Crohn's Disease Case Studies

Our patient is a 27yr old male with history of Crohn’s disease who presented to the ED with vomiting and nausea for 1 day. Patient has been having non-bilious non-bloody vomiting around 10-15 times /day. Patient complained of mild generalized abdominal pain but denied any diarrhea or fever. He denied any recent travel or sick contacts or eating outside food. Patient was a known case of Crohn’s diagnosed at an outside hospital –the outside hospital was contacted and the information was confirmed. Patient was recently started on infliximab for Crohn’s disease and he reported improvement of his Crohn’s symptoms. Patient admitted cannabis use and smokes around 2-3 joints /day. On presentation patient had stable vitals with no fever. Physical exam was unremarkable with soft abdomen. His labs were significant for hypokalemia and mild elevation of creatinine from baseline. (0.7 on admission and next day 1.1). His hepatic panel …show more content…
The exact pathophysiology of Cannabis hyperemesis syndrome resulting from long term use is unknown. Some authors propose that the episode is not caused by cannabis itself but causative agent might be other components and contaminants in the cannabis 5. It is also possible that the accumulation of increasing levels cannabis metabolites leads to paradoxical vomiting seen with long term use6 .Cannabidiol is one of the metabolite which is a partial agonist at CB receptors thus acting as an agonist in lower concentration and antagonist at higher levels 6.Cannabigerol is a metabolite of cannabis which is antagonist of cannabis at the receptors .These metabolites tend to accumulate in chronic users and hence there is latency period before onset of symptoms in THC users6. Studies have reported mean latency period of up to 15 yrs6. The situation is further compounded by delay in diagnosis. Studies have reported that it might take approximately 6 years from symptom onset to arrival at