Cannabinoid hyperemesis syndrome: A 6‐year audit of adult presentations to an urban district hospital PMC

The patient continued to experience symptoms and received a second dose of IV propranolol 1 mg an hour later, whereupon his symptoms stopped completely. The patient could be discharged 4 h later and was counseled to stop smoking marijuana [118]. Propranolol is a nonspecific, lipophilic beta-1/beta-2-blocker that has been used to treat CVS, particularly in pediatric patients [119].

• A description of a patient with CHS in Australia revealed that her CHS symptoms exacerbated her anxiety disorder, and she presented to the ED with anxiety plus vomiting [127].
• This systematic review alerts the possible outcomes of cannabis use and explores the available management options of CHS.
• Severe and persistent vomiting can also lead to Mallory-Weiss tear [47].
• Benzodiazepines have been reported effective in some cases but can pose a risk of dependence.
• It is not clear why cannabis appears to suppress emesis under certain circumstances and induces it in others.
• In all 4 cases, CHS was diagnosed, and patients were counseled to avoid cannabis in the future.
• 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.

A toilet could help address chronic diseases. Here’s how.

For CHS patients, these tests typically offer normal-range results, but they are expensive, time-consuming, and place a hardship on the patient as well as the healthcare system. Thus, prompt diagnosis of CHS can save valuable clinical time and resources. CHS tends to affect younger people; the patients reported in Table ​Table22 ranged in age from 15 to 47 years. It has been suggested that this is due to the fact that cannabinoid use is about double in younger people compared to older individuals [135]. The authors found no cases of geriatric CHS (≥65 years), but there is no reason evident why geriatric individuals who used marijuana long term would be immune from CHS.

Marijuana Cessation

This activity introduces the pathophysiology, clinical manifestation, and management of cannabis hyperemesis. There were 5 men and 5 women included, mean age 27 years (range 19–51 years) with symptoms of abdominal pain, nausea, and hyperemesis refractory to medical therapy. The mean delay to the accurate diagnosis of CHS was 15.2 ± 10.5 months with a median of 4 ED admissions (range 0 to 14).

How common is cannabis hyperemesis syndrome?

Accidepntal overuse can occur with marijuana edibles due to excessive ingestion during the extended, unanticipated time it can take for peak action. [6]Inadvertant ingestions most often occur in the pediatric population due to exploratory behavior and ingesting what may otherwise look like a normal food product. Greater availability due to legalization and commercial availability has led to novel preparations of cannabis, including baked goods, various candies, hash, and oils. Despite the wider availability of cannabis, most significat cannabinoid toxicity is likely due to the abuse of synthetic cannabinoids, which are known to have more adverse effects. A lack of long-term follow-up is also a major shortcoming in our knowledge of CHS. The majority of reported cases that have provided follow-up included a period of less than one year [6,52,54,56–60,62,68,71].

More recent data shows that around 30% of daily users will have trouble stopping. Mr Smith, who died in 2018 from CHS, first went to the hospital with his mother, Regina Denney, to complain about severe vomiting and abdominal pain and, at the time, had lost about 30 pounds in a single month. Daily marijuana smokers are at risk of developing cannabinoid hyperemesis syndrome cannabinoid hyperemesis syndrome (CHS), which researchers warn could become more common as marijuana becomes increasingly legal. CHS is a condition that involves cyclic nausea and vomiting in people who generally have a long history of cannabis use. Indeed, with any syndrome that results in frequent vomiting, there is a concern for a disorder of electrolytes and fluid balance in the body.

However, Camilleri said that men are more likely to develop it, as are people who have used marijuana frequently and for many years. There’s no cure for this syndrome, with the only known, surefire treatment being abstinence from marijuana. More research needs to be done about CHS and its causes and treatment.

Unveiling Treatment Strategies for Cannabis Hyperemesis Syndrome (CHS)

The GI effects of cannabinoids are mediated mainly via the CB1 receptor, which can inhibit gastric acid secretion, lower esophageal sphincter relaxation, and alter intestinal motility, cause visceral pain, and produce inflammation [27, 48]. Activating CB1 receptors reduces gastric motility, resulting in delayed gastric emptying in murine [49, 50] and human studies [51, 52]. The delay in gastric emptying seems as if it would be promote emesis [53], yet this delay often occurs with the antiemetic benefits of THC, possibly because those antiemetic effects override the effects of delayed intestinal motility [13]. This applies not just to botanical marijuana; dronabinol (delta-9-tetrahydrocannabinol) slows gastric emptying and decreases colonic tone as well [54]. In America, 22.2 million Americans reportedly used some form of cannabinoids in the past month [3]. The Drug Abuse Warning Network (DAWN) states that marijuana mentions (the number of times “marijuana” is mentioned in a medical record) have increased 21% from 2009 to 2011 [3].

Although many of the statistics performed showed no significant difference between groups with or without a diagnosis of CHS, it is worth noting that patients in the CHS No group may later be diagnosed with CHS as more symptoms develop with continued cannabis use. Cost of (a) imaging, (b) laboratory tests, (c) medications, (d) procedures, and (e) total costs for patients with and without confirmed cannabinoid hyperemesis syndrome (CHS) compared to control groups in the emergency department, clinic, and admission setting. The vasodilation induced by heat exposure in hot showers can enhance peripheral blood vessel dilation, promoting improved circulation. This increased blood flow to the skin and peripheral tissues may help shift blood volume away from the gastrointestinal tract, potentially alleviating nausea and vomiting symptoms by reducing visceral hypersensitivity and enhancing overall comfort levels. The Rome Foundation (Rome IV) has emerged as a beacon of clarity in the labyrinth of diagnosing Cannabinoid Hyperemesis Syndrome (CHS), categorizing it as a variant of cyclical vomiting syndrome under the umbrella of functional gut-brain disorders. With the absence of definitive biomarkers, the diagnostic journey for CHS predominantly revolves around the process of exclusion.

Hot Showers

• Understanding what CHS is, can help us better understand why the syndrome affects some people the way it does.
• This applies not just to botanical marijuana; dronabinol (delta-9-tetrahydrocannabinol) slows gastric emptying and decreases colonic tone as well [54].
• All patients had a history of long-term use of cannabis (mean length 42 months, range 15–81.8 months), and 80% found relief in taking hot showers.
• In other words, topical capsaicin opens the TRPV1 channels, which has an antiemetic effect.
• The hot temperatures may provide some relief as they affect your hypothalamus, the part of your brain that regulates both vomiting and your internal body temperature.
• Cannabinoid hyperemesis syndrome (CHS) is a very unpleasant — and potentially dangerous — complication of long-term marijuana use.

However, in the digestive tract, marijuana has the opposite effect and makes nausea and vomiting more likely to occur. ‘Patients who suffer from this condition have recurrent bouts of vomiting and abdominal pain. When a person experiences CHS, they may need timely and effective treatment to prevent health complications. This article covers the symptoms to look out for and methods for diagnosis. “If you overdose with it, it can cause nausea and vomiting,” said Dr. Ian Mitchell, an emergency physician and clinical assistant professor at the University of British Columbia in Vancouver. Severe and uncontrollable vomiting increases the risk of dehydration and electrolyte imbalances, and in rare cases, patients can experience esophageal tears, Camenga said.