A 28-year-old pregnant woman had multiple hospital admissions for severe vomiting before CHS was diagnosed, highlighting the similarity between CHS and hyperemesis gravidarum.
Read this if you are pregnant, use cannabis, and experience severe nausea and vomiting.
CHS mimics hyperemesis gravidarum; compulsive bathing is the key diagnostic clue
What the researchers found
A 28-year-old pregnant woman was repeatedly admitted for episodic nausea, vomiting, and abdominal pain, experiencing complications including Mallory-Weiss esophageal tears and dehydration. Hospital staff noted she was showering compulsively during her admissions.
After extensive workup revealed no other cause, she was diagnosed with cannabinoid hyperemesis syndrome. The treatment was simply abstinence from marijuana use.
The case illustrates that CHS and hyperemesis gravidarum share nearly identical presentations, making CHS likely underdiagnosed in pregnant women. The compulsive bathing behavior is a key distinguishing feature that should prompt clinicians to ask about cannabis use.
Why it matters
As cannabis use during pregnancy ranges from 2-5%, CHS may be misdiagnosed as hyperemesis gravidarum more often than recognized. Correct diagnosis avoids unnecessary testing and invasive procedures while directing the patient to the effective treatment: cannabis cessation.
The numbers in context
Patient age: 28. Multiple hospitalizations. Complications: Mallory-Weiss tears, dehydration. Key diagnostic clue: compulsive showering during hospitalization.
How the study worked
Single case report describing a pregnant woman with multiple admissions for intractable nausea and vomiting, eventually diagnosed with CHS after an extensive negative workup.
What this study cannot tell us
Single case report. Cannot establish prevalence of CHS misdiagnosed as hyperemesis gravidarum. The interaction between pregnancy physiology and CHS is not well understood.
How to read the evidence
Single case report highlighting a diagnostic pitfall.
When this study was published
Published in 2015. Awareness of CHS in pregnancy has increased since.
The bigger picture
With marijuana use during pregnancy potentially increasing due to legalization, CHS should be included in the differential diagnosis for all pregnant women with severe, unexplained vomiting. A thorough substance use history is essential.
Questions still open
- How often is CHS misdiagnosed as hyperemesis gravidarum? Does pregnancy increase susceptibility to CHS? Are there differences in fetal outcomes between CHS and hyperemesis gravidarum?
Common questions
How is CHS different from hyperemesis gravidarum?
Can CHS harm the pregnancy?
Read the original research
Cannabinoid hyperemesis syndrome: a cause of refractory nausea and vomiting in pregnancy.
Obstetrics and gynecology, 125(6), 1484-1486
Citation
Alaniz, Veronica I; Liss, Jill; Metz, Torri D; Stickrath, Elaine. (2015). Cannabinoid hyperemesis syndrome: a cause of refractory nausea and vomiting in pregnancy.. Obstetrics and gynecology, 125(6), 1484-1486. https://doi.org/10.1097/AOG.0000000000000595
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