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

Additional treatments are needed and efforts to discontinue cannabis abuse are paramount. Both cannabinoid hyperemesis syndrome (CHS) and cyclic vomiting syndrome (CVS) cause people to feel sick to the stomach and throw up at times, while feeling normal at other times. This is more common in men than women and usually starts around 35 years old. These two conditions are hard to distinguish between and the main difference is CHS happens with using a lot of marijuana.

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To help you transition to the recovery phase, you can try a few home remedies such as regular hot baths. But too many of them may increase your risk for dehydration due to sweating. I’ve known many heavy smokers all my life and have only recently heard of it through research online. People are blaming the recent and increasing popularity of dabs for Cannabinoid Hyperemesis Syndrome (CHS), but CHS has been around since way before concentrates were popular.

The Endogenous Cannabinoids (Endocannabinoids)

If willing, patients should be referred to a substance abuse rehabilitation center. Extensive review of his medical record revealed that the patient had, in fact, presented to the ED with similar symptoms 11 times in the prior 8 years. The typical hospital course included supportive care with antiemetics and IV fluids. The patient’s symptoms typically resolved within 24 to 72 hours of hospitalization. Previous evaluations included additional unremarkable CT imaging of the abdomen and pelvis. The patient also had received 2 esophagogastroduodenoscopies (EGDs), one 2 years prior and the other 5 years prior.

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Once you do that, your repeated nausea and vomiting should go away and not return. Since THC is stored in your body fat, it can take weeks to months before all the symptoms go away and you notice a difference. Smoking extra marijuana won’t help your nausea but will make it worse. Often mistakenly called Cyclical Vomiting Syndrome, Cannabinoid Hyperemesis Syndrome is a rare form of cannabinoid toxicity that develops in chronic smokers. It’s characterized by cyclic episodes of debilitating nausea and vomiting.

Deterrence and Patient Education

• Thus, hot shower bathing may be more closely related to CHS, but is neither specific nor sensitive in its diagnosis.
• Once you do that, your repeated nausea and vomiting should go away and not return.
• Even though a benzodiazepine is not the mainstay of treatment, it may be tried if other agents fail.
• While conventional antiemetic medications like serotonin 5-HT3 receptor antagonists and dopamine antagonists can be prescribed to manage nausea and vomiting in CHS patients, their efficacy in CHS cases is limited.
• People with CHS often find temporary relief from these symptoms by taking hot baths and showers.

Darmani has suggested that cannabis increases the core body temperature while concomitantly decreasing skin temperature thus increasing blood flow to the skin and dissipating excess core body heat [72]. WS is a 54-year-old African American male with a medical cannabinoid hyperemesis syndrome history of diabetes mellitus type 2, hypertension, obstructive sleep apnea, and gastroparesis. He has multiple admissions for intractable nausea, vomiting, and abdominal pain believed to be from diabetic gastroparesis despite a normal gastric-emptying study.

Topical Capsaicin Cream

• In women, a pregnancy test is necessary to assess for any pregnancies, especially ectopic pregnancies.
• Activation of these receptors by the shower-induced warmth could trigger neural responses that modulate pain perception and sensory input, potentially influencing the transmission of signals related to nausea and vomiting pathways in the brain.
• Hot baths may relieve the nausea for a while, but they don’t cure CHS.

The importance of quitting cannabis with CHS

• The best characterized endocannabinoids are anandamide and 2-arachidonylglycerol (2-AG) [9].
• Additionally, some of the statistically significant studies did not measure symptom relief, instead looked at the reduced LOS in hospitals [23, 24, 25, 28, 31].
• THC is excreted mainly as acid metabolites, with 60–85% cleared through the feces and 20–35% in the urine [20,21].
• For patients with marijuana use and compulsive hot showers, further work up of their symptoms (e.g., upper endoscopy, abdominal ultrasound, and/or nuclear medicine emptying study) should be avoided.