The title got me: “13-Year-Old Girl With Recurrent, Episodic, Persistent Vomiting: Out of the Pot and Into the Fire.”
What pot? What fire? Oh, dear, recurrent vomiting. What troubling case report was this, in this week’s Pediatrics journal?
The case, written up by Dr. Diana Felton of Boston Children’s Hospital and colleagues, was indeed troubling, but also instructive, on two counts:
First, its main lesson: a medication for gastrointestinal problems — a proton pump inhibitor called pantoprazole — can cause a false positive result on a urine test for marijuana use.
And second, though marijuana is generally known to have anti-nausea effects, it has been increasingly recognized over the last decade that heavy, long-term use can bring on cycles of vomiting, a phenomenon called Cannabinoid Hyperemesis Syndrome. (It can also bring on compulsive bathing in hot water. I know. Sounds crazy. But I’m not making it up. More on that later.)
She remembers the thought, “What on earth are they saying? This is crazy! All we’ve ever done is care for our child…”
Dr. Felton and colleagues write that as the use of organic and synthetic cannabinoids — pot-like compounds — increases, “the number of patients with Cannabinoid Hyperemesis Syndrome will surely grow.”
Now to their tale. The patient was a 13-year-old Massachusetts girl who suffered from recurrent bouts of vomiting, a condition known as Cyclic Vomiting Syndrome. She was on her fourth bout of vomiting in six weeks when she was brought in to the Emergency Department, retching.
Hit by a stroke while still in the womb, the girl could not speak, and had been hospitalized repeatedly for such vomiting attacks. This time, among other tests, “the treating physician opted to send a urine toxicology screen to evaluate for possible Cannabinoid Hyperemesis Syndrome.” It came back positive for cannabinoids. Social services got involved. A protective order was filed.
“Given the patient’s severe physical and developmental limitations, it was clear that she was unable to access or administer the cannabinoids herself,” the paper says.
Let’s just pause for a moment to put ourselves in the place of the patient’s parents. I imagine myself exploding: “So you’re accusing us of giving our disabled daughter so much pot that it made her throw up? Are you out of your mind???”
Not too far off, says Jessica Tufts of Topsfield, whose daughter, Hollis, now almost 15, was the patient in the paper. She remembers the thought, “What on earth are they saying? This is crazy! All we’ve ever done is care for our child…”
“They bring me into a room and they say, ‘We just wanted to let you know that Hollis has tested positive for cannabinoids,” she recalls. “I said, ‘How on earth could she be getting it? We don’t smoke it. We don’t cook it. We never even touched it. So how is she getting it?’ I flew into a panic because she can’t say, ‘Somebody at school is feeding me pot brownies or whatever.’ We were trying to figure out all the points of contact that could possibly explain it.”
And, “We got progressively more terrified, because, as the mom of a child who’s going to be limited all her life and can’t tell you what’s going on, your worst nightmare is that some caregiver who is out of your control has done something to her.” Continue reading