Hyperemesis and a High Water Bill

Zusammenfassung

Ein 28-jähriger Patient wurde mit Hyperemesis aufgenommen, die seit mehreren Tagen bestand und ambulant nicht zu therapieren war. Alle gängigen Differenzialdiagnosen wurden ausgeschlossen, alle Untersuchungen blieben ohne pathologischen Befund. Er berichtete über regelmäßigen Cannabis-Konsum und zeigte ein auffälliges Waschverhalten: mehrfach am Tag nahm er eine heiße Dusche, die einzelnen Sitzungen dauerten jeweils über eine Stunde. Dies war die einzige Maßnahme, die seine Übelkeit wirksam minderte. Aufgrund dieser klinischen Befunde konnte die Diagnose eines cannabisinduzierten Hyperemesis-Syndroms gestellt werden (cannabinoid hyperemesis syndrome). Nach dem Cannabis-Entzug blieb er symptomfrei. Das cannabisinduzierte Hyperemesis-Syndrom wurde erstmals 2004 in Australien beschrieben und ist eine oft unerkannte Ursache von therapierefraktärer Hyperemesis in der Kombination mit zwanghaftem Waschverhalten. Unseres Wissens handelt es sich um den ersten berichteten Fall aus Deutschland.

Abstract

A male patient aged 28 years was admitted with hyperemesis that did not cease in spite of different therapeutic approaches and had persisted for several days. A wide range of differential diagnoses was excluded and all tests remained without pathological findings. He reported regular cannabis use and showed abnormal bathing behavior taking hot showers several times a day for more than one hour each, which was the only measure to ease his nausea; on the basis of these clinical findings, the diagnosis of cannabinoid hyperemesis syndrome was made. After detoxification, he remained free of symptoms. Cannabinoid hyperemesis syndrome was first described in 2004 in Australia and is an underrecognized cause of hyperemesis and abnormal bathing behavior. To the best of our knowledge, this is the first reported case in Germany.

cannabisinduziertes Hyperemesis-Syndrom - Hyperemesis - zwanghaftes Waschverhalten - Cannabisabusus

cannabinoid hyperemesis syndrome - hyperemesis - compulsive bathing - marijuana abuse

References

• 1 Allen J H, Moore G M, Heddle de R et al. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse.  Gut. 2004;  53 1566-1570
• 2 Roche E, Foster P N. Cannabinoid hyperemesis: not just a problem in Adelaide Hills.  Gut. 2005;  54 731
• 3 Boeckxstaens G E. Cannabinoid hyperemesis with the unusual symptom of compulsive bathing.  Ned Tijdschr Geneeskd. 2005;  149 1468-1471
• 4 Wolfhagen F H. Cannabinoid hyperemesis with the unusual symptom of compulsive bathing.  Ned Tijdschr Geneeskd. 2005;  149 1970
• 5 Alfonso Moreno V, Ojesa F, Moreno-Osset E. Cannabinoid hyperemesis.  Gastroenterol Hepatol. 2006;  29 434-435
• 6 Vaziri N D, Thomas R, Sterling M et al. Toxicity with intravenous injection of crude marijuana extract.  Clin Toxicol. 1981;  18 353-366
• 7 Wallace D, Martin A L, Park B. Cannabinoid hyperemesis: marijuana puts patients in hot water.  Australas Psychiatry. 2007;  15 156-158
• 8 Singh E, Coyle W. Cannabinoid hyperemesis.  Am J Gastroenterol. 2008;  103 1048-1049
• 9 Budhraja V, Narang T, Azeez S. Cannabinoid hyperemesis syndrome: cyclic vomiting, chronic cannabis use, and compulsive bathing.  Practical Gastroenterology. 2008;  32 79-80
• 10 Chepyala P, Olden K W. Cyclic vomiting and compulsive bathing with chronic cannabis abuse.  Clin Gastroenterol Hepatol. 2008;  6 710-712
• 11 Chang Y H, Windish D M. Cannabinoid hyperemesis relieved by compulsive bathing.  Mayo Clin Proc. 2009;  84 76-78
• 12 Donnino M W, Cocchi M N, Miller J et al. Cannabinoid hyperemesis: A case series.  J Emerg Med. 2009;  ; Sep 16 [Epub ahead of print]
• 13 Sontineni S P, Chaudhary S, Sontineni V et al. Cannabinoid hyperemesis syndrome: clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse.  World J Gastroenterol. 2009;  15 1264-1266
• 14 Watts M. Cannabinoid hyperemesis presenting to a New Zealand hospital.  N Z Med J. 2009;  122 116-118
• 15 Ochoa-Mangado E, Jimenez Gimenez M, Salvador Vadillo E et al. Cyclical hyperemesis secondary to cannabis abuse.  Gastroenterol Hepatol. 2009;  32 406-409
• 16 Patterson D A, Smith E, Monahan M et al. Cannabinoid hyperemesis and compulsive bathing: a case series and paradoxical pathophysiological explanation.  J Am Board Fam Med. 2010;  23 790-793
• 17 Soriano-Co M, Batke M, Cappell M S. 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.  Dig Dis Sci. 2010;  55 3113-3119
• 18 Sullivan S. Cannabinoid hyperemesis.  Can J Gastroenterol. 2010;  24 284-285
• 19 Mattens V, Aerts M, Mana F et al. Daily cannabis use and the digestive tract: an underrecognized relationship.  Acta Gastroenterol Belg. 2010;  73 403-405
• 20 Miller J B, Walsh M, Patel P A et al. Pediatric cannabinoid hyperemesis: two cases.  Pediatr Emerg Care. 2010;  26 919-920
• 21 Schmid S M, Lapaire O, Huang D J et al. Cannabinoid hyperemesis syndrome: an underreported entity causing nausea and vomiting of pregnancy.  Arch Gynecol Obstet. 2010;  ; Dec 18 [Epub ahead of print]
• 22 Machado Rocha F C, Stefano S C, De Cassia Haiek R et al. Therapeutic use of Cannabis sativa on chemotherapy-induced nausea and vomiting among cancer patients: systematic review and meta-analysis.  Eur J Cancer Care. 2008;  17 431-443
• 23 Iversen L. Cannabis and the brain.  Brain. 2003;  126 1252-1270
• 24 Ware M A, Daeninck P, Maida V. A review of nabilone in the treatment of chemotherapy-induced nausea and vomiting.  Ther Clin Risk Manag. 2008;  4 99-107
• 25 Pertwee R G. Cannabinoids and the gastrointestinal tract.  Gut. 2001;  48 859-867
• 26 Gill E W, Paton W D, Pertwee R G. Preliminary experiments on the chemistry and pharmacology of cannabis.  Nature. 1970;  228 134-136
• 27 Pertwee R G. Effects of cannabinoids on thermoregulation: a brief review. In Harvey D J, ed Marihuana ’84.. Oxford: IRL press; 1984: 263-277
• 28 Pertwee R G. Cannabis and cannabinoids: pharmacology and rationale for clinical use.  Forsch Komplementarmed. 1999;  6 (Suppl 3) 12-15
• 29 Lozano I. The therapeutic use of Cannabis sativa (L.) in Arabic medicine.  J Cannabis Ther. 2001;  1 63-70
• 30 Smirnov M S, Kiyatkin E A. Behavioral and temperature effects of delta 9-tetrahydrocannabinol in human-relevant doses in rats.  Brain Res. 2008;  1228 145-160