This suggests that high doses of THC can lead to low levels of what is chs endocannabinoids within the hypothalamus, which may prevent inhibitory control of the HPA axis. More research is still needed to understand the impact of cannabinoids on hypothalamic endocannabinoid and endocannabinoid-related enzymes. An electrocardiogram may be useful to assess the patient’s QTc interval, especially in the context of antipsychotic medication use, as well as before the administration of certain antiemetics, which may prolong the QTc interval to extreme lengths.

Effects and Risk Factors of Cannabinoid Hyperemesis Syndrome

The profuse vomiting and potential dehydration inherent in CHS often mandate intravenous fluids administration to correct electrolyte imbalances and sustain hydration levels. Adequate fluid resuscitation is crucial during the acute phase of CHS to avert complications and ensure physiological stability. This evolution has been accompanied by a concerning uptick in cases of Cannabinoid Hyperemesis Syndrome (CHS), characterized by distressing bouts of nausea and vomiting with varying degrees of severity. Using cannabis for a prolonged period increases your risk of this condition. While any amount of long-term cannabis use can lead to CHS, daily cannabis use seems to be more likely to cause CHS than using it less often.

• Characterized by persistent nausea, severe vomiting, and stomach pain, CHS often leads patients to seek relief through compulsive bathing or hot baths, a hallmark symptom of the syndrome.
• The diagnostic criteria for CHS were ill-defined prior to the establishment of the Rome IV criteria of 2016.2223 Per the Rome IV criteria, all 3 of the following must be met to be diagnosed with CHS.
• A doctor confirmed that Brittany’s years of cannabis use had manifested in CHS.

Signs and Symptoms of Cannabinoid Hyperemesis Syndrome: Severe Vomiting

If you have cannabinoid hyperemesis syndrome (CHS), the best treatment is to stop using weed, even if you’ve been doing it for years with no previous side effects. Once you do that, your repeated nausea and vomiting should go away and not return. Since THC is stored in your body fat, it can take weeks to months before all the symptoms go away and you notice a difference. Smoking extra marijuana won’t help your nausea but will make it worse. Cannabinoid Hyperemesis Syndrome is a condition that affects individuals who use marijuana regularly, particularly those who have been using it for years or in large quantities. This syndrome is characterized by severe and persistent nausea, vomiting, and abdominal pain that do not respond to traditional anti-nausea treatments, and in many cases, it leads to dehydration and weight loss.

Complications

• In the case of CHS, the prolonged and high-dose use of cannabis can lead to an overstimulation of the cannabinoid receptors in the GI system.
• Cannabinoid Hyperemesis Syndrome is a serious but treatable condition linked to chronic cannabis use.
• Doctors at the hospital ran tests and ordered scans but could not name the source of her unrelenting nausea and vomiting.
• As CHS is a relatively recently recognized and studied phenomenon easily confused with other diseases, there is a paucity of sizeable randomized control studies.
• Researchers aren’t sure exactly why weed causes CHS symptoms only in some people.

In two case reports, doctors used lorazepam (Ativan) to manage CHS-related nausea and vomiting. Many people with CHS go to their doctor or an emergency room (ER) for treatment. However, doctors may find it challenging to diagnose the syndrome because people tend not to report their use of marijuana. When people with CHS stop using marijuana, their symptoms of nausea and vomiting usually disappear. Nausea and vomiting tend to return if they start using alcoholism treatment marijuana again.

How Does CHS Occur?

Furthermore, heat-induced vasodilation might facilitate toxin elimination through the skin, aiding in the detoxification process and potentially contributing to symptom improvement in individuals with CHS. Interestingly, patients dealing with Cyclical Vomiting Syndrome (CVS) also frequently mention this behavior. Yet, with the evolving comprehension of CHS, there is a likelihood that some cases attributed to CVS might actually be undiagnosed instances of CHS, marking it as pathognomonic.

The Rome IV criteria provide some objectivity to help with the diagnosis by placing CHS under the heading of functional gut-brain disorders, and consider it as a variant of CVS (Table 2). Venkatesan et al have proposed a new criterion for CHS with the use of clinical features, cannabis use patterns including duration and frequency, and symptoms resolution after at least 6 months of cessation 48. However, questions remain about the dosage of cannabis, individual and genetic susceptibility, abstinence period and the inclusion of abdominal pain as a criterion. The clinical effects of volume depletion dominate complications related to CHS. Reports of severe volume depletion resulting in acute kidney injury and severe electrolyte disturbances with rhabdomyolysis have been reported in the literature 49.

Cannabinoid Hyperemesis Syndrome: Symptoms, Causes, and Treatment

Camilleri also said that cannabis use is positively correlated with anxiety and depression, and noted that doctors should treat the whole patient and not just the disorder. Typical antiemetics such as ondansetron, commonly known as Zofran, have often been found ineffective at suppressing nausea caused by CHS. There are some drugs that may help, such as amitriptyline, Camilleri said. “There is evidence that if you send a message to the brain that competes with the message that’s causing the nausea, vomiting, that you can suppress it,” Camilleri said. One possible explanation for this is called “gate control theory,” which postulates that to some extent, the brain can regulate how much pain it perceives. Also, it’s possible there are more cases than have been reported, since not everyone with the illness will seek medical help or tell their doctor they use cannabis, the Cleveland Clinic notes.

• These therapies may offer transient relief but are not comprehensive solutions for CHS symptomatology.
• Studies show that between 90% to 100% of people with CHS use hot showering or bathing to relieve symptoms.
• While any amount of long-term cannabis use can lead to CHS, daily cannabis use seems to be more likely to cause CHS than using it less often.

When to Seek Emergency Medical Help

• Symptoms of CHS typically come on several years after the start of chronic marijuana use.
• Venkatesan et al have proposed a new criterion for CHS with the use of clinical features, cannabis use patterns including duration and frequency, and symptoms resolution after at least 6 months of cessation 48.
• In one study of frequent cannabis users with potential CHS symptoms, 33% of participants met the definition of CHS.
• While it is possible to return to feeling normal during the recovery phase, research indicates that symptoms recur if cannabis use resumes.

Genetic factors and individual differences in how the body processes cannabis may also play a role in the development of CHS. It is unclear, however, if this was due to an increase in cannabis use or an increase in cannabis use reporting due to the increased acceptance and legalization of cannabis. Schreck et al.62 determined that the rate of reporting in France is similar to that reported in international literature. These studies only provide estimates, and rely on accurate diagnosis and disclosure of cannabis use; therefore, they are likely underestimations of the actual prevalence. Indeed, Habboushe et al.64 acknowledge the limitations of their estimation and conclude that CHS is much more prevalent than is recognized in society. Prevalence cannot accurately be determined until accurate diagnosis and classification are agreed upon.