Symptoma

Cannabinoid Hyperemesis Syndrome

CHS

CASE PRESENTATION A 45-year-old man presented to the ED with a 5-day history of persistent nausea and vomiting that began abruptly. The symptoms had been constant since onset, resulting in very little oral intake. [ncbi.nlm.nih.gov]

The results of this initiative are presented here (Figure). [westjem.com]

The present case is that of a 29-year-old, 15-week pregnant woman who presented with symptoms suggestive of Cannabis induced panic disorder and Cannabis Hyperemesis Syndrome. [scitechnol.com]

This constellation of symptoms is not typically present in CHS, and patients do not abstain from cannabis [2, 3]. [hindawi.com]

However, subjects with acute cannabinoid intoxication are present more and more frequently in emergency departments (EDs) or clinics. [iem-student.org]

  • Vomiting

    Cyclical vomiting syndrome (CVS) causes similar symptoms. [weedmaps.com]

    Are cyclic vomiting syndrome and cannabinoid hyperemesis syndrome the same thing? There is definite overlap between cyclic vomiting syndrome and CHS. [uwhealth.org]

    Per the Nelson Textbook of Pediatrics, cyclic vomiting syndrome is defined by having sudden onset episodes of vomiting, having at least four bouts of vomiting per hour, and often having 12 to 15 episodes of vomiting per day. [statpearls.com]

    Yet some chronic cannabis users may develop Cannabinoid Hyperemesis Syndrome (also sometimes called “Cannabis Hyperemesis Syndrome,” a condition that causes persistent vomiting, seemingly endless vomiting episodes, and severe abdominal pain. [remedycolumbia.com]

    Heavy Marijuana Use Linked To Vomiting Illness. Retrieved from [drugrehab.com]

  • Nausea

    This may explain its beneficial effect of reducing nausea and vomiting in our patient. [hindawi.com]

    Because cannabis is usually known to help keep nausea and vomiting at bay, these users may consume more cannabis once symptoms of CHS present. [weedmaps.com]

    However, many patients up their cannabis use, thinking the cannabis will cure their nausea and vomiting. It’s obviously paradoxical that cannabis (which many patients use to get rid of nausea and vomiting) could cause it others. [remedycolumbia.com]

    Patients often demonstrate the learned behavior of frequent hot bathing, which produces temporary cessation of nausea, vomiting, and abdominal pain. [eurekaselect.com]

  • Abdominal Pain

    Physicians should have a high index of suspicion for this rare condition in patients with unexplained chronic abdominal pain and vomiting. This report provides useful information on a rare disease as the cause of chronic abdominal pain and vomiting. [wjgnet.com]

    Narcotic use should be avoided for management of abdominal pain. Patients should be counseled against marijuana use. [the-hospitalist.org]

    […] by episodes of morning sickness and abdominal pain. [analesdepediatria.org]

    Upon further questioning, he reported the hot showers significantly helped the nausea and abdominal pain. He had learned this behavior after experiencing previous episodes of self-limited nausea, vomiting, and abdominal pain. [ncbi.nlm.nih.gov]

    CHS is characterized by nausea, vomiting, abdominal pain and chronic cannabis use. Consider CHS diagnosis in patients with recurrent presentations and negative abdominal pain work-ups. Avoid opiates for CHS treatment. [emdocs.net]

  • Recurrent Vomiting

    vomiting, about 6% have the condition.[1] The syndrome was first described in 2004, and simplified diagnostic criteria published in 2009.[7][8] Signs and symptoms[edit] The long-term and short-term effects of cannabis use are associated with behavioral [en.wikipedia.org]

  • Epigastric Pain

    For the previous 20 years, he had experienced daily sharp epigastric pain with generalization to the entire abdomen. The pain typically began late in the morning and could last from hours to days. [cjgim.ca]

    Criteria essential for diagnosis include chronic marijuana use and then major features include cyclic N/V, epigastric pain, weekly use of marijuana, resolution of symptoms with cannabis cessation. [acep.org]

    And despite the intense GI symptoms and epigastric pain, endoscopy also is negative. Laboratory studies may reveal dehydration and subsequent electrolyte imbalance or acute renal failure, but will otherwise be unremarkable. [myamericannurse.com]

    Chronic cannabis use with hyperemesis, epigastric pain and conditioned showering behavior. Journal of Gastroenterology and Hepatology Research. 2012;1(6):107–110. [Google Scholar] 15. Nicolson SE, Denysenko L, Mulcare JL, Vito JP, Chabon B. [ncbi.nlm.nih.gov]

  • Musculoskeletal Pain

    Capsaicin, a chili-pepper derivative commonly used in topical creams to treat musculoskeletal pain, is thought to cause vasodilation and disrupt the impaired thermoregulatory processes contributing to the patient’s symptoms; it’s considered a substitute [myamericannurse.com]

  • Restless Legs Syndrome

    This patient began to use cannabis in 2004 for self-management of tremors, restless leg syndrome, and to calm his irritability and anxiety. [journals.sagepub.com]

  • Aura

    Researchers frequently describe them as similar to the “aura” of migraines because they precede an intense worsening of symptoms. In this phase, patients experience nausea, mild GI discomfort, and anxiety or restlessness. [myamericannurse.com]

  • Amnesia

    Now, a new study provides insight on this association, revealing how cannabinoids in the drug activate receptors in the mitochondria of the brain's memory center to cause amnesia. [dalgarnoinstitute.org.au]

  • Intracranial Hemorrhage

    Hemorrhage Ischemic bowel Meningitis Sepsis Emergent Acute radiation syndrome Acute gastric dilation Acetaminophen toxicity Adrenal insufficiency Appendicitis Aspirin toxicity Bowel obstruction/ileus Carbon monoxide poisoning Cholecystitis CNS tumor [wikem.org]

Prior workup included abdominal radiographs, abdominal ultrasonography, abdominal CT, and gastric biopsy; all are normal. He has mild gastritis and esophagitis on esophagogastroduodenoscopy and mildly delayed gastric emptying. [mdedge.com]

Physicians should be aware of this unique cluster of symptoms to avoid misdiagnosis even after a protracted, invasive and costly workup. [wjgnet.com]

An initial workup showed a mild elevation of serum creatinine to 1.36 mg/dL (baseline is 1.10 mg/dL). [ncbi.nlm.nih.gov]

Earlier recognition of this syndrome can help reduce unnecessary workups, doctor visits, and hospital admissions. The prognosis is very good with resolution of symptoms in most patients upon cessation of cannabis use. [sites.kowsarpub.com]

As a result, patients may undergo extensive negative workups for various other conditions, such as CVS, pancreatitis, and gastroparesis, which may mimic some symptoms of CHS. [uspharmacist.com]

CHS patients frequently present to the emergency department and may require treatment for intractable emesis, dehydration, and electrolyte abnormalities. [ucdavis.pure.elsevier.com]

Conclusion An expert consensus treatment guideline is provided to assist with diagnosis and appropriate treatment of CHS. [westjem.com]

In an expert consensus treatment guideline, topical capsaicin 0.075% applied three times daily to the back of the arms or abdomen is recommended as a reasonable first-line treatment [17]. [clinmedjournals.org]

[Topical capsaicin cream in the treatment for cannabinoid hyperemesis syndrome]. Med Clin (Barc). 2016;147(11):517-518. Graham J, Barberio M, Wang Capsaicin cream for treatment of cannabinoid hyperemesis syndrome in adolescents: a case series. [epmonthly.com]

Research on the treatment of CHS is limited. [emdocs.net]

Long-term follow-up and prognosis of CHS have not been reported previously. [wjgnet.com]

Prognosis The prognosis is generally good as long as the diagnosis is made early and the patient commits to cannabinoid cessation. [statpearls.com]

She was subsequently lost to follow-up; thus we were unable to determine her long-term prognosis. 3. Discussion The pathophysiology behind cannabis-induced hyperemesis is not completely understood. [hindawi.com]

The prognosis is very good with resolution of symptoms in most patients upon cessation of cannabis use. More studies are needed for better understanding of the etiology, prevalence, and risk factors for developing this syndrome. References 1. [sites.kowsarpub.com]

[…] metoclopramide).[19] Acetaminophen has shown some benefit in case reports for alleviating headaches associated with CHS.[11] Opioids can provide some relief of abdominal pain, but their use is discouraged due to the risk of worsening nausea and vomiting.[10] Prognosis [en.wikipedia.org]

Once out of hospital, follow‐up was limited, and weaning off cannabis, the only etiological treatment, was difficult to set up. [onlinelibrary.wiley.com]

It demands a finely detailed history to further tease out an etiology as well as directed treatments. [statpearls.com]

Etiology and Pathophysiology The pathophysiology remains unknown, but there have been multiple proposed mechanisms. Cannabinoids such as cannabidiol (CBD) at high doses may be proemetic, whereas low doses are antiemetic (3). [unboundmedicine.com]

To rule out other organic etiologies, the patient underwent abdominal computed tomography, which was unremarkable. Upper gastrointestinal endoscopy with gastric biopsies revealed no pathology. [cjgim.ca]

CVS has an unknown etiology, though it is associated with psychological stressors and family history of migraines. [ncbi.nlm.nih.gov]

Knowledge of the epidemiology, pathophysiology, and natural course of Cannabinoid Hyperemesis Syndrome is limited and requires further investigation. [eurekaselect.com]

The objectives of this study were to describe the prevalence of CHS, the patients' epidemiological characteristics, and to show the difficulties encountered in caring for these patients in emergency departments, the extent of health care and an unsuitable [onlinelibrary.wiley.com]

However, it is likely that CHS is under-recognized and under-reported.2,4,5 CHS symptoms may be misattributed to cyclic vomiting syndrome,3 because 50% of patients diagnosed with cyclic vomiting syndrome report daily Cannabis use.6 There is no epidemiological [mdedge.com]

Cyclic vomiting syndrome: epidemiology, diagnosis, and treatment. Clin Auton Res. 2018 Apr;28(2):203–9. Alaniz VI, Liss J, Metz TD, Stickrath E. Cannabinoid hyperemesis syndrome: a cause of refractory nausea and vomiting in pregnancy. [iem-student.org]

Table 2 summarizes some of the epidemiological and clinical characteristics that may help distinguish CVS and CHS. [ncbi.nlm.nih.gov]

Objective: This aim of this review is to investigate the pathophysiology of CHS and evaluate the published literature on pharmacologic treatment in the emergency department. [ucdavis.pure.elsevier.com]

Etiology and Pathophysiology The pathophysiology remains unknown, but there have been multiple proposed mechanisms. Cannabinoids such as cannabidiol (CBD) at high doses may be proemetic, whereas low doses are antiemetic (3). [unboundmedicine.com]

More clinical and pre-clinical research is needed to fully understand the underlying pathophysiology of this disorder and the negative consequences of prolonged high-dose cannabis use. [liebertpub.com]

Pathophysiology The pathophysiology of CHS is not clearly understood, but research is underway. Many theories have been proposed to explain its occurrence. For example, THC is highly lipophilic. [journals.lww.com]

Knowledge of the epidemiology, pathophysiology, and natural course of Cannabinoid Hyperemesis Syndrome is limited and requires further investigation. [eurekaselect.com]

Prevention You can prevent CHS by not using cannabis. References Adverse effects of cannabinoids. EBSCO DynaMed website. Available at: . Updated October 28, 2018. Accessed April 5, 2019. Cannabinoid hyperemesis syndrome. Cedars-Sinai website. [lahey.org]

Can Cannabinoid Hyperemesis Syndrome Be Prevented? Unfortunately, CHS cannot even be predicted, let alone prevented. Most people who use cannabis heavily never develop the syndrome, so prevention is not necessary for most people. [therecoveryvillage.com]

Prevention You can prevent CHS by not using cannabis. Resources DrugFree.org National Institute on Drug Abuse Canadian Resources Canadian Centre on Substance Use and Addiction Health Canada References Adverse effects of cannabinoids. [winchesterhospital.org]

Prevention You can prevent CHS by not using cannabis. References Cannabinoid hyperemesis syndrome. Cedars-Sinai website. Available at: . Accessed April 5, 2019. Revision Information Reviewer: EBSCO Medical Review Board Daniel A. [wkhs.com]