I'll preface everything by stating this paper is not high science.
These authors performed a retrospective chart review on adult patients who they thought had cannabinoid hyperemesis syndrome (CHS) in their single ED in northern Melbourne.
Obviously, the diagnosis of CHS is based on clinical findings. There is no blood test for CHS and no agreed formal diagnostic criteria. So, who knows if they identified all patients with CHS or if the ones they diagnosed truly had it?
Nevertheless, there might be a few useful pieces of information… so let’s continue on our magic carpet ride.
142 patients were included. 77 were unique presentations and the rest were frequent visitors.
I’m not going to report their clinical features as this formed part of how they identified patients in the first place… kind of an incorporation bias. (Suffice to say, they were vomiting a lot.) Plus, the retrospective nature of the data means a lot of things were probably not recorded (i.e. relief from hot shower was only written down 11% of the time).
More objectively, I was interested to see that most had elevated white blood cell counts and lactates. Median WBC was 14 (IQR 11.2-16.8) and lactate was 1.95 (IQR 1.4-2.9)
These doctors also liked droperidol and the authors go on to state, “Response to droperidol (or haloperidol) as previously reported may also guide clinicians in their determination as to whether CHS should be considered.”
Arguably the best part of the paper is their proposed CHUNDER score to aid in the diagnosis of CHS. This mnemonic stands for, “Cyclical vomiting, History of regular cannabis, Under fifty years old, Normal lipase, Diagnosis of exclusion, Elevation of CRP<50, and Reduction in symptoms after droperidol.
I’m chunder struck…
Rotella J, Ferretti O, Raisi E, et al. Cannabinoid hyperemesis syndrome: A-year audit of adult presentations to an urban district hospital. 2022 Feb 23. doi: 10.1111/1742-6723.13944 [link to article]