Cannabinoid hyperemesis syndrome: largest case series to date
February 22, 2012, 1:27 am
Cannabinoid Hyperemesis: A Case Series of 98 Patients. Simonetto DA et al. Mayo Clin Proc 2012;87:114-119.
When TPR first discussed cannabinoid hyperemesis syndrome (CHS) last August, we noted that there had been only 31 cases reported in the medical literature up to that time. We immediately heard from a number of clinicians who said that this syndrome must be considerably under-reported, since they had each seen many cases. A few additional cases have been documented since then, but this large cases series (from a single institution) expands the database considerably.
The authors reviewed 5-½ years of medical records from the Mayo Clinic (Rochester MN) to identify patient who had: 1) long-term marijuana use predating onset of symptoms; 2) recurrent vomiting; and 3) no alternative diagnosis after extensive work-up. One should note that the Mayo Clinic is a tertiary referral center. They had relatively stringent methods for including these patients in the study.
They identified 98 patients. On the basis of their findings, they propose the following clinical criteria for making the diagnosis of CHS:
Essential for diagnosis
Long-term cannabis use
Major features
Severe cyclic nausea and vomiting
Resolution with cannabis cessation
Relief of symptoms with hot showers or baths
Abdominal pain, epigastric or periumbilical
Weekly use of marijuana
Supportive features
Age less than 50 y
Weight loss of > 5 kg
Morning predominance of symptoms
Normal bowel habits
Negative laboratory, radiographic, and endoscopic test results
This is interesting but unfortunately not all that helpful. For example, they say that long-term cannabis use is essential for the diagnosis of CHS, yet the duration of use in this cohort ranged from 4 months to 27 years. To my mind, 4 months hardly qualifies as “long-term use”. As a criterium essential for the diagnosis, this is hopelessly vague.
I still like the simpler criteria for the diagnosis:
- chronic use of marijuana (usually daily for more than a year)
- recurrent episodes of severe nausea and vomiting
- abdominal pain
- relief of symptoms from a hot bath or shower, leading to compulsive bathing
- termination of symptoms when use of cannabis ceases
Of course, not all these criteria need be present in every case.
To read my Emergency Medicine News column on cannabinoid hyperemesis syndrome, click here.
Related posts:
Review: cannabinoid hyperemesis syndrome
Lorry Says:
My son has had 3 separate long term episodes of this syndrome. There was no Dr. in the ****** Medical Center that even knew of this syndrome. My son was seen by medical teams that could not figure out what was wrong with him.I was sitting in my sons room while he was in DHMC a team of Doctors were with him. I was doing a search of my sons symptoms on the internet and came across this syndrome. I typed in severe vomiting and hot showers. I showed one of the Dr. what I had found on the internet. after some time they did diagnose him with this syndrome. I think all doctors should be aware of this. My son suffered severally for a month at a time with this. He almost died. He was in and out of the emergency room several times a week at 2 hospitals. Neither hospital had any knowledge of this syndrome. My sons Dr. at **MC has done a power point study since.
March 6th, 2012
Leon Says:
Lorry:
Thanks so much for the comment. Physicians are only recently becoming aware of cannabinoid hyperemesis syndrome — I hadn’t heard of it until last summer. Although occasional small articles about CHS had appeared before, it is only during the last year that discussion and writing about this condition has become common. I admire your initiative in doing your own research and coming up with the diagnosis. I hope your son is doing well.
March 8th, 2012