User:GhostRiver/chs

Causes
Risk factors, triggers, genetics, virology, spread

Mechanism
Because most of the research on CHS utilizes case studies, the exact underlying neurobiological mechanisms controlling the syndrome are unknown. As such, the pathophysiology behind CHS can only be inferred using information from these case studies as well as the known pharmacology of cannabinoids.

Pathogenesis and pathophysiology

Diagnosis
Characteristic biopsy findings and differential diagnosis

Treatment
Patients with CHS frequently attempt to self-treat the syndrome by compulsively bathing, with higher water temperatures generating greater symptom relief. The rationale behind this treatment is unknown. It is possible that, because the endocannabinoid system affects the hypothalamus, disrupting the hypothalamic thermoregulatory system through contact with hot water also disrupts cannabis's effect on the body. An alternative explanation is that bathing in hot water stimulates vasodilation and the release of histamines, which redistributes blood flow from the digestive system to the skin to relieve symptoms. Regardless of the mechanism, bathing in hot water is the most reliable outpatient treatment for many suffering from CHS.

Outcomes
As both persistent vomiting and excessive hot bathing predispose individuals to dehydration and to electrolyte imbalances, one sequela of CHS is acute kidney injury. The first two fatalities associated with CHS were first identified in 2016; both patients' cause of death was hyponatremic dehydration either exacerbated by or in the setting of probable CHS.

Epidemiology
The lack of precise diagnostic criteria for CHS, as well as a lack of awareness among medical professionals, makes it difficult to ascertain any epistemological data regarding the disease.Although CHS is estimated to affect 0.1% of the general population, other estimates suggest that CHS or a CHS-like disease affects nearly $1/3$ of frequent marijuana smokers. Most CHS patients report chronic cannabis consumption beginning in their teenage years, with symptoms developing after several years of daily use. Patients who are hospitalized for CHS are predominantly under the age of 50 or 55, which is consistent with higher rates of marijuana use among the younger population. Literature conflicts on whether a gender predilection exists for CHS: broadly, it is more common in males, but cannabis use is more popular among men than women, while cyclic vomiting syndrome regardless of marijuana use is more populat among women.

Since the first description of CHS in 2004, the number of emergency department visits for vomiting associated with cannabis use have dramatically increased. This is attributed to increasing marijuana usage, increased awareness and acceptance of cannabis leading to greater medical reporting, and increased awareness about the connection between chronic cannabis use and gastrointestinal distress. Beginning in 2009, when several U.S. states passed laws legalizing cannabis for medical use, there was a significant increase in both cannabis use disorders and hospitalizations for persistent vomiting. In the U.S. state of Colorado, in addition to a general increase in hospitalizations for cyclic vomiting after the legalization of medical marijuana, more vomiting patients reported cannabis use during their intake. In the first five years of the post-legalization period, hospitalizations for persistent vomiting among CUD patients decreased in black and non-Hispanic white patients but increased in Hispanic patients.

History
CHS was first described and named in 2004, when emergency physicians in the Adelaide Hills region of South Australia detailed a pattern of 19 chronic cannabis users who had been hospitalized for cyclic vomiting, which they self-remedied through compulsive bathing in scalding temperatures.

Early discoveries, historical figures, and outdated treatments

Society and culture
Social perceptions, cultural history, stigma, economics, religious aspects, awareness, legal issues, notable cases