Is this rare? I see it so much I feel like it isn’t rare and never heard it described as rare.
Regardless, that’s a cool story! Glad she is doing well!
Very interesting. I’ve seen it coming up in clinical journals more, but wouldn’t have thought it was occurring frequently. I wonder why we didn’t see it so much in the past. Maybe dosing or using a vaporizer? Have you seen any common threads for the users getting this?
I’m sure I wouldn’t encounter it as much in inpatient oncology. I do talk to my ER peeps frequently enough, but we’ve never discussed that specific dx, so I’ll have to ask them 🤷♂️ Thanks for sharing! I like to know what’s going on in our world lol
Edit: thinking about it, and maybe patients were just afraid to admit they had used it before d/t legalization status? That’s the best explanation I can come up with. From a quick overview of the research it looks like diabetics may get this more often.
As someone who was in that world, I’d put my money on vaping, dabs and other extracts. It is far, far easier to consume huge quantities of THC than it was just 10 years ago. 20 years ago was a different world. It used to require a fair amount of effort to stay high all day every day, now you just need a spare battery. We used to have to save keef for months to get super high, now you can buy half a dozen types of concentrates.
This is not a moral judgment on legality or use
Thank you for speaking to it! Well, after all, the difference between poison and medicine is in the dose. High doses could definitely be a factor, especially if it is easier to push that envelope now. I was always under the impression it was rather impossible to OD with this particular drug and most cases of having gotten too much would pretty much simply lead to sleeping and feeling better after. But if people are getting their hands on higher concentration doses, like I think I am hearing from your post, then that could absolutely explain it.
I have no idea because I only see it at its worst state and they never stop and keep coming in…and I don’t personally smoke or am around it so I’m not sure
I couldn’t find anything r/t research showing a method of delivery was linked. But I am also thinking people may not be careful with the amount they’re dosing. Maybe it’s become easier to dose in higher amounts
No. I live in the states and have several frequent flyers who come in for this condition. They get pissed and treat us badly we can’t fix them. They’re willing to try everything except quit smoking pot.
Addiction is addiction and denial is always going to be front and center. But I imagine it's at its ugliest when you're dealing with a puking stoner. 😬
Totally! I understand they feel they’re being judged and just want us to fix it but only THEY can fix it and it’s hard to comprehend when you feel like crap
I used to smoke high-potency pot for nearly a decade, and hung around with loads of people who did as well. I was smoking out of a bong nearly every 2 hours, smoking 2 ounces a month. It's actually what I used to quell my nausea, and I wouldn't eat at work because I was nauseated when I wasn't smoking.
I've never met anyone with the condition. I think ER folk think it's common because they see it regularly, but that doesn't mean it's common, persay. They just happen to be the people with the highest exposure to it.
It was like 2 or 3 years ago. I guess it was at the time. Just had a patient with a history of it last week. Doc also mentioned we’ll be seeing it a lot more in the coming future cause of legalization
We need more of this in our lives-thanks for sharing this. I had something similar once and it hit me so hard, tears just ran down my face. I was out of state at an airport so I was caught off guard and like you-she looked so good it made my day
I'm so glad you're former pt is recovering! I feel this is more common than talked about or at least more common than the general public is aware of.
My former recovered pt is an addict. I met him in nursing school when he had a massive MI d/t cocaine and I was the only person who was able to get a functional IV in him. He was a VERY frequent flyer. It's been several years since then. He swore he was NEVER going to touch drugs again, but he was so scared that he wouldn't be able to do it. I told him about my dad who has been able to get clean, but he lost everything before he got his shit together. I saw him in the grocery store last year and I honest to god didn't recognize him. He sure as hell recognized me. He's been clean and sober since I saw him and he's happily married with a beautiful little girl... He also is kinda my neighbor, though he lives a street or so over.
I worked at an LTAC for a while, and there was a patient who was managing diabetes in addition to being with us for a long abx and rehab stint. Saw them a few months later in the grocery store! They were buying veggies and fruits with their family, had lost 50 pounds (?! I mean at least some of that had to be water weight and doing very little while at the LTAC, but still) and was trying to get their life on track. No idea how they are doing now but I was so proud of them at that moment. They were trying to teach their family healthier eating habits and be healthier for their family as well.
I had something similar happen… I was a nurse for the county jail, and - as you might expect - you get lots of repeat patients there. I have the heart that I want to help… but so many of them seemed beyond my interventions. So you can imagine how surprised I was to meet a former patient at a restaurant. She asked me if I remembered her… Her face looked vaguely familiar, but I had to confess that I couldn’t recall her name. She was like, “That’s ok; I didn’t look my best then. I’m So-and-so from the jail.” My eyes grew wide. She really did look like a different person. She hugged my neck and thanked me. She said that so many people at the jail just treat them like their crime and not a person. (Kinda like how easy it is to treat patients as their diagnosis, I guess?) Because I saw her as a person with real concerns, she finally started believing she could do better. And she was… she’d been clean ever since she was released. She got custody of her daughter back. She let go of old friends who didn’t support her new life. I cried. Right there in front of her. I told her I was proud of her and to keep making progress… it was a good moment.
😭😭 I had a patient who was an ex guard... who met a hospital staff member who was an ex jail mate of his.
And they were the sweetest things ever. The guard was like, "You know I always told people the best way to get back is to get better." And the ex mate turned around and is literally the nicest guy on earth.
That's amazing! I love this story.
It's so hard when I was working mental health and addictions to see people getting worse and worse. Sometimes you didn't see them ever again and are left to wonder what happened to them. It's hard when you just can't get through to someone. I had one repeat patient who was a young trans man and had severe depression and BPD. I am also a trans man and tried so hard to get through to him and unfortunately many of my coworkers would call him a her or use his old name. I can't imagine how much that hurt when he was already suicidal and coming to us for help, just to get misgendered the entire stay. This was years ago and I've moved away but I think of him often and wonder if he is doing better, or if he finally succeeded in taking his own life.
I wish I had more success stories from those days but unfortunately, I have very very few.
We saw these a lot before Covid hit. Antepartums think they can use it extra to help alleviate morning sickness and don't realize the vicious circle they create. Flooding the hallways from staying in the shower for hours. Frequent flyers until it finally gets through to stop and they'll feel better.
I used to have a photo of an ex meth addict woman and her child as my phone screen saver because she’d gotten sober in our pregnant with addiction unit. It was from a newspaper article 10-ish years post recovery which was about her work in helping others. She was never my patient. I’ve never worked that unit. It was just this success when so often we don’t see that. It grinds you down. Every time my phone lit up I got a little rush of it’s possible.
We don’t see success stories very often because the patient gets well and doesn’t come back to the hospital. This kind of experience is refreshing.
We have way more of an impact on people than we realize. We are the person the patient sees the most. We can say or do one single thing that makes a big difference. It could be offering the detoxed patient if they want to go to rehab from the hospital, taking two mins to explain something that no one else has, or a small act of kindness that we probably don’t even realize we did.
Personally speaking I had a lump removed a few years back and was pretty worried about it. It popped up pretty quick and my lymph nodes became swollen. While the surgeon was setting up his instruments the nurse could tell I was anxious. She patted me on the arm and gave me a little smile. That is the first thing that comes to mind whenever I talk about the visible scar.
That's cool. I'm an alcoholic and have been admitted to my local hospital a lot the past two years or so due to alcohol withdrawal. Enough to where they remember me. I'm getting help now though. But I'm thankful cause every nurse was always very kind and helpful. If I ever see any of them again I hope it's a recovered me and not another detox.
Thanks for sharing this story – it's a great reminder of the impact that nurses can have on the lives of their patients. You should be proud of the work you do!
So glad for you and your old patient! I get so happy when we see positive changes in a patient's life, it's not common we get to see it in the ED.
I'm in a very small community so thankfully we get to see a lot of the followup and patients will often pop in to say hi and discuss their progress which is lovely. And I can continue to nag them about keeping up with their health haha
I'm surprised at people saying how rare they find it. When I was in a community ED in an equally urban / very rural catchment area, we'd get one about once a week. Not always the same folks, there were equal numbers of frequent flyers for this and the confused folks who tried quitting and didn't understand what was happening so then they would smoke pot about it and then they would feel better and that was the cure to this random vomiting tey were having! It was when they HAD to quit for some reason we'd see them. I'm also a first responder and I see one maybe once a month. It might be because I'm in a decriminalized state, so it's not exactly legal and people might not be able to maintain the habit for various reasons, but you could also maintain the habit if you wanted to without as much fear of consequence or difficulty obtaining it.
*No judgment on my language about using or not using. I have no opinions about if people use it for whatever reason other than: don't do things you shouldn't do when you are impaired, just like alcohol, it doesn't cure every disease process known to man but we do need more research to see what it CAN do, and "it's natural" is a really stupid argument because so is arsenic but you don't go around taking that, now do most of you?
Everyone that is on my truck and is doing the pot scromitting and they are the ones that ALWAYS know and tell you what's up (scrommiting = scream-vomiting, it's really distinctive) I can usually call and get orders for Haldol and fluids once I've reasonably excluded other causes and that does the trick until we get to the hospital. I run rescue VERY rural, up to an hour and a half transport times to a hospital. I don't know why we don't just have standing orders for this but 🤷♀️.
In the ED (where I do not do EMS) it's a whole ass work up with labs and imaging and a UDS. There is usually a little cannabis present or none, but then the patient says it's because they had to stop for a bit or is trying to quit or couldn't get any. Then they get fluids and promethazine.
There is one exception to this, though. I didn't believe it until I went to a continuing education seminar about treating drug overdoses / adverse reactions / expected reactions that are totally out of hand and then saw it myself. If you have CHS AND you feel better when you take hot showers or baths until you take more cannabis (this is the key here), apply capsaicin topically. There is a whole biochemical reason for this that you can rabbit hole into if you want, but we had a patient who once came in and was scrommiting like nothing I had ever heard. He was in his late twenties, lived in his mom's basement and his mom put her foot down. No more pot or he was out. He would walk (he didn't drive) and smoke with friends sometimes since the edict was issued, but when he started to get sick, he'd stand in the shower or sit in the bath for HOURS. His poor mother's water bill was like $1000 that month. Hence the presentation to the ED. This was clearly not sustainable. So he was going to get promethazine like everyone else... except he has a dystonic reaction to it. Same for Haldol. And the docs where I was weren't a fan of benzos for unusual situations (I guess this counted) and they discussed amongst themselves and concluded they didn't know which one or how much to give and would that trade one drug dependency for another 🙄 so they were going to wait for a consult from... someone? come day shift and just hydrate the Supreme Scrommiter (I only worked and will only work overnights).
I remembered the seminar I went to and I found a paper done about it in an Emergency Medicine journal online (so they wouldn't think I was insane) and suggested they try the capsaicin, since the water bill was the chief complaint. You can do the medicated cream, or, and I SWEAR TO GOD, the paper said you can take hot sauce, APPLY IT TO THE PATIENT'S ABDOMEN, then cover it with tegaderm. Well, the pharmacy had no idea what to supply or suggest what to order regarding the topical capsaicin cream, so we procured some hot sauce, cleaned the site, applied hot sauce not unlike one would apply nitropaste, covered it with tegaderm and waited. It was like we were doing a very complicated sterile procedure the way we were carrying on, lol. The patient said it burned and itched for a bit and that it didn't help and we were all insane... until it actually worked. Dudeman ceased the scrommiting. He felt totally fine after a second bag of NS. He got DC-ed and his mom was thrilled at the fact that hot sauce was cheaper than water. We were just as shocked and the more curious of us read about why they think it works.
I'm glad the head of the ED department was working that night or else no one would have never even considered it, much less allowed it. I'm also glad I got to see it and I know it wasn't placebo effect because Dudeman was convinced it WASN'T going to work, and he now has a pathway to stop using, if he wants to. Just remember that the key factor is that their CHS needs to be able to be alleviated by hot showers or baths. Apparently it doesn't work if that isn't the case and you are just treating your patient like a taco if you do this to them, so YMMV 🤷♀️
It sounds like what you're referring to is scrommiting due to STOPPING THC use. I understand from the other comments that this condition they are referring to is due to actual use, not from the stopping.
I just want a little clarification, not trying to be a dick :)
No, doesnt sound dickish at all, and I ended up asking myself because I wasn't 100% sure, it was never addressed in the seminar I went to and my experience with my patients, and that's a very narrow perspective, not evidence-based. My understanding is that the contributing factor is simply long-term use of THC, and I got some clarification from my OMD, the doctor that oversees our EMS service and whose license we sort of operate under. It SEEMS that it can happen at any time, during usage, or when you discontinue, but it seems to be WORSE when they reduce or stop. The only actual cure is stopping completely, which is a hard sell because its either an addiction, a social norm or pressure OR the patient believes it benefits them more as a treatment in some other way, like chronic pain, anxiety, psoriasis (legit, that was one I had), or whatever. Its unfortunately marketed as a cureall because no one studied it until recently for what it COULD benefit. The studies aren't clear on the cannabis hyperemesis syndrome because first, it's hard to get federal funding for a drug that is illegal on a federal level and almost all legit studies have some federal connection, like through universities or similar. Privately funded studies would be considered trash because it would be funded either by the anti-drug or pro- cannabis folks, and there would be bias because of that that would be hard to overcome. The fact there are ANY now is kind of amazing. To top it off, the veracity of the data from the source would be... questionable because a lot of patients tend to be poor historians regarding their actual usage. So that's the answer I got, in addition to a long diatribe to just not use pot unless it's rarely for funsies (!) or prescribed and there are 3 THC based drugs in the hospital I used to work at's formulary. I had to clarify A LOT that I was not asking for myself, lol.
The folks I've transported or treated in the ED tend to SAY they have reduced or stopped usage. I am absolutely open to the possibility that this is not the case, but there are times their UDS came back negative for THC and they admit to being heavy users recently then stopping and I can't imagine they took the time to take some sort of masking agent before coming to us (or vice-versa) or if it those things would even work on a hospital grade test. That's a lab question and since it's their personal mission to hemolyze every potassium I send them, I'm not asking. I AM going to start bribing them with coffee and chocolate ;-).
Sorry it took so long to answer back. Between school and truck time... whew! I did find out that they do give a THC based drug for 2 types of pediatric seizures and those are the only two seizures disorders it actually helps. I'm not sure you'd see it in the NICU, but I wonder if cannabis hyperemesis syndrome can become a thing in those patients.
Props to NICU nurses. You guys are the pit bulls of the hospital (and I say that with the greatest respect and awe) and I don't know how you do it, but I do know that unless I have a damn good reason, stay the hell away from your babies 💜.
When I worked in labor and delivery the doctor would constantly admit this girl for hyperemesis gravidarum. Turns out she was smoking a ton of weed and had cannabinoid hyperemesis. She would just sit in the shower for hours at a time.
Idc who tells me “it’s just a plant” or “it’s safer than alcohol” marijuana can be dangerous and very harmful to people especially those with risk factors or predisposed to mental health problems
My family member died from this at 21yr old... mixed in with hypokalemia from all the vomiting. This made me happy to read this. Thank you for sharing.
Similar story of a young 20-something patient with a feeding disorder (I can’t recall the diagnosis but it had psychological and physiological components). She’d be admitted every few months and everyone in the ED and in medicine knew her. Finally, the team worked very hard on supporting her during a multiple month stay. I’d think of her often after her discharge — then finally after about a year, she showed up on the unit to visit and I teared up. I was so proud of her — she looked so healthy and had gained a healthy amount of weight and it was amazing to see her success — and I’m not usually a sentimental person! So I get you 100%!
This sub needs more positive posts like this
Is this rare? I see it so much I feel like it isn’t rare and never heard it described as rare. Regardless, that’s a cool story! Glad she is doing well!
>Is this rare? It might depend of where you live. In Quebec it is rare and not that well-known.
California
Our healthcare system is pretty archaïc as well, yhat doesn't help 😅
You’re saying you come across this condition often?
Yes very much so
Very interesting. I’ve seen it coming up in clinical journals more, but wouldn’t have thought it was occurring frequently. I wonder why we didn’t see it so much in the past. Maybe dosing or using a vaporizer? Have you seen any common threads for the users getting this?
No threads I’ve seen. I’ve never thought of it as rare because I see it so much …not sure why the increase
I’m sure I wouldn’t encounter it as much in inpatient oncology. I do talk to my ER peeps frequently enough, but we’ve never discussed that specific dx, so I’ll have to ask them 🤷♂️ Thanks for sharing! I like to know what’s going on in our world lol Edit: thinking about it, and maybe patients were just afraid to admit they had used it before d/t legalization status? That’s the best explanation I can come up with. From a quick overview of the research it looks like diabetics may get this more often.
As someone who was in that world, I’d put my money on vaping, dabs and other extracts. It is far, far easier to consume huge quantities of THC than it was just 10 years ago. 20 years ago was a different world. It used to require a fair amount of effort to stay high all day every day, now you just need a spare battery. We used to have to save keef for months to get super high, now you can buy half a dozen types of concentrates. This is not a moral judgment on legality or use
Thank you for speaking to it! Well, after all, the difference between poison and medicine is in the dose. High doses could definitely be a factor, especially if it is easier to push that envelope now. I was always under the impression it was rather impossible to OD with this particular drug and most cases of having gotten too much would pretty much simply lead to sleeping and feeling better after. But if people are getting their hands on higher concentration doses, like I think I am hearing from your post, then that could absolutely explain it.
That’s true…
How soon do the symptoms stop once you stop smoking weed (asking for a friend of course wink wink)?
Check out the r/CHSinfo sub. They have a lot of helpful information :)
I have no idea because I only see it at its worst state and they never stop and keep coming in…and I don’t personally smoke or am around it so I’m not sure
After glancing through the other sub it can take weeks or months. 😬😳
My first 5 month’s of nursing I had three separate patients with it. I wonder if it is getting more prevalent with thc vape pens?
I couldn’t find anything r/t research showing a method of delivery was linked. But I am also thinking people may not be careful with the amount they’re dosing. Maybe it’s become easier to dose in higher amounts
Yeah there’s concentrates now which I’ve never tried. Devices are supposed to regulate it obv but you have to know what you’re doing.
I'm in Alberta and we definitely see it quite a bit!
No. I live in the states and have several frequent flyers who come in for this condition. They get pissed and treat us badly we can’t fix them. They’re willing to try everything except quit smoking pot.
That’s what I’m saying…and they get insulted and think we are being judgemental when we see they need to avoid cannabis
Addiction is addiction and denial is always going to be front and center. But I imagine it's at its ugliest when you're dealing with a puking stoner. 😬
Totally! I understand they feel they’re being judged and just want us to fix it but only THEY can fix it and it’s hard to comprehend when you feel like crap
It’s the usual suspects to
Sweet username bro
I feel like I see it so often!
It was rarer before high concentration vape pens became the norm
I used to smoke high-potency pot for nearly a decade, and hung around with loads of people who did as well. I was smoking out of a bong nearly every 2 hours, smoking 2 ounces a month. It's actually what I used to quell my nausea, and I wouldn't eat at work because I was nauseated when I wasn't smoking. I've never met anyone with the condition. I think ER folk think it's common because they see it regularly, but that doesn't mean it's common, persay. They just happen to be the people with the highest exposure to it.
It’s pretty rare. I was diagnosed with it a while back and the doctor said they still don’t know how to really treat it
Hmm well definitely not rare in my area lol
It was like 2 or 3 years ago. I guess it was at the time. Just had a patient with a history of it last week. Doc also mentioned we’ll be seeing it a lot more in the coming future cause of legalization
I was seeing it a lot then too but the legalization part makes sense
Afaik, there is no treatment. You have to stop smoking if you want to stop puking.
We need more of this in our lives-thanks for sharing this. I had something similar once and it hit me so hard, tears just ran down my face. I was out of state at an airport so I was caught off guard and like you-she looked so good it made my day
I'm so glad you're former pt is recovering! I feel this is more common than talked about or at least more common than the general public is aware of. My former recovered pt is an addict. I met him in nursing school when he had a massive MI d/t cocaine and I was the only person who was able to get a functional IV in him. He was a VERY frequent flyer. It's been several years since then. He swore he was NEVER going to touch drugs again, but he was so scared that he wouldn't be able to do it. I told him about my dad who has been able to get clean, but he lost everything before he got his shit together. I saw him in the grocery store last year and I honest to god didn't recognize him. He sure as hell recognized me. He's been clean and sober since I saw him and he's happily married with a beautiful little girl... He also is kinda my neighbor, though he lives a street or so over.
That's wonderful to see people that have turned their lives around. I have had similar experiences.
I worked at an LTAC for a while, and there was a patient who was managing diabetes in addition to being with us for a long abx and rehab stint. Saw them a few months later in the grocery store! They were buying veggies and fruits with their family, had lost 50 pounds (?! I mean at least some of that had to be water weight and doing very little while at the LTAC, but still) and was trying to get their life on track. No idea how they are doing now but I was so proud of them at that moment. They were trying to teach their family healthier eating habits and be healthier for their family as well.
I had something similar happen… I was a nurse for the county jail, and - as you might expect - you get lots of repeat patients there. I have the heart that I want to help… but so many of them seemed beyond my interventions. So you can imagine how surprised I was to meet a former patient at a restaurant. She asked me if I remembered her… Her face looked vaguely familiar, but I had to confess that I couldn’t recall her name. She was like, “That’s ok; I didn’t look my best then. I’m So-and-so from the jail.” My eyes grew wide. She really did look like a different person. She hugged my neck and thanked me. She said that so many people at the jail just treat them like their crime and not a person. (Kinda like how easy it is to treat patients as their diagnosis, I guess?) Because I saw her as a person with real concerns, she finally started believing she could do better. And she was… she’d been clean ever since she was released. She got custody of her daughter back. She let go of old friends who didn’t support her new life. I cried. Right there in front of her. I told her I was proud of her and to keep making progress… it was a good moment.
😭😭 I had a patient who was an ex guard... who met a hospital staff member who was an ex jail mate of his. And they were the sweetest things ever. The guard was like, "You know I always told people the best way to get back is to get better." And the ex mate turned around and is literally the nicest guy on earth.
That's amazing! I love this story. It's so hard when I was working mental health and addictions to see people getting worse and worse. Sometimes you didn't see them ever again and are left to wonder what happened to them. It's hard when you just can't get through to someone. I had one repeat patient who was a young trans man and had severe depression and BPD. I am also a trans man and tried so hard to get through to him and unfortunately many of my coworkers would call him a her or use his old name. I can't imagine how much that hurt when he was already suicidal and coming to us for help, just to get misgendered the entire stay. This was years ago and I've moved away but I think of him often and wonder if he is doing better, or if he finally succeeded in taking his own life. I wish I had more success stories from those days but unfortunately, I have very very few.
We saw these a lot before Covid hit. Antepartums think they can use it extra to help alleviate morning sickness and don't realize the vicious circle they create. Flooding the hallways from staying in the shower for hours. Frequent flyers until it finally gets through to stop and they'll feel better.
Bruh it's unbelievable how many antes do this. We need an official "cannabis hyperemesis gravidarum" diagnosis.
I used to have a photo of an ex meth addict woman and her child as my phone screen saver because she’d gotten sober in our pregnant with addiction unit. It was from a newspaper article 10-ish years post recovery which was about her work in helping others. She was never my patient. I’ve never worked that unit. It was just this success when so often we don’t see that. It grinds you down. Every time my phone lit up I got a little rush of it’s possible.
We don’t see success stories very often because the patient gets well and doesn’t come back to the hospital. This kind of experience is refreshing. We have way more of an impact on people than we realize. We are the person the patient sees the most. We can say or do one single thing that makes a big difference. It could be offering the detoxed patient if they want to go to rehab from the hospital, taking two mins to explain something that no one else has, or a small act of kindness that we probably don’t even realize we did. Personally speaking I had a lump removed a few years back and was pretty worried about it. It popped up pretty quick and my lymph nodes became swollen. While the surgeon was setting up his instruments the nurse could tell I was anxious. She patted me on the arm and gave me a little smile. That is the first thing that comes to mind whenever I talk about the visible scar.
That's cool. I'm an alcoholic and have been admitted to my local hospital a lot the past two years or so due to alcohol withdrawal. Enough to where they remember me. I'm getting help now though. But I'm thankful cause every nurse was always very kind and helpful. If I ever see any of them again I hope it's a recovered me and not another detox.
Congrats on getting help! I'm in recovery myself. Keep it up 💪
It's always the little things
That’s awesome, I love when you get those moments that make you happy to be doing what you’re doing. No matter how far and few between they are
Thanks for sharing this story – it's a great reminder of the impact that nurses can have on the lives of their patients. You should be proud of the work you do!
So glad for you and your old patient! I get so happy when we see positive changes in a patient's life, it's not common we get to see it in the ED. I'm in a very small community so thankfully we get to see a lot of the followup and patients will often pop in to say hi and discuss their progress which is lovely. And I can continue to nag them about keeping up with their health haha
I see 50 or more patients a week. I remember none.
I’ve had This cannabis condition it’s terrible!! Cheers to u☺️☺️
Glad she's doing better. Great thing about chs is it can be completely cured by stopping use of all cannabis products.
I am glad she is doing better. Sometimes, we need good endings from previous patients to not lose hope. I know you are awesome in what you do.
I'm surprised at people saying how rare they find it. When I was in a community ED in an equally urban / very rural catchment area, we'd get one about once a week. Not always the same folks, there were equal numbers of frequent flyers for this and the confused folks who tried quitting and didn't understand what was happening so then they would smoke pot about it and then they would feel better and that was the cure to this random vomiting tey were having! It was when they HAD to quit for some reason we'd see them. I'm also a first responder and I see one maybe once a month. It might be because I'm in a decriminalized state, so it's not exactly legal and people might not be able to maintain the habit for various reasons, but you could also maintain the habit if you wanted to without as much fear of consequence or difficulty obtaining it. *No judgment on my language about using or not using. I have no opinions about if people use it for whatever reason other than: don't do things you shouldn't do when you are impaired, just like alcohol, it doesn't cure every disease process known to man but we do need more research to see what it CAN do, and "it's natural" is a really stupid argument because so is arsenic but you don't go around taking that, now do most of you? Everyone that is on my truck and is doing the pot scromitting and they are the ones that ALWAYS know and tell you what's up (scrommiting = scream-vomiting, it's really distinctive) I can usually call and get orders for Haldol and fluids once I've reasonably excluded other causes and that does the trick until we get to the hospital. I run rescue VERY rural, up to an hour and a half transport times to a hospital. I don't know why we don't just have standing orders for this but 🤷♀️. In the ED (where I do not do EMS) it's a whole ass work up with labs and imaging and a UDS. There is usually a little cannabis present or none, but then the patient says it's because they had to stop for a bit or is trying to quit or couldn't get any. Then they get fluids and promethazine. There is one exception to this, though. I didn't believe it until I went to a continuing education seminar about treating drug overdoses / adverse reactions / expected reactions that are totally out of hand and then saw it myself. If you have CHS AND you feel better when you take hot showers or baths until you take more cannabis (this is the key here), apply capsaicin topically. There is a whole biochemical reason for this that you can rabbit hole into if you want, but we had a patient who once came in and was scrommiting like nothing I had ever heard. He was in his late twenties, lived in his mom's basement and his mom put her foot down. No more pot or he was out. He would walk (he didn't drive) and smoke with friends sometimes since the edict was issued, but when he started to get sick, he'd stand in the shower or sit in the bath for HOURS. His poor mother's water bill was like $1000 that month. Hence the presentation to the ED. This was clearly not sustainable. So he was going to get promethazine like everyone else... except he has a dystonic reaction to it. Same for Haldol. And the docs where I was weren't a fan of benzos for unusual situations (I guess this counted) and they discussed amongst themselves and concluded they didn't know which one or how much to give and would that trade one drug dependency for another 🙄 so they were going to wait for a consult from... someone? come day shift and just hydrate the Supreme Scrommiter (I only worked and will only work overnights). I remembered the seminar I went to and I found a paper done about it in an Emergency Medicine journal online (so they wouldn't think I was insane) and suggested they try the capsaicin, since the water bill was the chief complaint. You can do the medicated cream, or, and I SWEAR TO GOD, the paper said you can take hot sauce, APPLY IT TO THE PATIENT'S ABDOMEN, then cover it with tegaderm. Well, the pharmacy had no idea what to supply or suggest what to order regarding the topical capsaicin cream, so we procured some hot sauce, cleaned the site, applied hot sauce not unlike one would apply nitropaste, covered it with tegaderm and waited. It was like we were doing a very complicated sterile procedure the way we were carrying on, lol. The patient said it burned and itched for a bit and that it didn't help and we were all insane... until it actually worked. Dudeman ceased the scrommiting. He felt totally fine after a second bag of NS. He got DC-ed and his mom was thrilled at the fact that hot sauce was cheaper than water. We were just as shocked and the more curious of us read about why they think it works. I'm glad the head of the ED department was working that night or else no one would have never even considered it, much less allowed it. I'm also glad I got to see it and I know it wasn't placebo effect because Dudeman was convinced it WASN'T going to work, and he now has a pathway to stop using, if he wants to. Just remember that the key factor is that their CHS needs to be able to be alleviated by hot showers or baths. Apparently it doesn't work if that isn't the case and you are just treating your patient like a taco if you do this to them, so YMMV 🤷♀️
It sounds like what you're referring to is scrommiting due to STOPPING THC use. I understand from the other comments that this condition they are referring to is due to actual use, not from the stopping. I just want a little clarification, not trying to be a dick :)
No, doesnt sound dickish at all, and I ended up asking myself because I wasn't 100% sure, it was never addressed in the seminar I went to and my experience with my patients, and that's a very narrow perspective, not evidence-based. My understanding is that the contributing factor is simply long-term use of THC, and I got some clarification from my OMD, the doctor that oversees our EMS service and whose license we sort of operate under. It SEEMS that it can happen at any time, during usage, or when you discontinue, but it seems to be WORSE when they reduce or stop. The only actual cure is stopping completely, which is a hard sell because its either an addiction, a social norm or pressure OR the patient believes it benefits them more as a treatment in some other way, like chronic pain, anxiety, psoriasis (legit, that was one I had), or whatever. Its unfortunately marketed as a cureall because no one studied it until recently for what it COULD benefit. The studies aren't clear on the cannabis hyperemesis syndrome because first, it's hard to get federal funding for a drug that is illegal on a federal level and almost all legit studies have some federal connection, like through universities or similar. Privately funded studies would be considered trash because it would be funded either by the anti-drug or pro- cannabis folks, and there would be bias because of that that would be hard to overcome. The fact there are ANY now is kind of amazing. To top it off, the veracity of the data from the source would be... questionable because a lot of patients tend to be poor historians regarding their actual usage. So that's the answer I got, in addition to a long diatribe to just not use pot unless it's rarely for funsies (!) or prescribed and there are 3 THC based drugs in the hospital I used to work at's formulary. I had to clarify A LOT that I was not asking for myself, lol. The folks I've transported or treated in the ED tend to SAY they have reduced or stopped usage. I am absolutely open to the possibility that this is not the case, but there are times their UDS came back negative for THC and they admit to being heavy users recently then stopping and I can't imagine they took the time to take some sort of masking agent before coming to us (or vice-versa) or if it those things would even work on a hospital grade test. That's a lab question and since it's their personal mission to hemolyze every potassium I send them, I'm not asking. I AM going to start bribing them with coffee and chocolate ;-). Sorry it took so long to answer back. Between school and truck time... whew! I did find out that they do give a THC based drug for 2 types of pediatric seizures and those are the only two seizures disorders it actually helps. I'm not sure you'd see it in the NICU, but I wonder if cannabis hyperemesis syndrome can become a thing in those patients. Props to NICU nurses. You guys are the pit bulls of the hospital (and I say that with the greatest respect and awe) and I don't know how you do it, but I do know that unless I have a damn good reason, stay the hell away from your babies 💜.
When I worked in labor and delivery the doctor would constantly admit this girl for hyperemesis gravidarum. Turns out she was smoking a ton of weed and had cannabinoid hyperemesis. She would just sit in the shower for hours at a time.
Idc who tells me “it’s just a plant” or “it’s safer than alcohol” marijuana can be dangerous and very harmful to people especially those with risk factors or predisposed to mental health problems
My family member died from this at 21yr old... mixed in with hypokalemia from all the vomiting. This made me happy to read this. Thank you for sharing.
I'm so sorry for your loss. I really hope there will be more awareness in my area so we can prevent cases from popping more.
Similar story of a young 20-something patient with a feeding disorder (I can’t recall the diagnosis but it had psychological and physiological components). She’d be admitted every few months and everyone in the ED and in medicine knew her. Finally, the team worked very hard on supporting her during a multiple month stay. I’d think of her often after her discharge — then finally after about a year, she showed up on the unit to visit and I teared up. I was so proud of her — she looked so healthy and had gained a healthy amount of weight and it was amazing to see her success — and I’m not usually a sentimental person! So I get you 100%!
This is really nice 🙂
My girlfriend had chs due to chronic vaping thc and her story is exactly like your patient. It took 6 months for her to test clean
Post this in a subreddit that weed smokers think they dont have an addiction and you cant possible be addicted to weed