Cannabinoid hyperemesis syndrome - Revision history

Danbot: Add MedicationDose entries for haloperidol, diphenhydramine, lorazepam

2026-03-20T21:03:16Z

Add MedicationDose entries for haloperidol, diphenhydramine, lorazepam

← Older revision		Revision as of 21:03, 20 March 2026
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	**[[Special:MyLanguage/Lorazepam\|Lorazepam]] 1-2 mg IV <ref>Smith TN, et al. Cannabinoid hyperemesis syndrome: an unrecognized cause of nausea and vomiting. JAAPA. 2019. Apr;32(4):1-5 </ref>		**[[Special:MyLanguage/Lorazepam\|Lorazepam]] 1-2 mg IV <ref>Smith TN, et al. Cannabinoid hyperemesis syndrome: an unrecognized cause of nausea and vomiting. JAAPA. 2019. Apr;32(4):1-5 </ref>


			==Medication Dosing==
			{{MedicationDose
			\| drug = Haloperidol
			\| dose = 5mg IV or IM
			\| route = IV/IM
			\| context = Antiemetic, first-line
			\| indication = Cannabinoid hyperemesis syndrome
			\| population = Adult
			}}
			{{MedicationDose
			\| drug = Diphenhydramine
			\| dose = 50mg IV
			\| route = IV
			\| context = Adjunct with haloperidol
			\| indication = Cannabinoid hyperemesis syndrome
			\| population = Adult
			}}
			{{MedicationDose
			\| drug = Lorazepam
			\| dose = 1-2mg IV
			\| route = IV
			\| context = Anxiolytic/antiemetic
			\| indication = Cannabinoid hyperemesis syndrome
			\| population = Adult
			}}

	==Disposition== <!--T:15-->		==Disposition== <!--T:15-->

Ostermayer: Marked this version for translation

2026-01-07T12:26:50Z

Marked this version for translation

← Older revision		Revision as of 12:26, 7 January 2026
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	<translate>		<translate>

	==Background==		==Background== <!--T:1-->

			<!--T:2-->
	*Cannabis is the most widely used drug in the US and the world		*Cannabis is the most widely used drug in the US and the world
	*Cannabinoid hyperemesis syndrome, first described by Allen et al. in 2004 consists of nausea, vomiting, and abdominal pain in a patient with no other organic cause who frequently uses marijuana and has relief of symptoms with hot showers<ref> Allen, J H; De Moore, GM; Heddle, R; Twartz, JC (2004). "Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse". Gut 53 (11): 1566–70. doi:10.1136/gut.2003.036350. PMC 1774264</ref>		*Cannabinoid hyperemesis syndrome, first described by Allen et al. in 2004 consists of nausea, vomiting, and abdominal pain in a patient with no other organic cause who frequently uses marijuana and has relief of symptoms with hot showers<ref> Allen, J H; De Moore, GM; Heddle, R; Twartz, JC (2004). "Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse". Gut 53 (11): 1566–70. doi:10.1136/gut.2003.036350. PMC 1774264</ref>
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	==Clinical Features<ref>Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). "Cannabinoid Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings 87 (2): 114–9. doi:10.1016/j.mayocp.2011.10.005. PMID 22305024</ref>==		==Clinical Features<ref>Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). "Cannabinoid Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings 87 (2): 114–9. doi:10.1016/j.mayocp.2011.10.005. PMID 22305024</ref>== <!--T:3-->


	===Essential Features===		===Essential Features=== <!--T:4-->

			<!--T:5-->
	*Long term cannabis use (typically > 2 years)		*Long term cannabis use (typically > 2 years)


	===Major Features===		===Major Features=== <!--T:6-->

			<!--T:7-->
	*Severe cyclical [[Special:MyLanguage/nausea\|nausea]], [[Special:MyLanguage/vomiting \|vomiting ]]		*Severe cyclical [[Special:MyLanguage/nausea\|nausea]], [[Special:MyLanguage/vomiting \|vomiting ]]
	*Weekly use of [[Special:MyLanguage/marijuana\|marijuana]]		*Weekly use of [[Special:MyLanguage/marijuana\|marijuana]]
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	===Supportive Features===		===Supportive Features=== <!--T:8-->

			<!--T:9-->
	*Age < 50y		*Age < 50y
	*Weight loss > 5kg		*Weight loss > 5kg
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	==Differential Diagnosis==		==Differential Diagnosis== <!--T:10-->

	</translate>		</translate>
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	==Evaluation==		==Evaluation== <!--T:11-->

			<!--T:12-->
	*Generally considered a diagnosis of exclusion after evaluating for other causes of [[Special:MyLanguage/nausea and vomiting\|nausea and vomiting]]		*Generally considered a diagnosis of exclusion after evaluating for other causes of [[Special:MyLanguage/nausea and vomiting\|nausea and vomiting]]


	==Management==		==Management== <!--T:13-->

			<!--T:14-->
	*Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses		*Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses
	*Symptomatic treatment ([[Special:MyLanguage/Antiemetics\|Antiemetics]], anxiolytics, and hydration)		*Symptomatic treatment ([[Special:MyLanguage/Antiemetics\|Antiemetics]], anxiolytics, and hydration)
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	==Disposition==		==Disposition== <!--T:15-->

			<!--T:16-->
	*Discharge once tolerating PO		*Discharge once tolerating PO


	==See Also==		==See Also== <!--T:17-->

			<!--T:18-->
	*[[Special:MyLanguage/Nausea and vomiting\|Nausea and vomiting]]		*[[Special:MyLanguage/Nausea and vomiting\|Nausea and vomiting]]
	*[[Special:MyLanguage/Marijuana\|Marijuana]]		*[[Special:MyLanguage/Marijuana\|Marijuana]]


	==External Links==		==External Links== <!--T:19-->

			<!--T:20-->
	*[http://lifeinthefastlane.com/therapeutic-showering/ LITFL:Therapeutic Showering]		*[http://lifeinthefastlane.com/therapeutic-showering/ LITFL:Therapeutic Showering]
	*[http://www.thepoisonreview.com/2014/07/16/review-of-cannabinoid-hyperemesis-syndrome/ The Poison Review: Review of cannabinoid hyperemesis syndrome]		*[http://www.thepoisonreview.com/2014/07/16/review-of-cannabinoid-hyperemesis-syndrome/ The Poison Review: Review of cannabinoid hyperemesis syndrome]


	==References==		==References== <!--T:21-->

			<!--T:22-->
	<references/>		<references/>

			<!--T:23-->
	[[Category:Toxicology]]		[[Category:Toxicology]]
	[[Category:GI]]		[[Category:GI]]
	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:46:37Z

Prepared the page for translation

← Older revision		Revision as of 21:46, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	*Cannabis is the most widely used drug in the US and the world		*Cannabis is the most widely used drug in the US and the world
	*Cannabinoid hyperemesis syndrome, first described by Allen et al. in 2004 consists of nausea, vomiting, and abdominal pain in a patient with no other organic cause who frequently uses marijuana and has relief of symptoms with hot showers<ref> Allen, J H; De Moore, GM; Heddle, R; Twartz, JC (2004). "Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse". Gut 53 (11): 1566–70. doi:10.1136/gut.2003.036350. PMC 1774264</ref>		*Cannabinoid hyperemesis syndrome, first described by Allen et al. in 2004 consists of nausea, vomiting, and abdominal pain in a patient with no other organic cause who frequently uses marijuana and has relief of symptoms with hot showers<ref> Allen, J H; De Moore, GM; Heddle, R; Twartz, JC (2004). "Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse". Gut 53 (11): 1566–70. doi:10.1136/gut.2003.036350. PMC 1774264</ref>
	*Pathophysiology not yet well understood<ref>Byrne, A; Hallinan, R; Wodak, A (2006). "'Cannabis hyperemesis' causation questioned". Gut 55 (1): 132; author reply 132. PMC 1856368</ref>		*Pathophysiology not yet well understood<ref>Byrne, A; Hallinan, R; Wodak, A (2006). "'Cannabis hyperemesis' causation questioned". Gut 55 (1): 132; author reply 132. PMC 1856368</ref>


	==Clinical Features<ref>Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). "Cannabinoid Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings 87 (2): 114–9. doi:10.1016/j.mayocp.2011.10.005. PMID 22305024</ref>==		==Clinical Features<ref>Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). "Cannabinoid Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings 87 (2): 114–9. doi:10.1016/j.mayocp.2011.10.005. PMID 22305024</ref>==


	===Essential Features===		===Essential Features===

	*Long term cannabis use (typically > 2 years)		*Long term cannabis use (typically > 2 years)


	===Major Features===		===Major Features===
	*Severe cyclical [[nausea]], [[vomiting ]]
	*Weekly use of [[marijuana]]		*Severe cyclical [[Special:MyLanguage/nausea\|nausea]], [[Special:MyLanguage/vomiting \|vomiting ]]
			*Weekly use of [[Special:MyLanguage/marijuana\|marijuana]]
	*Relief of symptoms with hot showers or baths		*Relief of symptoms with hot showers or baths
	*[[Abdominal pain]]: epigastric or periumbilical		*[[Special:MyLanguage/Abdominal pain\|Abdominal pain]]: epigastric or periumbilical
	*Resolution of symptoms with cannabis cessation		*Resolution of symptoms with cannabis cessation


	===Supportive Features===		===Supportive Features===

	*Age < 50y		*Age < 50y
	*Weight loss > 5kg		*Weight loss > 5kg
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	*Normal bowel habits		*Normal bowel habits
	*Negative labs, imaging and endoscopy		*Negative labs, imaging and endoscopy


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Nausea and vomiting DDX}}		{{Nausea and vomiting DDX}}
			<translate>


	==Evaluation==		==Evaluation==
	*Generally considered a diagnosis of exclusion after evaluating for other causes of [[nausea and vomiting]]
			*Generally considered a diagnosis of exclusion after evaluating for other causes of [[Special:MyLanguage/nausea and vomiting\|nausea and vomiting]]


	==Management==		==Management==

	*Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses		*Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses
	*Symptomatic treatment ([[Antiemetics]], anxiolytics, and hydration)		*Symptomatic treatment ([[Special:MyLanguage/Antiemetics\|Antiemetics]], anxiolytics, and hydration)
	**[[Haloperidol]] 5 mg IV/IM and [[diphenhydramine]] 50 mg IV<ref>Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6.</ref>		**[[Special:MyLanguage/Haloperidol\|Haloperidol]] 5 mg IV/IM and [[Special:MyLanguage/diphenhydramine\|diphenhydramine]] 50 mg IV<ref>Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6.</ref>
	**Hot shower (>109°F), though short-lived<ref>Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.</ref>		**Hot shower (>109°F), though short-lived<ref>Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.</ref>
	**[[Capsaicin]] cream 0.025-0.075% across abdomen/arms/back, with symptoms diminishing within 30 min<ref>Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.</ref>		**[[Special:MyLanguage/Capsaicin\|Capsaicin]] cream 0.025-0.075% across abdomen/arms/back, with symptoms diminishing within 30 min<ref>Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.</ref>
	**[[Lorazepam]] 1-2 mg IV <ref>Smith TN, et al. Cannabinoid hyperemesis syndrome: an unrecognized cause of nausea and vomiting. JAAPA. 2019. Apr;32(4):1-5 </ref>		**[[Special:MyLanguage/Lorazepam\|Lorazepam]] 1-2 mg IV <ref>Smith TN, et al. Cannabinoid hyperemesis syndrome: an unrecognized cause of nausea and vomiting. JAAPA. 2019. Apr;32(4):1-5 </ref>


	==Disposition==		==Disposition==

	*Discharge once tolerating PO		*Discharge once tolerating PO


	==See Also==		==See Also==
	*[[Nausea and vomiting]]
	*[[Marijuana]]		*[[Special:MyLanguage/Nausea and vomiting\|Nausea and vomiting]]
			*[[Special:MyLanguage/Marijuana\|Marijuana]]


	==External Links==		==External Links==

	*[http://lifeinthefastlane.com/therapeutic-showering/ LITFL:Therapeutic Showering]		*[http://lifeinthefastlane.com/therapeutic-showering/ LITFL:Therapeutic Showering]
	*[http://www.thepoisonreview.com/2014/07/16/review-of-cannabinoid-hyperemesis-syndrome/ The Poison Review: Review of cannabinoid hyperemesis syndrome]		*[http://www.thepoisonreview.com/2014/07/16/review-of-cannabinoid-hyperemesis-syndrome/ The Poison Review: Review of cannabinoid hyperemesis syndrome]


	==References==		==References==

	<references/>		<references/>

	[[Category:Toxicology]]		[[Category:Toxicology]]
	[[Category:GI]]		[[Category:GI]]
			</translate>

Shihabali: /* Management */

2019-11-24T21:43:17Z

Management

← Older revision		Revision as of 21:43, 24 November 2019
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	**Hot shower (>109°F), though short-lived<ref>Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.</ref>		**Hot shower (>109°F), though short-lived<ref>Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.</ref>
	**[[Capsaicin]] cream 0.025-0.075% across abdomen/arms/back, with symptoms diminishing within 30 min<ref>Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.</ref>		**[[Capsaicin]] cream 0.025-0.075% across abdomen/arms/back, with symptoms diminishing within 30 min<ref>Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.</ref>
			**[[Lorazepam]] 1-2 mg IV <ref>Smith TN, et al. Cannabinoid hyperemesis syndrome: an unrecognized cause of nausea and vomiting. JAAPA. 2019. Apr;32(4):1-5 </ref>

	==Disposition==		==Disposition==

ClaireLewis: /* Major Features */

2019-09-29T19:46:06Z

Major Features

← Older revision		Revision as of 19:46, 29 September 2019
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	*Weekly use of [[marijuana]]		*Weekly use of [[marijuana]]
	*Relief of symptoms with hot showers or baths		*Relief of symptoms with hot showers or baths
	*Abdominal pain: epigastric or periumbilical		*[[Abdominal pain]]: epigastric or periumbilical
	*Resolution of symptoms with cannabis cessation		*Resolution of symptoms with cannabis cessation

ClaireLewis: /* Management */

2019-09-24T03:44:26Z

Management

← Older revision		Revision as of 03:44, 24 September 2019
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	**[[Haloperidol]] 5 mg IV/IM and [[diphenhydramine]] 50 mg IV<ref>Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6.</ref>		**[[Haloperidol]] 5 mg IV/IM and [[diphenhydramine]] 50 mg IV<ref>Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6.</ref>
	**Hot shower (>109°F), though short-lived<ref>Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.</ref>		**Hot shower (>109°F), though short-lived<ref>Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.</ref>
	**Capsaicin cream 0.025-0.075% across abdomen/arms/back, with symptoms diminishing within 30 min<ref>Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.</ref>		**[[Capsaicin]] cream 0.025-0.075% across abdomen/arms/back, with symptoms diminishing within 30 min<ref>Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.</ref>

	==Disposition==		==Disposition==

Rossdonaldson1 at 14:43, 2 October 2016

2016-10-02T14:43:27Z

← Older revision		Revision as of 14:43, 2 October 2016
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	==See Also==		==See Also==
			*[[Nausea and vomiting]]
	*[[Marijuana]]		*[[Marijuana]]

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	*[http://lifeinthefastlane.com/therapeutic-showering/ LITFL:Therapeutic Showering]		*[http://lifeinthefastlane.com/therapeutic-showering/ LITFL:Therapeutic Showering]
	*[http://www.thepoisonreview.com/2014/07/16/review-of-cannabinoid-hyperemesis-syndrome/ The Poison Review: Review of cannabinoid hyperemesis syndrome]		*[http://www.thepoisonreview.com/2014/07/16/review-of-cannabinoid-hyperemesis-syndrome/ The Poison Review: Review of cannabinoid hyperemesis syndrome]

	~~==See Also==~~
	*[[Nausea and vomiting]]
	*[[Marijuana]]

	==References==		==References==

Rossdonaldson1: /* Disposition */

2016-10-02T14:42:58Z

Disposition

← Older revision		Revision as of 14:42, 2 October 2016
Line 37:		Line 37:
	==Disposition==		==Disposition==
	*Discharge once tolerating PO		*Discharge once tolerating PO

			==See Also==
			*[[Marijuana]]

	==External Links==		==External Links==

Rossdonaldson1: /* Evaluation */

2016-10-02T14:42:32Z

Evaluation

← Older revision		Revision as of 14:42, 2 October 2016
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	==Evaluation==		==Evaluation==
	*Generally considered a diagnosis of exclusion after evaluating for other causes of [[~~Nausea~~ and vomiting]]		*Generally considered a diagnosis of exclusion after evaluating for other causes of [[nausea and vomiting]]

	==Management==		==Management==

Rossdonaldson1: /* Management */

2016-10-02T14:42:22Z

Management

← Older revision		Revision as of 14:42, 2 October 2016
Line 31:		Line 31:
	*Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses		*Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses
	*Symptomatic treatment ([[Antiemetics]], anxiolytics, and hydration)		*Symptomatic treatment ([[Antiemetics]], anxiolytics, and hydration)
	**Haloperidol 5 mg IV/IM and diphenhydramine 50 mg IV<ref>Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6.</ref>		**[[Haloperidol]] 5 mg IV/IM and [[diphenhydramine]] 50 mg IV<ref>Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6.</ref>
	**Hot shower (>109°F), though short-lived<ref>Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.</ref>		**Hot shower (>109°F), though short-lived<ref>Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.</ref>
	**Capsaicin cream 0.025-0.075% across abdomen/arms/back, with symptoms diminishing within 30 min<ref>Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.</ref>		**Capsaicin cream 0.025-0.075% across abdomen/arms/back, with symptoms diminishing within 30 min<ref>Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.</ref>