Cannabinoid Hyperemesis Syndrome


Step 1: View clinicals

A 38 year old man presents with nausea, vomiting and abdominal pain for 2 weeks. The nausea and vomiting were unresponsive to therapy with Metoclopramide, but the pain was relieved to an extent by hot showers He had experienced several similar episodes in the past few months, all of which resolved spontaneously over 2 to 3 days. His medical, surgical and family histories are otherwise unremarkable. He has used standard and synthetic K2 cannabinoids for the last 5 years, consuming between 5 to 10 rolls every day, including yesterday. He denies using cocaine, heroin, or other 'hard' drugs, drinks only socially, and does not smoke. A complete blood count reveals mild leukocytosis with a WBC count of 14,000/mm3, while a urinalysis is only significant for hyaline casts. A urine drug screen is negative, while a capillary blood glucose level, ECG, and plain radiograph of the abdomen are also normal.

Step 2: Order all relevant investigations

Serum Electrolytes

Sodium: 123 mmol/L (135-153) Potassium: 3.4 mmol/L (3.5-5.3) Chloride: 74 mmol/L (98-109) Bicarbonate: 21 mmol/L (24-31)

Liver Profile + Pancreatic Enzymes

AST: 16 U/L (<35) ALT: 12 U/L (<35) S. Bilirubin: 0.4 mg/dL (<1) Albumin: 3.9 g/dL (3.4- 5.4) Serum Amylase: 80 U/L (40-140) Serum Lipase: 50 U/L (0-160)

Renal Function Tests

Blood urea nitrogen: 98 mg/dL (5-26) Creatinine: 1.6 mg/dL (0.5-1.5)

Ultrasound Abdomen

The ultrasound scan of the abdomen is normal. No features suggestive of bowel edema are seen.

Step 3: Select appropriate management

IV Fluids

Score: ★★☆