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Cannabis Hyperemesis Syndrome: What Is It, Symptoms & Treatment
Cannabis hyperemesis syndrome (CHS) is a condition that causes severe nausea and vomiting. It occurs in people who use cannabis regularly.
Cannabis Hyperemesis Syndrome
Cannabis hyperemesis syndrome (CHS) affects people who use cannabis (marijuana). CHS causes frequent, severe nausea and vomiting. You have a higher risk of developing CHS if you use cannabis at least once a week. Your risk also increases if you have used cannabis since adolescence. The only way to cure CHS is to stop using cannabis.
What is cannabis hyperemesis syndrome?
Cannabis hyperemesis syndrome (CHS) is a condition caused by long-term cannabis (marijuana) use. People who have CHS experience reoccurring episodes of nausea, vomiting, dehydration and abdominal pain, with frequent visits to the emergency department.
Hyperemesis means severe vomiting. Another name for CHS is cannabinoid hyperemesis syndrome. Cannabinoids are compounds found in the cannabis plant that bind to cannabinoid receptors found in our brains, gastrointestinal tracts and immune cells. The most studied exogenous cannabinoids are tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabigerol (CBG).
CHS is more than just a side effect of marijuana. It is a condition that can lead to health complications if left untreated.
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Who might get cannabis hyperemesis syndrome?
People who use cannabis chronically are at risk of developing CHS. It tends to occur in people who use cannabis at least once a week and occurs more often in adults who have been using cannabis since their adolescent years. Typically, there is a delay of several years in the onset of symptoms preceded by chronic marijuana misuse in nearly all cases.
How common is cannabinoid hyperemesis syndrome?
Only a small portion of people who regularly use cannabis develop CHS. Because CHS is a newly discovered condition, many people may have it and not report it or are misdiagnosed. One study found that up to 6% of people who visited the emergency room for vomiting had CHS.
SYMPTOMS AND CAUSES
What causes cannabis hyperemesis syndrome?
Experts don’t know exactly what causes cannabis hyperemesis syndrome. Some researchers suspect genetics may play a role. Others believe CHS may occur due to overstimulation of your endocannabinoid system (ECS). The ECS is a network of receptors in your body that respond to compounds in cannabis.
What are the symptoms of CHS?
The primary symptoms of CHS are intense and persistent nausea and vomiting. People with this condition vomit extensively, often without warning, and can vomit up to five times per hour. They may also experience diffused abdominal pain, often report weight loss, and appear dehydrated.
People with CHS self-learn to take hot showers, which helps reduce or curb some nausea they experience. Many people with CHS will compulsively shower or bathe — often for hours every day — to relieve cannabis hyperemesis syndrome symptoms.
There are three phases of cannabis hyperemesis syndrome. Slightly different symptoms occur in each stage:Prodromal phase: This phase is most common in adults who have used cannabis since they were teenagers. You may have abdominal pain or morning nausea. You may also fear throwing up but never actually vomit.Hyperemetic phase: Usually lasting 24 to 48 hours, people in this phase have overwhelming, recurrent vomiting and nausea. You may start compulsively bathing, and avoid certain foods or purposefully restrict your food intake.Recovery phase: During recovery, people stop using cannabis (even in small amounts). When you are in the recovery phase, symptoms lessen over a few days or months. Eventually, they completely disappear.
DIAGNOSIS AND TESTS
How is cannabis hyperemesis syndrome diagnosed?
Your healthcare provider diagnoses CHS based on your symptoms. If you are vomiting frequently, tell your provider about all substance use, including cannabis. Your provider may ask you:
How often you use cannabis.
How long you have used cannabis.
When you vomit or feel nauseated.
If other factors, such as certain foods, lead to vomiting.
Whether you have lost weight for no known reason.
If you take hot baths or showers to try to relieve symptoms.
You may also have blood tests, a CT scan or MRI to rule out other causes of nausea and vomiting. You may also take a pregnancy test if pregnancy is a possibility.
MANAGEMENT AND TREATMENT
Is there a cannabis hyperemesis syndrome cure?
The only known treatment to permanently get rid of CHS is to stop cannabis use completely. You may have symptoms and side effects of CHS for a few weeks after quitting cannabis. Over time, symptoms will disappear.
Can I treat CHS symptoms at home?
The only cure for CHS is to stop using cannabis. Hot baths may relieve the nausea temporarily, but they don’t cure CHS. Taking too many hot baths can increase dehydration due to sweating.
You may use home treatments to relieve CHS symptoms immediately after quitting cannabis. These remedies are not effective long-term, but they can help you transition to the recovery phase.
Your healthcare provider may recommend:Antihistamines such as diphenhydramine (Benadryl®).
Emergency Department Treatment of Cannabinoid Hyperemesis Sy... : American Journal of Therapeutics
rategies agreed upon universally. Areas of Uncertainty: Thus far, most data about CHS have come from case reports and case series. Consequently, the pathophysiology of the syndrome is unclear, and its occurrence in some cannabis users, but not others, is not understood. Data Sources: A literature search was conducted through PubMed, Embase, and Google Scholar from inception until 2017. Publications only in English describing the epidemiology, pathophysiology, diagnostic criteria, and treatments of CHS were incorporated after thorough evaluation. National government surveys were also referred to for current information about the CHS patient population. Results: CHS should be considered in the differential diagnosis of any patient presenting with persistent nausea and vomiting. In particular, the diagnosis is suggested if the patient demonstrates regular and chronic cannabis use, intractable nausea and vomiting, cyclical vomiting, relief of symptoms with hot baths, and resolution of symptoms after cannabis cessation. There are currently many possible explanations regarding the mechanisms behind CHS. A variety of treatment options have also been examined, including hot water baths, haloperidol, capsaicin, and benzodiazepines. Conclusions: CHS is becoming an increasingly prevalent and complicated problem for health care providers and patients. Further research must be done to address the diagnostic and therapeutic challenges of this syndrome....
Cannabinoid Hyperemesis Syndrome
Cannabinoid hyperemesis syndrome (CHS) is a condition that leads to repeated and severe bouts of vomiting. It results from long-term use of marijuana).
Cannabinoid Hyperemesis Syndrome
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What is cannabinoid hyperemesis syndrome?
Cannabinoid hyperemesis syndrome (CHS) is a condition that leads to repeated and severe bouts of vomiting. It is rare and only occurs in daily long-term users of marijuana.
Marijuana has several active substances. These include THC and related chemicals. These substances bind to molecules found in the brain. That causes the drug “high” and other effects that users feel.
Your digestive tract also has a number of molecules that bind to THC and related substances. So marijuana also affects the digestive tract. For example, the drug can change the time it takes the stomach to empty. It also affects the esophageal sphincter. That’s the tight band of muscle that opens and closes to let food from the esophagus into the stomach. Long-term marijuana use can change the way the affected molecules respond and lead to the symptoms of CHS.
Marijuana is the most widely used illegal drug in the U.S. Young adults are the most frequent users. A small number of these people develop CHS. It often only happens in people who have regularly used marijuana for several years. Often CHS affects those who use the drug at least once a day.
What causes cannabinoid hyperemesis syndrome?
Marijuana has very complex effects on the body. Experts are still trying to learn exactly how it causes CHS in some people.
In the brain, marijuana often has the opposite effect of CHS. It helps prevent nausea and vomiting. The drug is also good at stopping such symptoms in people having chemotherapy.
But in the digestive tract, marijuana seems to have the opposite effect. It actually makes you more likely to have nausea and vomiting. With the first use of marijuana, the signals from the brain may be more important. That may lead to anti-nausea effects at first. But with repeated use of marijuana, certain receptors in the brain may stop responding to the drug in the same way. That may cause the repeated bouts of vomiting found in people with CHS.
It still isn’t clear why some heavy marijuana users get the syndrome, but others don't.
What are the symptoms of cannabinoid hyperemesis syndrome?
People with CHS suffer from repeated bouts of vomiting. In between these episodes are times without any symptoms. Healthcare providers often divide these symptoms into 3 stages: the prodromal phase, the hyperemetic phase, and the recovery phase.Prodromal phase. During this phase, the main symptoms are often early morning nausea and belly (abdominal) pain. Some people also develop a fear of vomiting. Most people keep normal eating patterns during this time. Some people use more marijuana because they think it will help stop the nausea. This phase may last for months or years.Hyperemetic phase. Symptoms during this time may include:
Repeated episodes of vomiting
Decreased food intake and weight loss
Symptoms of fluid loss (dehydration)
During this phase, vomiting is often intense and overwhelming. Many people take a lot of hot showers during the day. They find that doing so eases their nausea. (That may be because of how the hot temperature affects a part of the brain called the hypothalamus. This part of the brain effects both temperature regulation and vomiting.) People often first seek medical care during this phase.
The hyperemetic phase may continue until the person completely stops using marijuana. Then the recovery phrase starts.Recovery phase. During this time, symptoms go away. Normal eating is possible again. This phase can last days or months. Symptoms often come back if the person tries marijuana again.
How is cannabinoid hyperemesis syndrome diagnosed?
Many health problems can cause repeated vomiting. To make a diagnosis, your healthcare provider will ask you about your symptoms and your past health. He or she will also do a physical exam, including an exam of your belly.
Your healthcare provider may also need more tests to rule out other causes of the vomiting. That’s especially the case for ones that may signal a health emergency. Based on your other symptoms, these tests might include:
Blood tests for anemia and infection
Tests for electrolytes
Tests for pancreas and liver enzymes, to check these organs
Urine analysis, to test for infection or other urinary causes
Drug screen, to test for drug-related causes of vomiting
X-rays of the belly, to check for things such as a blockage
Upper endoscopy, to view the stomach and esophagus for possible causes of vomiting
Head CT scan, if a nervous system cause of vomiting seems likely
Abdominal CT scan, to check for health problems that might need surgery
CHS was only recently discovered. So some healthcare providers may not know about it. As a result, they may not spot it for many years. They often confuse CHS with cyclical vomiting disorder. That is a health problem that causes similar symptoms. A specialist trained in diseases of the digestive tract (gastroenterologist) might make the diagnosis.
You may have CHS if you have all of these:
Long-term weekly and daily marijuana use
Severe, repeated nausea and vomiting
You feel better after taking a hot shower