In a pediatric hospital study, cannabinoid hyperemesis syndrome patients were older, had higher blood pressure, lower potassium, and higher creatinine than cyclic vomiting syndrome patients, while abdominal imaging was rarely useful for either condition.
Pediatricians, emergency medicine providers, and parents of adolescents
Abdominal imaging was abnormal in only 2.4% of cases
What the researchers found
Patients with CHS were significantly older (mean 18.1 vs 14.5 years), more likely to have a positive urine drug screen (86% vs 2.9%), had lower potassium, higher creatinine, and higher systolic blood pressure compared to CVS patients. Imaging was obtained in 36% of all patients but only 2.4% showed abnormalities.
Why it matters
CHS and CVS present almost identically with recurrent nausea, vomiting, and abdominal pain. Misdiagnosis delays appropriate treatment. These distinguishing clinical features could help pediatric providers reach the correct diagnosis faster and avoid unnecessary imaging.
The numbers in context
125 patients included (out of 201 screened). CHS mean age: 18.06 years vs CVS: 14.50 years. Positive urine drug screen: CHS 86% vs CVS 2.9%. CHS systolic BP: 124.46 vs CVS: 118.55 mmHg. Imaging abnormalities in only 2.4% of cases.
How the study worked
Retrospective chart review of 125 patients admitted to a large children's health care system from 2015 through 2022. Patients were identified using ICD-9 and ICD-10 codes for CHS and CVS.
What this study cannot tell us
Retrospective design with ICD code-based identification may miss or misclassify cases. Single health care system. The sample of CHS patients may include only those with confirmed cannabis use, potentially missing cases where use was denied or undetected.
How to read the evidence
Retrospective cohort from a single institution with reasonable sample size but inherent limitations of chart review.
When this study was published
2024 study using 2015-2022 data
The bigger picture
As cannabis use among adolescents continues, CHS is becoming more common in pediatric settings. Having objective clinical markers to distinguish it from CVS could reduce diagnostic delays, unnecessary testing, and inappropriate treatment.
Questions still open
- Can these distinguishing features be validated prospectively into a clinical decision tool? Why is blood pressure higher in CHS? Is the elevated creatinine in CHS related to dehydration from vomiting or a direct cannabis effect?
Common questions
How can doctors tell CHS apart from cyclic vomiting syndrome?
Is imaging useful for diagnosing CHS or CVS?
Read the original research
Distinguishing Clinical Features of Cannabinoid Hyperemesis Syndrome and Cyclic Vomiting Syndrome: A Retrospective Cohort Study.
The Journal of pediatrics, 271, 114054
Citation
Shah, Meera; Jergel, Andrew; George, Roshan P; Jenkins, Elan; Bashaw, Hillary. (2024). Distinguishing Clinical Features of Cannabinoid Hyperemesis Syndrome and Cyclic Vomiting Syndrome: A Retrospective Cohort Study.. The Journal of pediatrics, 271, 114054. https://doi.org/10.1016/j.jpeds.2024.114054
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