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The cannabis hyperemesis syndrome characterized by persistent nausea and vomiting, abdominal pain, and compulsive bathing associated with chronic marijuana use: a report of eight cases in the United States

Soriano-Co, M., 2010, The cannabis hyperemesis syndrome characterized by persistent nausea and vomiting, abdominal pain, and compulsive bathing associated with chronic marijuana use: a report of eight cases in the United States

- The mean interval between the onset of cannabis use and the development of recurrent vomiting was 19.0 -/+ 3.7 years. In all cases marijuana use predated the onset of CHS. - All patients were daily marijuana users smoking between 2-10 joints per day. - The average frequency of vomiting or retching episodes was every 3.0 +/- 1.7 hours.

Clinical Characteristics, Comorbidities and Hospital Outcomes in Hospitalizations with Cyclic Vomiting Syndrome: A Nationwide Analysis

Bhandari, S., 2017, Clinical Characteristics, Comorbidities and Hospital Outcomes in Hospitalizations with Cyclic Vomiting Syndrome: A Nationwide Analysis

Study type and years: Cross-sectional analysis of hospitalization data 2010-2011 Population and location: Hospital inpatients age 18-55 years with and without cyclic vomiting, n>13,000 Exposure: Multiple covariates examined, including marijuana use Outcomes: Cyclic vomiting syndrome by diagnostic coding

- Found significant association between CVS and marijuana use (OR=5.5, 95% CI 4.5-6.7, p<0.001) - 14% of CVS patients used marijuana versus 3% of non-CVS patients.

von Both, I., et al., 2021, Death of a young woman with cyclic vomiting: a case report

Study Type and Years: Case Report Population and Location: 22-year-old woman with history of anxiety and cyclic vomiting Exposures: 3.5 year history of cyclic vomiting & 8 year history of cannabis use Outcomes: Cannabinoid hyperemesis syndrome, cardiac arrest, death

- Patient presented to the ED 6 times in the 6 months prior to her death -- Hypokalemic at all visits -- Treatment consisted of: fluid & electrolyte replacement, lorazepam, ondansetron, gravol, olanzapine, and/or haloperidol. --- One visit patient stated she discontinued cannabis use for 3 months with no improvement of symptoms - Two days prior to final ED visit: main complaint of nausea & vomiting, hypokalemic, and electrocardiogram demonstrated borderline QT interval. -- Electrolytes corrected, given haloperidol, lorazepam, and ondansetron. - Final visit: bradycardic, hypertensive, dry mucous membranes, hypokalemic. -- Rehydrated with normal saline, three doses of potassium phosphate, ondansetron, olanzapine, and dimenhydrinate. -- Found w/o vital signs 25mins after receiving dimenhydrinate. -- ECG demonstrated ventricular fibrillation. Converted to torsades de pointes after defib. Resuscitation achieved brief return of spontaneous circulation, but subsequently arrest

10.1016/j.jadohealth.2020.09.024

Lonsdale, H., et al., 2020, Pediatric Cannabinoid Hyperemesis: A Single Institution 10-Year Case Series

Study Type and Years: Case series, January 1, 2007

- 34 cases of pediatric/adolescent cannabinoid hyperemesis were identified. - Length of use before symptom onset was available for 50% of the sample and the median length of use was 42 months. - Frequency of use before symptoms onset was available for 70% of the sample and the median frequency of use was 21 times per week. - All 34 cases presented with nausea and emesis, 91% with abdominal pain, and 85% reported a cyclical nature of symptoms. - 88% of patients had history of similar episodic emesis, usually lasting several days.

10.1016/j.jemermed.2009.07.033

Donnino, M. W., 2011, Cannabinoid hyperemesis: a case series

Study type and dates: Case series; 2005-2008 Population: 3 patients with daily cannabis use Exposure: Daily cannabis use Outcome: Cyclic vomiting

- Three patients with daily cannabis use had recurrent bouts of cyclic vomiting, which resolved for those who quit or reduced their cannabis use

Simonetto, D. a., 2012, Cannabinoid hyperemesis: a case series of 98 patients

- 68% reported using cannabis for more than 2 years before symptom onset with 13% of patients reporting use for greater than 11 years, 11% with use between 6-10 years and 44% with use between 2-5 years. - 59% of patients were daily marijuana users, 16% used 4-6 times per week, 20% used 1-3 times per week and 5% reported use less than once per week. - All had symptoms of nausea and vomiting that occurred in cyclic nature. - Follow up was available in 10 patients and among those, 30% did not abstain from cannabis use and continued to have symptoms. Six patients (60%) stopped using cannabis and noted complete resolution of their symptoms.

Nicolson, S. E., 2012, Cannabinoid hyperemesis syndrome: a case series and review of previous reports

Study type and dates: Case series; dates not given Population: 4 patients with chronic daily cannabis use Exposure: Chronic daily cannabis use Outcome: Cyclic vomiting

- Four patients with chronic daily cannabis use had recurrent bouts of cyclic vomiting, which resolved for those who quit using cannabis

Russo, E. B., et al., 2021, Cannabinoid Hyperemesis Syndrome Survey and Genomic Investigation

Study Type and Years: Cross-sectional study, 11/2019

Of participants meeting criteria for CHS, 85.7% used cannabis daily or greater-than-daily. - All participants reported nausea and vomiting history, often lasting days to years.

10.1097/SMJ.0b013e3182297d57

Wallace, E. A., 2011, Cannabinoid hyperemesis syndrome: literature review and proposed diagnosis and treatment algorithm

- CHS developed after years of chronic daily use (mean 10.2 years SD 7.1). - 28 patients reported cannabis use multiple times per day and in 3 cases amount of use was not specified.

Nourbakhsh, M., 2018, Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases

Study type and dates: Case series; dates not given Population: 3 patients with chronic cannabis use Exposure: Chronic cannabis use Outcome: Cyclic vomiting and death

- Three patients with chronic cannabis use had a history of recurrent bouts of cyclic vomiting; they all died and two of the deaths were attributed to complications of cannabinoid hyperemesis syndrome

Rotella, J. A., et al., 2022, Cannabinoid hyperemesis syndrome: A 6-year audit of adult presentations to an urban district hospital

Study Type and Years: Retrospective chart review, 1/2015

- Patients were included if they reported or had a documented history of cannabis use, had presented with nausea and/or vomiting and alternative diagnoses had been excluded. - Diagnostic criteria used was proposed by Simonetto et al. and Sorensen et al. - Of patients that had a documented history of cannabis use frequency all of them reported daily use. - Of the 142 presentations from 67 different patients; cyclical nausea and/or vomiting was the most common feature (97.2%), then epigastric pain (28.9%), and cyclical abdominal pain (24.6%). Normal bowel habit was seen in 98.5% of patients. Relief from hot showers/bathing was seldom reported (11.2%). - 132 presentations had white cell count and neutrophils investigated, with 75.8% having high values in both (greater than 11.0 and 8.0, respectively). -

Kim, H. S., 2015, Cyclic vomiting presentations following marijuana liberalization in Colorado

Cross-sectional study of cyclic vomiting visits to the emergency department (ED) before and after marijuana liberalization.

- The prevalence of cyclic vomiting visits increased from 41 per 113,262 ED visits to 87 per 125,095 ED visits after marijuana liberalization, corresponding to a prevalence ratio of 1.92 (95% confidence interval [CI] = 1.33 to 2.79). - Patients with cyclic vomiting in the postliberalization period were more likely to have marijuana use documented than patients in the preliberalization period (odds ratio = 3.59, 95% CI = 1.44 to 9.00).

10.1111/j.1365-2982.2006.00867.x

Clinical, psychiatric and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy

Namin, F., 2007, Clinical, psychiatric and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy

Case series of 31 adults diagnosed with cyclic vomiting syndrome

- 13 admitted to daily marijuana use. Two of these patients reported chronic marijuana use since teenage years and were the only 2 of nine patients to experience cessation of symptoms following abstinence from marijuana use.

Allen, J. H., 2004, Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse

Case series of 10 patients diagnosed with CHS "Observational study of 10 patients diagnosed with CHS"

- Cessation of cannabis use lead to cessation of cyclic vomiting in all seven patients who abstained. Three patients did not abstain and continued to have episodes of vomiting. Three patients rechallanged themselves after a period of abstinence and all suffered a return to illness. - The average duration of marijuana use prior to development of CHS was on average 8.6 years (range 2-27 years). In all cases chronic marijuana abuse predated the cyclic vomiting syndrome. - All were daily marijuana users, with 80% reporting 5-10 "cones" per day, 10% reporting 3-4 "cones" per day and 10% reporting 1-5 "cones per day. - All patients experienced vomiting and frequency of attacks ranged from one to twelve months with most reporting episodes every 2-4 months.

Klassen, J., 2018, Cannabinoid Hyperemesis Syndrome Masquerading as Uremia: An Educational Case Report

Study Type and Years: Case report; 2011-2016 Population and Location: 37 year old man; Saskatchewan, Canada Exposures: Medical marijuana used for 7 years prior Outcomes: Hyperemesis lasting 5 years

- A 37 year old man developed severe nausea and vomiting after 7 years of medical marijuana use. Cannabis hyperemesis syndrome was considered after 5 years of treatment including 3 years of dialysis and ongoing IV nausea medications. - Cessation of cannabis use in 2016 resolved the symptoms. The patient continued to refrain and remained symptom free.

Monte, A. A., 2019, Acute Illness Associated With Cannabis Use, by Route of Exposure: An Observational Study

Study Type and Years: Retrospective chart review; 2012 through 2016 Population and Location: Retrospective chart review; 2012 through 2016 Exposures: Cannabis use Outcomes: Emergency department visit

- 301 patients presented for 440 visits due to cannabinoid hyperemesis syndrome (CHS). This was 17.1% of all cannabis attributable ED visits.

Contreras Narvaez, C.

Contreras Narvaez, C., 2016, Cannabinoid hyperemesis syndrome. A report of six new cases and a summary of previous reports

Study type and years: Case series between November 2012 and June 2014 Population and location: 6 patients treated in units of Mataró hospital Exposure: Cannabis use Outcomes: Cyclic vomiting syndrome

- 3 of 6 subjects achieved cannabis absti¬nence and experienced no new CHS episodes - Case series of 6 - Average quantity and frequency of cannabis use was 7.5 'cigarettes' per day (min <1 and max=12 per day). - All patients had been smoking cannabis for at least a year before the first acute episode of CHS; the average was 5.5 years - 3/6 achieved cannabis absti¬nence and experienced no new CHS episodes - Previous case reports (n=83) - Majority of cases male (72.2%). - Average age when vomiting began was 25.9 years. The average onset age of cannabis use was 17.4 years - Bathing in hot water was present in 91% of cases.

doi: 10.1001/jamanetworkopen.2022.31937.

Changes in Emergency Department Visits for Cannabis Hyperemesis Syndrome Following Recreational Cannabis Legalization and Subsequent Commercialization in Ontario, Canada

Cannabinoid hyperemesis syndrome presentation to the emergency department: A two-year multicentreretrospective chart review in a major urban area

10.1001/jamanetworkopen.2021.25063

10.14309/ajg.0000000000002216

Frazier, Rosita MD1; Li, B U.K. MD2; Venkatesan, Thangam MDa,3. Diagnosis and management of cyclic vomiting syndrome: A critical review. The American Journal of Gastroenterology ():10.14309/ajg.0000000000002216, February 15, 2023. | DOI: 10.14309/ajg.0000000000002216

Comparing CHS with CVS