In the United States, Marijuana or cannabis is among the most abused drug. In fact, women who are pregnant often use cannabis. From 2008, the use of cannabis has greatly increased due to its legalization for recreational and medicinal purposes. Corresponding to the rising rate of cannabis use is the acknowledgment of a new condition called Cannabinoid Hyperemesis Syndrome.
Cannabinoid Hyperemesis Syndrome is described as:
- Chronic use of cannabis
- Recurring episodes of abdominal pain nausea and vomiting
- Regular hot bathing
Cannabinoid Hyperemesis Syndrome has three stages:
- Prodromal or the pre-emetic phase – characterized by 1-2 weeks of episodes of morning nausea, food abhorrence, limited eating habits, potential weight loss and intermittent vomiting.
- Hyperemetic phase – described as nausea, recurrent vomiting, abdominal discomfort and uncontrollable bathing for temporarily relieving symptoms.
- Recovery phase – characterized by the improvement of symptoms after cannabis use is halted. Improvement of symptoms usually happens around 12 hours from the cessation of cannabis use but can also take longer for up to three weeks. Patients are free of symptoms while not using cannabis; however, symptoms will recur use is resumed.
For patients experiencing chemotherapy-associated nausea or for HIV-infected patients with anorexia, Cannabis is used as an appetite stimulant and as an antiemetic. The pathogenesis of inconsistent symptoms of hyperemesis of CHS is still not clear, however, many mechanisms have been recommended.
The main active cannabinoid component found in Cannabis is the extremely lipophilic compound THC, which attaches to cannabinoid type 1 (CB1) and type 2 (CB2) receptors in the CNS and other tissues. It’s believed that the appetite-stimulating and antiemetic properties of Cannabis are due to the activation of CB1 receptors located in the hypothalamus. Nausea and vomiting are said to be controlled by CB1 receptor stimulation in the enteric nervous system, which can result in delayed gastric emptying, splanchnic vasodilation and slowed peristalsis.
For centuries, cannabis has been used by many people, so it’s not clear as to why CHS is only just being acknowledged. Perhaps it is due to greater amount of THC content through selective breeding of plants or the use of female buds that have more concentrated levels of THC compared to the leaves and stems. On the other hand, CHS may be due to exogenous substances like additives, pesticides, preservatives and other forms of chemicals utilized in the preparation of marijuana, though there is minimal evidence in supporting this claim. The reason for symptom relief after hot bathing is also not clear.
Cannabinoid Hyperemesis Syndrome and Pregnancy
Are you currently pregnant and experiencing recurrent, persistent vomiting and nausea during pregnancy? Have yourself checked, especially if you are using cannabis during your pregnancy. You might be positive for cannabinoid hyperemesis syndrome.
A case of a pregnant 28-year-old woman was reported multiple times for episodes of nausea and vomiting, which resulted in Mallory-Weiss esophageal tears, abdominal pain, and dehydration. It was noted that the patient took frequent long warm baths for symptom relief. The social history of the patient was characterized by chronic marijuana use (an estimated “20 bowls” of marijuana every day).
After an extensive examination of the cause of her nausea and pain, she was later diagnosed with cannabinoid hyperemesis syndrome, which was simply treated after she began abstaining from cannabis.
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Diagnosis
Cannabinoid Hyperemesis Syndrome diagnosis involves:
- History and physical exam
- Initial studies and work up geared towards ruling out other causes of acute nausea and vomiting
- Urine toxicology screen
Four key features should be present when making a diagnosis of CHS:
- Marijuana use
- Periodic episodes of severe nausea, vomiting, and abdominal cramping
- Compulsive bathing for transient symptom relief
- Improvement of symptoms once the use of cannabis is terminated
CHS patients can present with other symptoms, including:
- Polydipsia
- Mild fever
- Weight loss
- Orthostasis
- Mild leukocytosis
- Hypokalemia
- Hypochloremia
- Elevated salivary amylase
- Mild gastritis on esophagogastroduodenoscopy
- Delayed gastric emptying
Bottom Line
Due to the extensive use of marijuana, both for medicinal and recreational purposes, the inconsistent effect of cannabinoid hyperemesis syndrome needs more attention. The effects of chronic use of cannabis are still being investigated, and the explanation of cannabis resulting to nausea and vomiting is still not clear.
Cannabinoid hyperemesis syndrome must be taken into consideration among pregnant women that have intractable nausea relieved by taking frequent hot baths. By taking into consideration this diagnosis, comprehensive diagnostic testing can be eluded and proper therapy, refraining cannabis use, can be suggested.
About the Author:
Elena Shephard (@ElenaShephard) lives in New York, Albany, USA. She is an independent researcher by profession who loves reading, writing and hanging around with friends. In her spare time, she enjoys doing research and writing certain health and beauty related articles for online websites, journals, etc. She also work as a content coordinator at Consumerhealthdigest.com. The best part of her job is generating awareness about the many remedial factors one can carry out from his/her daily life practices, with the help of her writing skills. Get in touch with her on G+, Facebook and Pinterest.
