Cannabinoid Hyperemesis Syndrome: A Case Report of an Underdiagnosed Condition

Abstract

Cannabinoid hyperemesis syndrome (CHS) is characterized by episodic bursts of nausea, vomiting and abdominal pain, affecting chronic cannabis users. The clinical picture mimics an acute abdomen, usually leading to multiple assessments in the emergency department. Several complementary diagnostic examinations are performed with non-specific results, making differential diagnosis puzzling. We present a case of a 42-year-old man, who has been admitted multiple times to the emergency department in the last 3 months for abdominal pain, nausea and vomiting, without triggering factors and improving only with hot water baths. He was evaluated by different specialties, the various complementary diagnostic tests performed showed no significant results, and no definitive diagnosis was obtained. Treatment resulted only in a partial and transient resolution of symptoms. A more detailed medical history revealed cannabis use for more than 5 years, with a recent increase in the amount consumed. After psychoeducation, explaining the risks associated with consumption and its relationship with the clinical symptoms, which resulted in complete suspension of cannabis, there have been no new symptomatic episodes since then. We present an illustrative case of a poorly reported clinical entity despite having a probable significant prevalence, raising awareness in order that clinicians identify and properly manage these cases.

Síndrome de hiperemesis cannabinoide en el servicio de urgencias. Una revisión

“…Los vómitos no suelen responder a los antieméticos habituales y mejoran con la abstinencia de cannabis 4 . La etiología y fisiopatología aún no está clara, pero el cannabis parece interactuar con la motilidad gastrointestinal 2,7,11 . Esta enfermedad es una entidad clínica escasamente reconocida y muy infradiagnosticada, pues el desconocimiento de los profesionales de la salud por dicha entidad es alta y su diagnóstico frecuentemente es diferido; es por eso que el diagnóstico debe hacerse después de una historia clínica completa y usando los criterios diagnósticos de forma adecuada y minuciosa 3,4,7,8,12 .…”