Case Report: Is haloperidol the wonder drug for cannabinoid hyperemesis syndrome? PMC

CHS, or Cannabinoid Hyperemesis Syndrome, is a condition thought to be triggered by heavy and/or long term cannabis use, including CBD. Individuals with CHS may suffer from recurring episodes of nausea, vomiting, dehydration, and abdominal pain, often leading to frequent emergency department visits. These patients described in these case reports were below the age of 40 years and presented with nausea and intractable vomiting with a history of chronic cannabis abuse. It is important to note that CHS symptoms in all of these cases were refractory to repeated doses of conventional antiemetics. This highlights the importance of haloperidol as a novel therapy in such patients. Due to the growing use of cannabinoid integrative medicines, healthcare professionals must be cognizant that N/V in patients undergoing prolonged cannabis treatment may develop cannabinoid toxicity and CHS.

Treatment of Cannabinoid Hyperemesis Syndrome

Computed tomography of the abdomen with intravenous contrast showed narrowing of the third duodenal segment at the SMA level, a nonspecific finding that can be suggestive of SMA syndrome (Figure 1). Ultrasonography of the mesenteric artery showed a widely patent SMA with decreased aortomesenteric angle of approximately 18° (Figure 2). This finding is non-specific but can be seen with SMA syndrome in the appropriate clinical setting. SMA syndrome initially was not included in the differential diagnosis. The PICO tool was used to inform and guide the keywords used in the search. We assessed adults and older populations with N/V who were using recreational or medicinal cannabinoids.

Cannabinoid Hyperemesis Syndrome Diagnosis

In addition https://ecosoberhouse.com/ to stopping marijuana use, patients with CHS may benefit from making dietary and lifestyle changes. Patients should avoid trigger foods and drinks and eat small, frequent meals throughout the day. Find out everything you need to know about weight loss drugs in our prescription weight loss drug guide. This feeling is temporary and usually subsides after a few weeks of sobriety. Engaging in activities like watching a new TV show or committing to a hobby can help distract and entertain.

Unveiling Treatment Strategies for Cannabis Hyperemesis Syndrome (CHS)

Avoid ibuprofen (Advil), naproxen (Aleve) and other NSAIDs, as they are notoriously hard on your stomach even when healthy. For CHS symptoms other than cessation of cannabis and time, several remedies may alleviate symptoms. Note that none of the methods below will work if you are still using cannabis. Some people use it in low dosages to reduce depression, social anxiety, and post-traumatic stress disorder (PTSD), and it can help relieve nausea and vomiting that occur due to chemotherapy.

Cannabis hyperemesis syndrome: an update on the pathophysiology and management

• As CHS is a relatively recently recognized and studied phenomenon easily confused with other diseases, there is a paucity of sizeable randomized control studies.
• In severe cases, patients may also require intravenous fluids and electrolytes.
• There is also a belief that marijuana may help in opioid addiction recovery, and researchers are publishing new studies all the time, highlighting many other potential benefits.
• The emotional and physical toll of CHS has been devastating to some, as many sufferers were misdiagnosed and made many visits to the emergency room as a result.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Moderating use will not make CHS go away – you need to quit entirely for an extended period of time to allow your body to heal. Using again and trying to moderate is much harder for most people than quitting entirely. Trying to moderate cannabis use comes with a very high likelihood of CHS returning. Tylenol (acetaminophen) for abdominal pain according to the package instructions. Do not exceed the recommended dose on the package – the “therapeutic dose” and “toxic dose” of Tylenol are very close to each other.

Despite this trend, a strict criterion for the diagnosis of CHS is lacking. Early recognition of CHS is essential to prevent complications related to severe volume depletion. The recent body of research recognizes that patients with CHS impose a burden on the healthcare systems.

Topical capsaicin and haloperidol are currently the only treatment with efficacy validated in RCTs 22, 32. Haloperidol showed improvements in N/V and decreased the LOS in the ED; however, caution should be exercised as it has been shown to cause acute dystonia in higher dosages 30, 31, 32, 33. Other pharmacological interventions, such as droperidol used in the ED for the treatment of CHS, showed accelerated discharge which may help preserve ED resources 27, 28. Propranolol has also cannabinoid hyperemesis syndrome shown relief in N/V for individuals with severe recurrent CHS 34. Aprepitant was found to rapidly relive N/V in patients resistant to traditional antiemetics 35.

Unveiling the Therapeutic Potential of Hot Showers in CHS Symptom Management

Through a holistic and individualized treatment regimen, healthcare providers can navigate the challenges of CHS, offering hope and relief to those affected by this puzzling condition. Hot showers have emerged as an intriguing phenomenon in assuaging the symptoms of Cannabis Hyperemesis Syndrome (CHS), offering a peculiar yet effective avenue for relief. 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. In older patients, especially those with hypertension, cardiovascular illnesses such as aortic pathology and atypical coronary artery syndromes may present as vague abdominal pain, nausea, and vomiting. The symptoms of CHS include severe nausea, repeated vomiting, and stomach pain. The symptoms of CHS can be debilitating, and they can last for several days.

• A major limitation of this case report is that the dosage of aprepitant was not described.
• The focus of this review is to stress the importance of rapid recognition, diagnosis, and the available treatment options in adults and older populations.
• We assessed adults and older populations with N/V who were using recreational or medicinal cannabinoids.
• A patient-centered approach aimed to avoid attribution and anchoring errors is vital to provide proper treatment in a timely manner for medical conditions resulting from prolonged marijuana use.

He was discharged from the hospital with strong counselling for permanent cannabis cessation. At the 1-month follow-up visit, he did not report recurrence of nausea, vomiting or abdominal pain. Since then, the patient continues to enjoy a stable and healthy life. In select cases, topical application of capsaicin cream on the abdomen has demonstrated promise in alleviating CHS symptoms.

A high index of suspicion for the numerous possible CHS complications, including SMA syndrome, is warranted for clinicians when treating a patient with marijuana use and persistent cyclical vomiting. The first four days are often the worst, with withdrawal symptoms (more below) exacerbating CHS. Around days 5-7, daily routines may resume, though prodromal symptoms may persist. By the two-week mark, many report feeling better, and a month into sobriety, most symptoms subside. Note that you’ll probably be experiencing some CHS symptoms, and some cannabis withdrawal symptoms at the same time for a while.