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Cannabinoid hyperemesis syndrome
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Cannabinoid hyperemesis syndrome

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Contributors: Abhijeet Waghray MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Cannabinoid hyperemesis syndrome is characterized by recurring episodes of intractable nausea, abdominal pain, and vomiting in long-term cannabis users. Onset of the syndrome occurs after several years of chronic cannabis use and occurs more frequently in males. Each episode of hyperemesis typically lasts 24-48 hours.

The provoking mechanism is uncertain. Prior to each episode, the user may experience a prodrome of autonomic symptoms such as agitation, sweating, flushing, thirst, and anxiety. Dehydration and volume depletion are not uncommon following episodic vomiting. Patients often continue to use cannabis, mistakenly believing that it will help when, in actuality, it prolongs the symptoms. Resulting complications may include gastritis, esophagitis, hypokalemia, and rarely acute renal failure.

Lack of knowledge of this syndrome may lead to delayed diagnosis, and misdiagnosis of cyclic vomiting syndrome may occur. A patient history of chronic use of marijuana and compulsive hot showers to alleviate symptoms of hyperemesis suggests cannabinoid hyperemesis syndrome.

Management begins once other severe conditions are ruled out and regular cannabis use is confirmed. Antiemetics appear to have little or no effect in stopping the vomiting. Rehydration and symptomatic care are indicated. With cessation of cannabis use, the syndrome resolves. If the patient resumes cannabis use, the hyperemesis syndrome typically returns.

Related topics: Cannabis use disorder, Synthetic cannabinoid adverse reaction

Codes

ICD10CM:
F12.288 – Cannabis dependence with other cannabis-induced disorder

SNOMEDCT:
11048011000119103 – Cannabis hyperemesis syndrome co-occurrent and due to cannabis dependence

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 03/20/2018
Last Updated: 04/19/2018
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Cannabinoid hyperemesis syndrome
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Cannabinoid hyperemesis syndrome : Nausea, Cramping abdominal pain, Recurring episodes, Chronic, heavy cannabis use, Cyclic vomiting
Copyright © 2019 VisualDx®. All rights reserved.