Case Report ABSTRACTS

Cannabis Induced Hyperemesis Syndrome
Patricia Cunningham
Aintree University Hospital
Case Report
A 33 year old male presented with a five day history of vomiting associated with severe cramping
abdominal pain. On examination: clinically dehydrated, generalized abdominal tenderness, voluntary
guarding but no peritonism and bowel sounds present. He had an erythematous rash to his upper thighs
and buttocks which was blanching. He had deranged renal function with a stage 3 AKI. Venous blood gas
showed no metabolic derangement. Urgent US KUB showed no evidence of obstruction. With aggressive
fluid resuscitation his renal function improved rapidly back to baseline within 48 hours.
He had found bathing in a hot bath improved his symptoms and the rash was felt to be from scalding. He
also admitted to daily cannabis use over many years.
On review of his past medical notes he’d had multiple admissions stretching back at least five years with
similar presentations. He had been extensively investigated with US abdomen, gastroscopy and full renal
screen including immunology on prior occasions. With the only abnormality detected being mild gastritis.
He had features consistent with cannabis hyperemesis syndrome. He met diagnostic criteria as proposed by
the Mayo Clinic 1 . These include: long-term cannabis use, severe cyclical vomiting, relief of symptoms with
hot showers or baths, abdominal pain, weekly use of marijuana, normal bowel habit and negative
laboratory, radiological and endoscopic test results.
Given the widespread use of cannabis, 6.6% of adults aged between 16 and 59 in England and Wales in
2014 2 , cannabis hyperemesis syndrome needs to be considered in all cases of unexplained vomiting.
References
1. Simonetto, Douglas A.; Oxentenko, Amy S.; Herman, Margot L.; Szostek, Jason H. (2012). "Cannabinoid
Hyperemesis: A Case Series of 98 Patients". Mayo Clinic Proceedings 87 (2): 114–9
2. Drug misuse: Findings from the 2013/14 Crime Survey for England and Wales. Home Office Statistics.
https://www.gov.uk/government/publications/drug-misuse-findings-from-the-2013-to-2014-csew