Cannabinoid hyperemesis in adolescents: A poorly diagnosed syndrome

Management of Pediatric Cannabinoid Hyperemesis Syndrome: A Review

With significant increases noted in adolescent marijuana use across the United States, perhaps as a result of legislative changes over the past half-decade, clinicians must be increasingly aware of the potential negative health effects. One such effect that warrants concern is cannabinoid hyperemesis syndrome (CHS) in the pediatric population. A systematic review of the literature was performed to determine the safety and efficacy of management strategies for CHS using PubMed, Scopus, the Cumulative Index of Nursing and Allied Health (CINAHL), Web of Science, and Cochrane Library databases. Search terms used in each database were "pediatric OR child OR children OR adolescent" AND "cannabinoid OR marijuana" AND "hyperemesis OR cyclic vomiting OR vomiting" NOT "seizure OR chemotherapy OR pregnancy OR cancer OR AIDS OR HIV." Fourteen pieces of literature that described either effective, ineffective, or supportive management strategies for pediatric CHS were included in this review. Benzodiazepines were the most reported efficacious agents, followed by topical capsaicin cream and haloperidol. A total of 9 of the 14 studies described intravenous fluid resuscitation and hot bathing rituals as supportive measures, and 7 cases reported traditional antiemetics were ineffective for CHS. The heterogenicity of reported data, combined with the limited number of encounters, make it difficult to ascertain whether a definitive treatment strategy exists. Clinicians should be cognizant of pharmacotherapy agents that are efficacious, and perhaps more importantly, avoid using traditional antiemetic therapies that do not provide benefit.

Pediatric Cannabinoid Hyperemesis: A Single Institution 10-Year Case Series

PURPOSE

Cannabis hyperemesis (CH) is an under-recognized condition in patients with chronic or cyclic vomiting and who regularly use cannabis. Once thought to be rare, it is now increasingly recognized in both adults and children. We report a case series of adolescent patients with CH who presented at a single institution over 10 years.

METHODS

Patients were included if they had a diagnosis code of cannabis-related or cyclic vomiting, experienced the onset of regular vomiting after starting to regularly use cannabis, and if no other diagnosis was found to better explain the presentation. Thirty-four patients aged 13-20 years (median 17 years) met the inclusion criteria.

RESULTS

The presenting clinical features were broadly similar to adult CH: cyclic nausea and emesis after at least 3 months of regular cannabis use, abdominal pain, change in bowel habit, and symptomatic relief from hot showers or baths. No antiemetic was found to be of particular benefit. Follow-up was recorded in under half of the patients; documentation of drug history was also frequently incomplete. Clinicians should consider CH when assessing any adolescent with cyclic or chronic vomiting.

CONCLUSIONS

A detailed drug history, preferably taken in the absence of parents or other involved adults and corroborated by urine drug screening, is helpful in substantiating the diagnosis. Further prospective studies are needed to confirm the incidence, prevalence, presenting features, and the effectiveness of treatments, including drug counseling and cessation. Based on our findings, we propose pragmatic criteria to aid in the diagnosis of pediatric CH.

Diagnosis and Acute Management of Adolescent Cannabinoid Hyperemesis Syndrome: A Systematic Review

PURPOSE

This study aimed to synthesize qualitative and quantitative data on the diagnosis and effective management of cannabinoid hyperemesis syndrome (CHS) in the adolescent population.

METHODS

Using keywords, 1,334 studies published between December 1954 and December 2019 were extracted from MEDLINE via PubMed, Embase via OVID, CINAHL via EBSCO, Web of Science, and the Cochrane Library. Studies were evaluated by two independent reviewers using predetermined inclusion and exclusion criteria.

RESULTS

The search yielded 148 studies for full-text review, of which 21 were included in this systematic review. A total of 10 articles were related to the diagnosis of CHS, while 11 articles discussed the treatment and management of adolescent cases of CHS.

CONCLUSIONS

CHS in the adolescent population fulfills the major and minor diagnostic criteria of CHS in the adult population; however, in adolescent patients, CHS may present more frequently in females, with the earliest reported case presenting at age 15 years. There appears to be a substantial proportion (21%) of adolescent patients diagnosed with CHS that have a history of anxiety and depression; however, higher quality studies to assess the prevalence are warranted. Although haloperidol and topical capsaicin cream may provide symptom relief in isolated cases, complete cessation of cannabis use is currently the only known effective treatment.