In addition to appropriate antiemetic therapy, fluid resuscitation, and management of the patient’s symptoms, patients must recognize behaviors and exposures that place them at risk for their pathology. For supportive care, a clinician should work together with the pharmacist to see if any medications could contribute to the patient’s presentation. If administering antiemetics, the nursing staff should be familiar with the adverse event profile so they can report any concerns that may arise. Ultimately, the treatment of any illness is the removal of precipitating factors, not merely the management of its symptoms. Indeed, with any syndrome that results in frequent vomiting, there is a concern for a disorder of electrolytes and fluid balance in the body.
- While various approaches can help manage the symptoms, the only known cure for CHS is to stop using cannabis.
- Hospital admission in and of itself can serve to resolve CHS in that patients abstain from marijuana during the time they are inpatients.
- Both CVS and CHS are complex gastrointestinal conditions influenced by several entities, including genetic, environmental, and lifestyle factors.
- This causes the pituitary gland to release adrenocorticotropic hormone into the blood stream, which activates the adrenal cortex and leads to the production of corticosteroids 57.
- However, health professionals warn that given the recurrent nature of CHS, even moderate cannabis use may trigger a relapse, leading to the return of debilitating symptoms.
- In this phase, patients gradually resume normal eating and dietary habits.
- “Cannabinoid” refers to cannabis (marijuana) and “hyperemesis” is a word meaning “prolonged vomiting.”
Clinical Features, Diagnosis and Treatment
Patients who stop using marijuana but continue to experience cyclic vomiting are more likely to have CVS. It is typical that CHS symptoms resolve in a matter of days once marijuana is stopped; in some case reports, symptoms resolved in hours. Some important questions for patients to better and more rapidly diagnose CHS are shown in Table 1. The objective of our research was to establish a clinically meaningful description of CHS and its presentation, to evaluate diagnostic challenges in identifying this syndrome, and to describe effective treatment options. Articles that were not in English were excluded as were case reports that did not report the age, sex, presentation, diagnosis, and treatment of the patient. Case reports were summarized in Table 2 and case series presented in the narrative text.
What Causes Cannabis Hyperemesis Syndrome?
Some of those hospital visits are related to a severe condition that develops after using high concentrations of cannabinoids over a long time, called Cannabinoid Hyperemesis Syndrome (CHS). This illness poses potential health risks with the quickly changing drug. First described in 2004, it has become increasingly recognized as cannabis use has grown more widespread. The syndrome is characterized what is alcoholism by recurring episodes of nausea and vomiting. Discontinuation of cannabis use in any form is required for complete long-term management of CHS. A multimodal approach, including structured psychotherapy such as cognitive behavior therapy (CBT), along with addiction counseling in educating patients about the consequences of cannabis use, is necessary 92.
Treatment / Management
These physiological alterations manifest as anxiety, tremors, and paranoia in some cannabis users. Benzodiazepines, such as lorazepam, have proven acute treatment for CHS 65,66. Intravenous lorazepam administered in doses of 1 to 2 mg every 4 to 6 h has shown symptom relief 65,66.
Can you smoke CBD if you have CHS?
In this case series, 17.2% of patients suffered from chronic anxiety. It is not clear if there is a comorbid association between CHS and anxiety or whether the symptoms of CHS are so distressing that patients become anxious. Capsaicin, a topical agent with an active compound what is chs derived from chili peppers, interacts with transient receptor potential vanilloid-1 (TRPV1) receptors 86. TRPV1 receptors are involved in the modulation of transmitting pain signals and altering pain perception 87. These TRPV1 receptors are present throughout the gastrointestinal (G.I.) tract and the medullary vomiting center. They are frequently located closer to CB1 receptors, indicating a potential functional interaction.
Hyperemetic Phase of CHS –
The literature contains a wealth of case studies and case reports on patients suffering from CHS; these case reports come from around the world but have striking similarities. With the liberalization of marijuana laws since 2009, investigators retrospectively evaluated 2,574 ED visits in Colorado and identified 36 patients diagnosed with cyclic vomiting; this occurred in 128 visits. Episodes of cyclic vomiting nearly doubled in prevalence, increasing from 41 per 113,262 ED visits/year to 87 per 125,095 ED visits per year after marijuana laws were liberalized 74. The information in this article and any included images or charts are for educational purposes only. This information is neither a substitute for, nor does it replace, professional legal advice or medical advice, diagnosis, or treatment. If you have any concerns or questions about laws, regulations, or your health, you should always consult with an attorney, physician or other licensed professional.
The CVS has strong links to mitochondrial dysfunction and neurobiological pathways related to migraine, while CHS is primarily influenced by chronic cannabis use and endocannabinoid system dysfunction. Understanding these primary differences in the pathophysiology between these two disease entities is crucial for clinicians when diagnosing, especially since they share overlapping gastrointestinal symptoms. The effects of cannabis and its interactions on the various organ systems were elucidated further with the discovery of the endocannabinoid system (ECS) 1. Tetrahydrocannabinol (THC) is the primary psychoactive compound in cannabis. The role of cannabinoid (C.B.) receptors has enhanced our understanding of cannabis’s effects on inflammation, seizures, nausea, and appetite regulation 5,6,7.
- CHS is a condition caused by chronic and repeated cannabis use that leads to severe nausea and vomiting.
- TPRV1 receptors are activated at temperatures above 43 °C attained during hot showers.
- Patients with CVS also have times where they are feeling sick to the stomach and can also throw up for between 12 hours to about a week.
- The cause of death in both people was found to be hyponatremic dehydration, also known as low sodium levels.
- One 2018 study found that 32.9% of self-reported frequent marijuana users who’d gone to the emergency room (ER) had symptoms of CHS.
- Cannabis Hyperemesis Syndrome (CHS) is a rare but important condition that can affect long-term, frequent cannabis users.
- It’s a serious medical problem that can cause major health issues if you leave it untreated.
Marijuana Cessation
As it progresses, the cycle of nausea, vomiting, dehydration, diarrhea, and abdominal pain becomes more frequent, and patients may attempt to self-medicate. Some patients increase their cannabis use, believing the anti-emetic benefits it provides will ease their symptoms when, in fact, it will only increase them. In hospitalized patients with CHS during the hyperemesis phase, a “nothing by mouth” regimen and IV hydration are typically employed until symptoms improve. As recovery progresses, patients are initially given clear liquids and gradually advance to a regular diet as tolerated.
- Hot baths may relieve the nausea for a while, but they don’t cure CHS.
- They stimulate the cannabinoid receptors in various brain regions, including the temporal lobe, orbitofrontal cortex, insula, and parahippocampal areas, to produce their effects 29.
- It is essential to raise CHS awareness with increasing cannabis legalization, which would also help us understand its mechanisms, early recognition, and treatment.
- Abrupt cessation of cannabis use may cause catatonia from hypoactivity of GABA and dopamine D2 receptors, along with hyperactivity of the glutamate N-methyl-D-aspartate receptor 71,72.
- Most resources and recommendations come from case studies and expert opinions.
2 Again, this is something that doesn’t happen with short-term marijuana use. All of these words have been used to describe cannabinoid hyperemesis syndrome (CHS). CHS is a condition caused by chronic and repeated cannabis use that leads to severe nausea and vomiting. It’s important to note that each individual’s recovery timeline can vary; some may recover faster or slower than others. The key to recovery is the complete cessation of cannabis use and supportive care to manage symptoms.1 Recovery from CHS can be challenging, but remembering these guidelines can make the process less arduous. Patience, self-care, and professional guidance can make a significant difference in regaining health and wellness.