Cannabinoid hyperemesis syndrome

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Background

Cannabis is the most widely used drug in the US and the world

Clinical Features

Essential Features

  • Long term cannabis use (typically > 2years)

Major Features

  • severe cyclical nausea, vomiting
  • weekly use of marijuana
  • relief of symptoms with hot showers or baths
  • abdominal pain: epigastric or periumbilical
  • resolution of cannabis cessation

Supportive Features

  • Age < 50y
  • Weight loss > 5kg
  • Symptoms greater in morning
  • Normal bowel habits
  • Neg lab, imaging and endoscopy

Differential Diagnosis

Vomiting

Workup

Diagnosis of exclusion, see workup for vomiting

Management

Symptomatic treatment: antiemetics, IV/PO hydration
Cessation of marijuana use

Disposition

Home

See Also

Sources

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.