It is important to address any dehydration that may be present due to excessive vomiting, and sometimes intravenous fluid administration is necessary. Yet, the information is not available to discern if CVS patients concurrently use cannabis to relieve emetic symptoms or if these are individuals with CHS. One treatment that’s been highly effective in treating CHS is topical capsaicin (yes, the stuff that gives hot peppers their heat). A 2015 study found that out of 13 patients admitted to the hospital with CHS, using a capsaicin cream got rid of the symptoms in all 13 patients. Notably, a hallmark behavior observed in CHS cases is https://ecosoberhouse.com/ the propensity for pathologic hot bathing or showering.
- SMA syndrome often arises due to recurrent bouts of emesis that trigger rapid weight loss; in the case presented here, the recurrent emesis was prompted by cannabis consumption.
- Not everyone with the condition seeks medical help or tells their provider that they use marijuana.
- Finally, on March 6, 2019 — my birthday — I was able to pick up the autopsy report.
- Although recommendations are based on the available scientific evidence, prescribing panelists also used their clinical judgment, which could result in a potential for bias.
- Brian was also experiencing symptoms even after he had quit smoking, which caused us to doubt the diagnosis further.
- They are however also encountered in cannabis withdrawal syndrome (CWS), an often debated but officially (ICD and DSM) recognized withdrawal syndrome.
What are the symptoms?
This article was reviewed by Bonni Goldstein, MD, a physician specializing in cannabis medicine in Los Angeles, California, owner and medical director of CannaCenters, and medical advisor to Weedmaps.com. Contact your physician right away if you experience symptoms of CHS, and stop consuming cannabis. Stopping cannabis use is the only known way to permanently get rid of CHS. Researchers are continuing to examine potential treatment options for CHS. The researchers found that 32.9 percent of the participants reported having experienced symptoms of CHS in the past.
Supportive Care with Fluid and Electrolyte Replacement
Serotonin antagonism in the gastrointestinal tract from medications such as ondansetron, dolasetron, and granisetron likewise have varying levels of efficacy. Tricyclic antidepressants also antagonist serotonin receptors and may limit nausea due to this mechanism, though their extensive side effect profile such as transaminitis and predisposition to various dysrhythmias via QTc prolongation and QRS widening make appropriate dosing of these medications a priority. 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. Opioids, while often prescribed for the patient’s debilitating abdominal pain, are not appropriate for CHS, as they may, in fact, worsen nausea and vomiting. Cannabis-related medical consultations are increasing worldwide, a non-negligible public health issue; patients presenting to acute care traditionally complain of abdominal pain and vomiting.
Understanding Cannabis Hyperemesis Syndrome
Refeeding syndrome might be diagnosed after a healthcare provider performs a physical exam and takes a careful history, especially of any digestive problems or changes related to eating and nutrition. Refeeding syndrome can be serious and can lead to complications, so it’s important to understand the symptoms and when to seek treatment from a healthcare provider. Often CHS may not be recognized when symptoms first start, and a person may think that using more cannabis will relieve their symptoms, but it will only make them worse. In one of the deaths mentioned above, nausea and vomiting were assumed to be from food poisoning, and not a syndrome related to marijuana use.
Cannabinoid Hyperemesis Syndrome (CHS): Causes, Symptoms, Treatment
Often recurrent, these frequent consultations add to the congestion of already chronically saturated emergency department(s) (ED). In order cannabinoid hyperemesis syndrome to curb this phenomenon, a specific approach for these patients is key, to enable appropriate treatment and long-term follow-up. Cannabinoid hyperemesis syndrome (CHS) can affect people who use cannabis (marijuana) long-term. Cannabinoid hyperemesis syndrome (CHS) is a condition that you might get if you’ve regularly smoked weed or used marijuana in some other form for a long time.
Refeeding Syndrome Tests
- We had never heard of marijuana causing nausea or vomiting and were only familiar with its various health benefits, so we did not believe that CHS was what Brian had.
- It’s important to be honest about your marijuana use if you have symptoms of CHS.
- These therapies may offer transient relief but are not comprehensive solutions for CHS symptomatology.
- In addition, she was initially instructed on cannabis cessation and a trial of topical capsaicin for treatment of CHS.
- A representative can refer you to local treatment facilities, support groups, and community-based organizations.
Vital signs were significant for mild hypertension (150/75), but the patient was afebrile with a normal heart rate. An abdominal exam revealed a nontender, nondistended abdomen with no signs of rebound or guarding. An initial workup showed a mild elevation of serum creatinine to 1.36 mg/dL (baseline is 1.10 mg/dL). Other workups, including complete blood count (CBC) with differential, complete metabolic panel, lipase, amylase, and urine analysis, were all unremarkable. It is hypothesized that pesticides used on cannabis plants may play a role in CHS as well, but that has not been well researched at this time.
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. The use of cannabis as a recreational substance has increased worldwide in the past 20 years, as its use becomes more socially accepted. Now regularly consumed by a large spectrum of the population, this trend has resulted in an increase in the number of cannabis-related medical consultations 1, making its consumption a non-negligible public health issue. In Switzerland, nearly 1/3 of the population over the age of 15 years has already tried cannabis for reasons other than medical purposes 2.
Vasodilatory Effects
As with any patient, obtaining a detailed history is a vital component to correctly establish a differential diagnosis. In terms of abdominal pain and hyperemesis, this relies on excluding a wide range of differentials (see Table Table1)1) thanks to a thorough exam and the use of paraclinical tests (see below), and focusing on certain differences may help differentiate CHS from CWS. To arrive at an accurate diagnosis, physicians may look at how often and how much cannabis a patient uses, so if you’re feeling symptoms of CHS, be honest with your doctor about how much cannabis you consume. Daily cannabis use and/or high doses of THC are more likely to cause CHS, but you may need a physical exam to rule out other causes.
Cannabinoid Hyperemesis Syndrome Treatment
If this flap doesn’t work properly, your stomach acids might flow upward and cause you to have nausea and vomiting. During the patient’s hospital stay, nutritional support and intravenous hydration were provided. In addition, she was initially instructed on cannabis cessation and a trial of topical capsaicin for treatment of CHS. After the definitive diagnosis of SMA syndrome, a conservative approach of intravenous hydration and nasogastric feeding was applied to treatment. Gastric decompression was continued through a nasogastric tube until appropriate weight gain was achieved and the blockage was relieved, which allowed for discontinuation once oral intake could be tolerated.
