Nabilone mimics THC, the primary psychoactive compound found naturally occurring in cannabis. Despite the current acceptance of Nabilone as a treatment option for N/V in patients with CHS, there is a lack of data regarding the side effects of its prolonged use such as accumulation and toxicity, resulting in exacerbation of N/V rather than curing it. Indeed, with any syndrome that results in frequent vomiting, there is a concern for a disorder of electrolytes and fluid balance in the body. Patients who fail to respond to antiemetic therapy are at high risk for dehydration and resulting in nutritional deficiencies.
- Subsequently, after obtaining informed consent from the patient, it was decided to give a trial of haloperidol.
- As CHS is a relatively recently recognized and studied phenomenon easily confused with other diseases, there is a paucity of sizeable randomized control studies.
- In the emergency department, the patient’s temperature, heart rate, respiratory rate, and blood pressure were within or only slightly above the normal range.
- The exclusion criteria included studies published outside the time period of January 2009 to June 2021; non-English language articles that had poor translations; articles not assessing cannabinoid use and CHS as the primary focus; adolescent and youth populations under the age of 18 years were excluded.
- In view of our patient’s cyclic vomiting pattern, and repetitive admissions; extensive workup was conducted to exclude other causes of these alarming signs and symptoms.
- Most studies regarding the epidemiology of CHS lack information about patient histories, comorbid psychiatric illnesses, possible re-disposing factors, and type of cannabis consumed (i.e. THC percentage), which may aid the understanding of the etiology of CHS.
ED Management of Cannabinoid Hyperemesis Syndrome: Breaking the Cycle
Attribution errors, in which decisions are influenced by negative stereotypes, may lead clinicians to underestimate the possibility of serious diseases, hindering the diagnostic process 6. Anchoring errors, in contrast, result in clinicians rigidly adhering to initial impressions, even when presented with conflicting data, potentially delaying an accurate diagnosis and timely treatment 6. These cognitive pitfalls demonstrate the intricacies and challenges of medical decision-making and highlight the need for awareness and education among both health care professionals and patients to ensure comprehensive, patient-centered investigations.
Differential Diagnosis
- These supportive treatments can help people during the hyperemesis stage of the condition, but recovery depends on the person stopping their use of marijuana.
- More research on CHS is needed to enhance knowledge translation, education, and create awareness in the medical community on the side effects of cannabinoids and to propose the best treatment options.
- Many different treatments and dosages have been reported among case studies, which may not be generalized to the wider population.
At the 1-month follow-up visit, he did not report recurrence of nausea, vomiting or abdominal pain. Complete cessation of cannabis use is the most effective long-term treatment for CHS. However, advising patients with CHS to stop cannabis cannabinoid hyperemesis syndrome use immediately may cause cannabis withdrawal symptoms and high rates of relapse. Counseling to achieve cannabis cessation and tricyclic antidepressants (such as amitriptyline) are recommended for long-term management of CHS.
Cannabinoid Hyperemesis Syndrome Management
These therapies may offer transient relief but are not comprehensive solutions for CHS symptomatology. While marijuana seems to bring on nausea in the stomach, in the brain it usually has opposite effect. When cannabinoids bind with brain receptors, they tend to prevent nausea and vomiting. Experts think that when you first smoke weed, your brain signals are more important, but after repeated use of the drug, the brain receptors may no longer respond to marijuana in the same way, causing more nausea and vomiting.
- Furthermore, heat-induced vasodilation might facilitate toxin elimination through the skin, aiding in the detoxification process and potentially contributing to symptom improvement in individuals with CHS.
- Factors such as persistent stigma, conflicting regulations, research barriers, and scarcity among medicinal cannabinoids, which arises from poor awareness in patients, healthcare professionals, and stakeholders, can hinder the successful integration of cannabinoids in multiple settings 1.
- Additionally, some of the statistically significant studies did not measure symptom relief, instead looked at the reduced LOS in hospitals 23, 24, 25, 28, 31.
- Hot showers have emerged as an intriguing phenomenon in assuaging the symptoms of Cannabis Hyperemesis Syndrome (CHS), offering a peculiar yet effective avenue for relief.
Symptoms of CHS typically come on several years after the start of chronic marijuana use. (A) Sagittal view shows a narrowing of the distal duodenum at the level of the superior mesenteric artery, with an aortomesenteric distance of 5.0 mm. (B) Axial view with intravenous contrast provides an alternative perspective of decreased aortomesenteric distance. We aim to disrupt how medical providers and trainees can gain public access to high-quality, educational content while also engaging in a dialogue about best-practices in EM and medical education. 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 https://ecosoberhouse.com/ them aware of this fact. Another doctor reported using a combination of injectable lorazepam and promethazine, another antinausea medication.
