vostok
Well-Known Member
A 22-year male presented with recurrent episodes of nausea, refractory vomiting, and colicky epigastric pain for one week. The symptoms were characterized by treatment-resistant nausea in the morning, continuous vomiting, and colicky epigastric abdominal pain. Each episode lasted 2 to 3 h and increased with food intake. He often had two or more episodes a day during the symptomatic period. He had been treated for the severe nausea and vomiting in the emergency room on two occasions in the preceding two months. He also reported having learned to help himself by taking a hot bath each time the symptoms appeared, which dramatically improved his symptoms. This habit had become a compulsion for him for symptom relief with each episode of hyperemesis. On physical examination his mucous membranes were dry, his pulse rate was 102/min and blood pressure was 140/100 with positive orthostasis. The remainder of the physical examination was unremarkable. His complete blood count and comprehensive metabolic panel were unremarkable. In addition, serum amylase and lipase levels were within the normal range. His urine drug screen was positive for tetrahydrocannabinol (THC). Abdominal X-ray series and ultrasonography were within normal limits.
Oesophagogastroduodenoscopy revealed Grade 2 distal oesophagitis and hiatal hernia. On further interviewing, he admitted to consistent marijuana abuse for the past 6 years, often smoking cannabis every hour or two on a daily basis. The patient and his mother did not recall any significant past illnesses or recurrent vomiting when he was a child. He was treated with intravenous fluids with steady improvement in symptoms, and metoclopramide, pantoprazole and morphine for the abdominal pain. It was explained that marijuana was the cause of his symptoms and he was advised not to resume marijuana abuse. On subsequent follow-up, he had abstained from cannabis and remained symptom-free.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658859/
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Nineteen patients were identified following an original clinical observation by Allen linking chronic cannabis abuse to a cyclical vomiting illness in several cases in South Australia in 2001. Patients were either referred by doctors (12 cases), self referred (two cases), or identified on the ward by the nursing staff (five cases) during acute admission for profuse vomiting. Of these 19 patients, five refused consent and were lost to follow up and 14 fully consented for publication and presentation. Each patient was allotted a letter of the alphabet to preserve anonymity. Patients were followed up with serial urine drug screens and regular clinical consultations to chart their clinical course.
Inpatients were observed with particular reference to autonomic changes in body temperature (measured tympanically), blood pressure, heart rate, fluid intake, skin flushing, and perspiration. However, patient anxiety, compounded by the severity of the hyperemesis, made formal autonomic testing impossible.
All reasonable efforts were made to exclude confounding causes for their cyclical vomiting given the resources at hand. As a result, five patients were excluded from the study for the following reasons:
–4. They were compared with a case of psychogenic vomiting described in 1996 by de Moore and colleagues.4
Table 1
Characteristics of the first five study subjects
Table 4
Clinical characteristics of the remaining four study subjects and the case of psychogenic vomiting described in 1996 by de Moore and colleagues (Mr G*)4
In their article, de Moore and colleagues4 described in detail a man (Mr G), who had smoked marijuana as a teenager, developed a cyclical vomiting syndrome in his twenties, and was noted to have multiple showers on the ward. Marijuana was not proposed as a cause of his illness.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774264/
the best at WIKI: https://en.wikipedia.org/wiki/Cannabinoid_hyperemesis_syndrome
Cannabinoid hyperemesis was first reported in the Adelaide Hills of South Australia in 2004
Oesophagogastroduodenoscopy revealed Grade 2 distal oesophagitis and hiatal hernia. On further interviewing, he admitted to consistent marijuana abuse for the past 6 years, often smoking cannabis every hour or two on a daily basis. The patient and his mother did not recall any significant past illnesses or recurrent vomiting when he was a child. He was treated with intravenous fluids with steady improvement in symptoms, and metoclopramide, pantoprazole and morphine for the abdominal pain. It was explained that marijuana was the cause of his symptoms and he was advised not to resume marijuana abuse. On subsequent follow-up, he had abstained from cannabis and remained symptom-free.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658859/
....
Nineteen patients were identified following an original clinical observation by Allen linking chronic cannabis abuse to a cyclical vomiting illness in several cases in South Australia in 2001. Patients were either referred by doctors (12 cases), self referred (two cases), or identified on the ward by the nursing staff (five cases) during acute admission for profuse vomiting. Of these 19 patients, five refused consent and were lost to follow up and 14 fully consented for publication and presentation. Each patient was allotted a letter of the alphabet to preserve anonymity. Patients were followed up with serial urine drug screens and regular clinical consultations to chart their clinical course.
Inpatients were observed with particular reference to autonomic changes in body temperature (measured tympanically), blood pressure, heart rate, fluid intake, skin flushing, and perspiration. However, patient anxiety, compounded by the severity of the hyperemesis, made formal autonomic testing impossible.
All reasonable efforts were made to exclude confounding causes for their cyclical vomiting given the resources at hand. As a result, five patients were excluded from the study for the following reasons:
- Polydrug use (patients O and C).
- Porphyria cutanea tarda (patient Z).
- Acute pancreatitis (patient B).
- Schizophrenia (patient T).
–4. They were compared with a case of psychogenic vomiting described in 1996 by de Moore and colleagues.4Table 1
Characteristics of the first five study subjects
Table 4
Clinical characteristics of the remaining four study subjects and the case of psychogenic vomiting described in 1996 by de Moore and colleagues (Mr G*)4
In their article, de Moore and colleagues4 described in detail a man (Mr G), who had smoked marijuana as a teenager, developed a cyclical vomiting syndrome in his twenties, and was noted to have multiple showers on the ward. Marijuana was not proposed as a cause of his illness.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774264/
the best at WIKI: https://en.wikipedia.org/wiki/Cannabinoid_hyperemesis_syndrome
Cannabinoid hyperemesis was first reported in the Adelaide Hills of South Australia in 2004
