Skip to main content

Advertisement

SpringerLink
Log in

The Cannabis Hyperemesis Syndrome Characterized by Persistent Nausea and Vomiting, Abdominal Pain, and Compulsive Bathing Associated with Chronic Marijuana Use: A Report of Eight Cases in the United States

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Goals/Background

The cannabis hyperemesis syndrome, which is associated with chronic cannabis use, was recently reported in seven case reports and one clinical series of ten patients from Australia. We further characterize this syndrome with eight well-documented cases in the United States and report results of cannabis discontinuation and cannabis rechallenge.

Study Methods

Patients were identified by the three investigators in gastroenterology clinic or inpatient wards at William Beaumont Hospital from January to August 2009 based on chronic cannabis use; otherwise unexplained refractory, recurrent vomiting; and compulsive bathing. Charts were retrospectively analyzed with follow-up data obtained from subsequent physician visits and patient interviews.

Results

The eight patients on average were 32.4 ± 4.1 years old. Five were male. The mean interval between the onset of cannabis use and development of recurrent vomiting was 19.0 ± 3.7 years. Patients had a mean of 7.1 ± 4.3 emergency room visits, 5.0 ± 2.7 clinic visits, and 3.1 ± 1.9 admissions for this syndrome. All patients had visited at least one other hospital in addition to Beaumont Hospital. All patients had vomiting (mean vomiting episodes every 3.0 ± 1.7 h), compulsive bathing (mean = 5.0 ± 2.0 baths or showers/day; mean total bathing time = 5.0 ± 5.1 h/day), and abdominal pain. Seven patients took hot baths or showers, and seven patients experienced polydipsia. Four out of five patients who discontinued cannabis use recovered from the syndrome, while the other three patients who continued cannabis use, despite recommendations for cessation, continued to have this syndrome. Among those four who recovered, one patient had recurrence of vomiting and compulsive bathing with cannabis resumption.

Conclusions

Cannabis hyperemesis is characterized by otherwise unexplained recurrent nausea and vomiting, compulsive bathing, abdominal pain, and polydipsia associated with chronic cannabis use. This syndrome can occur in the United States as well as in Australia. Cannabis cessation may result in complete symptomatic recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CB:

Cannabinoid receptor

CVS:

Cyclic vomiting syndrome

BMI:

Body mass index

HPA:

Hypothalamic pituitary adrenal

THC:

Tetrahydrocannabinol

References

  1. Chang YH, Windish D. Cannabinoid hyperemesis relieved by compulsive bathing. Mayo Clin Proc. 2009;84(1):76–78.

    Article  PubMed  Google Scholar 

  2. Chepyala P, Olden KW. Cyclic vomiting and compulsive bathing with chronic cannabis abuse. Clin Gastroenterol Hepatol. 2008;6(6):710–712.

    Article  PubMed  Google Scholar 

  3. Donnino MW, Cocchi MN, Miller J, et al. Cannabinoid hyperemesis: a case series. J Emerg Med; 2009 Sep 16 [Epub ahead of print].

  4. Roche E, Foster PN. Cannabinoid hyperemesis: not just a problem in Adelaide Hills. Gut. 2005;54(5):731.

    Article  CAS  PubMed  Google Scholar 

  5. Singh E, Coyle W. Cannabinoid hyperemesis. Am J Gastroenterol. 2008;103(4):1048–1049.

    Article  PubMed  Google Scholar 

  6. Sontineni SP, Chaudhary S, Sontineni V, et al. Cannabinoid hyperemesis syndrome: clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse. World J Gastroenterol. 2009;15(10):1264–1266.

    Article  PubMed  Google Scholar 

  7. Allen JH, de Moore GM, Heddle R, et al. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis use. Gut. 2004;53(11):1566–1570.

    Article  CAS  PubMed  Google Scholar 

  8. Compton W, Grant BF, Colliver J, et al. Prevalence of marijuana use disorders in the United States: 1991–1992 and 2001–2002. JAMA. 2004;291(17):2114–2121.

    Article  CAS  PubMed  Google Scholar 

  9. Stinson FS, Ruan WJ, Pickering R, Grant BF. Cannabis use disorders in the USA: prevalence, correlates and co-morbidity. Psychol Med. 2006;36(10):1447–1460.

    Article  PubMed  Google Scholar 

  10. Howlett AC, Barth F, Bonnie TI, et al. International Union of Pharmacology. XXVII. Classification of cannabinoid receptor. Pharmacol Rev. 2002;54(2):161–202.

    Article  CAS  PubMed  Google Scholar 

  11. National Institutes of Health website: NIDA info facts: marijuana. National Institute on Drug Abuse. Available at: URL: http//www.nida.nih.gov/infofacts/marijuana. Accessed September 5, 2009.

  12. Vaziri ND, Thomas R, Sterling M, et al. Toxicity with intravenous injection of crude marijuana extract. Clin Toxicol. 1981;18(3):353–366.

    Article  CAS  PubMed  Google Scholar 

  13. Boekxstaens GE. Cannabinoid hyperemesis with the unusual symptom of compulsive bathing. Ned Tidjschr Geneeskd. 2005;149(26):1468–1471.

    Google Scholar 

  14. Cappell MS. Colonic toxicity of administered drugs and chemicals. Am J Gastroenterol. 2004;99(6):1175–1190.

    Article  CAS  PubMed  Google Scholar 

  15. Devane WA, Hanus L, Breuer A, et al. Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science. 1992;258(5090):1946–1949.

    Article  CAS  PubMed  Google Scholar 

  16. Duncan M, Davison JS, Sharkey KA. Review article: endocannabinoids and their receptors in the enteric nervous system. Aliment Pharmacol Ther. 2005;22(8):667–683.

    Article  CAS  PubMed  Google Scholar 

  17. Wallace D, Martin AL, Park B. Cannabinoid hyperemesis: marijuana puts patients in hot water. Aust Psychiatry. 2007;15(2):156–158.

    Article  Google Scholar 

  18. Ashton CH. Adverse effects of cannabis and cannabinoids. Br J Anaesth. 1999;83(4):637–649.

    CAS  PubMed  Google Scholar 

  19. Cota D, Steiner M, Marsicano G, et al. Requirement of cannabinoid receptor type 1 for the basal modulation of hypothalamic-pituitary-adrenal axis function. Endocrinology. 2007;148(4):1574–1581.

    Article  CAS  PubMed  Google Scholar 

  20. McCallum RW, Soykan I, Sridhar KR, et al. Delta-9-tetrahydrocannabinol delays the gastric emptying of solid food in humans: a double-blind, randomized study. Aliment Pharmacol Ther. 1999;13(1):77–80.

    Article  CAS  PubMed  Google Scholar 

  21. Davis M, Maida V, Daeninck P, et al. The emerging role of cannabinoid neuromodulators in symptom management. Support Care Cancer. 2007;15(1):63–71.

    Article  PubMed  Google Scholar 

  22. Degenhardt L, Hall WD. The adverse effects of cannabinoids: implications for use of medical marijuana. CMAJ. 2008;178(13):1685–1686.

    PubMed  Google Scholar 

  23. Pertwee RG. Cannabinoids and the gastrointestinal tract. Gut. 2001;48(6):859–867.

    Article  CAS  PubMed  Google Scholar 

  24. Pagotto U, Marsicano G, Fezza F, et al. Normal human pituitary gland and pituitary adenomas express cannabinoid receptor type 1 and synthesize endogenous cannabinoids: first evidence for a direct role of cannabinoids on hormone modulation at the human pituitary level. J Clin Endocrinol Metab. 2001;86(6):2687–2696.

    Article  CAS  PubMed  Google Scholar 

  25. Budney AJ, Roffman R, Stephens RS, et al. Marijuana dependence and its treatment. Addict Sci Clin Pract. 2007;4(1):16–18.

    Article  Google Scholar 

  26. Pagotto U, Marsicano G, Cota D, et al. The emerging role of the endocannabinoid system in endocrine regulation and energy balance. Endocr Rev. 2006;27(1):73–100.

    Article  CAS  PubMed  Google Scholar 

  27. Abell TL, Adams KA, Boles RG, et al. Cyclic vomiting syndrome in adults. Neurogastroenterol Motil. 2008;20(4):269–284.

    Article  CAS  PubMed  Google Scholar 

  28. Pareek N, Fleisher DR, Abell T. Cyclic vomiting syndrome: what a gastroenterologist needs to know. Am J Gastroenterol. 2007;102(12):2832–2840.

    Article  PubMed  Google Scholar 

  29. Forbes D, Withers B, Silburn S, et al. Psychological and social characteristics and precipitants of vomiting in children with cyclical vomiting syndrome. Dig Dis Sci. 1999;44(8):19–22.

    Google Scholar 

  30. McRonald FE, Fleisher DR. Anticipatory anxiety in cyclical vomiting. BMC Pediatr. 2005;5(1):3.

    Article  PubMed  Google Scholar 

  31. Stickler GB. Relationship between cyclic vomiting syndrome and migraine. Clin Pediatr. 2005;44(6):505–508.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, William Beaumont Hospital, Royal Oak, MI, USA

    Maria Soriano-Co

  2. Division of Gastroenterology, William Beaumont Hospital, Royal Oak, MI, USA

    Mihaela Batke

  3. Division of Gastroenterology, William Beaumont Hospital, MOB 233, 3535 W. Thirteen Mile Road, Royal Oak, MI, 48073, USA

    Mitchell S. Cappell

Authors
  1. Maria Soriano-Co
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mihaela Batke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mitchell S. Cappell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mitchell S. Cappell.

Additional information

Current knowledge: Limited quantitative information on the newly described cannabis hyperemesis syndrome with only seven published case reports and one clinical series of ten patients from Australia; This syndrome is potentially clinically much more common than reported or realized due to the high prevalence of chronic marijuana use and dependence in the United States and other Western countries.

New information: Report of eight cases of this syndrome occurring in the United States within a 9-month period at a single large hospital in the United States; Quantitative description of syndrome: All patients had vomiting (mean vomiting episodes every 3.0 ± 1.7 h), compulsive bathing (mean = 5.0 ± 2.0 baths or showers/day, mean total bathing time = 5.0 ± 5.1 h/day), and abdominal pain. Seven of the eight patients took hot baths or showers, and seven patients experienced polydipsia. Patients had a mean of 7.1 ± 4.3 ER visits, 5.0 ± 2.7 clinic visits, and 3.1 ± 1.9 admissions for this syndrome; Evidence is presented of a specific association of syndrome with cannabis use: cessation of syndromic symptoms in four of five patients who ceased cannabis use, and recurrence of syndrome in one patient who subsequently resumed cannabis use (drug rechallenge).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Soriano-Co, M., Batke, M. & Cappell, M.S. The Cannabis Hyperemesis Syndrome Characterized by Persistent Nausea and Vomiting, Abdominal Pain, and Compulsive Bathing Associated with Chronic Marijuana Use: A Report of Eight Cases in the United States. Dig Dis Sci 55, 3113–3119 (2010). https://doi.org/10.1007/s10620-010-1131-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-010-1131-7

Keywords

Search

Navigation