Dr Sanil Rege, Consultant Psychiatrist, discusses a clinical case of an 18yearold female who presented to the emergency department on multiple occasions for severe episodes of vomiting.
As no medical causes were identified, she was referred to psychiatry to evaluate anxiety that was thought to cause vomiting.
#cannabisuse #cannabis #cannabishyperemesissyndrome

Applying a diagnostic hierarchy, the cause was due to chronic cannabis use.
Cannabis Hyperemesis Syndrome is characterised by:

1. Chronic cannabis use
2. Cyclic episodes of nausea and vomiting
3. Frequent hot bathing
The gastrointestinal actions of cannabinoids are mediated chiefly by CB1 receptors.
Activation of CB1 receptors results in inhibition of gastric acid secretion, lower oesophageal sphincter relaxation, altered intestinal motility, visceral pain, and inflammation.

The clinical course of Cannabinoid Hyperemesis Syndrome is divided into three phases:
Phase 1: The prodromal phase can last for months or years, with patients developing early morning nausea, a fear of vomiting, and abdominal discomfort.
Phase 2 :
The hyperemetic phase is characterised by intense and persistent nausea and vomiting episodes.
Phase 3:
Recovery phase. This is associated with the cessation of cannabis use.

Despite the wellestablished antiemetic properties of marijuana, there is increasing evidence of its paradoxical effects on the gastrointestinal tract and CNS.

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