Original articleCannabinoid Hyperemesis: A Case Series of 98 Patients
Section snippets
Patients and Methods
Inclusion criteria were determined by reviewing all PubMed indexed journals with case reports and case series on CH. On the basis of the results of that review, patients were included if they had (1) long-term marijuana use before the start of symptoms, (2) a history of recurrent vomiting, and (3) the absence of a major illness that could explain the symptoms. Using institutional software, the electronic medical record was searched from January 1, 2005, through June 15, 2010, for the terms
Results
The demographic characteristics of the study population are shown in Table 2. Sixty-six patients (67%) were males, the mean ± SD age at evaluation was 32.3±9.9 years, and the mean ± SD age at symptom onset was 25.3±8.9 years (range, 14-48 years). Sixty patients (65%) had a body mass index (calculated as the weight in kilograms divided by the height in meters squared) of 25 or less, and only 11 (12%) were obese, defined as a body mass index of greater than 30. Forty-eight patients (49%) used
Discussion
Current knowledge of CH is based on several case reports and small case series. In fact, diagnostic clinical criteria originate from a review of only 13 cases of CH.7 Our case series, the largest to date, confirms the essential and major criteria previously proposed by Sontineni et al7 but additionally expands the major criteria and modifies the previously proposed “characteristics suggestive of the diagnosis.” Firstly, long-term cannabis use is essential for the diagnosis. The major features
Conclusion
Cannabinoid hyperemesis should be considered in younger patients with long-term cannabis use and recurrent nausea, vomiting, and abdominal pain. The timing, location, and characteristics of symptoms can be helpful in determining the diagnosis of CH, and patients should be asked about the relief of symptoms with hot water bathing. Cessation of cannabis use should result in improvement of clinical symptoms. Studies with higher rates of follow-up are needed, and validation of the proposed
Acknowledgments
We thank Donna K. Lawson, LPN, (Mayo Clinic, Rochester, MN) for assistance with data collection and Felicity T. Enders, PhD, (Mayo Clinic, Rochester, MN) for assistance with data analysis.
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