This case report and literature review describes CHS as a condition where chronic cannabis users develop severe cyclic vomiting, often relieved by hot bathing.
Read this if you use cannabis regularly and experience unexplained nausea or vomiting.
Hot bathing relief is a hallmark diagnostic feature of CHS
What the researchers found
The authors presented a case of a young man who developed cannabinoid hyperemesis syndrome (CHS), characterized by cyclic episodes of severe nausea, vomiting, and abdominal pain. The patient found relief through compulsive hot water bathing, a hallmark feature of the condition.
The literature review accompanying the case outlined the three phases of CHS: a prodromal phase with morning nausea, a hyperemetic phase with intense vomiting, and a recovery phase after cannabis cessation. The condition is linked specifically to chronic, long-term cannabis use.
The authors emphasized that CHS is often misdiagnosed because cannabis is widely known as an antiemetic, leading clinicians to overlook it as a cause of vomiting. Cessation of cannabis use was identified as the definitive treatment.
Why it matters
CHS is frequently misdiagnosed, leading to expensive and unnecessary medical workups. Recognizing the pattern of cyclic vomiting plus hot bathing relief plus chronic cannabis use can save patients from prolonged suffering and unnecessary emergency department visits.
The numbers in context
One case presented. Cannabis is described as the most widely used illicit drug worldwide. The three clinical phases (prodromal, hyperemetic, recovery) were characterized.
How the study worked
Case report of a single patient with CHS, combined with a narrative review of existing literature on the condition's pathogenesis, clinical features, and management approaches.
What this study cannot tell us
Single case report with limited generalizability. The pathogenesis of CHS was not fully explained at the time of publication. The literature review was narrative rather than systematic.
How to read the evidence
Single case report with accompanying narrative literature review.
When this study was published
Published in 2015. CHS awareness and diagnostic criteria have improved since.
The bigger picture
As cannabis use increases globally, CHS recognition has become more important. The paradox of a known antiemetic causing severe vomiting in some chronic users highlights how dose, duration, and individual biology can produce unexpected effects from any substance.
Questions still open
- Why does cannabis cause vomiting in some chronic users but not others? What is the mechanism behind hot water bathing providing relief? At what threshold of use does CHS risk begin?
Common questions
What is cannabinoid hyperemesis syndrome?
How is CHS treated?
Read the original research
Cannabinoid hyperemesis syndrome: a guide for the practising clinician.
BMJ case reports, 2015
Citation
Bajgoric, Sanjin; Samra, Kiran; Chandrapalan, Subashini; Gautam, Nishant. (2015). Cannabinoid hyperemesis syndrome: a guide for the practising clinician.. BMJ case reports, 2015. https://doi.org/10.1136/bcr-2015-210246
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