How are patients with cannabinoid hyperemesis syndrome likely to present and what is the possible mechanism?

Bottom line: Patients present with history of episodic, intractable nausea and vomiting that is relieved with bathing in hot water.  Exact mechanism for the nausea and vomiting is unknown; one theory is that the hyperemesis is somehow brought about by the neuromodulatory effects of delta-9-tetrahydrocannabi-nol (THC) on the brain.  Another is that the syndrome may be associated with some other additive or other chemical used in the preparation of marijuna.  Management includes evaluating volume status; rehydration, if needed; cessation of cannabis.  Cyclic antiemetics tend to be ineffective.

DetailsNicolson SE, et al.  Cannabinoid Hyperemesis Syndrome: A Case Series and Review of Previous Reports.  Psychosomatics. 2012; 53(3): 212-219.

Wallace EA, et at.  Cannabinoid Hyperemesis Syndrome: Literature Review and Proposed Diagnosis and Treatment Algorithm.  Southern Med J.  2011; 104(9): 659-664.

Fig. 1 presents an algorithm for managing patients presenting with intractable vomiting, using the history and urine drug screen to direct management.

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About Amy

Clinical Informationist at EUH Branch Library
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