Cannabinoid Hyperemesis Syndrome: Case Report of a Paradoxical Reaction with Heavy Marijuana Use

Abstract

Cannabinoid hyperemesis syndrome (CHS) is a rare constellation of clinical findings that includes a history of chronic heavy marijuana use, severe abdominal pain, unrelenting nausea, and intractable vomiting. A striking component of this history includes the use of hot showers or long baths that help to alleviate these symptoms. This is an underrecognized syndrome that can lead to expensive and unrevealing workups and can leave patients self-medicating their nausea and vomiting with the very substance that is causing their symptoms. Long-term treatment of CHS is abstinence from marijuana use—but the acute symptomatic treatment of CHS has been a struggle for many clinicians. Many standard medications used for the symptomatic treatment of CHS (including ondansetron, promethazine, and morphine) have repeatedly been shown to be ineffective. Here we present the use of lorazepam as an agent that successfully and safely treats the tenacious symptoms of CHS. Additionally, we build upon existing hypotheses for the pathogenesis of CHS to try to explain why a substance that has been used for thousands of years is only now beginning to cause this paradoxical hyperemesis syndrome.

Cannabinoid Hyperemesis Syndrome

“…Most of the information in the literature is based on case reports, and treatment is targeted to the hyperemetic phase. 4,7,9,18,19 The therapeutic goal during the hyperemetic phase is to prevent dehydration and terminate the nausea and vomiting. Patients should be evaluated for signs and symptoms of volume depletion once a presumptive diagnosis of CHS has been made.…”

Cannabinoid Hyperemesis

“…The highest THC concentrations are found in buds, then leaves (about 1/10th as much by weight), and even less in stalks [9]. Advances in breeding the plants, raising them under high-intensity lights under optimally controlled conditions, and the sale of buds with stalks, stems, and leaves almost entirely removed has led to unprecedented potency in current marijuana products [10]. Furthermore, relaxed legal restrictions and a favorable public opinion about the medical and recreational properties of cannabis may have increased use.…”

“…A summary of these studies appears in Table 2 [6, 7, 10, 19, 22, 54, 94, 97, 99, 101, 105, 111, 113, 114, 116, 117, 121, 126, 127, 132-173]. …”

Keine Opiate gegen das Cannabis-Hyperemesis-Syndrom

“…Im Gegensatz zur bekannten antiemetischen Wirkung von medizinischem Cannabis und dessen psychotropen Hauptinhaltsstoffes THC tritt das CHS erst relativ spät unter chronischem Einfluss höherer Cannabismengen auf [1,6,8,11,14]. No opiates against cannabis hyperemesis syndrome ▼ History and clinical findings: An otherwise healthy 25-year-old patient with heavy cannabis-abuse suffered from an undiagnosed cannabis hyperemesis syndrome (CHS) over years, which characteristically was resistant to usual antiemetics.…”