Cannabinoid Hyperemesis Syndrome

Abstract

Cannabinoid hyperemesis is a relatively rare but significant adverse effect of chronic marijuana use characterized by severe, cyclic nausea, vomiting, and abdominal pain and marked by compulsive hot-water bathing for temporary symptom relief. A 37-year-old African American male with no significant medical history other than the habitual abuse of marijuana was admitted for intractable nausea, vomiting, and abdominal pain. With the exception of abdominal skin hyperpigmentation and scarring secondary to the direct application of heat through a heating pad, physical examination of the abdomen was unremarkable. Laboratory studies revealed a mild leukocytosis and acute renal dysfunction. All diagnostic examinations were found to be unremarkable or noncontributory to the patient's presenting state. Consistent with previous admissions, the patient's urine toxicology screening was found to be positive for marijuana. After several days of aggressive IV fluid hydration and as needed antiemetics and pain management, all laboratory studies and vital signs returned to baseline and the patient was subsequently discharged. Symptoms of cannabinoid hyperemesis resolve with cannabis cessation and recur when cannabis use is reinitiated, supporting an association between chronic use and cyclic vomiting. A Naranjo algorithm score of 5 revealed a probable incidence of cyclic vomiting associated with chronic cannabis abuse in our patient. Marijuana use, both legal and illegal, is becoming more prevalent in the United States. Given the nationwide increase in marijuana use for recreational and medical reasons, pharmacists and other health care providers should be aware of this interesting drug-induced phenomenon.

Efficacy of Capsaicin for the Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review

“…[32][33][34] Metoclopramide, ondansetron, and benzodiazepines have also been reported as effective in noncomparative studies. 18,[35][36][37] A recent retrospective cohort study compared the use of droperidol with other antiemetics for patients presenting with CHS to an ED and found shorter median lengths of stay and less ondansetron use in patients who received droperidol compared with those who did not. 38 For long-term therapy, one prospective study suggests that tricyclic antidepressants may represent a potentially beneficial option in CVS, although this was not specific to cannabinoid users.…”

Pharmacological and Toxicological Effects of Phytocannabinoids and Recreational Synthetic Cannabinoids: Increasing Risk of Public Health

“…A case report of a 37-year-old African American male who is suffering from intermittent symptoms like nausea, vomiting and epigastric pain for the last 14 years has a history of long-term use of Cannabis and to relieve the symptoms the patient applies heat to the abdomen [191]. It remains a puzzle how CBs induce hyperemesis despite its antiemetic property demonstrated in clinical and animal models, by stimulating CB1 receptors [192].…”

“…Abdominal heat application with hot showers helps in the redistribution of heat around the gastrointestinal tract and relieves the symptoms of CHS [194]. One case report suggests that chronic use of CBs may turn CHS into Cyclic Vomiting Syndrome (CVS) [191]. A study conducted by Simonetto and colleagues on 98 patients concluded that CHS symptoms occur in patients who use Cannabis frequently for many years and start to decline after the cessation of the Cannabis use [195].…”

Cannabinoid hyperemesis syndrome: a case report in Mexico

“…Interaction between Δ9-THC and CB1 receptors at low doses mediates as a partial agonist, creating antiemetic effects, although at high doses it may create hyperemesis (Darmani, 2002;Woods, Wright, Gee & Scobey, 2016). 2.…”

“…2. Genetic vulnerability and high doses of cannabis mediate an alteration of the hepatic cytochrome p450 in the metabolization of Δ9-THC, increasing the concentration of the substance in the body (Woods et al, 2016). 3.…”