Cannabinoid Hyperemesis Syndrome (CHS), High-Potency THC Panic, and Synthetic Edibles¶

ʻOiai ʻo ka cannabis lāʻau kahiko i loaʻa i ka 2 a i ka 4 pakeneka delta-9-tetrahydrocannabinol (THC), nā mea kūʻai kālepa hou, nā pahu vape, wax dabs, infused pre-rolls, a me nā gummies kiʻekiʻe e hāʻawi mau i ka 70 a i ka 95 pākēneka THC, me ka unregulated hemp-derived semi-synthetics (THC-O-a-synthetics, THC-O-a) lethal synthetic receptor agonists ("Spice," "K2," MDMB-4en-PINACA, ADB-BUTINACA). Ua hoʻokumu kēia piʻi nui o ka mana i ʻehā mau pilikia olakino kūikawā e hoʻopiha nei i nā keʻena pilikia o ka haukapila i kēlā me kēia lā: Cannabinoid Hyperemesis Syndrome (CHS) ("scromiting": agonizing, cyclical projectile luaʻi a me ka uē ʻana i nā mea hoʻohana maʻamau i kēlā me kēia lā e hoʻoulu ai i ka ola ** hypokalemic cardiac arrhythmias kiʻekiʻe ) psychosis, ke keiki ulia pōpilikia a me ka maʻi ʻawaʻawa THC maʻi maʻi maʻi (ʻo ia ke kumu o ka coma a me ke kaumaha o ka hanu i nā keiki liʻiliʻi), a me ka ** synthetic cannabinoid ("Spice") neurotoxicity**.

Ma muli o ka hana maʻamau ʻo THC ma ke ʻano he pūhui anti-nausea i nā mea hoʻohana i kekahi manawa, ʻaʻole i manaʻo ka poʻe kūʻai cannabis maʻi me Cannabinoid Hyperemesis Syndrome ʻo ka cannabis ke kumu o ko lākou luaʻi ikaika, a ma kahi o ka uahi a i ʻole ka vape * ʻoi aʻe * THC e hoʻoponopono i ko lākou ʻōpū, e hoʻopaʻa iā lākou iho i kahi pōʻai physiological pōʻino. ʻO ka mea ʻino, hoʻopaʻa pinepine ka poʻe maʻi i ka manawa hyperemetic o CHS iā lākou iho i loko o ka ua wela wela no 6 a 12 mau hola i ka lā e hoʻāla ai i nā mea wela o ka ʻili (TRPV1), e loaʻa ana i ka ** wela wela o ka ʻili a me ka dehydration intravascular wikiwiki**. Ke ʻike nei pehea e ʻike ai i nā hōʻailona o CHS, pehea e hoʻohana ai i ka ** topical capsaicin cream** me ka palekana ma mua o ka hoʻolapalapa ʻana i ka ua, pehea e hoʻopau ai i kahi hōʻeha weliweli THC hiki ke hoʻohana ʻia me ka ** hoʻopaneʻe hepatic 11-hydroxy-THC timeline **, a i ka manawa e kāhea ai i kahi kaʻa kaʻa no ka hāʻule ʻana o ka electrolyte a i ʻole ka ʻai ʻana o ke keiki e ola ai nā ola.

E hana i kēia i kēia manawa¶

1. E kelepona i kāu helu pilikia kūloko (911 ma US a me Kanada, 112 ma ka EU, 999 ma UK) inā e ʻai koke ke keiki ʻōpio a i ʻole ke keiki liʻiliʻi i kekahi cannabis gummy, kokoleka, a i ʻole ka aila vape, a i ʻole ke hōʻike ʻia e kekahi kanaka makua i ka ʻeha, ʻeha o ka umauma, maule, a i ʻole hiki ʻole ke mālama i ka wai no nā hola he 12 a 24. E nānā i kā mākou helu pilikia papa kuhikuhi, a i ʻole kelepona i ka Poison Control (1-800-222-1222 ma ʻAmelika Hui Pū ʻIa). ʻAʻole e like me nā pākeke, hiki i nā kamaliʻi e ʻai ana i nā meaʻai THC hiki ke paʻa koke i loko o ** coma hohonu, pilikia hanu hanu (hoʻopau ka hanu ʻana), a me ka hopu ʻana **.
2. **Inā pilikia ka mea hoʻohana cannabis i kēlā me kēia lā.
3. Huki i ka mea maʻi CHS mai loko mai o ka ua wela ma mua o ka puhi ʻana i ko lākou ʻili a maule paha i ka maloʻo ʻana, a kau ma luna o ka counter 0.025% a i ka 0.075% Topical Capsaicin Cream i ka ʻōpū ma kahi.TRPV1 nā mea hoʻopaʻa wela ma ke ʻano he wai paila me ka ʻole o ka wela a i ʻole ka hoʻoheheʻe ʻana i ka wela.
4. **E ʻimi i nā wai wai a me ka hoʻololi electrolyte o ka mea maʻi luaʻi CHS inā he ʻeleʻele a ʻaʻole paha ka mimi o ka mea maʻi luaʻi CHS, ʻo ka ʻiʻo o ka ʻiʻo, puʻuwai palpitations, huikau, a luaʻi paha i ke koko.
5. **Inā loaʻa kekahi i ka weliweli weliweli, ka puʻuwai heihei, a i ʻole ka paranoia ma hope o ka ʻai ʻana i ka THC pono e ʻai ʻia (me ka hanu maʻamau a ʻaʻohe kemika synthetic), e hoʻoneʻe iā ia i kahi lumi polū a mālie a hōʻoiaʻiʻo iā ia e hala ana ka piko. E alakaʻi i ka hanu pahu lohi, hāʻawi i ka wai anuanu, a e nau a honi iā ​​lākou ka pepa ʻeleʻele holoʻokoʻa a i ʻole ka ʻili lemon (ke kōkua ka beta-caryophyllene a me ka limonene terpenes i ka lepo i nā puka manaʻo hopohopo).
6. **E mālama i kekahi ʻano o ka "Spice," "K2," street-vape aila, a i ʻole ka pahu hau "THC-P / HHC / Mushroom" gummies ma ke ʻano he lāʻau make e hoʻoweliweli ana i ke ola.

Rapid Triage: Ka ʻike ʻana i ka Cannabinoid Emergency e hana nei¶

flowchart TD
    A["Cannabis a i ʻole Cannabinoid Emergency"] --> B{"ʻO wai ke ʻano maʻi lapaʻau e kūlike me ka mea maʻi?"}
    B -->|Young Child / Toddler Ate THC Edible| C["PEDIATRIC EMERGENCY: Kāhea iā 911 / Manaʻo Poison I kēia manawa - Loaʻa kiʻekiʻe o ka Coma & Hoʻopau ʻia ka hanu"]
    B -->|Chronic Daily User: Non-Stop Vomiting, Belly Pain, Compulsive Hot Showers| D["Cannabinoid Hyperemesis Syndrome - CHS"]
    B -->|Ate Too Much THC Edible / High-Dose Dab: Racing Heart, Terror, Time Distortion| E["Acute High-Potency THC Panic / Over-Intoxication"]
    B -->|Used Synthetic Spice, K2, Street Vape, or Unknown Gas-Station Analog| F["SYNTHETIC TOXICITY: E kāhea koke iā 911 - Ka pilikia o ka hopu ʻana, ka hoʻouka ʻana o ka naʻau, a me ka psychosis."]
    D --> G["1. E hooki koke i na Cannabis a pau 2. E hoopili i ka Capsaicin Topical 0.075% i ka Opu."]
    E --> H["1. Keʻena Polū mālie 2. E hōʻoluʻolu i nā kiʻekiʻe o 11-OH-THC ma 2 a 4 mau hola 3. Hoʻomaha mālie a me ka wai ʻana i ka wai 4. E kelepona iā 911 wale nō inā ʻeha ʻeha o ka ʻūhā, Syncope, a i ʻole Psychosis palekana"]

Hoʻohālikelike Hoʻohālikelike o nā ʻEhā Cannabinoid Emergencies¶

Mahele 1: Cannabinoid Hyperemesis Syndrome (CHS) a me "Scromiting"¶

Ua wehewehe mua ʻia i loko o nā palapala lapaʻau i ka makahiki 2004 a ua hoʻopaʻa inoa ʻia ma ka Rome IV Diagnostic Criteria for Functional Gastrointestinal Disorders, Cannabinoid Hyperemesis Syndrome (CHS) pili i nā mea hoʻohana kaumaha a maʻamau o nā huahana cannabis (me ka cannabis lapaʻau, concentrates leʻaleʻa, Delta-8 THC, a hui pū ʻia me THC).

1. ʻEkolu mau lāʻau lapaʻau o CHS¶

1. Ka Māhele Prodromal (Mahina a Makahiki): Hoʻomaka ke kanaka i ka nausea i ke kakahiaka nui, ka manaʻo ʻawaʻawa a i ʻole "butterfly" i loko o ka ʻōpū, makaʻu i ka luaʻi ʻana, a me ka ʻeha ʻeha o ka ʻōpū. The Fatal Trap: No ka mea, ʻo ka hanu ʻana i ka THC no ka manawa pōkole e hoʻoulu i ka lolo waena CB1 ʻO nā mea loaʻa e uhi i ka nausea no 30 mau minuke, hoʻomaka ke kanaka e ala a hoʻopaʻa a puhi paha i kēlā me kēia kakahiaka e hoʻōki i ka nausea, e hoʻonui mau ana i kā lākou haʻawina cannabinoid i kēlā me kēia lā a hiki i kā lākou mau puʻupuʻu puʻupaʻa e piʻi i loko o ka pilikia.
2. ** ʻO ka Hyperemetic Phase (Acute Emergency: 24 Hours to 10+ La):**
   • ʻO ka hoʻomaka koke ʻana o ka ** hoʻomaha ʻole, hiki ʻole ke nausea a me ka luaʻi projectile** (pinepine 5 a 20 mau manawa o ka hola) i ukali ʻia me nā leo leo nui a me ka ʻeha epigastric ʻeha ("scromiting").
   • Ke ʻauʻau wai wela ʻo Pathognomonic: Ma luna o 90 pakeneka o nā maʻi CHS ʻike ʻo ke kū ʻana ma lalo o ka ʻauʻau wela a i ʻole ka noho ʻana i loko o ka ʻauʻau ʻauʻau e hoʻopau koke i ko lākou ʻeha ʻōpū a me ka nausea, no ka hoʻi ʻana o ka luaʻi i loko o nā minuke o ka puka ʻana i waho o ka wai. Hoʻokahe mau ka poʻe maʻi i ka mea hoʻomehana wai wela o ko lākou home i nā manawa he nui i ka lā a i ʻole e nānā i loko o nā lumi hōkele no ka wai wela mau.
3. Ka Hana Hoʻihoʻi (He pule a i nā mahina ma hope o 100% hoʻopau): Hoʻopau ka luaʻi ʻana i loko o 2 a 10 mau lā o ka hoʻōki loa ʻana i nā cannabinoids a pau, a hoʻi hou ka ʻai maʻamau a me ke kaumaha i kekahi mau pule. CB1 a TRPV1 hoʻopaʻa hou nā mea hoʻokipa. Akā naʻe, inā hoʻohana ke kanaka i ka cannabis i hoʻokahi manawa i ka wā o ka hoʻihoʻi ʻana, e hoʻihoʻi pinepine ka pae hyperemetic piha i loko o nā hola a i ʻole mau lā.

2. No ke aha e hana ai ka ua wela (a no ke aha ʻo Topical Capsaicin Cream ka mea lapaʻau palekana)¶

I loko o ka hypothalamus o ke kanaka (e hoʻoponopono ana i ka mahana o ke kino) a me nā aʻalolo sensory o ka ʻōpū ʻōpū, **CB1 ʻO nā mea loaʻa cannabinoid e noho kokoke ana TRPV1 (Transient Receptor Potential Vanilloid 1) nā mea loaʻa , nā ala ion pololei i hoʻāla ʻia e ** wela wela (> 43 degrees Celsius / 109 degrees Fahrenheit) a me ka pepa chili-pepper capsaicin.

• Ke hoʻohaʻahaʻa ʻia ka THC kiʻekiʻe kiʻekiʻe CB1 nā mea hoʻokipa a hoʻopale i ka hoʻokahe ʻana o ka ʻōpū (gastroparesis), hele hewa ka hōʻailona ʻeha o ka ʻōpū.
• Ke kū nei ma lalo o ka ua 45-degere-Celsius (113-degere-Fahrenheit) ua kahe ka ʻili. TRPV1 nā aʻalolo me nā hōʻailona wela, ka hoʻokaʻe ʻana i ke koko mai nā kīʻaha splanchnic gut a i ka ʻili ("cutaneous steal syndrome") a me ka hoʻopau ʻana i ke kikowaena nausea o ka lolo.
• Pehea e hoʻohana ai i ka Topical Capsaicin Cream ma ka home a i ʻole ma ka hoʻāʻo ʻana ma kahi o ka ua wela:
  1. E kūʻai i ka maʻamau ma luna o ka hale kūʻai 0.025%, 0.075%, a i ʻole 0.1% Capsaicin Cream (kūʻai ʻia ma kēlā me kēia lāʻau lapaʻau no ka ʻeha o ka ʻāʻī/nerve).
  2. Me ka hoʻohana ʻana i nā mīkina lima hiki ke hoʻopau (a holoi lima paha me ke kopa kīʻaha ma hope), e hoʻopili i ka ** lipine ʻiʻo ka nui o ka ʻiʻo capsaicin ma ka ʻili o ka ʻōpū (opu) a i ʻole ke kua o nā lima luna** a hiki i 3 manawa i kēlā me kēia lā.
  3. Mai hoʻopili koke i ka ʻaila capsaicin ma hope o ka puka ʻana i waho o ka ʻauʻau wela (e kali a maʻalili ka ʻili i ka mahana maʻamau, a i ʻole e ikaika ka ʻeha), a mālama pono ia mai nā maka, ka waha, ka ʻili i haki, a me nā ʻōpū. (Inā ʻaʻa nui ka capsaicin, holoi ʻia me ka ʻaila meaʻai kuke a i ʻole waiu anuanu, ʻaʻole wai; ʻike. ʻAi ka chili pepper capsaicin i nā maka, ka ʻili, a me nā lima.)
  4. I loko o 20 a 45 mau minuke, hoʻāla ka ʻōpū mehana o ka capsaicin. TRPV1 nā mea loaʻa a uhaʻi i ka nausea/pain loop me ka pau ʻole o ka wai kino i loko o kahi ʻauʻau wela.

3. Nā hae ʻulaʻula o ka 'Oihana Hoʻopilikia a no ke aha i pau ʻole ai nā lāʻau nausea maʻamau¶

Ma kahi keʻena pilikia o ka haukapila, serotonin maʻamau 5-HT3 ʻO nā mea kū'ē e like me ondansetron (Zofran) a i ʻole promethazine ʻaʻole maikaʻi loa i ka CHS koʻikoʻi no ka mea ke alakaʻi ʻia ka luaʻi e dopamine/TRPV1/CB1 dysregulation ma mua o ke serotonin. Ua hōʻike ʻia nā hoʻokolohua lapaʻau like ʻole (e like me ka HaVOC Trial) he haʻahaʻa IV haloperidol (0.05 mg/kg a i ʻole 2.5 to 5 mg) a i ʻole IV droperidol, i hui pū ʻia me 1 a i ka 2 lita o ka wai crystalloid IV, pani potassium/magnesium, a me ka capsaicin ʻōpū, e hoʻōki i ka luaʻi ʻana o CHS me ka wikiwiki a pale i ka komo ʻana i ka haukapila.

E hele koke i ka Oihana Hoʻopilikia inā loaʻa i kahi mea hoʻohana cannabis luaʻi kekahi o kēia mau hae ʻulaʻula:

• ʻAʻole hiki ke hoʻopaʻa i nā sips liʻiliʻi o ka hopena electrolyte waha i lalo no ** ma mua o 12 a 18 mau hola **.
• Nā hōʻailona o ka Hypokalemia & Dehydration Koʻikoʻi: ʻO ka ʻiʻo o ka ʻiʻo a nāwaliwali paha i nā wāwae, ka puʻuwai a i ʻole ka heihei ʻana o ka puʻuwai, ka ʻūlū nui a maule paha ke kū i luna, maloʻo nā maka pohō, a i ʻole ** ʻaʻohe mimi no 8+ hola (a i ʻole ʻeleʻele ʻeleʻele mimi)**.
• Ka luaʻi ʻana i ke koko ʻulaʻula ʻulaʻula a i ʻole nā ​​mea ʻeleʻele "kope-pa" (Mallory-Weiss esophageal tear from violent retching) a i ʻole nahae hikiwawe ** ʻeha ʻeha o ka umauma a i ʻole ka ʻāʻī me nā ea ma lalo o ka ʻili ma lalo o ka ʻili** (Boerhaave syndrome: fatal esophageal rupture).
• ** ʻO ka ʻōpū ʻoʻoleʻa, like me ka papa, ke kuni kiʻekiʻe, a i ʻole ka ʻeha ʻākau-haʻahaʻa-haʻahaʻa:** Mai manaʻo i ka ʻeha o ka ʻōpū i ka mea hoʻohana cannabis he "CHS wale nō" a hiki i ka wā i hoʻokuʻu ʻia ai ke kauka e ke kauka.

Mahele 2: ʻO THC Edible Panic Attacks a me ka ʻona nui¶

ʻO ke kumu maʻamau o ka hele ʻana o ka lumi ulia pōpilikia cannabis ma waena o nā mea hoʻohana i kekahi manawa, nā mākaʻikaʻi, a me nā poʻe ʻelemakule ʻo oral THC edible over-consumption ("greening out").

1. No ke aha i ʻoi aku ka paʻakikī o ka ʻai ʻana ma mua o ka puhi ʻana: The 11-Hydroxy-THC hei¶

+-------------------------------------------------------------------------+
|        INHALED THC vs. ORAL EDIBLE THC PHARMACOKINETIC TIMELINE         |
|                                                                         |
|  INHALED (Smoking / Vaping):                                            |
|  - Onset: 2 to 10 minutes  |  Peak: 15 to 30 minutes                    |
|  - Duration: 2 to 4 hours  |  Active Molecule: Mostly Delta-9-THC       |
|                                                                         |
|  ORAL EDIBLES (Gummies, Chocolates, Baked Goods, Tinctures):            |
|  - Onset Delay: 45 to 120 minutes (up to 3 hours after a fatty meal)    |
|  - Peak Intensity: 2 to 4 hours after ingestion                         |
|  - Total Duration: 6 to 12+ hours (residual grogginess up to 24 hours)  |
|  - Active Molecule: Liver Cytochrome P450 (CYP2C9) converts Delta-9-THC |
|    into 11-HYDROXY-THC, a metabolite that crosses the blood-brain       |
|    barrier far more rapidly and produces intense psychoactive effects.  |
+-------------------------------------------------------------------------+

No ka mea, he 60 a hiki i ka 120 mau minuke** ka ʻai ʻana, ʻai mau nā mea hoʻohana ʻole 10 mg a i ʻole 25 mg gummy, ʻaʻohe manaʻo i nā minuke 45, a ʻai i ʻelua a ʻekolu paha gummies ma mua pono o ka paʻi ʻana o ka maʻi mua i ko lākou ate (** hoʻopaʻa ʻia **). ʻElua hola ma hope, 50 to 100 mg o 11-hydroxy-THC kahe ka lolo i ka manawa like.

2. ʻO ka hoʻoneʻe ʻana i ka home no kahi hōʻeha weliweli THC¶

Ke hoʻopilikia ʻia kekahi e ka THC i hoʻopaʻa ʻia e hiki ke ʻai a i ʻole ka concentrate (a ʻaʻohe ** ʻeha o ka umauma, hopu, a i ʻole ka ʻike ʻana i ka lāʻau synthetic), ʻike pinepine lākou i ka ** sinus tachycardia (110 to 145 beats per minute), orthostatic hypotension (manaʻo me he mea lā e make lākou i ke kū ʻana), ka hoʻomāhuahua ʻana o ka manawa (5 mau minuke me he 2 mau hola), a me ka manaʻo nui e kū ana ko lākou puʻuwai a i ʻole ua poina iā lākou pehea e hanu aunoa**.

1. Hana i kahi Laa Hoʻoulu Haʻahaʻa:
   • E alakaʻi i ke kanaka i kahi lumi moe mālie a i ʻole kahi moe. E hoʻopio i nā mele nui, nā ʻōniʻoniʻo kīwī, a me nā kukui ʻālohilohi ma luna, a noi aku i nā lālā lehulehu e haʻalele i ka lumi no laila hoʻokahi wale nō leo mālie a hilinaʻi ʻia e kamaʻilio ana.
2. Hoʻouna i ka hōʻoia heleuma a me ka hoʻopaʻa ʻana i ka manawa:
   • E kamaʻilio me ka leo mālie, mahana, a me ka ʻoiaʻiʻo: * "Ua ʻai ʻoe i kahi THC ikaika e ʻai ʻia i ka [Time]. ʻO kou manaʻo i kēia manawa ʻo 11-hydroxy-THC peaking i kāu ʻōnaehana. ʻO kou puʻuwai wikiwiki he adrenaline reflex maʻamau mai THC, ʻaʻole he puʻuwai puʻuwai. iwaho, ke hoomaemae nei kou ake akea, a e malie auanei oe."*
3. E Moe Paa a Hoʻomoe paha e Kāohi i ka Syncope (Maʻule):
   • ʻO THC ke kumu o ka vasodilation peripheral (ke koko i loko o nā wāwae), kahi e hāʻule koke ai ke koko a maule ke kū koke ke kanaka e hele i ka lumi lumi. E hoʻomoe a hoʻopaʻa ʻia paha ma luna o nā uluna me nā wāwae i hoʻokiʻekiʻe ʻia, a e alakaʻi kino iā lākou inā pono lākou e kū i ka lua.
4. Sensory Grounding and the Black Peppercorn / Lemon Technique:
   • E noi iā lākou e kau i kahi ** lole ʻauʻau ʻoluʻolu a pulu ma ko lākou lae a me ke kua o ko lākou ʻāʻī** (e hoʻāla i ka mammalian dive reflex a me ke aʻalolo vagus e hoʻolohi mālie i ka puʻuwai puʻuwai).
   • Ka Pepa ʻEleʻele a i ʻole ka ʻili Lemona Hou: Inā ʻala lākou a hiki iā lākou ke ale me ka palekana, e honi lākou i ka pepa ʻeleʻele hou a nau paha ** 2 a 3 mau pepa ʻeleʻele holoʻokoʻa**, a i ʻole e honi i ka ʻili lemon i kālai ʻia a inu i ka wai lemon. Loaʻa i ka pepa ʻeleʻele nā pae kiʻekiʻe o beta-caryophyllene, he sesquiterpene meaʻai e hana ma ke ʻano he koho **CB2 ʻO ka agonist receptor a me ka modulator allosteric maikaʻi ʻole ** i hōʻike ʻia i ka noiʻi cannabinoid clinical e hoʻomaha i ka hopohopo i hoʻokomo ʻia THC, ʻoiai ʻo citrus ** limonene ** e hōʻemi ana i ka paranoia THC nui.
   • E hoʻomaha mālie 4-6 Vagal Breathing: E aʻo iā lākou e hanu mālie ma ka ihu no 4 kekona a hoʻomaha mālie ma nā lehelehe i ʻoki ʻia no 6 kekona (ʻo ka hoʻolōʻihi ʻana i ka hanu e hoʻoulu i ka leo vagal parasympathetic a hoʻohaʻahaʻa i ka puʻuwai puʻuwai).
5. He aha ka mea ʻaʻole e hana i ka wā o kahi hanana panic THC:
   • Mai hāʻawi i ka caffeine, nā mea inu ikaika, a i ʻole ka waiʻona (hoʻonui ka caffeine i ka tachycardia a me ka panic; hoʻonui nui ka waiʻona i ka ʻai ʻana o THC).
   • Mai hoʻoikaika iā lākou i loko o ka ʻauʻau anu i ka wā e kū ana (no ka hoʻoulu ʻana a i ʻole ka ʻeha poʻo paheʻe a hāʻule).

Mahele 3: ʻAi ʻia ʻana o THC Gummy no nā keiki maʻi (Pūkia koʻikoʻi)¶

Hoʻokomo pinepine ʻia nā gummies THC kalepa, nā kīlekaleka, a me nā lole nerd-rope i loko o nā wīwī mylar waihoʻoluʻu e nānā like me ka lole kūʻai nui, me ka pūʻolo hoʻokahi i loko o 100 a 1,000 milligrams o THC (10 a 100 mau doses makua).

• No ke aha e hoʻoweliweli ai ʻo THC Edibles i ke ola i nā kamaliʻi a me nā kamaliʻi liʻiliʻi: I ke kanaka makua he 75 kilokani (165 paona), 50 mg ʻO THC ke kumu o ka hoʻouka kaua weliweli. I loko o kahi kamaliʻi liʻiliʻi 12 kilokani (26 paona), hopu a ʻai i kahi lima o nā gummies i loko 100 to 300 mg Hāʻawi ʻo THC i kahi maʻi ʻona nui (10 to 25 mg/kg).
• Ka holomua o ke kino keiki (1 a 6 hola ma hope o ka ʻai ʻana):
  • ʻO nā hōʻailona mua (30 a 90 mau minuke): Ke hele wāwae ʻole (ataxia), nā maka aniani i ʻākea ʻia, ʻakaʻaka a i ʻole ka uē hikiwawe ʻole, ka haʻalulu ʻōlelo, a me ka haʻalulu ʻiʻo.
  • ʻO nā hōʻailona koʻikoʻi (1 a 4 mau hola): ʻO ka piʻi wikiwiki ʻana i lethargy hohonu, hiki ʻole ke ala i ka hoʻoulu ʻana i ka ʻeha (coma), lohi a pāpaʻu paha ka hanu ʻana (bradypnea / apnea e koi ana i ka endotracheal intubation), hāʻule i ka wela o ke kino (hypothermia), a me ka maʻi tonic-clonic maʻamau.
• Ka hana koke no nā mākua a me nā kahu hānai:
  1. Mai kali i ka ʻike ʻana mai o nā hōʻailona. No ka mea, he 1 a 2 mau hola ke komo ʻana o ka gummies waha, hiki i ke keiki ke nānā maʻamau i 20 mau minuke ma hope o ka ʻai ʻana i ka gummy THC hiki ke hoʻōki i ka hanu ʻana ma ko lākou wahi moe i ʻelua hola ma hope.
  2. E kelepona iā 911 / 112 / 999 a i ʻole Ka Manaʻo Poison (1-800-222-1222 i ka US) koke a lawe aku i ke keiki A me ka lole lole lole pololei i ka halemai kokoke loa.
  3. E 100 pakeneka pono me ka poʻe lapaʻau a me nā kauka ER e pili ana i ka mea a ke keiki i ʻai ai. ʻO ka haʻi koke ʻana i ke kauka he mea ʻai THC ia e hoʻopakele ai i ke keiki mai nā kīʻaha spinal invasive (lumbar punctures), head CT radiation, a me nā lāʻau antibiotic pono ʻole ʻoiai e ʻimi ana nā kauka i ke kumu o ke koma koke.

Mahele 4: Synthetic Cannabinoids ("Spice," "K2") a me Unregulated Hemp Analogs¶

Mai huikau i ka cannabis botanical maoli me Synthetic Cannabinoid Receptor Agonists (SCRAs) i kūʻai ʻia ma ke ʻano he mea ʻala lāʻau ("Spice," "K2," "Black Mamba," "Scooby Snax"), adulterated street vape liquid, or high-power semi-synthetic hemp derivatives (THC-O-acetate, THC-P

1. Full Agonist Neurotoxicity ("Spice" / "K2"): ʻO Delta-9-THC kūlohelohe wale nō he agonist hapa ma ka lolo. CB1 nā mea loaʻa, ʻo ia hoʻi ka hopena physiological e pili ana i ke kaupaku kūlohelohe. ʻO nā cannabinoids synthetic i hana ʻole ʻia e ka lab (e like me MDMB-4en-PINACA, ADB-BUTINACA, a 5F-MDMB-PICA) he agonists piha me 20 a 800 manawa ka mana o THC. Hoʻomaka lākou i ka ʻeha nui loa, hyperthermia kiʻekiʻe, rhabdomyolysis (ka ʻāʻī ʻana o ka ʻiʻo e hoʻopau ana i nā puʻupaʻa), ka maʻi ʻaʻaʻa coronary e hōʻeha ʻia ai ka puʻuwai i nā ʻōpio, a me ka psychosis paranoid violent.
2. Vitamin E Acetate & Ketene Gas mai Illicit THC-O Vape Cartridges: Hoʻomaʻamaʻa THC-O-acetate a i ʻole nā aila vape i ʻoki ʻia me Vitamin E acetate i loko o kahi peni vape e haki i ka hui acetate i loko o ketene gas (CH2=C=O), he mea make o ka pulmonary poison pili kemika i pili i ka phosgene i kumu EVALI (E-cigarette or Vaping Use-Associated Lung Injury), kemika pneumonia, a me ka hanu hanu nui.
3. Brodifacoum ("Superwarfarin" Rat Poison) ʻAi moe kolohe: ʻO nā maʻi maʻi maʻi lehulehu i nānā ʻia e ka CDC ua pili i nā cannabinoids synthetic alanui i kāpī ʻia me brodifacoum (lōʻihi i ka ʻiole ʻawaʻawa) e hoʻolōʻihi i ke kiʻekiʻe, e hoʻokahe koke ai ka poʻe maʻi mai ko lākou ʻāʻī, ihu, ʻōpū, a me nā puʻupaʻa i nā lā ma hope o ka ʻulaʻula nui. ʻO ka lāʻau lapaʻau ʻo Vitamin K1 (phytonadione)**.

Mahele 5: Ke ola nei i ka haʻalele ʻana i ka cannabis a me ka hoʻihoʻi hou ʻana i ka hiamoe ma hope o ka haʻalele ʻana no CHS¶

No nā poʻe maʻi i hōʻike ʻia me Cannabinoid Hyperemesis Syndrome a i ʻole ka hilinaʻi nui i kēlā me kēia lā (70% to 90% THC wax/vape carts), ʻo ka mea pale paʻakikī loa e noho maikaʻi ʻo ke ola ʻana i ka ** 7 mua a i 14 mau lā o ka wehe ʻana i ka cannabis acute ** me ka ʻole o ka hoʻihoʻi ʻana e hoʻōki i ka pilikia.

1. ʻO ka manawa o ka haʻalele ʻana o THC kiʻekiʻe kiʻekiʻe¶

Hoʻomaopopo ʻia ma ka DSM-5-TR, Cannabis Withdrawal Syndrome (CWS) hoʻomaka i loko o 24 a 48 hola o ka hoʻomaha ʻana i ka hoʻohana ʻana i kēlā me kēia lā, piʻi ma waena o La 2 a me 6, a hoʻomaha loa i loko o 2 a i 3 pule (ʻoiai hiki ke mau nā moe REM rebound no 30 a 45 mau lā):

• ** Hoʻi hou ʻana o ka ʻōpū:** Nalo ka ʻai, ʻeha ʻeha o ka ʻōpū, a me ka ʻeha kakahiaka. (ʻOiaʻiʻo, ke hala ʻoe i ka hola 48 a i 72 me ka ʻole o THC, pau ka "scromiting" ikaika o CHS a hoʻololi ʻia e ka queasiness māmā.)
• Sleep Architecture Rebound: Ma muli o ka hoʻopaʻa ʻana o THC i ka Rapid Eye Movement (REM) hiamoe, ʻo ka haʻalele ʻana e hoʻoulu i kahi ** REM hiamoe hoʻihoʻi hou**: ʻo ka insomnia mua loa a ukali ʻia e nā moeʻuhane weliweli, ʻano ʻano, a i ʻole nā ​​moe moe pōʻino a me nā ** ʻāhu pō** e hoʻoheheʻe i nā pepa moe.
• Autonomic & Mood Dysregulation: Hoʻomaha ʻole, huhū, huhū hikiwawe, huʻihuʻi, haʻalulu lima haʻalulu, a me ke poʻo.

2. Mālama ʻoluʻolu palekana, ʻaʻole cannabinoid i ka wā o ka hoʻoponopono hou ʻana o CHS i nā lā 14¶

1. Hoʻomaʻamaʻa waha a me ka BRAT-Plus Progression:
   • No nā hola 48 mua ma hope o ka pau ʻana o kahi hanana CHS, e inu i paʻakai hoʻoheheʻe waha i hoʻoheheʻe ʻia (WHO ORS, Pedialyte, a i ʻole Liquid I.V.), ka iwi a me ka hupa huaʻai, a me nā mea inu haʻuki i hoʻoheheʻe ʻia ma 15 milliliters (1 punetēpona) i kēlā me kēia 10 mau minuke ma mua o ka ʻai ʻana i ke aniani piha o ka wai maʻemaʻe.
   • Ke emi ka wai no nā hola he 12, e hoʻokomo i nā meaʻai haʻahaʻa momona (ka maiʻa, laiki keʻokeʻo maʻemaʻe, ka ʻāpala, ka palaoa maloʻo, nā pahū paʻakai, a me ke kī kīwī). Hōʻalo i nā meaʻai momona a palai paha no ka pule mua, no ka mea, hoʻolohi ka momona o ka meaʻai i ka hemo ʻana o ka ʻōpū.
2. Hoʻokele i nā ʻauʻau pō a me Rebound Insomnia me ka hoʻi ʻole ʻana:
   • E mālama mālie i ka lumi moe (16 a i 18 degere Celsius / 60 a 65 degere Fahrenheit), e hoʻopaʻa i nā ʻāpana pulupulu hanu, a mālama i kahi hoʻololi maloʻo o nā pālule ma ka ʻaoʻao o kahi moe.
   • E nīnau i kāu kauka e pili ana i ka hiamoe pōkole a i ʻole ke kākoʻo nausea (e like me melatonin 1 a i 3 mg, hydroxyzine, doxylamine, a i ʻole ** promethazine/prochlorperazine ** suppositories) i nā lā 1 a hiki i 7. ** Mai hoʻohana i ka ʻaila CBD, pua hemp**, a i ʻole ka Delta-8 vape a hiki i ka Delta-8 nontoxic. Hoʻopili nā phytocannabinoids me ka enteric TRPV1 a CB1 nā mea loaʻa a hoʻoulu hou i ka hyperemesis.

(Inā ʻoe a i ʻole kekahi mea āu e mālama nei e hakakā nei me ka hilinaʻi cannabis kiʻekiʻe i kēlā me kēia lā, hoʻohana lāʻau synthetic, a i ʻole nā ​​hale hoʻomaha CHS hou, ʻike. Ka hoʻohana ʻana i ka lāʻau a me ka hoʻohui ʻana i ka lāʻau: alakaʻi kōkua pilikia a Kākoʻo ʻana i kekahi lālā o ka ʻohana me ka addiction. Manaʻo mākou e lawe i kahi papa kōkua mua i ʻae ʻia mai ke Keʻa ʻulaʻula, St John Ambulance, a i ʻole kahi mea lawelawe kūloko.)

Nīnau pinepine¶

Nānā ʻia nā kumu¶

• American College of Gastroenterology (ACG) and Rome Foundation: Rome IV Diagnostic Criteria and Clinical Practice Guidelines for Cannabinoid Hyperemesis Syndrome (CHS) (Phases of CHS, compulsive water-water bathing pathophysiology, a me ka hopena o ka pau ana).
• ** American College of Emergency Physicians (ACEP) & Annals of Emergency Medicine (HaVOC Randomized Trial):** Intravenous Haloperidol / Droperidol and Topical Capsaicin (0.075% a hiki i 0.1%) vs. Ondansetron i ka Emergency Department Management of Cannabinoid Hyperemesis Syndrome.
• Na Center for Disease Control and Prevention (CDC) and American Association of Poison Control Centers (AAPCC, United States): Pediatric Unintentional Cannabis Edible Ingestions, Outbreak Advisories on Brodifacoum-Adulterated Synthetic Cannabinoids, a me *EVALI (Vitamin E Acetate / Keteneid Guanceng)
• National Institute on Drug Abuse (NIDA / NIH, United States) & World Health Organization (WHO): Pharmacokinetics o ka waha 11-hydroxy-THC vs. inhaled Delta-9-THC, a me ka toxicology acute o Full-Agonist Synthetic Cannabinoid Receptor Agonists (Spice / K2).
• British Journal of Pharmacology (Russo, E. B.): Taming THC: Potential Cannabis Synergy and Phytocannabinoid-Terpenoid Entourage Effects (Pharmacology of beta-caryophyllene and limonene in attenuating acute THC anxiety).

Nā alakaʻi pili¶

• Ka hoʻohana ʻana i ka lāʻau a me ka hoʻohui ʻana i ka lāʻau: alakaʻi kōkua pilikia
• Kākoʻo ʻana i kekahi lālā o ka ʻohana me ka addiction
• ʻO ka hoʻouka kaua a me ka hopohopo nui
• ʻO nā pilikia olakino noʻonoʻo a me nā pōʻino suicidal
• ʻO ka ʻai ʻana, ka maʻi gastroenteritis, a me ka dehydration
• ʻAi ka chili pepper capsaicin i nā maka, ka ʻili, a me nā lima
• Hoʻomake i ke kōkua mua
• Helu pilikia