Psychological stress, such as post-traumatic stress disorder or a history of physical and sexual abuse, are potential triggers for disrupting the expected anti-emetic effects of THC. Though the precise mechanisms remain unclear, higher amounts of marijuana consumption, genetic influences, and psychological stress lead to intoxication and paradoxically promote vomiting. Understanding the ECS and its impact on the brain’s vomiting center is essential in the CHS pathophysiology 25,26. The ECS includes ligands, receptors, signaling pathways, and enzymes acting as regulators and inhibitors.
Physical, Emotional, and Social Effects of CHS
During this phase, patients may experience morning nausea, abdominal discomfort, or anxiety about vomiting. Symptoms, patients often eat well, maintain weight, and remain functional at work. The patients continue using cannabis in this phase, believing in its anti-nausea effects. TRPV1, PPARα, GRP55, and GRP119 are the other receptors influenced by cannabinoids 27. Cannabinoid receptor type 1 (CB1R) is a G protein-coupled receptor (GPCR) primarily expressed in the central nervous system but also found in peripheral tissues.
- Eventually, sufficiently high concentrations may be achieved to stimulate TRP channels to their emetic threshold (9).
- All laboratory findings were unremarkable, including normal 24-h urine porphyrin levels and urinalysis.
- Cannabis legalization should include balanced details on its benefits and potential risks.
- They are frequently located closer to CB1 receptors, indicating a potential functional interaction.
- Severe nausea, vomiting, and stomach pain are the hallmark symptoms of cannabinoid hyperemesis syndrome (CHS).
CHS Symptoms
Multiple and forceful vomiting events can cause Mallory–Weiss tears with hematemesis and rarely lead to pneumomediastinum or Boerhaave’s syndrome 58. Multiple studies report pathological frequent and prolonged hot shower behaviors with CHS. Hot showers have been reported to assist in stabilizing the hypothalamic thermostat, frequently altered by chronic cannabis use 51. Accordingly, they have been reported as one of the therapeutic modalities for the management of the CHS. Further, these behaviors could also be noted in CVS, preadolescents, and adolescents with no prior exposure to cannabis 8. These changes from hot bathing are probably not specific to CHS but can be seen across all functional nausea and vomiting disorders, including CVS, and are probably aggravated by cannabis use 9.
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This constellation of genetic susceptibilities may represent a valid diagnostic tool for identifying at-risk individuals. https://ecosoberhouse.com/ Disorder but rather a manifestation of the gene–environment interaction in a rare genetic disease unmasked by a toxic reaction to excessive THC exposure 47. A recent study Omri Bar et al. showed 12 genes that were “Highly likely” (SCN4A, CACNA1A, CACNA1S, RYR2, TRAP1, MEFV) or “Likely” (SCN9A, TNFRSF1A, POLG, SCN10A, POGZ, TRPA1) to be CVS-related 48. As per this study, CVS is likely the result of a vicious cycle of elevated intracellular cations and mitochondrial dysfunction leading to cellular hyperexcitability 48. The endogenous ligands, AEA and 2-AG, are derived from arachidonic acid.
Cannabinoid Hyperemesis Syndrome (CHS): Causes, Symptoms, and Treatment
Another proposed explanation is that in susceptible individuals the pro-emetic effect of cannabis on the gut (e.g. delayed gastric emptying) overrides its anti-emetic CNS properties 62. This hypothesis is supported by the demonstration of delayed gastric emptying on gastric emptying scintigraphy in some cases 6,55,62. Further research is required to investigate the gastrointestinal physiology in these patients during both the acute attacks of hyperemesis and between episodes.
- Or they might think it’s something else, since repeated throwing up is a sign of many health problems.
- Benzodiazepines, with their gamma-aminobutyric acid (GABA) agonistic actions, inhibit the medullary and vestibular nuclei, causing anti-emetic action.
- Some patients use hot water bags across the center of their belly and can burn the skin if done a lot.
- This has increased both the number of people using the drug and the «high» in the available weed.
- 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.
This may be difficult if marijuana is being used as an appetite stimulant or for treatment of chemotherapy-induced nausea and vomiting. If willing, patients should be referred to a substance abuse rehabilitation center. Initially patients present with prodromal symptoms of abdominal discomfort and nausea. Patients are still able to tolerate a liquid diet in this prodromal phase. Indeed, with any syndrome that results in frequent vomiting, there is a concern for a disorder of electrolytes and fluid balance in the body. Patients who fail to respond to antiemetic therapy are at high risk for dehydration and resulting in nutritional deficiencies.
- The exact reason for marijuana causing CHS is yet not fully understood by the scientists and remains a controversial topic.
- He had learned this behavior after experiencing previous episodes of self-limited nausea, vomiting, and abdominal pain.
- This episode is debilitating and overwhelming, with patients vomiting and retching up to five times per hour, requiring several emergency room (E.R.) visits.
- This approach is often enhanced by personalized feedback and education regarding the treatment seeker’s patterns of cannabis use, becoming motivational enhancement therapy.
- Understanding what triggers cannabinoid hyperemesis syndrome (CHS) can help those affected make better decisions about their cannabis use.
Hyperemetic Phase of CHS –
In clinical practice CHS is most often confused with cyclic vomiting syndrome (CVS). In fact patients with CHS are often mislabeled as having CVS and vice versa. Confusion exists in the medical literature secondary Oxford House to a failure to recognize chronic marijuana use as a source of vomiting. For example, in two recently published series of adult patients with CVS, approximately one third of patients reported daily marijuana use 65,66.
Emetic Phase
Twenty-four hour urine porphyrin levels were normal and urinalysis did not show occult blood. Three years ago, he underwent upper endoscopy and colonoscopy, which were also unremarkable. This chs syndrome condition adversely affected all aspects of his life, including his relationship with family, friends and peers, making him unemployable. In retrospect, he had likely accumulated cannabis in his adipose tissue over the 2 years, he was on cannabidiol. Moreover, due to the highly lipophilic nature of cannabis, initiation of the ketogenic diet may have resulted in attainment of plasma concentrations high enough to induce a pro-emetic effect.
