title: Cannabis Hyperemesis Syndrome in the Emergency Department: How Can a Specialized Addiction Team Be Useful? A Pilot Study.
abstract: BACKGROUND
  Chronic cannabis users may experience cyclical episodes of nausea and vomiting and learned behavior of hot bathing. This clinical condition, known as cannabis hyperemesis syndrome, was first reported in 2004.
  
  
  OBJECTIVE
  Our aim was to promote early recognition of this syndrome in emergency departments (EDs) and to increase referral to addiction specialists.
  
  
  METHODS
  Cannabis abusers were admitted to the ED for vomiting or abdominal pain from June 1, 2014 to January 1, 2015 and diagnosed with cannabis hyperemesis syndrome by a specialized addiction team. Then, medical records were examined retrospectively.
  
  
  RESULTS
  Seven young adults were included. Their mean age was 24.7 years (range 17-39 years) and the majority were men (male-to-female ratio 1.2). Biological and toxicological blood samples were taken in all patients. Tetrahydrocannabinol blood level was measured in 4 patients, with a mean blood concentration of 11.6 ng/mL. Radiographic examination including abdominal computed tomography and brain imaging were negative, as was upper endoscopy. Five patients compulsively took hot baths in an attempt to decrease the symptoms. Treatment was symptomatic. Five patients have started follow-up with the specialized addiction team.
  
  
  CONCLUSIONS
  Cannabis hyperemesis syndrome is still under-diagnosed 10 years after it was first described. Physicians should be aware of this syndrome to avoid repeated hospitalizations or esophageal complications. Greater awareness should lead to prompt treatment and prevention of future recurrence through cannabis cessation. Addiction specialists, as well as medical toxicologists, are experts in the management of cannabis abusers and can help re-establish the role of medical care in this population in collaboration with emergency physicians.
authors.affiliation: Poisons Center, Toulouse-Purpan University Hospital, Toulouse, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Pélissier
authors.affiliation: Pediatric Emergency Unit, Children's Hospital, CHU Toulouse, Toulouse, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Claudet
authors.affiliation: Laboratory of Pharmacokinetics and Clinical Toxicology, Institute of Biology, University Hospital of Toulouse, Toulouse, France.
authors.forename: Peggy
authors.initials: P
authors.lastname: Gandia-Mailly
authors.affiliation: National Institute for Medical Research (INSERM) U-669, Hôpital Universitaire Paul Brousse, Villejuif, France.
authors.forename: Amine
authors.initials: A
authors.lastname: Benyamina
authors.affiliation: Poisons Center, Toulouse-Purpan University Hospital, Toulouse, France; Department of Addiction Treatments, Toulouse-Purpan University Hospital, Toulouse, France; Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1027, Paul Sabatier University, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Franchitto
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D002188:Cannabis / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000097:blood / Q000150:complications*; D010348:Patient Care Team / Q000592:standards*; D010865:Pilot Projects; D012017:Referral and Consultation / Q000639:trends; D019966:Substance-Related Disorders / Q000628:therapy*; D014839:Vomiting / Q000209:etiology*
keywords: addiction-consultation liaison; cannabis abuse; emergency; hyperemesis