Management of Acute Kidney Injury in Patients with Cannabinoid Hyperemesis Syndrome

Initial Assessment and Management

The Kidney Disease: Improving Global Outcomes (KDIGO) criteria can be used to evaluate the severity of acute kidney injury (AKI), with a serum creatinine increase of ≥0.3 mg/dL within 48 hours being a key indicator 1
Fluid status and risk factors for worsening kidney function should be assessed, with careful monitoring of serum creatinine and electrolytes 1, 2
The American Society of Nephrology recommends discontinuing all nephrotoxic agents when possible to prevent further kidney damage 3, 4
The National Kidney Foundation suggests avoiding ARBs and ACE inhibitors during acute kidney injury episodes, except in patients with chronic kidney disease 5
Medication dosages should be adjusted based on estimated glomerular filtration rate (GFR) to minimize nephrotoxicity 3

Serum creatinine and electrolytes should be checked daily to monitor kidney function and electrolyte balance 2, 3
Fluid balance should be carefully monitored to prevent dehydration and fluid overload 1
The American Diabetes Association recommends maintaining serum glucose levels between 140-180 mg/dL to prevent hypoglycemia and hyperglycemia 6, 7
The European Society for Clinical Nutrition and Metabolism suggests ensuring adequate nutritional intake despite nausea and vomiting, with consideration of formulas with lower electrolyte content if electrolyte disturbances are present 6, 7, 8

Recovery from AKI should be monitored for at least 7 days after the initial insult, with sustained recovery defined as independence from renal replacement therapy for >14 days 3