I'll preface everything by stating this paper is not high science.
Sorry…
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…
Covering:
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]
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