Patient and Presentation (Reference number) | Cannabinoid Use | Labs and Diagnostics | Intervention | Patient Outcome |
34-year-old man with epigastric pain, nausea, and vomiting for 4 days. History of similar symptoms every 2 to 3 months for approximately 10 years. (Gnanaraj et al. 2011, [8] ) | Daily cannabis use since 1992, with only short intervals of abstinence resulting in complete resolution of his vomiting. | Unremarkable diagnostic tests: 3 computed tomographic scans, esophagogastroduodenoscopy, and several specialty consults. Vitals: BP: 116/64 mmHg, HR 94 beats/min, RR 20 breaths/min, pulse Oxygen 97% on room air, temperature 98.4˚F. | Morphine 4 mg IV, OND 4 mg IV, 1 liter normal saline IV fluid bolus. | The previous therapies did not help symptoms, but when given haloperidol 5 mg IV, symptoms resolved within 1 hour. He exhibited no further vomiting during 8 hours of observation, tolerated oral fluids, and then discharged. |
27-year-old man presents with vomiting and abdominal pain for 3 days. Patient reported 15 - 20 episodes of non-bloody, non-projectile, and non-bilious vomiting, which were alleviated partially by taking hot showers. (Inayat et al. 2017, [16] ) | Smoking at least five joints a day for approximately 10 years. | Normal vital signs. Toxicology screening positive for cannabis. Abdominal examination: soft, non-tender and non-distended abdomen. No rebound or tenderness and normal bowel sounds. Initial laboratory evaluation was unremarkable. | OND, lorazepam and IV fluids. | Severe hyperemesis persisted after 2 days of conventional antiemetic treatment. Given haloperidol 1 mg IV, the patient responded well with clinically significant improvement. His compulsive hot bathing and GI symptoms began to diminish following next two dosages of 2 mg IV haloperidol. |
18-year-old woman with emesis consistently non-bloody and non-bilious. Symptoms were worse in the morning and relieved only by smoking marijuana. (Joneset al. 2016, [18] ) | History of smoking using cannabis 2 - 3 times per day for two years and unwilling to quit. | Initial physical exam was unremarkable and vital signs were within normal limits. BMP, LFTs, and CBC were all normal. Tested positive for cannabis while symptomatic. | Haloperidol 5 mg daily for symptom relief. | At the next visit, patient reported complete resolution of previous refractory nausea, vomiting, and abdominal pain within one day of starting treatment. |
34-year-old man with previously diagnosed recurrent CHS arrived to the ED with vomiting for 4 days. (Witsil et al. 2017, [17] ) | Previously admitted to hospital 7 times for same issue. | Unremarkable diagnostic tests and several specialty consults. | Promethazine and OND 4 mg IV and IV fluids. | Given haloperidol 5 mg IV, and within 1 hour, symptoms resolved and was discharged home from the ED. |
48-year-old man presented to the ED with vomiting for 2 days. (Witsil et al. 2017, [17] ) | Chronic cannabis use. | Multiple unremarkable workups over the past year for cyclical vomiting | MET, promethazine, OND 4 mg IV, chlorpromazine and IV fluids with no symptom relief. | Given haloperidol 5 mg IV; within 1 hour, his vomiting resolved and was discharged home within 8 hours. |
22-year-old man arrived for treatment of cyclical vomiting (Witsil et al. 2017, [17] ) | Recurrent CHS diagnosed 2 years ago. | Not reported | MET, OND 4 mg IV, and IV fluids. | Initial ED treatment with OND 4 mg IV and IVF were unsuccessful. He was then given haloperidol 5 mg IV; within 2 hours, his vomiting resolved, and he was discharged home 6 hours later. |
28-year-old man (Witsil et al. 2017, [17] ) | Not reported. | Nondiagnostic workups | OND, MET, chlorpromazine with no symptom relief. | His initial ED treatment included haloperidol 5 mg IV, diphenhydramine 25 mg IV, and IVF. Within 1 hour, improved, had no further episodes of vomiting, and was discharged from our ED 6 hours later. |