Synthetic cannabinoid hyperemesis resulting in rhabdomyolysis and acute renal failure

Argamany, Jacqueline R.; Reveles, Kelly R.; Duhon, Bryson M.

doi:10.1016/j.ajem.2015.08.051

Cited by 29 publications

(18 citation statements)

References 8 publications

(7 reference statements)

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“…One recent report described a case of hyperemesis and rhabdomyolysis after a patient used a synthetic cannabinoid product, but this was non-exertional rhabdomyolysis and a different compound. 13 We believe that this patient's learned behavior of alleviation of CHS symptoms with strenuous exercise gives additional support to the hypothesis of redistribution of blood flow from the gut as the mechanism behind the hot-water bathing learned behavior characteristic of CHS. Clinicians should ask patients with CHS about their exercise habits and have a high index of suspicion for exercise-associated injuries and conditions, such as rhabdomyolysis.…”

Section: Discussionsupporting

confidence: 59%

Running Out of Options: Rhabdomyolysis Associated with Cannabis Hyperemesis Syndrome

Trappey

Olson

2017

J GEN INTERN MED

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Cannabis hyperemesis syndrome (CHS) is a condition in which some patients with long-term, frequent use of cannabis paradoxically develop recurrent episodes of nausea and vomiting. The pathophysiology underlying this condition is poorly understood, as is the explanation for its common association with patients' discovery that hot-water bathing alleviates symptoms. We describe the case of a 24-year-old male with daily marijuana use and a history of CHS who was found to have rhabdomyolysis induced by a period of 15 h of continuous jogging after he discovered that this activity helped to alleviate his symptoms. To our knowledge, this is the first reported case of exercise-alleviated CHS symptoms, and we propose that this case provides support to the theory of redistribution of enteric blood flow as the mechanism behind the learned hot-water bathing behavior seen so commonly in CHS.

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Section: Discussionsupporting

confidence: 59%

Running Out of Options: Rhabdomyolysis Associated with Cannabis Hyperemesis Syndrome

Trappey

Olson

2017

J GEN INTERN MED

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“…For these case series, the following CHS pharmacologic treatments were reported as helpful: benzodiazepines (six), topical capsaicin (five), haloperidol (five), and olanzapine (one) . The 44 level‐5 case reports involved 44 patients . For these case reports, the following CHS pharmacologic treatments were reported as effective: benzodiazepines (five), metoclopramide (four), haloperidol (four), ondansetron (two), morphine (two), and topical capsaicin (two) .…”

Section: Resultsmentioning

confidence: 99%

“…Medications ineffective with exception of fentanyl patches Case report 67 Morphine, ondansetron 5 1 Medications ineffective Case report 68 Ondansetron, promethazine 5 1 Medications ineffective (continued) complexity of the endocannabinoid system and hypothalamic-pituitary-adrenal (HPA) axis regulation of nausea and emesis, it is not surprising that no one consistently effective class of antiemetics was cited for the treatment of CHS. 12 Endogenous cannabinoids bind to the G protein-coupled cannabinoid receptors CB1 and CB2.…”

Section: Medications Ineffectivementioning

confidence: 99%

Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review

et al. 2017

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Cannabinoid hyperemesis syndrome (CHS) has become more prevalent with increasing cannabis use. CHS is often resistant to standard antiemetics. The objective of this study is to review the current evidence for pharmacologic treatment of CHS. Medline, PsycINFO, DARE, OpenGrey, Google Scholar, and the Cochrane Library were searched from inception to February 2017. Articles were selected and reviewed independently. Evidence was graded using Oxford Center for Evidence-Based Medicine guidelines. The search resulted in 1262 articles with 63 of them eligible for inclusion (205 human subjects). There were 4 prospective level-2, 3 retrospective level-3 studies, 12 level-4 case series, and 44 level-5 case reports. Among level-2 studies (64 subjects), tricyclic antidepressants (TCAs) and lorazepam were discussed as effective long- and short-term treatments, respectively, in two studies. Ondansetron, promethazine, diphenhydramine, and opioids were also mentioned, but the authors did not comment on their efficacy. Among level-3 studies (43 subjects), one reported effective treatment with antiepileptics zonisamide and levetiracetam, but not TCAs. Another reported favorable response to morphine, ondansetron, and lorazepam but did not specify the actual number of patients receiving specific treatment. Among the level-4 case series (54 subjects), benzodiazepines, haloperidol, and capsaicin were reported as helpful. For level-5 case reports (44 subjects), benzodiazepines, metoclopramide, haloperidol, ondansetron, morphine, and capsaicin were reported as effective. Effective treatments mentioned only once included fentanyl, diazepam, promethazine, methadone, nabilone, levomepromazine, piritramide, and pantoprazole. Hot showers and baths were cited in all level-4 and -5 articles as universally effective. High-quality evidence for pharmacologic treatment of CHS is limited. Benzodiazepines, followed by haloperidol and capsaicin, were most frequently reported as effective for acute treatment, and TCAs for long-term treatment. As the prevalence of CHS increases, future prospective trials are greatly needed to evaluate and further define optimal pharmacologic treatment of patients with CHS.

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“…Some other side effects of SCs like hypokalemia or hyperthermia may also have contribution. [16][17][18] In addition to these two clinical approaches, unfortunately the pathophysiology of cannabinoid-associated renal injury has not been fully clarified. The treatment strategies for SC induced rhabdomyolysis did not differ from classical approaches.…”

Section: Cannabinoid Hyperemesis Syndrome (Chs)mentioning

confidence: 99%

Synthetic cannabinoids in the kidneys

Alp

Akdam

Avcioglu

et al. 2017

Rev. Assoc. Med. Bras.

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Synthetic cannabinoid hyperemesis resulting in rhabdomyolysis and acute renal failure

Cited by 29 publications

References 8 publications

Running Out of Options: Rhabdomyolysis Associated with Cannabis Hyperemesis Syndrome

Running Out of Options: Rhabdomyolysis Associated with Cannabis Hyperemesis Syndrome

Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review

Synthetic cannabinoids in the kidneys

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