View source for Cannabinoid hyperemesis syndrome

<languages/>
<translate>

==Background== <!--T:1-->

<!--T:2-->
*Cannabis is the most widely used drug in the US and the world
*Cannabinoid hyperemesis syndrome, first described by Allen et al. in 2004 consists of nausea, vomiting, and abdominal pain in a patient with no other organic cause who frequently uses marijuana and has relief of symptoms with hot showers<ref> Allen, J H; De Moore, GM; Heddle, R; Twartz, JC (2004). "Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse". Gut 53 (11): 1566–70. doi:10.1136/gut.2003.036350. PMC 1774264</ref>
*Pathophysiology not yet well understood<ref>Byrne, A; Hallinan, R; Wodak, A (2006). "'Cannabis hyperemesis' causation questioned". Gut 55 (1): 132; author reply 132. PMC 1856368</ref>


==Clinical Features<ref>Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). "Cannabinoid Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings 87 (2): 114–9. doi:10.1016/j.mayocp.2011.10.005. PMID 22305024</ref>== <!--T:3-->


===Essential Features=== <!--T:4-->

<!--T:5-->
*Long term cannabis use (typically > 2 years)


===Major Features=== <!--T:6-->

<!--T:7-->
*Severe cyclical [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting |vomiting ]]
*Weekly use of [[Special:MyLanguage/marijuana|marijuana]]
*Relief of symptoms with hot showers or baths
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]]: epigastric or periumbilical
*Resolution of symptoms with cannabis cessation


===Supportive Features=== <!--T:8-->

<!--T:9-->
*Age < 50y
*Weight loss > 5kg
*Symptoms greater in morning
*Normal bowel habits
*Negative labs, imaging and endoscopy


==Differential Diagnosis== <!--T:10-->

</translate>
{{Nausea and vomiting DDX}}
<translate>


==Evaluation== <!--T:11-->

<!--T:12-->
*Generally considered a diagnosis of exclusion after evaluating for other causes of [[Special:MyLanguage/nausea and vomiting|nausea and vomiting]]


==Management== <!--T:13-->

<!--T:14-->
*Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses
*Symptomatic treatment ([[Special:MyLanguage/Antiemetics|Antiemetics]], anxiolytics, and hydration)
**[[Special:MyLanguage/Haloperidol|Haloperidol]] 5 mg IV/IM and [[Special:MyLanguage/diphenhydramine|diphenhydramine]] 50 mg IV<ref>Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6.</ref>
**Hot shower (>109°F), though short-lived<ref>Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.</ref>
**[[Special:MyLanguage/Capsaicin|Capsaicin]] cream 0.025-0.075% across abdomen/arms/back, with symptoms diminishing within 30 min<ref>Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.</ref>
**[[Special:MyLanguage/Lorazepam|Lorazepam]] 1-2 mg IV <ref>Smith TN, et al. Cannabinoid hyperemesis syndrome: an unrecognized cause of nausea and vomiting. JAAPA. 2019.  Apr;32(4):1-5 </ref>


==Medication Dosing==
{{MedicationDose
| drug = Haloperidol
| dose = 5mg IV or IM
| route = IV/IM
| context = Antiemetic, first-line
| indication = Cannabinoid hyperemesis syndrome
| population = Adult
}}
{{MedicationDose
| drug = Diphenhydramine
| dose = 50mg IV
| route = IV
| context = Adjunct with haloperidol
| indication = Cannabinoid hyperemesis syndrome
| population = Adult
}}
{{MedicationDose
| drug = Lorazepam
| dose = 1-2mg IV
| route = IV
| context = Anxiolytic/antiemetic
| indication = Cannabinoid hyperemesis syndrome
| population = Adult
}}

==Disposition== <!--T:15-->

<!--T:16-->
*Discharge once tolerating PO


==See Also== <!--T:17-->

<!--T:18-->
*[[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]]
*[[Special:MyLanguage/Marijuana|Marijuana]]


==External Links== <!--T:19-->

<!--T:20-->
*[http://lifeinthefastlane.com/therapeutic-showering/ LITFL:Therapeutic Showering]
*[http://www.thepoisonreview.com/2014/07/16/review-of-cannabinoid-hyperemesis-syndrome/ The Poison Review: Review of cannabinoid hyperemesis syndrome]


==References== <!--T:21-->

<!--T:22-->
<references/>

<!--T:23-->
[[Category:Toxicology]]
[[Category:GI]]
</translate>