Concurrent Management of Adolescent Cannabinoid Hyperemesis Syndrome and Delirium With Haloperidol.

Abstract

Cannabinoid hyperemesis syndrome (CHS) manifests in adults as severe nausea accompanied by episodic vomiting and intense abdominal pain, typically associated with prolonged, high-dose cannabis use. The clinical course of CHS is divided into 3 distinct phases: prodromal, hyperemetic, and recovery. Traditional antiemetic and antinausea medications, such as ondansetron and metoclopramide, are often used in the acute clinical setting to address these isolated symptoms. Discussions and occasional use of haloperidol have demonstrated a level of symptom relief in patients with CHS. In several instances, patients report complete resolution of symptoms previously refractory to, or only partially relieved by, traditional antiemetics and antinausea medications. This case report explores the hospital course of a 15-year-old female adolescent who presented to the emergency department with a recurrent episode of CHS. The patient reported symptoms of nausea, intense abdominal pain, compulsive bathing behavior, physical agitation, and delirium. In the setting of CHS symptoms refractory to traditional antiemetics and concurrent behavioral disturbances, the patient was started on a standing low dose of haloperidol. Within 6 days of starting haloperidol treatment, the patient reported complete resolution of her presenting symptoms and was subsequently discharged from the hospital. We conclude that patients presenting with CHS and concurrent delirium, as is often the clinical presentation, would further benefit from the off-label use of haloperidol. Although minimal literature exists on the management of CHS, there is almost no evidence examining CHS comorbid with delirium and/or agitation. This report seeks to demonstrate the underlying causality and explore the scientific mechanisms to show the clear benefits of haloperidol as an antiemetic and antinausea medication, in addition to any sequelae of delirium, and highlighting the need for a revision of pre-existing CHS treatment protocols, specifically in the emergency department setting.