New York State Practitioner Education-Medical Use of Marijuana 4-hr Required Course

New York State Practitioner Education-Medical Use of Marijuana 4-hr Required Course

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Section 7.0: Cannabinoid Hyperemesis Syndrome

Part 1


Cannabinoid Hyperemesis Syndrome


As the rates of cannabis use increase, so will the incidence of side effects.  This course focuses on cannabinoid hyperemesis syndrome, an uncommon side effect of long-term cannabis use. At the start of this section, we offer a clinical presentation of cannabinoid hyperemesis syndrome and then we discuss the diagnostic criteria, pathophysiology and the natural course of this syndrome.


A 27-year-old female with no significant past medical history presents to the emergency room complaining of diffuse but mild abdominal pain. She has been experiencing profound nausea and more than 20 episodes of vomiting per day for several days. The patient stated that the vomitus has occasionally been green, but it has never been bloody. She gets nauseated by the smell of food and has been reluctant to eat or drink anything other than water.


As a result of this illness, she has lost about 4 pounds in the last few days.  Although, she has tried the conventional anti-emetic medications on several occasions, those remedies have never relieved her symptoms.  Smoking cannabis exacerbated the abdominal pain as well as the nausea and vomiting.  The patient reported that bathing in hot water provided symptomatic relief at first, but as the symptoms worsened, she required increasingly longer baths.  Most recently, the patient has been bathing for several hours each day. These symptoms have occurred sporadically between periods of wellness over the past ten months, and the bouts of nausea and vomiting seem to be worsening over time.


A review of systems provided no additional significant information except that the patient denied any neurological changes/deficits and denied having a history of a psychiatric illness.


The patient denied tobacco and alcohol use but admitted to long-term heavy cannabis use.  She claims to have smoked three cannabis cigars with 1-2 grams of cannabis bud in each cigar on a daily basis for several years.  She denied using any other recreational drugs.


On physical exam, it was noted that the patient was afebrile, her pulse was 110 beats/min and her blood pressure was 115/60 (mmHg) with positive orthostatic changes.  Her mucous membranes were dry and the patient had mild abdominal tenderness to palpation in the epigastric region.  Otherwise, the physical exam, including a complete neurological exam, was unremarkable.


Comprehensive radiographic, endoscopic and blood tests were performed, but uncovered no abnormalities except for moderate gastritis on EGD biopsy. Of significance, no pancreatic or gall bladder abnormalities were noted on any of the imaging tests.

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