Cannabinoid hyperemesis syndrome: Causes, symptoms, and treatment 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. And a 2022 Canadian study found that ER visits for CHS-related problems had https://ecosoberhouse.com/ increased 13-fold between 2014 and 2021. (Recreational use and sale of cannabis in Canada was legalized starting in 2018). It’s not clear what percentage of all heavy marijuana users have experienced CHS. Hyperemetic phase They should also have the freedom and empowerment to speak up to other team members if they feel that this may be getting overlooked in the diagnostic picture. Over time, the symptoms will go away completely unless you start to use again. The ECS is composed of ligands, receptors, signaling, and enzymes (its regulators and inhibitors) [22]. With the widespread use, increased potency and legalization of marijuana in multiple states in the U.S., CHS may be becoming increasingly common. When you use weed, these compounds bind to cannabinoid receptors found in your brain, digestive tract (gut), and certain cells in your body. Further, genetic polymorphisms in the metabolic P450 enzymes lead to a change in the metabolic rate of THC breakdown causing hyper or hyposensitivity [12, 13]. In-depth mechanisms for different CHS hypotheses are presented in Figure Figure11. 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. In older patients, especially those with hypertension, cardiovascular illnesses such as aortic pathology and atypical coronary artery syndromes may present as vague abdominal pain, nausea, and vomiting. Ceasing and abstaining from the use of cannabis is the only treatment that relieves and prevents symptoms of CHS, according to a systematic review on CHS management. History and Physical People who use marijuana long-term — typically for about 10 to 12 years — are at risk of developing CHS. But not every person who uses marijuana, even long-term use, develops CHS. Treatment that helps prevent dehydration and loss of electrolytes can help reduce your risk of many of these problems. If you do use cannabis, quitting can ward off future episodes of CHS. What happens if cannabis hyperemesis syndrome is left untreated? As CHS is a relatively recently recognized and studied phenomenon easily confused with other diseases, there is a paucity of sizeable randomized control studies. Most resources and recommendations come from case studies and expert opinions. 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. Indeed, with any syndrome that results in frequent vomiting, there is a concern for a disorder of electrolytes and fluid balance in the body. Proving the emetic and antiemetic effects of cannabinoids is difficult due to the overlapping nature of the symptoms with other conditions such as cyclic vomiting syndrome, viral gastroenteritis, and bulimia nervosa [14]. Furthermore, it was only categorized as a functional gastrointestinal disease in 2016 [14]. This syndrome produces consequences ranging from volume loss to esophagus rupture [15]. The metabolism of anandamide is principally carried out via fatty acid amide hydrolase (FAAH), whereas the major enzyme metabolizing 2-AG is monoacylglycerol lipase (MAGL) [18]. CHS symptoms typically present in a cyclical pattern every few weeks to months when cannabis is being used. Experts believe only a fraction of habitual cannabis users develop CHS. Diagnosis and Tests As CHS is a new diagnosis, the manufacturers of these drugs did not design them for treating CHS, but a doctor may opt to prescribe them for this use. Another doctor reported using a combination of injectable lorazepam and promethazine, another antinausea medication. It should be noted that the majority of evidence found for haloperidol were case studies, which had limited generalizability [30, 31, 33]. A systematic review was conducted using PubMed, Ovid MEDLINE, Cochrane Central, EMBASE, and Google Scholar. Databases were used to search for articles on CHS published from January 2009 to June 2021, yielding 225 results of which 17 were deemed relevant and underwent review by 2 separate reviewers. All data generated or analyzed during this study are included in this article and its supplementary material files. In the prodromal phase the patient has morning predominance of nausea, usually without emesis. This is followed by the hyperemesis phase, which is characterized by hyperemesis, vague abdominal pain, and learned compulsive hot bathing. With the emergence of cannabis and its widespread usage in various settings, clinicians and users should cannabinoid hyperemesis syndrome be more aware of the long-term effects of cannabinoids. CHS is a potential side effect of prolonged cannabis use, causing major distress to consumers. While synthetic cannabinoids have been accepted as one of the main drugs to relieve N/V, their dosage and duration of administration have not been thoroughly investigated long term. Since it was first identified in 2004 in Australia, researchers have looked at the effects of cannabis on the vomiting centers of the brain. 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. 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. People in the hyperemesis stage will experience intense and persistent nausea and vomiting. Doctors also noticed that individuals with CHS would take frequent hot showers and baths. Richards and Dutzak [34] presented a single case study that examined an extreme case of CHS in the ER who had intractable N/V, abdominal discomfort and who was unresponsive to standard antiemetics.
