Proposed Etiologies of Cannabinoid Hyperemesis Syndrome
• A genetic variation in cannabinoid metabolism leads to toxic accumulation.8
• The main active ingredient of cannabis, THC, is highly lipophilic, and long-term use causes THC to accumulate in cerebral fat, which may lead to toxicity and emesis in sensitive patients.11
• Nausea and vomiting are influenced by the balance between enteric and central nervous system effects. The enteric pro-emetic effects of cannabis may override its central nervous system–mediated antiemetic effects to promote emesis.8,10
• The central effects of long-term cannabis use on the hypothalamic-pituitary-adrenal axis might play a major role in the development of CHS.12
• The impairment of the physiologic thermoregulation provoked by cannabis use might account for the relief of symptoms with compulsive hot bathing.7,12
Note: CHS = cannabinoid hyperemesis syndrome; THC = delta-9-tetrahydrocannabinol.