Cannabinoid hyperemesis syndrome

Cannabinoid hyperemesis syndrome (CHS)
Synonyms
Pronounce
Field	Toxicology
Symptoms	Nausea, vomiting, stomach pain
Complications	Kidney failure, electrolyte problems, skin burns from hot water
Onset
Duration
Types
Causes	Long term cannabis use
Risks
Diagnosis	Based on the symptoms
Differential diagnosis	Cyclical vomiting syndrome
Prevention
Treatment	Stopping cannabis, hot showers
Medication	Capsaicin cream
Prognosis
Frequency	2.7 million per year (US)
Deaths

Cannabinoid hyperemesis syndrome (CHS) is a medical condition associated with chronic cannabis use, characterized by recurrent bouts of nausea, vomiting, and abdominal pain. Relief from these symptoms is often found temporarily through hot baths or showers. CHS can lead to complications such as kidney failure, electrolyte imbalances, and skin burns from excessive hot water use. Cases of fatalities linked to CHS have been reported.

Etiology

CHS typically manifests in individuals who consume cannabis on a weekly basis. The precise pathophysiological mechanisms behind CHS remain unclear, although several theories have been proposed.

Clinical Presentation

The symptoms of CHS can often persist for an extended period before a diagnosis is reached. The syndrome can mimic cyclic vomiting syndrome, another condition with recurrent episodes of severe vomiting.

Phases of CHS

CHS can be divided into three clinical phases:

Prodromal Phase: This phase often consists of nausea and abdominal discomfort upon waking, and a fear of vomiting. It may last for months or years, and patients continue using cannabis due to its known antiemetic properties. Hyperemetic Phase: This phase is characterized by continuous nausea, vomiting, and dehydration. Patients often take hot showers to relieve symptoms. Weight loss over 5 kg is commonly seen. Recovery Phase: This phase begins within days of stopping cannabis and may last for days, weeks, or months. Patients usually regain their appetite and normal bathing habits during this period.

Diagnosis

Diagnosis of CHS is primarily based on clinical symptoms, particularly in patients with a history of chronic cannabis use. The diagnosis is often delayed due to the lack of awareness of the condition.

Treatment

The definitive treatment for CHS is abstaining from cannabis use. Symptomatic relief may take up to two weeks to occur. During acute vomiting episodes, treatment is generally supportive. There is preliminary evidence supporting the use of capsaicin cream applied on the abdomen to alleviate symptoms during an acute phase.

Epidemiology

The prevalence of CHS is not well-determined. In the United States, around 6% of patients who present to the emergency department with recurrent vomiting are diagnosed with the condition.

History

CHS was first described in the medical literature in 2004. Simplified diagnostic criteria for CHS were published in 2009.

References

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