Cannabis hyperemesis syndrome: an update on the pathophysiology and management PMC

However, doctors may find it challenging to diagnose the syndrome because people tend not to report their use of marijuana. They also experience episodes of vomiting that return every few weeks or months. Chronic cannabinoid usage can lead to recurrent N/V with distinct pathogenesis, known as CHS. There is a need for awareness among the medical community about what cannabis can and cannot do as CHS can lead to death [36].

Highlights of the Study

Overnight, the nursing staff reported that the patient took multiple, prolonged hot showers. Upon further questioning, he reported the hot showers significantly https://ecosoberhouse.com/ helped the nausea and abdominal pain. He had learned this behavior after experiencing previous episodes of self-limited nausea, vomiting, and abdominal pain.

Topical Capsaicin

THC accumulates largely within body fat which serves as a long-term storage site for the drug [20,22]. This characteristic partially explains its prolonged elimination half-life. A large reservoir of stored THC in fat tissue may produce a “reintoxication effect” secondary to increased lipolysis during times of increased stress or food deprivation [23]. Cannabis is the most commonly used illicit drug in the United States with over 16.7 million users in 2009 [1]. The 18–25 year old age group has the highest prevalence of marijuana use [1]. The majority of these individuals are less than nineteen years of age [2].

When to Seek Emergency Medical Help

Table 2 summarizes some of the epidemiological and clinical characteristics that may help distinguish CVS and CHS. A thorough history, physical examination and directed testing of differential diagnoses may assist in ruling out these diagnoses. The Rome IV criteria provide some objectivity to help with the diagnosis by placing cannabinoid hyperemesis syndrome CHS under the heading of functional gut-brain disorders, and consider it as a variant of CVS (Table 2). Venkatesan et al have proposed a new criterion for CHS with the use of clinical features, cannabis use patterns including duration and frequency, and symptoms resolution after at least 6 months of cessation [48].

• Typically, patients can only find relief from intense and persistent nausea by taking hot baths or showers.
• It’s still not clear which of the more than 100 cannabinoids found in cannabis are responsible for CHS, but it’s thought that CBD could potentially be a contributor.
• Or they might think it’s something else, since repeated throwing up is a sign of many health problems.
• Many people experience temporary relief from their nausea and vomiting when bathing in hot water.

“It’s the best medication that helps her sleep for the last five years. “It may be that the cannabinoid is only sort of one aspect of the way the patient is hurting that needs to be addressed to really get them to heal,” he said. Though cannabis has become more culturally acceptable and more widely legal, both in the U.S. and abroad, its regular use is still a sensitive topic.

• People in the hyperemesis stage will experience intense and persistent nausea and vomiting.
• In one small study of eight patients hospitalized with CHS, four of the five who stopped using weed recovered from CHS.
• Recognition of the function of the endocannabinoid system (ECS) was a breakthrough in explaining the effects of cannabis on different organs, at least in part [2].
• Stopping cannabis use is the only known way to permanently get rid of CHS.

CHS Symptoms

The time to improvement varies from 1 to 3 months in the current literature.12 Patients may be reluctant to accept that cannabis has played a role in their symptoms, and they should be educated about the nature of the disorder. This is an area where clinical pharmacists can play an important role. To make a diagnosis, your healthcare provider will conduct a thorough physical examination and ask you about your past health and current symptoms.

History and Physical

• Certain individuals may have a genetic polymorphisms in the cytochrome P450 enzymes responsible for the metabolism of the cannabinoids [62,72].
• Caution should be made against the overprescription of lorazepam, as it can cause physical and/or psychological dependence especially in CHS patients who are vulnerable to substance abuse.
• If you think you have CHS or cannabis use disorder, talk to a healthcare provider.