Cannabis Hyperemesis Syndrome (CHS)

Timothy C. Hain, MD•Most recent update: June 23, 2022

Also see: Treatment of EmesisCyclic Vomitingcannabis

Emesis
(From Nasa Symposium)

 

What is CHS ?

A recent newcomer to the vomiting scene is Cannabis Hyperemesis Syndrome. Cannabis hyperemesis Syndrome (CHS), it is recognized by severe cyclical nausea and vomiting and epigastric or periumbilical abdominal pain in the context of long-term cannabis use. (Sandhu et al. 2021) It is thought to be responsible for an increased prevalence in ED admissions for emesis (Wang et al. 2021)

Diagnosis:

CHS appears to have no pathognomonic physical findings or testing abnormalities, but has a very different time course than BPPV (precipitated by positional changes), and cyclic vomiting (spells every 3 months). Of course, CHS diagnosis depends on there being a history of Cannabis use, usually in significant quantities.

Treatment:

According to Burillo-Putze, the most effective treatment for CHS are antipsychotics (such as haloperidol), benzodiazepines, Capsaicin, and hot showers/baths. (Burillo-Putze et al. 2022) Thus the treatment with IV droperidol would fall into the antipsychotic (dopamine antagonist) category. According to Senderovich et al (Senderovich et al. 2022), additional options include aprepitant and propranol. Hsu found that olanzapine helpful. (Hsu et al. 2021) Missing from this list is the standard emesis drug ondansetron.

A common thread to the treatments listed above is that several are dopamine antagonists. These drugs are very powerful to stop vomiting, but can also induce movement disorders as well as acute very disturbing reactions such as ocular deviations or jaw dystonias. These are more common in young women, but are a general risk of this class of drug.

We are puzzled how treatment with Capsaicin (applied to the abdominal area), or hot showers could be helpful, as they are not helpful for other variants of vomiting. Similarly, we are puzzled how propranolol would be helpful for vomiting.

Stopping use of Cannabis is strongly recommended in the literature.

 

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