A 23-year-old woman who had been continuously vomiting for two years finally got some respite after her doctors accurately diagnosed the culprit - cannabis.
For nearly two years, the woman showed up at the emergency department every month with the same set of systems: nausea, abdominal pain, and throwing up uncontrollably, Business Insider reported.
According to doctors' diagnosis, she was thought to have gastroparesis, a condition where the stomach is not evacuated completely. People with diabetes are known to be affected by gastroparesis, and the woman in question was diabetic.
Strangely, previous studies and scans of her digestive system revealed that she was in good health. The medication prescribed to treat gastroparesis wasn't effective either. When the woman told her doctors that she was a frequent cannabis user, the doctors began to consider a new diagnosis.
The woman was diagnosed with cannabinoid hyperemesis syndrome
The patient's urine was tested during one of her ER trips. It tested positive for cannabis, and the woman revealed that she smoked cannabis at least five times a week, including two days before her most recent hospital visits.
Most people use cannabis to reduce nausea, as the drug, in low doses, is known to be effective in treating nausea. But it didn't work for this patient. In fact, the only time her symptoms were eased was during hot baths at home.
In this case, the doctors realized that the drug was the primary culprit in causing the patient's gastrointestinal distress and diagnosed the woman with cannabinoid hyperemesis syndrome (CHS), a "condition characterized by bouts of severe nausea and vomiting in people who frequently use high doses of cannabis for long periods of time."
The only permanent cure from CHS is quitting cannabis
Patients suffering from CHS have previously noted that hot baths and showers helped relieve symptoms. While such measures provide temporary relief, the only permanent cure is quitting cannabis itself.
The patient was given counseling sessions to stop the usage of cannabis. She remained symptom-free when she stopped using, but nausea and vomiting returned when she started using cannabis again.
According to the doctors, since recreational cannabis use has been legalized in 21 states and Washington, DC, in the past ten years, there could be an increase in patients with CHS in emergency rooms.
The report also emphasizes the importance of taking a comprehensive social history of all patients. It is also a robust reminder that cannabinoid use can trigger nausea, vomiting, and abdominal pain. "Physicians should always inquire about the frequency of cannabis use. Moreover, relief of symptoms with cannabis cessation or hot baths should further heighten suspicion of CHS. This will help avoid unnecessary repeated tests and imaging and help initiate definite treatment much earlier," the scientists wrote in the report.
The report is published in the American Journal of Case Reports.
Study abstract:
Patients with type 1 diabetes mellitus may experience gastrointestinal symptoms, including those suggestive of diabetic gastroparesis. Cannabinoid hyperemesis syndrome (CHS) includes nausea, vomiting, and abdominal pain in the setting of chronic cannabinoid use. This report presents a case of CHS in a 23-year-old woman with uncontrolled type 1 diabetes mellitus.
A 23-year-old woman with chronically uncontrolled type 1 diabetes mellitus had been presenting monthly at the emergency department for the last 2 years, for acute bouts of intractable nausea and vomiting, occasionally with abdominal pain. Given her history of uncontrolled diabetes, she had been managed for diabetic gastroparesis with prokinetics. A gastric emptying study 6 months prior to admission was normal, and the patient had had multiple unremarkable abdominal computed tomography imaging scans. On this admission, she benefitted from supportive management with only temporary improvement of symptoms. On further questioning, she reported consistent use of cannabis for the last few years, and regression of acute vomiting with hot baths at home. With counseling, she ceased cannabis for 2 months and was symptom-free during this period.
This report has shown the importance of taking a comprehensive drug history in all patients, including in patients with type 1 diabetes, and is a reminder that cannabinoid use can cause severe nausea, vomiting, and abdominal pain in this patient group.
