A 21-year-old woman with 7 years of heavy cannabis use developed cannabinoid hyperemesis syndrome; symptoms resolved with abstinence but relapsed each time she resumed cannabis use.
Read this if you experience unexplained vomiting and use cannabis regularly.
Multiple relapses, each tied to cannabis resumption and resolved by abstinence
What the researchers found
A 21-year-old woman presented with four weeks of sudden-onset vomiting, nausea, and appetite loss. She had smoked cannabis heavily for 7 years. All other causes were ruled out through extensive testing.
Blood work showed mild metabolic derangement (low potassium and bicarbonate) consistent with prolonged vomiting. Urine tested positive for cannabinoids. All other investigations (blood counts, kidney and liver function, ECG, pregnancy test, CT head scan) were normal.
Symptoms resolved with IV fluids, antiemetics, and cannabis abstinence. However, since discharge she experienced several relapses, each directly related to resuming cannabis use and each resolving again with abstinence. She was seeking cognitive behavioral therapy to achieve permanent abstinence.
Why it matters
This case illustrated the recurring nature of CHS and the difficulty of maintaining abstinence, demonstrating why some patients require behavioral therapy support to avoid relapse.
The numbers in context
Age 21, 7 years of heavy cannabis smoking. Low potassium and bicarbonate. Multiple relapses, each resolved with abstinence.
How the study worked
Single case report of a 21-year-old woman presenting to hospital with 4 weeks of vomiting. Standard workup to exclude other causes. Follow-up documented multiple relapse-remission cycles correlated with cannabis use and abstinence.
What this study cannot tell us
Single case report. Cannot determine prevalence or risk factors. Self-reported cannabis use history.
How to read the evidence
Single case report documenting a clear pattern of relapse and remission, but limited to one patient.
When this study was published
Published in 2010. CHS has since become widely recognized in emergency medicine.
The bigger picture
The repeated relapse-remission pattern in this young patient highlighted that CHS management requires not just symptom treatment but addressing the underlying cannabis use through behavioral interventions.
Questions still open
- How effective is cognitive behavioral therapy for achieving permanent cannabis abstinence in CHS patients? What proportion of CHS patients successfully maintain long-term abstinence?
Common questions
Can cannabinoid hyperemesis come back?
How is cannabinoid hyperemesis treated?
Read the original research
Cannabinoid hyperemesis.
BMJ case reports, 2010
Citation
Wild, Kim; Wilson, Hugh. (2010). Cannabinoid hyperemesis.. BMJ case reports, 2010. https://doi.org/10.1136/bcr.01.2010.2605
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