinical practice

Annals of Hepatology ◽

10.1016/s1665-2681(19)30861-0 ◽

2014 ◽

Vol 13 (3) ◽

pp. 327-336 ◽

Cited By ~ 8

Author(s):

Ezequiel Ridruejo ◽

Sebastián Marciano ◽

Omar Galdame ◽

María V. Reggiardo ◽

Alberto E. Muñoz ◽

...

Keyword(s):

Chronic Hepatitis ◽

Clinical Practice ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Efficacy And Safety ◽

Hepatitis B Treatment ◽

Treatment Naïve

Download Full-text

Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

Endocrine ◽

10.1007/s12020-020-02418-x ◽

2020 ◽

Vol 70 (2) ◽

pp. 280-291

Author(s):

Alfredo Campennì ◽

Daniele Barbaro ◽

Marco Guzzo ◽

Francesca Capoccetti ◽

Luca Giovanella

Keyword(s):

Nuclear Medicine ◽

Thyroid Cancer ◽

Clinical Practice ◽

Molecular Imaging ◽

Routine Clinical Practice ◽

Whole Body ◽

Neck Ultrasound ◽

Long Term Follow Up

Abstract Purpose The standard of care for differentiated thyroid carcinoma (DTC) includes surgery, risk-adapted postoperative radioiodine therapy (RaIT), individualized thyroid hormone therapy, and follow-up for detection of patients with persistent or recurrent disease. In 2019, the nine Martinique Principles for managing thyroid cancer were developed by the American Thyroid Association, European Association of Nuclear Medicine, Society of Nuclear Medicine and Molecular Imaging, and European Thyroid Association. In this review, we present our clinical practice recommendations with regard to implementing these principles in the diagnosis, treatment, and long-term follow-up of patients with DTC. Methods A multidisciplinary panel of five thyroid cancer experts addressed the implementation of the Martinique Principles in routine clinical practice based on clinical experience and evidence from the literature. Results We provide a suggested approach for the assessment and diagnosis of DTC in routine clinical practice, including the use of neck ultrasound, measurement of serum thyroid-stimulating hormone and calcitonin, fine-needle aspiration, cytology, and molecular imaging. Recommendations for the use of surgery (lobectomy vs. total thyroidectomy) and postoperative RaIT are also provided. Long-term follow-up with neck ultrasound and measurement of serum anti-thyroglobulin antibody and basal/stimulated thyroglobulin is standard, with 123/131I radioiodine diagnostic whole-body scans and 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography suggested in selected patients. Management of metastatic DTC should involve a multidisciplinary team. Conclusions In routine clinical practice, the Martinique Principles should be implemented in order to optimize clinical management/outcomes of patients with DTC.

Download Full-text