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Question: Vomiting
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You are seeing a 19 year old male who has had several ED visits for abdominal pain, nausea and vomiting. He insists that he does not use cannabis at all.
Kelly January 18, 2022 - 11:27 pm
B) The symptoms of both are relieved by hot showers
Cannabis hyperemesis syndrome (CHS), seen with increasing frequency in PED’s, presents similarly to classic cyclic vomiting syndrome (CVS), and both can have symptoms relieved by hot showers. CHS, however, is associated with chronic cannabis use, and is “cured” by cessation of all cannabis use (although it may take longer than 1 month of abstinence with persisting symptoms to rule out CHS; some experts suggest 6 months). CVS onset tends to be in younger children, with a mean age 9.6 years at diagnosis, while CHS is seen in older teens, given that chronic cannabis use is uncommon in younger children. CVS is more common in females, while CHS is equal among males and females. CVS is associated with migraines and can be catamenial, which may explain its increase in females. Ondansetron tends to not be effective for CHS; haloperidol and capsaicin have been more effective. Care should be taken when using multiple agents that prolong QT as demonstrated in this case report: https://pubmed.ncbi.nlm.nih.gov/34735682/