Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment a Systematic Review PMC

“Cannabinoid” refers to cannabis (marijuana) and “hyperemesis” is a word meaning “prolonged vomiting.” There exists no epidemiological data regarding cannabinoid hyperemesis syndrome the incidence and prevalence of CHS among chronic marijuana users. The syndrome is likely underreported given its recent recognition [74,75].

What are the symptoms?

Maternal cannabinoid use alone does not necessarily mean that hyperemesis is CHS. One study of patients in the emergency room found that roughly 1 in 3 who reported smoking cannabis 20 or more times per month had CHS. Research also suggests that most people with CHS are between ages 18 and 40.

Assessment of Study Quality

These foods/beverages are mostly acidic, but relationships between them and CHS have not been studied scientifically, although the co-use of weed and alcohol is well-known, the study authors said. In the first phase of CHS (the prodromal phase), you don’t vomit. This word is a combination of “screaming” and “vomiting.” You’re in so much pain that you’re screaming while you’re vomiting. CHS is a relatively new disorder that is not only difficult to diagnose but to manage. To lower the morbidity, CHS is best managed by an interprofessional team.

Diagnosis of CHS

An abdominal exam revealed a nontender, nondistended abdomen with no signs of rebound or guarding. An initial workup showed a mild elevation of serum creatinine to 1.36 mg/dL (baseline is 1.10 mg/dL). Other workups, including complete blood count (CBC) with differential, complete metabolic panel, lipase, amylase, and urine analysis, were all unremarkable. The only way to prevent CHS is to avoid using any form of marijuana. It’s still possible to develop CHS if you use cannabis for many years without having any problems.

• The hot temperature affects a part of the brain called the hypothalamus, which regulates temperature and throwing up.
• The only way to end CHS symptoms is to completely stop using all marijuana products.
• CB-1 receptors are present in the heart, which makes it possible that cannabinoids might affect myocardial performance [150].
• Animal studies lend some credibility to this theory; however, results are not consistently reproducible in human studies.
• Additionally, agents such as topical capsaicin cream are not commonly stocked in hospitals and emergency departments but could be made available in the outpatient setting.

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. It is not known why the syndrome develops in some, but not all, long-term marijuana users and why symptoms take longer to manifest in some patients than others. Although there were very few case studies involving CHS patients with eating disorders, bulimia might present in such a way that it could be confused with CHS.

Cannabis hyperemesis syndrome is one of the lesser-known dangers of cannabis use that is gaining more attention in medical circles. Experts recommend that people who experience CHS stop using cannabis entirely. Talk with a healthcare professional about resources to help, such as support groups or an addiction counselor. The pain is usually around the belly button and can get better with hot shower/baths. Some patients use hot water bags across the center of their belly and can burn the skin if done a lot.

Case Series and Case Studies

It is difficult to quantify the precise amount of cannabis consumed by patients who manifest CHS. Reporting is often subjective and qualitative, and there is no metric for how much physiologically active compounds are contained in one joint, cone, bong, etc. In addition, higher THC content through selective breeding of plants and more selective use of female buds that contain more concentrated THC levels may cause CHS to appear in patients who report lower amounts of cannabis use [170]. Twenty-four additional articles were identified through the bibliographies of articles returned in the primary search.

Recovery stage

Limited evidence also suggests that an individual’s genetics, as well as variability in the cannabinoid components of individual plants [131], may play a role in the manifestation of CHS. In one small study of eight patients hospitalized with CHS, four of the five who stopped using weed recovered from CHS. One of the 4 who recovered went back to using marijuana and the vomiting resumed. If you have CHS and don’t stop using, your symptoms like nausea and vomiting are likely to come back.

• The patient’s urine drug screen (UDS) was positive for tetrahydrocannabinol (THC).
• This could result in excessive levels of pro-emetic cannabinoids or emetogenic metabolites.
• The mechanism of action of topical capsaicin likely involves TRPV1 receptors.
• In a retrospective review of CHS patients admitted to a single urban ED in France, 7 patients were identified with a mean age of 24.7 years (range 17–39 years); most were men.
• However, research suggests that it could be far more prevalent and may continue to increase due to factors like the legalization of marijuana and the increased use of medical marijuana.

As the laws regarding the possession and use of marijuana change, CHS may become more prevalent because more people will have legal access to the drug. Doctors have a lack of knowledge of CHS, and this makes it hard to identify people with the condition. People often remain https://ecosoberhouse.com/ misdiagnosed for years, which delays treatment. Another doctor reported using a combination of injectable lorazepam and promethazine, another antinausea medication. As CHS is a newly described condition, many doctors may find it challenging to diagnose and treat.