The word “cannabinoid” refers to compounds uniquely found in cannabis, and “hyperemesis” means severe vomiting. This case has highlighted the difficulty of diagnosis and treatment of CHS in a population of patients with concurrent disorders, including unnecessary exposure to potentially harmful procedures such as CT. One challenge that can arise in any population, but particularly this one, is dealing with poor reporting of the history by the patient.
Medical
Patients may also benefit from oral lorazepam tablets, doses between 0.5 to 1 mg every 6 to 8 h on discharge. Benzodiazepines, with their gamma-aminobutyric acid (GABA) agonistic actions, inhibit the medullary and vestibular nuclei, causing anti-emetic action. Additionally, anxiolytic and sedative properties aid in counteracting the abnormal sympathetic nervous system response, helping in the reduction in vomiting and decreasing pain perception 67.
Differential Diagnosis
Hot water helps calm the symptoms for a while, but the relief doesn’t last long after stepping out. So far, giving up cannabis has been shown to be the only long-term solution. But quitting cold turkey can lead to cannabis withdrawal symptoms such as anxiety, irritability, anger, sleep disturbances, depressed mood, and loss of appetite. Working with a counselor and taking a tricyclic antidepressant (such as amitriptyline) “can help with marijuana cessation,” Angulo says.
Management
Most of the evidence on effective treatment and management comes from published case reports. Doctors have also noticed that people in the hyperemesis stage take frequent showers and baths, which seem to relieve nausea. People in the hyperemesis stage will experience intense and persistent nausea and vomiting. In CHS, receptors that bind to the different components of marijuana can become altered. CB1 receptors are mostly present in the brain, but they also occur in other organs.
Symptoms
It can rob your body of essential fluids, leading to dehydration and serious health issues. People with CHS might also struggle with an electrolyte imbalance, which can harm the heart, kidneys, and other vital organs. When your internal electrolyte levels go off the rails, your body’s ability to function properly gets compromised.
- The patient expressed much frustration with the situation, and although he admitted to being aware that cannabis was the source of his symptoms, he continued to deny any recent usage.
- Working in a dose-dependent and biphasic manner, progressive desensitization of CB1 receptors can occur when overstimulated, creating paradoxical effects.
- Another doctor reported using a combination of injectable lorazepam and promethazine, another antinausea medication.
CHS is a newly identified condition, so doctors currently know little about it. No clinical guidelines exist, so they must rely on published case reports to treat people with CHS. Results from these case studies suggest that lorazepam might be an effective drug to control symptoms during the hyperemesis stage. Some people with CHS require pain relievers if abdominal pain is present. Currently, doctors do not have treatment guidelines for the management of CHS.
- Doctors also noticed that individuals with CHS would take frequent hot showers and baths.
- However, their use is approached with caution due to the risk of dependence, especially in patients with a history of substance use.
- Public health responses to CHS are hampered by a lack of comprehensive data and research.
- This will help to rule out life-threatening causes or diagnoses that confer significant potential morbidity to the patient or to establish the presumptive diagnosis of CHS.
- This was demonstrated in a study by McCallum et al., where male participants were given either marijuana or a placebo before undergoing a radionuclide gastric emptying test 53.
- Speak with a doctor or healthcare professional if you or someone you know has symptoms of CHS.
But it’s also important to acknowledge the positive uses of marijuana, Camilleri said. Decades ago, most people had less opportunity to consume cannabis in daily life. “No kid could use continuously throughout the day and also be doing anything else, because they would have been smoking a joint before,” she said. It’s not clear if some people are more prone marijuana addiction to the syndrome than others.
1 Diagnostic and psychometric testing toward a better understanding of CHS
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. Case reports have demonstrated a remission in CHS symptoms upon cessation of cannabis use for extended periods 6,51–54,57,59–62,68,71. Unfortunately, many of these patients relapse upon resuming cannabis 6,59,61,62. It has been suggested that many of these patients increase or continue their cannabis use because of their perception that it will have beneficial effects on nausea 52. Patient education should therefore be provided with emphasis on the paradoxical nature of the symptoms of CHS.
However, uncertainties remain about cannabis dosage, individual and genetic factors, the duration of abstinence, and the role of abdominal pain in its diagnosis. 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. Recent research noted that type 1 cannabinoid receptors in the intestinal nerve plexus exhibit an inhibitory effect on gastrointestinal motility.
- A systematic review by Richards et al. 64 showed that these standard anti-emetics are often ineffective when used alone and demonstrated superior efficacy with intravenous benzodiazepines.
- In a 2019 review of 271 cases, researchers found that the mean age for having CHS was 30 and that 69 percent of people were male.
- One theory behind CHS is that chronic overstimulation of the body’s endocannabinoid receptors leads to your body not being able to control nausea and vomiting.
- And a 2022 Canadian study found that ER visits for CHS-related problems had increased 13-fold between 2014 and 2021.
- Typically, patients can only find relief from intense and persistent nausea by taking hot baths or showers.
- CHS is also included in the Rome IV definition as a functional gastrointestinal disorder, while CWS is encompassed in the DSM-5 (5th edition of the Diagnostic and Statistical Manual of Mental Disorders) 19, 20.
Ancient Chinese texts document the use of Cannabis sativa for pain and cramp relief. If you have CHS and don’t stop using, your symptoms like nausea and vomiting are likely to come back. Researchers need to study CHS in more detail to make it easier for doctors to recognize and treat the condition. Further studies are also necessary to determine the causes of CHS and its risk factors.