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Cannabinoid Hyperemesis Syndrome
Aka: Cannabinoid Hyperemesis Syndrome, Cannabis Hyperemesis Syndrome
- Pathophysiology
- Associated with chronic Marijuana use
- Proposed mechanisms
- Cerebral fat deposition of lipophilic Marijuana metabolites with frequent Marijuana use
- THC binding to vanilloid receptors in the Hypothalamus (transient receptor potential vanilloid receptor, TRPV1)
- Low THC concentrations and warmer Temperatures (>109.4 F or 43 C) are Anti-emetic
- High THC concentrations are pro-emetic
- Diagnosis
- Essential criteria
- Chronic Marijuana use
- Major criteria
- Severe cyclical Nausea or Vomiting
- Abdominal Pain
- Weekly Marijuana use
- Resolves with Marijuana cessation
- Hot showers or baths help to relieve Nausea
- Supportive criteria
- Age under 50 years
- Weight loss over 5 kg
- Symptoms predominant in morning
- Normal bowel habits
- Negative diagnostic evaluation
- Management
- Home
- Marijuana cessation
- Symptomatic relief with hot showers or bath
- Emergency Department
- Antiemetics (e.g. Ondansetron, Prochlorperazine, Promethazine, metoclopramide)
- Typically less effective in canabinoid hyperemesis
- Capsaicin cream (0.075 to 0.25%)
- Applied thinly with gloved finger over a palm sized area of the Abdomen
- Peak effect in 20-30 minutes and lasts 3 hours
- May work on vanilloid receptors in Hypothalamus (similar to the action of a hot shower)
- Dezieck (2017) Clin Toxicol 55(8): 908-13 +PMID:28494183 [PubMed]
- Haloperidol
- Haloperidol 2.5 mg IV or IM
- Some studies have used doses as high as 0.05 to 1 mg/kg IV (higher than typical dosing)
- Jones (2016) Case Rep Psychiatry +PMID: 27597918 [PubMed]
- Ruberto (2021) Ann Emerg Med 77(6):613-619 +PMID:33160719 [PubMed]
- Inapsine (Droperidol)
- Dosing: 0.625 mg to 1.25 mg IV
- Lee (2019) Clin Toxicol 57(9): 773-7 [PubMed]
- References
- Orman and Zodda in Herbert (2018) EM:Rap 18(2): 10
- Oxentenko (2011) Mayo Internal Medicine Review