People with a cannabis addiction may need additional help to make this happen. The low-dose, coformulated regimen was well tolerated, and overall data supports its use in children with HIV aged 2 years and older weighing between 30.86 lbs (14 kg) and 55.11 lbs (25 kg). Approximately 1 in 5 youths who identify as a sexual gender minority will undergo a gender identity change in their adolescence; however, such changes do not appear to impact their mental health. Twenty-four additional articles were identified through the bibliographies of articles returned in the primary search. After removal of duplicates, 1253 abstracts were independently screened by reviewers, of which 170 satisfied criteria for inclusion. The symptoms typically last a few weeks, though the throwing up should ease up in a day or two.
Cannabinoid Hyperemesis Syndrome: A Review of Potential Mechanisms
Adolescents with CHS and cannabis use disorder (CUD) benefit from a combination of pharmacologic treatment, behavioral interventions, and family support. The strength and quality of each study were evaluated using the GRADE working group metrics [83]. Grading and Recommendations Assessment, Development, and Evaluation (GRADE) defines high-quality studies as randomized trials or double-upgraded observational studies.
Skin Conditions
In addition, CVS patients have a high prevalence of migraine headaches or a family history of migraines. Furthermore, gastric emptying rates in patients with CVS are often accelerated rather than delayed [46,65]. Table 2 summarizes some of the epidemiological and clinical characteristics that may help distinguish CVS and CHS. This study is limited by the heterogeneity of the case series and case reports and the lack of controlled studies examining this syndrome. The internal validity of our findings is limited by the possibility of missing articles from our search strategy. We limited the search to English-language articles, so any relevant articles published in foreign languages were not included, and articles not indexed in MEDLINE, Embase, Web of Science, or the Cochrane Library would be missed.
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In the 321 patients, there were 664 ED visits, 350 clinic visits, and 296 admissions; patients with suspected CHS comprised 21.5% of the ED visits and 34.9% of the admissions. Hot showers have emerged as an intriguing phenomenon in assuaging the symptoms of Cannabis Hyperemesis Syndrome (CHS), offering a peculiar yet effective avenue for relief. While the precise physiological mechanisms underpinning this phenomenon continue to be explored, several theories shed light on why hot showers might hold therapeutic value for CHS patients. Notably, a hallmark behavior observed in CHS cases is the propensity for pathologic hot bathing or showering. While not exclusive to individuals with CHS, the act of hot bathing or showering manifests in approximately 80-90% of patients with this condition. With the expanding acceptance and legalization of cannabis worldwide, healthcare providers face a crucial imperative to accurately identify CHS amidst a sea of similar clinical presentations.
Since there are no laboratory or radiographic examinations that can be used to diagnose CHS, CHS should be diagnosed based on symptoms and patient behaviors. In some cases, CHS is a diagnosis of exclusion after other hyperemetic conditions (such as hyperemesis gravidarum, psychogenic vomiting [PV], or CVS) are ruled out. More research on CHS is needed to enhance knowledge translation, education, and create awareness in the medical community on the side effects of cannabinoids and to propose the best treatment options. The only proven way to prevent cannabis hyperemesis syndrome is to avoid cannabis (marijuana). Most people with CHS who stop using cannabis have relief from symptoms within 10 days.
Treatment / Management
Patients present with recurrent episodes of nausea, vomiting, and dehydration with frequent visits to the emergency department. Patients are typically young adults with a long history of cannabis use. 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].
- CHS causes you to have repeated episodes of vomiting, severe nausea, stomach pain, and dehydration.
- CHS may be confused with hyperemesis gravidarum, so an accurate diagnosis is important to avoid costly and time-consuming diagnostic steps and to avoid prolonging the patient’s suffering as these two conditions respond to different treatments [121].
- Other known complications of forceful and uncontrolled vomiting include aspiration and subsequent pneumonitis or aspiration pneumonia as well as injury to the esophageal wall such as Boerhaave’s syndrome.
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Yet, with the evolving comprehension of CHS, there is a likelihood that some cases attributed to CVS might actually be undiagnosed instances of CHS, marking it as pathognomonic. This underscores the critical need to correlate symptoms with cannabis consumption, ruling cannabinoid hyperemesis syndrome out overlapping diagnoses that could be mistaken for CVS. This evolution has been accompanied by a concerning uptick in cases of Cannabinoid Hyperemesis Syndrome (CHS), characterized by distressing bouts of nausea and vomiting with varying degrees of severity.
- Most of his previous admissions were attributed to viral gastroenteritis due to the self-limited nature of the symptoms.
- Additionally, many inferential hypotheses were identified that attribute different aspects of CHS to a myriad of dysregulatory issues at CB-1 receptors throughout the body (brain, gastrointestinal tract, and vasculature) [97, 98, 102, 105, 133, 135–137].
- It remains unknown how changes to the endocannabinoid system could lead to the development of CHS and more empirical research is needed to identify the mechanism.
- Because he died at home, detectives had to investigate, and the coroner prepared a report.
- Cannabis can be addictive, and people who stop using it can experience symptoms not unlike opioid or alcohol withdrawal, said Dr. Deepak Cyril D’Souza, director of the Yale Center for the Science of Cannabis and Cannabinoids.
Haloperidol
This has increased both the number of people using the drug and the “high” in the available weed. After stopping cannabis use, symptoms generally resolve within days or months. A 2017 review of studies found that 97.4 percent of people who developed CHS reported using cannabis at least weekly. The mechanism of action of topical capsaicin likely involves TRPV1 receptors. In other words, topical capsaicin opens the TRPV1 channels, which has an antiemetic effect. Other cannabinoids have been implicated in the pathogenesis of CHS, such as CBD and cannabigerol (CBG).
Unveiling the Complexities of Cannabinoid Hyperemesis Syndrome: Mechanisms Underlying CHS
- When dopamine receptors are blocked, the blockade reduces the effect of dopamine on the dopamine-2 receptors in the vomiting center [96].
- The literature contains a wealth of case studies and case reports on patients suffering from CHS; these case reports come from around the world but have striking similarities.
- Hot showers improve symptoms of nausea and vomiting [6,52–56,60,62,68,71], abdominal pain [6,56,71], and decreased appetite [68] during the hyperemetic phase.
- The syndrome consists of vomiting, nausea and abdominal pain, which can often be alleviated by taking hot showers.
- It has been proposed that hot bathing may act by correcting the cannabis-induced disequilibrium of the thermoregulatory system of the hypothalamus [6].
- The mechanism by which cannabis induces hyperemesis is presently unknown.
- CHS was reported for the first time in 2004, and since then, an increasing number of cases have been reported.
There are at least four reported cases where the time lag was equal to or less than three years [54,59,60]. Daily marijuana use is characteristic and often reported as exceeding three to five times per day. An intriguing point to keep in mind is that the Rome IV criteria include the phrase “resembling cyclical vomiting syndrome.” In that regard, it is important to distinguish between the two. Per the Nelson Textbook of Pediatrics, cyclic vomiting syndrome is defined by having sudden onset episodes of vomiting, having at least four bouts of vomiting per hour, and often having 12 to 15 episodes of vomiting per day. These episodes of vomiting are often separated by weeks or months, and there is a return to baseline between episodes. Importantly, for the definition of cyclic vomiting syndrome, these episodes of vomiting cannot be attributed to other disorders.
Dysregulated stress response in nausea and vomiting
This antagonism might theoretically reverse the antiemetic effects of low doses of CBD at the serotonin receptor [38]. Thus, it is possible that the severe nausea and intractable vomiting of CHS might be due to the combined proemetic effects of high-dose CBD coupled with CBG’s antagonism at the serotonin receptors [13]. Furthermore, indications, contraindications, and drug-drug interaction should be kept in mind and risks versus benefits weighed in older adults with multiple comorbidities while considering the management options. In older populations, benzodiazepines should be used with caution in the management of CHS due to the potential risk of addiction, cognitive impairment, development of delirium, and falls [45]. Haloperidol should also be used with caution in patients with dementia and Parkinson’s disease, as dopamine blockade can dramatically worsen symptoms causing extrapyramidal side effects and incapacitation [46].