CANNABINOID HYPEREMESIS SYNDROME IN
ADOLESCENTS- CASE REPORT
Maria Mazurek- Staroń, Independent Public Health Care Facility, Hospital in
Świdnik, Pediatric Ward, Poland , Email: m.mazurekstaron@gmail.com
Urszula Dziedzic, Independent Public Health Care Facility, Hospital in
Świdnik, Pediatric Ward, Poland
Magdalena Michalska- Borowiec, Independent Public Health Care Facility,
Hospital in Świdnik, Pediatric Ward, Poland
Izabela Zgardzińska- Głab,
˛ Independent Public Health Care Facility, Hospital
in Świdnik, Pediatric Ward, Świdnik, Poland
ABSTRACT
Keywords: Cannabinoid Hyperemesis Syndrome, CHS, Adolescents, Vomiting, Cannabis Use,
Diagnosis, Rome IV Criteria
CANNABINOID HYPEREMESIS SYNDROME IN ADOLESCENTS
Background: Cannabinoid Hyperemesis Syndrome (CHS) is a rare and underrecognized
condition affecting chronic cannabis users, characterized by recurrent vomiting, nausea, and relief
from hot showers. It is often misdiagnosed due to its nonspecific symptoms.Case Presentation:
We present a case of a 17-year-old male hospitalized multiple times with severe abdominal pain
and persistent vomiting. Despite repeated negative laboratory and imaging results, a urine drug
test revealed chronic cannabis use. Symptoms were alleviated with hot showers, a key feature of
CHS. Based on Rome IV criteria, CHS was suspected.Discussion: CHS remains a diagnostic challenge due to its similarity to other gastrointestinal disorders. The primary treatment is cannabis
cessation, which can be difficult due to dependence. Misdiagnosis can lead to unnecessary hospitalizations and invasive procedures.Conclusion: CHS should be considered in adolescents presenting with recurrent unexplained vomiting, especially in known or suspected cannabis users.
Increased awareness among healthcare professionals can facilitate early diagnosis and appropriate
management.
Cannabinoid Hyperemesis Syndrome, CHS, Adolescents, Vomiting, Cannabis Use, Diagnosis, Rome IV Criteria
Abbreviations
CHS – Cannabinoid Hyperemesis SyndromeCVS – Cyclic Vomiting SyndromeED – Emergency DepartmentAKI – Acute Kidney Injury
INTRODUCTION
Cannabinoid Hyperemesis Syndrome (CHS) is a rare condition primarily affecting chronic
cannabis users. J. Chen and Mccarron (2013) It manifests as recurrent nausea, vomiting, and abdominal pain, often leading to multiple hospital visits. While cannabis is known for its antiemetic
properties, excessive long-term use can paradoxically induce hyperemesis. The condition is often
underdiagnosed, particularly in adolescents. This report presents a challenging case of CHS in a
17-year-old male and highlights the diagnostic difficulties associated with this syndrome.
Case Presentation
A 17-year-old male presented to the pediatric ward three times within five weeks and visited the emergency department (ED) twice due to severe abdominal pain and recurrent vomiting.
Patient was not previously diagnosed with chronic diseases, has not been prescribed regular medications, initially denied drug use, only admitted to smoking about 10 cigarettes daily.
Hospitalization 1
Symptoms: Epigastric pain (4 days), repeated vomiting after eating or drinking.Investigations:
Blood tests, abdominal ultrasound, and X-ray—all normal, except for mild leukocytosis.Treatment:
IV fluids and probiotics → Symptoms resolved, patient discharged.
Hospitalization 2
Symptoms: Colicky pain in the left upper quadrant, relieved by hot showers.Investigations:
All tests normal, except mild lumbar scoliosis on X-ray.Treatment: IV fluids and probiotics →
Symptoms resolved, patient discharged.
Hospitalization 3
Symptoms: Severe abdominal pain, persistent vomiting (including bile).Investigations: Expanded blood work, negative infection panels. Urine drug test positive for cannabis.Diagnosis:
Based on Rome IV criteria, CHS was suspected.Management: Patient and guardians were informed. Advised cannabis cessation and referred to addiction counseling.
DISCUSSION
CHS is a difficult-to-diagnose condition, often mistaken for gastrointestinal disorders such
as cyclic vomiting syndrome (CVS) Szczepanek and Strzeszyński (2016) . The paradoxical mechanism is thought to involve desensitization of CB1 Desjardins, Jamoulle, Taddeo, and Stheneur
(2015); Galli, Sawaya, and Friedenberg (2011) cannabinoid receptors in the brain and gut, leading
to recurrent hyperemesis despite cannabis’ known antiemetic effects. Hot showers may temporarily relieve symptoms via thermoregulation mechanisms.
CHS follows three distinct phases:
Table 1:
Phase
Prodromal
Symptoms
Morning nausea, abdominal discomfort, normal appetite
Hyperemetic
Recovery
Severe nausea, uncontrollable vomiting, abdominal pain, relief with hot
showers
Withdrawal symptoms, complete resolution with cannabis cessation
CHS vs. CVS
Table 2:
Criteria
Vomiting Episodes
Cannabis Use
Hot Showers for Relief
Symptoms Resolve
CVS
≥2 episodes in 6 months
Absent
Absent
Spontaneous
CHS
Same pattern as CVS
Chronic, excessive use
Present
After stopping cannabis
Duration
Months to
years
Weeks
Variable
CONCLUSION
A 2018 study conducted by Kantar Polska and the National Bureau for Drug Prevention
showed that marijuana was the most commonly used drug in Poland, with 12.1% prevalence Malczewski and Jabłoński (2020) , especially among those aged 15-24 years and predominantly among
males. While medicinal marijuana has shown promise in some conditions, its easy access contributes to addiction and negative side effects. CHS remains relatively unknown among both
patients and healthcare professionals. With the increasing legalization and social acceptance of
cannabis use, a rise in CHS cases has been observed Y. C. Chen and Klig (2019) .
In pediatric emergency departments, suspected CHS should be considered in differential diagnoses, particularly for patients presenting with unexplained recurrent gastrointestinal symptoms,
especially young males, who are at higher risk of cannabis use.
CHS is an underdiagnosed cause of unexplained vomiting in adolescents. It should be
suspected in patients with recurrent vomiting, especially if symptoms improve with hot showers.
Early recognition can prevent unnecessary hospitalizations and invasive procedures. The only
effective treatment is cannabis cessation, which can be challenging due to addiction.
ACKNOWLEDGMENTS
We thank the medical staff of the Pediatric Ward at the Independent Public Health Care
Facility, Hospital in Świdnik, for their assistance in this case.
REFERENCES
Chen, J., & Mccarron, R. M. (2013).
Chen, Y. C., & Klig, J. E. (2019). Cannabis-related emergencies in children and teens. Curr Opin Pediatr, 31(3),
291-296.
Desjardins, N., Jamoulle, O., Taddeo, D., & Stheneur, C. (2015). Cannabinoid Hyperemesis Syndrome in a 17-yearold adolescent. J Adolesc Health, 57(5), 565-567.
Galli, J. A., Sawaya, R. A., & Friedenberg, F. K. (2011). Cannabinoid Hyperemesis Syndrome. Curr Drug Abuse
Rev, 4(4), 241-249.
Malczewski, A., & Jabłoński, P. (2020). Report on the state of drug addiction 2020. national bureau for drug
prevention. Warsaw.
Szczepanek, M., & Strzeszyński, Ł. (2016). Functional gastrointestinal disorders - Rome IV criteria. Med Prakt,
27-38.