Cannabinoid Hyperemesis Syndrome: The Missed Diagnosis

Authors

DOI:

https://doi.org/10.51338/rppsm.2020.v6.i3.133

Keywords:

Baths, Cannabinoids/adverse effects, Marijuana Abuse/complications, Syndrome, Vomiting/chemically induced

Abstract

Cannabis is the most cultivated and abused illicit drug worldwide. Paradoxically to the antiemetic properties attributed to cannabis, a relatively new cannabinoid hyperemesis syndrome (CHS) started to be recognized and is characterized by cyclic vomiting that are interspaced by asymptomatic phases. We present a case of a 36‑year‑old woman who repeatedly presented to the emergency room with cyclic vomiting that alleviated with hot showers. She was a long‑term cannabis user and the diagnosis was only established several years later after the onset of symptoms. The diagnostic work up was unremarkable, and the only effective treatment was cannabis cessation. Hot bathing behavior is a key characteristic of this syndrome. CHS is a new clinical condition that should be considered in a setting of recurrent and intractable vomiting in patients with a history of cannabis use.

Downloads

Download data is not yet available.

References

World Health Organization. Cannabis: Facts and Figures. Available from: https://www.who.int/substance_abuse/facts/cannabis/en/.

World Drug Report 2019 (United Nations publication, Sales No. E.19.XI.8).

European Monitoring Centre for Drugs and Drug Addiction. European Drug Report 2019: Trends and Developments, Publications Office of the European Union, Luxembourg. Luxembourg: EMCDDA; 2019.

Direção‑Geral da Saúde. Programa Nacional para a Saúde MentalLisboa:DGS; 2017.

Amato L, Minozzi S, Mitrova Z, Parmelli E, Saulle R, Cruciani F, et al. Systematic review of safeness and therapeutic efficacy of cannabis in patients with multiple sclerosis, neuropathic pain, and in oncological patients treated with chemotherapy. Epidemiol Pev. 2017;41(5‑6): 279‑93. doi: 10.19191/EP17.5‑6.AD01.069

Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for Medical Use: A Systematic Review and Meta‑analysis. JAMA. 2015;313:2456‑73. doi: 10.1001/jama.2015.6358

Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut. 2004;53:1566‑70. doi: 10.1136/gut.2003.036350

European Monitoring Centre for Drugs and Drug Addiction. Developments in the European cannabis market. Luxembourg: EMCDDA; 2019.

Atakan Z. Cannabis, a complex plant: different compounds and different effects on individuals. Ther Adv Psychopharmacol. 2012;2:241‑54. doi: 10.1177/2045125312457586

Nocerino E, Amato M, Izzo AA. Cannabis and cannabinoid receptors. Fitoterapia. 2000;71 Suppl 1:S6‑12. doi: 10.1016/s0367‑326x(00)00171‑4

Galli JA, Sawaya RA, Friedenberg FK. Cannabinoid hyperemesis syndrome. Curr Drug Abuse Rev. 2011;4:241‑9.

doi: 10.2174/1874473711104040241

Darmani NA. The potent emetogenic effects of the endocannabinoid, 2‑AG (2‑arachidonoylglycerol) are

blocked by delta(9)‑tetrahydrocannabinol and other cannnabinoids. J Pharmacol Exp Ther. 2002;300:34‑42. doi: 10.1124/jpet.300.1.34

Gunasekaran N, Long LE, Dawson BL, Hansen GH, Richardson DP, Li KM, et al. Reintoxication: the release of fat‑stored

delta(9)‑tetrahydrocannabinol (THC) into blood is enhanced by food deprivation or ACTH exposure. Br J Pharmacol. 2009;158:1330‑7. doi: 10.1111/j.1476‑5381.2009.00399.x

Camilleri M. Cannabinoids and gastrointestinal motility: Pharmacology, clinical effects, and potential therapeutics in humans. Neurogastroenterol Motil. 2018;30:e13370. doi: 10.1111/nmo.13370

Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid hyperemesis syndrome: diagnosis, pathophysiology, and treatment‑a systematic review. J Med Toxicol. 2017;13:71‑87. doi: 10.1007/s13181‑016‑0595‑z

Chocron Y, Zuber JP, Vaucher J. Cannabinoid hyperemesis syndrome. BMJ. 2019;366:l4336. doi: 10.1136/bmj.l4336

Downloads

Published

2020-12-30

How to Cite

Fonseca, J. B., Vilaverde, D., Rodrigues, R. ., & Morgado, P. (2020). Cannabinoid Hyperemesis Syndrome: The Missed Diagnosis. Revista Portuguesa De Psiquiatria E Saúde Mental, 6(3), 127–130. https://doi.org/10.51338/rppsm.2020.v6.i3.133

Issue

Section

Case Report