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Cannabinoid Hyperemesis Syndrome

Alexis J. Rogers, MD and Carl Bryce, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Cannabinoid hyperemesis syndrome (CHS) is defined by cyclic nausea, vomiting, and abdominal pain typically relieved by hot showers or baths in the setting of chronic cannabis use.

  • Eas...

DIAGNOSIS

HISTORY

  • CHS occurs in three phases: prodromal, hyperemetic, and recovery phase (3).

    • Prodromal phase: early morning nausea and abdominal discomfort with normal eating patterns—can last for mo...

TREATMENT

GENERAL MEASURES

  • Acute treatment includes fluid replacement, antiemetics, benzodiazepines, electrolyte replacement if necessary, and cessation of cannabis to control symptoms (4)[C].

  • Admission...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Referral for outpatient or inpatient treatment for cessation of cannabis such as cognitive behavioral therapy and rehabilitation programs 

Patient Monitoring

Follow...

REFERENCES

1
Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health...

ADDITIONAL READING

  • Sorensen CJ, DeSanto K, Borgelt L, et al. Cannabinoid hyperemesis syndrome: diagnosis, pathophysiology, and treatment—a systematic review. J Med Toxicol.  2017;13(1):71–87. [Vi...

SEE ALSO

Cyclic Vomiting Syndrome; Marijuana (Cannabis) Use Disorder; Substance Use Disorders, Pediatric 

CODES

SNOMED

  • 11047881000119101 Cannabis hyperemesis syndrome co-occurrent and due to cannabis abuse

  • 11048011000119103 Cannabis hyperemesis syndrome co-occurrent and due to cannabis dependence

CLINICAL PEARLS

  • Cannabis cessation completely resolves symptoms.

  • Patients often maintain a fixed belief that the cannabis actually helps them with their nausea, making long-term remission challenging.

  • I...

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