Doctors of Type 1 Patients Should Ask About Cannabis Use

Cannabis use should be suspected in patients with ketoacidosis and frequent vomiting and abdominal pain.

Researchers suggest that cannabis use is an important consideration for anyone with signs of diabetic ketoacidosis (DKA), but with elevated pH and bicarbonate levels, as this may indicate cannabis hyperemesis syndrome (CHS ). CHS was recently discovered in chronic heavy cannabis users, and researchers believe it is due to “slowed gastric motility,” which causes morning vomiting and abdominal pain. Sometimes this pain can be relieved by showering. The results were published in the December 8 online version of Diabetic treatments.

In people with type 1 diabetes, vomiting can cause ketosis and high blood sugar (hyperglycemia), which is different from traditional ACD, where high blood sugar is caused by insulin deficiency, and it happens before ketoacidosis.

Symptoms are identical in both conditions, and both will have elevated ketonemia, the team reports, as “measured by serum hydroxybutyrate and high anion gap.” However, they suggest, while “DKA diagnostic criteria include arterial pH 15 mmol / L. “

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“Patients with ACD and unusual acid-base disorder should be evaluated for cannabis use,” noted lead author Halis Kaan Akturk, MD, who suggests that urine screening for cannabis be done, as well as ” ask patients about their consumption. In acute management, he says, “insulin and fluids are needed to bridge the high anion gap, the long-term prognosis for this CHS differs because the patient is likely to return to the emergency room unless they are. he does not cut his cannabis use ”.

Akturk, from the Barbara Davis Center for Diabetes, University of Colorado, Aurora, and colleagues published the article. The team came up with a new name for it called ‘hyperglycemic ketosis due to cannabis hyperemesis syndrome (HK-CHS)’. They concluded: “Cannabis use was associated with an increased risk of ACD in adults with T1DX. Providers should educate their patients about the potential risk of DKA from cannabis use.

“Because of the CHS, they throw up a lot and feel nauseous all the time. We believe that in these people, the gut slows down and that is why they have more alkalosis, ”Akturk explained. “So the question is whether we should call this DKA or not? It’s not acidosis, so it’s something other than ADC. We wanted to give it a different name. He added that the disease can be life threatening.

“The beta-hydroxybutyrate is high, the anion gap is high,” he said. “These patients are very sick. Don’t just focus on pH and baking soda to sort cannabis users with type 1 diabetes with DKA. Vomiting associated with CHS here adds metabolic alkalosis as a huge compensation, [and] most of the time, metabolic alkalosis is the main problem. Be careful about this.

In 2018, the team found that approximately “30% of their 450 adult patients with type 1 diabetes reported using cannabis,” which nearly doubled the risk of DKA risk compared to those who did not. users.


Cannabis suspect with diabetic ketoacidosis and high pH

Cannabis use is associated with an increased risk of diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D exchange clinic registry

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