When marijuana users can’t stop vomiting
| The recent rise of Cannabinoid Hyperemesis Syndrome [hyper = lots of; emesis = vomiting]
| Ray Cavanaugh, The Lancet – Amid the easing of marijuana laws and the increase of marijuana availability and potency in the U.S., more people are presenting with cannabinoid hyperemesis syndrome (CHS).
This syndrome – which is marked by severe vomiting – tends to affect those who have consumed marijuana, especially highly potent strains, for a prolonged period.
In a sense, CHS is a paradoxical condition: Marijuana has been used to mitigate vomiting in persons with cancer and other conditions. However, consistent and extended use of marijuana can beget a hyperemetic reaction.
People with cannabinoid hyperemesis syndrome often find some relief with hot showers
Aside from severe nausea and vomiting, other CHS symptoms can include abdominal discomfort, bloating, excessive sweating, and weight loss.
Some patients may present with diarrhea, but it’s by no means a requirement for diagnosis. Patients often seek relief by taking hot baths or showers, and such immersion in hot water may become a compulsion.
Many healthcare workers, let alone the general public, are unaware of the potential hyperemetic effects of long-term cannabis use. But as potency and availability increase, emergency room doctors across the country are more likely to encounter at least a few cases of CHS.
“I think it’s fair to say that dose matters,” says Eric Lavonas, M.D. “Marijuana use has been around a long time, but the highly potent clonal strains grown under precise indoor conditions are relatively new, and their widespread availability preceded the uptick in CHS cases by a few years.”
In 1993, the average marijuana potency was 3.4 percent THC. By contrast, Colorado’s legal marijuana has an average potency of 18.7 percent THC, and some brands contain as much as 30 percent.
CHS made it into medical literature in 2004 with a paper involving cases in southern Australia. Specific numbers of CHS’s prevalence in the U.S. are difficult, if not impossible, to ascertain … Read the full story at The Lancet. Image: Ingeborg Bernhard (Schnorch), CC BY-SA 4.0
From Wikipedia, the free encyclopedia
Cannabinoid hyperemesis syndrome can occur with cannabis use and is characterized by recurrent nausea, vomiting, and crampy abdominal pain.
These symptoms have been reported to be improved temporarily by taking a hot shower or bath, or more fully by stopping the use of cannabis.
It is important that cannabinoid hyperemesis syndrome be distinguished from other causes of nausea and vomiting, such as cyclic vomiting syndrome.
The pathogenesis of cannabinoid hyperemesis syndrome is unclear, but it may involve accumulation of exogenous cannabinoids or alterations in the brain’s regulation of body temperature.
While definitive treatment involves abstinence from cannabinoids, various drug therapies have been studied for symptomatic relief in the acute presentation of a patient suffering from cannabinoid hyperemesis syndrome, often in the setting of a hospital emergency department.
The syndrome was described by Allen and colleagues (2004) and Sontineni and colleagues (2009) who offer simplified diagnostic criteria.
A subsequent, larger study reported a case series of 98 subjects with cannabinoid hyperemesis syndrome, confirming the earlier reported findings.
Signs and symptoms
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 physiologic states.
Cannabinoid hyperemesis syndrome is a paradoxical syndrome characterized by hyperemesis (persistent vomiting), as opposed to the better known antiemetic properties of cannabinoids. Specifically, cannabinoid hyperemesis syndrome 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 cannabinoid hyperemesis syndrome: the prodromal phase, the hyperemetic phase, and the recovery phase.
The prodromal phase is characterized by subsyndromal symptoms of cannabinoid hyperemesis syndrome, including mild discomfort and nausea upon waking.
Prior to the use of compensatory exposure to hot water to treat symptoms, people sometimes increase their intake of cannabinoids in an effort to treat the persistent nausea they experience. This phase can last for months or even years.
The hyperemetic phase is characterized by the full syndromal symptoms of cannabinoid hyperemesis syndrome, including persistent nausea, vomiting, abdominal pain, and retching. Retching can occur up to 5 times per hour.
It is very difficult to take food or medicine by mouth during this stage, and patients may develop a fear of eating.
Weight loss and dehydration due to decreased oral intake and vomiting are possible. Compensatory exposure to hot water, even for hours at a time, may be attempted for symptomatic relief, resulting in compulsive bathing/showering.
People have described the hot water relief as “temperature-dependent,” meaning that hotter temperatures provide greater relief. It is during this phase that people with cannabinoid hyperemesis syndrome are likely to present to the emergency department of the hospital for treatment.
The recovery phase begins after the patient abstains from cannabinoids, and can last days to months.
Lost weight can be regained due to a restoration of normal oral intake, and compulsive bathing/showering can give way to normal patterns of behavior. Read more at Wikipedia