Case Report: Cannabinoid Hyperemesis Treated with Lorazepam and Hot Showers | Research

The takeaway

A 32-year-old man with 19 years of daily cannabis use presented with five days of severe nausea, vomiting, and abdominal pain that improved with benzodiazepines and hot showers.

Read this if you use cannabis daily and experience recurrent nausea or vomiting episodes.

19 years of daily cannabis use before symptom onset

What the researchers found

A 32-year-old man with no significant medical history arrived at the emergency department with five days of nausea, vomiting, and diffuse abdominal pain. He reported that hot showers alleviated his symptoms.

His vital signs and lab work were normal except for a positive urine THC screen. He was diagnosed with cannabinoid hyperemesis syndrome based on his 19-year history of daily cannabis use and the classic symptom pattern.

Treatment with lorazepam and access to hot showers improved his nausea, and he was discharged the next day in stable condition.

Why it matters

This case adds to the growing body of reports documenting cannabinoid hyperemesis syndrome and highlights the importance of taking a thorough substance use history in patients with unexplained cyclic vomiting, potentially avoiding expensive and unnecessary diagnostic workups.

The numbers in context

32-year-old male; 19 years of daily cannabis use; 5 days of symptoms; normal CBC and CMP; positive THC screen; discharged next day

How the study worked

Single case report describing clinical presentation, workup, and management of one patient with cannabinoid hyperemesis syndrome.

What this study cannot tell us

Single case report provides the lowest level of clinical evidence. No follow-up data on whether the patient ceased cannabis use or had recurrent episodes.

How to read the evidence

Single case report. Illustrates a clinical entity but cannot establish prevalence, risk factors, or optimal treatment.

When this study was published

Published in 2015. Cannabinoid hyperemesis syndrome is now much more widely recognized in emergency medicine.

The bigger picture

As cannabis use becomes more widespread and potency increases, clinicians are likely to encounter more cases of cannabinoid hyperemesis. Recognition of the hot shower relief pattern and association with chronic cannabis use can expedite diagnosis.

Questions still open

Why do some daily cannabis users develop hyperemesis while others do not? What is the mechanism by which lorazepam helps? Would the symptoms have resolved without treatment if cannabis use stopped?

Common questions

What is cannabinoid hyperemesis syndrome?

It is a condition where chronic, heavy cannabis use paradoxically causes severe episodes of nausea, vomiting, and abdominal pain. A hallmark feature is that hot showers or baths temporarily relieve symptoms. The only definitive treatment is stopping cannabis use.

How common is cannabinoid hyperemesis syndrome?

The true prevalence is unknown. It appears to occur primarily in people with years of daily or near-daily heavy cannabis use, but not all heavy users develop it. Increasing recognition by clinicians is leading to more diagnoses.

Read the original research

Cannabis hyperemesis syndrome: A case report review of treatment.

Toxicology reports, 2, 889-890

View on PubMed ↗Publisher’s paper ↗

Citation

Mahmad, Abdul I; Jehangir, Waqas; Littlefield, Jay M; John, Sujith; Yousif, Abdalla. (2015). Cannabis hyperemesis syndrome: A case report review of treatment.. Toxicology reports, 2, 889-890. https://doi.org/10.1016/j.toxrep.2015.05.015