Cannabis hyperemesis was mistaken for routine post-surgical nausea for three days | Research

The takeaway

A 40-year-old daily cannabis user experienced three days of refractory postoperative nausea and vomiting before cannabis hyperemesis syndrome was recognized, highlighting a diagnostic blind spot in surgical care.

Anesthesiologists, perioperative nurses, surgeons, postoperative care teams

3-day delay in CHS diagnosis after surgery

What the researchers found

A 40-year-old woman with two years of daily cannabis use underwent laparoscopic hysterectomy and experienced persistent nausea and vomiting despite multiple antiemetics. By postoperative day 2, vomiting occurred in refractory episodes. On day 3, she developed hematemesis and hallucinations. CHS was recognized and managed with supportive care including IV hydration, electrolyte replacement for hypokalemia and hypophosphatemia. Symptoms resolved by day 4 with oral intake resumed.

Why it matters

Standard postoperative nausea protocols fail for CHS patients, and the delay in diagnosis led to three days of unnecessary suffering, electrolyte derangements, and hematemesis. As cannabis use increases among surgical patients, perioperative teams need CHS on their differential diagnosis for refractory nausea.

The numbers in context

40-year-old female; 2 years daily cannabis use; day 3 hematemesis and hallucinations; hypokalemia and hypophosphatemia; symptoms resolved day 4; discharged with cannabis cessation counseling

How the study worked

Single case report documenting the clinical course, delayed diagnosis, and management of CHS presenting as refractory postoperative nausea and vomiting.

What this study cannot tell us

Single case report. Postoperative context introduces multiple potential causes of nausea. Cannot determine how common perioperative CHS presentations are. Cannabis cessation during hospitalization may have contributed to both withdrawal and symptom resolution.

How to read the evidence

Single case report highlights an important diagnostic pitfall but cannot establish prevalence or best practices for perioperative CHS management.

When this study was published

2025 publication

The bigger picture

CHS is increasingly recognized in emergency medicine but remains a diagnostic blind spot in perioperative care. The overlap with expected postoperative nausea and vomiting means CHS may be routinely missed in surgical patients who use cannabis, leading to prolonged hospital stays and unnecessary testing.

Questions still open

Should preoperative screening for cannabis use disorder include CHS risk assessment? Would pre-emptive CHS protocols reduce postoperative complications in daily cannabis users?

Common questions

Why was CHS not recognized sooner?

Nausea and vomiting are expected after surgery, so the symptoms were initially attributed to anesthetic effects, opioid-induced nausea, or surgical complications. CHS was only suspected on day 3 when symptoms escalated to hematemesis and hallucinations despite multiple antiemetics.

How was it eventually treated?

Once CHS was recognized, treatment shifted to supportive care with IV hydration, electrolyte replacement, and cannabis cessation counseling. Symptoms resolved within 24 hours of this management change.

Read the original research

Cannabinoid Hyperemesis Syndrome Presenting as Postoperative Nausea and Vomiting in a Chronic Cannabis User: A Case Report.

Cureus, 17(7), e87990

View on PubMed ↗Publisher’s paper ↗

Citation

Atkins, Justin B; Levine, Daniel; Shaw, Laura. (2025). Cannabinoid Hyperemesis Syndrome Presenting as Postoperative Nausea and Vomiting in a Chronic Cannabis User: A Case Report.. Cureus, 17(7), e87990. https://doi.org/10.7759/cureus.87990