A Young Woman With Diabetes Was Misdiagnosed With Gastroparesis for Two Years Before Cannabis Was Identified as the Cause | Research

The takeaway

A 23-year-old woman with type 1 diabetes had monthly ER visits for two years for intractable vomiting attributed to diabetic gastroparesis, until cannabinoid hyperemesis syndrome was identified and symptoms resolved completely after stopping cannabis.

People who use cannabis regularly and experience nausea or vomiting, clinicians managing diabetes patients with GI symptoms.

2 years of misdiagnosis resolved by identifying cannabis as the cause

What the researchers found

The patient presented monthly to the ER for two years with intractable nausea and vomiting, managed as diabetic gastroparesis despite a normal gastric emptying study. She reported consistent cannabis use for several years and symptom relief with hot baths. After counseling, she stopped cannabis for two months and was completely symptom-free.

Why it matters

Cannabinoid hyperemesis syndrome (CHS) can mimic conditions common in diabetes like gastroparesis, leading to years of misdiagnosis. This case underscores the importance of asking about cannabis use in patients with cyclic vomiting, especially when standard treatments fail and gastric emptying is normal.

The numbers in context

Monthly ER visits for 2 years. Normal gastric emptying study 6 months prior. Multiple unremarkable abdominal CT scans. Complete symptom resolution after 2 months cannabis cessation.

How the study worked

Single case report of a 23-year-old woman with uncontrolled type 1 diabetes presenting with cannabinoid hyperemesis syndrome misdiagnosed as diabetic gastroparesis.

What this study cannot tell us

Single case report cannot establish generalizable patterns. The patient had uncontrolled diabetes, which could contribute to GI symptoms independently. No objective measurement of cannabis use or cessation.

How to read the evidence

Single case report providing a clinical teaching point but no statistical evidence.

When this study was published

Published 2023.

The bigger picture

As cannabis use becomes more common, CHS diagnoses are increasing. But in patients with pre-existing conditions that cause similar symptoms, like diabetes, cannabis as a cause may be overlooked for years. The hot bath relief pattern is a clinical clue that should prompt cannabis use inquiry.

Questions still open

How many patients with diabetes and cyclic vomiting have unrecognized CHS?
Should screening for cannabis use be standard in diabetes patients presenting with unexplained GI symptoms?

Common questions

Can cannabis cause vomiting even though it is used for nausea?

Yes. Cannabinoid hyperemesis syndrome causes cyclic vomiting in chronic cannabis users, paradoxically opposite to the anti-nausea effects cannabis is known for.

How was CHS identified in this patient?

After two years of treatment for presumed diabetic gastroparesis, detailed drug history revealed chronic cannabis use and symptom relief with hot baths, classic signs of CHS. Symptoms resolved after stopping cannabis.

Read the original research

Cannabinoid Hyperemesis Syndrome in a 23-Year-Old Woman with Uncontrolled Type 1 Diabetes Mellitus.

The American journal of case reports, 24, e938418

View on PubMed ↗Publisher’s paper ↗

Citation

Nana Sede Mbakop, Raissa; Kesiena, Onoriode; Greene, Tayla E; Amakye, Dominic. (2023). Cannabinoid Hyperemesis Syndrome in a 23-Year-Old Woman with Uncontrolled Type 1 Diabetes Mellitus.. The American journal of case reports, 24, e938418. https://doi.org/10.12659/AJCR.938418