Comparison of Antiemetics in the Management of Pediatric Cannabinoid Hyperemesis Syndrome.

Emily Geraci, Carrie Cake, Kevin M Mulieri, Norman E Fenn
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Abstract

Objective: As a result of recent legislative changes allowing for increased access to marijuana products, there have been increasing rates of cannabis abuse among adolescents and subsequent diagnoses of cannabinoid hyperemesis syndrome (CHS). Most available literature on this syndrome exists within the adult population and describes benzodiazepines, haloperidol, and topical capsaicin as potentially efficacious in the management of CHS. The objectives of this study were to identify antiemetics and compare their efficacy and safety in the management of pediatric CHS.

Methods: A retrospective review of Penn State Children's Hospital electronic health record was performed to identify patients 18 years or younger who had an emergency department or inpatient encounter, a cannabis hyperemesis-related diagnosis code, and met diagnostic criteria for CHS. Antiemetic efficacy was determined using subjective patient perception of nausea and objective documentation of vomiting. Benzodiazepines, haloperidol, and topical capsaicin were classified as nontraditional antiemetics, whereas all other antiemetics were classified as traditional.

Results: Nontraditional antiemetic medications appeared to be more effective in resolving patient symptoms compared with traditional antiemetics. Analysis of all ordered antiemetics demonstrated a gap in partial or full symptom resolution between nontraditional and traditional agents. Reported adverse effects were minimal.

Conclusions: Cannabinoid hyperemesis syndrome is an underrecognized and underdiagnosed condition characterized by cyclic vomiting related to chronic cannabis use. Abstinence from cannabis remains the most effective approach to mitigating morbidity associated with CHS. Medications such as lorazepam or droperidol may have benefit in managing toxidrome symptoms. Traditional antiemetic prescribing remains a key barrier to effective management of pediatric CHS.

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止吐药在小儿大麻素呕吐综合征治疗中的比较。
目的:由于最近的立法变化允许更多地获得大麻产品,青少年中大麻滥用的比例越来越高,随后被诊断为大麻素呕吐综合征(CHS)。大多数关于该综合征的文献存在于成人人群中,并将苯二氮卓类药物、氟哌啶醇和局部辣椒素描述为治疗CHS的潜在有效药物。本研究的目的是鉴别止吐药,并比较它们在小儿CHS治疗中的有效性和安全性。方法:回顾性分析宾夕法尼亚州立儿童医院的电子健康记录,以确定18岁或以下的急诊科或住院患者,大麻呕吐相关的诊断代码,并符合CHS的诊断标准。止吐效果通过患者主观的恶心感觉和客观的呕吐记录来确定。苯二氮卓类药物、氟哌啶醇和外用辣椒素被归类为非传统止吐药,而所有其他止吐药都被归类为传统止吐药。结果:与传统止吐药相比,非传统止吐药在缓解患者症状方面似乎更有效。对所有有序止吐药的分析表明,非传统药物和传统药物在部分或完全缓解症状方面存在差距。报告的不良反应很小。结论:大麻素呕吐综合征是一种未被充分认识和诊断的疾病,其特征是与慢性大麻使用有关的周期性呕吐。戒除大麻仍然是减轻与CHS相关的发病率的最有效方法。诸如劳拉西泮或氟哌啶醇之类的药物可能对控制应激症状有益。传统的止吐处方仍然是有效管理儿科CHS的关键障碍。
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来源期刊
Journal of Pediatric Pharmacology and Therapeutics
Journal of Pediatric Pharmacology and Therapeutics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
2.40
自引率
0.00%
发文量
90
期刊介绍: The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.
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