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.