Unusual Case of Cannabinoid Hyperemesis with Bradycardia and Cold-Water Relief | Research

The takeaway

A case report described a non-classical presentation of cannabinoid hyperemesis syndrome featuring bradycardia and symptom relief from cold (not hot) water, expanding the known clinical picture.

Read this if you experience nausea with cannabis use and find cold (not hot) temperatures help.

Cold water, not hot, relieved symptoms in this case

What the researchers found

This case report described a patient with cannabinoid hyperemesis syndrome who presented with atypical features. Unlike the classic presentation where hot water relieves symptoms, this patient found relief from cold temperatures.

The patient also developed bradycardia (slow heart rate), which is not part of the classical CHS description. The authors emphasized that non-classical forms of CHS exist and that clinicians should maintain a broad differential when evaluating chronic cannabis users with cyclic vomiting.

Why it matters

Expanding the recognized presentation of CHS beyond the classic triad (cyclic vomiting, chronic cannabis use, hot water relief) could prevent missed diagnoses when patients present with non-classical features.

The numbers in context

Single case; atypical features: bradycardia, cold-water relief (vs. typical hot-water relief)

How the study worked

Single case report documenting an atypical presentation of cannabinoid hyperemesis syndrome with bradycardia and cold-temperature relief.

What this study cannot tell us

Single case report represents the lowest level of clinical evidence. Cannot determine how common non-classical presentations are. Bradycardia could have had other causes.

How to read the evidence

Single case report documenting an atypical presentation. Useful for clinical awareness but cannot establish prevalence.

When this study was published

Published in 2015. More atypical CHS presentations have since been documented.

The bigger picture

As CHS becomes more widely recognized, clinical variants are being documented. These non-classical presentations challenge the existing diagnostic criteria and suggest the underlying pathophysiology may be more complex than initially understood.

Questions still open

How common are non-classical CHS presentations? Does the response to cold versus hot water indicate different pathophysiological mechanisms? Should diagnostic criteria for CHS be broadened?

Common questions

Is it always hot showers that help with CHS?

Not always. This case report documented a patient whose symptoms were relieved by cold temperatures instead. This suggests that the thermoregulatory mechanism underlying CHS may be more variable than initially thought.

Can CHS affect your heart rate?

This case included bradycardia (slow heart rate). While not part of the classical CHS description, it suggests that the autonomic nervous system disruption in CHS may extend beyond the gastrointestinal system.

Read the original research

A non-classical cannabinoid syndrome.

Acta clinica Belgica, 70(4), 299-300

View on PubMed ↗Publisher’s paper ↗

Citation

Muschart, X; Flament, J. (2015). A non-classical cannabinoid syndrome.. Acta clinica Belgica, 70(4), 299-300. https://doi.org/10.1179/2295333714Y.0000000116