{"id":1929,"date":"2017-02-20T09:45:34","date_gmt":"2017-02-20T17:45:34","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=1929"},"modified":"2017-01-05T09:46:50","modified_gmt":"2017-01-05T17:46:50","slug":"cannabinoid-hyperemesis-syndrome","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=1929","title":{"rendered":"CANNABINOID HYPEREMESIS SYNDROME"},"content":{"rendered":"

While watching the CBS Evening News and feeling miserable about the deaths of Carrie Fisher and Debbie Reynolds, a health related story came on the air about a young man who presented multiple times to emergency departments with abdominal pain, vomiting and dehydration.\u00a0 Turns out he fit the diagnosis of a contemporary syndrome of which we in California and other marijuana liberalized states are likely to encounter more frequently \u2013 cannabinoid hyperemesis syndrome (CHS).\u00a0 Early reports were published by Allen et. al<\/a> in 2004 and other reports followed with a recent report by Kim, et al, associating an increased incidence of CHS related emergency room visits in Colorado following its legalization of marijuana.<\/p>\n

A light bulb lit up in my head realizing that I had a patient in care, with the diagnosis of cyclic vomiting, who might actually have CHS.\u00a0 Read on.<\/p>\n

The syndrome, described by Galli et al<\/a> is characterized by cyclic episodes of nausea and vomiting, a learned behavior of frequent hot showers or baths \u2013 as this temporarily relieves the nausea \u2013 and relief with cessation of marijuana use.\u00a0 Typically the use of marijuana is chronic with an average duration of use of 16.3 years but has been reported with much shorter use, less than three years.\u00a0 Use is commonly several times daily.\u00a0 Three phases have been described.\u00a0 The prodromal, pre-emesis, phase with nausea, abdominal distress and fear of vomiting.\u00a0 Not uncommonly, due to the otherwise beneficial anti- emetic effects of marijuana, use increases.\u00a0 The hyperemetic phase follows with episodes of intense, incapacitating nausea, vomiting, retching and diffuse but mild abdominal pain. \u00a0\u00a0Weight loss is common in this phase.\u00a0 \u00a0This can eventuate in multiple emergency department visits and extensive diagnostic evaluation.\u00a0 The diagnosis of cyclic vomiting often follows. Of course CHS is but one of a number of possible diagnoses in this symptom setting and other diagnoses should be considered.\u00a0 Oddly, a self-discovered temporary remedy of hot showers soon becomes compulsive.\u00a0 The recovery phase, with the discontinuation of marijuana use, occurs over days to months and wellness, weight, and eating patterns return to baseline.\u00a0 In the CBS story the interviewed patient also remarked on his return of motivational energy \u2013 (immediate flashback to Spicoli, \u201cAll I need are some tasty waves, a cool buzz, and I\u2019m fine.\u201d in Fast Times at Ridgemont High). \u00a0\u00a0Relapse in cannabis use results in relapse.<\/p>\n

Odd that an herb known for its antiemetic and appetite enhancing properties should cause vomiting and weight loss.\u00a0 Well, herbs are complex and not single chemical pharmaceuticals.\u00a0 There have been over 100 identified metabolites of THC.\u00a0 Some, cannabidiol and cannabigerol, may be complicit in the syndrome.<\/p>\n

So, I\u2019m going to check up on that patient of mine to explore this possibility.<\/p>\n

Jeff Spicoli:\u00a0 \u201cAwesome! Totally awesome!\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

While watching the CBS Evening News and feeling miserable about the deaths of Carrie Fisher and Debbie Reynolds<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1929","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\nCANNABINOID HYPEREMESIS SYNDROME - PHC Primary Care Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/phcprimarycare.org\/?p=1929\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CANNABINOID HYPEREMESIS SYNDROME - 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