The anti-munchies: cannabinoid hyperemesis syndrome
August 25, 2011, 11:14 pm
Cannabinoid Hyperemesis Syndrome: Literature Review and Proposed Diagnosis and Treatment Algorithm. Wallace EA et al. Southern Med J 2011 Sep;104:659-664.
Last month we reviewed a diagnosis TPR had not heard of before: narcotic bowel syndrome. This paper describes another diagnosis new to us: cannabinoid hyperemesis syndrome (CHS). Although cannabis has well-known anti-emetic properties, frequent chronic use can produce paradoxical nausea and vomiting. This may have something to do with alterations of the cannabinoid type I (CB1) receptors.
Hallmark of CHS are:
- chronic use of marijuana (usually daily for more than a year)
- recurrent episodes of severe nausea and vomiting
- abdominal pain
- relief of symptoms from a hot bath or shower, leading to compulsive bathing
It is not known why exposure to hot water in a bath or shower relieves symptoms of CHS, but the extremes to which patients may go to seek relief this away can be astounding. Baths or showers can last for several hours and be repeated multiple times in a day. In one case described in the medical literature (there have been a total of 31 so far), the patient was said to have spent 300 or 365 days a year in the bath. (I would like to see his water heating bill.) Patients usually have been seen multiple times in emergency rooms and other healthcare facilities, and often have undergone extensive workup for recurrent symptoms.
Treatment involves rehydration and cessation of exposure to cannabinoids. The authors hypothesize that with medical marijuana becoming more freely available, we may be seeing more cases of CHS.
[Addendum August 27, 2011: On further reflection, I decided that this article deserved an upgrade from TPR's original rating of 3 skulls.]