Cannabinoid Hyperemesis Syndrome

Thankfully, cannabinoid hyperemesis syndrome isn’t a life- or limb-threatening condition. Malpractice attorneys would be having a field day if it were. I have been attuned to this condition only for the past several years, but it’s apparent that this condition remains diagnostically elusive.   Every new case I pick up has presented previously to my or another community emergency department multiple times without anyone making the diagnosis. And the patient almost always has a trail of CT scans, abdominal ultrasounds, and other imaging studies as well as hundreds of dollars in laboratory testing. It’s known that this condition is commonly not recognized by health care providers, and patients often go years with this recurrent or cyclical condition before a diagnosis is eventually made. (Mayo Clin Proc 2009;84[1]:76.)   This condition has only recently been described. Allen et al from South Australia initially recognized it in 2001 and first published a small case series in 2004. (Gut 2004;53[11]:1566.) A number of small case series and case reports were subsequently published. A 2012 article by Simonetto et al from the Mayo Clinic is one of the largest case series published. These authors (Mayo Clin Proc 2012;87[2]:114) reviewed 98 patients presenting with the syndrome, and proposed diagnostic criteria:• Long-term cannabis use• Severe cyclic nausea and vomiting• Resolution with cannabis cessation• Relief of symptoms with hot showers or baths• Epigastric ...
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