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Levinthal DJ, Killian B, Issenman RM. Acute care of cyclic vomiting syndrome and cannabinoid hyperemesis syndrome in the home and emergency department for: Special supplement/proceedings of 3rd international symposium. Neurogastroenterol Motil 2024:e14901. [PMID: 39155452 DOI: 10.1111/nmo.14901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS) are both characterized by episodic, acute transitions from asymptomatic states to highly symptomatic states of nausea, repetitive vomiting, and often severe abdominal pain. Patients with CVS and CHS face significant challenges to abort or mitigate episodes at home and often require emergency department (ED)-based care. PURPOSE This paper reviews the current treatment approach to abort acute CVS and CHS episodes at home and in ED settings. Multiple pharmacologic and nonpharmacologic interventions have been demonstrated to potentially abort CVS or CHS episodes. Systemic pharmacologic agents often used as abortive therapy include triptans, antiemetics, anxiolytics, NK-1 receptor antagonists, antipsychotics, sedatives in general, and various analgesic / anti-inflammatory medications. Nonsystemic, nonpharmacologic approaches include reducing external stimuli (quiet room, dim lights, etc.), and hot water bathing or the application of topical capsaicin cream. More research is needed to develop evidence-based, individualized abortive treatment plans, as well as to determine whether the abortive treatment for CVS requires a fundamentally different approach than for CHS. When home-based approaches fail, all patients with CVS or CHS should receive nonjudgmental, informed, and compassionate care in the ED to abort their episode. Patients with more severe forms of CVS/CHS who require more frequent ED utilization should develop care plans with their ED to assure predictable and effective treatment.
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Affiliation(s)
| | - Blynda Killian
- Cyclic Vomiting Syndrome Association, Milwaukee, Wisconsin, USA
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Lathrop JR, Rosen SN, Heitkemper MM, Buchanan DT. Cyclic Vomiting Syndrome and Cannabis Hyperemesis Syndrome: The State of the Science. Gastroenterol Nurs 2023; 46:208-224. [PMID: 37074964 DOI: 10.1097/sga.0000000000000730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/10/2022] [Indexed: 04/20/2023] Open
Abstract
This article provides a narrative review of the state of the science for both cyclic vomiting syndrome and cannabis hyperemesis syndrome along with a discussion of the relationship between these 2 conditions. The scope of this review includes the historical context of these conditions as well as the prevalence, diagnostic criteria, pathogenesis, and treatment strategies for both conditions. A synopsis of the endocannabinoid system provides a basis for the hypothesis that a lack of cannabidiol in modern high-potency Δ 9 -tetrahydrocannabinol cannabis may be contributory to cannabis hyperemesis syndrome and possibly other cannabis use disorders. In concluding assessment, though the publications addressing both adult cyclic vomiting syndrome and cannabis hyperemesis syndrome are steadily increasing overall, the state of the science supporting the treatments, prognosis, etiology, and confounding factors (including cannabis use) is of moderate quality. Much of the literature portrays these conditions separately and as such sometimes fails to account for the confounding of adult cyclic vomiting syndrome with cannabis hyperemesis syndrome. The diagnostic and therapeutic approaches are, at present, based generally on case series publications and expert opinion, with a very limited number of randomized controlled trials and a complete absence of Level 1 evidence within the cyclic vomiting literature overall as well as for cannabis hyperemesis syndrome specifically.
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Affiliation(s)
- James R Lathrop
- James R. Lathrop, DNP, FNP, ARNP, is a PhD student under the Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Sheldon N. Rosen, MD, is Clinical Associate Professor, Division of Gastroenterology, School of Medicine, University of Washington, Seattle
- Margaret M. Heitkemper, PhD, RN, FAAN, is Professor and Elizabeth Sterling Soule Endowed Chair in Nursing, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Diana Taibi Buchanan, PhD, RN, is Associate Professor and Mary S. Tschudin Endowed Professor of Nursing Education, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
| | - Sheldon N Rosen
- James R. Lathrop, DNP, FNP, ARNP, is a PhD student under the Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Sheldon N. Rosen, MD, is Clinical Associate Professor, Division of Gastroenterology, School of Medicine, University of Washington, Seattle
- Margaret M. Heitkemper, PhD, RN, FAAN, is Professor and Elizabeth Sterling Soule Endowed Chair in Nursing, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Diana Taibi Buchanan, PhD, RN, is Associate Professor and Mary S. Tschudin Endowed Professor of Nursing Education, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
| | - Margaret M Heitkemper
- James R. Lathrop, DNP, FNP, ARNP, is a PhD student under the Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Sheldon N. Rosen, MD, is Clinical Associate Professor, Division of Gastroenterology, School of Medicine, University of Washington, Seattle
- Margaret M. Heitkemper, PhD, RN, FAAN, is Professor and Elizabeth Sterling Soule Endowed Chair in Nursing, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Diana Taibi Buchanan, PhD, RN, is Associate Professor and Mary S. Tschudin Endowed Professor of Nursing Education, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
| | - Diana Taibi Buchanan
- James R. Lathrop, DNP, FNP, ARNP, is a PhD student under the Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Sheldon N. Rosen, MD, is Clinical Associate Professor, Division of Gastroenterology, School of Medicine, University of Washington, Seattle
- Margaret M. Heitkemper, PhD, RN, FAAN, is Professor and Elizabeth Sterling Soule Endowed Chair in Nursing, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
- Diana Taibi Buchanan, PhD, RN, is Associate Professor and Mary S. Tschudin Endowed Professor of Nursing Education, Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle
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Cheung F, Doherty SM, Tatara AW. Ketamine in Refractory Cyclic Vomiting Syndrome: A Case Report and Review of Literature. J Pharm Pract 2021; 35:805-810. [PMID: 33813940 DOI: 10.1177/08971900211000684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the use of ketamine in an adult patient in aborting a cyclic vomiting syndrome (CVS) episode. SUMMARY A 40-year-old man with a history of CVS was admitted after several days of nausea and vomiting. He was given parenteral doses of lorazepam and ondansetron but was unable to remain emesis-free. Ketamine was recommended by Gastroenterology as a therapeutic option after exhausting all first- and second-line agents. Ketamine is a noncompetitive N-methyl-D-aspartate receptor antagonist that is widely used for its analgesic and sedative effects. While there is some data to support its use in CVS, most of the published literature has been limited to the Emergency Department setting and no specific therapeutic dose has been established. We will review our institution's experience with low dose ketamine in an adult patient with a CVS episode that is refractory to first-line agents. CONCLUSION In the case described, ketamine at a low sub-anesthetic dose successfully aborted a CVS episode with no appreciable side effects. As much of ketamine's full effects remain relatively unknown, additional studies are needed to determine optimal strategies for ketamine use in patients with a CVS episode.
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Affiliation(s)
- Fiona Cheung
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie M Doherty
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
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Carpenter A, Levinthal DJ, Binion DG, Emerick T. Improvement of Cyclic Vomiting Syndrome with Outpatient Ketamine Infusions. Case Rep Gastroenterol 2021; 15:9-16. [PMID: 33613157 PMCID: PMC7879312 DOI: 10.1159/000510933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/11/2020] [Indexed: 01/18/2023] Open
Abstract
Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent flares of nausea and vomiting, often with significant abdominal pain, of several days duration. Although traditional prophylactic and abortive treatments for CVS are often successful, a subset of CVS patients with chronic abdominal pain may not respond as well to standard therapies. This report is the first, to our knowledge, to describe the use of outpatient ketamine infusions as therapy for refractory CVS. We describe a 63-year-old woman with history of CVS who presented with abdominal pain and recurrent episodes of nausea and vomiting. She first received ketamine during an inpatient admission for a CVS flare, with the aim of treating the abdominal pain. Given her improvement, she was offered a series of outpatient ketamine infusions, which led to a significant reduction in her symptoms. Thus, ketamine may be useful as both an abortive and prophylactic therapy in CVS. Prior reports have noted the anti-emetic effects of ketamine in the perioperative setting, and there is emerging evidence for the use of ketamine infusions for the treatment of chronic pain. However, this report is the first to describe ketamine as a potential prophylactic treatment for CVS.
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Affiliation(s)
- Anna Carpenter
- Department of Anesthesiology, West Virginia University Ruby Memorial Hospital, Morgantown, West Virginia, USA
| | - David J Levinthal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David G Binion
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Muric NN, Arsenijevic NN, Borovcanin MM. Chlorpromazine as a Potential Antipsychotic Choice in COVID-19 Treatment. Front Psychiatry 2020; 11:612347. [PMID: 33424669 PMCID: PMC7785719 DOI: 10.3389/fpsyt.2020.612347] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/01/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Nemanja N Muric
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Psychiatric Clinic, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Nebojsa N Arsenijevic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Milica M Borovcanin
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.,Psychiatric Clinic, Clinical Center Kragujevac, Kragujevac, Serbia
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