Death of a young woman with cyclic vomiting: a case report
We report the death of a 22-year-old woman, with a 3½ year history of cyclic vomiting and cannabis use since age 14, who developed torsades de pointes cardiac arrythmia while being treated in the emergency room for nausea and vomiting. Resuscitation restored spontaneous cardiac circulation, however,...
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Veröffentlicht in: | Forensic science, medicine, and pathology medicine, and pathology, 2021-12, Vol.17 (4), p.715-722 |
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description | We report the death of a 22-year-old woman, with a 3½ year history of cyclic vomiting and cannabis use since age 14, who developed
torsades de pointes
cardiac arrythmia while being treated in the emergency room for nausea and vomiting. Resuscitation restored spontaneous cardiac circulation, however, due to post-cardiac arrest anoxic brain injury, she never regained consciousness and was declared brain dead 4 days later. Postmortem examination confirmed hypoxic-ischemic encephalopathy, in keeping with the in-hospital diagnosis of brain death. The heart was anatomically normal but showed signs of acute post-cardiopulmonary arrest reperfusion injury. As a consequence of limited survival in hospital in a neuro-vegetative state, early bronchopneumonia and isolated pulmonary thromboemboli were seen. Toxicological studies confirmed cannabis use, in addition to the presence of haloperidol and ondansetron. Genetic studies were performed to rule out a possible channelopathy and revealed a mutation in the
MYBPC3
and
RYR2
genes. Death in this woman with cannabinoid hyperemesis syndrome was attributed to a fatal cardiac arrhythmia complicating vomiting-induced hypokalemia and treatment with QT interval prolonging and potentially arrhythmogenic medications, with the identified cardiac genetic mutations listed as contributing factors. The emphasis of this report is a) to raise awareness that death can occur due to cyclic vomiting, b) provide a brief but practical overview of cannabinoid hyperemesis syndrome, c) describe the findings from our postmortem examination and come to the most reasonable cause and mechanism of death, d) comment on the risk factors associated with
torsades de pointes
cardiac arrythmia, and e) conclude that a complete postmortem examination is needed to exclude an anatomical or toxicological cause of death in cannabinoid hyperemesis syndrome, a disabling but preventable disorder. |
doi_str_mv | 10.1007/s12024-021-00410-z |
format | Article |
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torsades de pointes
cardiac arrythmia while being treated in the emergency room for nausea and vomiting. Resuscitation restored spontaneous cardiac circulation, however, due to post-cardiac arrest anoxic brain injury, she never regained consciousness and was declared brain dead 4 days later. Postmortem examination confirmed hypoxic-ischemic encephalopathy, in keeping with the in-hospital diagnosis of brain death. The heart was anatomically normal but showed signs of acute post-cardiopulmonary arrest reperfusion injury. As a consequence of limited survival in hospital in a neuro-vegetative state, early bronchopneumonia and isolated pulmonary thromboemboli were seen. Toxicological studies confirmed cannabis use, in addition to the presence of haloperidol and ondansetron. Genetic studies were performed to rule out a possible channelopathy and revealed a mutation in the
MYBPC3
and
RYR2
genes. Death in this woman with cannabinoid hyperemesis syndrome was attributed to a fatal cardiac arrhythmia complicating vomiting-induced hypokalemia and treatment with QT interval prolonging and potentially arrhythmogenic medications, with the identified cardiac genetic mutations listed as contributing factors. The emphasis of this report is a) to raise awareness that death can occur due to cyclic vomiting, b) provide a brief but practical overview of cannabinoid hyperemesis syndrome, c) describe the findings from our postmortem examination and come to the most reasonable cause and mechanism of death, d) comment on the risk factors associated with
torsades de pointes
cardiac arrythmia, and e) conclude that a complete postmortem examination is needed to exclude an anatomical or toxicological cause of death in cannabinoid hyperemesis syndrome, a disabling but preventable disorder.</description><identifier>ISSN: 1547-769X</identifier><identifier>EISSN: 1556-2891</identifier><identifier>DOI: 10.1007/s12024-021-00410-z</identifier><identifier>PMID: 34735682</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adolescent ; Adult ; Arrhythmias, Cardiac ; Brain ; Cannabinoids - adverse effects ; Case Report ; Criminology and Criminal Justice ; Diagnosis ; Emergency medical services ; Female ; Forensic Medicine ; Heart ; Humans ; Injuries ; Marijuana ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Nausea ; Pathology ; Syndrome ; Torsades de Pointes ; Vomiting ; Young Adult</subject><ispartof>Forensic science, medicine, and pathology, 2021-12, Vol.17 (4), p.715-722</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2021</rights><rights>2021. Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>COPYRIGHT 2021 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-6be9bbb40251787eedab2325607e5aafa8c7b5be40ad576b69b0ef87c57e37223</citedby><cites>FETCH-LOGICAL-c414t-6be9bbb40251787eedab2325607e5aafa8c7b5be40ad576b69b0ef87c57e37223</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12024-021-00410-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12024-021-00410-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34735682$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>von Both, Ingo</creatorcontrib><creatorcontrib>Santos, Brittini</creatorcontrib><title>Death of a young woman with cyclic vomiting: a case report</title><title>Forensic science, medicine, and pathology</title><addtitle>Forensic Sci Med Pathol</addtitle><addtitle>Forensic Sci Med Pathol</addtitle><description>We report the death of a 22-year-old woman, with a 3½ year history of cyclic vomiting and cannabis use since age 14, who developed
torsades de pointes
cardiac arrythmia while being treated in the emergency room for nausea and vomiting. Resuscitation restored spontaneous cardiac circulation, however, due to post-cardiac arrest anoxic brain injury, she never regained consciousness and was declared brain dead 4 days later. Postmortem examination confirmed hypoxic-ischemic encephalopathy, in keeping with the in-hospital diagnosis of brain death. The heart was anatomically normal but showed signs of acute post-cardiopulmonary arrest reperfusion injury. As a consequence of limited survival in hospital in a neuro-vegetative state, early bronchopneumonia and isolated pulmonary thromboemboli were seen. Toxicological studies confirmed cannabis use, in addition to the presence of haloperidol and ondansetron. Genetic studies were performed to rule out a possible channelopathy and revealed a mutation in the
MYBPC3
and
RYR2
genes. Death in this woman with cannabinoid hyperemesis syndrome was attributed to a fatal cardiac arrhythmia complicating vomiting-induced hypokalemia and treatment with QT interval prolonging and potentially arrhythmogenic medications, with the identified cardiac genetic mutations listed as contributing factors. The emphasis of this report is a) to raise awareness that death can occur due to cyclic vomiting, b) provide a brief but practical overview of cannabinoid hyperemesis syndrome, c) describe the findings from our postmortem examination and come to the most reasonable cause and mechanism of death, d) comment on the risk factors associated with
torsades de pointes
cardiac arrythmia, and e) conclude that a complete postmortem examination is needed to exclude an anatomical or toxicological cause of death in cannabinoid hyperemesis syndrome, a disabling but preventable disorder.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Arrhythmias, Cardiac</subject><subject>Brain</subject><subject>Cannabinoids - adverse effects</subject><subject>Case Report</subject><subject>Criminology and Criminal Justice</subject><subject>Diagnosis</subject><subject>Emergency medical services</subject><subject>Female</subject><subject>Forensic Medicine</subject><subject>Heart</subject><subject>Humans</subject><subject>Injuries</subject><subject>Marijuana</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Nausea</subject><subject>Pathology</subject><subject>Syndrome</subject><subject>Torsades de Pointes</subject><subject>Vomiting</subject><subject>Young Adult</subject><issn>1547-769X</issn><issn>1556-2891</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9r3DAQxUVJaDbbfoEegiGXXLzVX8vaW0iTtBDIJYXehKQdbxVsayPZDbufPtp4UyiEooPE6PceM_MQ-kLwgmAsvyZCMeUlpqTEmBNc7j6gGRGiKmmtyNH-zWUpK_XrBJ2m9Igxk4Syj-iEcclEVdMZWn4DM_wuQlOYYhvGfl08h870xbPPVbd1rXfFn9D5wffrZWacSVBE2IQ4fELHjWkTfD7cc_Tz5vrh6nt5d3_74-ryrnSc8KGsLChrLcdUEFlLgJWxlFFRYQnCmMbUTlphgWOzErKylbIYmlo6IYFJStkcXUy-mxieRkiD7nxy0LamhzAmTYXiVOX5VUbPJ3RtWtC-b8IQjdvj-lISpoQSjGdq8Q6Vzwo670IPjc_1fwR0ErgYUorQ6E30nYlbTbDeR6GnKHSOQr9GoXdZdHZoe7QdrP5K3nafATYBKX_1a4j6MYyxz6v8n-0LdTeSJw</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>von Both, Ingo</creator><creator>Santos, Brittini</creator><general>Springer US</general><general>Springer</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20211201</creationdate><title>Death of a young woman with cyclic vomiting: a case report</title><author>von Both, Ingo ; Santos, Brittini</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-6be9bbb40251787eedab2325607e5aafa8c7b5be40ad576b69b0ef87c57e37223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Arrhythmias, Cardiac</topic><topic>Brain</topic><topic>Cannabinoids - adverse effects</topic><topic>Case Report</topic><topic>Criminology and Criminal Justice</topic><topic>Diagnosis</topic><topic>Emergency medical services</topic><topic>Female</topic><topic>Forensic Medicine</topic><topic>Heart</topic><topic>Humans</topic><topic>Injuries</topic><topic>Marijuana</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Nausea</topic><topic>Pathology</topic><topic>Syndrome</topic><topic>Torsades de Pointes</topic><topic>Vomiting</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>von Both, Ingo</creatorcontrib><creatorcontrib>Santos, Brittini</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Forensic science, medicine, and pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>von Both, Ingo</au><au>Santos, Brittini</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Death of a young woman with cyclic vomiting: a case report</atitle><jtitle>Forensic science, medicine, and pathology</jtitle><stitle>Forensic Sci Med Pathol</stitle><addtitle>Forensic Sci Med Pathol</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>17</volume><issue>4</issue><spage>715</spage><epage>722</epage><pages>715-722</pages><issn>1547-769X</issn><eissn>1556-2891</eissn><abstract>We report the death of a 22-year-old woman, with a 3½ year history of cyclic vomiting and cannabis use since age 14, who developed
torsades de pointes
cardiac arrythmia while being treated in the emergency room for nausea and vomiting. Resuscitation restored spontaneous cardiac circulation, however, due to post-cardiac arrest anoxic brain injury, she never regained consciousness and was declared brain dead 4 days later. Postmortem examination confirmed hypoxic-ischemic encephalopathy, in keeping with the in-hospital diagnosis of brain death. The heart was anatomically normal but showed signs of acute post-cardiopulmonary arrest reperfusion injury. As a consequence of limited survival in hospital in a neuro-vegetative state, early bronchopneumonia and isolated pulmonary thromboemboli were seen. Toxicological studies confirmed cannabis use, in addition to the presence of haloperidol and ondansetron. Genetic studies were performed to rule out a possible channelopathy and revealed a mutation in the
MYBPC3
and
RYR2
genes. Death in this woman with cannabinoid hyperemesis syndrome was attributed to a fatal cardiac arrhythmia complicating vomiting-induced hypokalemia and treatment with QT interval prolonging and potentially arrhythmogenic medications, with the identified cardiac genetic mutations listed as contributing factors. The emphasis of this report is a) to raise awareness that death can occur due to cyclic vomiting, b) provide a brief but practical overview of cannabinoid hyperemesis syndrome, c) describe the findings from our postmortem examination and come to the most reasonable cause and mechanism of death, d) comment on the risk factors associated with
torsades de pointes
cardiac arrythmia, and e) conclude that a complete postmortem examination is needed to exclude an anatomical or toxicological cause of death in cannabinoid hyperemesis syndrome, a disabling but preventable disorder.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>34735682</pmid><doi>10.1007/s12024-021-00410-z</doi><tpages>8</tpages></addata></record> |
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subjects | Adolescent Adult Arrhythmias, Cardiac Brain Cannabinoids - adverse effects Case Report Criminology and Criminal Justice Diagnosis Emergency medical services Female Forensic Medicine Heart Humans Injuries Marijuana Medical research Medicine Medicine & Public Health Medicine, Experimental Nausea Pathology Syndrome Torsades de Pointes Vomiting Young Adult |
title | Death of a young woman with cyclic vomiting: a case report |
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