Richards John R
Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California.
J Emerg Med. 2018 Mar;54(3):354-363. doi: 10.1016/j.jemermed.2017.12.010. Epub 2018 Jan 5.
Cannabinoid hyperemesis syndrome (CHS) is a challenging clinical disorder. CHS patients frequently present to the emergency department and may require treatment for intractable emesis, dehydration, and electrolyte abnormalities. Thought to be a variant of cyclic vomiting syndrome, CHS has become more prevalent with increasing cannabis potency and use, as enabled by various states having legalized the recreational use of cannabis.
This aim of this review is to investigate the pathophysiology of CHS and evaluate the published literature on pharmacologic treatment in the emergency department. This information may be helpful in providing evidence-based, efficacious antiemetic treatment grounded in knowledge of antiemetic medications' mechanisms of action, potentially precluding unnecessary tests, and reducing duration of stay.
The endocannabinoid system is a complex and important regulator of stress response and allostasis, and it is occasionally overwhelmed from excessive cannabis use. Acute episodes of CHS may be precipitated by stress or fasting in chronic cannabis users who may have pre-existing abnormal hypothalamic-pituitary-adrenal axis feedback and sympathetic nervous system response. The reasons for this may lie in the physiology of the endocannabinoid system, the pathophysiology of CHS, and the pharmacologic properties of specific classes of antiemetics and sedatives. Treatment failure with standard antiemetics is common, necessitating the use of mechanistically logical sedating agents such as benzodiazepines and antipsychotics.
Despite the increasing prevalence of CHS, there is a limited body of high-quality research. Benzodiazepines and antipsychotics represent logical choices for treatment of CHS because of their powerful sedating effects. Topical capsaicin holds promise based on a totally different pharmacologic mechanism. Discontinuation of cannabis use is the only assured cure for CHS.
大麻素呕吐综合征（CHS）是一种具有挑战性的临床疾病。CHS患者经常前往急诊科就诊，可能需要针对顽固性呕吐、脱水及电解质异常进行治疗。CHS被认为是周期性呕吐综合征的一种变体，随着大麻效力增强及使用增加，CHS愈发普遍，这得益于多个州将大麻娱乐性使用合法化。
本综述旨在研究CHS的病理生理学，并评估急诊科药物治疗的已发表文献。这些信息可能有助于基于对止吐药物作用机制的了解提供循证、有效的止吐治疗，可能避免不必要的检查，并缩短住院时间。
内源性大麻素系统是应激反应和稳态的复杂且重要的调节因子，偶尔会因过度使用大麻而不堪重负。CHS的急性发作可能由慢性大麻使用者的应激或禁食诱发，这些使用者可能已有下丘脑 - 垂体 - 肾上腺轴反馈异常和交感神经系统反应。其原因可能在于内源性大麻素系统的生理学、CHS的病理生理学以及特定类别的止吐药和镇静剂的药理学特性。标准止吐药治疗失败很常见，因此需要使用如苯二氮䓬类药物和抗精神病药物等具有合理作用机制的镇静剂。
尽管CHS的患病率在上升，但高质量研究的数量有限。苯二氮䓬类药物和抗精神病药物因其强大的镇静作用，是治疗CHS的合理选择。基于完全不同的药理学机制，外用辣椒素也有前景。停用大麻是治疗CHS的唯一可靠方法。
