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In this case, after a diagnosis of CHS was made, the patient was counseled against marijuana use. His abdominal pain and intractable vomiting did not improve with conservative management of n.p.o status, prochlorperazine, metoclopramide, and ondansetron. He was given a trial of low-dose lorazepam with significant improvement in his symptoms. He was counseled extensively against marijuana use and discharged. A follow-up phone call at 3 months showed continued abstinence and no recurrence of symptoms.
Dr. Gupta is a hospitalist at Yale New Haven Health and Bridgeport (Conn.) Hospital.
1. Bajgoric S et al. Cannabinoid hyperemesis syndrome: A guide for the practising clinician. BMJ Case Rep. 2015. doi: 10.1136/bcr-2015-210246.
2. Batke M et al. The cannabis hyperemesis syndrome characterized by persistent nausea and vomiting, abdominal pain, and compulsive bathing associated with chronic marijuana use: A report of eight cases in the united states. Dig Dis Sci. 2010 Nov;55(11):3113-9.
3. Iacopetti CL et al. Cannabinoid hyperemesis syndrome: a case report and review of pathophysiology. Clin Med Res. 2014 Sep;12(1-2):65-7.
4. Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun. 31(6):1003.e5-6. Epub 2013 Apr 10.
Suspect CHS for patients with recurrent abdominal pain, nausea, and vomiting with negative initial work-up.
- Ask directly about marijuana use.
- Ask whether symptoms are relieved with hot shower/ bath.
- Send a toxicology screen.
- Make a diagnosis of CHS if:
1. Positive marijuana use.
2. Symptom improvement with hot baths or
3. Toxicology positive for marijuana.
- Manage conservatively with hydration and antiemetics.
- Suspect CHS if traditional antiemetics are not providing relief .
- If traditional antiemetics fail, trial of haloperidol or low-dose benzodiazepines.
- Avoid narcotics.
- Avoid unnecessary investigations.
- Counsel patients against marijuana use and refer to substance abuse center if patient agrees.