Download PDF
Z Gastroenterol 2011; 49(11): 1479-1481
DOI: 10.1055/s-0029-1246107
Kasuistik

© Georg Thieme Verlag KG Stuttgart · New York

Hyperemesis and a High Water Bill

Hyperemesis und eine hohe WasserrechnungS. Fleig1 , R. Brunkhorst2
  • 1Klinik für Nieren- und Hochdruckerkrankungen, Zentrum Innere Medizin, Medizinische Hochschule Hannover
  • 2Medizinische Klinik I, Klinikum Oststadt-Heidehaus, Hannover
Further Information

Publication History

manuscript received: 29.11.2010

manuscript accepted: 1.2.2011

Publication Date:
08 November 2011 (online)

Also available at
    Permissions and Reprints

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.

Schlüsselwörter

cannabisinduziertes Hyperemesis-Syndrom - Hyperemesis - zwanghaftes Waschverhalten - Cannabisabusus

Key words

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
    Google Scholar
  • 2 Roche E, Foster P N. Cannabinoid hyperemesis: not just a problem in Adelaide Hills.  Gut. 2005;  54 731
    Google Scholar
  • 3 Boeckxstaens G E. Cannabinoid hyperemesis with the unusual symptom of compulsive bathing.  Ned Tijdschr Geneeskd. 2005;  149 1468-1471
    Google Scholar
  • 4 Wolfhagen F H. Cannabinoid hyperemesis with the unusual symptom of compulsive bathing.  Ned Tijdschr Geneeskd. 2005;  149 1970
    Google Scholar
  • 5 Alfonso Moreno V, Ojesa F, Moreno-Osset E. Cannabinoid hyperemesis.  Gastroenterol Hepatol. 2006;  29 434-435
    Google Scholar
  • 6 Vaziri N D, Thomas R, Sterling M et al. Toxicity with intravenous injection of crude marijuana extract.  Clin Toxicol. 1981;  18 353-366
    Google Scholar
  • 7 Wallace D, Martin A L, Park B. Cannabinoid hyperemesis: marijuana puts patients in hot water.  Australas Psychiatry. 2007;  15 156-158
    Google Scholar
  • 8 Singh E, Coyle W. Cannabinoid hyperemesis.  Am J Gastroenterol. 2008;  103 1048-1049
    Google Scholar
  • 9 Budhraja V, Narang T, Azeez S. Cannabinoid hyperemesis syndrome: cyclic vomiting, chronic cannabis use, and compulsive bathing.  Practical Gastroenterology. 2008;  32 79-80
    Google Scholar
  • 10 Chepyala P, Olden K W. Cyclic vomiting and compulsive bathing with chronic cannabis abuse.  Clin Gastroenterol Hepatol. 2008;  6 710-712
    Google Scholar
  • 11 Chang Y H, Windish D M. Cannabinoid hyperemesis relieved by compulsive bathing.  Mayo Clin Proc. 2009;  84 76-78
    Google Scholar
  • 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]
    Google Scholar
  • 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
    Google Scholar
  • 14 Watts M. Cannabinoid hyperemesis presenting to a New Zealand hospital.  N Z Med J. 2009;  122 116-118
    Google Scholar
  • 15 Ochoa-Mangado E, Jimenez Gimenez M, Salvador Vadillo E et al. Cyclical hyperemesis secondary to cannabis abuse.  Gastroenterol Hepatol. 2009;  32 406-409
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 18 Sullivan S. Cannabinoid hyperemesis.  Can J Gastroenterol. 2010;  24 284-285
    Google Scholar
  • 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
    Google Scholar
  • 20 Miller J B, Walsh M, Patel P A et al. Pediatric cannabinoid hyperemesis: two cases.  Pediatr Emerg Care. 2010;  26 919-920
    Google Scholar
  • 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]
    Google Scholar
  • 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
    Google Scholar
  • 23 Iversen L. Cannabis and the brain.  Brain. 2003;  126 1252-1270
    Google Scholar
  • 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
    Google Scholar
  • 25 Pertwee R G. Cannabinoids and the gastrointestinal tract.  Gut. 2001;  48 859-867
    Google Scholar
  • 26 Gill E W, Paton W D, Pertwee R G. Preliminary experiments on the chemistry and pharmacology of cannabis.  Nature. 1970;  228 134-136
    Google Scholar
  • 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
    Google Scholar
  • 28 Pertwee R G. Cannabis and cannabinoids: pharmacology and rationale for clinical use.  Forsch Komplementarmed. 1999;  6 (Suppl 3) 12-15
    Google Scholar
  • 29 Lozano I. The therapeutic use of Cannabis sativa (L.) in Arabic medicine.  J Cannabis Ther. 2001;  1 63-70
    Google Scholar
  • 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
    Google Scholar

Susanne Fleig

Klinik für Nieren- und Hochdruckerkrankungen, Zentrum Innere Medizin, Medizinische Hochschule Hannover

Carl-Neuberg-Str. 1

30625 Hannover

Germany

Phone: + 49/5 11/5 32 63 19

Fax: + 49/5 11/55 23 66

Email: fleig.susanne@mh-hannover.de