Doctors warn of cannabis risk to diabetics after a woman was stricken with a two-year debilitating illness.
The 23-year-old, who had type 1 diabetes, was in and out of the hospital with severe vomiting and nausea that baffled doctors who struggled to determine the cause.
She was misdiagnosed with a diabetes-related stomach problem that prevents food from being removed from the body.
But the doctors missed an important detail: that the young woman had been an avid marijuana user for eight years. She did not reveal this until a later visit, after which she was diagnosed with cannabinoid hyperemesis syndrome (CHS).
At first, doctors in Athens, Georgia, thought the woman, who has uncontrolled type 1 diabetes and stage 3 kidney failure, had a condition characterized by the stomach’s inability to empty itself. It wasn’t until she told doctors she was a regular marijuana user that they started connecting the dots with cannabinoid hyperemesis syndrome (file image)
CHS is caused by long-term, frequent cannabis use that leads to repeated episodes of vomiting, severe nausea, stomach pain, and dehydration.
Marijuana can be especially dangerous in diabetics who use it regularly over a long period of time.
Cannabis users with type 1 diabetes are twice as likely than non-users to develop diabetic ketoacidosis, a life-threatening condition characterized by a buildup of acids in your blood due to prolonged periods of high blood sugar.
A team of gastroenterologists from Piemonte Athens Regional Medical Center in Athens, Georgia, revealed the case in a report published in the American Journal of Case Reports.
Physicians wrote in the case study, “With the legalization of cannabis in the United States, clinicians can expect to see more and more patients presenting with complications of cannabis use.
“This report has demonstrated the importance of taking a comprehensive social history in all patients, including those with type 1 diabetes, and is a reminder that cannabinoid use can cause severe nausea, vomiting and abdominal pain in this patient group.”
The female patient – who was not named – had a seven-year history of type 1 diabetes that doctors described as “uncontrolled,” meaning her blood sugar was too high despite treatment for her condition. This put her at risk for life-threatening diabetic ketoacidosis.
The team of doctors initially thought it was a case of diabetic gastroparesis (DGP), a condition in which your stomach has trouble clearing its contents because of damaged stomach muscles, which allows food to stay in your body longer than it should. Although a visit six months prior to admission that doctors wrote about in the case study showed that she had “normal gastric emptying.”
But the doctors didn’t know about her history of regular marijuana use until later.
When she told the doctors, they considered the possibility that they were, in fact, dealing with a case of little-understood CHS, estimated to be approximately 2.75 million Americansalthough the actual burden is hard to estimate because CHS is a newly discovered condition and people may not want to disclose how much marijuana they consume.
Some heavy marijuana users can get CHS, while others don’t. Experts are still unclear on how cannabis causes CHS symptoms, but some believe genetics play a role.
CHS takes a long time to develop, so it is very unlikely that someone who smokes occasionally will develop symptoms. But for a day-to-day user, it’s a different story.
Many people who experience CHS symptoms will complain of “scromiting,” or episodes of intense vomiting and screaming at the same time. Symptoms also include stomach pain and cramping, as well as severe dehydration that depletes the body’s electrolytes, increasing the risk of kidney disease.
While there is no specific dosage of THC that will definitely cause someone to develop CHS, some patients with the condition have admitted to smoking 2000mg of THC per day50 times the recommended maximum dose.
At her most recent hospitalization, doctors looked at a diagnosis of CHS. She received IV hydration, anti-nausea medications, and an intravenous infusion of the antipsychotic medication Haldol typically used to treat schizophrenia, tics in Tourette’s syndrome, mania in bipolar disorder, delirium, agitation, acute psychosis, and alcohol withdrawal hallucinations.
The patient continued to experience severe upper abdominal pain, although CT and other imaging scans were both normal.
The doctors wrote: ‘At that time, given her history of chronic cannabis use and unrevealing previous investigations, there was more concern about CHS. On further history taking, she reported a clear improvement in symptoms after hot baths.’
Most people with intestinal problems caused by CHS will find relief in a hot shower or bath. The pain can be so acute for some that hot showers become hours of activity.
‘When she took the history, she reported a marked improvement in symptoms after hot baths. She smoked cannabis at least 5 times a week and her last use was 2 days prior to presentation.
“After discharge, she abstained from cannabis for 2 months, during which she remained symptom-free until she resumed cannabis use and symptoms returned.”
The case study is just one example of doctors struggling to diagnose the relatively new condition.
The first case of CHS was described in 2004 by Australian doctors who followed a series of patients who developed nausea, vomiting and abdominal pain after using marijuana regularly. Their symptoms stopped when they stopped taking the drug, and symptoms started again when they did.