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Cannabinoid Hyperemesis Syndrome
At the beginning of the week, we presented a patient with cannabinoid hyperemesis syndrome. Today, we will focus on the remedies used to ameliorate the nausea and vomiting of the acute hyperemetic phase and the definitive treatment to prevent relapse of this disorder.
Patients describe the immersion in hot water as the most effective means of controlling the intense nausea, vomiting and abdominal pain. This compulsive bathing is a learned behavior that may not be present in all cases. A few logical explanations for the hot shower/bath cravings have been offered:
Some researchers believe that cannabis toxicity disrupts the equilibrium of the thermoregulatory system of the hypothalamus. The heat of the bath water may counter the hyperstimulation of the cannabinoid CB1 receptors in the hypothalamic region.
Patterson et al. suggests an alternative explanation – a cutaneous steal syndrome. Cannabinoid receptors (CB1) are present in the splanchnic circulation. The stimulation of these receptors may lead to slowed gastric emptying and overall slowed peristalsis, and cause vasodilation in the splanchnic circulation. As a result, nausea and vomiting ensue. Bathing in hot water may lead to a redistribution of the blood containing the free-floating cannabinoids away from the gut and towards the skin.