A Rare Case of Cannabinoid Hyperemesis Syndrome Secondary to Cannabidiol for Refractory Epilepsy PMC

27 May A Rare Case of Cannabinoid Hyperemesis Syndrome Secondary to Cannabidiol for Refractory Epilepsy PMC

The first description of cannabinoid hyperemesis syndrome (CHS) was in 2004. The recent legalisation on cannabis in many countries raises a concern about increased use. Cannabinoids are CB1 and CB2 receptor agonists, which are predominantly located in the brain, and are believed to produce anti-seizure and anti-emetic effects when activated.

• “Cannabinoid” refers to cannabis (marijuana) and “hyperemesis” is a word meaning “prolonged vomiting.”
• Overall, most cannabis users find the experience safe and without any problems.
• With cannabis use increasing throughout the world as the threshold for legalization becomes lower, its user numbers are expected to rise over time.
• There is a growing body of research showing the benefit of cannabis in the aforementioned disorders, and its legalization will further augment research on understanding its critical role in new drug developments 3,4.
• In several clinical trials, the most common adverse events in patients on cannabidiol included diarrhea, loss of appetite, and less commonly vomiting.
• Most cannabinoids act through two receptors, CB1 and CB2, which reduce anterior pituitary hormone and increase corticotrophin release15.

Differentiating CHS from Other Conditions

Several studies have shown the anti-emetic properties of Cannabinoid and TRPV1 agonists (transient receptor potential cation channel subfamily V member 1, also known as the capsaicin receptor and the vanilloid receptor 1) 19. However, chronic cannabis use may lead to CHS demonstrating its complex dual effects 10,20. Extensive review of his medical record revealed that the patient had, in fact, presented to the ED with similar symptoms 11 times in the prior 8 years. The typical hospital course included supportive care with antiemetics and IV fluids. The patient’s symptoms typically resolved within 24 to 72 hours of hospitalization. Previous evaluations included additional unremarkable CT imaging of the abdomen and pelvis.

Pharmacology of Cannabinoids

Based on published case reports of CHS, lorazepam could be considered as an agent of choice in the management of the acute hyperemetic phase of CHS to relieve symptoms of nausea and vomiting (Table 1). The role of lorazepam and its optimal dosing requires further clinical evaluation. Clinical pharmacists can play an important role in the management of CHS patients through therapy recommendation. Caution should be made against the overprescription of lorazepam, as it https://ecosoberhouse.com/ can cause physical and/or psychological dependence especially in CHS patients who are vulnerable to substance abuse. Certain therapies, such as taking hot showers or using prescription medications, may help relieve symptoms.

Potential Mechanisms Behind CHS

• As per this study, CVS is likely the result of a vicious cycle of elevated intracellular cations and mitochondrial dysfunction leading to cellular hyperexcitability 48.
• Symptoms are most common in early middle-aged adults who have consistently been using cannabis since adolescence.
• Hyperemesis cannabis syndrome is directly linked to long-term cannabis use, while CVS is not related to cannabis.
• He was also on liraglutide, but his symptoms predated this medicine use.
• One study found up to 6% of people who went to the emergency room for cyclical vomiting had CHS.

However, chronic exposure to cannabis leads to desensitization and decreased density of CB1 and CB2 receptors, therefore resulting in a pro-emetic effect (8). When ligand concentration is high, TRP is anti-emetic, and when ligand concentration is low, TRP is pro-emetic. Chronic cannabis use leads to downregulation of TRP channels, which results in an increase in nausea and vomiting. As cannabinoids are highly lipophilic and accumulate in adipose tissue, patients with chronic use accumulate cannabis in their body fat over time.

While the precise physiological mechanisms underpinning this phenomenon continue to be explored, several theories shed light on why hot showers might hold therapeutic value for CHS patients. Initial symptoms are feeling sick to the stomach, belly pain and the feeling like you may throw up. After about years of chronic marijuana use, patients begin to have a strong feeling of sickness, throwing up, and belly pain.

• The most effective treatment during the hyperemetic phase of CHS is the use of hot showers by patients.
• Now, these cannabinoid receptors are also present in the digestive tract of the body.
• Without knowing this background, providers often misdiagnose CHS as other conditions, like cyclic vomiting syndrome (CVS).
• Although both conditions share an astonishing similarity, there are several significant differences.

Your digestive tract also has a number of chs syndrome molecules that bind to THC and related substances. For example, the drug can change the time it takes the stomach to empty. That’s the tight band of muscle that opens and closes to let food from the esophagus into the stomach.

Knowing these can help marijuana users recognize the signs early, seek appropriate treatment, and avoid further complications. By recognizing these symptoms and understanding the different phases, marijuana users can better identify what is cannabinoid hyperemesis syndrome and seek proper medical care to manage and recover from the condition. TCAs are anticholinergics that modulate alpha-2-adrenoreceptors, thereby decreasing sympathetic nervous system activity and mitigating brain–gut autonomic dysfunction 95. Amitryptine helps to prevent vomiting cycles in CHS, usually at doses between 50 and 200 mg daily 96. Or hospital, and dosage titration can be made during closer outpatient care. A study evaluating the TCA effect on CVS with CHS indicated that both conditions showed significant pain relief 5.

Patients must be informed that habitual cannabis use can result in cannabinoid accumulation in adipose tissue, leading to prolonged or recurrent symptoms that may take weeks to completely resolve. Preventing a recurrence necessitates complete abstinence to facilitate recovery. To help you transition to the recovery phase, you can try a few home remedies such as regular hot baths. But too many of them may increase your risk for dehydration due to sweating. If you need help quitting, ask your doctor whether a drug rehabilitation program is a good fit for you.

Causes of CHS

CUD is treated with psychotherapy, which Drug rehabilitation involves motivational interviewing, cognitive behavioral therapy, and contingency management. Another thing that must be considered is that while not everybody who uses cannabis develops the CHS syndrome, people who started using cannabis during their adolescent years often tend to develop the CHS symptoms and condition. Our patient was born at 35 weeks by cesarian section due to maternal preeclampsia. He grew and developed with no medical issues until he was 6 years old. He then acutely developed altered mental status and status epilepticus and was admitted to an outside hospital, where he remained in a deep state of unconsciousness for 6 weeks.

4. Pathological Bathing Behavior

• Significant improvements in nausea and vomiting, as well as shorter length of hospital stay, were noted in patients treated with 0.075% topical capsaicin applied to the abdominal region 62.
• WS is a 54-year-old African American male with a medical history of diabetes mellitus type 2, hypertension, obstructive sleep apnea, and gastroparesis.
• Hence, raising the awareness of CHS with an understanding of its pathophysiology and the potential role of therapeutic agents is paramount.

Patients often adopt this behavior to alleviate nausea, vomiting, and abdominal pain symptoms of CHS, and some reports have referred to this symptom as CHS as “cannabis hot shower syndrome”. It is hypothesized that hot showers help stabilize the thalamic thermostat, which is frequently disrupted by chronic cannabis use, including CHS. However, this proposed mechanism has not been empirically validated 59.