For supportive care, a clinician should work together with the pharmacist to see if any medications could contribute to the patient’s presentation. If administering antiemetics, the nursing staff should be familiar with the adverse event profile so cannabinoid hyperemesis syndrome they can report any concerns that may arise. It’s important to be honest about your marijuana use if you have symptoms of CHS. Without knowing this background, providers often misdiagnose CHS as other conditions, like cyclic vomiting syndrome (CVS).

• Often recurrent, these frequent consultations add to the congestion of already chronically saturated emergency department(s) (ED).
• Benzodiazepines have been reported effective in some cases but can pose a risk of dependence.
• This has been well demonstrated in regularly THC-exposed animals and humans, whom, when administered Rimonabant© (a CB1 receptor blocker, used to treat obesity) [11, 12], rapidly develop abdominal pain and hyperemesis.
• For CWS, patients should at least have three DSM-5 symptoms, within 1 week of complete cessation or reduction in cannabis use; this should occur following a heavy or prolonged use.
• Cannabinoids are compounds in the Cannabis sativa plant that bind to cannabinoid receptors in your brain, spinal cord, gastrointestinal tract and other body tissues.

ED Management of Cannabinoid Hyperemesis Syndrome: Breaking the Cycle

An intriguing point to keep in mind is that the Rome IV criteria include the phrase “resembling cyclical vomiting syndrome.” In that regard, it is important to distinguish between the two. Per the Nelson Textbook of Pediatrics, cyclic vomiting syndrome is defined by having sudden onset episodes of vomiting, having at least four bouts of vomiting per hour, and often having 12 to 15 episodes of vomiting per day. These episodes of vomiting are often separated by weeks or months, and there is a return to baseline between episodes.

Population Health Research Capsule

In older patients, especially those with hypertension, cardiovascular illnesses such as aortic pathology and atypical coronary artery syndromes may present as vague abdominal pain, nausea, and vomiting. Cannabinoids are compounds in the Cannabis sativa plant that bind to cannabinoid receptors in your brain, spinal cord, gastrointestinal tract and other body tissues. Examples of cannabinoids include tetrahydrocannabinol (THC) and cannabidiol (CBD). Figure 2 summarizes our proposed emergency department therapeutic algorithm for cannabis use disorders.

Pertinent Studies and Ongoing Trials

It is believed these occur through decreased mesolimbic dopamine function [13]. Sorensen et al. identified seven diagnostic frameworks, with significant overlap among characteristics listed by the various authors; however, there was no specific mention of how many of the above features are required for diagnosis. Those with the highest sensitivity include at least weekly cannabis use for greater than one year, severe nausea and vomiting that recurs in cyclic patterns over months usually accompanied by abdominal pain, resolution of symptoms after cannabis cessation, and compulsive hot baths/showers with symptom relief. Clinicians should consider other causes of abdominal pain, nausea and vomiting to avoid misdiagnosis.

No studies have evaluated the treatment of abdominal pain, as its incidence in CWS is significantly less than in CHS. Furthermore, in light of the pathophysiological processes behind CWS, its presence may not be a direct consequence to THC but simply a response to emesis (and if present, may be a sign that the patient is experiencing CHS rather than CWS). Thus, if present, it should theoretically be manageable with conventional non-opioid analgesics and anticholinergics (such as butylscopolamine), the latter having the advantage of increasing dopamine concentrations in the brain. Regarding nausea, antipsychotics should be withheld as they tend to decrease central dopamine levels and may worsen withdrawal symptoms such as craving [42].

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Opioids, while often prescribed for the patient’s debilitating abdominal pain, are not appropriate for CHS, as they may, in fact, worsen nausea and vomiting. Cannabinoid hyperemesis syndrome (CHS) is a very unpleasant — and potentially dangerous — complication of long-term marijuana use. Because of this possible complication, it’s important to use caution with marijuana and other cannabis products. If you think you have CHS or cannabis use disorder, talk to a healthcare provider.

Acute Kidney Injury (AKI) in Young Synthetic Cannabinoids Abusers

• If patients deny cannabis use but suspicion remains high, a urine drug screen should be considered.
• Our study emphasizes the importance of both acute care and long-term outpatient follow-up, as key processes in cannabis-related disorder treatment.
• Other known complications of forceful and uncontrolled vomiting include aspiration and subsequent pneumonitis or aspiration pneumonia as well as injury to the esophageal wall such as Boerhaave’s syndrome.