16-Year-Old Male with Recurrent Vomiting Diagnosed with Cannabinoid Hyperemesis Syndrome

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Journal of Investigative Medicine





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Case report Cannabis is the most widely used illicit drug in United States. In 2016, 35.6% 12th graders had used marijuana during the year prior to the survey and 22.5% used it in the past month. With recent legalisation of cannabis use in certain states, the public perception of cannabis use is changing. Cannabinoid Hyperemesis Syndrome consists of constellation of symptoms like nausea, vomiting, abdominal pain, weight loss with a history of regular marijuana use. Hot showers are known to be comforting to these patient and abstinence is the only effective treatment. Unnecessary testing and hospitalizations in these patients can put a large burden on the healthcare system. 16-year-old male with no past medical history presented to ER with epigastric pain and vomiting for 1 week. The pain was constant, cramping, non-radiating and aggravated by food consumption. His physical exam was normal. He denied weight loss. Initial history for drug consumption was negative. His vomiting did not respond to multiple anti- emetics. His abdominal ultrasound and labs were normal. He underwent esophagogastroduodenoscopy which showed evidence of H.pylori infection. The patient was treated adequately and discharged after 2 weeks of hospitalisation. The patient returned to ER after 4 weeks with abdominal pain, nausea, vomiting and poor oral intake. He was discharged from ER after IV fluids and antiemetics. The patient returned to ER after 4 days with similar symptoms and was managed with antiemetics and fluids. His repeat esophagogastroduodenoscopy showed resolution of H.pylori infection. CT scan and gastric emptying study were normal. The patient was found to take long showers multiple times in a day and reported daily marijuana use for many months when questioned again. He was discharged with counselling and outpatient psychiatry referral. The patient was admitted to hospital 2 more times over the next 3 month for vomiting and abdominal pain and he reported cannabis use during each encounter. This case report emphasises the importance of considering cannabinoid hyperemesis syndrome as a diagnosis in paediatric patients with cyclic vomiting as early diagnosis can avoid unnecessary investigations and prevent delays in treatment.


Medicine and Health Sciences



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