A 24-year-old man with daily heavy cannabis use presents with recurrent episodes of severe nausea, vomiting, and abdominal pain lasting days. He has been seen repeatedly in the emergency department. He tells you that long hot showers are the only thing that relieves his symptoms. What is the most likely diagnosis and definitive treatment?
- A Cannabinoid hyperemesis syndrome, cessation of cannabis use ✓
- B Cyclic vomiting syndrome, tricyclic antidepressant prophylaxis
- C Opioid-induced nausea, ondansetron scheduled dosing
- D Functional dyspepsia, proton pump inhibitor trial
Correct answer: A. Cannabinoid hyperemesis syndrome, cessation of cannabis use
Explanation
Cannabinoid hyperemesis syndrome occurs with chronic heavy cannabis use and features cyclical intractable vomiting with a pathognomonic relief from hot bathing or showering, attributed to TRPV1-mediated thermoregulatory effects. Antiemetics are typically ineffective and the only definitive cure is complete cessation of cannabis, after which symptoms resolve over weeks to months. Cyclic vomiting syndrome shares the episodic pattern but lacks the hot-water relief, and PPIs or ondansetron address neither the mechanism nor the trigger.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.