Cannabis hyperemesis syndrome: Incidence and treatment with topical capsaicin. / Síndrome de hiperémesis por cannabis: incidencia y tratamiento con capsaicina tópica.

There are few studies in Spain on cannabinoid hyperemesis syndrome (CHS), as well as on the use of topical capsaicin as a treatment. METHODS: Retrospective study of patients over 14 years of age seen in a hospital emergency department during 2018 and 2019 with a diagnosis of CHS based on the following criteria: compatible clinical picture, cannabis use less than 48h and positive urine cannabis test. Epidemiological and clinical variables, attendance times and treatment (including use of topical capsaicin 0.075%) were collected. RESULTS: Fifty-nine attendances were studied, from 29 patients (4.4 cases/10,000 visits, 95% CI 2.8-4.7). Fifty per cent returned for CHS, differing only in more tobacco (P=.01) and cocaine (P=.031) use. Capsaicin was used in 74.6% of visits. The mean time to resolution of vomiting after application was 17.87min. CONCLUSIONS: Although probably underdiagnosed, CHS has a low incidence in the emergency department in Spain, with high patient recurrence. The use of capsaicin ointment is efficient and safe.

Tolvaptán en un caso de síndrome cardiorrenal pediátrico: ¿Cuál es su papel? / Tolvaptan in a pediatric cardiorenal syndrome: What is its role?

El síndrome cardiorrenal se define como la asociación de insuficiencia renal y cardíaca de forma aguda o crónica. Se establece una resistencia a los diuréticos convencionales que hace difícil el manejo de estos niños. El tolvaptán, un antagonista de los receptores de vasopresina, ha sido empleado con éxito en adultos, aunque la experiencia en niños es muy limitada. Se presenta el caso de una paciente de 5 años en lista de trasplante cardíaco que padecía síndrome cardiorrenal. Había tenido una hospitalización prolongada con buena respuesta a dosis mínimas de tolvaptán (0,1 mg/kg/día). Se analizaron las curvas de urea, creatinina, sodio y volumen urinario, y se evidenció una mejoría llamativa en la función renal. Al cuarto día de haber iniciado el tratamiento, se le pudo dar el alta con seguimiento ambulatorio y buena evolución hasta el trasplante. El tolvaptán podría considerarse una opción de tratamiento en niños con resistencia a diuréticos convencionales e insuficiencia cardíaca, especialmente, cuando presentan insuficiencia renal.

The cardiorenal syndrome has been defined as a situation in which therapy to relieve congestive symptoms of heart failure is limited by a decreased renal function. The resistance to conventional diuretic treatment makes difficult managing these patients. Tolvaptan, a selective vasopressin-2 receptor antagonist, has been used successfully in adults with this pathology but the experience with children is very limited. A five-year-old girl with renal failure waiting for a heart transplant is presented. Tolvaptan (0.1 mg/kg/day) was started at very low dosage, resulting in an excellent response. We analyzed the creatinine, urea, urine volume and sodium evolution. Renal function also improved. She could be discharged after four days of treatment (156 days of hospitalization) with ambulatory favourable follow-up until heart transplant. Tolvaptan should be considered in pediatric cases of conventional diuretic-resistant congestive heart failure, especially when complicated by kidney disease.