J Psychiatr Pract. 2023 Sep 1;29(5):354-358. doi: 10.1097/PRA.0000000000000732.
Cannabinoid hyperemesis syndrome (CHS), an under-recognized and seemingly paradoxical condition, arises in some adolescents and adults who chronically use cannabis. It presents acutely with intractable nausea, vomiting, and abdominal pain but standard antiemetic therapy leads to improvement for only a minority of patients. Randomized controlled trial evidence in adults indicates the superiority of haloperidol over ondansetron in alleviating the acute symptoms of CHS, but safe and effective treatment for adolescents with the disorder is currently unknown. The successful use of topical capsaicin has also been reported. We report a case series of 6 adolescent patients with CHS who presented to Johns Hopkins All Children's Hospital and were treated with haloperidol, lorazepam, and/or capsaicin. Four patients given 5 mg intravenous (IV) haloperidol and 2 mg IV lorazepam and 1 patient treated with 5 mg IV haloperidol and peri-umbilical topical capsaicin (0.025%) experienced full acute symptomatic relief. One patient, treated only with topical capsaicin, reported improvement of symptoms with some persistent nausea. Haloperidol/lorazepam, haloperidol/capsaicin, and topical capsaicin alone appear safe and effective in adolescents, but larger studies are required to confirm our findings.
大麻相关性呕吐综合征（CHS）是一种被低估的、看似矛盾的病症，发生于一些长期使用大麻的青少年和成年人中。它以难治性恶心、呕吐和腹痛为特征，但标准止吐治疗仅能使少数患者得到改善。成人的随机对照试验证据表明，氟哌啶醇在缓解 CHS 的急性症状方面优于昂丹司琼，但目前尚不清楚青少年 CHS 患者的安全有效治疗方法。也有报道称外用辣椒素的使用效果良好。我们报告了约翰霍普金斯所有儿童医院收治的 6 例 CHS 青少年患者的病例系列，他们接受了氟哌啶醇、劳拉西泮和/或辣椒素治疗。4 例患者接受 5mg 静脉注射（IV）氟哌啶醇和 2mg IV 劳拉西泮，1 例患者接受 5mg IV 氟哌啶醇和脐周外用辣椒素（0.025%）治疗，急性症状完全缓解。1 例仅接受辣椒素外用治疗的患者报告症状改善，仍有一些持续性恶心。氟哌啶醇/劳拉西泮、氟哌啶醇/辣椒素和单独使用辣椒素在青少年中似乎安全有效，但需要更大规模的研究来证实我们的发现。
