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Concept
Cannabinoid hyperemesis syndrome
Summary
Cannabinoid hyperemesis syndrome (CHS) is recurrent nausea, vomiting, and cramping abdominal pain that can occur due to prolonged, high-dose cannabis use. These symptoms may be relieved temporarily by taking a hot shower or bath. Complications may include kidney failure and electrolyte problems
Weekly cannabis use is generally required for the syndrome to occur; synthetic cannabinoids can also cause CHS. The underlying mechanism is unclear, with several possibilities proposed. Diagnosis is based on the symptoms, as well as the history of cannabis use (including a urine screen test if necessary). The condition is typically present for some time before the diagnosis is made. Another condition that presents similarly is cyclic vomiting syndrome (CVS).
The only known effective treatment for CHS is to stop using cannabis. Two weeks (or possibly more) may be required to see a benefit. The primary differentiation between CHS and CVS is that cessation of cannabis use only relieves CHS.
Treatments during an episode of vomiting are generally supportive in nature (e.g., hydration). There is tentative evidence for the use of capsaicin cream on the abdomen during an acute episode.
The syndrome was first described in 2004, and simplified diagnostic criteria were published in 2009.
The long-term and short-term effects of cannabis use are associated with behavioral effects leading to a wide variety of effects on the body systems and physiological states. CHS is a paradoxical syndrome characterized by hyperemesis (persistent vomiting), as opposed to the better known antiemetic properties of cannabinoids. Specifically, CHS takes the pattern of cyclical nausea, vomiting, and abdominal pain in the setting of chronic cannabinoid use. The abdominal pain tends to be mild and diffused. There are three phases of CHS: the prodromal phase, the hyperemetic phase, and the recovery phase.
The prodromal phase is characterized by mild symptoms of CHS, including nausea, anxiety, mild discomfort, sweating, and increased thirst; symptoms are more severe in the morning.
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