What is Cannabinoid Hyperemesis Syndrome CHS? Part 1

Her urinalysis was within normal limits with a specific gravity of 1.020, glucose 500 mg/dL, ketones 40 mg/dl, nitrite negative, leukocyte esterase, and no crystals seen on the microscopic evaluation. Urine pregnancy testing was negative, and ECG showed normal sinus rhythm at 76 beats per minute, no ectopy, normal QT, and no ST segment changes. Urine toxicology is positive for cocaine and cannabinoids, but negative for phencyclidine, benzodiazepines, amphetamines, opiates, and barbiturates. Probably, a crucial factor in the genesis of CHS is the composition of cannabis. Since the 1990s, there has been a progressive change in the composition of the plant, with increases in the tetrahydrocannabinol (THC) and a reduction of cannabidiol (CBD).6 This trend correlates with increased cannabis use. Some individuals, for instance, also admitted to smoking 2000 mg of THC per day.

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

Emergency physicians should include CHS in the differential diagnosis of patients presenting with cyclic vomiting, especially when the patient is less responsive to typical treatment modalities for abdominal pain and vomiting. Physicians should also consider treatments, such as benzodiazepines, haloperidol, and heat or topical capsaicin in these cases, especially when the patient reports a history of cannabis use. While these treatments may provide temporary relief for patients while in the acute care setting, cessation of cannabinoid use has been linked to complete resolution of CHS.

The rising alarm about the dangers of legalized marijuana

• Other organs where CB1 receptors have been identified are the spleen, heart, liver, uterus, bladder, and vas deferens 10.
• Indeed, with any syndrome that results in frequent vomiting, there is a concern for a disorder of electrolytes and fluid balance in the body.
• Ultimately, the treatment of any illness is the removal of precipitating factors, not merely the management of its symptoms.
• Capsaicin is a chemical found in several varieties of chili peppers and is a unique treatment option with encouraging results in the treatment of CHS.
• Hurd also notes a Danish epidemiological study that showed a strong correlation between increased cannabis use and potency and rising schizophrenia rates.
• This was her third ER trip with cannabinoid hyperemesis syndrome (CHS) in as many years.

For example, THC has two main metab­olites (11-hydroxy-delta9-tetrahydrocannabinol or 11-OH- THC and 11-nor-9-carboxy-THC-delta9-tetrahydrocannabinol or THC-COOH) but it also has over 100 minor metabolites 40. The 11-OH-THC metabolite is psychoactive and is equipotent to THC in terms of psychoactive effects; THC-COOH is not psychotropic and has anti-inflammatory and analgesic properties 41, 42. CBD is not psychotropic, has little affinity for the CB1/CB2 receptors, and appears to be a partial agnostic at the serotonin receptors 43. CBD enhances the expression of the CB1 receptors in the hypothalamus, plus it amplifies the hypothermic effects of THC 44. In preclinical studies, toxin-induced vomiting treated with CBD showed a biphasic response, that is, low doses of CBD had an antiemetic effect while higher doses had a proemetic effect 37, 45.

Case Series and Case Studies

• In two case reports, doctors used lorazepam (Ativan) to manage CHS-related nausea and vomiting.
• Researchers are currently studying several treatment options to manage the hyperemetic phase of CHS.
• Within 10 minutes, nausea and vomiting stopped, and the person no longer felt abdominal pain.
• The hot temperature affects a part of the brain called the hypothalamus, which regulates temperature and throwing up.
• Typical treatment for nausea, vomiting, and abdominal pain may not be effective in patients with CHS.

With cannabis use increasing throughout the world as the threshold for legalization becomes lower, its user numbers are expected to rise over time. Despite this trend, a strict criterion for the diagnosis of CHS is lacking. Early recognition of CHS is essential to prevent complications related to severe volume depletion. The recent body of research recognizes that patients with CHS impose a burden on the healthcare systems. 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 chs symptoms and signs frequency and prevalence of CHS change in accordance with the doses of tetrahydrocannabinol and other cannabinoids in various formulations of cannabis.

• About 100 of McIff’s patients currently use medical cannabis, mostly for chronic pain.
• In America, 22.2 million Americans reportedly used some form of cannabinoids in the past month 3.
• Little is known of the aetiology of CHS as the literature is predominantly informed by case reports and chart reviews.

How soon after cannabis hyperemesis syndrome treatment will I feel better?

This factor is a key distinguishing feature from cannabis hyperemesis syndrome, where the toxicokinetics of cannabis itself influence the course of the disease. Although this study had some limitations, including self reported use of cannabis, Meltzer says it suggests a substantial risk of this painful and costly condition, especially for users who begin daily use of cannabis as adolescents. He says more research is needed to understand why some people suffer from alcoholism treatment the condition after prolonged cannabis exposure and others do not. In addition, it is unclear why cannabis changes from a drug that has been known to ease nausea and vomiting, especially among patients undergoing chemotherapy, to causing nausea and vomiting in a subset of people. To assess the burden of disease, Meltzer and his colleagues conducted a survey of 1,052 people who reported suffering from cannabinoid hyperemesis syndrome.

• For example, CVS patients usually have important psychological comorbidities including depression and anxiety 64,65.
• Marijuana cessation was recommended to all patients, but there was no long-term follow-up.
• CBD is not psychotropic, has little affinity for the CB1/CB2 receptors, and appears to be a partial agnostic at the serotonin receptors 43.
• In this narrative review, we elaborate on the role of the ECS, its management, and the identification of gaps in our current knowledge of CHS to further enhance its understanding in the future.
• In addition to its antiemetic properties, cannabis consumption creates appetite stimulation and has been used for cachexia as well as conditions such as AIDS, Parkinson’s, and Alzheimer’s, ALS, inflammatory bowel disease, and migraine/headaches 5, 6.