Another Case of Vomiting

​A 26-year-old man presented to the emergency department with nausea, vomiting, and abdominal pain. He said he had had the pain, which he said encompassed his entire abdomen, for three days.​He had been unable to tolerate anything by mouth. His vitals on presentation included a heart rate of 115 bpm, blood pressure of 126/70 mm Hg, respiratory rate of 22 bpm, and pulse oximetry of 100% on room air.Physical examination revealed dry mucus membranes, dry skin, tachycardia without murmurs, and clear lungs. Abdominal examination demonstrates hyperactive bowel sounds without pain on palpation or hepatosplenomegaly. The patient had no medical history except for this chronic abdominal pain and vomiting, for which he takes metoclopramide and ondansetron.This was his fourth visit in six months for the same complaint, and all workups, including CT of the abdomen/pelvis and labs, were negative. He had also been evaluated by a GI doctor who performed an endoscopy, which was negative. The patient stated that nothing relieved his symptoms except for hot showers, so he took three to four of them daily.What is the differential for cyclic vomiting?Cyclic vomiting syndromeCannabinoid hyperemesis syndrome (CHS)InfectionHyperemesis gravidarumMigrainesMetabolic disordersMotility disordersPsychogenic vomitingDiabetic gastroparesisBulimiaWhat are the clinical features of CHS?Long-term, regular cannabis use (essential)Severe cyclic nausea and vomitingResolution with cannabis cessationRelief of sy...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs