Résumé
RESUMO Os autores relatam um caso da enfermaria psiquiátrica do Hospital Geral Santa Casa de Misericórdia de Sorocaba-SP. Paciente gestante, de 19 anos, usuária crônica de maconha que apresenta náuseas e vômitos intensos não responsivos aos antieméticos, associados a dor abdominal, agitação psicomotora e hábito compulsivo de tomar banhos quentes para alívio dos sintomas, quadro que caracteriza a SHC. Trata-se de uma síndrome rara, com efeito paradoxalmente emetogênico da maconha. É subdiagnosticada e relacionada ao uso crônico e intenso de maconha. Destacamos que não foi encontrada descrição de caso na literatura brasileira. A conclusão deste relato reporta a importância do reconhecimento e categorização da síndrome e sua correlação com a dependência de maconha, pois o tratamento implica a suspensão do uso de maconha, tratamento da dependência, além da prevenção de suas complicações clínicas.
ABSTRACT The authors report a case from the psychiatric department of a general hospital (Santa Casa de Misericordia at Sorocaba city, São Paulo, Brazil). A patient, 19-year-old, pregnant woman, marijuana chronic user, presenting abdominal pain, psychomotor agitation, unmanageable nausea, severe vomiting, not responsive to antiemetic drugs, associated with compulsive hot water showering. Cannabinoid hyperemesis syndrome is sub-diagnosed and rare, characterized by those three symptoms: heavy marijuana use, vomiting and repeated hot showering. There is no prior report in Brazilian medical literature. This paper aims to emphasize the importance of recognizing and categorizing this syndrome and its correlation to marijuana use. Main treatment is supportive care, withdrawing substance and supportive carries to suspension of marijuana use as well as clinical complications prevention.
Résumé
Abstract Background The first case report on the Cannabinoid hyperemesis syndrome (CHS) was registered in 2004. Years later, other research groups complemented the description of CHS, adding that it was associated with such behaviors as chronic cannabis abuse, acute episodes of nausea, intractable vomiting, abdominal pain and compulsive hot baths, which ceased when cannabis use was stopped. Objective To provide a brief review of CHS and report the first documented case of CHS in Mexico. Method Through a systematic search in PUBMED from 2004 to 2016, a brief review of CHS was integrated. For the second objective, CARE clinical case reporting guidelines were used to register and manage a patient with CHS at a high specialty general hospital. Results Until December 2016, a total of 89 cases had been reported worldwide, although none from Latin American countries. Discussion and conclusions Despite the cases reported in the scientific literature, experts have yet to achieve a comprehensive consensus on CHS etiology, diagnosis and treatment. The lack of a comprehensive, standardized CHS algorithm increases the likelihood of malpractice, in addition to contributing to the patient's biopsychosocial deterioration and raising care costs.
Resumen Antecedentes En 2004 se registró el primer reporte de caso del Síndrome de hiperémesis cannabiniode (SHC). Años más tarde, otros grupos de investigación fueron complementando su descripción, añadiendo que éste se asociaba a comportamientos como: consumo crónico y abusivo de cannabis, episodios agudos de náuseas, vómito incontrolable, dolor abdominal, baños compulsivos de agua caliente, que remitían tras el cese del consumo de cannabis. Objetivo Presentar una breve revisión del SHC y presentar el primer caso documentado en México. Método Mediante una búsqueda sistematizada en PUBMED entre 2004 y 2016, se integró una breve revisión del SHC. Para el segundo objetivo, se utilizó la guía de reporte de casos CARE para registrar y manejar a un paciente con SHC en un hospital general de alta especialidad. Resultados Hasta diciembre de 2016 se había registrado un total de 89 casos en todo el mundo, aunque ninguno en América Latina. Discusión y conclusiones A pesar de los casos reportados en la literatura científica, aún no existe un consenso de expertos más completo sobre la etiología, el diagnóstico y el tratamiento del SHC. Asimismo la ausencia de un algoritmo integral y estandarizado aumenta la probabilidad de mala praxis, además de incrementar el deterioro biopsicosocial del paciente e incrementar el costo de la atención.