Disama dia Cannabinoid Hyperemesis Syndrome (CHS), High-Potency THC Panic, ne Synthetic Edibles¶

Nansha muvua manga a kale avua ne 2 too ne ku 4 pa lukama delta-9-tetrahydrocannabinol (THC), bintu bia mushinga mukole bia matuku etu aa, biamu bia vape, wax dabs, infused pre-rolls, ne gummies ya dose mikole bitu anu bifila 70 too ne ku 95 pa lukama bia THC, pamue ne hempsythetics idi kayiyi milongolola (THC-O-acetate, THC-P, HHC, Delta-8 THC) ne lethal fully synthetic cannabinoid receptor agonists ("Spice," "K2," MDMB-4en-PINACA, ADB-BUTINACA). Dikola dia bukole edi ndipatule bilumbu binayi bia lukasa bia luondapu bidi mpindieu biuwuja nzubu ya luondapu ya lukasa lukasa dituku dionso: Cannabinoid Hyperemesis Syndrome (CHS) ("scromiting": disama dia kanyinganyinga, dia nsongo dia tshintu tshidi tshiendakana ne diela mbila mu bantu badi benza mudimu ne tshiamu tshia mitaku tshidi tshikebesha lufu disama dia mutshima ne disama dia mu tshiadi dipanga), buôwa bua kudia ne THC wa bukole bua bungi ne disama dia lungenyi, disama dia muana mutekete ne dia THC mu mpukapuka (didi difikisha bana bakese ku dipanga ne ku dipanga dia mupuya), ne disama dia mu mikolo dia cannabinoïde ("Spice") dia mpukapuka.

Bu mudi THC wenza mudimu bu tshintu tshidi tshiluisha disama dia mutshima kudi bantu badi banua misangu mikuabu, bantu badi banua manga a cannabis badi ne disama dia Cannabinoid Hyperemesis Syndrome kabatu bitaba ne: cannabis ke udi ubafikisha ku diela diabu dia tshikisu to, ne pamutu pa nanku batu banua makanya anyi banua THC ya bungi bua kujikija tshifu tshiabu, ne badibueja mu njiwu ya mubidi. Tshidi tshibi menemene, babedi badi mu tshitupa tshia hyperemetic tshia CHS batu misangu ya bungi badisuika mu mayi a kapia kakole munkatshi mua mêba 6 too ne ku 12 ku dituku bua kuenza mudimu ne bintu bidi bitaba kapia ka dikoba (TRPV1), udi ukenga bikole disama dia dikoba dia kapia ne dijimija dia mâyi mu mishipa ya lukasa. Kumanya mushindu wa kujingulula bimanyinu bia CHS, mushindu wa kuenza mudimu ne creme wa capsaicine bimpe pamutu pa kuenza mudimu ne tshikondo tshia 11-hydroxy-THC tshia mu tshifu, ne dîba dia kubikila ambulanse bua dikuluka dia electrolyte anyi bua kusungila mioyo ya bana.

Enza nunku mpindieu¶

1. Bikila nimero ya njiwu ya muaba unudi (911 mu États-Unis ne mu Canada, 112 mu UE, 999 mu UK) diakamue pikala muana mutekete anyi muana mutekete mudie tshintu tshionso tshia cannabis gummy, chocolat, anyi mafuta a vape, anyi pikala muntu mukulumpe muleje disama dia tshiadi, disama dia mu tshiadi, dijimija lungenyi, anyi kayi mua kulama mâyi panshi munkatshi mua mêba mapite pa 12 anyi 24. Tangila nomba ya tshimpitshimpi tshilaminu, anyi ubikile Poison Control (1-800-222-1222 mu États-Unis). Bishilangane na bantu bakole, bana batekete badi badia bintu bia kudia bia THC badi mua kubuela lukasa mu koma mukole, disama dia dipuyakana dia njiwu (dilekela dia kupuyakana), ne disama dia tshiadi.
2. Bikala muntu udi unua manga a cannabis ku dituku ne ku dituku udi umvua bibi, usama misangu ne misangu ne disama dikole dia mu difu didi dijika anu ku diowa mâyi a kapia (Cannabinoid Hyperemesis Syndrome / CHS), LEKELA THC ONSO NE CBD DIAMUE DIAMUE. Kunua makanya, kunua makanya, kunua, anyi kunua bintu bia kudia bua kuenza mudimu ne dose yonso ya cannabis "mutantshi mule" tshijengu tshia dibutuka.
3. Patula mubedi wa CHS mu tshina tshia mâyi tshia kapia kumpala kua yeye kuosha kikoba anyi kujimija mâyi mu mubidi, ne kuela 0.025% too ne ku 0.075% wa Capsaicin Cream mu difu pamutu pawu. Kuela tshintu tshikese tshia capsaicin mu difu (ne bianza, kuepuka mêsu ne mêsu) kudi kuenza mudimu wa muomumue TRPV1 heat receptors bu mudi tshina tshia mâyi tshidi tshitoka katshiyi tshikebesha kapia anyi dipanga dia mâyi mu mubidi didi difumina ku tuishi.
4. Keba tshiamu tshia nzembu tshia IV ne tshiamu tshia electrolyte pikala mubedi wa CHS udi upela ne mashi mafiike anyi kayiku, disama dia mifuba, mutshima udi utshioka, dipanga dia lungenyi, anyi udi utua mashi. Dibutuka dia CHS didi kadiyi dijika didi dijimija potassium, chloride, ne sodium ku mubidi, ne didi difikisha ku lufu lua dijika dia muoyo mutantshi mule (TQ) ne dikola dia muoyo disama dia tshiadi tshia kumpala kua tshiadi.
5. Bikala muntu ne tshipupu tshikole tshia buôwa, mutshima wenda unyunguluka, anyi tshiji tshikole kunyima kua yeye mumane kudia tshiakudia tshia THC tshidi tshianyishibue (tshidi ne mupuya muimpe ne katshiyi ne bintu bia kuenza nabi mudimu), umufikishe mu nzubu mutoke, mupole ne umujadikile ne: tshikondo atshi netshipite. THC wa ku mishiku udi ukudimuka mu tshifu mu 11-hydroxy-THC, udi ufika ku 11-hydroxy-TH, udi ne tshibungubungu too ne ku 444h4 udi ujika mu mêba 6 too ne ku 12. Lombola mushindu wa kupuyakana mu kazubu, ubapeshe mayi mashika, ne ubalombe bua batafuna anyi banunkishe bimuma bia nsukadi bifiike anyi tshipese tshia ludimi (beta-caryophyllene ne limonene terpenes bidi biambuluisha bua kuenza malu adi kaayi makane).
6. Angata tshienzedi tshionso tshia "Spice," "K2," mafuta a mu njila, anyi mafuta a "THC-P / HHC / Mushroom" bu tshintu tshidi mua kushipa muntu. Cannabinoïdes mienza ne bintu bionso idi ifila status epilepticus (disama dia tshimpitshimpi), hyperthermie, ryohlysis, stroke excitent delirium ne udi dijinga ne luondapu lua lukasa lua lupitadi.

Disungula dia lukasa: Kumanya tshilumbu tshia tshimpitshimpi tshia Cannabinoid tshidi tshienzeka¶

flowchart TD
    A["Cannabis anyi Cannabinoid Emergency"] --> B{"Ntshilejilu kayi tshia luondapu tshidi tshikumbanangana ne mubedi?"}
    B -->|Young Child / Toddler Ate THC Edible| C["BUALU BUA BANA: Bikila 911 / Poison Control Mpindieu - Njiu mikole ya Coma ne Dilekela dia kupuyakana"]
    B -->|Chronic Daily User: Non-Stop Vomiting, Belly Pain, Compulsive Hot Showers| D["Disama dia Cannabinoid Hyperemesis - CHS"]
    B -->|Ate Too Much THC Edible / High-Dose Dab: Racing Heart, Terror, Time Distortion| E["Buôwa bua bungi bua THC / Dikuatshika dia maluvu mapite bungi"]
    B -->|Used Synthetic Spice, K2, Street Vape, or Unknown Gas-Station Analog| F["BUALU BUA KUENZA: Bikila 911 diakamue - Njiu ya disama dia tshiadi, disama dia mutshima, ne disama dia lungenyi"]
    D --> G["."]
    E --> H["1. Nzubu udi kayi ne mutoyi 2. Ujadike ne: 11-OH-THC udi ufika ku ndekelu kua mêba 2 anyi 4 3. Kupuya bitekete ne kunua mâyi 4. Bikila 911 anu padiye ne disama dia mu tshiadi, disama dia tshiadi anyi disama dia lungenyi didi kadiyi ne bukubi"]

Difuanyikija dia malu a luondapu dia malu anayi a tshimpitshimpi a cannabinoid¶

Tshitupa 1: Disama dia Cannabinoid Hyperemesis (CHS) ne "Scromiting"¶

Bua musangu wa kumpala mu mikanda ya malu a luondapu mu 2004 ne mufunda mu Rome IV Diagnostic Criteria for Functional Gastrointestinal Disorders, Cannabinoid Hyperemesis Syndrome (CHS) udi ulenga bantu ba bungi badi banua manga a cannabis (mudi cannabis wa buanga, nansha THC, ne THC CBD wa bungi musangisha ne THC).

1. Bitupa bisatu bia luondapu bia CHS¶

1. Tshitupa tshia Prodromal (Ngondo too ne ku Bidimu): Muntu udi upeta disama dia mutshima mu dinda menemene, disama dia tshifu anyi dia "tshipupu" mu tshifu, buôwa bua kuela nsukadi, ne disama dia tshifu dikese. Buteyi bua lufu: Bualu dipuekesha dia THC didi dijula buongo bua munkatshi bua tshitupa tshîpi CB1 bia kuangata bua kusokoka disama dia mutshima mu minite 30, muntu udi utuadija kujuka ne kunua makanya anyi kunua makanya diakamue mu dinda dionso bua kuimanyika disama dia tshiadi, wenda uvudija bungi bua cannabinoid wende wa dituku dionso too ne padi biamu bia munda biende binyanguka.
2. Tshikondo tshia Hyperemetic (Disama dia tshimpitshimpi: mêba 24 too ne matuku 10+):
   • Dituadija dia tshimpitshimpi dia disama dia mutshima didi kadiyi dijika, ne disama dia nsukadi (misangu ya bungi misangu 5 too ne ku 20 ku dîba) dilondangana ne dîyi dikole ne disama dia mu tshifu ("scromiting").
   • Pathognomonic Hot-Water Bathing Behavior: Bantu bapite pa 90 pa lukama badi ne disama dia CHS badi bamona ne: kuimana muinshi mua tshina tshia mâyi a kapia anyi kusomba mu tshina tshia mâyi tshidi tshitoka kudi kujikija diakamue kanyinganyinga ka mu difu ne disama dia muoyo, anu bua disama dia nsukadi didi dipingana mu minite mikese panyima pa dipatuka mu mâyi. Babedi batu bapatula mayi a kapia a mu nzubu yabu misangu ya bungi ku dituku anyi babuela mu nzubu ya otele anu bua kupeta mayi a kapia.
3. Tshikondo tshia diondopangana (Mbingu too ne ku ngondo kunyima kua dilekela dia 100%)): Difuisha didi dijika mu matuku 2 too ne ku 10 kunyima kua dilekela dionso dia cannabinoïdes, ne dijinga dia kudia ne bujitu bidi bipingana mu mbingu ya bungi bu mudi CB1 ne TRPV1 bipetu bidi bipingajibua. Kadi, shi muntu udi unua makanya nansha musangu umua mu tshikondo tshia diondapibua, tshitupa tshijima tshia hyperemetic tshitu tshipingana misangu ya bungi mu mêba anyi matuku makese.

2. Bua tshinyi diowa dia mâyi a kapia didi dienza mudimu (ne bua tshinyi Topical Capsaicin Cream udi tshintu tshimpe tshia kupingana pa muaba wa luondapu)¶

Munda mua hypothalamus wa muntu (udi ulombola luya lua mubidi) ne mu mijilu yonso ya mu tshifu, CB1 bipedi bia cannabinoid bidi anu ku luseke lua TRPV1 (Transient Receptor Potential Vanilloid 1) receptors, the exact ion channels activated by noxious heat (> 43 degrees Celsius / 109 degrees Fahrenheit) ne chili-pepper capsaicin.

• Padi THC wa bungi wa tshiendelele ujimija lungenyi CB1 bintu bidi bitaba ne bidi bipangisha tshifu tshia munda (gastroparesis), tshimanyishilu tshia disama dia munda tshidi tshienda tshinyanguka.
• Kuimana muinshi mua mvula wa 45-degree-Celsius (113-degree-Fahrenheit) udi ulengeja kikoba TRPV1 mijilu idi ne bimanyinu bia luya, idi ifila mashi ku mishipa ya munda ya splanchnic too ne ku dikoba ("syndrome cutanéous steal") ne ipita tshitupa tshia buongo tshidi tshienza bua muntu ikale ne tshiji.
• Mushindu wa kwingidija tshiamu tshia Capsaicin kumbelu anyi mu tshisuku pamutu pa kuowa mâyi a kapia:
  1. Sumba 0.025%, 0.075%, anyi 0.1% Capsaicin Cream (udibu bapanyisha mu farmasi yonso bua disama dia nsukadi anyi dia mijilu).
  2. Ku diambuluisha dia bianza bia kuela (anyi kusukula bianza bimpa ne nsabanga wa kusukula nawu malonga pashishe), ela tshilamba tshikese tshia bunene bua nkunde tshia capsaicin pa dikoba dia difu (difu) anyi panyima pa maboko a kuulu misangu 3 ku dituku.
  3. Kuena ne bua kuela tshiamu tshia capsaicine diakamue paudi upatuka mu tshina tshia mâyi a kapia (indila too ne padi dikoba difika ku luya lua pa tshibidilu, anyi disama dia kapia nedikale dikole), ne ikala kule ne mêsu, mukana, dikoba ditshibuka ne bitupa bia lulelu. (Bikala capsaicine utema bikole, umupuekeshe ne mafuta a bisonsa anyi mabele mashika, ki mayi to; tangila Tshiamu tshia chili tshidi tshiosha mu mêsu, mu kikoba, ne mu bianza.)
  4. Mu minite 20 to ne 45, luya lua capsaicine ludi luenza mudimu mu difu TRPV1 récepteurs ne udi utshibula tshitupa tshia disama dia mutshima/disama kayi ujimija mayi a mubidi mu tshina tshia mâyi a kapia.

3. Tshibambalu tshia malu a mpukapuka tshidi tshileja ne bua tshinyi manga a disama dia tshiadi adi apanga¶

Mu tshibambalu tshia lupitadi lua lukasa, serotonine wa tshibidilu 5-HT3 bintu bidi biluisha bu mudi ondansetron (Zofran) anyi promethazine kabiena ne bukole bua kuluisha disama dia CHS dikole bualu disama dia nsukadi didi difumina ku dopamine/TRPV1/CB1 dinyanguka dia malu pamutu pa serotonine. Bikebelu bia mu lupitadi (bu mudi HaVOC Trial) bileja ne dose mukese wa IV haloperidol (0.05 mg/kg anyi 2.5 to 5 mg) anyi IV droperidol, musambakaja ne 1 too ne ku 2 litre ya IV crystalloid fluid, potassium/magnesium replacement, ne abdominal capsaicine, bidi bipangisha CHS bua kuela mbila lukasa ne bipangisha muntu bua kubuela mu lupitadi.

Ndaku diakamue ku tshibambalu tshia malu a mpukapuka pikala muntu udi unua makanya udi utua mikemu udi ne tshimue tshia ku bimanyinu ebi:

• Dipanga dia kulama nansha tu-maluba tukese tua tshiamu tshia electrolyte tshia ku mishiku munkatshi mua mêba mapite pa 12 to ne 18.
• Bimanyinu bia Hypokalemia ne dipanga dia mayi mu mubidi: Disama dia misunyi anyi diteketa mu maulu, dikuma dia mutshima anyi dienda lubilu, disama dia tshiadi dikole anyi dijimija dia lungenyi padi muntu wimana, mêsu maume, anyi kakuyi diela dia nsukadi munkatshi mua mêba 8+ (anyi nsukadi mifike).
• Kuela mashi makunze anyi tshintu tshifiike tshia "kafe" (Mallory-Weiss udi utshibuka mu tshifu) anyi udi utshibuka mu tshimpitshimpi disama dia mu tshiadi anyi dia mu nshingu ne bipepele bia muinshi mua dikoba (Disama dia Boerhaave: ditshibuka dia mu tshifu didi dishipa).
• Difu dikole, bu dia mabaya, kapia kakole, anyi disama dia mu tshitupa tshia kuinshi tshia ku dia balume: Kuedi meji ne: disama dia mu difu dia muntu udi unua makanya didi "anu CHS" too ne padi malu a tshimpitshimpi adi mua kunyanga muoyo (appendicite, pancréatite, dikanga dia mala, difu dia pambelu pa difu, anyi dijimija dia bile) mimane kujika kudi mikenji munganga.

Tshitupa 2: THC wa bukole bua bungi udi mua kudia ne dikuatshika dia maluvu¶

Tshidi tshitamba kufikisha bantu ku dibuela mu nzubu wa luondapu lua lukasa lua cannabis munkatshi mua bantu badi banua misangu ne misangu, benyi, ne bantu bakulumpe ntshia se: didia dia bungi dia THC ("greening out").

1. Bua tshinyi bintu bia kudia bidi bikuata bikole ne panyima pa dinua dia makanya: 11-Hydroxy-THC buteyi¶

+-------------------------------------------------------------------------+
|        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.  |
+-------------------------------------------------------------------------+

Bu mudi tshintu tshia kudia tshiangata minite 60 too ne ku 120** bua kudia, bantu badi kabayi banji kutshienza batu badia pa tshibidilu 10 mg anyi 25 mg gummy, kuyi umvua tshintu nansha tshimue mu minite 45, ne udia kabidi gummies ibidi anyi isatu kumpala kua dose wa kumpala kufikaye ku tshifu tshiabu (dose stacking). Kunyima kua meba abidi, 50 to 100 mg wa 11-hydroxy-THC udi uwuja buongo buabu musangu umue.

2. Dilengeja dia ku nzubu ku kakese ku kakese bua tshipupu tshikole tshia THC¶

Padi muntu mubungame bua THC udibu mua kudia anyi udibu bajadike (ne kayi ne disama dia mu tshiadi, disama dia tshiadi anyi dikuatshika dia manga), utu misangu ya bungi upeta disama dia sinus tachycardia (110 to 145 beats per minute), orthostatic hypotension (kumvua bu ne: nebafue padibu bimane), divula dia dîba (minite 5 idi yumvuika bu mêba 2), ne dishindika dikole dia mubidi dia se: mutshima wabu udi wimana anyi mbapue muoyo mushindu wa kupuyakana nkayende**.

1. Kuenza muaba wa tshijila wa tshijila tshikese:
   • Lombola muntu mu nzubu wa bulalu udi kayi ne butoke bua bungi anyi mu ditanda. Jima mizike mikole, tshiamu tshia televizion tshidi tshikenka, ne miendu ya fluorescence idi pa mutu, ne lomba bantu bakuabu bua kupatuka mu nzubu bua anu dîyi dimue dia ditalala, dia kueyemena ke diakula.
2. Kufila dishindika dia tshishimikidi ne dijadika dia dîba:
   • Akula mu dîyi ditekete, dia luse, dia malu malelela: "Uvua mudie THC mukole wa kudia mu [Tshikondo]. Tshiudi umvua mpindieu ntshia se: 11-hydroxy-THC udi wenda ubanda mu mubidi webe. Dikuma dia mutshima webe dia lukasa didi difumina ku THC, ki ndisama dia muoyo to. Kakuena muntu ukadi mufue ku tshibungubungu tshia THC tshia pa tshibidilu tshidi tshienzeka to. mpindieu ku [dîba dia mpindieu], ne minite 30 yonso kubangila apa too ne pambelu, tshifu tshiebe tshidi tshitshilengeja ne neudiumvue mupole."
3. Lala panshi anyi kulala panshi bua kuepuka disama dia tshiadi (dipanga dia lungenyi):
   • THC udi ukebesha divulangana dia mashi mu mikolo (disangisha dia mashi mu mikolo), didi difikisha ku dipueka dia tshimpitshimpi dia mashi ne dijimija dia lungenyi padi muntu wimana lukasa bua kuya ku tshina tshia mâyi. Ubalame balale panshi anyi bashindame pa matadi ne maulu abu mabandisha, ne ubalombole ku mubidi bikalabu ne bua kuimana bua kuya mu tshina tshia mâyi.
4. Dilongolola dia bintu bia mu lungenyi ne mushindu wa kuenza mudimu ne nkunde mitoke / dimuma dia ludimu:
   • Ubalombe bua kuteka tshilamba tshia mashika, tshitoke pa mpala yabu ne kunyima kua nshingu yabu (tshidi tshienza bua tshienzedi tshia dibuela dia mâyi tshia nyama ne tshia vague bua kukepesha dikuma dia mutshima bitekete bitekete).
   • Ntete ya nkunde mijima anyi tshipese tshia ludimi lupialupia: Shi badi batabale ne badi mua kumina bimpa, balekele banunkishe nkunde mifike mipiamipia anyi batafuna 2 to ne ku 3 nkunde ya nkunde mijima, anyi banunkishe nkunde mifike ne kunua mayi a ludimi. Mupuya mufike udi ne bungi bua beta-caryophyllene, sesquiterpene udi mu biakudia udi wenza mudimu bu CB2 tshintu tshidi tshienza mudimu ne tshiamu tshia allostérique tshibi tshileja mu makebulula a cannabinoid bua kujikija tunyinganyinga tudi tufumina ku THC, eku citrus limonene ukepesha buôwa bua THC.
   • Kupuya bitekete bitekete 4-6: Balongeshe bua kuela mupuya bitekete bitekete ku diambuluisha dia muulu munkatshi mua sekonde 4 ne kupatula mupuya bitekete bitekete ku mishiku mikanga munkatshi mua sekonde 6 (kuela mupuya mutantshi mule kudi kukolesha dîyi dia vagal dia parasympathique ne kukepesha dikuma dia mutshima).
5. Tshiudi kuyi mua kuenza mu tshikondo tshia buôwa bua THC:
   • Kupeshi kafeine, maluvu adi afila bukole, anyi maluvu nansha kakese (kafeine udi unyanga mutshima ne buôwa; maluvu adi avudija bikole dikuata dia THC mu mala).
   • Kubaenzeji nansha kakese bua kuowa mâyi mashika paudi muimane (udi mua kuenza bua mijilu ikale mikole mu tshimpitshimpi anyi mputa wa mutu wa dikuluka).

Tshitupa 3: Didia dia THC Gummy dia bana mu mpukapuka (tshilumbu tshikole)¶

Bintu bia THC bia mu tshisalu, bipese bia tshikolakola, ne bonbon ya nerd-rope bitu misangu ya bungi bibueja mu bipese bia mylar bia mekala matoke bidi bimueneka bu bonbon bia mu tshisalu tshinene, ne tshibombi tshimue tshidi ne 100 too ne ku 1000 milligrams ya THC (10 too ne ku 100 ya bantu bakole).

• Bua tshinyi bintu bia kudia bidi ne THC bidi mua kunyanga muoyo wa bana batekete ne bana batekete: Mu muntu mukole udi ne bujitu bua kilo 75 (165 pounds), 50 mg wa THC udi ukebesha buôwa budi kabuyi buimpe. Mu muana mutekete udi ne bujitu bua 12 kilograms (26 pounds), udi ukuata ne udia tshianza tshia gummies tshidi ne 100 to 300 mg wa THC udi ufila dose munene wa buanga (10 to 25 mg/kg).
• Dikola dia disama dia bana (mêba 1 too ne ku 6 kunyima kua didia):
  • Bimanyinu bia kumpala (minite 30 too ne ku 90): Kuenda kakuyi dishindama (ataxia), mêsu mabulule, kuseka anyi kudila kua tshimpitshimpi, ngakuilu mubi, ne dikankamika dia mifuba.
  • Bimanyinu bikole (mêba 1 too ne ku 4): Dikola dia lukasa too ne ku **dipanga dia bukole, dipanga dia kujuka ku malu adi asama (coma), dipuekesha dia luya lukole anyi dia patupu (bradypnée / apnée didi dilomba dibueja dia endotracheal intubation), dipueka dia luya lua mubidi (hypothermie), ne tshipupu tshia tonic-aclonic tshidi tshitangalake.
• Tshienzedi tshia lukasa kudi baledi ne balami:
  1. KUINDI bua bimanyinu bimueneke. Bualu bua mafuta a mukana adi angata dîba 1 anyi 2 bua kudia, muana udi umueneka muimpe menemene minite 20 kunyima kua yeye mumane kudia mampa a THC udi mua kulekela kupuyakana mu bulalu buende mêba abidi pashishe.
  2. Bikila 911 / 112 / 999 anyi Poison Control (1-800-222-1222 mu États-Unis) diakamue ne wangate muana NE tshibombi tshia bonbon tshiakane ku tshibambalu tshia malu a mpukapuka tshia lupitadi tshidi pabuipi.
  3. Ikala ne bululame 100 pa lukama kudi baminganga ne baminganga ba mu nzubu wa luondapu bua tshivua muana mudie. Kuambila munganga diakamue ne: uvua tshintu tshia kudia tshia THC kudi kusungila muana ku bipupu bia mukolo (lumbar punctures), radiation wa CT ku mutu, ne manga adi kaayi ne mushinga padi baminganga bakeba tshidi tshikebesha koma wa tshimpitshimpi.

Tshitupa 4: Cannabinoids ("Spice," "K2") ne Hemp Analogs Unregulated¶

Kuena ne bua kufuanyikija manga a mu mitshi ne Synthetic Cannabinoid Receptor Agonists (SCRAs) adibu bapanyisha bu musenga wa manananshi ("Spice," "K2," "Black Mamba," "Scooby Snax"), mâyi a mu njila adibu bashintulule, anyi hemps wa semi-synthèse wa bukole bua bungi (HCO-tace, THC-taceta, HHC**):

1. Full Agonist Neurotoxicity ("Spice" / "K2"): Natural Delta-9-THC udi anu partial agonist mu buongo CB1 récepteurs, mbuena kuamba ne: tshienzedi tshiende tshia mubidi tshidi tshifika ku tshibandilu tshia pa tshibidilu. Cannabinoïdes mienza mu laboratware idi kayiyi mianyishibue (bu mudi MDMB-4en-PINACA, ADB-BUTINACA, ne 5F-MDMB-PICA) badi agoniste mikumbane ne bukole bua misangu 20 too ne ku 800 bua THC. Bidi bijula bipupu bia lufu, hyperthermie mikole, rhabdomyolyse (dinyanguka dia mifuba didi dinyanga mifuba), disama dia mishipa ya mu mikolo didi difikisha bansonga ku disama dia mutshima, ne psychose paranoïde wa tshikisu.
2. Vitamine E Acetate & Ketene Gas from Illicit THC-O Vape Cartridges: Kuosha THC-O-acetate anyi illicit vape oils mikosa ne Vitamin E acetate mu tshiamu tshia vape kudi kutshibula tshisumbu tshia acetate mu ketene gaz (CH2=C=O), tshintu tshidi tshishipa bantu tshidi tshipetangana ne phosgene tshidi tshikebesha EVALI (E-cigarette anyi Vaping Use-Associated Lung Injury), disama dia tshiadi, ne dipanga dia mupuya.
3. Brodifacoum ("Superwarfarin" Rat Poison) Adulteration: Bipupu bia bungi bia malu a bukola bua mubidi bivua bilonda kudi CDC bivua bitangila manga a cannabinoïdes a mu misesu adibu bapuekesha ne brodifacoum (mushipa wa mpuku udi wenza mudimu mutantshi mule) bua kuenza bua babedi bapatuke mashi diakamue mu mishiku yabu, mu tshifu, ne mu tshifu (mashi makunze mu mashi) matuku makese pashishe, bidi bikengela ngondo ya bungi ya luondapu lua Vitamine K1 (phytonadione).

Tshitupa 5: Kupanduka ku dilekela dia manga ne dipanga dia tulu kunyima kua dilekela bua CHS¶

Bua babedi badibu bapeta ne Cannabinoid Hyperemesis Syndrome anyi dipanga dia bintu bidi ne bukole bua bungi dituku dionso (70% to 90% THC wax/vape carts), tshintu tshimuepele tshikole tshidi mua kupangisha muntu bua kuikala bimpe nkushala ne muoyo mu matuku 7 too ne ku 14 a kumpala a dilekela dia manga a cannabis kuyi upingana bua kujikija kanyinganyinga.

1. Tshikondo tshia dilekela dia THC wa bukole bua bungi¶

Mu DSM-5-TR, Cannabis Withdrawal Syndrome (CWS) udi utuadija mu mêba 24 too ne ku 48 kunyima kua dilekela dia dinua dia dituku dionso, udi ufika ku tshibungubungu pankatshi pa Matuku 2 ne 6, ne udi ujika bikole mu mbingu 2 anyi 3 (nansha mudi bilota bia dipingana dia REM mua kuikala matuku 43 too ne ku 40):

• Dipingana dia mu tshifu: Dipanga dia dijinga dia kudia, disama dia tshifu dikese, ne disama dia tshifu mu dinda. (Mu bulelela, paudi upita dîba dia 48 too ne ku 72 kuyi ne THC, "scromiting" wa tshikisu wa CHS udi wimana ne udi upingana pa muaba wa disama dia tshimpitshimpi didi mua kukokeshibua.)
• Dipingana dia mushindu wa kulala: Bualu bua THC udi ukandamena tulu tua lukasa lua mêsu (REM), dilekela didi dijula dipingana dia tulu tua REM: dipanga tulu dikole dia ku ntuadijilu dilonda kudi bilota bibi bia dikema, bia dikema, anyi bia patoke ne **tuishi tua bungi ** tudi tulengeja bulalu.
• Autonomic & Mood Dysregulation: Dipanga dikisha, tshiji, tshiji tshia tshimpitshimpi, mashika, dikankamika dia bianza, ne mutu usama.

2. Dilama dia bukubi, didi kadiyi ne cannabinoid mu tshikondo tshia matuku 14 a dijadikulula dia CHS¶

1. Dipingaja dia mayi mukana ne dikola dia BRAT-Plus:
   • Mu ma nsa 48 a kumpala kunyima kua tshipupu tshia CHS tshimane kuimana, nua mukele wa mukana mu mashika (WHO ORS, Pedialyte, anyi Liquid I.V.), tshisuku tshia mifuba/bimuma bia muitu, ne maluvu a manaya adibu balengeja ne 15 millilitres (1 tablespoon) kunyima kua minite 10 pamutu pa kunua dikopo diuwule tente ne mayi (adi anyanga tshifu reflexe wa ditantamana ne udi ukebesha disama dia nsukadi).
   • Padi mayi ashala panshi munkatshi mua meba 12, udi mua kudia biakudia bidi ne mafuta makese (manana, mpunga mutoke, mampa, mampa maume, mampa a mukele, ne tshiayi tshia ginger). Epuka biakudia bidi ne mafuta a bungi anyi bikuate mu lumingu lua kumpala, bualu mafuta adi mu biakudia adi atekesha dipatuka dia tshifu.
2. Kulama tuishi tua butuku ne dipanga tulu dia kupingana kuyi upingana:
   • Lama nzubu wa bulalu mu mashika (16 too ne ku 18 degre Celsius / 60 too ne 65 degre Fahrenheit), wela bilamba bia tshitoke bidi mua kupuyakana, ne ikala ne tshilamba tshiume tshia kushintulula ku luseke lua bulalu.
   • Ela munganga webe lukonko bua tulu tua matuku makese tudi katuyi tuenza tshibidilu anyi diambuluisha dia disama dia mutshima (bu mudi melatonin 1 too ne ku 3 mg, hydroxyzine, doxylamine, anyi promethazine/prochlorperazine suppositories) mu matuku 1 too ne ku 7. Kuena ne bua kuenza mudimu ne mafuta a CBD, hemp8, hemp-8 bua kupueka ku CHS, bualu nansha phytocannabinoids idi kayiyi ikola idi ipetangana ne enteric TRPV1 ne CB1 bia kuangata ne kupingaja hyperemesis.

(Biwikala wewe anyi muntu uudi munange udi uluangana ne dikuatshika dia maluvu a bungi a dituku dionso, dikuatshika dia manga a kuenza nawu bintu, anyi dibuela mu lupitadi misangu ne misangu ya CHS, tangila Dikuatshika dia maluvu ne dikuatshika dia manga: bulombodi bua diambuluisha dia lukasa ne Kuambuluisha muena mu dîku udi ne tshilele tshia dikuatshika dia maluvu. Tudi kabidi tunulomba bua kulonga tulasa tua diambuluisha dia kumpala tudibu bitabe kudi Croix-Rouge, St John Ambulance, anyi kudi mufidi wa diambuluisha wa muaba unudi.)

Nkonko itubu bela misangu ya bungi¶

Miaba mifumina¶

• 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 hot-water bathing pathophysiology, and complete cessation outcomes).
• American College of Emergency Physicians (ACEP) & Annals of Emergency Medicine (HaVOC Randomized Trial): Intravenous Haloperidol / Droperidol and Topical Capsaicin (0.075% to 0.1%) vs. Ondansetron in Emergency Department Management of Cannaid Syndromeme.
• Centres for Disease Control and Prevention (CDC) and American Association of Poison Control Centres (AAPCC, United States): Pediatric Unintentional Cannabis Edible Ingestions, Outbreak Advisories on Brodifacoum-Adulterated Synthetic Cannabinoids, and EVALITEC EVALITEN LETENING /Injute Bulombodi.
• Tshibambalu tshia ditunga tshia dikuatshika dia manga (NIDA / NIH, mu États-Unis) ne bulongolodi bua malu a bukola bua mubidi pa buloba bujima (OMS): Pharmacokinetics of oral 11-hydroxy-THC vs. mupuya Delta-9-THC, ne toxicology wa 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 attenuation acute THC anxiety).

Malu adi apetangana¶

• Dikuatshika dia maluvu ne dikuatshika dia manga: bulombodi bua diambuluisha dia lukasa
• Kuambuluisha muena mu dîku udi ne tshilele tshia dikuatshika dia maluvu
• Buôwa ne tunyinganyinga tua bungi
• Malu a mu lungenyi ne njiwu ya kudishipa
• Disama dia tshiadi, disama dia mu tshifu, ne dipanga dia mâyi mu mubidi
• Tshiamu tshia chili tshidi tshiosha mu mêsu, mu kikoba, ne mu bianza
• Diambuluisha dia kumpala dia poison
• Nomba ya tshimpitshimpi