A chronic marijuana user died after a severe multi-day bout of vomiting and abdominal pain caused a fatal heart rhythm disorder that led to brain death.
The 22-year-old woman treated in Canada began using weed at 14 and had been suffering from multiple bouts of severe cannabis hyperemesis syndrome – a condition marked by violent, painful, repeated episodes of severe vomiting – for more than three years.
When she was admitted to the hospital with vomiting and abdominal pain, she developed a specific life-threatening irregular heartbeat called torsades de pointes, which caused her heart to stop.
While doctors were able to restart her heart, her brain had already suffered catastrophic loss of oxygen and she was declared brain dead four days later.
Cannabis hyperemesis syndrome can develop in habitual marijuana because the drug can cause certain receptors in the brain to malfunction.
In people who first begin using cannabis or those who don’t use it regularly, the signals to cannabinoid receptors in the brain and gastrointestinal tract usually continue to function normally.
But with chronic marijuana use, those receptors become desensitized and don’t respond to the drug in the same way, disrupting the body’s natural ability to control nausea, which can lead to cannabis hyperemesis syndrome
CT scans of the woman’s brain showed the extent of the damage caused by a lack of oxygen when her severe vomiting caused a fatal irregular heartbeat. The brain’s folds have been flattened and the whole brain swelled
The woman’s cause of death was eventually attributed to a fatal irregular heartbeat made worse by low potassium levels caused by her frequent vomiting and by medications that can affect the heart’s rhythm.
She also had genetic mutations that contributed to her heart problems and had been taking haloperidol and ondansetron, an antipsychotic and anti-nausea medicine, respectively.
According to the Toronto doctors who wrote the case report, published in the journal Springer Link, there have only been two other deaths due to cannabis hyperemesis syndrome described in medical literature.
In the six months leading up to the woman’s hospitalization, she visited the emergency department six different times with episodes of vomiting and nausea that lasted about a week each time.
She had low potassium levels during almost all her visits to the emergency department. To treat this, she was given fluids and electrolytes.
Low potassium can lead to muscle cramping and weakness, heart rhythm abnormalities, kidney stones, and digestive issues.
During her severe episodes and to prevent them at home, she was treated with a combination of medications, including various anti-nausea and anti-anxiety drugs, as well as sedatives.
On the day of her hospital admission, the woman arrived at the ER around 9:30 am and was found to have a low heart rate and high blood pressure. Her potassium was also low, indicating an electrolyte imbalance.
Throughout the afternoon, she was given potassium through an IV, as well as several other medications until around 6 pm. The final medication she was given was the anti-vomiting drug dimenhydrinate.
But 25 minutes later, nurses checked her and found no vital signs. While doctors tried to resuscitate her, they used an electrocardiogram (ECG) to monitor her heart rhythm.
Initially, the ECG detected ventricular fibrillation, a severe condition in which the heart’s lower chambers lose their ability to pump normally, making the heart rhythm chaotic and disorganized.
After being shocked with a defibrillator in an effort to restart her heart, her rhythm worsened to the point at which the heartbeat showed a twisting pattern on the ECG known as the torsades de pointes, a fatal type of arrhythmia – irregular heartbeat.
The woman’s heart rate was disorganized and at once very low while at other seconds very high. The above photo is an example of an irregular heatbeat
Doctors restarted her heart, but her brain’s ‘downtime’ had exceeded 30 minutes, meaning it had not been receiving crucial oxygen, killing off brain cells that left her in a vegetative state.
She was declared brain dead, removed from life support four days later and died.
Cannabis hyperemesis can potentially be caused by any form of cannabis, from smoking and vaping to edibles, though the case study does not say how the woman consumed her cannabis.
The condition causes compulsive vomiting that is often painful and includes forceful retching. Prolonged use of cannabis causes a build up of cannabinoids and other toxins in the body, affecting receptors in the brain and GI tract, leading to nausea and vomiting.
It may also affect the motility and function of the GI tract.
A unique sign of CHS is the temporary relief one gets when taking a hot shower, and people with the condition often take several in a day to reduce nausea.
CT scans of the woman after her death examining the extent of her brain injury showed the grooves on her brain had been flattened out, her entire brain had swelled, and the boundary between the outer layer of the brain and the inner layer was not well defined, indicating widespread damage caused by a lack of oxygen.
Cannabis use has seen a meteoric rise over the past decade, culminating in legal recreational use in 24 states.
And while it has been shown to have benefits for epilepsy and chemotherapy-linked nausea, using the drug daily has also proven extremely risky.
Cannabis use disorder is loosely defined as people who smoke marijuana every day and cannot stop using the drug even though it is causing health and social issues, such as affecting their work and relationships.
It affects roughly 30 percent of users, though that may be underestimated.
A study by Canadian researchers last year compared people who had been diagnosed with cannabis use disorder with people who had not.
During the study period, 721 (2.4 percent) of people in the cannabis use disorder group suffered a cardiovascular disease event for the first time, such as a heart attack or stroke, compared to 458 (1.5 percent) of people in the group who did not abuse the drug.
Adults with cannabis use disorder had a roughly 60 percent higher risk of experiencing heart attacks and strokes than those without the disorder.
Cannabis can also harm a person’s sleep health. Daily marijuana users were more likely than non- and even occasional users to suffer with insomnia.
According to a 2016 study published in the Journal of Addictive Diseases, 39 percent of daily users satisfied criteria for clinical insomnia, compared to 20 percent of non-users.
Weed has also been linked to potentially severe mental health events such as psychotic episodes, major depression, and suicidal thoughts.
A study published in the May issue of the journal Psychological Medicine found cannabis use disorder was linked to about 30 percent of schizophrenia diagnoses in young Danish men in the year 2021.
Regular cannabis use can disrupt the delicate balance of neurotransmitters responsible for regulating mood and motivation.
Many people who already live with depression may self-medicate with marijuana for its calming abilities, but continued use could have the opposite effect.
As marijuana laws have loosened, a black market industry of high-potency strains and vapes has emerged, with such products that provide a high much more potent than previous ones.
Now, more than 40million adults – 16 percent of the population – use marijuana, a rate that has more than doubled in the last 10 years amid a seismic cultural shift that sees more acceptance toward medical and recreational use.
