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

Geographic differences exist in expectations of nonapproved CBD products and FDA‐approved CBD. Pathogenic SCN1A variants are common but not required for a DS diagnosis, and non‐SCN1A gene mutations may present with a DS phenotype.26, 27, 28 There is no evidence that gene variants impact clinical response to Epidiolex. The accuracy of pediatric DS diagnosis has improved with increased awareness resulting from DS clinical trials and increasingly accessible genetic testing. Abnormal gait and movement may occur in some patients with DS,23, 24 but is not a required feature of the disease phenotype.

What is CHS?

Anecdotally, while some patients hesitate to report side effects to avoid discontinuing Epidiolex, others misattribute side effects to Epidiolex that may not be treatment related. Epidiolex has a broad dose range; therefore, the optimum dose should be based on the relative risks and benefits for each patient. Recently, unsubstantiated benefits of nonapproved CBD products for various health conditions have been popularized via consumer‐focused marketing,38, 39, 40 which can lead to unrealistic expectations for outcomes with Epidiolex treatment. Thus, HCPs should set accurate and realistic expectations with patients before initiating Epidiolex therapy.

• The following criteria can help lead to an accurate cannabinoid hyperemesis syndrome diagnosis and management of symptoms and reduce the need for unnecessary and expensive medical testing.
• While not exclusive to individuals with CHS, the act of hot bathing or showering manifests in approximately 80-90% of patients with this condition.
• If this flap doesn’t work properly, your stomach acids might flow upward and cause you to have nausea and vomiting.

What causes CHS?

Additional research is underway regarding CHS, but the underlying mechanism is complex. It is possible that THC accumulates in the body with frequent, long-term marijuana use, which may be toxic to the gastrointestinal system. There are possible direct effects on the brain and central nervous system, which plays a large role in the normal vomiting processes. While stress and anxiety are common occurrences for many people, there are clear relationships between stress, anxiety, and several nausea and vomiting disorders.

• And a 2022 Canadian study found that ER visits for CHS-related problems had increased 13-fold between 2014 and 2021.
• Cannabinoids are found in the cannabis plant and bind to cannabinoid receptors found in our brains, gastrointestinal tracts and immune cells.

Diagnosis

In October 2018, Brian began vomiting again, and I decided to take him to the ER. I told the doctors about the CHS diagnosis, and tests revealed that his kidneys were shutting down once more. The team gave Brian both Haldol and Phenergan, which helped his vomiting improve. The blood work results came back, showing that his kidneys were failing and that all of his levels were out of the normal range.

How is cannabis hyperemesis syndrome treated?

The patient was referred to a nutritionist for additional support and education. She had not gained substantial weight by 1 week after hospital discharge, and she reported continued nausea with no emesis. At a gastroenterology consultation 7 months after https://ecosoberhouse.com/ discharge, she had improvement of symptoms, although early satiety remained.

A Guide to Cannabis Hyperemesis Syndrome (CHS)

When exposed to low doses of cannabinoid, the activation of this system principally has an antiemetic effect. Within the gastrointestinal tract, this interaction inhibits the opening of the gastro-esophageal sphincter, slows peristalsis (through its action on smooth muscle cells), and lowers acid secretion 3, 4. In the CNS, activation of these receptors has a direct role in regulating the sympathetic and hypothalamic-pituitary-adrenal axis, preventing overstimulation. The correct identification of the underlying cannabis-related syndrome, and subsequent therapeutic choice, may help decrease ED presentations.

Management and Treatment

Lots of patients with CHS find relief from heat therapy such as hot showers & baths, a heating pad also works! Although there’s no official reason for why this provides relief for CHS patients, scientists believe that warm temperatures correct the cannabis-induced disequilibrium at the thermoregulatory centers. Heat/hot showers also activates TRPV1 which helps with inhibiting pain signals, resulting in analgesic and antiemetic effects. In select cases, topical application of capsaicin cream on the abdomen has demonstrated promise in alleviating CHS symptoms. Capsaicin, the active compound in chili peppers, acts on TRPV1 receptors, potentially modulating gastrointestinal sensory pathways and altering intestinal blood flow to provide relief from nausea and vomiting. The vasodilation induced by heat exposure in hot showers can enhance peripheral blood vessel dilation, promoting improved circulation.

Food Recommendations while in the Hyperemetic phase:

Most people who use cannabis heavily never develop the syndrome, so prevention is not necessary for most people. The emotional and physical toll of CHS has been devastating to some, as many sufferers were misdiagnosed and made many visits to the emergency room as a result. There were several people in and out of the house during this time, including police, firefighters, EMTs, and detectives. In the state of Indiana, if anyone under the age of 18 dies, the death requires investigation as a homicide. The doctor decided that Brian needed to be at a children’s hospital to receive specialized care. They agreed with the CHS diagnosis and ordered monitoring of his levels, which improved with the rehydration again.

• The correct identification of the underlying cannabis-related syndrome, and subsequent therapeutic choice, may help decrease ED presentations.
• If you have any symptoms of severe dehydration, like dizziness, confusion and a rapid heartbeat, call 911 right away.
• Right now, the only known effective treatment for CHS is to stop using cannabis.
• Prolonged, chronic cannabis use can cause cannabinoid hyperemesis syndrome (CHS), a condition that manifests as serious nausea, abdominal pain, and frequent vomiting.
• Serotonin antagonism in the gastrointestinal tract from medications such as ondansetron, dolasetron, and granisetron likewise have varying levels of efficacy.

Most cases of CHS have been shown to occur in people who consume cannabis roughly 20 days per month, and about 75% of those patients have used cannabis regularly for more than a year. The primary symptoms of CHS — cyclic abdominal cramping, nausea, and vomiting — are not unique to this condition, making CHS hard to diagnose. Because of this, CHS is considered among physicians to be a “diagnosis of cannabinoid hyperemesis syndrome exclusion,” or a diagnosis that is made when all other probable causes are ruled out.