Signs and symptoms edit
Prodromal phase edit
Hyperemetic phase edit
Recovery phase edit
Causes edit
Risk factors, triggers, genetics, virology, spread
Mechanism edit
Because most of the research on CHS utilizes case studies, the exact underlying neurobiological mechanisms controlling the syndrome are unknown. As such, the pathophysiology behind CHS can only be inferred using information from these case studies as well as the known pharmacology of cannabinoids.[1]
Pathogenesis and pathophysiology
Diagnosis edit
Characteristic biopsy findings and differential diagnosis
Prevention edit
Treatment edit
Patients with CHS frequently attempt to self-treat the syndrome by compulsively bathing, with higher water temperatures generating greater symptom relief.[2] The rationale behind this treatment is unknown. It is possible that, because the endocannabinoid system affects the hypothalamus, disrupting the hypothalamic thermoregulatory system through contact with hot water also disrupts cannabis's effect on the body.[3] An alternative explanation is that bathing in hot water stimulates vasodilation and the release of histamines, which redistributes blood flow from the digestive system to the skin to relieve symptoms.[4] Regardless of the mechanism, bathing in hot water is the most reliable outpatient treatment for many suffering from CHS.[2]
Outcomes edit
As both persistent vomiting and excessive hot bathing predispose individuals to dehydration and to electrolyte imbalances, one sequela of CHS is acute kidney injury.[5][6] The first two fatalities associated with CHS were first identified in 2016; both patients' cause of death was hyponatremic dehydration either exacerbated by or in the setting of probable CHS.[7]
Epidemiology edit
The lack of precise diagnostic criteria for CHS, as well as a lack of awareness among medical professionals, makes it difficult to ascertain any epistemological data regarding the disease.Although CHS is estimated to affect 0.1% of the general population,[8] other estimates suggest that CHS or a CHS-like disease affects nearly 1⁄3 of frequent marijuana smokers.[9] Most CHS patients report chronic cannabis consumption beginning in their teenage years, with symptoms developing after several years of daily use.[10] Patients who are hospitalized for CHS are predominantly under the age of 50 or 55, which is consistent with higher rates of marijuana use among the younger population.[11][12] Literature conflicts on whether a gender predilection exists for CHS: broadly, it is more common in males, but cannabis use is more popular among men than women, while cyclic vomiting syndrome regardless of marijuana use is more populat among women.[13]
Since the first description of CHS in 2004, the number of emergency department visits for vomiting associated with cannabis use have dramatically increased. This is attributed to increasing marijuana usage, increased awareness and acceptance of cannabis leading to greater medical reporting, and increased awareness about the connection between chronic cannabis use and gastrointestinal distress.[14] Beginning in 2009, when several U.S. states passed laws legalizing cannabis for medical use, there was a significant increase in both cannabis use disorders and hospitalizations for persistent vomiting.[15] In the U.S. state of Colorado, in addition to a general increase in hospitalizations for cyclic vomiting after the legalization of medical marijuana, more vomiting patients reported cannabis use during their intake.[16] In the first five years of the post-legalization period, hospitalizations for persistent vomiting among CUD patients decreased in black and non-Hispanic white patients but increased in Hispanic patients.[17]
History edit
CHS was first described and named in 2004, when emergency physicians in the Adelaide Hills region of South Australia detailed a pattern of 19 chronic cannabis users who had been hospitalized for cyclic vomiting, which they self-remedied through compulsive bathing in scalding temperatures.[18]
Early discoveries, historical figures, and outdated treatments
Society and culture edit
Social perceptions, cultural history, stigma, economics, religious aspects, awareness, legal issues, notable cases
Research directions edit
References edit
- ^ DeVuono, Marieka V.; Parker, Linda A. (2020). "Cannabinoid Hyperemesis Syndrome: A Review of Potential Mechanisms". Cannabid and Cannabinoid Research. 5 (2): 132–144. doi:10.1089/can.2019.0059. PMID 32656345. Retrieved May 24, 2022.
- ^ a b Khattar, Neera; Routsolias, Joanne C. (2018). "Emergency Department Treatment of Cannabinoid Hyperemesis Syndrome: A Review". American Journal of Therapeutics. 25 (3): e357–e361. doi:10.1097/MJT.0000000000000655. Retrieved May 24, 2022.
- ^ Chang, Yoon Hee; Windish, Donna M. (January 1, 2009). "Cannabinoid Hyperemesis Relieved by Compulsive Bathing". Mayo Clinic Proceedings. 84 (1): 76–78. doi:10.4065/84.1.76. Retrieved May 24, 2022.
- ^ Patterson, Dale A.; Smith, EmmaLeigh; Monahan, Mark; Medvecz, Andrew; Hagerty, Beth; Krijger, Lisa; Chauhan, Aakash; Walsh, Mark (November 2010). "Cannabinoid Hyperemesis and Compulsive Bathing: A Case Series and Paradoxical Pathophysiological Explanation". The Journal of the American Board of Family Medicine. 23 (6): 790–793. doi:10.3122/jabfm.2010.06.100117. Retrieved May 24, 2022.
- ^ Habboushe, Joseph; Sedor, Jennifer (June 2014). "Cannabinoid hyperemesis acute renal failure: a common sequela of cannabinoid hyperemesis syndrome". The American Journal of Emergency Medicine. 32 (6): 690.e1-690.e2. doi:10.1016/j.ajem.2013.12.013. PMID 24418446. Retrieved May 25, 2022.
- ^ Nourbakhsh, Mahra; Miller, Angela; Gofton, Jeff; Jones, Graham; Adeagbo, Baidele (2019). "Cannabinoid Hyperemesis Syndrome: Reports of Fatal Cases". Journal of Forensic Sciences. 64 (1): 270–274. doi:10.1111/1556-4029.13819. PMID 29768651. Retrieved May 25, 2022.
- ^ Soota, Kaartik; Lee, Ye-Jin; Schouweiler, Katie; Keeney, Matthew; Nashelsky, Marcus; Holm, Adrian (October 2016). "Cases of Death Secondary to Cannabinoid Hyperemesis Syndrome". American Journal of Gastroenterology. 111: S1063. Retrieved May 25, 2022.
- ^ Aziz, Imran; Palsson, Olafur S.; Whitehead, William E.; Sperber, Ami D.; Simrén, Magnus; Törnblom, Hans (April 2019). "Epidemiology, Clinical Characteristics, and Associations for Rome IV Functional Nausea and Vomiting Disorders in Adults". Clinical Gastroenterology and Hepatology. 17 (5): 878–886. doi:10.1016/j.cgh.2018.05.020. Retrieved May 22, 2022.
- ^ Habboushe, Joseph; Rubin, Ada; Liu, Haoming; Hoffman, Robert S. (January 12, 2018). "The Prevalence of Cannabinoid Hyperemesis Syndrome Among Regular Marijuana users in an Urban Public Hospital". Basic & Clinical Pharmacology & Toxicology. 122: 660–662. doi:10.1111/bcpt.12962. Retrieved May 22, 2022.
- ^ Wallace, Erik A.; Andrews, Sarah E.; Garmany, Chad L.; Jelley, Martina J. (2011). "Cannabinoid Hyperemesis Syndrome: A Literature Review and Proposed Diagnosis and Treatment Algorithm". Southern Medical Journal. 104 (9): 659–664. doi:10.1097/SMJ.0b013e3182297d57. Retrieved May 22, 2022.
- ^ Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (February 2012). "Cannabinoid Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings. 87 (2): 114–119. doi:10.1016/j.mayocp.2011.10.005. PMID 22305024. Retrieved May 22, 2022.
- ^ Hernandez, Jeremy M.; Paty, Jared; Price, Ira M. (2018). "Cannabinoid hyperemesis syndrome presentation to the emergency department: A two-year multicentre retrospective chart review in a major urban area". Canadian Journal of Emergency Medicine. 20 (4): 550–555. doi:10.1017/cem.2017.381. Retrieved May 23, 2022.
- ^ Venkatesan, Thangam; Levinthal, David J.; Li, B U. K.; Tarbell, Sally E.; Adams, Kathleen A.; Issenman, Robert M.; Sarosiek, Irene; Jaradeh, Safwan S.; Sharaf, Ravi N.; Sultan, Shahnaz; Stave, Christopher D.; Monte, Andrew A.; Hasler, William L. (June 2019). "Role of chronic cannabis use: Cyclic vomiting syndrome vs cannabinoid hyperemesis syndrome". Neurogastroenterology & Motility. 31 (52): e13606. doi:10.1111/nmo.13606. Retrieved May 23, 2022.
- ^ Bollom, Andrea; Austrie, Jasmine; Hirsch, William; Nee, Judy; Friedlander, Daniel; Iturrino, Johanna; Ballou, Sarah; Lembo, Anthony (October 2018). "Emergency Department Burden of Nausea and Vomiting Associated With Cannabis Use Disorder: US Trends From 2006 to 2013". Journal of Clinical Gastroenterology. 52 (9): 778–783. doi:10.1097/MCG.0000000000000944. Retrieved May 23, 2022.
- ^ Al-Shammari, Mustafa; Herrera, Karina; Liu, Xibei; Gisi, Brandon; Yamashita, Takashi; Han, Kyu-Tae; Azab, Mohamed; Mashiana, Harmeet; Maklad, Muthena; Farooqui, Muhammed Talha; Makar, Ranjit; Yoo, Ji Won (July 12, 2017). "Effects of the 2009 Medical Cannabinoid Legalization Policy on Hospital Use for Cannabinoid Dependency and Persistent Vomiting". Clinical Gastroenterology and Hepatology. 15 (2): 1876–1881. doi:10.1016/j.cgh.2017.06.055. Retrieved May 23, 2022.
- ^ Kim, Howard S.; Anderson, John D.; Saghafi, Omeed; Heard, Kennon J.; Monte, Andrew A. (April 22, 2015). "Cyclic Vomiting Presentations Following Marijuana Liberalization in Colorado". Academic Emergency Medicine. 22 (6): 694–699. doi:10.1111/acem.12655. PMID 25903855. Retrieved May 22, 2022.
- ^ Madireddy, Sowmya; Patel, Rikinkumar S.; Ravat, Virendrasinh; Ajibawo, Temitope; Lal, Anthony; Patel, Jenil; Patel, Riddhi; Goyal, Hemant (August 27, 2019). "Burden of Comorbidities in Hospitalizations for Cannabis Use-associated Intractable Vomiting during Post-legalization Period". Cureus. 11 (8): e5502. doi:10.7759/cureus.5502. PMID 31511820. Retrieved May 23, 2022.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Allen, J. H.; de Moore, G. M.; Heddle, R.; Twartz, J. C. (November 2004). "Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse". Gut. 53 (11): 1566–1570. doi:10.1136/gut.2003.036350. PMID 15479672. Retrieved May 23, 2022.
