It was so bad she thought it might be a recurrence of her severe pancreatitis, the illness for which she once had been hospitalized and put on life support. The susceptibility to CHS may also be influenced by cytochrome CYP450 metabolism and genetic polymorphisms. Variations in genes encoding enzymes like CYP2C9, CYP2C19, and CYP3A4 can lead to an excess accumulation of cannabinoid metabolites, potentially triggering vomiting. THC is primarily metabolized to two major metabolites, 11-hydroxy-delta9-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-THC-delta9-tetrahydrocannabinol (THC-COOH), illustrated in Figure 1, along with over 100 minor metabolites 27. 11-OH-THC is psychoactive and shares similar potency to THC, whereas THC-COOH is non-psychoactive and has anti-inflammatory effects 27-29.
1. Acute Treatment Strategies
This results in elevated adrenocorticotropic hormone (ACTH) action on adipocyte receptors, causing lipolysis to meet bodily demands 50. This leads to high THC concentrations, particularly after consuming potent cannabis, which explains its pro-emetic effects 51. Furthermore, chronic marijuana use has been shown to impair gastric emptying, thereby causing nausea and vomiting after meals 52. This was demonstrated in a study by McCallum et al., where male participants were given either marijuana or a placebo before undergoing a radionuclide gastric emptying test 53. Medications are sometimes used to manage symptoms, but they aren’t always fully effective in controlling severe vomiting. Doctors might try anti-nausea drugs or pain relievers, but real progress usually hinges on quitting cannabis.
What can you do at home to relieve CHS symptoms?
Addiction rehab programs or CBT may be helpful resources for quitting cannabis. Speak with a doctor or healthcare professional if you or someone you know has symptoms of CHS. CHS symptoms typically present in a cyclical pattern every few weeks to months when cannabis is being used. But because CHS is a somewhat newly discovered condition that was first diagnosed in 2004, some people may be underdiagnosed or misdiagnosed. The only treatment that can get rid of CHS symptoms for good is to stop using cannabis completely. But cannabinoid hyperemesis syndrome there are some other treatments that may help manage your symptoms and make you feel better.
Case Series and Case Studies
As noted earlier, hot baths or showers provide temporary relief for many patients. Warm stimulation is hypothesized to transiently activate transient receptor potential vanilloid-1 (TRPV1) in the hypothalamus which would otherwise be downregulated by chronic cannabis use 34. However, it is essential healthcare providers also address the risk of dehydration and electrolyte imbalances, as these conditions are common in CHS patients and may lead to acute renal failure 27,35. Fluid resuscitation is therefore a cornerstone of treatment during the hyperemetic phase. Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months. Cannabinoids are often utilized for their antiemetic properties, so CHS can be a puzzling condition, and the diagnosis of CHS may be disputed by patients.
If vomiting is so frequent that you’re dangerously dehydrated, you might need hospital care. In that setting, medical staff can give you IV fluids, add electrolytes, and provide nutrition if you can’t keep food down. CHS is marked by persistent vomiting and ongoing abdominal pain, primarily affecting long-term, daily cannabis users. As cannabis becomes more potent and widely available, CHS is increasingly prevalent. Many patients are hesitant to consider cannabis as the cause of their symptoms, which can delay diagnosis and hinder further research. Moving forward, physicians should be aware of rising cannabis use and identify potential CHS cases to ensure proper treatment and investigation.
- Further initiatives are needed to determine this disease prevalence and its other epidemiological characteristics, natural history, and pathophysiology.
- This barrier to disclosure could result in delayed diagnosis of CHS and other cannabis-related health issues, potentially leading to prolonged suffering or more severe complications.
- Expert panel members engaged in an iterative process to provide evidence-based input into the draft guideline until complete consensus was achieved.
What are the symptoms of cannabis hyperemesis syndrome?
The use of lorazepam for CHS is also off-label, so a person’s doctor would need to make them aware of this fact. The best and only way to prevent or reduce your risk for CHS is to avoid or quit marijuana use. This word is a combination of “screaming” and “vomiting.” You’re in so much pain that you’re screaming while you’re vomiting. “We don’t know if it’s related to the greater general availability of cannabis or the higher THC potency of some products or something else,” Buresh said. It tends to affect people who use cannabis at least once a week and happens more often in adults who’ve been using cannabis since their adolescent years.
Diagnosis
They should not be used in isolation to guide treatment choices or public health policy. In serious cases, doctors might insert a nasogastric tube, which goes through your nose into your stomach. Liquid nutrition can be delivered this way, letting your system rest while still getting the calories you need. You’ll stay in the hospital until you can hold down regular meals and your vomiting subsides.
The dose can be gradually increased in 10 mg increments every 1–2 weeks until the G.I. In this phase, patients gradually resume normal eating and dietary alcoholism habits. Patients experience complete relief of the symptoms, which can last days, weeks, or even months. The duration of this phase ranges from weeks to months, depending on resuming marijuana use, which may trigger another relapse. Throughout this phase, the patient maintains an average weight and returns to their baseline state 49.
Chronic or excessive use of cannabinoids may also stimulate the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system in addition to disrupting the endocannabinoid system. The endocannabinoid system plays a role in allostasis of the autonomic nervous system following episodes of stress 55. The HPA axis is the main neuroendocrine system activated by the body when confronting stress 56.
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. That’s in part because there’s no diagnostic code for cannabinoid hyperemesis syndrome. When patients are discharged from a UCHealth emergency department, the official diagnosis is typically “vomiting,” though the CHS details are entered into the medical record’s notes. Due to the rise in CHS prevalence, likely from cannabis legalization in more states, public health outreach programs can play a crucial role in bringing awareness and prevention to this condition.
