Cannabinoid hyperemesis syndrome

Clinical Presentation and Phases

• CHS is characterized by recurrent nausea, vomiting, and abdominal pain.
• Symptoms may be temporarily relieved by hot showers or baths.
• Complications can include kidney failure and electrolyte imbalances.
• Weekly cannabis use is often linked to the syndrome.
• Synthetic cannabinoids can also trigger CHS.
• Prodromal Phase involves mild symptoms like nausea and anxiety, which worsen in the morning and may last for months.
• Hyperemetic Phase involves persistent nausea, vomiting, and abdominal pain, with episodes lasting 24-48 hours.
• Recovery Phase begins after abstaining from cannabis, with symptoms resolution varying from 2 weeks to 1-3 months.

Pathogenesis and Diagnosis

• Cannabis contains over 400 chemicals, with about 60 being cannabinoids.
• Role of THC amount, duration, and stress in CHS not fully understood.
• Genetics, stress, and emotional factors may influence CHS risk.
• Various theories on CHS pathogenesis exist, including cannabinoid buildup and receptor functionality.
• THC, a fat-soluble cannabinoid, can accumulate in fat stores, leading to the reintoxication effect.
• Rome IV criteria established in 2016 for CHS diagnosis.
• Symptoms resemble cyclic vomiting syndrome and cease with cannabis cessation.
• History of cannabis use is crucial for diagnosis.
• Urine drug screen can confirm cannabinoid presence.

Treatment and Management

• Traditional medications for nausea and vomiting are often ineffective.
• Supportive treatment focuses on stopping cannabis use.
• Proper patient education includes linking symptoms to cannabis use.
• Clinical pharmacists can assist in patient education and mental health referrals.
• Abstinence from cannabinoids is the main treatment.

Epidemiology and History

• Under-reporting of CHS cases is likely.
• Analysis shows an increase in ER attendees with cannabis use disorder.
• CHS is more common in daily cannabis users.
• States with legalized cannabis have seen a rise in CHS cases.
• Prevalence of CHS is expected to increase with cannabis legalization.
• CHS was first reported in South Australia in 2004, with the term coined in the same year.
• Warm baths were found to provide relief for some patients.

Research, Publications, and Awareness

• Genetic differences in cannabis users may affect CHS risk.
• Pathophysiology of CHS, especially gut effects of cannabinoids, is unclear.
• Long-term outcomes of CHS patients are unknown.
• Various publications and clinical studies focus on CHS, its treatment, diagnosis, and medical research.
• Media coverage and public awareness of CHS are limited, with emergency departments increasingly diagnosing the condition.

Cannabinoid hyperemesis syndrome Data Sources