Cannabinoid Hyperemesis Syndrome: A Case Report and Literature Review

Purpose: As society has seen an increase in rates of cannabis abuse, largely related to an increase in legalization of the substance, a new clinical condition deemed cannabinoid hyperemesis syndrome has been recognized. This syndrome of idiopathic etiology is stimulated from chronic marijuana usage and produces cyclic episodes of nausea, vomiting, and epigastric pain often alleviated with compulsive hot water bathing. Patient and Methods: A 42-year-old woman with a medical history of hypertension and myasthenia gravis was admitted to the authors' institution with a mandibular fracture. Results: Her laboratory work showed her to be extremely hypokalemic and with slight metabolic alkalosis. This was attributed to her reports of chronic vomiting, multiple times daily, over several weeks' duration. After her medical workup, cannabinoid hyperemesis syndrome was diagnosed and treated by fluid resuscitation, antiemetic medications, and marijuana cessation. After correction of her clinical symptoms and laboratory work, she was able to undergo open reduction and internal fixation of her mandibular fracture. Conclusions: The dental community is well aware of the positive antiemetic and appetite-stimulating effects of marijuana, but they might be unaware of some of the paradoxical effects it can produce as shown in this newly documented clinical condition. As society is seeing an increase in the legalization of marijuana for medical and recreational usage in the United States, the dental community should be aware of this condition and its implications. (C) 2015 American Association of Oral and Maxillofacial Surgeons