Cannabinoid Hyperemesis Syndrome

Abstract

Coinciding with the increasing rates of cannabis abuse has been the recognition of a new clinical condition known as Cannabinoid Hyperemesis Syndrome. Cannabinoid Hyperemesis Syndrome is characterized by chronic cannabis use, cyclic episodes of nausea and vomiting, and frequent hot bathing. Cannabinoid Hyperemesis Syndrome occurs by an unknown mechanism. Despite the well-established anti-emetic properties of marijuana, there is increasing evidence of its paradoxical effects on the gastrointestinal tract and CNS. Tetrahydrocannabinol, cannabidiol, and cannabigerol are three cannabinoids found in the cannabis plant with opposing effects on the emesis response. The clinical course of Cannabinoid Hyperemesis Syndrome may be divided into three phases: prodromal, hyperemetic, and recovery phase. The hyperemetic phase usually ceases within 48 hours, and treatment involves supportive therapy with fluid resuscitation and anti-emetic medications. Patients often demonstrate the learned behavior of frequent hot bathing, which produces temporary cessation of nausea, vomiting, and abdominal pain. The broad differential diagnosis of nausea and vomiting often leads to delay in the diagnosis of Cannabinoid Hyperemesis Syndrome. Cyclic Vomiting Syndrome shares several similarities with CHS and the two conditions are often confused. Knowledge of the epidemiology, pathophysiology, and natural course of Cannabinoid Hyperemesis Syndrome is limited and requires further investigation.

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

“…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]. Initial reports describe an average of 7.1 emergency department visits, 3.1 hospitalizations, and 5.0 clinic visits prior to diagnosis [12], but as the syndrome is recognized more and cannabis availability increases, more rapid diagnosis is likely.…”

“…Greater education is needed among clinicians in order to limit repeated Bexclusionary^workups and iatrogenesis. In addition, as the Opiates should be used with caution as they have the potential to cause emesis Galli [170] Case report Very low Cessation of cannabis appears to be the best treatment for CHS. Our review revealed that CHS patients may often have poor follow-up.…”

“…The authors suggest that capsaicin may exert its effects via the TRVP-1 receptor, capsaicin's only known receptor, which is known to interact with the endocannabinoid system [169]. Some authors recommend the avoidance of narcotic pain medication in the treatment of CHS as opioid analgesic use is associated with bowel dysfunction and could theoretically worsen CHS symptoms and additionally create opioid dependence [170] (see Table 5 for a summary of treatments and associated data to support each modality).…”

Cannabinoid Hyperemesis Syndrome

“…It is also during this phase the patients will visit the ED for management of the overwhelming vomiting and retching. The recovery phase begins only when cannabis use is stopped (Allen et al, 2004;Galli et al, 2011;Price, Fisher, Kumar, & Hilgesson, 2011;Soriano-Co et al, 2010;Sun & Zimmerman, 2013).…”

“…These studies supported the findings of Allen et al's (2004) study. Literature further identifies three phases of cyclic vomiting: prodromal, hyperemetic, and the recovery phase (Galli, Sawaya, & Friedenberg, 2011). Routine treatment of the nausea and vomiting with antiemetics usually is ineffective in patients with CHS.…”