Cannabinoid hyperemesis syndrome with extreme hydrophilia

Abstract

Marijuana is the most widely used recreational drug in the US. Hyperemetic hydrophilic syndrome is a previously described but infrequently recognized condition of cannabinoid abuse with hyperemesis and obsessive hot showering. We present a 47-year-old male known marijuana addict with intractable abdominal pain who could not wait for physical examination, meal, or medication, because of obsessive compulsive warm baths. He had a history of epilepsy and addiction to marijuana, which he took on the day of admission. He presented to the hospital with a seizure, complicated by nausea, vomiting, and severe abdominal pain. His examination was unremarkable, except for mild epigastric tenderness. His laboratory and radiological tests were within normal limits, except for a positive urine drug screen for marijuana and opiates. He took himself immediately to the bathroom and remained under a hot shower with the exception of two 15-minute breaks for the rest of the day. He stated that it made him feel better than medication. Receiving medication and even eating was a problem because of this compulsive showering. Abstinence from marijuana during the hospital stay made the patient’s nausea and vomiting resolve significantly. Cannabinoid hyperemesis is a differential diagnosis among patients with intractable nausea, vomiting, and obsessive hot bathing. The syndrome is an unmistakable indication of marijuana addiction. A thorough history and observation is very valuable. Recognition of this entity will reduce unnecessary testing and utilization of health care resources.

Cannabinoid Hyperemesis

“…The patient found that hot water relieved his symptoms better than anything else. After 3 days in the hospital (and no marijuana use), his symptoms resolved [94]. It should be noted that in the case of CHS, compulsive showering in hot water is not an anxiety disorder but rather a learned behavior that the patient develops to relieve symptoms [94].…”

“…After 3 days in the hospital (and no marijuana use), his symptoms resolved [94]. It should be noted that in the case of CHS, compulsive showering in hot water is not an anxiety disorder but rather a learned behavior that the patient develops to relieve symptoms [94]. Similar to hot water, capsaicin provides symptomatic relief of CHS [95-97] but not other vomiting disorders.…”

“…A summary of these studies appears in Table 2 [6, 7, 10, 19, 22, 54, 94, 97, 99, 101, 105, 111, 113, 114, 116, 117, 121, 126, 127, 132-173]. …”

Cannabinoids Hyperemesis Syndrome

“…In addition, CB1 receptors are also located on peripheral enteric nerves, and their stimulation lead to slow gastrointestinal transit. CB1 receptors are also found in the hypothalamus close to the thermoregulatory center which could explain the role of compulsive hot bathing in relieving symptoms, this has been thought to be related to counteraction of cannabis effect at the thermoregulatory center (6)(7)(8).…”

“…Care during the chronic maintenance phase involves prevention of relapse and patient education of the condition to help them understand cannabinoid substance use as the cause of their symptoms. Other measures to prevent relapse include cognitive behavioral therapy and drug rehabilitation programs (7)(8)(9).…”