An electrocardiogram may be useful to assess the patient’s QTc interval, especially in the context of antipsychotic medication use, as well as before the administration of certain antiemetics, which may prolong the QTc interval to extreme lengths. In women, a pregnancy test is necessary to assess for any pregnancies, especially ectopic pregnancies. Imaging is up to the discretion of the clinician, depending on various specific factors of history or physical exam, which may be concerning for surgical processes.
For Health Professionals
If you are experiencing severe vomiting or other concerning symptoms, contact your health cannabinoid hyperemesis syndrome care provider. As many other health problems could lead to repeated vomiting, it’s important to discuss your complete health history, including your cannabis use, with any provider you see for your symptoms. During the patient’s hospital stay, nutritional support and intravenous hydration were provided.
Clinical Features
Although the exact number of people with CHS is unknown, based on emergency department surveys, CHS is estimated to affect about 2.75 million people in the US yearly. From 2017 to 2021, emergency department visits for CHS doubled in the US and Canada and were most common among males aged 16 to 34 years. The rise in CHS coincides with legalization of recreational cannabis and increases in delta-9-tetrahydrocannabinol (THC) concentration in cannabis products. One 2018 study found that 32.9% of self-reported frequent marijuana users who’d gone to the emergency room (ER) had symptoms of CHS.
Capsaicin
In contrast, SMA syndrome is a rare gastrointestinal illness, and clinicians should be aware of the possible relationship between it and CHS, as highlighted by this and previous case reports 4,5. A high index of suspicion for the numerous possible CHS complications, including SMA syndrome, is warranted for clinicians when treating a patient with marijuana use and persistent cyclical vomiting. The patient was referred to a nutritionist for additional support and education. She had not gained substantial weight by 1 week after hospital discharge, and she reported continued nausea with no emesis. At a gastroenterology consultation 7 months after discharge, she had improvement of symptoms, although early satiety remained. Surgical consultation was not sought by the patient, and it remains unclear whether she continued to use cannabis upon symptom relief.
- In refractory CHS cases, experimental therapies such as benzodiazepines, tricyclic antidepressants, and dopaminergic agents like haloperidol have been explored.
- If you have symptoms, your doctor will do a physical exam and ask for your detailed medical history.
- That’s because hot water can help ease cannabinoid hyperemesis syndrome symptoms like nausea.
- Laboratory evaluation findings were remarkable for increased values of serum albumin, bilirubin, alanine and aspartate aminotransferases, and total protein (Table 1).
- Despite the scarcity of randomized controlled trials (RCTs) on optimal treatment approaches for CHS, a holistic care plan can significantly enhance patient outcomes and well-being.
Cannabinoids are compounds in the Cannabis sativa plant that bind to cannabinoid receptors in your brain, spinal cord, gastrointestinal tract and other body tissues. Examples of cannabinoids include tetrahydrocannabinol (THC) and cannabidiol (CBD). The Rome Foundation (Rome IV) has emerged as a beacon of clarity in the labyrinth of diagnosing Cannabinoid Hyperemesis Syndrome (CHS), categorizing it as a variant of cyclical vomiting syndrome under the umbrella of functional gut-brain disorders.
Hot baths may relieve the nausea for a while, but they don’t cure CHS. Many people with CHS will compulsively shower or bathe — often for hours every day — to relieve CHS symptoms. 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 https://ecosoberhouse.com/ to correct electrolyte imbalances and sustain hydration levels.
Frequent vomiting due to CHS can cause erosion of teeth enamel and may result in tooth loss. CHS may also cause dehydration, acute kidney injury, and low blood levels of chloride, potassium, sodium, and bicarbonate, which may require emergency department visits and hospitalizations. Rare severe complications of CHS include heart rhythm abnormalities, kidney failure, seizures, and death. When you do this, your symptoms usually start to go away in few days to a few months. Over time, the symptoms will go away completely unless you start to use again.
Diagnosis
- This increased blood flow to the skin and peripheral tissues may help shift blood volume away from the gastrointestinal tract, potentially alleviating nausea and vomiting symptoms by reducing visceral hypersensitivity and enhancing overall comfort levels.
- When cannabinoids bind with brain receptors, they tend to prevent nausea and vomiting.
- Complete cessation of cannabis use is the most effective long-term treatment for CHS.
With the absence of definitive biomarkers, the diagnostic journey for CHS predominantly revolves around the process of exclusion. Quitting cannabis use is the only way to get better if you have CHS. Contact your health care provider if you suspect you might have CHS or for information on treatment options for cannabis use disorder. Risk factors for CHS include heavy cannabis use (typically daily or multiple times per day) for more than 1 year.
Wellness Phase
Adequate fluid resuscitation is crucial during the acute phase of CHS to avert complications and ensure physiological stability. Interestingly, patients dealing with Cyclical Vomiting Syndrome (CVS) also frequently mention this behavior. Yet, with the evolving comprehension of CHS, there is a likelihood that some cases attributed to CVS might actually be undiagnosed instances of CHS, marking it as pathognomonic. This underscores the critical need to correlate symptoms with cannabis consumption, ruling out overlapping diagnoses that could be mistaken for CVS. Notably, a hallmark behavior observed in CHS cases is the propensity for pathologic hot bathing or showering.
CHS Phases
Higher rates of CHS are reported in people who use cannabis before age 16 years, have other substance use disorders, and/or smoke cigarettes. Many people experience temporary relief from their nausea and vomiting when bathing in hot water. Some people with CHS may compulsively bathe in hot water for hours a day to find relief. While conventional antiemetic medications like serotonin 5-HT3 receptor antagonists and dopamine antagonists can be prescribed to manage nausea and vomiting in CHS patients, their efficacy in CHS cases is limited.
