Cannabinoid hyperemesis syndrome (CHS) is a condition that sometimes develops due to the long term use of marijuana. The syndrome causes repeated and severe vomiting and nausea.As CHS is a newly described condition, many doctors may find it challenging to diagnose and treat. Researchers have tried to explain what causes CHS, but further study is necessary.
In this article, we describe CHS and discuss the causes, symptoms, diagnosis, and treatment of the condition.
People with CHS usually have a long historyTrusted Source of marijuana use. They also experience episodes of vomiting that return every few weeks or months.
When people with CHS stop using marijuana, their symptoms of nausea and vomiting usually disappear. Nausea and vomiting tend to return if they start using marijuana again.
Doctors also noticed that individuals with CHS would take frequent hot showers and baths. People with the syndrome tended to feel better when bathing.
Many people with CHS go to their doctor or an emergency room (ER) for treatment. However, doctors may find it challenging to diagnose the syndrome because people tend not to report their use of marijuana.
CHS is also underdiagnosed because people sometimes use marijuana to suppress nausea and vomiting. Doctors currently lack knowledge of the condition, and there are no clinical guidelines for its treatment and management.
With the consumption of marijuana increasing due to the legalization of its recreational use in many states, doctors may receive more reports of side effects from marijuana use.
On the basis that only a small number of regular and long term users of marijuana develop CHS, some researchers suggest that genetics might play a role. Other researchers theorize that the effects of marijuana can change with chronic use.
Researchers have identified two receptors called CB1 and CB2 to which marijuana molecules attach. Receptors are specialized cells that respond to specific stimuli or changes in the environment.
CB1 receptors are mostly present in the brain, but they also occur in other organs. Research suggests that CB1 receptors regulate the effects of marijuana on the gastrointestinal tract. Scientists do not know much about the function of the CB2 receptors.
In CHS, receptors that bind to the different components of marijuana can become altered. Some receptors may become more active, while others can shut down. These changes may be responsible for the symptoms of CHS.
The evidence supporting these theories is lacking, though, and further study is necessary to confirm the cause of CHS.
severe, recurring nausea and vomiting that follows a pattern
symptoms that resolve when the person stops using marijuana
relief of symptoms with hot showers or baths
abdominal pain
3. Other features that support a diagnosis of CHS include:
age younger than 50 years
weight loss of more than 5 kilograms (kg) during the hyperemesis stage
morning nausea and vomiting
normal bowel habits
Although this information comes from case reports, doctors can use these criteria to diagnose the condition more quickly. Once they have confirmed the diagnosis, treatment can begin.
One doctor reported using injectable lorazepam to help control nausea and vomiting symptoms in an adult. Within 10 minutes, nausea and vomiting stopped, and the person no longer felt abdominal pain.
Another doctor reported using a combination of injectable lorazepam and promethazine, another antinausea medication.
Results from these case studies suggest that lorazepam might be an effective drug to control symptoms during the hyperemesis stage.
However, doctors exercise caution when prescribing lorazepam because it is a controlled substance with the potential for abuse and addiction. The use of lorazepam for CHS is also off-label, so a person's doctor would need to make them aware of this fact.
CHS is a newly identified condition, so doctors currently know little about it. No clinical guidelines exist, so they must rely on published case reports to treat people with CHS.
Since 2004, doctors have identified key symptoms and characteristics of the condition that can help speed up diagnosis. However, researchers have yet to determine the cause of CHS since it does not affect all users of marijuana.
It is important for people with CHS to stop using marijuana because this will resolve their nausea and vomiting. Preventing dehydration and stopping nausea and vomiting are the treatment goals during the hyperemesis stage of the condition.
Researchers need to study CHS in more detail to make it easier for doctors to recognize and treat the condition. Further studies are also necessary to determine the causes of CHS and its risk factors.
