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The endocannabinoids are present in both the central nervous system 8 and enteric nervous system 15. Anandamide and 2-AG are released locally on demand by neurons, are present in small quantities, and undergo rapid inactivation 8. Endocannabinoids are thought to act as either neuromodulators or neurotransmitters 11. Anandamide and 2-AG possess similar biochemical structures, but each has a distinct pathway for biosynthesis and degradation. Anandamide is synthesized from the precursor N-arachidonoyl phosphatidylethanolamine, while 2-AG is produced from an inositol-1,2-diacylglycerol precursor 8,16,17.
What is cannabinoid hyperemesis syndrome? Here’s what to know, and why experts say it’s on the rise
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 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. To diagnose CHS, a healthcare professional will study your symptoms and ask you questions.
Clinical Presentation, work up and differential diagnosis of Cannabinoid Hyperemesis Syndrome
This guide outlines the necessary steps to manage acute symptoms and navigate the path toward full health. Cannabinoid hyperemesis syndrome (CHS) is a condition in which a patient experiences cyclical nausea, vomiting, and abdominal pain after using cannabis. The almost pathognomic aspect of a patient’s presenting history is that their symptoms are relieved by hot baths or shower. This activity introduces the pathophysiology, clinical manifestation, and management of cannabis hyperemesis. In clinical practice CHS is most often confused with cyclic vomiting syndrome (CVS).
- Recent studies have explored the potential use of biomarkers in diagnosing CHS.
- • The hyperemetic phase, marked by recurrent vomiting and nausea, may last 24 to 48 hours.
- That disorder is cannabis (cannabinoid) hyperemesis syndrome (CHS)—a condition that can push otherwise healthy people into repeated emergency room visits, severe dehydration, and even kidney failure.
- Anandamide is synthesized from the precursor N-arachidonoyl phosphatidylethanolamine, while 2-AG is produced from an inositol-1,2-diacylglycerol precursor 8,16,17.
CHS in emergency care
Until more studies are done on cannabis in all its new forms, putting cannabis “under the umbrella of a safe, Sober living house legal drug is wrong,” she said. Modern companies have “turned out inconspicuous vape pens, fast-acting edibles and pre-rolled joints infused with potency enhancers and concentrates” that contain as much as 99% THC. With these new products, hospitals saw influxes of CHS, and researchers called for more public health guidance and education for providers. Diagrammatic representation of the pathophysiology of cannabinoid hyperemesis syndrome (CHS).4 5 TRPV1, transient receptor potential vanilloid 1.
Drugs with an anticholinergic effect may likewise block medullary mediated vomiting, though they Sober living house 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. 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. An intriguing point to keep in mind is that the Rome IV criteria include the phrase “resembling cyclical vomiting syndrome.” In that regard, it is important to distinguish between the two.
Between 2016 and 2022, researchers at the University of Illinois Chicago found that CHS visits to emergency departments rose from roughly 4 visits per 100,000 people visiting the emergency department to 22 visits per 100,000. If you need help quitting, speak to a healthcare provider or connect with your local addiction treatment services. In the brain, the cannabinoid system helps regulate several aspects of the endocrine system. CB1 receptor activation in the hypothalamus and pituitary gland results in modulation of all hypothalamic-pituitary axes 38. Receptor activation leads to inhibitory effects on the release of growth hormone, thyroid hormone, prolactin, and luteinizing hormone 38.
The exact mechanism of hyperemesis associated with long-term cannabis use is unknown
Both primary research and secondary literature, such as systematic reviews and meta-analyses, were included to provide a broad perspective on the condition. One study found up to 6% of people who went to the emergency room for cyclical vomiting had CHS. But because CHS is a somewhat newly discovered condition that was first diagnosed in 2004, some people may be underdiagnosed or misdiagnosed.
- The only way to stop CHS and its symptoms is to completely quit using cannabis.
- This buildup is thought to eventually overstimulate the endocannabinoid system, leading to a paradoxical reaction where the drug, which usually suppresses nausea, begins to cause it.
- 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.
- The word “cannabinoid” refers to compounds uniquely found in cannabis, and “hyperemesis” means severe vomiting.
- In two case reports, doctors used lorazepam (Ativan) to manage CHS-related nausea and vomiting.
- If you are experiencing severe vomiting or other concerning symptoms, contact your health care provider.
Future studies following patients longitudinally for extended periods of time are needed. Nothing in this website is meant to be used for medical or nursing diagnosis or professional treatment. There are significant differences between the adult and pediatric populations regarding CHS. Available literature shows that about one-third of patients in the pediatric population do not experience nausea and vomiting, and only half experience resolution of symptoms with cessation of cannabis use. This differs from the adult population where nearly 100% of patients experience nausea and vomiting as well as resolution of symptoms with cessation of cannabis use. Dehydration and electrolyte imbalances are significant concerns during an acute episode.
Cannabinoid Hyperemesis Syndrome (CHS) and the Cyclic Vomiting Syndrome (CVS) in Adults
The use of lorazepam for CHS is also off-label, so a person’s doctor would need to make them aware of this fact. Results from these case studies suggest that lorazepam might be an effective drug to control symptoms during the hyperemesis stage. Another doctor reported using a combination of injectable lorazepam and promethazine, another antinausea medication. Currently, doctors do not have treatment guidelines for the management of CHS. Most of the evidence on effective treatment and management comes from published case reports.