CANNABINOID HYPEREMESIS SYNDROME: PATHOPHYSIOLOGY AND TREATMENT IN THE EMERGENCY DEPARTMENT
CANNABINOID HYPEREMESIS SYNDROME: PATHOPHYSIOLOGY AND TREATMENT IN THE EMERGENCY DEPARTMENT
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DOI：
10.1016/j.jemermed.2017.12.010
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发表时间：
2018-03-01
影响因子：
1.5
通讯作者：
Richards, John R.
中科院分区：
文献类型：
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作者：
Richards, John R.
背景：大麻素样呕吐综合征（CHS）是一种具有挑战性的临床疾病。CHS患者经常到急诊室就诊，可能需要治疗顽固性呕吐、脱水和电解质异常。被认为是周期性呕吐综合征的一种变体，随着大麻效力和使用的增加，CHS变得更加普遍，这是由于各州将大麻的娱乐性使用合法化。目的：这篇综述的目的是调查CHS的病理生理学，并评价已发表的文献在急诊科的药物治疗。这些信息可能有助于提供基于止吐药物作用机制的循证有效止吐治疗，可能排除不必要的检查，并缩短住院时间。讨论内容：内源性大麻素系统是一种复杂而重要的应激反应和变稳态调节器，偶尔会因过度使用大麻而不堪重负。CHS的急性发作可能是由慢性大麻使用者的压力或禁食引起的，这些大麻使用者可能预先存在异常的下丘脑-垂体-肾上腺轴反馈和交感神经系统反应。其原因可能在于内源性大麻素系统的生理学、CHS的病理生理学以及特定类别的止吐药和镇静剂的药理学特性。标准止吐药治疗失败是常见的，需要使用机械逻辑镇静剂，如苯二氮卓类和抗精神病药。结论：尽管CHS的患病率不断增加，但高质量的研究有限。苯二氮卓类药物和抗精神病药因其强大的镇静作用而成为治疗CHS的合理选择。局部辣椒素基于完全不同的药理学机制而有希望。停止使用大麻是唯一有保证的治疗CHS的方法。(C)2017爱思唯尔公司All rights reserved.
Background: Cannabinoid hyperemesis syndrome (CHS) is a challenging clinical disorder. CHS patients frequently present to the emergency department and may require treatment for intractable emesis, dehydration, and electrolyte abnormalities. Thought to be a variant of cyclic vomiting syndrome, CHS has become more prevalent with increasing cannabis potency and use, as enabled by various states having legalized the recreational use of cannabis. Objective: This aim of this review is to investigate the pathophysiology of CHS and evaluate the published literature on pharmacologic treatment in the emergency department. This information may be helpful in providing evidence-based, efficacious antiemetic treatment grounded in knowledge of antiemetic medications' mechanisms of action, potentially precluding unnecessary tests, and reducing duration of stay. Discussion: The endocannabinoid system is a complex and important regulator of stress response and allostasis, and it is occasionally overwhelmed from excessive cannabis use. Acute episodes of CHS may be precipitated by stress or fasting in chronic cannabis users who may have pre-existing abnormal hypothalamic-pituitary-adrenal axis feedback and sympathetic nervous system response. The reasons for this may lie in the physiology of the endocannabinoid system, the pathophysiology of CHS, and the pharmacologic properties of specific classes of antiemetics and sedatives. Treatment failure with standard antiemetics is common, necessitating the use of mechanistically logical sedating agents such as benzodiazepines and antipsychotics. Conclusion: Despite the increasing prevalence of CHS, there is a limited body of high-quality research. Benzodiazepines and antipsychotics represent logical choices for treatment of CHS because of their powerful sedating effects. Topical capsaicin holds promise based on a totally different pharmacologic mechanism. Discontinuation of cannabis use is the only assured cure for CHS. (C) 2017 Elsevier Inc. All rights reserved.