Haloperidol as a treatment option in cannabinoid hyperemesis syndrome

A review of the current medical literature recognizes cannabinoid hyperemesis syndrome (CHS) as recurrent episodes of heavy nausea and vomiting with clinical stability and symptomatic resolution between episodes [1]. A prerequisite for CHS is the use of cannabis or cannabinoid-containing products. Two distinct phases make up CHS: a long prodromal phase (often lasting several years) with chronic bouts of nausea, abdominal pain, and fear of vomiting, and an active intractable hyperemetic phase [1]. During the hyperemetic phase of CHS, patients present acutely in a hospital setting and are discharged after empiric treatment with antiemetic medications. Patients find themselves with acute symptom relapse and have multiple hospital admissions with similar presentations. From the current literature review, only in complete abstinence from cannabis or cannabinoid-containing products can patients have resolution of symptoms [1].
We present a unique treatment approach, exploring the use of haloperidol as an effective treatment for a severe case of CHS.
A previously healthy 20-year-old black woman arrived at the emergency department (ED) with a 3-day history of nausea associated with multiple episodes of intractable non-bilious, non-bloody vomiting, accompanied by severe diffuse abdominal cramping. She had previously been hospitalized 7 times for this presentation and had numerous unremarkable diagnostic tests. The patient admitted to previous episodes of cyclical vomiting that continue to occur every month and last up to several hours. The symptoms were not related to her menstrual cycle. This patient had no family history of such a disorder. The patient admitted to smoking marijuana several times daily for the last 8 years. She denied any concomitant alcohol use or history of eating disorder. Vital signs on admission were significant for a heart rate of 99 bpm and decreased blood pressure of 100/60 mm Hg. Blood work was remarkable for a mild reactive leukocytosis of (16.8 × 109/l) and notable for hypokalaemia of 3.0 mmol/l. All other laboratory investigations were unremarkable including COVID-19 testing, computed tomography (CT) of the abdomen and pelvis, stool occult blood, and Helicobacter pylori testing. The patient underwent upper endoscopy, which was also unremarkable. Despite acute management involving the administration of intravenous fluids, antiemetics, and prompt electrolyte repletion, the patient continued to experience intractable...


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