Additionally, gradual titration of the dose prevents cardiac arrhythmias. TCA is used in caution with underlying cardiac arrhythmias, recent myocardial infarction, mania, or severe liver disease 97. Amitriptyline use is not advised during pregnancy, and it is classified as a Category C drug by the FDA. Motility, mucosal hemostasis, and the release of chemical mediators such as histamine, prostaglandin, acetylcholine, and serotonin 68. Cannabinoid’s interaction with cannabinoid receptors inhibits GABA-mediated neurotransmission, thus reducing the negative inhibition of dopaminergic neurons. This increases dopamine release and decreases extracellular glutamate in the striatum and mesolimbic systems 69,70.
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- It has been suggested that this is due to the fact that cannabinoid use is about double in younger people compared to older individuals 135.
- Still, others fault cannabis products themselves, suggesting that excessive THC or commercial pesticides might trigger the condition.
- In some cases, lorazepam may be helpful to counteract the anxiety suffered by the patient, but lorazepam as treatment for CHS is generally not effective 116.
- In a healthy individual, the stress response results in the release of corticotrophin-releasing hormone from the hypothalamus into the capillaries and going to the pituitary gland.
- Oncology patients may be advised to use cannabinoids to relieve chemotherapy-induced nausea and vomiting, only to develop CHS over time.
Or they might think it’s something else, since repeated throwing up is a sign of many health problems. You may need to see a gastroenterologist, a doctor who specializes in the digestive tract, for a proper diagnosis. The throwing up can be bad and can cause you to be low on body water. We fix this by giving the water back through the veins and giving drugs to stop the sick feeling and lower the acid in the stomach.
- Additionally, anxiolytic and sedative properties aid in counteracting the abnormal sympathetic nervous system response, helping in the reduction in vomiting and decreasing pain perception 67.
- Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months.
- Shrine, indicating its use in ancient Jewish religious ceremonies 2.
- Partnership with cannabis producers and retailers to include CHS warnings on packaging similar to alcohol and tobacco products will improve awareness among its users.
- One of the 4 who recovered went back to using marijuana and the vomiting resumed.
Are there methods for taking cannabis without worsening CHS?
This constellation of genetic susceptibilities may represent a valid diagnostic tool for identifying at-risk individuals. 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.
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Our emergency department (ED) experience is similar to others who report CHS is unresponsive to conventional pharmacologic anti-emetics 2, 3. Failure of standard ED medications results in additional testing and hospital admission when clinicians are afraid they are missing something 4. We recently published a case series of patients that improved dramatically with haloperidol after failing standard medications, all patients ended up going home from the ED 5. That alcoholism symptoms compelling case series was not referenced in the otherwise excellent review 1. Haloperidol also has a long successful history of clinical use for post-operative nausea 7.
Practice Management
Immersing oneself in very hot water relieves vomiting symptoms in CHS patients but has no antiemetic effect on patients with other types of CVS or PV. Thus, learned behavior of bathing in hot water may be used to help diagnose CHS and differentiate it from other CVS 93. Over 90% of CHS patients exhibit this behavior 75, which is sometimes described as compulsive. The patient found that hot water relieved his symptoms better than anything else. After 3 days in the hospital (and no marijuana use), his symptoms resolved 94.
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- The objective of our research was to establish a clinically meaningful description of CHS and its presentation, to evaluate diagnostic challenges in identifying this syndrome, and to describe effective treatment options.
- Establishing trust and rapport between the patient and physician is crucial.
- CHS often goes undiagnosed due to inconsistent criteria, subjective symptoms, and similarity to cyclical vomiting syndrome (CVS).
Symptoms of CHS often improve with cessation of cannabis use but are also noted to respond with compulsive hot showers 12. The exact prevalence of CHS is hard to assess due to its variable presentation. It is essential what is chs to raise CHS awareness with increasing cannabis legalization, which would also help us understand its mechanisms, early recognition, and treatment. This review will explore the recent update on CHS’s pathophysiology, prevalence, and treatment options based on the Rome criteria. Chronic or excessive use of cannabinoids may also stimulate the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system in addition to disrupting the endocannabinoid system. The endocannabinoid system plays a role in allostasis of the autonomic nervous system following episodes of stress 55.
