![]() History of regular cannabis use (100% Sensitivity) While no diagnostic criteria currently exist for definitive CHS diagnosis major characteristics patients typically display are: It is speculated that the reason patients with CHS take repetitive hot showers is to upregulated the TRPV1 receptor. There is another theory that the TRPV1 receptor (transient receptor potential vanilloid subtype 1), which is activated by marijuana, capsaicin, and heat, is altered by chronic marijuana use. The theory is that the CB receptors in the medulla are responsible for anti-emetic properties, but the CB receptors in the GI tract are the source of dysregulation. Cannabinoid CB1 and CB2 are the main receptors for THC, one of the main active substances in marijuana. There is speculation that there is a dose-dependency, and that a biphasic mechanism of action of THC may have anti-emetic effects at low doses, but pro-emetic at higher doses. ![]() Theoretically, this paradoxical illness is caused by highly potent THC that effects genetically predisposed individuals by differentially downregulating CBD receptors and causing autonomic dysfunction. Ironically, cannabinoids are used very commonly to treat nausea and vomiting, particularly in patients with chemotherapy-related symptoms, or patients with cyclic vomiting syndrome. As legislation in many states in the USA eases restrictions on its use (as of March 31, 2021, it is legal for adults 21 and older to possess up to three ounces of cannabis for personal use in New York), we are seeing more and more patients appearing in the ED presenting with the relatively rare side-effects from marijuana, including hyperemesis. Cannabis has been used as a medicine for centuries. ![]() The patient encountered is suffering from cannabinoid hyperemesis syndrome. Another beautiful night on South Side- better have 3 In 1 on speed dial for some munchies. With a new feeling of empathy for this person’s exceptionally vocal nausea, you mosey on to the doctor’s station to await sign-out from your eager and exhausted colleagues. One quick look and you can size them up- this person looks ill and uncomfortable, but not sick. They usually are with a concerned loved one who is rubbing their shoulder for comfort. A young person, actively retching to a volume audible from the waiting room, clutching a kidney basin for dear life. Stepping through the triage area you first hear- then see- our patient. Let me set the scene: You’re walking into the South Side 7 PM shift, through the ambulance bay doors, hot coffee in one hand and a large and refreshing bottle of San Pellegrino Mineral Water in the other. Today I want to delve into a topic that I feel like we encounter relatively regularly in the ED. Hope you had your fill of Thanksgiving, turkey, football, relatives, and political disagreements over the dinner table. ![]()
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