Trying to power through your daily responsibilities can chs syndrome feel almost impossible. This stage typically lasts about 24 to 48 hours but can extend longer, especially if you continue using marijuana. The rise in cannabis legalization could also mean more people have ready access to stronger strains. Since high-potency cannabis can pack a more powerful effect on the body, it’s possible that even fewer years of use could lead to CHS in some cases. If you or someone you care about is struggling with heavy marijuana use and unrelenting vomiting, learning about CHS might explain many of the symptoms you’re seeing. Read on to understand what CHS is, how it develops, what the main signs are, and why seeking help is critical if you want to break free from this difficult cycle.

Treatment / Management

• CBD enhances the expression of CB1 receptors in the hypothalamus and amplifies the hypothermic effects caused by THC 29.
• Dysfunction in these pathways leads to recurrent nausea and vomiting in CHS.
• However, further studies are warranted to support this finding to be used as a first-line treatment option for CHS management.
• That kind of specialized program will address what led you to use cannabis heavily in the first place.
• If vomiting is so frequent that you’re dangerously dehydrated, you might need hospital care.

This information is not published but raises questions regarding the role of an unidentified molecule, whether cannabinoid or non-cannabinoid (e.g., a pesticide) may precipitate of the syndrome. In practice, clinicians may have evolved treatment algorithms for managing CHS patients, but our search did not identify any studies reporting this. A case series from Spain from 2012 to 2016 involved 6 patients (5 men) with an average age of 28.3 years who, on average, began to use marijuana at age 16. 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.

Clinical Diagnosis of CHS

• Typical symptoms include intractable nausea and vomiting, refractory to conventional antiemetic therapy, often accompanied by abdominal pain.
• It is not clear if there is a comorbid association between CHS and anxiety or whether the symptoms of CHS are so distressing that patients become anxious.
• Without knowing this background, providers often misdiagnose CHS as other conditions, like cyclic vomiting syndrome (CVS).
• While patients benefit from rehydration and other forms of supportive care, the only effective treatment for CHS is marijuana cessation.
• This includes laboratory tests (complete blood count and differential, glucose, basic metabolic panel, pancreatic and hepatic enzymes, pregnancy test), urinalysis, urinary drug screen, and plain flat radiographic series 63,64.

Multiple and forceful vomiting events can cause Mallory–Weiss tears with hematemesis and rarely lead to pneumomediastinum or Boerhaave’s syndrome 58. 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.

Differential Diagnosis

• As CHS is a newly described condition, many doctors may find it challenging to diagnose and treat.
• Over the ensuing 48 hours, his symptoms improved and he was slowly weaned off medication.
• Evidence-based management of CHS is based on case series and small clinical trials 63.
• The cannabis plant contains over four hundred different chemicals, with sixty possessing cannabinoid structures 76.
• These foods/beverages are mostly acidic, but relationships between them and CHS have not been studied scientifically, although the co-use of weed and alcohol is well-known, the study authors said.

Serotonin antagonism in the gastrointestinal tract from medications such as ondansetron, dolasetron, and granisetron likewise have varying levels of efficacy. Drugs with an anticholinergic effect may likewise block medullary mediated vomiting, though they 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. 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. 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.

Supportive care with IV fluids and anti-emetics is the mainstay of treatment in the acute phase of illness. There is very limited evidence to suggest that agents such as dopamine antagonists and capsaicin cream and avoidance of opiate pain medications may be of benefit. While many providers utilize these agents in practice and find them effective, prospective case-control studies are needed before recommendations can be made based upon effectiveness. The authors of this study acknowledge the potential difficulties of such studies, owing to the fact that CHS is a heterogeneous clinical entity, and thus, selecting a comparable group of patients may prove difficult. Additionally, agents such as topical capsaicin cream are not commonly stocked in hospitals and emergency departments but could be made available in the outpatient setting. There is moderate evidence to support that the definitive treatment for CHS is cannabis cessation.

Experts also aren’t clear on what causes CHS, or why some people develop it while others don’t. Since it was first identified in 2004 in Australia, researchers have looked at the effects of cannabis on the vomiting centers of the brain. When Dr. Deepa Camenga began her career about 20 years ago, she rarely if ever saw pediatric patients with CHS, she https://ecosoberhouse.com/ said. Today, hospitals in her area around New Haven, Connecticut, see pediatric CHS cases nearly every day, she added. 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. Here is what pediatric health care providers need to know about this often debilitating disorder.

Amos Cottage Therapeutic Day Program: Empowering Children with Special Needs

Furthermore, CBG may be able to reverse the antiemetic properties of CBD 38. This would mean that the proemetic effects observed in CHS involve an interplay of processes, possibly including high levels of CBD reversed by CBG 39. Severe and uncontrollable vomiting increases the risk of dehydration and electrolyte imbalances, and in rare cases, patients can experience esophageal tears, Camenga said. Doctors often treat CHS patients who seek help at hospitals with fluids. “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.

A Comprehensive Review and Update on Cannabis Hyperemesis Syndrome

THC is excreted mainly as acid metabolites, with 60–85% cleared through the feces and 20–35% in the urine 20,21. Even cannabis products that don’t contain THC have the potential to cause or worsen CHS. If you need help quitting cannabis, the Substance Abuse Alcoholics Anonymous and Mental Health Services Administration offers a 24/7 helpline in English and Spanish. A representative can refer you to local treatment facilities, support groups, and community-based organizations.

Clinical Presentation, work up and differential diagnosis of Cannabinoid Hyperemesis Syndrome

Only peer-reviewed articles, case reports, clinical trials, and review articles focusing on CHS or its comparison with similar disorders (e.g., CVS) were considered. Both primary research and secondary literature, such as systematic reviews and meta-analyses, were included to provide a broad perspective on the condition. Cannabinoid hyperemesis syndrome (CHS), or cannabis hyperemesis syndrome, is caused by long-term cannabis (marijuana) use. People who have CHS experience repeated and severe bouts of nausea, vomiting, dehydration and stomach pain. Long-term management success relies on patient and physician commitment, availability, and the coordination of regular follow-up visits. Establishing trust and rapport between the patient and physician is crucial.

Some people find that certain foods trigger their symptoms, while others struggle with maintaining proper nutrition due to frequent vomiting episodes. A nutritionist can help develop a diet plan that supports recovery and overall health. It is often described as a syndrome that affects only a small portion of people who are heavy, chronic cannabis users. However, research suggests that it could be far more prevalent and may continue to increase due to factors like the legalization of marijuana and the increased use of medical marijuana.