Most CHS patients discover the symptomatic relief of hot showers on their own and use this method to control symptoms [1]. In a case study from Texas, a 27-year-old male patient with CHS reported he found relief in hot showers but over time, he became refractory to the hot water and ended up having to visit the ED [105]. The objective of our research was to establish a clinically meaningful description of CHS and its presentation, https://ecosoberhouse.com/ to evaluate diagnostic challenges in identifying this syndrome, and to describe effective treatment options. Articles that were not in English were excluded as were case reports that did not report the age, sex, presentation, diagnosis, and treatment of the patient. Case reports were summarized in Table Table22 and case series presented in the narrative text. In some cases, the bibliographies of these articles were also searched.
- Additionally, criteria vary significantly, which may contribute to diagnostic uncertainty among providers.
- During his last hospitalization he was given conventional antiemetic therapy but his symptoms persisted for 2 more days.
- Researchers have tried to explain what causes CHS, but further study is necessary.
- Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months.
Hot Showers
Studies show that between 90% to 100% of people with CHS use hot showering or bathing to relieve symptoms. Researchers have proposed that this behavior may be included in the diagnostic criteria for CHS. One doctor reported using injectable lorazepam to help control nausea and vomiting symptoms in an adult. Within 10 minutes, nausea and vomiting stopped, and the person no longer felt abdominal pain. 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.
Epidiolex and CBD Dosages: Your GoodRx Guide
Since vomiting is a symptom of many conditions, CHS patients often undergo computed tomography scans, magnetic resonance imaging, gastric emptying tests, endoscopy, colonoscopy, even exploratory procedures before a CHS diagnosis is made [91]. It is not unusual for CHS patients to present frequently at the ED and to be hospitalized multiple times per year. This suggests that prompt, accurate diagnosis of CHS may save the healthcare system considerable resources and spare the patient unnecessary testing and procedures.
Clinical Presentation, work up and differential diagnosis of Cannabinoid Hyperemesis Syndrome
Δ9-tetrahydrocannabinol (THC) is the principle active compound in cannabis (Figure 1). The metabolism of THC occurs mainly in the liver via oxidation and hydroxylation reactions. In humans this is carried out largely by the CYP2C isoenzyme subfamily of the cytochrome P450 complex [19]. 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]. THC is excreted mainly as acid metabolites, with 60–85% cleared through the feces and 20–35% in the urine [20,21].
The Endogenous Cannabinoids (Endocannabinoids)
In one multicenter cohort study, the mean numbers of abdominal CT studies and abdominal/pelvic US and abdominal radiographs were 5.3 ± 4.1, 3.8 ± 3.6, and 5.5 ± 6, respectively [7]. For one participating ED with seven patients enrolled in the study, the median charge for ED visits and hospital admissions over the course of a patient’s illness was $95,023 (range $62,420 to 268,110). Nausea, vomiting, and abdominal pain are diffuse symptoms that may derive from any of several diverse etiologies. For CHS patients, these tests typically offer normal-range results, but they are expensive, time-consuming, and place a hardship on the patient as well as the healthcare system.
Cannabinoid Hyperemesis Syndrome Diagnosis
A computed tomography (CT) scan of his abdomen and pelvis with contrast was unremarkable. The patient was admitted for his inability to tolerate oral intake and dehydration and treated supportively with IV fluids and antiemetics. Chronic cannabis use is the primary risk factor for developing CHS. Using cannabis for a prolonged period increases your risk of this condition.
Diagnosis and Tests
Given that evidence statements are based primarily on case reports and case series, the vast majority of evidence is considered limited. Therefore, limited evidence ratings should not be misconstrued as negative clinical findings but, rather, that there are no higher-level cannabinoid hyperemesis syndrome studies to qualify the statement as higher-level evidence. The primary findings for each category are summarized in the following sections. Two reviewers (CS and AM) independently reviewed all titles generated by the search to identify potentially relevant articles.
More studies will be required to evaluate the overall prevalence of this condition as well as if there are any changes following the liberalization of marijuana laws in many states. The hyperemetic phase of CHS typically lasts for only 24–48 hours [6], but the risk for relapse is high if the patient returns to cannabis use. Case reports have demonstrated a remission in CHS symptoms upon cessation of cannabis use for extended periods [6,51–54,57,59–62,68,71]. Unfortunately, many of these patients relapse upon resuming cannabis [6,59,61,62].
- Such genetic variations have yet to be studied in patients diagnosed with CHS and represent an area for future research.
- In the gastrointestinal system, CB2 receptors are expressed by lamina propria plasma cells and activated macrophages, as well as by the myenteric and submucosal plexus ganglia in human ileum [9,12,13].
- The average length of time between the onset of symptoms and a CHS diagnosis was 6.1 years (range 1–10 years) and patients visited the ED at average of 10 times before diagnosis was made.
CHS symptoms include nausea, abdominal pain, and uncontrollable vomiting. CHS symptoms can lead to severe dehydration, which can be life-threatening. Patients with CHS usually remain misdiagnosed for a considerable time period.