Navigating the Intricacies of Cannabinoid Hyperemesis Syndrome CHS: Understanding the Unseen Challenges

N/V induced by cannabinoids may be masked by N/V related to cancer or side effects of chemotherapy drugs 5. This awareness may help reduce, identify and effectively manage polypharmacy and cannabinoid-related side effects. A systematic review was conducted by 2 independent researchers using PubMed, Ovid MEDLINE, Cochrane Central, EMBASE and Google Scholar. For each study, the keywords “cannabinoid hyperemesis syndrome,” “nausea,” “vomiting,” and “cannabinoids” were utilized in the search. Eligibility assessment was performed by the independent reviewers (H.S. and S.W.) and disagreements were resolved by consensus. A data extraction excel sheet was developed and used to compile and summarize the relevant studies.

Unveiling the Complexities of Cannabinoid Hyperemesis Syndrome: Mechanisms Underlying 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. The patient was recommended for surgical consultation if improvement did not occur, but additional medical action was not pursued at this time. This report recounts the case of an adolescent girl with symptoms similar to those of her previous episodes of tetrahydrocannabinol-induced hyperemesis, despite a 21-kg weight loss over 6 months.

Differential Diagnosis

You’re more likely to get CHS if you use marijuana at least once a week and have been doing so since you were a teenager. “Cannabinoid” refers to cannabis (marijuana) and “hyperemesis” is a word meaning “prolonged vomiting.” It can lead to symptoms such as nausea, vomiting, and abdominal pain. If you experience CHS seek medical care immediately or go to your local emergency department. On day 3 of admission, the patient started tolerating regular oral intake demonstrating an unremarkable recovery after total three doses of intravenous haloperidol.

• In older populations, benzodiazepines should be used with caution in the management of CHS due to the potential risk of addiction, cognitive impairment, development of delirium, and falls 45.
• For our patient who had previously used cannabis, most of these were ruled out in the initial diagnostic evaluation through laboratory evaluation and imaging.

Topical Capsaicin

Capsaicin, the active compound in chili peppers, acts on TRPV1 receptors, potentially modulating gastrointestinal sensory pathways and altering intestinal blood flow to provide relief from nausea and vomiting. Serotonin antagonism in the gastrointestinal tract from medications such as ondansetron, dolasetron, and granisetron likewise have varying levels of efficacy. 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. The differential diagnosis related to chronic abdominal pain and recurrent bouts of emesis is expansive, which hinders identifying the underlying cause and proper treatment. Common possible diagnoses include gastroenteritis, gallbladder disease, peptic ulcer disease, celiac syndrome, appendicitis, pancreatitis, and functional dyspepsia.

• Do not exceed the recommended dose on the package – the “therapeutic dose” and “toxic dose” of Tylenol are very close to each other.
• In the emergency department, the patient’s temperature, heart rate, respiratory rate, and blood pressure were within or only slightly above the normal range.
• If you experience CHS seek medical care immediately or go to your local emergency department.
• Hot showers have emerged as an intriguing phenomenon in assuaging the symptoms of Cannabis Hyperemesis Syndrome (CHS), offering a peculiar yet effective avenue for relief.
• The overlap in symptoms between CHS and SMA syndrome, especially in a patient previously diagnosed with CHS, can lead to diagnostic delays, which necessitates greater awareness and education for both health care professionals and patients.

Importantly, for the definition of cyclic vomiting syndrome, these episodes of vomiting cannot be attributed to other disorders. This factor is a key distinguishing feature from cannabis hyperemesis syndrome, where the toxicokinetics of cannabis itself influence the course of the disease. This case report seeks to raise awareness of the effects of cognitive errors in clinical practice.

History

To lower the morbidity, CHS is best managed by an interprofessional team. The best and only way to prevent or reduce your risk for CHS is to avoid or quit marijuana use. One study looking at Reddit posts on the subject found that spicy food, greasy food, coffee, black tea, and alcohol were frequently mentioned as CHS triggers. These foods/beverages are mostly acidic, but relationships between them and CHS have not been studied scientifically, although the co-use of weed and alcohol is well-known, the study authors said. Your doctor may ask you questions, like how long you’ve been using cannabis and what type of products you normally use. For example, if you smoke https://ecosoberhouse.com/ weed, eat edibles, use tinctures, or dab or vape THC, tell your doctor about any or all of them.

• Consequently, there has been limited research conducted, leaving many unanswered questions about why cannabis triggers it, its effects on the body, and potential treatments or cures.
• The continuation of nausea and emesis exhibited in this case showcases the complications arising from cyclical vomiting that often go misdiagnosed without new symptom development, which exacerbates existing gastrointestinal distress.
• N/V induced by cannabinoids may be masked by N/V related to cancer or side effects of chemotherapy drugs 5.

General Health

Preventing a recurrence necessitates complete abstinence to facilitate recovery. Indeed, with any syndrome that results in frequent vomiting, there is a concern for a disorder of electrolytes and fluid balance in the body. Patients who fail to respond to antiemetic therapy are at high risk for dehydration cannabinoid hyperemesis syndrome and resulting in nutritional deficiencies. Other known complications of forceful and uncontrolled vomiting include aspiration and subsequent pneumonitis or aspiration pneumonia as well as injury to the esophageal wall such as Boerhaave’s syndrome. Marijuana has a lot of active chemical compounds called cannabinoids. When you use weed, these compounds bind to cannabinoid receptors found in your brain, digestive tract (gut), and certain cells in your body.