Teens treated for cannabis hyperemesis syndrome face dangerous heart rhythm risks from both the condition and its treatment

A 15-year-old with CHS developed QTc prolongation to 528 msec with hypokalemia and hypomagnesemia during haloperidol treatment. A 17-year-old had borderline QTc prolongation (476 msec). Literature review identified five additional severe cases of QTc prolongation or Torsades de Pointes in adolescents and young adults treated for CHS.

Two case reports of adolescent CHS patients treated in the emergency department, supplemented by a systematic literature review through October 2024 for QTc prolongation and TdP cases in CHS treatment.

Haloperidol is becoming a go-to treatment for CHS in emergency departments, but both cannabis itself and haloperidol independently prolong QTc. Combined with the electrolyte imbalances from vomiting, CHS patients face a triple threat to cardiac safety.

As CHS cases surge with rising cannabis potency and use, emergency departments need protocols that account for the cardiac risks of treating a condition caused by a substance that itself affects the heart. Current standard practice may be creating avoidable cardiac emergencies.

Case reports cannot establish incidence rates. Seven total cases across the literature may underrepresent or overrepresent the true risk. No controlled comparison of haloperidol versus alternative antiemetics for cardiac safety in CHS.