Cannabinoid Hyperemesis Syndrome Treatment, Symptoms, More

The recent legalisation on cannabis in many countries raises a concern about increased use. On the second visit, CHS was diagnosed and the patients were treated with capsaicin cream 0.025% applied in a layer approximately 1 mm thick on the abdomen. In both cases, topical capsaicin provided symptomatic relief in about 30 min. Both patients reported a burning sensation where the capsaicin was applied but were satisfied with the results 97.

2. Endocannabinoid System (ECS)

In one small study of eight patients hospitalized with CHS, four of the five who stopped using weed recovered from CHS. One of the 4 who recovered went back to using marijuana and the vomiting resumed. Because CHS is a fairly new medical condition, not all doctors know about it. Or they might think it’s something else, since repeated throwing up is a sign of many health problems. You may need to see a gastroenterologist, a doctor who specializes in the digestive tract, for a proper diagnosis. One over-the-counter treatment that may ease symptoms is capsaicin cream, an analgesic that creates a sensation of heat.

• Propranolol is a nonspecific, lipophilic beta-1/beta-2-blocker that has been used to treat CVS, particularly in pediatric patients 119.
• THC accumulates largely within body fat which serves as a long-term storage site for the drug 20,22.
• However, their use is approached with caution due to the risk of dependence, especially in patients with a history of substance use.

How is Cannabinoid Hyperemesis Syndrome Treated?

• Its sedative and anti-emetic properties help to manage hyperemesis in CHS patients.
• The majority of these individuals are less than nineteen years of age 2.
• There are multiple hypotheses regarding the pathophysiology of CHS; however, because of the multitude of active chemicals in cannabis and the existence of various sites of action, the definitive pathophysiological process is unknown.

As cannabis legalization continues to spread across the country, doctors are sounding the alarm about the potential health risks of the quickly changing drug. One rare condition is sending chronic marijuana users to emergency rooms. Researchers are attempting to spread awareness about that condition, cannabinoid hyperemesis syndrome (CHS), and the need for more government oversight in the legal cannabis industry. The CHS what is alcoholism diagnostic criteria consist of those essential for diagnosis (long-term cannabis use), major features, and supportive features of CHS (see box, Proposed Clinical Diagnostic Criteria for Cannabinoid Hyperemesis Syndrome). These diagnostic criteria can aid clinical pharmacists in the evaluation of patients presenting with cyclic vomiting with no obvious organic cause and a history of repeated ED visits for the same condition. Since the Department of Justice issued a memo that it would not prosecute marijuana users and sellers who complied with state law in 2009, hospital discharges for compulsive vomiting have increased by 8% annually 13.

Hyperemetic phase

Most CHS patients present to the emergency department multiple times, often undergoing various diagnostic tests, including lab work and advanced imaging, which typically yield negative results. Common clinical findings include signs of dehydration, electrolyte imbalances, and ketonuria following episodes of severe nausea and vomiting. The onset of symptoms was reported in 13 of those cases at a median of 9 years (range 3–25 years). In the limited subset of cases where data were available, it appeared that it took a mean of 2.6 years (range 1 day to 9 years) to get a CHS diagnosis. All patients reported intractable vomiting for 24–48 h, and all patients suffered abdominal pain; many experienced weight loss as well. Hot showers for symptomatic relief were reported by 17/19 patients 128.

Although some patients who use marijuana present with CVS, there are several differentiating factors between CVS and CHS. CVS usually involves a personal or family history of migraines, a history of psychiatric disorders, and a lack of compulsive hot bathing.11 Patients with CHS often present to the emergency department (ED) because of symptoms. Cannabis, derived from Cannabis sativa plants, is a prevalent illicit substance in the United States, containing over 400 chemicals, including 100 cannabinoids, each affecting the body’s organs differently upon ingestion. Cannabis hyperemesis syndrome (CHS) is a gut-brain axis disorder characterized by recurring nausea and vomiting intensified by excessive cannabis consumption. CHS often goes undiagnosed due to inconsistent criteria, subjective symptoms, and similarity to cyclical vomiting syndrome (CVS). Understanding the endocannabinoid system (ECS) and its dual response (pro-emetic at higher doses and anti-emetic at lower doses) is crucial in the pathophysiology of CHS.

TRPV1 and temperature regulation

Thus, learned behavior of bathing in hot water may be used to help diagnose CHS and differentiate it from other CVS 93. Over 90% of CHS patients exhibit this behavior 75, which is sometimes described as compulsive. The patient found that hot water relieved his symptoms better than anything else. After 3 days in the hospital (and no marijuana use), his symptoms resolved 94. It should be noted that in the case of CHS, compulsive showering in hot water is not an anxiety disorder but rather a learned behavior that the patient develops to relieve symptoms 94. Similar to hot water, capsaicin provides symptomatic relief of CHS 95, 96, 97 but not other vomiting disorders.

Risk Factors for Developing Cannabinoid Hyperemesis Syndrome

It is characterized by episodes of nausea and vomiting, which may be relieved by hot baths and showers or by discontinuing cannabis use. Very little is known about this condition, including its causes, but researchers hypothesize that an oversaturation of cannabinoid receptors in the body could lead to these complications. Others suspect that certain pesticides used in cannabis cultivation might be the cause. The incidence of cannabinoid hyperemesis syndrome in patients presenting to U.S. emergency departments is increasing. Furthermore, lengths of stay are reduced when unnecessary testing is avoided. The hyperemetic phase of CHS typically lasts for only 24–48 hours 6, but the risk for relapse is high if the patient returns to cannabis use.

The exact mechanism of hyperemesis associated with long-term cannabis use is unknown

Public health can aid in creating safe consumption guidelines on lower dose usage for patients using it for medicinal reasons. Policy emphasizing mandatory labeling of high-potency cannabis products with information on their risk, including CHS, will benefit chronic users. Cannabis legalization should include balanced details on its benefits and potential risks. As cannabis becomes legal in more places, it is essential to monitor CHS cases across the country, which can help with public health strategies and policy decisions. It remains unknown how changes to the endocannabinoid system cannabinoid hyperemesis syndrome could lead to the development of CHS and more empirical research is needed to identify the mechanism.