CHS

Q: In cannabis hyperemesis syndrome (CHS) which of the following seems to be most effective? (select one)

A) droperidol

B) ondansetron

C) metoclopramide

D) diphenhydramine 

E) topical capsaicin 

Answer: A

In cannabis hyperemesis syndrome (CHS) it is important to perform detailed history and evaluation. Many institutions/ERs use the Rome IV criteria to diagnose CHS. The most vital strategy is to rule out all other potential causes of hyperemesis.

IV hydration is of paramount importance and works synergistically with antiemetics. 1 L of normal saline or lactated Ringer should be initiated as quickly as possible. Droperidol or haloperidol (dopamine antagonists) are very effective in controlling acute symptoms of CHS.

Ondansetron, metoclopramide, and diphenhydramine are often ineffective in CHS.

Benzodiazepines are partially effective.

Interestingly, topical capsaicin has some weak evidence of effectiveness in CHS.

#toxicology

#GI

#pharmacology

References:

1. Perisetti A, Gajendran M, Dasari CS, et al. Cannabis hyperemesis syndrome: an update on the pathophysiology and management. Ann Gastroenterol 2020; 33:571.

2. ROME Foundation, Rome IV Criteria. https://theromefoundation.org/rome-iv/rome-iv-criteria/ (Accessed on November 24, 2023)

3. Richards JR. Cannabinoid Hyperemesis Syndrome: Pathophysiology and Treatment in the Emergency Department. J Emerg Med 2018; 54:354.

4. Chocron Y, Zuber JP, Vaucher J. Cannabinoid hyperemesis syndrome. BMJ 2019; 366:l4336.

5. Sorensen CJ, DeSanto K, Borgelt L, et al. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review. J Med Toxicol 2017; 13:71.