While marijuana seems to bring on nausea in the stomach, in the brain it usually has opposite effect. When cannabinoids bind with brain receptors, they tend to prevent nausea and vomiting. Experts think that when you first smoke weed, your brain signals are more important, but after repeated use of the drug, the brain receptors may no longer respond to marijuana in the same way, causing more nausea and vomiting.
- The symptoms of CHS can be debilitating, and they can last for several days.
- “Cannabinoid” refers to cannabis (marijuana) and “hyperemesis” is a word meaning “prolonged vomiting.”
- Ultrasonography of the mesenteric artery showed a widely patent SMA with decreased aortomesenteric angle of approximately 18° (Figure 2).
- Since the only treatment is the removal of the offending agent, accurate diagnosis is the only portal to actual management.
Unveiling the Complexities of Cannabinoid Hyperemesis Syndrome: Mechanisms Underlying CHS
With the increasing popularity of marijuana for medical and recreational use, a better understanding of the endocannabinoid system is needed to provide proper treatment of CHS and its subsequent conditions. Accurate reporting of THC intake is important to expanding knowledge of the paradoxical effects of cannabis as an anti-emetic and pro-emetic agent. Conservative treatment is most appropriate for alleviating symptoms of SMA syndrome and achieving clinical remission without surgical intervention 8. A patient-centered approach aimed to avoid attribution and anchoring errors is vital to provide proper treatment in a timely manner for medical conditions resulting from prolonged marijuana use.
Wellness Phase
Quitting cannabis use is the 100% cure for CHS – but it is such a complex topic, that it’s beyond the scope of this forum. “Pink clouding” describes a stage of early addiction recovery marked by euphoria and confidence. It’s vital to remind yourself of the reasons for quitting and the severity of CHS, even long after recovery.
CHS Episodes and Recurrence
- Only 2 RCTs have investigated topical capsaicin and haloperidol use in patients with CHS 22, 32.
- Drugs with an anticholinergic effect may likewise block medullary mediated vomiting, though they may have minimal impact on visceral stimulation, including the crippling abdominal cramping pain that patients with CHS experience.
- Emesis in SMA syndrome is prolonged, even with cessation of drug use, due to duodenum blockage.
- The almost pathognomic aspect of a patient’s presenting history is that their symptoms are relieved by hot baths or shower.
For patients with CHS, symptom severity depends on factors such as the amount of tetrahydrocannabinol (THC) stored in adipose tissue, the duration until treatment is sought, and potential complications, including electrolyte depletion, kidney failure, and weight loss 2. Recurrent emesis due to SMA syndrome, however, differs in that it results from compression of the duodenum. The diagnostic parameters include an aortomesenteric angle in the range of 6° to 22° and an aortomesenteric distance of 2 to 8 mm 3. The overlap in symptoms between CHS and SMA syndrome, especially in a patient previously diagnosed with CHS, can lead to diagnostic delays, which necessitates greater awareness and education for both health care professionals and patients.
Understanding the pathophysiology of the endocannabinoid system (ECS) remains central in explaining the clinical features and potential drug targets for the treatment of CHS. The frequency and prevalence of CHS change in accordance with the doses of tetrahydrocannabinol and other cannabinoids in various formulations of cannabis. CHS is unique in presentation, because of the cannabis’s biphasic effect as anti-emetic at low doses and pro-emetic at higher doses, and the association with pathological hot water bathing. In this narrative review, we elaborate on the role https://ecosoberhouse.com/ of the ECS, its management, and the identification of gaps in our current knowledge of CHS to further enhance its understanding in the future. Symptom overlap between cyclical vomiting syndrome, CHS, and SMA syndrome, among other conditions, creates a need for thorough investigation whenever emesis is followed by substantial, rapid weight loss, because of rare but dangerous complications. When a patient presents with nonspecific symptoms, efforts must be increased to decrease the possibility of cognitive errors.
A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options
The team gave Brian both Haldol and Phenergan, which helped his vomiting improve. The blood work results came back, showing that his kidneys were failing and that all of his levels were out of the normal range. As a result, the doctor decided to admit Brian to the hospital so that they could continue to monitor his blood work.
What is the timeline for recovery? When will I start to feel better after quitting?
- The diagnostic criteria for CHS were ill-defined prior to the establishment of the Rome IV criteria of 2016.2223 Per the Rome IV criteria, all 3 of the following must be met to be diagnosed with CHS.
- To help you transition to the recovery phase, you can try a few home remedies such as regular hot baths.
- It is important to note that CHS symptoms in all of these cases were refractory to repeated doses of conventional antiemetics.
- Through a holistic and individualized treatment regimen, healthcare providers can navigate the challenges of CHS, offering hope and relief to those affected by this puzzling condition.
CHS, cannabis hyperemesis syndrome; RCT, randomized-controlled trial. In refractory CHS cases, experimental therapies such as benzodiazepines, tricyclic antidepressants, and dopaminergic agents like haloperidol have been explored. While the evidence supporting their efficacy is limited, these options could be considered in specific scenarios where conventional treatments prove inadequate. The profuse vomiting and potential dehydration inherent in CHS often mandate intravenous fluids administration to correct electrolyte imbalances and sustain hydration levels. Adequate fluid resuscitation is crucial during the acute phase of CHS to avert complications and ensure physiological stability.
Signs and symptoms
Conclusions made were limited due to the cannabinoid hyperemesis syndrome low-quality of available evidence. Additionally, some of the statistically significant studies did not measure symptom relief, instead looked at the reduced LOS in hospitals 23, 24, 25, 28, 31. Furthermore, LOS in the ED was used to measure the stabilization of N/V symptoms; however, it was not a marker of CHS cure.