Confirming the Diagnosis of Cannabinoid Hyperemesis–Reply–I

Abstract

We thank Dr Budhraja for pointing out other articles related to the use of cannabinoids and hyperemesis. When we saw our first patient with hyperemesis in June 2007, we were immediately intrigued by the patient's symptoms of refractory nausea and vomiting that were relieved only with hot showers. We immediately performed PubMed and Google searches and learned about cannabinoid hyperemesis. When we saw a second patient with a similar presentation in January 2008, we decided to write about our patients because, to the best of our knowledge at that time, they would be the first cases to be reported in the United States. We wrote the manuscript during the spring of 2008 and then submitted it to Mayo Clinic Proceedings. We think it was during that time that the other articles were published without our knowledge. The article by Bryne et al1 published in 2006, which we were aware of when writing our manuscript, raises the question of whether the syndrome is valid without further investigating the etiology. The purpose of our article was to raise awareness of the syndrome as one of the differential diagnoses in patients who present with hyperemesis and abnormal bathing behaviors and to tease out possible causes given the paradoxical response to marijuana use. In fact, our article in Mayo Clinic Proceedings is already shedding light on these topics. We have received many e-mails from physicians who have treated similar patients for years without a clear etiology, and they have said that their patients feel “validated” by the possibility of this diagnosis. We have also received e-mails from patients who report feeling relieved that this syndrome is receiving more attention because they have experienced it for years. We think that the issue raised by Dr Budhraja is an unfortunate consequence of overlap that occurred during simultaneous submissions of manuscripts.