Critical Care: Critical Care |

Legalizing Marijuana: What More to Expect! FREE TO VIEW

Khalid Sherani, MD; Abhay Vakil, MD; Hinesh Upadhyay, MD; Kelly Cervellione, MSPH; Mohammad Babury, MD
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Jamaica Hospital Medical Center, Jamaica, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A140. doi:10.1016/j.chest.2016.02.146
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SESSION TITLE: Critical Care

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Marijuana is being increasingly used in the United States for medicinal purposes due to its antiemetic, anxiolytic and appetite-stimulant properties. Despite its anti-emetic properties, a paradoxical syndrome of cannabinoid-induced hyperemesis (CHS) has been described. We report the case of a female presenting with vomiting leading to severe dehydration and electrolyte abnormalities requiring critical care monitoring. Preliminary work-up failed to reveal any gastrointestinal, obstetric or gynecologic pathology. Subsequently she admitted using synthetic marijuana chronically, the only recognizable cause of her symptoms.

CASE PRESENTATION: A 34-year-old healthy female presented with epigastric pain, intractable nausea, daily episodes of vomiting and 20 pounds weight loss over last 3 months. She denied fever, chills, cough, urinary symptoms, diarrhea, drug use and risk factors for HIV. Examination revealed a dehydrated, tachycardic female. Extremities failed to show evidence of drug use. There was no localized tenderness, guarding or rigidity on abdominal examination. Laboratory work-up showed pre-renal azotemia and electrolyte abnormalities with metabolic alkalosis (Table 1); markers of liver function were normal. Urine pregnancy test was negative. Imaging studies including CT and ultrasound of the abdomen and pelvis failed to reveal any pathology. Gastroscopy did not show ulcerations or erosions (Fig.1). She was treated with aggressive hydration and electrolyte replacement with improvement in clinical status and laboratory data. Subsequently her urine toxicology was positive for cannabinoids. On re-questioning, she admitted using synthetic marijuana and feeling better after hot water bathing. She was advised to discontinue cannabis use.

DISCUSSION: Chronic marijuana use has been known to cause obstructive/interstitial lung diseases, neurobehavioral problems, pan-hypopituitarism and predispose to myocardial injury. Of its more intriguing side-effects is CHS. The exact pathophysiology is unknown. Symptom relief has been noted with hot water bathing. Treatment is mainly supportive with anti-emetics having no role.

CONCLUSIONS: Physicians should be aware that chronic marijuana use may result in a paradoxical hyperemesis. The increasing incidence of CHS especially gains importance in the current time with the legalization of marijuana in several states.

Reference #1: JH Allen, GM de Moore. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut 2004, November; 53(11):1566-1570.

DISCLOSURE: The following authors have nothing to disclose: Khalid Sherani, Abhay Vakil, Hinesh Upadhyay, Kelly Cervellione, Mohammad Babury

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