Distinguishing Clinical Features of Cannabinoid Hyperemesis Syndrome and Cyclic Vomiting Syndrome: A Retrospective Cohort Study

Abstract

ObjectiveTo identify clinical characteristics that distinguish cannabinoid hyperemesis syndrome (CHS) from cyclic vomiting syndrome (CVS), two conditions marked by episodes of nausea, vomiting, and abdominal pain. Study designWe performed a retrospective chart review of patients admitted to a large children’s healthcare system from 2015 through 2022. CHS and CVS patients were identified by the electronic medical record using ICD-9/10 codes. ResultsOf 201 patients screened, 125 were included. CHS patients were older than those with CVS (mean [SD] 18.06 [1.41] vs. 14.50 [2.91] years, p<0.001). There were no significant differences in gender, race, ethnicity, or hospital length of stay between groups. CHS patients were more likely to have a positive urine drug screen (86% vs. 2.9%, p<0.001), lower mean (SD) serum potassium (3.62 [0.77] vs. 3.88 [0.49], p<0.001), and higher mean (SD) serum creatinine (0.83 (0.41) vs. 0.63 (0.17), p<0.001). The average (SD) systolic blood pressure (SBP) was significantly higher in CHS patients (SBP 124.46 [10.66] vs. 118.55 [10.99], p=0.032) compared with CVS children of comparable age range. Imaging was obtained in 36% of all patients and only 2.4% had abnormalities. ConclusionsClinical features including older age, higher systolic blood pressure, positive urine drug screen, and select electrolyte findings might distinguish CHS from CVS. Abdominal imaging in both conditions is of low yield. These findings may allow for early recognition and appropriate therapy in CHS patients.