| First author, year [Ref.] |
Age in years, sex, relevant history |
Prior reports |
Hot showers |
Prior marijuana use |
Diagnosis/treatment |
Resolution/follow-up |
| Alaniz, 2016 [121] |
28, F (3 trimester pregnant) |
Persistent nausea and vomiting leading to loss of consciousness |
Yes |
12 y heavy use |
Hyperemesis gravidarum at first, then CHS, patient cut back on marijuana use to 1/d |
Pt lost to follow-up |
| Bagdur, 2012 [105] |
27, M |
Multiple episodes |
Yes but eventually they provided little to no relief |
6 y |
CHS, marijuana cessation |
Symptoms resolved in 48 h after stopping marijuana |
| Baron, 2011 [138] |
28, M |
12 y |
Yes |
14 y |
Prerenal failure secondary to CHS but pt would not agree to d/c marijuana |
Pt returned to ED with same symptoms and secondary renal dysfunction |
| Beech, 2015 [132] |
42, F |
Head trauma complications |
Yes |
8 y |
CHS, marijuana cessation |
|
| Bonnet, 2016 [117] |
26, F |
2–3 episodes/wk past 5 y |
Yes |
11 y |
Misdiagnosed, pt read about CHS and reported to physician who confirmed diagnosis |
Symptoms resolved in 3 wk of cessation, follow-up at 12 mo found she had not resumed marijuana use and had no further symptoms |
| Braver, 2015 [134] |
34, M, veteran with PTSD |
Persistent vomiting |
Yes |
Heavy use, duration not quantified |
CHS, advised to stop marijuana |
Patient continued marijuana and returned to ED |
| Braver, 2015 [134] |
44, M |
Abdominal pain with recurrent vomiting 5 y |
Yes |
30 y |
CHS |
Symptoms resolved in 9 h |
| Brewerton, 2016 [133] |
22, F |
Mental health disorders, binge/purge anorexia, intractable vomiting |
Yes |
7 y |
CHS, patient became angered and asked to be discharged |
Unknown |
| Camilleri, 2018 [54] |
51, F |
Nausea, vomiting, abdominal pain, prior cholecystectomy and hysterectomy |
No |
Yes, duration not quantified |
Common bile duct stone (1 cm) removed which did not improve symptoms; delayed gastric emptying; CHS |
Pt counseled to stop cannabis, dietary restrictions, antiemetic therapy, referral to mental health provider |
| Cha, 2014 [136] |
44, M |
Recurrent, every morning, duration NR |
Yes, suffered burns from hot water |
>20 y |
CHS |
Follow-up at 9 y found pt stopped marijuana use, no return of symptoms |
| Chang, 2009 [101] |
25, F, bipolar disorder, obesity |
5 y of intermittent episodes |
Yes |
~7 y |
CHS |
2 h |
| Cox, 2012 [10] |
28, M |
2 wk |
Yes |
1.5 g/day |
CHS; IV lorazepam 1 mg relieved symptoms at once |
Pt counseled to stop marijuana; at 6 mo follow-up he had done so, no recurrent symptoms |
| Desjardins, 2015 [135] |
17, M |
5 ED visits in last year |
Yes |
Yes NR |
CHS |
About 5 d |
| Enuh, 2013 [94] |
47, M, diabetes |
Yes |
Yes |
39 y of daily use |
CHS |
3 d |
| Figueroa-Rivera, 2015 [7] |
29, M, anxiety disorder, MDD, SUD |
Multiple ED visits in past year |
Yes |
16 y, daily use |
IV lorazepam provided relief; CHS diagnosed |
3 d |
| Fleig, 2011 [6] |
28, M, recently unemployed |
Several days of vomiting preceded this ED visit |
Yes |
10 y regular marijuana use (also cocaine, other drugs); with unemployment marijuana use increased to hourly |
CHS, referral for detox |
Symptoms resolved quickly with marijuana cessation but patient was unsure if he wanted to forego use of marijuana |
| Graham, 2017 [97] |
16, F |
1 wk of vomiting preceded ED visit |
NR |
Regular use of marijuana which increased to manage her nausea and vomiting |
CHS, treated with topical capsaicin |
Symptoms resolved quickly with capsaicin; patient was educated about CHS |
| Graham, 2017 [97] |
20, M, asthmatic |
NR, presented with acute marijuana intoxication |
Yes |
Yes |
Antiemetic therapy prescribed, pt returned following week with same symptoms; CHS was diagnosed, treated with topical capsaicin |
Symptomatic relief occurred within 30 min of using capsaicin; patient was educated about CHS |
| Gregoire, 2016 [126] |
27, M, bipolar disorder taking Rx lithium |
4 wk history nausea, 3 wk vomiting, pt d/c lithium thinking it was causing symptoms |
Yes |
14 y, escalating use |
CHS confirmed when d/c of marijuana resolved symptoms |
25 d of inpatient care required to stabilize psychiatric drug regimen |
| Habboushe, 2014 [137] |
25, M |
Intractable vomiting (>20/d) for 1 d |
Yes |
8 y |
Creatinine 3.21 mg/dL, blood urea nitrogen 24 mg/dL, anion gap 34, diagnosed with acute renal failure secondary to dehydration caused by CHS |
Pt treated for renal failure and discharged after short hospital stay |
| Heard, 2017 [170] |
32, M |
12 h intractable vomiting, similar episodes over past 2 mo |
Yes |
10 y |
CHS, IV haloperidol 5 mg, IV diphenhydramine hydrochloride 25 mg |
~1 h |
| Heise, 2015 [139] |
17, M |
3 wk, multiple episodes |
Not reported |
Regular use, marijuana provided by his mother to manage symptoms |
Diagnosed with CVS at first presentation but antiemetics not effective; next visit, CHS diagnosed |
48 h |
| Hermes-Laufer, 2016 [140] |
26, M, Gilbert's syndrome and myringoplasty |
5 y |
Yes |
Regular use, duration not quantified |
Initially diagnosed with gall stones; laparoscopic cholecystectomy and some initial improvement; antiemetics ineffective. Repeated visits, CHS diagnosed |
NR |
| Hickey, 2013 [111] |
34, M |
10 y of episodes about every 2–3 mo |
Yes |
>20 y, daily use with short periods of abstinence |
CHS; IV haloperidol 5 mg, discharged in 8 h |
1 h |
| Iacopetti, 2014 [19] |
33, M, PTSD, GERD |
2 y (5 hospitalizations) |
Yes |
Daily use >2 y, intermittent use prior to that |
CVS diagnosed initially, revised to CHS on later ED visit |
Symptoms resolved, pt resistant to d/c marijuana |
| Inayat, 2017 [114] |
27, M |
2 y |
Yes |
10 y |
Pt underwent multiple tests, CHS, lorazepam ineffective, IV haloperidol effective |
2 d in hospital provided no relief, symptoms resolved with IV haloperidol |
| Ishaq, 2014 [141] |
42, M |
20 y (8 hospitalizations) |
Yes |
28 y |
Numerous tests before CHS diagnosis |
Symptoms resolved in hospital; pt d/c marijuana and at 3 mo was symptom-free |
| Jones, 2016 [113] |
18, F |
1 y |
NR |
Regular use, escalating, not quantified |
CHS, pt resistant; outpatient treatment with 5 mg haloperidol daily |
Haloperidol well tolerated, pt d/c marijuana at 3 wk, lost to follow-up |
| Kast, 2018 [142] |
21, M |
Yes, prior hospitalizations |
Yes |
4 y, including "dabbing" pure THC on marijuana cigarettes |
Antiemetics ineffective, CHS diagnosed; IV haloperidol 2 mg every 8 h as needed |
2 d |
| Kraemer, 2013 [143] |
42, M |
NR |
Yes |
Long term, not quantified |
Skin rash from hot showers; CHS |
Yes but duration of time NR |
| Mahmad, 2015 [144] |
32, M |
5 days |
Yes |
19 y |
CHS |
1 d |
| Manoharan, 2018 [145] |
16, F |
2 d |
Yes |
NR |
CHS |
Gradual resolution |
| Manning Meurer, 2018 [180] |
21, F, primigravida |
Multiple |
NR |
NR |
HG initially diagnosed, positive drug tests revised dx to CHS at 30 wk gestation; pt hospitalized for CHS symptoms 9 d postpartum |
NR |
| Miller, 2010 [146] |
17, M, ADHD, asthma, depression |
1 y |
Yes |
3 y |
CVS first dx, counseled to quit marijuana; dx revised to CHS when marijuana cessation resolved symptoms |
NR |
| Miller, 2010 [146] |
18, F |
2 y (10 ED visits and 3 hospitalizations in 18 mo) |
Yes |
2 y |
CHS |
NR |
| Mohammed, 2013 [147] |
26, M |
6 mo |
Yes |
2 y |
CHS |
48 h |
| Moon, 2018 [22] |
47, M |
8 y |
NR |
10 y |
CHS but continued use of marijuana; next ED visit treated with capsaicin 0.075% every 4 h as needed |
4 h |
| Morris, 2014 [148] |
20, F, migraineur |
9 mo |
Yes |
4 y |
CHS |
NR |
| Muschart, 2015 [99] |
28, M |
4 y, about 6 episodes/y |
Cold showers |
Several y of daily use, not quantified |
"Non-classical" CHS, pt resistant to d/c cannabis; pt also had bradycardia |
NR |
| Nicolson, 2012 [149] |
22, F, low back pain relieved with marijuana |
5 y, multiple hospitalizations and up to 2 ED visits/mo |
Yes |
5 y |
CHS |
4 d, but pt continued marijuana use and had further CHS hospitalizations |
| Nicolson, 2012 [149] |
24, M |
2 y, episodes every 2–3 mo, multiple hospitalizations |
Yes |
10 y |
CHS |
1 wk; pt refused further care, lost to follow-up |
| Nicolson, 2012 [149] |
20, F, depression, anxiety |
1.5 y, 4 hospitalizations |
Yes |
3.5 y |
CHS |
2 d |
| Nogi, 2014 [150] |
32, F, migraineur |
"Several years" |
Yes |
>10 y |
CHS |
Nausea persisted |
| Nourbakhsh, 2018 [171] |
27, F |
Pt found unresponsive, emergency services called, heart rate 40 beats per minute, hypoglycemic, 8 y history of vomiting; pt had been in ER 2 d prior for intractable vomiting |
NR |
Long history, not quantified |
Pt developed VF and died 2 h after being brought to ED; sinus rhythm deteriorated to ventricular fibrillation; autopsy stated she died of complications of CHS |
Fatality |
| Nourbakhsh, 2018 [171] |
27, M |
Pt had been vomiting excessively for 5–6 d before his death, history of cyclic vomiting; he was found deceased |
NR |
Long history, pt was in drug rehab center at the time of death |
Pt was dehydrated with dry mucus membranes; autopsy results were death due to complications of chronic cannabis use |
Fatality |
| Parekh, 2016 [151] |
38, M, GERD |
20 y, 3–4 episodes/mo |
Yes |
20 y |
CHS |
1 d |
| Phillips, 2017 [116] |
34, M |
3 y, episodes about 2× per wk, multiple ED visits |
Yes |
9 y |
CHS |
NR |
| Price, 2011 [152] |
30, M |
3 d |
Yes |
"Years," not quantified |
CHS |
4 d |
| Ramadurai, 2016 [153] |
21, M |
1 y (5 hospitalizations in y) |
Yes |
2 y |
CHS |
NR |
| Roca-Pallin, 2013 [154] |
36, F, 2° burns on 20% of body, anxiety |
5 y, multiple hospital visits |
Yes |
5 y |
CHS |
Several days |
| Roche, 2005 [155] |
21, M |
2 y (7 hospitalizations) |
Yes |
Yes, duration not quantified |
CHS, diagnosed when his girlfriend suggested CHS (and he fit profile) |
NR |
| Sannarangappa, 2009 [156] |
34, M, abdominal rash from hot water bottle |
10 y |
Yes |
15 y |
CHS after pt reported 2 y abstinence from marijuana alleviated symptoms |
5 d |
| Sawni, 2016 [125] |
15, F |
7 mo, 4 hospitalizations |
Yes |
>1 y, escalating use |
CHS |
NR |
| Sawni, 2016 [125] |
16, F |
4 mo, 4 hospitalizations |
Yes |
Yes, not quantified and included secondhand marijuana smoke from family |
CHS |
NR |
| Schmid, 2011 [157] |
26, F, 10 wk pregnant |
3.5 y, prior hospitalizations |
Yes |
13 y |
CHS Pt d/c marijuana about 10 d prior to hospitalization when she learned she was pregnant |
2 wk |
| Singh, 2008 [158] |
46, M |
3 y, multiple prior ED visits |
Yes |
>30 y |
First CVS, revised to CHS with cannabis history |
NR |
| Sontineni, 2009 [159] |
22, M |
2 mo, 2 prior ED visits |
Yes |
6 y |
CHS after pt disclosed cannabis use |
NR |
| Torka, 2012 [160] |
20, M |
NR |
Yes |
2–3 y |
Pancreatitis initial dx, use of hot showers led to CHS dx |
NR |
| Torka, 2012 [160] |
29, M |
3 mo |
Yes |
3 mo |
ST elevations, pt history led to dx of CHS |
NR |
| Trappey, 2017 [172] |
24, M |
Pt had 25 ED visits and 6 hospitalizations in past 4 y for intractable vomiting; he vomited for 2 d and was hospitalized, returned home and presented at ED 3 d later with same symptoms |
Yes, but when hot water was not available he jogged as exercise reduced symptoms resulting in exercise-induced rhabdomyolysis requiring IV hydration |
Described as "extensive," not quantified |
CHS had been diagnosed earlier but pt did not discontinue marijuana, in fact, he continued its use thinking it could help symptoms; pt continues to use marijuana and has been rehospitalized |
24 h |
| Valdivielso-Cortazar, 2018 [173] |
30, F |
Cyclic vomiting, abdominal pain, presented during an episode of stomach pain, nausea, and vomiting |
Yes |
14 y |
CHS was diagnosed and patient was counseled to abstain from marijuana |
NR |
| Wallace, 2007 [161] |
30, M |
5 y, 14 ED visits, 3 hospitalizations |
Yes |
16 y |
Initial diagnosis was stress-related vomiting, revised to PV, then CHS when symptoms described in 2004 |
NR |
| Warner, 2014 [162] |
28, M |
9 mo, repeated ED visits |
Yes |
13 y |
Pt initially denied use of marijuana and later minimized it; diagnosis of CHS when marijuana use and hot showers were disclosed |
NR |
| Wild, 2012 [163] |
21, F |
4 wk |
NR |
7 y |
CHS when gastroenteritis was ruled out (no diarrhea) |
NR |
| Williamson, 2014 [164] |
39, M |
6 y, at least 2× per mo |
Yes |
20 y |
CHS |
48 h |
| Williamson, 2014 [164] |
19, M |
2 wk |
NR |
2 y |
CHS |
48 h |
| Woods, 2016 [165] |
37, M |
14 y, 18 admissions in past 5 y |
Yes |
"Long term" not quantified |
CHS |
4 d |
|
Synthetic marijuana
Argamany, 2016 [166]
|
27, M |
1 wk |
NR |
Recent use of synthetic marijuana |
Acute renal failure attributed to rhabdomyolysis secondary to CHS |
Emergent hemodialysis not needed and kidney function returned to normal in about 1 wk |
| Bick, 2014 [167] |
29, M |
Recurrent episodes, sought help at PC, then ED |
Yes |
Patient denied use of marijuana and tested negative for THC but used K2 and Kryptonite (synthetic marijuana) regularly |
CHS |
6 mo |
| Hopkins, 2013 [168] |
30, M |
2 y |
Yes |
17 y, then drug testing required for parole led him to daily use of undetectable synthetics, K2, Spice, Scooby Snacks |
CHS |
Symptoms resolved in 2 wk; all marijuana d/c and pt symptom-free at 3 mo |
| Ukaigwe, 2014 [169] |
38, M |
NR but past episodes had occurred |
Yes |
NR but described as "long term": use of marijuana and synthetics |
CHS with prerenal acute kidney injury |
2 wk (both CHS and renal symptoms) |
|
Abbreviations: ADHD, attention deficit hyperactivity disorder; CHS, cannabinoid hyperemesis syndrome; d, day; d/c, discontinued, discontinuation; ED, emergency department; F, female; GERD, gastroesophageal reflux disorder; h, hour; HG, hyperemesis gravidarum; M, male; MDD, major depressive disorder; NR, not reported; PC, primary care; pt, patient; PTSD, posttraumatic stress disorder; Rx, prescribed/prescription; SUD, substance use disorder; wk, week; y, year(s); yo, years old. Studies are presented in alphabetical order by last name of first author of the report, and studies involving specifically synthetic cannabinoids appear at the end. As these case studies were conducted independently and did not always report the same data (for instance, some had no data on treatment or resolution or prior marijuana use), it was not possible to synthesize this information in any scientifically sound or clinically meaningful way. It is fair to glean from the chart some basic information, namely that no patient from a case study is >51 years old, the majority are men with a long history of marijuana use, many had previous encounters with the healthcare system before CHS was diagnosed, most found relief in hot showers, and, when reported, symptoms typically resolved in a short time when marijuana was discontinued.
References correspond to the cited literature sources described in the text.
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