The novel and highlighted unconventional management options for CHS can be solidified as best practice guidelines with future large-scale research initiatives. Compulsive hot water bathing can be an important marker for the diagnosis of CHS 5. Conditions can overlap or mask CHS including cyclic vomiting syndrome, eating disorders, or drug-seeking behavior 44. Knowledge of pharmacological treatments for managing CHS may lessen the burden of ED resources with the recurring admission of patients with CHS 20, 23, 25, 28, 31, 33, 35. Currently, there is no reliable management regime for patients with CHS with the exception of complete cessation of cannabis and response to conventional antiemetics is insufficient. Several treatments have been described to relieve N/V in CHS; however, there are limited controlled data to support management decisions.
Topical Capsaicin Cream
His levels slowly improved overnight, and he was released after 24 hours. Brian agreed to quit smoking until he was able to see a gastroenterologist, which was scheduled for 45 days after his release. A systematic review was conducted using PubMed, Ovid MEDLINE, Cochrane Central, EMBASE, and Google Scholar. Databases were used to search for articles on CHS published from January 2009 to June 2021, yielding 225 results of which 17 were deemed relevant and underwent review by 2 separate reviewers. All data generated or analyzed during this study are included in this article and its supplementary material files. CHS is a relatively new disorder that is not only difficult to diagnose but to manage.
Emetic Phase
- It highlights how clinicians may prematurely attribute symptoms to a familiar diagnosis and potentially overlook alternative, more accurate explanations.
- The symptoms of CHS can be severe and include nausea, vomiting, and abdominal pain.
- Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main cannabinoids in marijuana products.
- It’s a serious medical problem that can cause major health issues if you leave it untreated.
This tendency to prematurely attribute symptoms to a known diagnosis and thereby overlook alternative and potentially more accurate explanations can lead to delays in diagnoses and treatments. Awareness of cognitive error is especially important in the context of the increasing prevalence of legalization of cannabinoid hyperemesis syndrome tetrahydrocannabinol/marijuana in several states. Superior mesenteric artery syndrome, although rare, is linked to high morbidity and mortality when the diagnosis is delayed; thus, it is crucial to consider it in the differential diagnosis for a patient with weight loss and abdominal pain. By sharing this case, we hope clinicians and patients can become more aware of this rare consequence of tetrahydrocannabinol use to facilitate more comprehensive patient-centered investigations. Although cannabis is a US Food and Drug Administration-approved treatment for nausea in certain cases, most commonly after chemotherapy, it also has been proved to cause episodic vomiting, known as CHS 2. This biphasic effect of cannabis is minimally understood but can be reasonably linked to THC dosage.
- These errors can lead to misdiagnosis, delayed treatment, and, ultimately, prolonged distress for patients.
- Cannabis cessation is noted to be the most successful management, but other treatments also demonstrated symptom relief; these include hot water hydrotherapy, topical capsaicin cream, haloperidol, droperidol, benzodiazepines, propranolol, and aprepitant administration.
- Once you do that, your repeated nausea and vomiting should go away and not return.
- Surgical consultation was not sought by the patient, and it remains unclear whether she continued to use cannabis upon symptom relief.
- It should be noted that the majority of evidence found for haloperidol were case studies, which had limited generalizability 30, 31, 33.
Supportive Care with Fluid and Electrolyte Replacement
While it can be managed with proper treatment and abstinence from weed use, it is also important for patients and healthcare providers to remain aware of its symptoms and potential risks. If you suspect you may have CHS, it’s crucial to consult with a healthcare provider who is familiar with the condition. They can conduct a thorough evaluation, rule out other potential causes, and guide you in the appropriate management and treatment. Self-diagnosis is not recommended, as CHS shares symptoms with other serious medical conditions that require professional medical evaluation and care.
CHS Episodes and Recurrence
The endocannabinoid system is responsible for the mechanisms involving cannabinoid receptors and the hypothalamic-pituitary-adrenal axis 2. Stimulation of this axis results in increased secretion of THC stored in adipocytes, which leads to an intoxicating effect and possible emesis with high dosage 2. Although topical capsaicin is a promising treatment for CHS when standard anti-emetic agents fail, the primary goal is preventing recurrence, which involves patient counseling and continuous support for cannabis cessation 7. With prolonged symptomatic CHS, complications arise due to potential electrolyte abnormalities, dehydration, and weight loss. The case of this patient was substantially influenced by cognitive errors. Attribution https://ecosoberhouse.com/ errors, in which decisions are influenced by negative stereotypes, may lead clinicians to underestimate the possibility of serious diseases, hindering the diagnostic process 6.
