A diagnostic flow chart can be used by clinical pharmacists and clinicians for patients with suspected CHS to help reduce unnecessary costs and over-utilization of health care resources. Diagnosis begins with a thorough physical examination and history for all patients presenting with nausea, vomiting, and abdominal pain. This will help to rule out life-threatening causes or diagnoses that confer significant potential morbidity to the patient or to establish the presumptive diagnosis of CHS. History taking should include an inquiry about the patient’s past and present medical illness, medication use, illicit drug use, and therapeutic or recreational use of cannabis. Denial of cannabis use by the patient is typically the biggest stumbling block for clinicians in making a proper diagnosis of CHS.
Help quitting cannabis
On the basis that only a small number of regular and long term users of marijuana develop CHS, some researchers suggest that genetics might play a role. Other researchers theorize that the effects of marijuana can change with chronic use. With the consumption of marijuana increasing due to the legalization of its recreational use in many states, doctors may receive more reports of side effects from marijuana use. In this article, we describe CHS and discuss the causes, symptoms, diagnosis, and treatment of the condition. It should be noted that the majority of evidence found for haloperidol were case studies, which had limited generalizability [30, 31, 33]. However, the RCT by Ruberto et al. [32] was found to have low overall bias, as there was appropriate cohort randomization, allocation concealment, and blinding of participants and outcome assessors without selective reporting of haloperidol used for CHS.
Review Questions
This antagonism reverses the anti-emetic actions of low-dose CBD, which likely occurs at the 5-HT1A receptor [33]. The pro-emetic properties of CBD (at higher doses) and CBG may play a role in the severe nausea and vomiting observed in patients with Cannabinoid Hyperemesis Syndrome (Figure 2). THC accumulates largely within body fat which serves as a long-term storage site for the drug [20,22].
Recovery stage
The best characterized endocannabinoids are anandamide and 2-arachidonylglycerol (2-AG) [9]. The endocannabinoids are present in both the central nervous system [8] and enteric nervous system [15]. Anandamide and 2-AG are released locally on demand by neurons, are present in small quantities, and undergo rapid inactivation [8]. Endocannabinoids are thought to act as either neuromodulators or neurotransmitters [11].
At low doses, the effect of cannabis on your brain can have an antiemetic effect that suppresses nausea and vomiting. However, with repeated use in some people, it can have the opposite effect on the digestive tract. This results in the persistent vomiting and nausea characteristic of CHS. CHS is also underdiagnosed because people sometimes use marijuana to suppress nausea and vomiting. Doctors currently lack knowledge of the condition, and there are no clinical guidelines for its treatment and management. It should be noted that the case series using capsaicin cream had a small patient sample cohort of only 1–4 patients; as a result, success in larger cohorts may be questioned [23, 26].
Once you do that, your repeated nausea and vomiting should go away and not return. Since THC is stored in your body fat, it can take weeks to months before all the symptoms go away and you notice a difference. A set of clinical diagnostic cannabinoid hyperemesis syndrome criteria for CHS was proposed by Sontineni et al6 in 2009 based on case reports and was further modified by Simonetto et al12 in 2012 after a review of a case series of 98 patients, the largest to date, diagnosed with CHS.
Deterrence and Patient Education
- It is sometimes thought, often from anecdotal reports in popular media, that CHS is a result of poisoning from contaminants such as pesticides on cannabis and not from the actual plant constituents themselves.
- The true elimination plasma half-life of THC has been difficult to calculate, but several studies have estimated it to be in the range of 20–30 hours [20].
- The presented side effects of cannabinoid drugs suggest that further studies are needed to evaluate the safe concentrations of cannabinoid drugs.
Cannabis hyperemesis syndrome (CHS) is a form of functional gut-brain axis disorder characterized by bouts of episodic nausea and vomiting worsened by cannabis intake. It is considered as a variant of cyclical vomiting syndrome seen in cannabis users especially characterized by compulsive hot bathing/showers to relieve the symptoms. CHS was reported for the first time in 2004, and since then, an increasing number of cases have been reported.
The aim of this systematic review was to highlight current management options for CHS as a potential adverse effect of long-term cannabis use in adults and older populations. 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. If you have CHS and don’t stop using, your symptoms like nausea and vomiting are likely to come back. They may also prescribe antipsychotic medications such as haloperidol (Haldol) or olanzapine (Zyprexa) to help you calm down as you switch to the recovery phase.
Pertinent Studies and Ongoing Trials
This consideration may prevent further unnecessary workup and health care costs for patients with CHS. The prodromal phase4,17 can last for months or years, with patients developing early morning nausea, a fear of vomiting, and abdominal discomfort. Symptoms are most common in early middle-aged adults who have consistently been using cannabis since adolescence. Unlike anorexia nervosa or bulimia, these patients maintain normal eating patterns in this stage.
- Many different treatments and dosages have been reported among case studies, which may not be generalized to the wider population.
- Cannabinoids discovered in the cannabis plant with known effects on the regulation of emesis include tetrahydrocannabinol, cannabidiol, and cannabigerol.
- Chronic cannabinoid usage can lead to recurrent N/V with distinct pathogenesis, known as CHS.
Compulsive bathing or showering in hot water to soothe nausea is also a hallmark sign of CHS. The diagnostic criteria for CHS were ill-defined prior to the establishment of the Rome IV criteria of 2016.[20][21] Per the Rome IV criteria, all 3 of the following must be met to be diagnosed with CHS. They must be present for at least the last three months and the beginning of symptoms must be at least 6 months prior to the diagnosis being made. 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. The fundamental and definitive treatment for CHS involves ceasing cannabis consumption.