cannabinoid/cannabis hyperemesis syndrome (scromiting)
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Etiology
Clinical manifestations
- episodic nausea/vomiting
- screaming & loud vomiting
- abdominal pain
- compulsive bathing
- polydipsia
- symptoms improve with
- hot baths, hot showers
- cessation of marijuana use
- phases of the syndrome[4]
Diagnostic criteria
- episodic vomiting >= 3 times a year
- cannabis use (usually > 4 times weekly) for > 1 year prior to symptom onset
- symptoms resolve after cannabis abstinence for >= 6 months or duration of >= 3 vomiting cycles*[4]
* seems resolution of a syndrome not particularly useful as diagnostic criterion
Laboratory
Diagnostic procedures
- upper GI endoscopy as indicated[4]
Radiology
- abdominal CT as indicated
- neuroimaging if focal neurologic signs or symptoms[4]
Differential diagnosis
- gastroparesis
- pregnancy,
- migraines
- rumination syndrome
- non-cannabis associated cyclic vomiting syndrome[4]
Management
- marijuana cessation
- prodromal phase (abortive medications)[4]
- emetic phase
- antiemetics (benzodiazepines, promethazine, ondansetron, neuroleptics)
- topical capsaicin cream applied to the upper abdomen
- supportive therapies*
- maintaining an empty stomach
- resting in a quiet, dark room
- inter-episodic phase
- tricyclic antidepressants (mitriptyline, nortriptyline)
- start 75-100 mg of amitriptyline
- anticonvulsants
- mitochondrial supplements (riboflavin, coenzyme Q10)
- tricyclic antidepressants (mitriptyline, nortriptyline)
- opioids should be avoided during all phases[4]
Notes
- editorialist notes that this syndrome seems counterintuitive since Cannabis is used to treat nausea & vomiting[3]
More general terms
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012
- ↑ Soriano-Co M, Batke M, Cappell MS. The cannabis hyperemesis syndrome characterized by persistent nausea and vomiting, abdominal pain, and compulsive bathing associated with chronic marijuana use: a report of eight cases in the United States. Dig Dis Sci. 2010 Nov;55(11):3113-9 PMID: https://pubmed.ncbi.nlm.nih.gov/20130993
- ↑ 3.0 3.1 Simonetto DA et al. Cannabinoid hyperemesis: A case series of 98 patients. Mayo Clin Proc 2012 Feb; 87:114 PMID: https://pubmed.ncbi.nlm.nih.gov/22305024
Mechoulam R. Cannabis - A valuable drug that deserves better treatment. Mayo Clin Proc 2012 Feb; 87:107 PMID: https://pubmed.ncbi.nlm.nih.gov/22305022 - ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 Rubio-Tapia A et al. AGA Clinical Practice Update on diagnosis and management of cannabinoid hyperemesis syndrome: Commentary. Gastroenterology 2024 May; 166:930. PMID: https://pubmed.ncbi.nlm.nih.gov/38456869 https://www.gastrojournal.org/article/S0016-5085(24)00127-6/fulltext
- ↑ Frazier R, Li BUK, Venkatesan T. Diagnosis and Management of Cyclic Vomiting Syndrome: A Critical Review. Am J Gastroenterol. 2023 Jul 1;118(7):1157-1167 PMID: https://pubmed.ncbi.nlm.nih.gov/36791365 Review. https://journals.lww.com/ajg/fulltext/2023/07000/diagnosis_and_management_of_cyclic_vomiting.16.aspx
- ↑ Borgundvaag B, Bellolio F, Miles I et al Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. Acad Emerg Med. 2024 May;31(5):425-455. PMID: https://pubmed.ncbi.nlm.nih.gov/38747203 https://onlinelibrary.wiley.com/doi/10.1111/acem.14911
- ↑ Toce MS, Monuteaux MC, Fishman MD, Hudgins JD. Emergency Department Visits for Cannabis Hyperemesis Syndrome Among Adolescents. JAMA Netw Open. 2025 Jul 1;8(7):e2520492. PMID: https://pubmed.ncbi.nlm.nih.gov/40658419 PMCID: PMC12260988 Free PMC article https://pmc.ncbi.nlm.nih.gov/articles/PMC12260988/
- ↑ Swartz JA, Franceschini D. Cannabinoid Hyperemesis Syndrome, 2016 to 2022. JAMA Netw Open. 2025 Nov 3;8(11):e2545310. PMID: https://pubmed.ncbi.nlm.nih.gov/41284293 PMCID: PMC12645340 Free PMC article. https://pmc.ncbi.nlm.nih.gov/articles/PMC12645340/