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Cannabinoid hyperemesis syndrome

BMJ 2019; 366 doi: (Published 19 July 2019) Cite this as: BMJ 2019;366:l4336
  1. Yaniv Chocron, chief resident1,
  2. Jean-Philippe Zuber, consultant2,
  3. Julien Vaucher, consultant and senior clinical lecturer1
  1. 1Internal medicine, Lausanne University Hospital, Lausanne, Switzerland
  2. 2Internal medicine, St-Loup Hospital, Pompaples, Switzerland
  1. Correspondence to Y Chocron yaniv.chocron{at}

What you need to know

  • Cannabinoid hyperemesis syndrome is a new diagnosis, accounting for up to 6% of patients presenting to emergency departments with recurrent vomiting in one retrospective study

  • People experiencing cannabinoid hyperemesis syndrome compulsively take hot showers or baths to alleviate symptoms

  • The only known long term therapy for cannabinoid hyperemesis syndrome is cannabis cessation

A 26 year old man attends the emergency department with a four week history of diffuse abdominal pain and nausea, along with vomiting every 30 minutes. Laboratory test results show a sodium level of 124 mmol/L (reference range 135-145) and a creatinine level of 348 µmol/L (62-106). During the last six years he has sought medical care several times for similar episodes, but no precise diagnosis was made, despite multiple investigations (including abdominal ultrasound and computed tomography scan and upper and lower endoscopies). He admits smoking cannabis about 4-6 times a day for 13 years. His symptoms are only alleviated by taking hot showers and baths, which he takes 10 to 15 times a day. After rehydration and normalisation of renal function, he is discharged home with a psychiatric follow-up to support cannabis abstinence. Three years after cessation of cannabis consumption, he does not report any symptoms.

What is cannabinoid hyperemesis syndrome?

Cannabinoid hyperemesis syndrome (CHS) was first described in 20041 and associates cyclic nausea and vomiting with abdominal pain in regular cannabis users (defined, in the most comprehensive systematic review on CHS, as at least weekly cannabis use2). Typically, patients report compulsive hot showering or bathing to alleviate symptoms (encountered in 90-100% of reported cases and it has been proposed as a diagnostic criteria).123

Different mechanisms have been proposed to explain how, in certain individuals, the established anti-emetic properties of cannabis are overridden and CHS develops.24 Approximately 100 cannabinoids have been identified,5 and …

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