Supportive therapy serves as the mainstay of treatment during this phase . There is limited literature available on haloperidol as the standard of care in CHS. However, haloperidol has been widely used as an antiemetic for many years and has been described to provide symptom relief in some patients with CHS . This article presents the findings from a literature review on CHS. It discusses a female patient who was successfully treated for CHS with haloperidol given by mouth. A 34-year-old African American female presented to the emergency department with complaints of recurrent nausea and vomiting. Three days before admission, the patient reported having nausea and vomiting after smoking marijuana and was unable to keep any food down. The patient has had two previous admissions for the same symptoms. During those admissions, the patient was given on dansetron, metoclopramide, erythromycin, and promethazine with no relief of symptoms. The patient’s past medical history included Type 1 diabetes mellitus, gastroparesis, and hypertension. Her social history was significant for daily marijuana use, but she denied alcohol and tobacco.
The patient left the hospital against medical advice and was discharged on haloperidol 5 mg by mouth every 8 hours. The patient was given instructions regarding the diagnosis, expectations, follow-up, and return precautions. Unfortunately, despite counseling, the patient was not amenable to cannabis cessation at that time. She was also counseled on the importance of therapy adherence and following up with her primary care physician. Reports of CHS in patients have increased over the years,vertical grow rack despite the syndrome’s increasing prevalence, many physicians are unfamiliar with its diagnosis and treatment . This under-recognition may be due to the paradoxical use for the treatment of nausea and vomiting, the stigma associated with cannabis use, and the illegal status of cannabis in some areas leading to under-reporting of use. The frequency of emergency department visits and high hospital admission rates for CHS exemplify the difficulty in symptom management . The lack of knowledge and treatment recommendations regarding CHS compounds this issue. We report the first case of recurrent acute cannabinoid hyperemesis syndrome sucessfully treated with haloperidol given both intramuscularly and orally. The Naranjo adverse drug reaction probability scale was utilized to assess the probability that the hyperemesis was related to cannabinoid use, and a total score of 6 was obtained. Diagnosis is determined through receiving a detailed medication history and a comprehensive physical examination.
In a recent systematic review conducted by Sorensen and colleagues, the following diagnostic characteristics and frequency of each were found: history of regular cannabis use for over one year , severe nausea and vomiting , vomiting that recurs in a cyclic pattern over months , resolution of symptoms after stopping cannabis , compulsive hot baths/showers with symptom relief , male predominance , abdominal pain , at least weekly cannabis use , history of daily cannabis use , and age less than 50 at time of evaluation .
With >10 years of self-reported cannabis use, our patient experienced the following symptoms: severe nausea and vomiting that has recurred over many months in a cyclic pattern. Haloperidol is a drug primarily used for sedation, behavioral agitation, and as an antipsychotic. However, haloperidol has been used as an antiemetic for years, particularly in the anesthesia, general surgery, and oncology literature . Haloperidol is a butyrophenone antipsychotic that non-selectively blocks postsynaptic dopaminergic D2 receptors in the chemoreceptor trigger zone. The CTZ is located in the medulla oblongata and is exposed to toxins in the bloodstream, which triggers vomiting.The medication may decrease nausea and vomiting by blocking the dopamine receptors in the CTZ, thus reducing input to the medullary vomiting center. Early administration of haloperidol in acute episodes of CHS may reduce symptoms, minimize the time in the emergency room, and reduce the rate of hospital admissions . In 5 out of the 6 reported cases,haloperidol was given intramuscularly only , and in one case, the route of administration was not provided . Also, interestingly only one of the cases was a woman and our case makes two. In a recent analysis synthesizing findings from case reports found that men were overwhelmingly more likely to be diagnosed with CHS relative to women .