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Patients present with recurrent episodes of nausea, vomiting, and dehydration with frequent visits to the emergency department. Patients are typically young adults with a long history of cannabis use. In nearly all cases there is a delay of several years in the onset of symptoms preceded by chronic marijuana abuse 6.

Treatment / Management

Acetaminophen 1000 mg PO q6h PRN for pain did not relieve the patient’s stomach cramps. He achieved symptomatic relief by using a heating pad on his abdomen throughout the day and experienced about 20 min of relief by showering with hot water, which he did 3 to 12 times daily. At this point, staff in the treatment centre diagnosed CHS, on the basis of presentation and the exclusion of other diagnoses.

The approximate consumption of THC per day was a mean of 70.3 ± 40.8 mg. Seventy percent of pa tients reported symptoms typically began in the morning 120. Immersing oneself in very hot water relieves vomiting symptoms in CHS patients but has no antiemetic effect on patients with other types of CVS or PV. Thus, learned behavior of bathing in hot water may be used to help diagnose CHS and differentiate it from other CVS 93. Over 90% of CHS patients exhibit this behavior 75, which is sometimes described as compulsive.

Cannabinoid Hyperemesis Syndrome (CHS): Causes, Symptoms, Treatment

• It’s not clear if some people are more prone to the syndrome than others.
• Based on published case reports of CHS, lorazepam could be considered as an agent of choice in the management of the acute hyperemetic phase of CHS to relieve symptoms of nausea and vomiting (Table 1).

Cannabis, commonly referred to as marijuana, is a plant from the Cannabis sativa species that has been cultivated and consumed for medicinal, industrial, and recreational purposes for thousands of years. The plant’s psychoactive and medicinal effects are attributed to its cannabinoids, chemical alcoholism treatment compounds that interact with the body’s endocannabinoid system. Among these cannabinoids, tetrahydrocannabinol (THC) is the most well-known for its ability to induce euphoria, alter perception, and stimulate appetite. Cannabidiol (CBD), another major cannabinoid, has gained attention for its potential therapeutic properties, including anti-inflammatory, anxiolytic, and neuroprotective effects 1.

What other marijuana-related problems are emergency departments seeing these days?

“The brain’s endocannabinoid system modulates the stress response, and cannabis makes that pendulum swing further one way than the other,” which can trigger symptoms. So if your child has repeated nausea and vomiting and it seems like something else is going on, be sure to take them in to see their doctor, and don’t be surprised if your doctor does ask about drug use. Lately, I’m seeing a lot of teens, some kids as young as 12, who are using marijuana on a daily basis. According to the Centers for Disease Control and Prevention, in 2019, 37% of United States high school students reported using marijuana, and 22% said they had used it in the past 30 days. Eight percent of 8th graders, 19% of 10th graders, and 22% of 12th graders reported vaping marijuana. They often have reported going to the bathroom at their schools and finding other students vaping.

What causes cannabinoid hyperemesis syndrome?

• Some patients use hot water bags across the center of their belly and can burn the skin if done a lot.
• This often involves intravenous fluids to combat dehydration (because let’s face it, when you’re vomiting non-stop, you’re losing fluids faster than a leaky faucet), anti-nausea medications, and sometimes pain management.
• People with CHS also tend to have a strong urge to take very hot showers or baths.
• These compounds are referred to as endogenous cannabinoids, or endocannabinoids.
• One telltale sign – compulsive hot bathing – is frequently overlooked, despite its strong diagnostic value.
• The prevalence of CHS is still somewhat of a mystery, much like trying to count how many jelly beans are in a jar.

It is unclear whether the increased legalization of cannabis has also contributed to these findings, but this certainly could be a possibility. Hence, raising the awareness of CHS with an understanding of its pathophysiology and the potential role of therapeutic agents is paramount. Visits and extensive recurring serum testing and imaging evaluations with increased healthcare-related costs. It is crucial to exclude other entities such as Addison’s disease, migraines, hyperemesis gravidarum, bulimia, and psychogenic vomiting, which can mimic CHS symptoms and may also occur alongside it. A thorough medical history, complete physical examination, and focused diagnostic testing help differentiate from these other differential conditions.

Cannabinoid Hyperemesis Syndrome

Studies focused on individuals diagnosed with CHS, as well as those with comparable conditions like CVS, were selected. Emphasis was placed on studies that reported on demographic information, symptom patterns, diagnostic criteria, and treatments. First, doctors treating people with CHS advise them to stop using marijuana. During the hyperemesis stage, doctors focus on preventing dehydration and stopping the symptoms of nausea and vomiting. Cannabinoid hyperemesis syndrome (CHS) is a condition that sometimes develops due to the long term use of marijuana. Mood disorders such as anxiety and depression often coexist in patients with CHS 98.

How is cannabinoid hyperemesis syndrome diagnosed?

As a somewhat new problem, CHS is often mistaken for other problems with the same symptoms. When combined with the fact that people may not reveal they use cannabis, getting the right diagnosis can take years. In one study of frequent cannabis users with potential CHS symptoms, 33% of participants met the definition of CHS. When expanded to the general U.S. population, research indicates that about 2.75 million Americans annually may experience CHS. With the continued use canabis hyperemesis of cannabis and a lack of treatment, symptoms become more intense. The only treatment known to cure CHS is to stop using cannabis and not resume its use.

How can CHS be managed?

But it’s also important to acknowledge the positive uses of marijuana, Camilleri said. He also warned that people with serious mental illnesses, such as schizophrenia, should be cautious about marijuana use, as studies show cannabis can exacerbate the effects of those illnesses. Neither the psychological treatments nor the pharmacological treatments seem to be that effective,” he said. Ultimately, the only way to guarantee health is by totally abstaining, he added. If the patient quits cannabis consumption, vomiting due to CHS largely subsides. It’s possible that with lower amounts or lower frequency, patients might be able to use cannabis again, but the science is unclear.

CHS Symptoms

In this series, the mean amount of cannabis smoked per day was 7.5 cigarettes (range 1–12) for at least 1 year prior to the first episode of vomiting. 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. All patients found relief in hot showers and all were described as “uncooperative” with a CHS diagnosis. Upon being hospitalized, 100% of patients had complete resolution of all symptoms an average of 3.6 days after discontinuation of marijuana (range 2–5 days). In this case series, the investigators noted that this latter patient − who continued to use cannabis − had the greatest number of acute episodes of CHS 129.

What are the Symptoms of Cannabinoid Hyperemesis Syndrome?

Propranolol is a nonspecific, lipophilic beta-1/beta-2-blocker that has been used to treat CVS, particularly in pediatric patients 119. A telltale sign of CHS is that heat often temporarily relieves the condition’s symptoms. Hundreds of people told the Times that they spent hours in hot baths and showers.