A 24-year-old man with daily heavy cannabis use for five years presents with recurrent episodes of nausea, vomiting, and abdominal pain lasting several days. During attacks he is found repeatedly taking very hot baths and showers, which he says are the only thing that relieves his symptoms. Endoscopy and CT abdomen are normal. The single most effective intervention to prevent recurrence is:

• A Daily ondansetron prophylaxis
• B Long-term low-dose tricyclic antidepressant
• C Cholecystectomy
• D Permanent cessation of cannabis use ✓

Explanation

Compulsive hot bathing relieving symptoms is pathognomonic of cannabinoid hyperemesis syndrome, seen in chronic heavy cannabis users. Antiemetics provide poor relief and surgery is inappropriate with normal imaging. The condition resolves only with sustained abstinence from cannabis; symptoms typically recur with re-use. Tricyclics have no established preventive role here. Recognising the hot-water compulsion avoids unnecessary invasive investigations.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.