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

Ngenkathi insangu yamakhambi yendabuko yake yaba ne- 2 kuya ku-4% we-delta-9-tetrahydrocannabinol (THC), i-concentrate yesimanje yezentengiselwano, ama-vape cartridges, ama-wax dabs, ama-pre-rolls afakwe ngaphambili, nama-gummies anethamo eliphezulu ngokuvamile aletha ** ama-70 kuya ku-95 wamaphesenti we-THC**, kanye ne-hemp engalawulwa (THC-O-acetate, THC-P, HHC, Delta-8 THC) kanye nama-agonists abulalayo e-cannabinoid receptor ("Spice," "K2," MDMB-4en-PINACA, ADB-BUTINACA). Lokhu kukhula okumangalisayo kwamandla kuye kwadala izimo eziphuthumayo ezine ezihlukene zezokwelapha manje ezigcwalisa iminyango yezimo eziphuthumayo esibhedlela nsuku zonke: Cannabinoid Hyperemesis Syndrome (CHS) ("scromiting": usizi, ukuhlanza okujikelezayo kanye nokuklabalasa kubasebenzisi abangapheli nsuku zonke okubangela ukuphila okusongelayo i-hypocutemic kidney failure nesifo senhliziyo esibuhlungu amandla aphezulu e-THC adlekayo ukwethuka kanye nengqondo enobuthi**, ingane encane ngengozi kanye ne-THC yezingane gummy poisoning (okubangela i-coma nokucindezeleka kokuphefumula ezinganeni ezincane), kanye ne-synthetic cannabinoid ("Spice") neurotoxicity.

Ngenxa yokuthi i-THC ngokuvamile isebenza njengenhlanganisela elwa nokucanuzela kwenhliziyo kubasebenzisi ngezikhathi ezithile, abathengi bensangu abangapheli abaphethwe Cannabinoid Hyperemesis Syndrome abavamile ukukholelwa ukuthi insangu iyimbangela yokuhlanza kwabo okunobudlova, futhi esikhundleni salokho bayabhema noma bavape okungaphezulu kwe-THC ukuze baxazulule izisu zabo, bazibambele emjikelezweni oyingozi wokuphila. Okubi nakakhulu, iziguli ezisesigabeni se-hyperemetic se-CHS zivame ukuzivalela emanzini ashisayo amahora angu-6 kuya kwayi-12 ngosuku ukuze zenze kusebenze ama-receptors okushisa kwesikhumba.TRPV1), ehlushwa kakhulu **ukushiswa kwesikhumba okushisayo kanye nokuphelelwa amandla kwamanzi ngokushesha kwe-intravascular **. Ukwazi ukuqaphela izimpawu eziphawulekayo ze-CHS, ukusebenzisa ukhilimu we-capsaicin we-topical ngokuphepha esikhundleni samashawa abilayo, indlela yokunciphisa ukuhlaselwa kovalo olunamandla lwe-THC oludliwayo usebenzisa umugqa wesikhathi obambezelekile we-hepatic 11-hydroxy-THC, nokuthi ungayishayela nini i-ambulensi ngokuwa kwe-electrolyte noma ukumunca ingane kusindisa izimpilo.

Yenza lokhu manje¶

1. Shayela inombolo yakho yasendaweni yezimo eziphuthumayo (911 e-US naseCanada, 112 e-EU, 999 e-UK) ngokushesha uma ingane encane noma encane idla NOMA IYIPHI i-cannabis gummy, ushokoledi, noma amafutha e-vape, noma uma umuntu omdala ebonisa ukuquleka, ubuhlungu besifuba, ukuquleka, noma ukungakwazi ukugcina uketshezi luphansi amahora angaphezu kuka-12 kuya kwangu-24. izinombolo eziphuthumayo uhla lwemibhalo, noma shayela Ukulawula Ubuthi (1-800-222-1222 e-United States). Ngokungafani nabantu abadala, izingane ezisacathula ezidla okudliwayo kwe-THC zingangena ngokushesha kukoma okujulile, ukucindezeleka kokuphefumula okuyingozi (ukuyeka ukuphefumula), kanye nokuquleka.
2. Uma umsebenzisi we-cannabis nsuku zonke ebhekene nodlame, ukuhushulwa okuphindaphindiwe kanye nobuhlungu obukhulu besisu obudalulwa kuphela ngamanzi ashisayo (Cannabinoid Hyperemesis Syndrome / CHS), MISA KONKE I-THC KANYE NE-CBD MASHESHA. Ungabhemi, uvaphe, udab, noma uthathe izinto ezidliwayo ukuze "uthobe isicanucanu": yonke umthamo we-cannabinoid procycle.
3. Khipha isiguli se-CHS ezishaweni ezishisayo ngaphambi kokuba sishise isikhumba saso noma siquleke ngenxa yokuphelelwa amanzi emzimbeni, bese ugcoba i-Topical Capsaicin Cream esiswini esikhundleni salokho 0.025% kuya ku-0.075% esiswini. Ukuhlikihla ungqimba oluncane lwe-capsaicin cream esiswini (ngamagilavu, kuqhelelene namehlo nezitho zangasese) TRPV1 ama-heat receptors njengeshawa abilayo ngaphandle kokubangela ukushisa okushisayo noma ukuphelelwa amanzi emzimbeni okubangelwa umjuluko.
4. Funa uketshezi loMnyango Wezimo Eziphuthumayo IV kanye nokushintshwa kwe-electrolyte uma isiguli se-CHS esihlanzayo sinomchamo omnyama noma ungekho, amajaqamba, inhliziyo eshaya ngamandla, ukudideka, noma ukuhlanza igazi. Ukuhlanza okungapheli kwe-CHS kuhlubula umzimba i-potassium, i-chloride, ne-sodium, okubangela ukufa i-hypokalemic cardiacrenal ukulimala kwezinso* ezibukhali** kanye nokulimala kwenhliziyo* okubangelwa yi-QT.
5. Uma othile ehlaselwa ukwethuka okwesabekayo, inhliziyo egijimayo, noma i-paranoia ngemva kokudla ukudla okusemthethweni kwe-THC (enokuphefumula okuvamile futhi engenawo amakhemikhali okwenziwa), mhambise egumbini elimnyama, elithulile futhi umqinisekise ukuthi inani eliphakeme lizodlula. I-THC yomlomo iguqulela esibindini ibe 11-hydroxy-THC, ekhuphuka ifike ku-42 amahora* *2 futhi ifinyelele phezulu ngamahora angu-42 2 amahora. Qondisa ukuphefumula kwebhokisi okunensayo, unikeze amanzi abandayo, futhi wenze ukuba bahlafune noma bahogele ukhozo lukapelepele olumnyama wonke noma ikhasi likalamula (i-beta-caryophyllene kanye ne-limonene terpenes zisiza ekunciphiseni ukukhathazeka).
6. Yelapha noma yikuphi ukusabela ku-"Spice," "K2," uwoyela we-vape emgwaqweni, noma igalaji likaphethiloli "THC-P / HHC / Mushroom" njengobuthi obusongela ukuphila. Ama-cannabinoids okwenziwa agcwele abangela *isimo sokuquleka (ukuquleka okunganqamuki), i-hyperthermia, i-rhabdomyolysis, i-habdomyolysis, i-stroke, kanye nesibhedlela esiphuthumayo esidinga ukunakekelwa okukhulu.

I-Triage Esheshayo: Ukukhomba Isiphi Isimo Esiphuthumayo SeCannabinoid Esenzekayo¶

flowchart TD
    A["I-Cannabis noma I-Cannabinoid Emergency"] --> B{"Iyiphi Iphethini Yomtholampilo Efana Nesiguli?"}
    B -->|Young Child / Toddler Ate THC Edible| C["ISIPHUTHUMAYO SABANTWANA: Shayela ku-911 / Ukulawula Ubuthi Manje - Ingozi Ephezulu Yokuquleka Nokuyeka Ukuphefumula"]
    B -->|Chronic Daily User: Non-Stop Vomiting, Belly Pain, Compulsive Hot Showers| D["I-Cannabinoid Hyperemesis Syndrome - CHS"]
    B -->|Ate Too Much THC Edible / High-Dose Dab: Racing Heart, Terror, Time Distortion| E["I-Acute High-Potency THC Panic / Over-Intoxication"]
    B -->|Used Synthetic Spice, K2, Street Vape, or Unknown Gas-Station Analog| F["I-SYNTHETIC TOXICITY: Shayela ku-911 Ngokushesha - Ingozi Yokuquleka, Ukuhlaselwa Kwenhliziyo, kanye Nengqondo"]
    D --> G["1. Misa Yonke ICannabis Ngokushesha 2. Faka I-Topical Capsaicin 0.075% Esiswini 3. Iya ku-ER ukuthola i-IV Fluids, Potassium, & Haloperidol/Droperidol uma Ukuhlanza Kuphikelela"]
    E --> H["1. Igumbi Elimnyama Elithulile 2. Qinisekisa ukuthi i-11-OH-THC Iphakama Ngamahora angu-2 kuya kwangu-4 3. Ukuphefumula Kancane & Qhosha Amanzi 4. Shayela ku-911 Kuphela Uma Ubuhlungu Besifuba, I-Syncope, noma I-Psychosis Engaphephile"]

Ukuqhathaniswa Komtholampilo Kwezimo Eziphuthumayo Ezine zeCannabinoid¶

Ingxenye 1: ICannabinoid Hyperemesis Syndrome (CHS) kanye ne "Scromiting"¶

Ichazwe okokuqala ezincwadini zezokwelapha ngo-2004 futhi yabhalwa ngokusemthethweni ku-I-Rome IV Diagnostic Criteria for Functional Gastrointestinal Disorders, Cannabinoid Hyperemesis Syndrome (CHS) ithinta abasebenzisi abakhulu, abangapheli bemikhiqizo ye-cannabis (kuhlanganise ne-cannabis yezokwelapha, ukugxila kwezokungcebeleka, i-CBD kanye ne-THC ephezulu ehlanganisiwe ne-THC).

1. Izigaba ezintathu zomtholampilo ze-CHS¶

1. Isigaba Se-Prodromal (Izinyanga Kuya Eminyaka): Umuntu uba nesicanucanu sasekuseni, umuzwa omuncu noma "uvemvane" esiswini, ukwesaba ukuhlanza, kanye nokungaphatheki kahle kwesisu. I-Fatal Trap: Ngoba ukuhogela i-THC kudala ubuchopho obumaphakathi okwesikhashana CB1 ama-receptors ukuze afihle isicanucanu imizuzu engu-30, umuntu uqala ukuvuka futhi aphefumule noma abheme ngokushesha njalo ekuseni ukuze anqande isicanucanu, kancane kancane andise umthwalo wabo wansuku zonke we-cannabinoid kuze kube yilapho ama-receptors amathumbu efika enkingeni.
2. Isigaba se-Hyperemetic (Izimo Eziphuthumayo Eziphuthumayo: Amahora angu-24 kuya Ezinsukwini ezingu-10+):
   • Ukuqala ngokuzumayo ukucanuzela kwenhliziyo okunganqamuki, okukhubazayo kanye nokuhlanza okungapheli (ngokuvamile izikhathi ezi-5 kuye kwezingu-20 ngehora) okuhambisana nokukhala okukhulu kanye nobuhlungu be-epigastric obuhlabayo ("scromiting").
   • Indlela Yokugeza Ngamanzi Ashisayo Ye-Pathognomonic: Ngaphezu*** kwamaphesenti angu-90 eziguli ze-CHS** zithola ukuthi ukuma ngaphansi kweshawa elishisayo noma ukuhlala kubhavu obilayo kukhulula ubuhlungu besisu kanye nesicanucanu, kuphela ukuze ukuhlanza kubuye kungakapheli nemizuzu ephuma emanzini. Iziguli zivamise ukudonsa isifudumezi samanzi ashisayo sasekhaya izikhathi eziningi ngosuku noma zingene emagumbini ehhotela ukuze zithole amanzi ashisayo aqhubekayo.
3. Isigaba Sokubuyisela (Amaviki Kuya Ezinyangeni Ngemva Kokuyeka U-100%): Ukuhlanza kuyama phakathi ezinsukwini ezimbili kuya kweziyi-10 zokuwamisa ngokuphelele wonke ama-cannabinoids, futhi isifiso esivamile sokudla nesisindo sibuya emasontweni ambalwa njengoba CB1 futhi TRPV1 ukusetha kabusha ama-receptors. Kodwa-ke, uma umuntu esebenzisa insangu ngisho nakanye ngesikhathi sokululama, isigaba esigcwele se-hyperemetic sivamise ukubuya phakathi namahora noma izinsuku.

2. Kungani amashawa ashisayo esebenza (nokuthi kungani i-Topical Capsaicin Cream ithatha indawo ephephile yezokwelapha)¶

Ngaphakathi kwe-hypothalamus yomuntu (elawula izinga lokushisa lomzimba) nakuyo yonke imizwa yezinzwa yomgudu wamathumbu, CB1 Ama-cannabinoid receptors ahlala eduze TRPV1 (I-Transient Receptor Potential Vanilloid 1) receptors, iziteshi ze-ion ngqo ezicushwe ukushisa okuyingozi (> 43 degrees Celsius / 109 degrees Fahrenheit) kanye ne-chili-pepper capsaicin.

• Lapho umthamo ophezulu we-THC ongamahlalakhona uphela amandla CB1 ama-receptors futhi ikhubaze ukuphuma kwesisu (gastroparesis), ukubonakaliswa kobuhlungu bamathumbu kuhamba kancane.
• Ukuma ngaphansi kweshawa elingu-45-degree-Celsius (113-degree-Fahrenheit) kugcwala isikhumba TRPV1 izinzwa ezinezimpawu zokushisa, ukuvala igazi kusuka emithanjeni yamathumbu e-splanchnic kuya esikhumbeni ("cutaneous steal syndrome") kanye nokudlula isikhungo sobuchopho sokucanuzela kwenhliziyo.
• Isetshenziswa kanjani i-Topical Capsaicin Cream ekhaya noma ku-triage esikhundleni samashawa ashisayo:
  1. Thenga okujwayelekile ezitolo 0.025%, 0.075%, noma 0.1% Capsaicin Cream (ethengiswa kuwo wonke amakhemisi ngenxa yesifo samathambo/ubuhlungu bemizwa).
  2. Usebenzisa amagilavu ​​alahlwayo (noma ukugeza izandla kahle ngensipho yesitsha ngemva kwalokho), sebenzisa iribhonielincane, elilingana nepea likakhilimu we-capsaicin esikhumbeni sesisu (esiswini) noma ngemuva kwezingalo ezingenhla* kufika izikhathi ezingu-3 ngosuku.
  3. Ungalokothi ugcobe ukhilimu we-capsaicin ngokushesha ngemva kokuphuma eshaweni eshisayo (linda kuze kuphole isikhumba sibe ngaphansi kwezinga lokushisa elivamile, noma ukuzwa ukusha kuzobe kushubile), futhi ukugcine kude kakhulu namehlo, umlomo, isikhumba esiphukile, nezitho zangasese. (Uma i-capsaicin ishisa kakhulu, yesule ngamafutha okupheka emifino noma ubisi olubandayo, hhayi amanzi; bona Upelepele we-capsaicin ushisa emehlweni, esikhunjeni, nasezandleni.)
  4. Phakathi** nemizuzu engama-20 ukuya kwengama-45**, ukuzwa ukufudumala kwe-capsaicin kwenza isisu sisebenze. TRPV1 ama-receptors futhi aphule isicanucanu/ubuhlungu ngaphandle kokumosha amanzi emzimbeni okugeza okushisayo.

3. Amafulegi abomvu oMnyango Wezimo Eziphuthumayo nokuthi kungani amaphilisi avamile esicanucanu ehluleka¶

Emnyangweni wezimo eziphuthumayo esibhedlela, i-serotonin evamile 5-HT3 izimbangi ezifana ne-ondansetron (Zofran)* noma i-promethazine zidume ngokungasebenzi ngokumelene ne-CHS eqinile ngoba ukuhlanza kuqhutshwa i-dopamine/TRPV1/CB1 dysregulation esikhundleni serotonin. Ukuhlolwa komtholampilo okungahleliwe (okufana ne-HaVOC Trial) kubonise ukuthi umthamo ophansi IV haloperidol (0.05 mg/kg noma 2.5 to 5 mg) noma i-IV droperidol, ehlanganiswe ne-1 kuya ku-2 amalitha e-IV crystalloid fluid, indawo ye-potassium/magnesium, ne-capsaicin yesisu*, imisa i-CHS ukuhlanza ngokushesha futhi ivimbele ukulaliswa esibhedlela.

Yiya eMnyangweni Wezimo Eziphuthumayo ngokushesha uma umsebenzisi wensangu ohlanza enaNOMA IYIPHI kulawa mafulegi abomvu:

• Ukungakwazi ukugcina ngisho nokuncanyana kwesisombululo se-electrolyte yomlomo phansingaphezu kwamahora ayi-12 kuya kwayi-18.
• Izimpawu Ze-Hypokalemia Nokuphelelwa Amanzi Okubi Kakhulu: Amajaqamba noma ukuba buthakathaka kwemisipha emilenzeni, ukuphaphazela noma ukushaya kwenhliziyo okugijima kakhulu, isiyezi esidlulele noma ukuquleka lapho usukuma, amehlo omile ashone, noma ukungachami amahora angu-8+ (noma umchamo onsundu ngokumnyama).
• Ukuhlanza igazi elibomvu elikhanyayo noma izinto ezimnyama "ze-coffee-ground" (i-Mallory-Weiss izinyembezi zomminzo ngenxa yokuhushulwa okunodlame) noma ukudabuka kungazelelwe ubuhlungu besifuba noma bentamo obunamabhamuza omoya angaphansi kwesikhumba (Boerhaave syndrome: ukuqhuma komphimbo okubulalayo).
• Isisu esiqinile, esifana nebhodi, umkhuhlane ophezulu, noma ubuhlungu bendawo bendawo engaphansi kwekota yesokudla: Ungalokothi ucabange ukuthi ubuhlungu besisu kumsebenzisi we-cannabis "bumane nje bu-CHS" kuze kube yilapho izimo eziphuthumayo zokuhlinzwa ezibeka impilo engozini (i-appendicitis, i-pancreatitis, ukuvinjwa kwamathumbu, ukukhulelwa kwe-ectopic, noma ukubhobozwa kwenyongo) sekukhishwe udokotela.

Ingxenye 2: I-Acute High-Potency High-Potency THC Edible Panic Attacks kanye Nokudakwa Kakhulu¶

Isizathu esivame kakhulu sokuvakasha kwegumbi lezimo eziphuthumayo lwe-cannabis phakathi kwabasebenzisi ngezikhathi ezithile, izivakashi, kanye nabantu abadala I-THC yomlomo edliwayo ngokweqile ("greening out").

1. Kungani okudliwayo kushaye kakhulu futhi kamuva kunokubhema: The 11-Hydroxy-THC ugibe¶

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

Ngoba okudliwayo kuthatha amaminithi angu-60 kuya kwangu-120 ukugaya, abasebenzisi abangazijwayele badla 10 mg noma 25 mg i-gummy, uzizwe ungenalutho emizuzwini engu-45, futhi udle izinsini ezimbili noma ezintathu ngaphambi nje kokuba umthamo wokuqala ushaye isibindi sabo (ukunqwabelana komthamo). Ngemva kwamahora amabili, 50 to 100 mg kwe 11-hydroxy-THC zikhukhula ubuchopho babo kanyekanye.

2. Ukwehliswa kwesinyathelo ngesinyathelo ekhaya ukuze uthole ukuhlaselwa kovalo kweTHC¶

Uma othile egajwe ukudla okusemthethweni okuqinisekisiwe kwe-THC noma ukugxilisa ingqondo (futhi akukho ubuhlungu besifuba, ukuquleka, noma ukuchayeka kwezidakamizwa zokwenziwa), uvamise ukuba ne-sinus tachycardia (110 to 145 beats per minute),i-orthostatic hypotension (ukuzwa sengathi bazoquleka lapho bemile), ukwelula isikhathi (imizuzu emi-5 izwa sengathi amahora ama-2), kanye nokuqiniseka okunamandla kokuthi inhliziyo yabo ima noma bakhohlwe ukuphefumula ngokuzenzakalelayo.

1. Dala indawo engcwele enezivuseleli eziphansi:
   • Qondisa umuntu ekamelweni elithule, elinokukhanya kalufifi noma usofa. Vala umculo ophezulu, izikrini zikamabonakude ezikhanyayo, namalambu e-fluorescent angaphezulu, bese ucela amalungu esixuku engeziwe ukuthi aphume egumbini ukuze kube kukhuluma izwi elilodwa elipholile nelithembekile.
2. Letha Isiqiniseko Se-Anchor kanye Nokunyathela Isikhathi:
   • Khuluma ngendlela enensayo, efudumele, nenendaba eyiqiniso: "Udle i-THC eqinile edliwayo [Ngesikhathi]. Okuzwayo njengamanje ukuphakama kwe-11-hydroxy-THC ohlelweni lwakho. Ukushaya kwenhliziyo yakho okusheshayo kuyi-adrenaline reflex evamile evela ku-THC, hhayi ukuhlaselwa yinhliziyo. Akekho umuntu oseke wafa ngenxa ye-psychoactive peak of the psychoactive peak of the right time at natural, THC] njalo ngemva kwemizuzu engu-30 ukusuka lapha kuqhubeke, isibindi sakho siyasikhipha futhi uzozizwa uzolile.”
3. Lala uFlathi noma uncike ukuze uvimbele i-Syncope (Ukuquleka):
   • I-THC ibangela i-peripheral vasodilation (ukuhlangana kwegazi emilenzeni), okubangela ukwehla kungazelelwe komfutho wegazi kanye nokuquleka uma umuntu esukuma ngokushesha ukuze aye endlini yokugezela. Bagcine belele phansi noma bencike emicamelweni bephakamise imilenze yabo, futhi baphelezele ngokoqobo uma kufanele bame ukuze basebenzise indlu yangasese.
4. I-Sensory Grounding kanye ne-Black Peppercorn / Lemon Technique:
   • Mababeke indwangu yokuwasha epholile, eswakeme esiphongweni sabo nangemuva kwentamo yabo (yenza i-reflex ye-mammalian dive kanye ne-vagus nerve ukuthi ishaye kancane kancane ukushaya kwenhliziyo).
   • I-Whole Black Peppercorns noma I-Fresh Lemon Peel: Uma bephapheme futhi bekwazi ukugwinya ngokuphepha, bavumele bahogele upelepele omnyama osanda kuqhekezwa noma bahlafune 2 kuya ku-3 umbila omnyama ophelele, noma bahogele ikhasi likalamula eligayiwe bese bephuza amanzi kalamula. Upelepele omnyama uqukethe amazinga aphezulu e-beta-caryophyllene, i-sesquiterpene yokudla esebenza njengokukhetha CB2 i-receptor agonist kanye ne-negative allosteric modulator ekhonjiswe ocwaningweni lwe-cannabinoid lomtholampilo ukudambisa ukukhathazeka okubangwa yi-THC, kuyilapho i-citrus limonene yehlisa i-THC paranoia.
   • Slow 4-6 Vagal Breathing: Baqeqeshe ukuthi bahogele kancane kancane ngekhala imizuzwana emi-4 bese ukhipha umoya kancane ngezindebe ezicijileimizuzwana engu-6 (ukwelula i-exhale kuvuselela ithoni ye-vagal parasympathetic futhi kwehlisa ukushaya kwenhliziyo).
5. OKUNGAMELE ukwenze ngesikhathi se-THC isiqephu sokwethuka:
   • Ungalokothi unikeze i-caffeine, iziphuzo zamandla, noma utshwala (i-caffeine yenza i-tachycardia ibe yimbi kanye nokwethuka; utshwala kwandisa ngokumangalisayo ukumuncwa kwe-THC emathunjini).
   • Ungalokothi uwaphoqe eshaweni ebandayo ngenkathi umile (kudala ukuvaleka kwemithambo kungazelelwe noma ukulimala kwekhanda lokushelela nokuwa).

Ingxenye 3: I-THC Ngengozi Yezingane Ukungenisa Gummy (Isimo Esiphuthumayo Esibucayi)¶

Ososeshini be-THC bezentengiselwano, amabha kashokholethi, namaswidi e-nerd-rope avamise ukupakishwa kuma-mylar wrappers anemibala egqamile abukeka afana noswidi wesuphamakethe ovamile, ngephakheji elilodwa eliqukethe 100 kuya ku-1,000 milligrams we-THC (imithamo yabantu abadala eyi-10 kuye kwayi-100).

• Kungani I-THC Edibles Ibeka Impilo Engozini Ezinganeni Ezisacathula Nezingane Ezincane: Kumuntu omdala onesisindo esingamakhilogremu angu-75 (amaphawundi angu-165), 50 mg I-THC ibangela ukuhlaselwa kovalo okungemnandi. Enganeni enesisindo esingu-*12 kilograms (26 pounds)**, ebamba futhi edla izinsini ezigcwele isandla 100 to 300 mg I-THC iletha umthamo omkhulu onobuthi (10 to 25 mg/kg).
• Ukuthuthuka Komtholampilo Wezingane (ihora eli-1 kuye kwayisi-6 ngemuva kokungeniswa):
  • Izimpawu zangaphambi kwesikhathi (imizuzu engu-30 kuye kwengama-90): Ukuhamba okungagxilile (ataxia), amehlo avuleke njengengilazi, ukugigitheka noma ukukhala okungazelelwe okungaduduzi, inkulumo engahlangani, nokuvevezela kwemisipha.
  • Izimpawu ezibucayi (ihora eli-1 kuye kwayi-4): Ukuqhubekela phambili ngokushesha ku-ukuphelelwa amandla okujulile, ukungakwazi ukuvuka ngenxa yezisusa ezibuhlungu (ikhoma), ukuphefumula okunensayo okuyingozi noma okungajulile (i-bradypnea / i-apnea edinga i-endotracheal intubation), ukwehla kwezinga lokushisa lomzimba (hypothermia), kanye nokuquleka okujwayelekile kwe-tonic-clonic.
• Isinyathelo Esisheshayo Sabazali Nabanakekeli:
  1. UNGALINDI ukuthi kuvele izimpawu. Ngenxa yokuthi izinsini zomlomo zithatha ihora elingu-1 kuya kwangu-2 ukuze zimunce, ingane ebukeka ijwayeleke ngokuphelele emizuzwini engu-20 ngemva kokudla insangu ye-THC ingayeka ukuphefumula embhedeni wayo ngemva kwamahora amabili.
  2. Shayela ku-911/112/999 noma Ukulawula Ubuthi (1-800-222-1222 e-US) ngokushesha bese uthatha ingane KANYE ne-candy wrapper ngqo uyiyise esibhedlela esiseduze soMnyango Wezimo Eziphuthumayo.
  3. Thembeka ngamaphesenti angu-100 kwabezimo eziphuthumayo kanye nodokotela bakwa-ER mayelana nokuthi ingane idleni. Ukutshela udokotela ngokushesha ukuthi kwakuyi-THC edliwayo kusindisa ingane empompini womgogodla ohlaselayo (ama-lumbar punctures), imisebe yekhanda ye-CT, kanye nama-antibiotics angadingekile ngenkathi odokotela befuna imbangela ye-coma engazelelwe.

Ingxenye 4: Ama-Synthetic Cannabinoids ("Spice," "K2") kanye nama-Hemp Analogs Angalawulwa¶

Ungalokothi udide insangu yemvelo yezitshalo ne- Synthetic Cannabinoid Receptor Agonists (SCRAs) ethengiswa njengempepho yemithi ("Spice," "K2," "Black Mamba," "Scooby Snax"), uketshezi lwevape yasemgwaqweni oluxubile, noma okuphuma ku-semi-synthetic hemp-Phtates, THC-Th HHC):

1. I-Agonist Neurotoxicity Egcwele ("Spice" / "K2"): I-Delta-9-THC yemvelo iyi--agonist eyingxenye kuphela ebuchosheni CB1 ama-receptors, okusho ukuthi umphumela wawo wokuphila ufinyelela uphahla lwemvelo. Ama-cannabinoids okwenziwa elebhu enziwe ngokungemthetho (njenge MDMB-4en-PINACA, ADB-BUTINACA, futhi 5F-MDMB-PICA) kukhona ama-agonist agcwele anezikhathi ezingama-20 kuye kwezingama-800 amandla e-THC. Baqala ukuquleka okuyingozi okuyingozi, i-hyperthermia eyedlulele, i-rhabdomyolysis (ukuwohloka kwemisipha ebhubhisa izinso), ukuqaqamba komthambo wenhliziyo okubangela ukuhlaselwa yinhliziyo entsheni, kanye nesifo sengqondo esinobudlova.
2. I-Vitamin E Acetate & Ketene Gas Ephuma Ku-Illicit THC-O Vape Cartridges: Ukushisisa THC-O-acetate noma amafutha e-vape angekho emthethweni asikwe nge Vitamin E acetate esibayeni se-vape aqhekeze ngokufudumele iqembu le-acetate libe igesi yeketene (CH2=C=O), ushevu obulalayo wamaphaphu ohlobene ngamakhemikhali ne-phosgene obangela EVALI (E-cigarette noma i-Vaping Use-Associated Lung Injury), inyumoniya yamakhemikhali, kanye nokwehluleka ukuphefumula okukhulu.
3. I-Brodifacoum ("I-Superwarfarin" Ubuthi Begundane) Ukuphinga: Ukuqubuka kwezifo eziningi zomphakathi okulandelwa yi-CDC kuhilele ama-cannabinoids okwenziwa emigwaqweni afuthwe nge-brodifacoum (ushevu wamagundane osebenza isikhathi eside) ukuze andise ukuphakama, okubangela iziguli ukuba zophe ngokuzenzakalelayo ezinsinini zazo, ikhala, isisu esibomvu, nesisu ngemva kwezinyanga ezibomvu, kanye nezinso. umthamo omkhulu Ukwelashwa kwe-Vitamin K1 (phytonadione).

Ingxenye 5: Ukusinda Ekuhoxisweni KweCannabis Okubi kanye Nokuqwasha Kabusha Ngemva Kokuyeka I-CHS¶

Ezigulini ezitholwe zine-Cannabinoid Hyperemesis Syndrome noma ukuncika kwansuku zonke kwe-high-potency concentrate (70% to 90% THC Izinqola ze-wax/vape), isithiyo esisodwa esinzima kakhulu sokuhlala uphilile sisinda **ezinsukwini zokuqala eziyi-7 kuye kweziyi-14 zokuhoxiswa kwensangu okubuhlungu ** ngaphandle kokuphindela emuva ukumisa ukungakhululeki.

1. Umugqa wesikhathi wokuhoxiswa kwe-THC okunamandla amakhulu¶

Iqashelwa ku-DSM-5-TR, I-Cannabis Withdrawal Syndrome (CWS) iqala phakathi*** namahora angu-24 kuya kwangu-48** okuyekwa ukusetshenziswa kwansuku zonke, ifinyelela umvuthwandaba phakathi kuka-Izinsuku 2 no-6, futhi incipha kakhulu phakathi kwamaviki angu-2 kuya kwayi-3* (nakuba amaphupho acacile e-REM angu-30) angahlala izinsuku ezi-4

• Ukuphindaphinda kweGastrointestinal: Ukulahlekelwa ukudla, ukuminya kwesisu okuncane, nokuqunjelwa ekuseni. (Ngokuphawulekayo, uma usudlule ihora elingu-48 kuye ku-72 ngaphandle kwe-THC, umjikelezo onodlame othi "scromiting" we-CHS uyama futhi uthathelwa indawo yi-queasiness ethambile elawulekayo.)
• I-Sleep Architecture Rebound: Ngenxa yokuthi i-THC engapheli icindezela ubuthongo obu-Rapid Eye Movement (REM), ukuyeka kubangela ukuphindaphindeka kwe-REM kokulala: ukuqwasha okuqinile kokuqala okulandelwa amaphupho amabi acace ngendlela engavamile, ayinqaba, noma acacile kanye imijuluko yasebusuku ecwilisa imibhede.
• I-Autonomic & Mood Dysregulation: Ukungahlaliseki, ukucasuka, intukuthelo engazelelwe, ukugodola, ukuvevezela kwesandla okuncane, kanye nekhanda elibuhlungu.

2. Ukunakekelwa okuphephile, okungeyona i-cannabinoids phakathi nokusetha kabusha kwe-CHS kwezinsuku eziyi-14¶

1. Ukubuyiswa kwamanzi Amanzi Amanzi Ngomlomo kanye Nokuthuthuka kwe-BRAT-Plus:
   • Emahoreni okuqala angu-48 ngemva kokuma kwesiqephu se-CHS, phuza usawoti opholile wokubuyisela amanzi emzimbeni womlomo (WHO ORS, Pedialyte, noma Liquid I.V.), umhluzi ocwebile wamathambo/wemifino, neziphuzo zemidlalo ezihlanjululwe ku-15 milliliters (isipuni esingu-1) njalo emizuzwini eyi-10 kunokuba uqhubukushe ingilazi egcwele ye-gastromix ebangela ukunwebeka kwamanzi.
   • Uma uketshezi luhlala luphansi amahora angu-12, faka ukudla okungenalutho, okunamafutha amancane (**ubhanana, irayisi elimhlophe nje, ama-apulasi, ithosi elomile, ama-crackers kasawoti, netiye le-ginger **). Gwema ukudla okunamafutha amaningi noma okuthosiwe ngesonto lokuqala, njengoba amafutha okudla anciphisa ukuphuma kwesisu.
2. Ukuphatha Ukujuluka Kwasebusuku kanye Nokuqwasha Kabusha Ngaphandle Kokuphinda:
   • Gcina igumbi lokulala lipholile (16 kuya ku-18 degrees Celsius / 60 kuya ku-65 degrees Fahrenheit), ungqimba amashidi kakotini ophefumulayo, futhi ugcine ushintsho olomile lwezikibha eduze nombhede.
   • Buza udokotela wakho mayelana nokulala okungewona umkhuba wesikhathi esifushane noma ukwesekwa kwesicanucanu (okufana nokuthi melatonin 1 kuya ku-3 mg, hydroxyzine, doxylamine, noma promethazine/prochlorperazine suppositories) phakathi Nezinsuku 1 kuya ku-7. **Ungalokothi usebenzise amafutha e-CBD, i-Delta-downs i-Delta-down kusukela ku-Chs flower, noma i-Hemp flower, noma i-Ch. I-phytocannabinoids engadaki isebenzisana ne-enteric TRPV1 futhi CB1 ama-receptors futhi aqalise kabusha i-hyperemesis.

(Uma wena noma omunye umuntu omkhathalelayo ehlushwa ukuncika kwensangu enamandla kakhulu nsuku zonke, ukusetshenziswa kwezidakamizwa zokwenziwa, noma ukulaliswa esibhedlela kwe-CHS, bheka Ukusetshenziswa kwezidakamizwa nokuba umlutha wezidakamizwa: umhlahlandlela wosizo oluphuthumayo futhi Ukweseka ilungu lomndeni elinomlutha. Futhi sincoma ukuthatha isifundo sosizo lokuqala esigunyaziwe esivela kwa-Red Cross, St John Ambulance, noma umhlinzeki wendawo.)

Imibuzo evame ukubuzwa¶

Imithombo ihloliwe¶

• I-American College of Gastroenterology (ACG) kanye ne-Rome Foundation: I-Rome IV Diagnostic Criteria kanye Neziqondiso Zomtholampilo Zokusebenza ze-Cannabinoid Hyperemesis Syndrome (CHS) (Izigaba ze-CHS, i-pathophysiology yokugeza ngamanzi ashisayo eyimpoqo, kanye nemiphumela yokuyeka okuphelele).
• I-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 the Emergency Department Management of Cannabinoid Syndrome.
• Centers for Disease Control and Prevention (CDC) kanye ne-American Association of Poison Control Centers (AAPCC, United States): Pediatric Unintentional Cannabis Edible Ingestions, Izeluleko Zokuqubuka Ku-Brodifacoum-Adulterated Synthetic Cannabinoids, kanye *EVALI (Vitamin E Acedate / Ketene) Guitene
• Isikhungo Sikazwelonke Sokuxhashazwa Kwezidakamizwa (NIDA / NIH, United States) kanye Nenhlangano Yezempilo Yomhlaba (WHO): I-Pharmacokinetics of oral 11-hydroxy-THC vs. ukuhogela Delta-9-THC, kanye ne-acute toxicology ye-Full-Agonist Synthetic Cannabinoid Receptor Agonists (Spice / K2).
• I-British Journal of Pharmacology (Russo, E. B.): Ukulawula i-THC: I-Cannabis Synergy Engaba Khona kanye ne-Phytocannabinoid-Terpenoid Entourage Effects (I-Pharmacology ye-beta-caryophyllene kanye ne-limonene ekunciphiseni ukukhathazeka okukhulu kwe-THC).

Iziqondiso ezihlobene¶

• Ukusetshenziswa kwezidakamizwa nokuba umlutha wezidakamizwa: umhlahlandlela wosizo oluphuthumayo
• Ukweseka ilungu lomndeni elinomlutha
• Ukuhlaselwa kwe-panic kanye nokukhathazeka okukhulu
• Inkinga yempilo yengqondo kanye nezimo eziphuthumayo zokuzibulala
• Ubuthi bokudla, i-acute gastroenteritis, nokuphelelwa amanzi emzimbeni
• Upelepele we-capsaicin ushisa emehlweni, esikhunjeni, nasezandleni
• Usizo lokuqala olunobuthi
• Izinombolo eziphuthumayo