Use of Capsaicin Cream in Cannabinoid Hyperemesis Syndrome in Patients Presenting to the Emergency Department

Annals of Pharmacotherapy ◽

10.1177/10600280211018516 ◽

2021 ◽

pp. 106002802110185

Author(s):

Allison Lee ◽

Zlatan Coralic

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Pain Score ◽

Adverse Drug Events ◽

Symptomatic Relief ◽

Symptomatic Therapy ◽

Cannabis Consumption ◽

Cannabinoid Hyperemesis Syndrome ◽

Report Data ◽

Topical Capsaicin

Background Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclical nausea, vomiting, and abdominal pain often relieved with hot showers. Patients with CHS are usually long-term cannabis smokers whose symptoms are not relieved by antiemetics. The use of topical capsaicin has been recently reported as an adjunctive therapy in the emergency department (ED). Objective To describe the use of capsaicin cream in patients presenting to the ED with suspected CHS. Methods We performed a retrospective review of patients with suspected CHS receiving capsaicin in an ED from July 2014 to October 2018. We report data on demographics, cannabis consumption, hot showers use, length of stay, concurrent treatments, pain scores, and adverse events. Results There were 57 patients who received capsaicin cream for suspected CHS. Nearly all patients received antiemetics (98%), whereas 47% of patients received an opioid. Antiemetics were typically administered first (median, 1.6 hours; interquartile range [IQR], 0.9-2.4]), followed by an opioid (median, 1.8 hours [IQR, 1-3.75]), followed by capsaicin cream (median 4 hours [IQR, 2.7-5.2]). The overall precapsaicin pain score was 8 (IQR, 2-9), decreasing to 5.5 (IQR, 0-8). Around 42% of patients received no further symptomatic therapy after capsaicin. No adverse drug events to capsaicin were reported. Conclusion and Relevance This is the largest retrospective study describing capsaicin cream use in suspected CHS patients with a focus on abdominal pain relief. Capsaicin treatment was associated with a modest pain score reduction. Application of these findings may help providers in identifying more effective therapies to provide symptomatic relief for CHS patients.

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Cannabinoid Hyperemesis Syndrome: A Case Report of an Underdiagnosed Condition

GE Portuguese Journal of Gastroenterology ◽

10.1159/000512088 ◽

2020 ◽

pp. 1-5

Author(s):

João Machado Nogueira ◽

Inês Fonseca ◽

Marco Duarte

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Diagnostic Tests ◽

Clinical Symptoms ◽

Definitive Diagnosis ◽

Hot Water ◽

Illustrative Case ◽

Raising Awareness ◽

Detailed Medical History ◽

Cannabinoid Hyperemesis Syndrome

Cannabinoid hyperemesis syndrome (CHS) is characterized by episodic bursts of nausea, vomiting and abdominal pain, affecting chronic cannabis users. The clinical picture mimics an acute abdomen, usually leading to multiple assessments in the emergency department. Several complementary diagnostic examinations are performed with non-specific results, making differential diagnosis puzzling. We present a case of a 42-year-old man, who has been admitted multiple times to the emergency department in the last 3 months for abdominal pain, nausea and vomiting, without triggering factors and improving only with hot water baths. He was evaluated by different specialties, the various complementary diagnostic tests performed showed no significant results, and no definitive diagnosis was obtained. Treatment resulted only in a partial and transient resolution of symptoms. A more detailed medical history revealed cannabis use for more than 5 years, with a recent increase in the amount consumed. After psychoeducation, explaining the risks associated with consumption and its relationship with the clinical symptoms, which resulted in complete suspension of cannabis, there have been no new symptomatic episodes since then. We present an illustrative case of a poorly reported clinical entity despite having a probable significant prevalence, raising awareness in order that clinicians identify and properly manage these cases.

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

CJEM ◽

10.1017/cem.2020.103 ◽

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.

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Effect of Intravenous Acetaminophen on Pain and Peritoneal Irritation Signs in Patients with Acute Surgical Abdomen in the Emergency Department

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.7n.1p.12 ◽

2019 ◽

Vol 7 (1) ◽

pp. 12

Author(s):

Mahboub Pouraghaei ◽

Peiman Imamverdizadeh ◽

Payman Moharramzadeh ◽

Samad Shams Vahdati

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Pain Score ◽

Injection Pain ◽

Post Injection ◽

Emergency Ward ◽

Morphine Group ◽

Double Blind ◽

Acute Surgery ◽

Reduction Of Pain

Introduction: Acute surgery abdomen was one of the most common causes of emergency surgery in worldwide and a major cause of severe abdominal pain and sometimes harrowing and intolerable patients are presenting to the emergency department. The duty of every physician especially Emergency physician reduction of pain of patients that is considered as a major priority in new emergency medical treatment. The aim of this study was evaluation of effect IV Acetaminophen on abdominal pain in patients referred to emergency ward. Methods: In a double blind clinical trial that performed in emergency department on patients with abdominal pain, effect IV Acetaminophen on abdominal pain in patients referred to emergency ward evaluated. Results and Conclusion:155 of patients were male and 85 of them were female. Mean age of patients in acetaminophen group was 45.45 ± 20.47 and in Morphine group was 50.99 ± 19.40 year(P=0.0054). Mean of pre injection pain score in male was 8.69 ± 1.29 and in female patients was 9.17 ± 1.27(P=0.848). Mean of pre injection pain score in Morphine group patients was 8.80 ± 1.35 and Mean of post injection pain score in Morphine group patients was 4.06 ± 1.71(P<0.001). Mean of pre injection pain score in acetaminophen group patients was 8.92 ± 1.25 and Mean of post injection pain score in acetaminophen group patients was 6.46 ± 2.25(P<0.001). Mean of post injection pain score in acetaminophen group patients was significantly higher than patient’s of Morphine group. Significant liner direct correlation was found between pre injection and post injection pain score in the studied patients.

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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.

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Cannabinoid Hyperemesis Syndrome: An Unexpected Problem in an Unusual Setting—A Case Report

Military Medicine ◽

10.1093/milmed/usaa113 ◽

2020 ◽

Vol 185 (9-10) ◽

pp. e1894-e1896

Author(s):

Rory Stuart ◽

John Ray Richards

Keyword(s):

Emergency Department ◽

Acute Kidney Injury ◽

Abdominal Pain ◽

Case Report ◽

Kidney Injury ◽

Southwest Asia ◽

Severe Dehydration ◽

Military Hospitals ◽

Us Military ◽

Cannabinoid Hyperemesis Syndrome

Abstract Cannabinoid hyperemesis syndrome presents with abdominal pain, nausea, and intractable vomiting caused by phytogenic and synthetic cannabinoid use. Complications associated with this disorder range from severe dehydration to acute kidney injury and rhabdomyolysis. This syndrome mimics many acute surgical and emergency medical conditions and can present several diagnostic and treatment challenges. While this syndrome is increasingly recognized as a common clinical entity in civilian emergency departments, there is little data concerning experience at military hospitals. We present a case of cannabinoid hyperemesis syndrome that was diagnosed and treated in a combat-zone US military emergency department in Southwest Asia.

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

Case Reports in Gastrointestinal Medicine ◽

10.1155/2016/2815901 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

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.

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Authors’ response to “Efficacy and safety of topical capsaicin for cannabinoid hyperemesis syndrome in the emergency department”

Clinical Toxicology ◽

10.1080/15563650.2020.1716982 ◽

2020 ◽

Vol 58 (9) ◽

pp. 939-939

Author(s):

Samantha Wagner ◽

Jason Hoppe ◽

Matthew Zuckerman ◽

Kerry Schwarz ◽

Julie McLaughlin

Keyword(s):

Emergency Department ◽

Efficacy And Safety ◽

Cannabinoid Hyperemesis Syndrome ◽

Topical Capsaicin

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75 Paediatric Cannabinoid Hyperemesis Syndrome in the Emergency Department: a 5-year Retrospective Review

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.074 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e31-e31

Author(s):

Daniel Foster ◽

Kristine Van Aarsen ◽

Justin Yan ◽

John Teefy ◽

Tim Lynch

Keyword(s):

Emergency Department ◽

Weight Loss ◽

Abdominal Pain ◽

Venous Blood ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Cannabis Use ◽

Discharge Diagnosis ◽

Paediatric Patients ◽

Cannabinoid Hyperemesis Syndrome

Abstract Background Cannabinoid Hyperemesis Syndrome (CHS) in paediatric patients is poorly characterized. Identification and treatment of adolescents presenting to the emergency department (ED) for suspected CHS is challenging. Given the paucity of literature on paediatric CHS and the recent legalization of cannabis, it is important to gain a better understanding of this disorder. Objectives The objective of this study was to describe demographics and ED visit data of paediatric patients presenting to the ED with suspected CHS. Design/Methods A retrospective chart review was conducted of paediatric patients (12-17 years) with suspected CHS presenting to one of two tertiary-care EDs; one paediatric (annual census 38,500) and one paediatric and adult (annual census 60,000) 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 A total of 242 patients met criteria for review. Thirty-nine 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 and 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. Sixty-nine percent 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%). Eighty-nine percent of patients received treatment in the ED with 81% receiving anti-emetics, 68% receiving intravenous fluids, and 22% receiving analgesics. Normal saline was the most used intravenous 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). Sixty-two percent of patients had another visit to the ED within 30 days (59% of these for similar symptoms). Conclusion This study of paediatric CHS reveals unique findings including a preponderance of female patients, a majority that consume cannabis daily, and weight loss reported in nearly 1/3rd. Many received extensive workups and most had multiple clustered visits to the ED.

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