Coinciding with the increasing rates of
cannabis abuse has been the recognition of a new clinical condition known as
Cannabinoid Hyperemesis Syndrome.
Cannabinoid Hyperemesis Syndrome is characterized by chronic cannabis use, cyclic episodes of
nausea and
vomiting, and frequent hot bathing.
Cannabinoid Hyperemesis Syndrome occurs by an unknown mechanism. Despite the well-established
anti-emetic properties of marijuana, there is increasing evidence of its paradoxical effects on the gastrointestinal tract and CNS.
Tetrahydrocannabinol,
cannabidiol, and
cannabigerol are three
cannabinoids found in the cannabis plant with opposing effects on the
emesis response. The
clinical course of
Cannabinoid Hyperemesis Syndrome may be divided into three phases: prodromal, hyperemetic, and recovery phase. The hyperemetic phase usually ceases within 48 hours, and treatment involves supportive
therapy with fluid
resuscitation and
anti-emetic medications. Patients often demonstrate the learned behavior of frequent hot bathing, which produces temporary cessation of
nausea,
vomiting, and
abdominal pain. The broad differential diagnosis of
nausea and
vomiting often leads to delay in the diagnosis of
Cannabinoid Hyperemesis Syndrome.
Cyclic Vomiting Syndrome shares several similarities with CHS and the two conditions are often confused. Knowledge of the epidemiology, pathophysiology, and natural course of
Cannabinoid Hyperemesis Syndrome is limited and requires further investigation.