Cannabinoid hyperemesis syndrome

[Emergent, RN]

Have you all encountered providers identifying this syndrome? I think it's under-identified. It's marijuana induced vomiting.

In my state, marijuana has been made legal. Pts are becoming more open about their usage. This makes it more comfortable to approach the subject. One, occasional side effect of cannabinoid usage is hyperemesis. I've been educating my pts regarding this, even if they don't admit that they use.

http://en.wikipedia.org/wiki/Cannabinoid_hyperemesis_syndrome

[CraigB-RN, MSN, RN]

Yeah it's possible, but hard to DX. It's up there with the abdominal migraine DX.

[MILOBRI]

Yes, one of our ED physicians diagnosed a pt with this after consulting the university. The guy was in the ER 8 times in 7 days. He fit the diagnosis to a T.

[imapsychrn]

Does it only occur during the high?

[That Guy, BSN, RN, EMT-B]

Throw them in the shower and give them some haldol. All cleared up.

[thelema13]

How 'bout some Zofran ODT and a sandwich?

[ohiobobcat]

I don't remember the specifics around it, but one of our providers diagnosed this on a patient. I had never heard of it until then.

[CodeteamB]

Not that uncommon where I work, I'd say at least half of our "cyclical vomiting syndrome" patients end up with this diagnosis from the ER docs. It does have some easily identifiable characteristics (eg resolves with bath/shower, and of course history of chronic pot use).

Marijuana is not legal here, but it is decriminalized, and unless you are growing on a large scale the police aren't going to bother with you. People are pretty much open about their 3 J/day habits and have been as long as I have been working, so maybe that (as Emergent suggests) is a reason for it being identified often here.

[foragreatergood]

We have a 19yo m that comes in with this every few months - both him and his dad acknowledge that this is induced by smoking pot. Its usually unrelieved with zofran or reglan and can his stay can last 6 - 12 hours. Its mind boggling to me that he smokes pot again. But he does! I've never heard that a shower can help, Im going to keep that in mind!

[sandyfeet]

Yup. Home care instructions: "Stop smoking pot. It is making you sick." Done!

[JenNurse1972]

Agreed. Cyclic Vomiting is the diagnosis I have scene. In this case it's cyclic vomiting related to long term marijuana use (I am working in a legalized state).

I don't think Cannabinoid Hyperemesis Syndrome has an ICD 9 code. Best not to confuse coders in my opinion. Those docs are referring to Cyclic Vomiting.

[toomuchbaloney]

Interesting since we use cannabis to treat nausea.