Navigating the Intricacies of Cannabinoid Hyperemesis Syndrome CHS: Understanding the Unseen Challenges

If you need help quitting, speak to a healthcare provider or connect with your local addiction treatment services. One study found that 32.9% of self-reported frequent marijuana users who came to an emergency department for care met the criteria for CHS. With the widespread use, increased potency and legalization of marijuana cannabinoid hyperemesis syndrome in multiple states in the U.S., CHS may be becoming increasingly common. Cognitive errors are common in medical practice and can have serious consequences for patients related to misdiagnosis and delays in diagnosis and treatment. We report a case in which cognitive error substantially influenced a patient’s diagnosis and treatment.

Management and Treatment

Awareness of cognitive error is especially important in the context of the increasing prevalence of legalization of tetrahydrocannabinol/marijuana in several states. Superior mesenteric artery syndrome, although rare, is linked to high morbidity and mortality when the diagnosis is delayed; thus, it is crucial to consider it in the differential diagnosis for a patient with weight loss and abdominal pain. By sharing this case, we hope clinicians and patients can become more aware of this rare consequence of tetrahydrocannabinol use to facilitate more comprehensive patient-centered investigations. For patients with CHS, symptom severity depends on factors such as the amount of tetrahydrocannabinol (THC) stored in adipose tissue, the duration https://ecosoberhouse.com/ until treatment is sought, and potential complications, including electrolyte depletion, kidney failure, and weight loss 2. Recurrent emesis due to SMA syndrome, however, differs in that it results from compression of the duodenum. The diagnostic parameters include an aortomesenteric angle in the range of 6° to 22° and an aortomesenteric distance of 2 to 8 mm 3.

Wellness Phase

It’s important to be honest about your marijuana use if you have symptoms of CHS. Without knowing this background, providers often misdiagnose CHS as other conditions, like cyclic vomiting syndrome (CVS). With the expanding acceptance and legalization of cannabis worldwide, healthcare providers face a crucial imperative to accurately identify CHS amidst a sea of similar clinical presentations.

Supportive Care with Fluid and Electrolyte Replacement

Some people call certain symptoms of CHS “scromiting.” The term combines “vomiting” and “screaming.” You may have intense pain, which causes you to scream while you vomit. Not everyone with the condition seeks medical help or tells their provider that they use marijuana. While capsaicin is often discussed as a treatment ALiEM trick of the trade, the evidence supporting its use is limited to a small case series and a small RCT with some significant limitations. The small RCT published in support of capsaicin had large baseline differences between the capsaicin and placebo groups. The placebo group was “more sick”, having higher baseline nausea which was not corrected for in the analysis 7. The symptoms typically last a few weeks, though the throwing up should ease up in a day or two.

• With the expanding acceptance and legalization of cannabis worldwide, healthcare providers face a crucial imperative to accurately identify CHS amidst a sea of similar clinical presentations.
• At this time, the only known way to cure CHS is by quitting cannabis.
• Researchers are trying to understand why some people develop it and others don’t.
• Marijuana has a lot of active chemical compounds called cannabinoids.

This increased blood flow to the skin and peripheral tissues may help shift blood volume away from the gastrointestinal tract, potentially alleviating nausea and vomiting symptoms by reducing visceral hypersensitivity and enhancing overall comfort levels. The differential diagnosis related to chronic abdominal pain and recurrent bouts of emesis is expansive, which hinders identifying the underlying cause and proper treatment. Common possible diagnoses include gastroenteritis, gallbladder disease, peptic ulcer disease, celiac syndrome, appendicitis, pancreatitis, and functional dyspepsia.

Emetic Phase

In older patients, especially those with hypertension, cardiovascular illnesses such as aortic pathology and atypical coronary artery syndromes may present as vague abdominal pain, nausea, and vomiting. CHS is a condition caused by chronic and repeated cannabis use that leads to severe nausea and vomiting. In one 2018 study, a group of researchers surveyed 2,127 U.S. adults between the ages of 18 and 49 at an emergency department in New York. Of those surveyed, 155 met the criteria of smoking cannabis at least 20 days per month. The only known treatment to permanently get rid of CHS is to stop cannabis use completely.

Cannabinoid Hyperemesis Syndrome Causes

• The diagnostic puzzle posed by CHS is compounded by the ubiquitous nature of gastrointestinal complaints in emergency departments globally, making it arduous to differentiate CHS from a myriad of potential causes of nausea and vomiting that extend beyond gastrointestinal origins.
• The cause of death in both people was found to be hyponatremic dehydration, also known as low sodium levels.
• Cannabinoid hyperemesis syndrome (CHS) is a very unpleasant — and potentially dangerous — complication of long-term marijuana use.
• THC is what’s responsible for the “high” most people feel when they use marijuana.
• CHS is a condition caused by chronic and repeated cannabis use that leads to severe nausea and vomiting.
• Cognitive errors are common in medical practice and can have serious consequences for patients related to misdiagnosis and delays in diagnosis and treatment.

As CHS is a relatively recently recognized and studied phenomenon easily confused with other diseases, there is a paucity of sizeable randomized control studies. Most resources and recommendations come from case studies and expert opinions. In addition to appropriate antiemetic therapy, fluid resuscitation, and management of the patient’s symptoms, patients must recognize behaviors and exposures that place them at risk for their pathology.

• The same factors apply to clinicians, specialists, nurses, and pharmacists, as well as other healthcare personnel, to consider the diagnosis in any chronic vomiting disorder, and to better inform themselves regarding the condition.
• If you have cannabis use disorder and need help quitting, professional treatment is available.
• When a patient presents with nonspecific symptoms, efforts must be increased to decrease the possibility of cognitive errors.
• By sharing this case, we hope clinicians and patients can become more aware of this rare consequence of tetrahydrocannabinol use to facilitate more comprehensive patient-centered investigations.
• Superior mesenteric artery syndrome, although rare, is linked to high morbidity and mortality when the diagnosis is delayed; thus, it is crucial to consider it in the differential diagnosis for a patient with weight loss and abdominal pain.

Cannabinoid hyperemesis syndrome (CHS) happens when you have cycles of nausea, vomiting and abdominal pain after using cannabis (marijuana) for a long time. People with CHS often find temporary relief from these symptoms by taking hot baths and showers. Although cannabis is a US Food and Drug Administration-approved treatment for nausea in certain cases, most commonly after chemotherapy, it also has been proved to cause episodic vomiting, known as CHS 2. This biphasic effect of cannabis is minimally understood but can be reasonably linked to THC dosage. The endocannabinoid system is responsible for the mechanisms involving cannabinoid receptors and the hypothalamic-pituitary-adrenal axis 2. Stimulation of this axis results in increased secretion of THC stored in adipocytes, which leads to an intoxicating effect and possible emesis with high dosage 2.

Medical

Some individuals, for instance, also admitted to smoking 2000 mg of THC per day. It’s thought that genetics may play a role because only a small number of people who regularly use cannabis develop CHS. Some may be finding that there can be very real — and serious — complications that come with cannabis use. As more states legalize cannabis, more people are learning whether cannabis is right for them.