Repetitive Vomiting and Acute Renal Failure as the Presenting Features of Cannabinoid Hyperemesis Syndrome

Abstract

Cannabinoid hyperemesis syndrome (CHS) characterized by cyclic vomiting after chronic cannabis exposure has been increasingly reported but still less-appreciated with acute renal failure. An otherwise healthy 50-year-old man manifested vigorous vomiting with severe acute renal failure and metabolic alkalosis in the emergency department repetitively. Without receiving hemodialysis, all of his clinical symptoms and abnormal laboratory findings completely resolved after aggressive volume repletion, electrolyte supplementation, and control of vomiting. There was no ascertainable etiology for vomiting after serial laboratory and radiological workups. Based on his positive urine toxicology screening for tetrahydrocannabinol, an ill-concealed history of cannabis smoking, and the behavior of compulsive and prolonged hot spring baths alleviating the intractable vomiting, he was believed to have CHS. Repetitive vomiting and acute renal failure may be the presenting feature of CHS. Early recognition of CHS with prompt treatment is crucial to avoid futile examinations and inappropriate management, and to hasten cannabis cessation.