Cannabis Hyperemesis Syndrome

Cannabis hyperemesis syndrome (CHS): • Heavy chronic cannabis use (typically ≥1 year, often daily). • Cyclical severe vomiting + abdominal pain — refractory to standard antiemetics. • Compulsive hot showers / baths provide significant symptomatic relief — pathognomonic feature. • Often misdiagnosed as cyclic vomiting syndrome, IBS, gastroenteritis. • Three phases: prodromal (fear of vomiting, mild nausea); hyperemetic (severe); recovery. • Can lead to dehydration, electrolyte disturbance, AKI, weight loss. Differentials: • Cyclic vomiting syndrome — no cannabis; less hot shower response. • Gastroenteritis — acute, infectious context. • Hyperemesis gravidarum — pregnancy. • Bowel obstruction. • Adrenal insufficiency. • Bulimia.