Cannabis hyperemesis syndrome: an update on the pathophysiology and management

It’s important to be honest about your marijuana use if you have symptoms of CHS. Without knowing this background, providers often misdiagnose CHS as other conditions, like cyclic vomiting syndrome (CVS). According to the Cleveland Clinic, CHS “can affect people who use cannabis (marijuana) long-term,” and can cause “frequent, severe nausea and vomiting.”

Daily Cannabis use linked to cannabinoid hyperemesis syndrome: Study

In clinical practice CHS is most often confused with cyclic vomiting syndrome (CVS). In fact patients with CHS are often mislabeled as having CVS and vice versa. Confusion exists in the medical literature secondary to a failure to recognize chronic marijuana use as a source of vomiting. For example, in two recently published series of adult patients with CVS, approximately one third of patients reported daily marijuana use 65,66. Based on the categorization of functional disorders developed by Rome III, chronic marijuana use (CHS) is recognized as a mechanism for nausea and vomiting distinct from CVS 67. Although both conditions share an astonishing similarity, there are several significant differences.

How soon after cannabis hyperemesis syndrome treatment will I feel better?

• Preventing dehydration and stopping nausea and vomiting are the treatment goals during the hyperemesis stage of the condition.
• “The endocannabinoid system works in all these tissues and all these organs,” Piomelli said.
• While the above results were pending, a bedside glucose reading revealed hyperglycemia (338 mg/dL) and she received 2 L of IV normal saline, ondansetron 4 mg IV, and insulin glargine 34 units subcutaneous plus regular insulin 6 units subcutaneous.
• In a study of the treatment of neuropathic pain with topical capsaicin, the most common adverse effect was a burning sensation upon application, localized erythema, and nonproductive cough 106.

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. Finally, there have been anecdotal reports that changing the variety or strain of botanical marijuana can mitigate or even alleviate CHS. It has been Alcoholics Anonymous suggested that CHS may − in whole or in part − be the result of pesticides, toxins, or other substances accumulated on the plants during growth and harvest 67. Chemical residues on the plant can transfer to mainstream smoke with up to 60 or 70% inhaled via unfiltered glass pipes 68.

The Effects of Cannabinoids in the Brain

Preventing dehydration and stopping nausea and vomiting are the treatment goals during the hyperemesis stage of the condition. CHS is also underdiagnosed because people sometimes use marijuana to suppress nausea and vomiting. Doctors currently lack knowledge of the condition, and there are no clinical guidelines for its treatment and management. A 46-year-old woman presents to the Emergency Department with nausea, vomiting, and abdominal pain for 1 day. She admits to not taking her evening lantus last night and has had poor oral intake today. She has not taken her morning medications due to nausea and vomiting and complains of fatigue and thirst.

Although this information comes from case reports, doctors can use these criteria to diagnose the condition more quickly. People in the hyperemesis stage will experience intense and persistent nausea and vomiting. Many people with CHS go to their doctor or an emergency room (ER) for treatment. 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.

Cannabinoid Hyperemesis Syndrome Diagnosis

Cannabinoid hyperemesis syndrome (CHS) is a condition that you might get if you’ve regularly smoked weed or used marijuana in some other form for a long time. CHS causes you to have repeated episodes of vomiting, severe nausea, stomach pain, and dehydration. You’re more likely to get CHS if you use marijuana at least once a week and have been doing so since you were a teenager. “Cannabinoid” refers to cannabis (marijuana) and “hyperemesis” is a word meaning “prolonged vomiting.” Cannabinoid hyperemesis syndrome (CHS) can affect people who use cannabis (marijuana) long-term. Cessation of cannabis use results in resolution of CHS symptoms in nearly all patients 32.

Haloperidol is a familiar but unconventional antiemetic that may benefit CHS patients, likely because it blocks the brain’s postsynaptic dopamine receptors 111, 112. When dopamine receptors are blocked, the blockade reduces the effect of dopamine on the dopamine-2 receptors in the vomiting center 96. Haloperidol may further relieve nausea and vomiting by indirect activity at the CB1 receptors 111, 113. In a case study of a 27-year-old man who suffered repeated episodes of gastric pain, up to 20 vomiting episodes per day, coupled with severe nausea, multiple diagnostic tests were performed before a CHS diagnosis could be made. During his last hospitalization he was given conventional antiemetic therapy but his symptoms persisted for 2 more days.

THC is what’s responsible for the “high” most people feel when they chs symptoms and signs use marijuana. These supportive treatments can help people during the hyperemesis stage of the condition, but recovery depends on the person stopping their use of marijuana. Doctors also noticed that individuals with CHS would take frequent hot showers and baths. When people with CHS stop using marijuana, their symptoms of nausea and vomiting usually disappear. The first reports came from doctors treating regular users of marijuana for nausea and vomiting in South Australia.

Since vomiting is a symptom of many conditions, CHS patients often undergo computed tomography scans, magnetic resonance imaging, gastric emptying tests, endoscopy, colonoscopy, even exploratory procedures before a CHS diagnosis is made 91. It is not unusual for CHS patients to present frequently at the ED and to be hospitalized multiple times per year. This suggests that prompt, accurate diagnosis of CHS may save the healthcare system considerable resources and spare the patient unnecessary testing and procedures. 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.

Deterrence and Patient Education

Patients present with recurrent episodes of nausea, vomiting, and dehydration with frequent visits to the emergency department. In nearly all cases there is a delay of several years in the onset of symptoms preceded by chronic marijuana abuse 6. In one study the average duration of cannabis use prior to onset of recurrent vomiting was 16.3 ± 3.4 years 62. There are at least four reported cases where the time lag was equal to or less than three years 54,59,60.