Su1641 - Ketamine as a Novel Abortive Therapy for Cyclic Vomiting Syndrome Attacks

Ahuja, Ashish; Kingsley, Michael; Diable, Caitlin; Binion, David G.; Levinthal, David J.

doi:10.1016/s0016-5085(18)32063-8

Cited by 10 publications

(6 citation statements)

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“…One retrospective chart review of 20 patients who presented to the ED for a CVS episode found the response to ketamine to be dose-dependent. 13 Ketamine aborted a CVS episode in 11 out of 20 patients (55%), with stronger responses seen in doses >15 mg (31.2% admission rate) compared to doses <15 mg (100% admission rate). An interesting finding of this study was the improved response rate in patients with repeated doses in independent ED visits: 8 patients aborted their CVS episode 50% or more of the time.…”

Section: Discussionmentioning

confidence: 95%

Ketamine in Refractory Cyclic Vomiting Syndrome: A Case Report and Review of Literature

Cheung

Doherty

Tatara

2021

Journal of Pharmacy Practice

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Purpose: To describe the use of ketamine in an adult patient in aborting a cyclic vomiting syndrome (CVS) episode. Summary: A 40-year-old man with a history of CVS was admitted after several days of nausea and vomiting. He was given parenteral doses of lorazepam and ondansetron but was unable to remain emesis-free. Ketamine was recommended by Gastroenterology as a therapeutic option after exhausting all first- and second-line agents. Ketamine is a noncompetitive N-methyl-D-aspartate receptor antagonist that is widely used for its analgesic and sedative effects. While there is some data to support its use in CVS, most of the published literature has been limited to the Emergency Department setting and no specific therapeutic dose has been established. We will review our institution’s experience with low dose ketamine in an adult patient with a CVS episode that is refractory to first-line agents. Conclusion: In the case described, ketamine at a low sub-anesthetic dose successfully aborted a CVS episode with no appreciable side effects. As much of ketamine’s full effects remain relatively unknown, additional studies are needed to determine optimal strategies for ketamine use in patients with a CVS episode.

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Section: Discussionmentioning

confidence: 95%

Ketamine in Refractory Cyclic Vomiting Syndrome: A Case Report and Review of Literature

Cheung

Doherty

Tatara

2021

Journal of Pharmacy Practice

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“…Other newer medications such as 150 mg of IV fosaprepitant and IV ketamine have been used with success, although prospective studies are needed to establish their efficacy (66,67,69).…”

Section: Emergency Department Planmentioning

confidence: 99%

“…In general, prompt triage and treatment with intravenous (IV) fluids, antiemetics, and sedatives can help while opioids might be needed in the acute care setting (8,69). Other newer medications such as 150 mg of IV fosaprepitant and IV ketamine have been used with success, although prospective studies are needed to establish their efficacy (66,67,69).…”

Section: Emergency Department Planmentioning

confidence: 99%

Diagnosis and Management of Cyclic Vomiting Syndrome: A Critical Review

Frazier

Venkatesan

2023

Am J Gastroenterol

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Cyclic vomiting syndrome (CVS) is a chronic disorder of gut-brain interaction characterized by recurrent disabling episodes of nausea, vomiting, and abdominal pain. CVS affects both children and adults with a prevalence of approximately 2% in the United States. CVS is more common in female individuals and affects all races. The pathophysiology of CVS is unknown and a combination of genetic, environmental, autonomic, and neurohormonal factors is believed to play a role. CVS is also closely associated with migraine headaches and likely have a shared pathophysiology. The diagnosis of CVS is based on the Rome criteria, and minimal recommended testing includes an upper endoscopy and imaging studies of the abdomen. CVS is frequently associated with anxiety, depression, and autonomic dysfunction. Patients with CVS commonly use cannabis therapeutically for symptom relief. By contrast, cannabinoid hyperemesis syndrome is believed to be a subset of CVS with chronic heavy cannabis use leading to hyperemesis. Due to the recalcitrant nature of the illness, patients often visit the emergency department and are hospitalized for acute CVS flares. Guidelines on the management of CVS recommend a biopsychosocial approach. Prophylactic therapy consists of tricyclic antidepressants (amitriptyline), antiepileptics (topiramate), and aprepitant in refractory patients. Abortive therapy consists of triptans, antiemetics (ondansetron), and sedation. Treatment of comorbid conditions is extremely important to improve overall patient outcomes. CVS has a significant negative impact on patients, families, and the healthcare system, and future research to understand its pathophysiology and develop targeted therapies is needed.

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“…Evolving evidence supports the potential use of IV ketamine * (general anesthetic) for treatment of resistant depression and intractable pain. Recently two small pilot studies have evaluated ketamine * for CVS abortive therapy (Ahuja, Kingsley, Diable, Binion, & DJ, 2018; Valdovinos, Frazee, Hailozian, Haro, & Herring, 2020).…”

Section: Cvs Adult-onsetmentioning

confidence: 99%

Cyclic Vomiting Syndrome and Cannabis Hyperemesis Syndrome

Lathrop

Rosen

Heitkemper

et al. 2023

Gastroenterology Nursing

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This article provides a narrative review of the state of the science for both cyclic vomiting syndrome and cannabis hyperemesis syndrome along with a discussion of the relationship between these 2 conditions. The scope of this review includes the historical context of these conditions as well as the prevalence, diagnostic criteria, pathogenesis, and treatment strategies for both conditions. A synopsis of the endocannabinoid system provides a basis for the hypothesis that a lack of cannabidiol in modern high-potency Δ9-tetrahydrocannabinol cannabis may be contributory to cannabis hyperemesis syndrome and possibly other cannabis use disorders. In concluding assessment, though the publications addressing both adult cyclic vomiting syndrome and cannabis hyperemesis syndrome are steadily increasing overall, the state of the science supporting the treatments, prognosis, etiology, and confounding factors (including cannabis use) is of moderate quality. Much of the literature portrays these conditions separately and as such sometimes fails to account for the confounding of adult cyclic vomiting syndrome with cannabis hyperemesis syndrome. The diagnostic and therapeutic approaches are, at present, based generally on case series publications and expert opinion, with a very limited number of randomized controlled trials and a complete absence of Level 1 evidence within the cyclic vomiting literature overall as well as for cannabis hyperemesis syndrome specifically.

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Su1641 - Ketamine as a Novel Abortive Therapy for Cyclic Vomiting Syndrome Attacks

Cited by 10 publications

References 0 publications

Ketamine in Refractory Cyclic Vomiting Syndrome: A Case Report and Review of Literature

Ketamine in Refractory Cyclic Vomiting Syndrome: A Case Report and Review of Literature

Diagnosis and Management of Cyclic Vomiting Syndrome: A Critical Review

Cyclic Vomiting Syndrome and Cannabis Hyperemesis Syndrome

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