Cannabinoid hyperemesis syndrome

Cannabinoid hyperemesis syndrome
Classification and external resources
Specialty	Toxicology
Patient UK	Cannabinoid hyperemesis syndrome

Cannabinoid hyperemesis syndrome 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.

The syndrome was described by Allen and colleagues (2004), and Sontineni and colleagues (2009) who offer simplified clinical 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

Sontineni criteria

Essential	Cannabis use for years
Major	Severe nausea and vomiting Vomiting that recurs in a cyclic pattern over months Resolution of symptoms after stopping cannabis use.
Supportive	Compulsive hot baths with symptom relief Colicky abdominal pain No evidence of gall bladder or pancreatic inflammation

Modified criteria

Essential	Long-term cannabis use
Major	Severe cyclic nausea and vomiting Resolution with cannabis cessation Relief of symptoms with hot showers or baths Abdominal pain, epigastric or periumbilical Weekly use of marijuana.
Supportive	Age less than 50 y Weight loss of >5 kg Morning predominance of symptoms Normal bowel habits Negative laboratory, radiographic, and endoscopic test results

The long-term and short-term effects of cannabis use are associated with behavioural effects leading to a wide variety of effects on the body systems and physiologic states.

Sontineni and colleagues in 2009 discussed the cannabinoid hyperemesis syndrome to offer guidelines for the clinical diagnosis.

Individual attacks can lead to complications, such as acute kidney injury.

Pathogenesis

Various pathogenic mechanistic theories attempting to explain symptoms have been put forward. These theories fall into two themes: 1) dose dependent buildup of cannabinoids and related effects of cannabinoid toxicity, and 2) the functionality of cannabinoid receptors in the brain and particularly in the hypothalamus (which regulates body temperature and the digestive system). But the mechanisms by which cannabis causes or controls nausea and the adverse consequences of long-term cannabis toxicity remain unknown and organic disease should not be ruled out as a possible cause.

The neurobiology of the compound has led to the discovery of an endogenous cannabinoid system. The therapeutic potential of cannabinoids has been recognized and these compounds are utilized as antiemetics. Several studies have demonstrated the therapeutic effects of cannabinoids for nausea and vomiting in the advanced stages of illnesses such as cancer and AIDS.

Differential diagnosis

Cyclic vomiting syndrome may present similarly.

Epidemiology

The number of people affect is unclear as of 2015.

History

Cannabinoid hyperemesis was first reported in the Adelaide Hills of South Australia.

Treatment

Many traditional medications for nausea and vomiting are ineffective. However, treatment with lorazepam or haloperidol has provided relief for some people. Assessing for dehydration due to vomiting and hot showers is important as it can lead to cannabinoid hyperemesis acute renal failure (CHARF), and this is easily treated with IV fluids. Treatment is otherwise supportive and focuses on stopping cannabis use.

Prognosis

Acute episodes of cannabinoid hyperemesis typically last for 24–48 hours and the problem often resolves with long term stopping of cannabis use. Improvement can take one to three months to occur.

Relapses are common, and this is thought to be possibly secondary to a lack of education as many people use or increase their use of cannabis to treat their symptoms of nausea and vomiting.

Further reading

• http://medicine.missouri.edu/childhealth/fleisher.html
• http://www.biomedcentral.com/content/pdf/1741-7015-3-20.pdf