scholarly journals A hot bath to calm what ails you – the Cannabis Hyperemesis Syndrome

2012 ◽  
Vol 11 (1) ◽  
pp. 23-24
Author(s):  
V Luther ◽  
◽  
V Luther ◽  
Keyword(s):  
Hospital Admissions ◽  
Symptomatic Relief ◽  
Cannabis Use ◽  
Symptom Resolution ◽  
Recurrent Vomiting ◽  
Hot Bath ◽  
Cannabis Hyperemesis Syndrome

Abstract The Cannabis Hyperemesis Syndrome (CHS) defines a recently described paradoxical association between recurrent vomiting episodes, daily cannabis excess and symptomatic relief with a hot bath or shower. Importantly, symptom resolution only occurs with cessation of cannabis use. We describe a case of CHS which had resulted in repeated hospital admissions. As cannabis use is common, it is important for both patients and Acute Physicians to be aware of this increasingly recognised condition

scholarly journals LO69: Haloperidol versus ondansetron for hyperemesis due to cannabis (HaVOC): a randomized, controlled clinical trial

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S32-S33
Author(s):  
A. Ruberto ◽  
M. Sivilotti ◽  
S. Forrester ◽  
A. Hall ◽  
F. Crawford ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Symptomatic Treatment ◽  
Cannabis Use ◽  
Controlled Clinical Trial ◽  
Primary Analysis ◽  
Return Visits ◽  
Topical Capsaicin ◽  
Insight Into ◽  
Haloperidol Group ◽  
Cannabis Hyperemesis Syndrome

Introduction: One of the most common adverse effects of habitual cannabis use is hyperemesis—recurrent bouts of protracted vomiting, retching and abdominal pain superimposed on a baseline of daily nausea and anorexia. Largely anecdotal evidence supports the use of haloperidol, benzodiazepines or topical capsaicin over traditional antiemetics, yet little is known about the cause or optimal treatment of this newly recognized disorder. We report the results of one of the first clinical trials on so-called cannabis hyperemesis syndrome (NCT03056482). Methods: We approached adults with a working diagnosis of hyperemesis due to cannabis, provided they had ongoing emesis for >2 hours, a cyclic pattern of 3+ episodes in the last 2 years, and near daily use of cannabis by inhalation. We excluded those who were pregnant, deemed unreliable, or using opioids. Subjects provided written consent to be randomized during the index or any subsequent visit to either haloperidol (with a nested randomization to either 0.05 mg/kg or 0.1 mg/kg) or ondansetron 8 mg intravenously in a quadruple-blind fashion, and to be followed for 7 days. The primary outcome was the average reduction from baseline in abdominal pain and nausea (each measured on a 10-cm VAS) at 2 hours. While the original trial design allowed for crossover, the primary analysis used only the first treatment period since fewer than the prespecified threshold of 20% of subjects crossed over. Results: We enrolled 33 subjects, of whom 30 (16 men, 29+/-11 years old, using 1.5+/-0.9 g/day since age 19+/-2 years) were treated at least once (haloperidol 13, ondansetron 17). Haloperidol at either dose was superior to ondansetron (difference 2.3 cm [95%CI 0.6, 4.0]; p = 0.01), with similar improvements in both pain and nausea, as well as less rescue antiemetics (27% vs 61%; p = 0.04), and shorter time to ED departure (3.1+/-1.7 vs 5.6+/-4.5 hours; p = 0.03 Wilcoxon rank sum). There were two (haloperidol) vs six (ondansetron) return visits for ongoing nausea/vomiting, as well as two return visits for acute dystonia, both in the higher dose haloperidol group. Conclusion: Haloperidol is superior to ondansetron for the acute symptomatic treatment of patients with ongoing hyperemesis attributed to habitual cannabis use. The efficacy of this agent over ondansetron provides insight into the mechanism of this new disorder, now almost a daily diagnosis in many Canadian emergency departments.

scholarly journals Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes

2021 ◽  
Author(s):  
Halis Kaan Akturk ◽  
Janet Snell-Bergeon ◽  
Gregory L Kinney ◽  
Anagha Champakanath ◽  
Andrew Monte ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Mixed Models ◽  
Operating Characteristic ◽  
Cannabis Use ◽  
Urine Test ◽  
Icd 10 ◽  
Design And Methods ◽  
Cannabis Hyperemesis Syndrome

<b>Objective</b> <p>To differentiate diabetic ketoacidosis (DKA) from hyperglycemic ketosis due to cannabis hyperemesis syndrome (HK-CHS) in adults with type 1 diabetes.</p> <p><b>Research Design and Methods</b></p> <p>Of 295 adults with type 1 diabetes who were seen with DKA related ICD-10 codes, 68 patients with 172 DKA events meeting the inclusion criteria were analyzed. Cannabis use was defined as positive urine test for cannabis. Linear mixed models were used to define HK-CHS (pH ≥7.4 with bicarbonate ≥ 15) and sensitivity and specificity were calculated using receiver operating characteristic (ROC).</p> <p><b>Results</b></p> <p>Cannabis users had significantly higher pH (7.42 ± 0.01 vs 7.09 ± 0.02) and bicarbonate (19.2 ± 0.61 vs 9.1 ± 0.71) (p<0.0001) compared to non-users. The area under the ROC for positive cannabis urine test predicting HK-CHS was 0.9892.</p> <p><b>Conclusions</b></p> <p>In patients who present with DKA and higher pH, especially pH ≥ 7.4, cannabis use should be considered in differential diagnosis.</p>

scholarly journals Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes

2021 ◽  
Author(s):  
Halis Kaan Akturk ◽  
Janet Snell-Bergeon ◽  
Gregory L Kinney ◽  
Anagha Champakanath ◽  
Andrew Monte ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Mixed Models ◽  
Operating Characteristic ◽  
Cannabis Use ◽  
Urine Test ◽  
Icd 10 ◽  
Design And Methods ◽  
Cannabis Hyperemesis Syndrome

<b>Objective</b> <p>To differentiate diabetic ketoacidosis (DKA) from hyperglycemic ketosis due to cannabis hyperemesis syndrome (HK-CHS) in adults with type 1 diabetes.</p> <p><b>Research Design and Methods</b></p> <p>Of 295 adults with type 1 diabetes who were seen with DKA related ICD-10 codes, 68 patients with 172 DKA events meeting the inclusion criteria were analyzed. Cannabis use was defined as positive urine test for cannabis. Linear mixed models were used to define HK-CHS (pH ≥7.4 with bicarbonate ≥ 15) and sensitivity and specificity were calculated using receiver operating characteristic (ROC).</p> <p><b>Results</b></p> <p>Cannabis users had significantly higher pH (7.42 ± 0.01 vs 7.09 ± 0.02) and bicarbonate (19.2 ± 0.61 vs 9.1 ± 0.71) (p<0.0001) compared to non-users. The area under the ROC for positive cannabis urine test predicting HK-CHS was 0.9892.</p> <p><b>Conclusions</b></p> <p>In patients who present with DKA and higher pH, especially pH ≥ 7.4, cannabis use should be considered in differential diagnosis.</p>

scholarly journals Symptomatic relief from at-home use of activated Bifidobacterium infantis EVC001 probiotic in infants: results from a consumer survey on the effects on diaper rash, colic symptoms, and sleep

2021 ◽  
pp. 1-8
Author(s):  
S.M. Dimitratos ◽  
H. Brown ◽  
T. Shafizadeh ◽  
S. Kazi ◽  
T. Altmann ◽  
...  
Keyword(s):  
Online Survey ◽  
Symptomatic Relief ◽  
Poor Sleep ◽  
Night Time ◽  
Bifidobacterium Infantis ◽  
Symptom Resolution ◽  
Consumer Feedback ◽  
Post Purchase ◽  
At Home

The gut microbiome during infancy is directly involved in the digestion of human milk, development of the immune system, and long-term health outcomes. Gut dysbiosis in early life has been linked to multiple short-term ailments, from diaper dermatitis and poor stooling habits, to poor sleep and fussiness, with mixed results in the scientific literature on the efficacy of probiotics for symptom resolution. Despite the growing interest in probiotics for consumer use, observed symptomatic relief is rarely documented. This study aims to evaluate observed symptomatic relief from at-home use of activated Bifidobacterium infantis EVC001 in infants. Consumer feedback was collected over a 2-year period via a 30-day post-purchase online survey of B. infantis EVC001 (Evivo®) customers. Outcome measures included observed changes in diaper rash, symptoms of colic, and sleep behaviours in infants fed B. infantis EVC001. A total of 1,621 respondents completed the survey. Before purchasing B. infantis EVC001, the majority of respondents visited the product website, researched infant probiotics online, or consulted with their doctor or other healthcare professional. Of the participants whose infants had ever experienced diaper rash, 72% (n=448) reported improvements, and 57% of those reported complete resolution of this problem. Of those who responded to questions about gassiness/fussiness, naptime sleep, and night-time sleep behaviours, 63% (n=984), 33% (n=520), and 52% (n=806) reported resolution or improvements, respectively. Although clinical data regarding probiotic use are often inconclusive for symptom resolution, home use of B. infantis EVC001 in infants improved diaper rash, gassiness/fussiness, and sleep quality within the first week of use in a significant number of respondents who engaged in a voluntary post-purchase survey. These outcomes may be a result of the unique genetic capacity of B. infantis EVC001 to colonise the infant gut highlighting the importance of strain selection in evaluating the effects of probiotic products.

scholarly journals Assessing atrial fibrillation ablation priority during COVID-19 -does use of patient questionnaires help in stratification above physician assessment?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
C Pius ◽  
H Ahmad ◽  
R Snowdon ◽  
R Ashrafi ◽  
J Waktare ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Hospital Admissions ◽  
Symptomatic Relief ◽  
Subjective Symptom ◽  
Emergency Hospital ◽  
Af Ablation ◽  
Patients At Risk ◽  
Patient Responses

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablation for atrial fibrillation (AF) is largely offered for symptomatic relief. The ORBIT registry has shown that patients with a higher EHRA class and lower quality of life (QoL) scores (AFEQT score &lt;65.7) are more likely to suffer emergency hospital admissions. To help prevent unplanned AF admissions and to best utilise the reduced capacity for elective work during the COVID-19 pandemic, it has become even more important to prioritise the most symptomatic AF patients for ablation. Purpose: To evaluate the accuracy of a subjective symptom-based clinician prioritisation schema compared to objective patient-completed quality of life (QoL) scores. Methods: In July 2020, all elective cases awaiting AF ablation at our institution were categorised by their cardiologist as either category 1 (C1-urgent), category 2 (C2–priority, procedure to be done during the ongoing COVID-19 pandemic) or category 3 (C3–routine, procedure may be delayed until post pandemic). This categorisation was based on review of clinic letters where EHRA AF symptom class or PROMS are not routinely recorded.  All patients in C2 and C3 were then posted an AF specific (AFEQT) and a generic (EQ5D) QoL questionnaire to complete. Physicians were blinded to patient responses on the QoL questionnaires. Results: Details of physician prioritisation and completed questionnaires were available for 85 patients (62 ± 10 years, PAF in 61%, males 66%). The 18 patients that had been categorised in C2 (priority) group were found to have a significantly lower AFEQT score (30.4, IQR 17.2-51.9) compared to the 67 patients classed in C3 (routine) group (56.5, IQR 32.1-74.1; p &lt; 0.01)(Figure 1a). EQ5D scores also tended to be lower in the C2 patients (0.7, IQR 0.4-0.8) compared to C3 (0.8, IQR 0.6-0.9; p = 0.056) (Figure 1c). 16 (89%) patients in C2 had significant AF-related impact on QoL (as defined as AFEQT score &lt;65.7) compared to 42 (63%) of patients in C3.  However, there was significant overlap between groups (Figure 1b). 4 patients in C3 had unplanned AF related hospital admissions while awaiting ablation, as compared to none in C2. The median AFEQT score of these 4 patients was 23.3, indicating that they were highly symptomatic despite being classified in C3 by their cardiologist. Conclusion : Physician assessments are moderately accurate in prioritising patients awaiting AF ablation. The addition of formal patient-completed QoL assessment such as with AFEQT, helps to identify the most symptomatic patients at risk of emergency hospital admission, and physicians should consider using these as part of routine assessment, especially during the COVID pandemic. Abstract Figure 1

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 P108: Cannabis hyperemesis syndrome within emergency department users in the Calgary health region: a retrospective analysis

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S95-S95
Author(s):  
N. G. Packer ◽  
A. D. McRae ◽  
D. Wang
Keyword(s):  
Emergency Departments ◽  
Care Center ◽  
Admission Rate ◽  
Cannabis Use ◽  
Urgent Care ◽  
Health Region ◽  
Calgary Health Region ◽  
Number Of Patients ◽  
Ed Visits ◽  
Cannabis Hyperemesis Syndrome

Introduction: Cannabis hyperemesis syndrome (CHS) is associated with long-term, regular use of marijuana. CHS patients typically present to emergency departments (ED) during a hyper-emetic phase of paroxysmal nausea and vomiting. Despite extensive investigations as well as frequent ED presentations, CHS patients have a delayed time to diagnosis, and many are often missed. To date, there is a paucity of research examining CHS in emergency departments. Our objective was to identify CHS cases presenting to EDs within the Calgary health region, and to quantify the number of patients and frequency of ED visits for CHS. Methods: A retrospective chart review was performed on all patients who presented to any Calgary ED or urgent care center between January 1, 2015 and December 31, 2016 (ages 18 55 years) who had an ED discharge diagnosis of either nausea or vomiting alone, nausea with vomiting, or poisoning by cannabis, as identified in administrative data. Data abstraction from medical records was performed by trained personnel using standardized forms with comprehensive inclusion criteria for CHS. Results: The search strategy yielded a total of 320 ED visits from 156 individual patients. 55% of visits were by males, and 45% by females. The average age was 29.5 years. Of the 156 patients, 53% had cannabis use documented in the chart, with 51% reporting daily and/or regular cannabis use. Relief of symptoms from use of hot showers (a pathognomonic finding) was found in 17% of patients. 18% of patients (n=28) met criteria for CHS, and 28% (n=44) met partial criteria for CHS (having documented regular cannabis use, cyclic vomiting and abdominal pain) but no record of symptom resolution with cessation of cannabis use or from the use of hot showers. Patients meeting CHS criteria had an average of five repeat ED visits during the study period with 16% (n=12) of ED visits resulting in hospital admission. Conclusion: We identified a large cohort of patients with confirmed or suspected CHS. Given that nearly one third of the sample met partial criteria for CHS highlights the need for improved patient screening, as it is possible that this cohort may include missed cases. Further, many CHS patients are not responsive to first-line anti-emetics and accurate diagnosis is crucial for managing these patients effectively in the ED. This is of particular importance given the admission rate for CHS and resulting burden on the health system.

A phase-specific psychological therapy for people with problematic cannabis use following a first episode of psychosis: a randomized controlled trial

2014 ◽  
Vol 44 (13) ◽  
pp. 2749-2761 ◽  
Author(s):  
C. Barrowclough ◽  
M. Marshall ◽  
L. Gregg ◽  
M. Fitzsimmons ◽  
B. Tomenson ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Clinical Outcomes ◽  
Standard Care ◽  
Hospital Admissions ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Cannabis Use ◽  
First Episode ◽  
Recent Onset ◽  
Randomized Controlled

BackgroundCannabis use is high amongst young people who have recently had their first episode of psychosis, and is associated with worse outcomes. To date, interventions to reduce cannabis consumption have been largely ineffective, and it has been suggested that longer treatment periods are required.MethodIn a pragmatic single-blind randomized controlled trial 110 participants were randomly allocated to one of three conditions: a brief motivational interviewing and cognitive behavioural therapy (MI-CBT) intervention (up to 12 sessions over 4.5 months) with standard care from an early intervention service; a long MI-CBT intervention (up to 24 sessions over 9 months) with standard care; or standard care alone. The primary outcome was change in cannabis use as measured by Timeline Followback.ResultsNeither the extended nor the brief interventions conferred benefit over standard care in terms of reductions in frequency or amount of cannabis use. Also the interventions did not result in improvements in the assessed clinical outcomes, including symptoms, functioning, hospital admissions or relapse.ConclusionsIntegrated MI and CBT for people with cannabis use and recent-onset psychosis does not reduce cannabis use or improve clinical outcomes. These findings are consistent with those in the published literature, and additionally demonstrate that offering a more extended intervention does not confer any advantage. Many participants were not at an action stage for change and for those not ready to reduce or quit cannabis, targeting associated problems rather than the cannabis use per se may be the best current strategy for mental health services to adopt.

An approach to the management of paroxysmal laryngospasm

2007 ◽  
Vol 122 (1) ◽  
pp. 57-60 ◽  
Author(s):  
R J Obholzer ◽  
S A R Nouraei ◽  
J Ahmed ◽  
M R Kadhim ◽  
G S Sandhu
Keyword(s):  
Risk Factors ◽  
Botulinum Toxin ◽  
Proton Pump ◽  
Laryngopharyngeal Reflux ◽  
Botulinum Toxin Injection ◽  
Symptomatic Relief ◽  
Proton Pump Inhibitor Therapy ◽  
Symptom Resolution ◽  
Primary Risk Factor ◽  
Viable Treatment

AbstractObjective:To review the presentation, risk factors and management of paroxysmal laryngospasm.Study design:Retrospective review of cases.Setting:A teaching hospital otolaryngology department with a subspecialty interest in airway disorders.Patients:All patients diagnosed with laryngospasm over a two-year period were reviewed. Information was obtained about disease presentation, risk factors, management and symptom resolution.Results:Laryngospasm was diagnosed in nine women and six men. The average age at presentation was 56±6.5 years, and there was an 80 per cent association with gastroesophageal reflux disease. Proton pump inhibitors led to complete symptom resolution in six patients and to partial symptomatic relief, requiring no further treatment, in a further four patients. Of the remaining five patients unresponsive to proton pump inhibitor therapy, two continued to experience syncopal episodes due to laryngospasm. Both these patients achieved complete remission after laryngeal botulinum toxin injection. Symptoms recurred after three to four months and were successfully treated with a repeat injection.Conclusions:The primary risk factor for spontaneous laryngospasm is laryngopharyngeal reflux. Symptoms are distressing and may be relieved in most cases by treatment aimed at suppressing gastric acid secretion. Laryngeal botulinum toxin injection appears to be a viable treatment modality in selected patients with refractory symptoms.

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