Cyclic vomiters (drive me up the wall)

Anna Flaxis, BSN, RN · Sep 29, 2014

Thank you for sharing your story, HoneyMagnolia.

I have never cared for a pediatric patient with CVS, and I wonder if there might be some key differences between childhood and adult onset of CVS, as far as causes and contributing factors and so on?

Unlike some of the other posters here, the patients who have cannabis induced CVS (Cannabinoid Hyperemesis Syndrome) that I have taken care of are in the minority, but the nice thing about it is that there is an identified cause (whether the patient will ever stop using cannabis even though it makes them so sick is another story).

The adult patients with CVS that I have cared for have typically also displayed some really challenging behaviors that point to, as another poster stated, unmet psycho-social needs, which makes me highly suspicious for psychologically/emotionally induced symptoms. Of course, correlation does not equal causation, but it's interesting to me that for so many of the adult patients with CVS that I encounter, behavioral issues seem to go hand in hand with it.

Of course, this is very much distinct from some people who have other health problems that affect their GI motility- when their system is thrown out of whack by some insult, such as ineffective blood sugar control, viral infections, or even emotional stressors, you can see the connections between other body systems and their GI function. You can see it reflected in lab studies and diagnostic imaging.

I think what is so frustrating for so many of us is the former group, the adult onset CVS with no discernible lab abnormalities and nothing out of the ordinary on any imaging studies to explain the symptoms (which is why it's referred to as a "syndrome"), who act out in ways that are difficult to manage in an Emergency Department setting. After you've taken care of enough people who present this way, you begin to develop an opinion of what CVS is and what people with CVS are like- and, since this is a nursing forum, our discussions tend to be from the perspective of the nurse. :-)

I just wanted to thank you for not taking a defensive tone in your post. It was very informative.

Anyway, best of luck to you and yours.

That Guy, BSN, RN, EMT-B · Sep 30, 2014

5mg of Haldol. Seriously it is the absolute best I have ever seen for stopping it.

allnurses Guide · Sep 30, 2014

CVS is actually far more common in children.

As for adults, I have three patients on my panel with adult-onset CVS. All of them are former/current heavy THC abusers. What came first the chicken or the egg is the question. My professional policy is that narcotics are not indicated.

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**NickiLaughs, ADN, BSN, RN** · Oct 1, 2014

I had one guy who would come in every 6 weeks for CVS. Turns out he had cannabis induced hyperemesis. He smoked so much pot everyday all day long it got him admitted in the hospital every couple of weeks. You know what they say...too much of a good thing.

I feel like I might take care of the same guy. Huge ER and I get stuck with him every time. Frustrating because he doesn't do anything I ask him to, like stay in bed and don't drink water out of the sink. Nothing seems to work to make it stop either!!!

Christy1019, ASN, RN · Oct 4, 2014

I feel like I might take care of the same guy. Huge ER and I get stuck with him every time. Frustrating because he doesn't do anything I ask him to, like stay in bed and don't drink water out of the sink. Nothing seems to work to make it stop either!!!

I've noticed a trend that our CVS pts also tend to drink from the sink when they are told they can't have water. I don't know much about CVS, but I wonder if its because they feel so thirsty, because their throats are burning from the acidity, or because it feels easier to vomit something up than to just dry heave.

I personally would rather be in constant pain than to have constant nausea. I find that pain has more treatment options, but chronic nausea has far fewer treatments, and next to nothing over the counter works.

Guest219794 · Oct 7, 2014

By an overwhelming majority, most of the vomiting or cyclic vomiting PTs I treat are not vomiting.

They may be complaining of vomiting, but the effects of simply being in an ER bed seem to cure it.

So, we give IV zofran despite the proven efficacy of SL, and we give IVF despite their proven ability to drink water.

Since this treatment does not seem to induce vomiting, we call it successful.

Just got off 40 hrs in three days, no lunch. 6 hrs total commute time. I have noticed my posts are more cynical than usual.

Is this normal?

allnurses Guide · Oct 8, 2014

We had one CVer that was so non-compliant, along with many other needy behaviors, that we would actually turn off the water in the sink in her room. She died, likely of hyponatremia, but they didn't come back and confirm that to us, in her 40s. No idea if she was doing THC, but I don't recall it ever being mentioned.

psu_213, BSN, RN · Oct 9, 2014

We had one CVer that was so non-compliant, along with many other needy behaviors, that we would actually turn off the water in the sink in her room.

We had a CV patient that would drink the tap water, then force herself to vomit. Eventually we got away from offering her anything other than insulin for hyperglycemia and fluids for AKI. Now she has stopped coming to our ED.

skylark, BSN, RN · Oct 14, 2014

I know of one that seems to be genuine, comes in about every two months or so. No drug habit, doesn't want pain meds, just constant zofran and IV fluids. She is a student, and Mom comes with her. She does seem to have a rather needy personality, but then again, I guess we all do when we are nauseous?

But I have to agree that all the rest appear to be cannabis-induced.

foragreatergood · Oct 16, 2014

The parent of a 12yr old that comes in q 6-8 wks vomiting said he had done some of his own research and requested that we try an amp of D50. Patient was not diabetic, and FS was 78. So after multiple doses of Zofran, reglan and fluids I asked the MD, and since we had nothing to loose - I gave it. It worked. Why? I have no idea.

allnurses Guide · Oct 16, 2014

The parent of a 12yr old that comes in q 6-8 wks vomiting said he had done some of his own research and requested that we try an amp of D50. Patient was not diabetic, and FS was 78. So after multiple doses of Zofran, reglan and fluids I asked the MD, and since we had nothing to loose - I gave it. It worked. Why? I have no idea.

IMHO it's a different disorder in kids.

But from UpToDate:

"During vomiting episodes, the goal is to abort or shorten the episode. Anecdotal experience in children suggests that intravenous administration of a 10 percent dextrose solution can decrease the frequency and duration of vomiting episodes [26] in about one-half of patients."

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AZQuik · Oct 18, 2014

Drive me up the wall as well. My 13 y/o has it and the only thing that drives me up the wall more is the incompetency of the pediatric physicians in our area and the 150k I have paid in out of pocket hospital stays.

We have been on Medicare for about 6 months when my wife lost her job and I was finishing nursing school, and the judgement of healthcare workers thinking we are simply uneducated mooches is even worse. I had a physician try to explain to me last week just how expensive healthcare actually is, like I had never paid for anything. Her eyes about popped out of her head when I told her how much I have paid the last 10 years, and told her we have been riding the verge of bankruptcy this whole time. She said "why hasn't Medicare paid? "

Think it's hard taking care of one on a shift? Try raising one

BSN GCU 2014. Waiting to take my boards.

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