Cannabinoid Hyperemesis Syndrome

Cannabinoid Hyperemesis Syndrome (CHS) is an uncommon condition observed in chronic cannabis users marked by bouts of severe nausea, vomiting and abdominal pain which characteristically improves with hot showers. While the measures described below may be useful in providing acute symptom management, the only cure is abstinence from cannabis use.

• After consideration of alternative causes of acute vomiting, consider CHS in chronic cannabis users (typically daily use > 1 year) with:
  • Cyclic vomiting and abdominal pain in absence of alternative diagnosis
  • Symptoms temporarily relieved by hot showers
  • Profound dehydration

• Assess for dehydration and consider need for IV rehydration and laboratory investigations (e.g., electrolytes, glucose, blood gas, urea, creatinine). Treat hypoglycemia and/or electrolyte abnormalities, as required.

• Cannabis abstinence is the only long-term treatment for Cannabis Hyperemesis Syndrome. Discuss possible cannabis withdrawal syndrome symptoms and that CHS may not immediately resolve.
• With the exception of CBD for specific seizure disorders, there are very few proven indications for medical cannabis use in children.
• Provide education on the safe storage of dangerous medication and substances.
• Use harm reduction strategies to counsel teens regarding cannabis use and refer to local resources/services due to long-term concerns for their mental health (increased risk for psychosis), attention, concentration, memory and executive functioning
• For more information for parents, visit: Caring for Kids – Cannabis: what parents need to know.

Thank you to the following content experts who led the development of the Cannabis Intoxication and Cannabinoid Hyperemesis Syndrome Bottom Line Recommendations and Cannabis Supplement Table:

Kaitlin Hogue, MD, Resident – Pediatric Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Health Sciences Centre Children’s Hospital of Winnipeg

Neil Desai, MD, Clinical Assistant Professor, Division of Emergency Medicine, Department of Pediatrics, Faculty of Medicine, University of British Columbia

Thank you to the TREKK Editorial Committee, Editor Dr. Sarah Reid (CHEO), and CHRIM Parent and Youth Advisory Committee who provided editorial support and expertise in the development of this resource. Thank you as well to Mateja Carevic, TREKK Project Coordinator (University of Manitoba) who coordinated the development process.

To see our resource development process please visit our website here.

1. Vo KT. et al. Cannabis Intoxication Case Series: The Dangers of Edibles Containing Tetrahydrocannabinol. Ann Emerg Med. 2018;71(3), 306-313.
2. Richards JR, Smith NE, & Moulin AK. Unintentional Cannabis Ingestion in Children: A Systematic Review. J Pediatr. 2017;190, 142-152.
3. Ruberto AJ, Sivilotti MLA, Forrester S, Hall AK, Crawford FM, Day AG. Intravenous Haloperidol Versus Ondansetron for Cannabis Hyperemesis Syndrome (HaVOC): A Randomized, Controlled Trial. Ann Emerg Med. 2020 Nov 5:S0196-0644(20)30666-1.

For a complete list of the evidence that informed the creation of the Cannabinoid Hyperemesis Syndrome Bottom Line Recommendations see the Evidence Repository here.

The purpose of this document is to provide healthcare professionals with key facts and recommendations for the diagnosis and treatment of community acquired pneumonia in children in the emergency department. The TREKK Network is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. THIS DOCUMENT IS SUBJECT TO FULL DISCLAIMER HERE: trekk.ca/terms-of-use