Elsevier

Mayo Clinic Proceedings

Volume 87, Issue 2, February 2012, Pages 114-119
Mayo Clinic Proceedings

Original article
Cannabinoid Hyperemesis: A Case Series of 98 Patients

https://doi.org/10.1016/j.mayocp.2011.10.005Get rights and content

Abstract

Objective

To promote wider recognition and further understanding of cannabinoid hyperemesis (CH).

Patients and Methods

We constructed a case series, the largest to date, of patients diagnosed with CH at our institution. Inclusion criteria were determined by reviewing all PubMed indexed journals with case reports and case series on CH. The institution's electronic medical record was searched from January 1, 2005, through June 15, 2010. Patients were included if there was a history of recurrent vomiting with no other explanation for symptoms and if cannabis use preceded symptom onset. Of 1571 patients identified, 98 patients (6%) met inclusion criteria.

Results

All 98 patients were younger than 50 years of age. Among the 37 patients in whom duration of cannabis use was available, most (25 [68%]) reported using cannabis for more than 2 years before symptom onset, and 71 of 75 patients (95%) in whom frequency of use was available used cannabis more than once weekly. Eighty-four patients (86%) reported abdominal pain. The effect of hot water bathing was documented in 57 patients (58%), and 52 (91%) of these patients reported relief of symptoms with hot showers or baths. Follow-up was available in only 10 patients (10%). Of those 10, 7 (70%) stopped using cannabis and 6 of these 7 (86%) noted complete resolution of their symptoms.

Conclusion

Cannabinoid hyperemesis should be considered in younger patients with long-term cannabis use and recurrent nausea, vomiting, and abdominal pain. On the basis of our findings in this large series of patients, we propose major and supportive criteria for the diagnosis of CH.

Section snippets

Patients and Methods

Inclusion criteria were determined by reviewing all PubMed indexed journals with case reports and case series on CH. On the basis of the results of that review, patients were included if they had (1) long-term marijuana use before the start of symptoms, (2) a history of recurrent vomiting, and (3) the absence of a major illness that could explain the symptoms. Using institutional software, the electronic medical record was searched from January 1, 2005, through June 15, 2010, for the terms

Results

The demographic characteristics of the study population are shown in Table 2. Sixty-six patients (67%) were males, the mean ± SD age at evaluation was 32.3±9.9 years, and the mean ± SD age at symptom onset was 25.3±8.9 years (range, 14-48 years). Sixty patients (65%) had a body mass index (calculated as the weight in kilograms divided by the height in meters squared) of 25 or less, and only 11 (12%) were obese, defined as a body mass index of greater than 30. Forty-eight patients (49%) used

Discussion

Current knowledge of CH is based on several case reports and small case series. In fact, diagnostic clinical criteria originate from a review of only 13 cases of CH.7 Our case series, the largest to date, confirms the essential and major criteria previously proposed by Sontineni et al7 but additionally expands the major criteria and modifies the previously proposed “characteristics suggestive of the diagnosis.” Firstly, long-term cannabis use is essential for the diagnosis. The major features

Conclusion

Cannabinoid hyperemesis should be considered in younger patients with long-term cannabis use and recurrent nausea, vomiting, and abdominal pain. The timing, location, and characteristics of symptoms can be helpful in determining the diagnosis of CH, and patients should be asked about the relief of symptoms with hot water bathing. Cessation of cannabis use should result in improvement of clinical symptoms. Studies with higher rates of follow-up are needed, and validation of the proposed

Acknowledgments

We thank Donna K. Lawson, LPN, (Mayo Clinic, Rochester, MN) for assistance with data collection and Felicity T. Enders, PhD, (Mayo Clinic, Rochester, MN) for assistance with data analysis.

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