A Repeated ER Visitor With Cyclic Vomiting Was Not Diagnosed With CHS Until His Third Visit | Research

The takeaway

A 26-year-old chronic cannabis user made three emergency room visits with severe cyclic vomiting before cannabinoid hyperemesis syndrome was finally diagnosed, highlighting the cost of delayed recognition.

Read this if you experience recurring episodes of severe nausea and vomiting and use cannabis regularly.

3 ER visits and extensive testing before CHS diagnosis

What the researchers found

A young man with a history of heavy long-term cannabis use repeatedly showed up in the emergency room with severe cyclic nausea and vomiting that was only relieved by hot showers. Standard anti-nausea treatments were ineffective.

The diagnosis of cannabinoid hyperemesis syndrome was not made until his third ER visit. The authors emphasize that the syndrome, first described in 2004, remains poorly known among emergency medicine providers, leading to unnecessary and expensive diagnostic testing and delayed diagnosis.

The only effective long-term treatment was complete cessation of cannabis use. The authors note that standard anti-nausea medications targeting serotonin (5-HT3) or dopamine (D2) receptors do not work for this condition.

Why it matters

This case illustrates the real-world cost of underrecognizing CHS. Three ER visits with extensive workups represent significant healthcare spending and patient suffering that could have been avoided with earlier diagnosis. As cannabis use increases, CHS awareness among healthcare providers becomes more important.

The numbers in context

Three ER visits before diagnosis. 26-year-old male with long-term heavy cannabis use. Standard antiemetics ineffective. Hot showers provided symptom relief. Complete cannabis cessation resolved the condition.

How the study worked

Case report of a single patient with three emergency department presentations. Clinical course, failed treatments, and eventual diagnosis are described.

What this study cannot tell us

Single case report. No quantification of cannabis use amounts or duration. No follow-up data on whether the patient successfully maintained abstinence.

How to read the evidence

Single case report illustrating a clinical pattern. Useful for awareness but not for establishing prevalence or causation.

When this study was published

Published in 2016. CHS awareness has improved among emergency physicians since, though diagnosis delays remain common.

The bigger picture

CHS was only described in 2004 and remains unfamiliar to many clinicians. Each undiagnosed case can generate thousands of dollars in unnecessary testing. Building CHS into standard differential diagnosis algorithms for cyclic vomiting could prevent both wasted resources and patient suffering.

Questions still open

How many CHS cases are currently being misdiagnosed? Would including CHS screening questions in standard ER vomiting protocols reduce unnecessary testing?

Common questions

Why is CHS hard to diagnose?

The syndrome was only described in 2004 and many clinicians are unfamiliar with it. Patients may not disclose heavy cannabis use, and the symptoms mimic many other conditions, leading to expensive diagnostic workups.

What treatments work for CHS?

Standard anti-nausea medications do not work. Hot showers provide temporary relief, but the only lasting treatment is stopping cannabis use entirely.

Read the original research

Cannabinoid Hyperemesis Syndrome: A Case Report of Cyclic Severe Hyperemesis and Abdominal Pain with Long-Term Cannabis Use.

Case reports in gastrointestinal medicine, 2016, 2815901

View on PubMed ↗

Citation

Hermes-Laufer, Julia; Del Puppo, Lola; Inan, Ihsan; Troillet, François-Xavier; Kherad, Omar. (2016). Cannabinoid Hyperemesis Syndrome: A Case Report of Cyclic Severe Hyperemesis and Abdominal Pain with Long-Term Cannabis Use.. Case reports in gastrointestinal medicine, 2016, 2815901.