9/20/2016 AM Report – Cannabinoid Hyperemesis Syndrome

Cyclic Vomiting Syndrome
Define:

  • Stereotypical episodes of vomiting <1 week
  • 3 episodes in past year, 2 in past 6 months, at least one week apart
  • Absence of vomiting between episodes

3 Phases – Interepisodic, Prodromal, and Vomiting

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Epidemiology:

  • More common in children
  • More frequent bouts in children (12/year) vs. adults (4/year)
  • Broad age of onset for adults
  • Symptoms longer for adults prior to diagnosis
  • Nausea between episodes is more common in adults

Differential diagnosis:

ACUTE:

  • Acute gastroenteritis (rotovirus, enteric aderovirus, norovirus)
  • Post-operative nausea/vomiting
  • Vestibular neuritis
  • Chemotherpy/Drugs

CHRONIC:

  • Pregnancy
  • Chronic nausea/vomiting syndrome
  • Gastroparesis
  • Gastric outlet obstruction
  • CVS
  • Rumination syndrome

Cannabinoid Hyperemesis Syndrome
Define:

  • Stereotypical episodic vomiting similar to CVS (onset, duration, frequency)
  • Presentation after prolonged/excessive cannabis use
  • Relief of symptoms with sustained (1 week) cessation of cannabis*

* often associated with pathologic bathing behavior (prolonged hot baths/showers) – considered pathognomonic for CHS

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