A case of cannabinoid hyperemesis syndrome causing dangerous lactic acid buildup | Research

The takeaway

A chronic cannabis user presented with severe abdominal pain and dangerously elevated lactic acid levels, highlighting that cannabinoid hyperemesis syndrome can cause serious metabolic complications beyond vomiting.

Emergency physicians, gastroenterologists, and chronic cannabis users who should be aware of this syndrome.

Lactate reached 6.1 mmol/L (normal is under 2)

What the researchers found

The patient's lactate reached 6.1 mmol/L, a level indicating significant physiological stress, caused by severe dehydration and pain from intractable vomiting rather than from another underlying emergency.

Why it matters

Cannabinoid hyperemesis syndrome is increasingly recognized but can be missed when abdominal pain is the dominant symptom. The metabolic complications like lactic acidosis can trigger unnecessary invasive workups if CHS is not considered.

The numbers in context

Lactate: 6.1 mmol/L (normal <2). Treatment included haloperidol and capsaicin. CHS prevalence is rising in correlation with increased cannabis use in the UK.

How the study worked

Single case report with review of current evidence on cannabinoid hyperemesis syndrome pathophysiology, diagnostic criteria, and management strategies.

What this study cannot tell us

Single case report cannot establish generalized patterns. Lactic acidosis in CHS may be uncommon and its frequency is unknown.

How to read the evidence

Single case report provides an illustrative clinical example but cannot establish frequency or causation patterns.

When this study was published

Published in 2025.

The bigger picture

As cannabis use increases globally, emergency physicians encounter CHS more frequently. Recognizing it early, especially in presentations dominated by pain rather than vomiting, can prevent unnecessary testing and speed appropriate treatment.

Questions still open

How common is significant lactic acidosis in CHS? Should lactate levels be routinely monitored in suspected CHS cases?

Common questions

Can cannabinoid hyperemesis syndrome cause dangerous complications?

Yes. This case shows that the severe vomiting and pain of CHS can lead to profound dehydration and lactic acidosis, a metabolic emergency that requires aggressive fluid treatment.

How is cannabinoid hyperemesis syndrome treated?

The case was treated with aggressive fluid resuscitation, haloperidol, and capsaicin (topical cream). The underlying cause is chronic cannabis use, and cessation is the definitive treatment.

Read the original research

Cannabinoid Hyperemesis Syndrome: A Rare Cause of Severe Abdominal Pain and Hyperlactataemia.

Cureus, 17(9), e92444

View on PubMed ↗Publisher’s paper ↗

Citation

Elbaghdady, Ahmad; Ahmed, Abdelnasser; Elmahdy, Ahmed. (2025). Cannabinoid Hyperemesis Syndrome: A Rare Cause of Severe Abdominal Pain and Hyperlactataemia.. Cureus, 17(9), e92444. https://doi.org/10.7759/cureus.92444