Cyclic vomiting in the cannabis user

• Published in: Acta clinica belgica (English ed. Online) 2016-01, Vol.71 (S1), p.26
• Main Authors: De Herdt, Carlien, Pen, Jan
• Format: Article
• Language: English
• Subjects: Abdomen; Marijuana; Vomiting
• ISSN: 1784-3286; 2295-3337

Cannabis is one of the most commonly abused drugs worldwide. The increased knowledge of the endocannabinoid system led to clinical studies of the usability of cannabis in health care. For example the use of cannabis for cancer-associated nausea and vomiting. However in this case we present the paradoxical effect of hyperemesis in susceptible chronic cannabis smokers. An 18-year old woman presented at the emergency department due to vomiting and crampy abdominal pain. The day of admission she had already vomited more than twenty times. Remarkably, 2 days earlier she was dismissed from another hospital where she had been admitted with similar symptoms. Antiemetics prescribed by the previous hospital showed no improvement. This in contrast to taking a hot shower which diminished the symptoms for a short period of time. The patient affirmed to smoke marijuana daily, as well as acknowledged the abuse of benzodiazepines. Physical examination revealed a sick woman with normal parameters. There was deep epigastric pressure pain without signs of an acute abdomen. Biochemically, there was a hypokalaemia without further electrolyte disturbances, renal impairment or inflammation. No obstruction of the abdomen was seen on X-ray. Ultrasound of the abdomen showed no abnormalities of the gallbladder. Gastroscopy revealed a peptic oesophagitis grade C. The symptoms did not improve during intravenous administration of antiemetics and analgesia. After 6 days of hospitalisation the frequency of vomiting decreased and the patient asked for her dismission. The cannabinoid hyperemesis syndrome was first described by Allen in 2004. Before many cases were seen as a part of the cyclic vomiting syndrome. In 2009 Sontineni proposed clinical characteristics for diagnosing this syndrome. The rarity of the condition can lead to a diagnostic dilemma resulting in extensive and expensive investigations. With this case report we want to encourage the physicians to be aware of its symptomatology and to make the diagnosis based on a detailed history, avoiding unnecessary investigations.