Studies show that between 90% to 100% of people with CHS use hot showering or bathing to relieve symptoms. Researchers have proposed that this behavior may be included in the diagnostic criteria for CHS. A 42-year-old CHS patient treated for hyperemesis in the hospital presented with a reddish-brown pigmented rash on his trunk and extremities. The rash could be diagnosed as erythema ad igne or thermal keratosis. The patient reported that he got the rash from prolonged exposure to hot water in showers that he took to relieve the symptoms of his CHS [143]. Cutaneous problems arise typically from prolonged and excessive exposure to very hot water, heating pads, or hot water bottles.

Appointments & Care

“A lot of times qualitative information like where they procured the marijuana, the strain, the frequency of their use isn’t even in the record,” she explains. The profuse vomiting and potential dehydration inherent in CHS often mandate intravenous fluids administration to correct electrolyte imbalances and sustain hydration levels. Adequate fluid resuscitation is crucial during the acute phase of CHS to avert complications and ensure physiological stability. Interestingly, patients dealing with Cyclical Vomiting Syndrome (CVS) also frequently mention this behavior. Yet, with the evolving comprehension of CHS, there is a likelihood that some cases attributed to CVS might actually be undiagnosed instances of CHS, marking it as pathognomonic. This underscores the critical need to correlate symptoms with cannabis consumption, ruling out overlapping diagnoses that could be mistaken for CVS.

Care instructions

• Cannabis hyperemesis syndrome (CHS), some hospital workers claim, is on the rise — something they believe is the result of “high potency weed,” according to a report published in July by NBC News.
• The patient could be discharged 4 h later and was counseled to stop smoking marijuana [118].
• “It’s really hard to get accurate numbers unless you do a randomized controlled trial or a study where you follow people over time,” she says.
• Belly pain and a sense that you are going to vomit are also common.
• While paradoxical effects of cannabinoids are well known concerning emotions (e.g. relaxing effects vs. paranoia; euphoria vs. dysphoria), a potential emetic effect of cannabinoids is relatively unknown [6], [15].

The effects are similar to gastroparesis and, thus, CHS may be caused by a functional gastroparesis. The GI effects of cannabinoids are mediated mainly via the CB1 receptor, which can inhibit gastric acid secretion, lower esophageal sphincter relaxation, and alter intestinal motility, cause visceral pain, and produce inflammation [27, 48]. Activating CB1 receptors reduces gastric motility, resulting in delayed gastric emptying in murine [49, 50] and human studies [51, 52].

Unveiling the Complexities of Cannabinoid Hyperemesis Syndrome: Mechanisms Underlying CHS

Whatever you do, it’s also important to make sure that you replenish the many fluids you have undoubtedly lost with all that vomiting. Furthermore, there’s no real way to check the accuracy of those self-reported statements. It’s possible that what looks like a rise in cases could actually just be a rise in people seeking help and/or a rise in people admitting to their cannabis use. Reilly Kayser, a psychiatrist and assistant professor at Columbia University, has researched the endocannabinoid system. The authors report no actual or potential conflicts of interest with regard to this article. This material is not a substitute for the advice of a qualified health professional.

Hot Showers

An 18-year-old patient diagnosed with CHS refused to stop using marijuana and was treated in-clinic with haloperidol followed by outpatient 5 mg haloperidol which relieved her symptoms of nausea and vomiting. The patient discontinued haloperidol on her own after 3 weeks and was subsequently lost to follow-up [113]. cannabinoid hyperemesis syndrome A case series from Spain from 2012 to 2016 involved 6 patients (5 men) with an average age of 28.3 years who, on average, began to use marijuana at age 16. In this series, the mean amount of cannabis smoked per day was 7.5 cigarettes (range 1–12) for at least 1 year prior to the first episode of vomiting.

Cannabis hyperemesis syndrome: 5 scientific answers to “scromiting” questions

Electrolyte replacement is appropriate to correct any electrolyte imbalances that may have occurred with prolonged vomiting. While patients benefit from rehydration and other forms of supportive care, the only effective treatment for CHS is marijuana cessation. Conventional antiemetics are not contraindicated but are generally ineffective likely because of the atypical mechanisms behind CHS.

Emetic Phase

But while the condition very much exists, experts say the flurry of panicked headlines overstate what we actually know about CHS and how prevalent it is. This is true whether you use it for recreation or as medicine to treat nausea or chronic pain. This may differ from what you’ve heard or experienced about marijuana’s ability to ease nausea. But marijuana can start causing nausea and vomiting even if you’ve used it for a long time without problems.

Health & Wellness

• There should be no indication of a neurological cause of the displayed symptoms [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [13], [14], [15].
• The primary psychoactive component of cannabis is tetrahydrocannabinol (THC).
• Cannabinoid hyperemesis syndrome (CHS) is a very unpleasant — and potentially dangerous — complication of long-term marijuana use.
• Evidence supporting the hypothesis of cannabinoid hyperemesis is weak.
• Some patients use hot water bags across the center of their belly and can burn the skin if done a lot.
• Cannabinoid hyperemesis syndrome (CHS) is a condition that you might get if you’ve regularly smoked weed or used marijuana in some other form for a long time.

The heterogeneity of the case reporting makes data synthesis impossible. With many states legalizing the use of both medical and nonmedical marijuana and increasingly favorable public opinion emphasizing the benefits marijuana, it is reasonable to expect its use will become more frequent and widespread. Since there are no laboratory or radiographic examinations that can be used to diagnose CHS, CHS should be diagnosed based on symptoms and patient behaviors. In some cases, CHS is a diagnosis of exclusion after other hyperemetic conditions (such as hyperemesis gravidarum, psychogenic vomiting [PV], or CVS) are ruled out. In one small study of eight patients hospitalized with CHS, four of the five who stopped using weed recovered from CHS.

Treatment of CVS and CHS

The objective of our research was to establish a clinically meaningful description of CHS and its presentation, to evaluate diagnostic challenges in identifying this syndrome, and to describe effective treatment options. Articles that were not in English were excluded as were case reports that did not report the age, sex, presentation, diagnosis, and treatment of the patient. Case reports were summarized in Table ​Table22 and case series presented in the narrative text. In some cases, the bibliographies of these articles were also searched.