What are the symptoms and history of a 19-year-old female patient presenting with intractable nausea and vomiting, possibly related to cannabis (marijuana) use?

From the Guidelines

When evaluating a 19-year-old female with intractable nausea and vomiting potentially related to marijuana use, I would ask about her cannabis consumption patterns, including frequency, amount, duration, and most recent use, as this information is crucial in determining the likelihood of Cannabinoid Hyperemesis Syndrome (CHS) 1. To further assess the patient's condition, I would inquire about the timing of symptom onset relative to marijuana use, whether hot showers relieve symptoms (characteristic of CHS), and if she's experienced similar episodes before. Questions about other substance use, medication history (including over-the-counter and prescription), and recent dietary changes are important to consider, as they may contribute to the patient's symptoms or interact with potential treatments 1. I would assess for pregnancy status, last menstrual period, and sexual activity, as these factors can impact the patient's health and treatment options. Questions about abdominal pain characteristics, weight loss, and associated symptoms like fever or diarrhea help differentiate from other conditions, such as gastrointestinal disorders or infections 1. I would explore psychosocial factors including stress levels, living situation, and support systems, as these can influence the patient's overall well-being and response to treatment. A review of systems focusing on neurological symptoms, headaches, and visual changes would help rule out other causes, such as migraines or neurological disorders 1. Understanding her medical history, including previous hospitalizations, surgeries, and family history of gastrointestinal disorders, provides additional context and can inform treatment decisions. These questions help establish whether this is Cannabinoid Hyperemesis Syndrome, which typically presents with cyclic vomiting in chronic cannabis users and responds to cannabis cessation, or if other diagnoses should be considered. Key points to consider in the patient's history include:

• Cannabis consumption patterns and potential correlation with symptom onset
• Presence of hot shower relief, a characteristic feature of CHS
• Other substance use or medication that may interact with cannabis or contribute to symptoms
• Pregnancy status and sexual activity
• Abdominal pain characteristics and associated symptoms
• Psychosocial factors and stress levels
• Medical history, including previous hospitalizations and family history of gastrointestinal disorders.

From the FDA Drug Label

Symptoms are similar to cannabinoid hyperemesis syndrome (CHS), which is described as cyclical events of abdominal pain, nausea, and vomiting in chronic, long-term users of delta-9-THC products Because patients may not recognize these symptoms as abnormal, it is important to specifically ask patients or their caregivers about the development of worsening of nausea, vomiting, or abdominal pain while being treated with dronabinol capsules.

To assess a 19-year-old female patient with intractable nausea and vomiting likely related to marijuana use, key questions to ask include:

• Can you describe the pattern of your nausea and vomiting? Is it cyclical?
• How long have you been experiencing these symptoms?
• Have you noticed any abdominal pain associated with the nausea and vomiting?
• How often do you use marijuana, and have you recently changed your usage pattern?
• Have you experienced any other symptoms such as dehydration or electrolyte abnormalities? 2 2 2

From the Research

Patient Assessment

To assess a 19-year-old female patient experiencing intractable nausea and vomiting, likely related to marijuana use, the following questions can be asked:

• What is the duration and frequency of your nausea and vomiting episodes?
• Can you describe the severity of your symptoms on a scale of 1-10?
• Have you experienced any recent changes in your marijuana use or other substance use?
• Have you tried any antiemetic medications or other treatments for your symptoms?
• Do you have any underlying medical conditions that could be contributing to your symptoms?

Medical History

It is essential to consider the patient's medical history, including:

• Previous experiences with nausea and vomiting
• Any allergies or sensitivities to medications
• Current medications or supplements being taken
• Any history of substance use or addiction

Treatment Options

According to studies 3, 4, 5, 6, 7, various treatment options are available for nausea and vomiting, including:

• Antiemetic medications such as ondansetron, metoclopramide, and droperidol
• Pharmacotherapy, including safety concerns and controversies with established pharmaceuticals
• Newer immunotherapies, bioelectrical neuromodulation, behavioral, and surgical therapies
• Complementary medicine

Potential Side Effects

When considering treatment options, it is crucial to discuss potential side effects with the patient, such as:

• Prolonged QT interval on the ECG with certain antiemetic medications 3
• Extrapyramidal adverse effects, particularly in children 3
• Adverse events or side effects reported with ondansetron, metoclopramide, and placebo 5