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Cannabinoid Hyperemesis Syndrome – CB1 and TRPV1 Paradox’

Mansoor Zafar, Riaz Mohammad, Tila Muhammad, Muhammad Toqeer

A 37 years of age Caucasian male was eventually reffered to Gastroenterology Department at local hospital with recurrent history of visits to Accident and Emergency (A&E), for chronic history of nausea, vomiting, abdominal pain, unable to eat, failure to thrive and weight loss. With background history of Type 1 Diabetes mellitus on some occasions he was found to be ketoacidotic, while with normal blood sugars on most of the visits to A&E. He underwent thorough investigations with no abnormality found except for abnormal HbA1c. He declined urine drug testing and on further he gave history of using Cannabis in the form of CBD (cannabidiol) Oil 3-4 times per week since age 16. Patient was advised to stop use of CBD oil and educated for better control of HbA1c and neuropathic pain killers. Patient consented for these changes and this resulted in dramatic response with resolution of all the symptoms. Patient currently is strictly abstinent of cannabis in any form. The most populous model suggests overriding of gut Cannabinoid receptors-CB1 (emesis inducing) over the brain receptors (emesis inhibition) and down regulation of Transient Receptor Potential Vanilloid Subtype 1 (TRPV-1) in gut and chemoreceptor-trigger zone, causing nausea and vomiting and some relief with hot showers in patients with long term use of Cannabis.