Cannabinoid hyperemesis syndrome
| Cannabinoid hyperemesis syndrome (CHS) | |
|---|---|
| Specialty | Gastroenterology |
| Symptoms | Nausea, vomiting, stomach pain[1] |
| Complications | Kidney failure |
| Causes | Use of cannabis[1] |
| Diagnostic method | Based on the symptoms[2] |
| Differential diagnosis | Cyclical vomiting syndrome[3] |
| Treatment | Cannabis cessation, hot baths and showers[2] |
| Medication | Capsaicin cream Diphenhydramine[2] |
Cannabinoid hyperemesis syndrome (CHS) is recurrent nausea, vomiting, and cramping abdominal pain that can occur due to cannabis use.[4][5]
CHS is associated with frequent (weekly or more often), long-term (several months or longer) cannabis use; synthetic cannabinoids can also cause CHS.[6][5] The underlying mechanism is unclear, with several possibilities proposed.[2][5] Diagnosis is based on the symptoms; a history of cannabis use, especially persistent, frequent use of high-dose cannabis products; and ruling out other possible causes of hyperemesis (persistent vomiting).[6] The condition is typically present for some time before the diagnosis is made.[6]
The only known curative treatment for CHS is to stop using cannabis.[7][2] Symptoms usually remit after two weeks of complete abstinence, although some patients continue to experience nausea, cyclic vomiting, or abdominal pain for up to 90 days.[6][8] Treatments during an episode of vomiting are generally supportive in nature (one example being hydration). There is tentative evidence for the use of capsaicin cream on the abdomen during an acute episode.[2]
Frequent hot showers or baths are both a possible sign (diagnostic indicator) of CHS, and a short-term palliative treatment (often called hot water hydrotherapy in the medical literature).[9][10]
Another condition that presents similarly is cyclic vomiting syndrome (CVS).[3] The primary differentiation between CHS and CVS is that cessation of cannabis use resolves CHS, but not CVS.[5] Another key difference is that CVS symptoms typically begin during the early morning; predominant morning symptoms are not characteristic of CHS.[11][12] Distinguishing the two can be difficult since many people with CVS use cannabis, possibly to relieve their symptoms.[5]
The syndrome was first described in 2004, and simplified diagnostic criteria were published in 2009.[13][14]
- ^ a b Sullivan S (May 2010). "Cannabinoid hyperemesis". Canadian Journal of Gastroenterology. 24 (5): 284–285. doi:10.1155/2010/481940. PMC 2886568. PMID 20485701.
- ^ a b c d e f g Korn F, Hammerich S, Gries A (February 2021). "[Cannabinoid hyperemesis as a differential diagnosis of nausea and vomiting in the emergency department]". Der Anaesthesist (Review) (in German). 70 (2): 158–160. doi:10.1007/s00101-020-00850-2. PMC 7850992. PMID 33090239.
- ^ a b Galli JA, Sawaya RA, Friedenberg FK (December 2011). "Cannabinoid hyperemesis syndrome". Current Drug Abuse Reviews. 4 (4): 241–249. doi:10.2174/1874473711104040241. PMC 3576702. PMID 22150623.
- ^ Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA (March 2017). "Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review". Journal of Medical Toxicology. 13 (1): 71–87. doi:10.1007/s13181-016-0595-z. PMC 5330965. PMID 28000146.
- ^ a b c d e DeVuono MV, Parker LA (June 2020). "Cannabinoid Hyperemesis Syndrome: A Review of Potential Mechanisms". Cannabis and Cannabinoid Research. 5 (2): 132–144. doi:10.1089/can.2019.0059. PMC 7347072. PMID 32656345.
- ^ a b c d Cite error: The named reference
BMJ2019was invoked but never defined (see the help page). - ^ Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA (March 2017). "Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review". Journal of Medical Toxicology. 13 (1): 71–87. doi:10.1007/s13181-016-0595-z. PMC 5330965. PMID 28000146.
- ^ Sun S, Zimmermann AE (September 2013). "Cannabinoid hyperemesis syndrome". Hospital Pharmacy. 48 (8): 650–655. doi:10.1310/hpj4808-650. PMC 3847982. PMID 24421535.
- ^ Senderovich H, Patel P, Jimenez Lopez B, Waicus S (2022). "A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options". Medical Principles and Practice. 31 (1): 29–38. doi:10.1159/000520417. PMC 8995641. PMID 34724666.
Hot water hydrotherapy is a common self-treatment for patients diagnosed with CHS as it can cause redirection of blood flow from the enteric system to the skin.
- ^ Richards JR, Lapoint JM, Burillo-Putze G (January 2018). "Cannabinoid hyperemesis syndrome: potential mechanisms for the benefit of capsaicin and hot water hydrotherapy in treatment". Clinical Toxicology. 56 (1): 15–24. doi:10.1080/15563650.2017.1349910. PMID 28730896.
- ^ Venkatesan T, Levinthal DJ, Tarbell SE, Jaradeh SS, Hasler WL, Issenman RM, et al. (June 2019). "Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association". Neurogastroenterology and Motility. 31 (Suppl 2): e13604. doi:10.1111/nmo.13604. PMC 6899751. PMID 31241819.
- ^ Rotella JA, Ferretti OG, Raisi E, Seet HR, Sarkar S (August 2022). "Cannabinoid hyperemesis syndrome: A 6-year audit of adult presentations to an urban district hospital". Emergency Medicine Australasia. 34 (4): 578–583. doi:10.1111/1742-6723.13944. PMC 9545654. PMID 35199462.
- ^ Allen JH, de Moore GM, Heddle R, Twartz JC (November 2004). "Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse". Gut. 53 (11): 1566–1570. doi:10.1136/gut.2003.036350. PMC 1774264. PMID 15479672.
- ^ Sontineni SP, Chaudhary S, Sontineni V, Lanspa SJ (March 2009). "Cannabinoid hyperemesis syndrome: clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse". World Journal of Gastroenterology. 15 (10): 1264–1266. doi:10.3748/wjg.15.1264. PMC 2658859. PMID 19291829.