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J Med Toxicol. 2017 Mar;13(1):71-87. doi: 10.1007/s13181-016-0595-z. Epub 2016 Dec 20.

Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review.

Author information

1
Denver Health Residency in Emergency Medicine, Denver Health and Hospital Authority, Denver, CO, 80204, USA. Cecilia.Sorensen@denverem.org.
2
Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
3
Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
4
School of Psychological Sciences, University of Northern Colorado, Greeley, CO, USA.
5
Denver Health Residency in Emergency Medicine, Denver Health and Hospital Authority, Denver, CO, 80204, USA.
6
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
7
Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, CO, USA.

Abstract

Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic vomiting associated with cannabis use. Our objective is to summarize the available evidence on CHS diagnosis, pathophysiology, and treatment. We performed a systematic review using MEDLINE, Ovid MEDLINE, Embase, Web of Science, and the Cochrane Library from January 2000 through September 24, 2015. Articles eligible for inclusion were evaluated using the Grading and Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Data were abstracted from the articles and case reports and were combined in a cumulative synthesis. The frequency of identified diagnostic characteristics was calculated from the cumulative synthesis and evidence for pathophysiologic hypothesis as well as treatment options were evaluated using the GRADE criteria. The systematic search returned 2178 articles. After duplicates were removed, 1253 abstracts were reviewed and 183 were included. Fourteen diagnostic characteristics were identified, and the frequency of major characteristics was as follows: history of regular cannabis for any duration of time (100%), cyclic nausea and vomiting (100%), resolution of symptoms after stopping cannabis (96.8%), compulsive hot baths with symptom relief (92.3%), male predominance (72.9%), abdominal pain (85.1%), and at least weekly cannabis use (97.4%). The pathophysiology of CHS remains unclear with a dearth of research dedicated to investigating its underlying mechanism. Supportive care with intravenous fluids, dopamine antagonists, topical capsaicin cream, and avoidance of narcotic medications has shown some benefit in the acute setting. Cannabis cessation appears to be the best treatment. CHS is a cyclic vomiting syndrome, preceded by daily to weekly cannabis use, usually accompanied by symptom improvement with hot bathing, and resolution with cessation of cannabis. The pathophysiology underlying CHS is unclear. Cannabis cessation appears to be the best treatment.

KEYWORDS:

Cannabinoid hyperemesis syndrome; Cannabis; Cyclic vomiting syndrome; Marijuana

PMID:
28000146
PMCID:
PMC5330965
DOI:
10.1007/s13181-016-0595-z
[Indexed for MEDLINE]
Free PMC Article

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