Cannabinoid hyperemesis syndrome: Difference between revisions
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==Background==
<languages/>
Cannabis is the most widely used drug in the US and the world
<translate>
==Clinical Features==
Essential Features<br />
* Long term cannabis use (typically > 2years)<br />
Major Features<br />
* 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<br />
Supportive Features
* Age < 50y
* Weight loss > 5kg
* Symptoms greater in morning
* Normal bowel habits
* Neg lab, imaging and endoscopy


==Differential Diagnosis==
==Background== <!--T:1-->
[[Vomiting]]


==Workup==
<!--T:2-->
Diagnosis of exclusion after complete workup for [[Vomitting]]
*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>
*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>


'''Modified criteria for the diagnosis of "cannabinoid hyperemesis syndrome"'''<ref name="Simonetto">
</ref>
{| class="wikitable"
|-
! Essential
| Long-term cannabis use
|-
! Major
| Severe cyclic nausea and vomiting
Resolution with cannabis cessation


Relief of symptoms with hot showers or baths
==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-->


Abdominal pain, epigastric or periumbilical


Weekly use of marijuana.
===Essential Features=== <!--T:4-->
|-
! Supportive
|Age less than 50 y


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


Morning predominance of symptoms


Normal bowel habits
===Major Features=== <!--T:6-->


Negative laboratory, radiographic, and endoscopic test results
<!--T:7-->
|}
*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
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]]: epigastric or periumbilical
*Resolution of symptoms with cannabis cessation


==Management==
Symptomatic treatment: antiemetics, IV/PO hydration<br />
Cessation of marijuana use


==Disposition==
===Supportive Features=== <!--T:8-->
Home


==See Also==
<!--T:9-->
*Age < 50y
*Weight loss > 5kg
*Symptoms greater in morning
*Normal bowel habits
*Negative labs, imaging and endoscopy


==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.
==Differential Diagnosis== <!--T:10-->
 
</translate>
{{Nausea and vomiting DDX}}
<translate>
 
 
==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]]
 
 
==Management== <!--T:13-->
 
<!--T:14-->
*Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses
*Symptomatic treatment ([[Special:MyLanguage/Antiemetics|Antiemetics]], anxiolytics, and hydration)
**[[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>
**[[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>
**[[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== <!--T:15-->
 
<!--T:16-->
*Discharge once tolerating PO
 
 
==See Also== <!--T:17-->
 
<!--T:18-->
*[[Special:MyLanguage/Nausea and vomiting|Nausea and vomiting]]
*[[Special:MyLanguage/Marijuana|Marijuana]]
 
 
==External Links== <!--T:19-->
 
<!--T:20-->
*[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]
 
 
==References== <!--T:21-->
 
<!--T:22-->
<references/>
 
<!--T:23-->
[[Category:Toxicology]]
[[Category:GI]]
</translate>

Latest revision as of 12:26, 7 January 2026

Other languages:

Background

  • 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[1]
  • Pathophysiology not yet well understood[2]


Clinical Features[3]

Essential Features

  • Long term cannabis use (typically > 2 years)


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 symptoms with cannabis cessation


Supportive Features

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


Differential Diagnosis

Nausea and vomiting

Critical

Emergent

Nonemergent


Evaluation

  • Generally considered a diagnosis of exclusion after evaluating for other causes of nausea and vomiting


Management

  • Cessation of marijuana use, as hyperemetic phase lasts only 24-48 hrs unless pt relapses
  • Symptomatic treatment (Antiemetics, anxiolytics, and hydration)


Disposition

  • Discharge once tolerating PO


See Also


External Links


References

  1. ↑ 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
  2. ↑ Byrne, A; Hallinan, R; Wodak, A (2006). "'Cannabis hyperemesis' causation questioned". Gut 55 (1): 132; author reply 132. PMC 1856368
  3. ↑ 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
  4. ↑ Hickey JL et al. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013 Jun;31(6):1003.e5-6.
  5. ↑ Galli JA et al. Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse Rev. 2011 Dec; 4(4): 241–249.
  6. ↑ Leon G. Toxicology Rounds: The Anti-Munchies: Cannabinoid Hyperemesis Syndrome. Emergency Medicine News: November 2011 - Volume 33 - Issue 11 - p 14.
  7. ↑ Smith TN, et al. Cannabinoid hyperemesis syndrome: an unrecognized cause of nausea and vomiting. JAAPA. 2019. Apr;32(4):1-5
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