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Cannabis Associated HyperemesisAPPROACH

ABDOMINAL AND GASTROINTESTINAL · 19 SECTIONS

⚲

485 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Abdominal Distension Abdominal Pain, Undifferentiated Acute Abdominal Pain (general)Suspected Incarcerated Or Strangulated Hernia Pancreatitis Concern Biliary Colic And Cholecystitis Concern Appendicitis Concern Diverticulitis Concern Rectal Pain And Anorectal Complaints Dysphagia And Food Bolus Impaction Foreign Body Ingestion Refractory Vomiting And Recurrent Vomiting Syndromes Cannabis Associated Hyperemesis Upper Gastrointestinal Bleeding Symptoms (melena)Lower Gastrointestinal Bleeding And Hematochezia Constipation And Obstipation Diarrhea Acute Hepatitis And Jaundice Concern Right Upper Quadrant Pain Epigastric Pain Left Upper Quadrant Pain Right Lower Quadrant Pain Left Lower Quadrant Pain Suprapubic Pain

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx69

HPI overview

›Symptom characterization

›Recurrent episodes of severe nausea and vomiting

›Symptom free intervals between episodes

›Similar prior presentations with negative workups

›Pattern consistent with cannabis hyperemesis syndrome

›Cannabis exposure

›Daily or near daily use for months to years

›High potency products

›Concentrates or vaping

›Recent change in amount or formulation

›Last use timing relative to symptom onset

›Hot bathing behavior

›Compulsive hot showers or baths for relief

›Duration and frequency of hot bathing

›Trigger context

›Stress

›Sleep disruption

›Dietary indiscretion

›Intercurrent illness

›Prior treatments and response

›Ondansetron response

›Dopamine antagonist response

›Capsaicin response

›IV fluids response

›Baseline status

›Baseline oral intake

›Baseline weight trend

02Alarm Features/alarm25

Immediate escalation triggers

›Resuscitation triggers

›Hypotension or shock

›Altered mental status

›Respiratory distress

›Persistent tachycardia with dehydration

›Uncontrolled vomiting with inability to protect airway

›High risk abdominal features

›Peritoneal signs

›Severe focal tenderness

›Abdominal distension with obstipation

›Bilious vomiting

›GI bleeding

Vital sign danger thresholds

›Concerning vitals

›Systolic blood pressure less than 90 mmHg

›Heart rate greater than 130 beats per minute

›Respiratory rate greater than 30 per minute

›Oxygen saturation less than 92 percent on room air

›Temperature 38.0 C or higher

Special population red flags

›Pregnancy related

›Pregnancy positive test

›Severe dehydration with ketonuria

›Older adult or immunocompromised

›New onset vomiting without prior cyclic pattern

›Concern for obstruction

›Concern for infection

03Medications/meds22

Current and recent exposures

›Medication reconciliation

›Prescribed medications

›OTC medications

›Supplements

›Recent antibiotic exposure

›Recent medication changes

›Emetic medications and toxins

›GLP 1 receptor agonists

›Opioids

›Cannabis co exposures

›Alcohol

›Stimulants

Antiemetic risks and interactions

›QT prolongation and sedation risks

›Haloperidol exposure

›Droperidol exposure

›Ondansetron exposure

›Other QT prolonging agents

›Electrolyte depletion

›Contraindications

›Parkinson disease or Lewy body dementia

›Prior neuroleptic malignant syndrome

›Severe dystonia history with dopamine antagonists

04Diet/diet14

Intake and hydration pattern

›Recent intake

›Duration of poor oral intake

›Last tolerated solids

›Last tolerated liquids

›Hydration markers

›Thirst

›Dry mucosa

›Oliguria

›Orthostasis

Dietary triggers and substances

›Exposures

›Caffeine and energy drinks

›High fat meals

›Large meals after fasting

›Alcohol exposure

05Review of Systems/ros21

System review focused

›Constitutional

›Fever

›Chills

›Weight loss

›GI

›Abdominal pain

›Diarrhea

›Constipation

›GI bleeding

›GU

›Dysuria

›Flank pain

›Vaginal bleeding

›Neuro

›Headache

›Focal deficits

›Seizure

›Cardiorespiratory

›Chest pain

›Dyspnea

›Palpitations

06Collateral History and Family History/chafh9

Collateral and reliability

›Source

›Family or friend report of cannabis use pattern

›EMS report of hot shower behavior

›Reliability limitations

Family history

›Relevant conditions

›Migraine

›Cyclic vomiting syndrome

›Early cardiovascular disease

›Inherited metabolic disorders

07Risk Factors/rf16

Exposure and behavioral risks

›Cannabis risk profile

›Daily use

›Early onset use

›High potency THC

›Concentrates

›Withdrawal cycles with relapse

›Dehydration risks

›Limited access to fluids

›Repeated emesis

›Heat exposure from prolonged hot bathing

Medical risks and complications

›Complication risks

›Electrolyte depletion

›Acute kidney injury from volume loss

›Aspiration

›Esophageal injury

›Rhabdomyolysis risk with prolonged agitation or immobility

08Differential Diagnosis/ddx60

Life threatening

›Life threatening vomiting causes

›Bowel obstruction

›Bilious emesis

›Distension

›Obstipation

›Perforated viscus

›Peritoneal signs

›Severe sudden pain

›Upper GI bleeding

›Hematemesis

›Melena

›DKA

›Hyperglycemia

›Ketonemia or ketonuria

›Metabolic acidosis

›Adrenal crisis

›Hypotension

›Hyponatremia

›Hyperkalemia

›Intracranial pathology

›New severe headache

›Focal neurologic deficits

›Papilledema

Common

›Common vomiting causes

›Cannabis hyperemesis syndrome

›Chronic cannabis use

09Past Medical History/pmh15

Relevant chronic conditions

›Chronic conditions

›Cannabis use disorder

›Anxiety

›Depression

›Migraine

›Diabetes mellitus

›Chronic kidney disease

›Prior similar episodes

›Number of prior ED visits

›Prior admissions

›Prior diagnostic imaging results

Surgical and procedural history

›Abdomen related procedures

›Prior abdominal surgery

›Prior endoscopy

›History of bowel obstruction

10Physical Exam/exam22

General and vitals interpretation

›General appearance

›Volume depletion signs

›Toxic appearance

›Agitation and repeated retching

›Hemodynamic assessment

›Orthostatic changes

›Capillary refill delay

›Peripheral perfusion

Abdominal and focused systems

›Abdominal exam

›Tenderness distribution

›Guarding

›Rebound

›Distension

›Bowel sounds

›Neuro and cardiopulmonary

›Mental status

›Focal deficits

›Lung exam for aspiration

›Heart rhythm irregularity

›Skin and temperature exposure

›Hot water burn findings

›Diaphoresis

11Lab Studies/labs23

Core ED labs

›Basic evaluation

›CBC

›Electrolytes

›Creatinine

›Glucose

›Magnesium

›Phosphate

›Targeted labs by differential

›Lipase

›Liver enzymes

›Pregnancy test

›Urinalysis

›Serum ketones if suspected ketoacidosis

Interpretation pearls and pitfalls

›Common abnormalities in severe vomiting

›Hypokalemia

›Hypochloremic metabolic alkalosis

›Elevated creatinine from dehydration

›Alternative physiology patterns

›Metabolic acidosis with ketones in starvation or DKA

›Lactic elevation in shock

›Cannabinoid testing limitations

›Urine THC persistence for days to weeks

›Not confirmatory for CHS

12Imaging/img21

Scoring Systems

›Imaging decision logic framework

›Low imaging yield when classic CHS pattern and benign exam

›Imaging favored when alarm features present

›Imaging favored when first episode or atypical features

MRI

›Neuro imaging considerations

›MRI brain when persistent vomiting with focal neuro deficits

›MRI brain when concern for posterior fossa pathology

›Abdomen pelvis CT considerations

›CT when obstruction concern

›CT when peritoneal signs present

›CT when severe focal tenderness

›CT when new onset vomiting without prior cyclic pattern

›Contrast cautions

›Acute kidney injury risk with dehydration

›Allergy history

Ultrasound

›RUQ ultrasound

›RUQ pain or abnormal liver enzymes

›Suspected cholecystitis or biliary colic

›Pelvic ultrasound

›Pregnancy related pain or bleeding

›Concern for ectopic pregnancy

13Special Tests/spec10

Bedside diagnostics

›Bedside assessment adjuncts

›Point of care glucose

›Orthostatic vitals

›Bladder scan if urinary retention concern

›Pregnancy focused

›Point of care pregnancy test

›Ectopic risk assessment

Substance and tox considerations

›Toxicology adjuncts

›Acetaminophen level when overdose concern

›Salicylate level when mixed ingestion concern

14ECG/ecg7

Indications and safety monitoring

›ECG indications in vomiting presentations

›Electrolyte abnormalities

›Syncope or palpitations

›QT prolonging antiemetic use

›QT related risk mitigation

›Baseline QTc prior to haloperidol or droperidol when feasible

›Repeat ECG after treatment if QTc prolonged or symptoms develop

15Assessment/ax27

Working diagnosis and severity

›Cannabis hyperemesis syndrome

›Cannabis use with other cannabis induced disorder (F12.288)

›Nausea with vomiting (R11.2)

›Vomiting unspecified (R11.10)

›Classic features

›Chronic cannabis exposure

›Hot shower relief

›Recurrent stereotyped episodes

›Severity stratification

›Mild

›Able to tolerate some oral fluids

›No significant electrolyte derangement

›Moderate

›Persistent vomiting

›Requires IV fluids

›Correctable electrolyte derangement

›Severe

›Hemodynamic instability

›Acute kidney injury

›Refractory symptoms despite ED therapy

›QTc prolongation limiting antiemetic options

Diagnostic uncertainty and alternatives

›Alternative diagnoses requiring exclusion

›Pregnancy related vomiting

›Pancreatitis

›Obstruction

›DKA or starvation ketosis

16Plan/plan68

Differential Management

›!Cannabis-induced hyperemesis→

Approach to the critical patient

›First 5 minutes workflow

›Airway and aspiration risk

›Suction readiness

›Lateral positioning if actively vomiting

›Monitoring

›Continuous pulse oximetry

›Cardiac monitor if severe electrolyte derangement or QT risk

›IV access and fluids

›Two IVs if shock or severe dehydration

›Isotonic crystalloid bolus if hypovolemia

›Time critical tests

›Point of care glucose early

›Pregnancy test early in patients with pregnancy potential

›Reassessment loop

›Symptom reassessment every 30 to 60 minutes while in ED

›Repeat vitals after fluids and antiemetics

›Repeat electrolytes after repletion if severe derangements

›Escalate level of care for persistent instability

Fluids and electrolyte correction

›Volume resuscitation

›Normal saline or balanced crystalloid IV

›Bolus 10 to 20 mL per kg for significant dehydration local protocol dependent

›Maintenance IV fluids after bolus based on ongoing losses

›Potassium repletion

›If potassium less than 3.0 mmol per L IV replacement with cardiac monitoring

17Disposition/dispo27

Level of care criteria

›ICU criteria

›Shock requiring vasopressors

›Severe electrolyte derangement with arrhythmia

›Refractory vomiting with airway risk

›Severe metabolic derangement requiring intensive monitoring

›Inpatient admission criteria

›Acute kidney injury not improving with fluids

›Persistent electrolyte abnormalities requiring IV replacement

›Refractory symptoms after ED therapy

›Inability to tolerate oral intake after observation

›Complications

›Aspiration pneumonitis

›GI bleeding

›Observation pathway criteria

›Moderate symptoms responding to ED therapy but not ready for discharge

›Need for repeat labs after repletion

›Need for serial ECG for QTc risk

›Discharge criteria

›Vital signs stable

›Pain controlled

›Tolerating oral fluids

›Electrolytes corrected or mild and stable

›Reliable follow up and cessation counseling plan

Follow up timing

›Outpatient follow up

›Primary care within 3 to 7 days

›Substance use services within 1 to 2 weeks

18Discharge Instructions/di23

Copy discharge instructions

›Diagnosis summary

›Your symptoms are consistent with cannabis related recurrent vomiting

›The most effective treatment is stopping cannabis completely

›Medications

›Take nausea medicine exactly as prescribed

›Do not take extra doses of nausea medicine without medical advice

›Avoid alcohol and sedating drugs while using prescribed anti nausea medications

›Hydration and diet

›Small frequent sips of oral rehydration fluids

›Advance diet slowly as tolerated

›Activity

›Avoid driving if sedated from medications

›Avoid prolonged hot showers due to burn and dehydration risk

›Return to ED now if

›You cannot keep down fluids for 12 hours

›You have severe abdominal pain

›You have blood in vomit or black stools

›You faint or feel like you will faint

›You have chest pain or trouble breathing

›You have fever 38.0 C or higher

›Follow up

›Primary care follow up within 3 to 7 days

›Substance use support follow up within 1 to 2 weeks

19References/r6

Key guidelines and evidence

›Reference list

›American Gastroenterological Association clinical practice update on cannabinoid hyperemesis syndrome 2024

›Rome IV functional gastrointestinal disorders criteria 2016

›ACEP clinical policy on nausea and vomiting symptom management local protocol dependent

›Randomized trial evidence on haloperidol for cannabis hyperemesis syndrome 2020

›Review evidence on topical capsaicin for cannabis hyperemesis syndrome 2020

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Cannabis Associated HyperemesisAPPROACH

ABDOMINAL AND GASTROINTESTINAL · 19 SECTIONS

⚲

485 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx69

HPI overview

›Symptom characterization

›Recurrent episodes of severe nausea and vomiting

›Symptom free intervals between episodes

›Similar prior presentations with negative workups

›Pattern consistent with cannabis hyperemesis syndrome

›Cannabis exposure

›Daily or near daily use for months to years

›High potency products

›Concentrates or vaping

›Recent change in amount or formulation

›Last use timing relative to symptom onset

›Hot bathing behavior

›Compulsive hot showers or baths for relief

›Duration and frequency of hot bathing

›Trigger context

›Stress

›Sleep disruption

›Dietary indiscretion

›Intercurrent illness

›Prior treatments and response

›Ondansetron response

›Dopamine antagonist response

›Capsaicin response

›IV fluids response

›Baseline status

›Baseline oral intake

›Baseline weight trend

02Alarm Features/alarm25

Immediate escalation triggers

›Resuscitation triggers

›Hypotension or shock

›Altered mental status

›Respiratory distress

›Persistent tachycardia with dehydration

›Uncontrolled vomiting with inability to protect airway

›High risk abdominal features

›Peritoneal signs

›Severe focal tenderness

›Abdominal distension with obstipation

›Bilious vomiting

›GI bleeding

Vital sign danger thresholds

›Concerning vitals

›Systolic blood pressure less than 90 mmHg

›Heart rate greater than 130 beats per minute

›Respiratory rate greater than 30 per minute

›Oxygen saturation less than 92 percent on room air

›Temperature 38.0 C or higher

Special population red flags

›Pregnancy related

›Pregnancy positive test

›Severe dehydration with ketonuria

›Older adult or immunocompromised

›New onset vomiting without prior cyclic pattern

›Concern for obstruction

›Concern for infection

03Medications/meds22

Current and recent exposures

›Medication reconciliation

›Prescribed medications

›OTC medications

›Supplements

›Recent antibiotic exposure

›Recent medication changes

›Emetic medications and toxins

›GLP 1 receptor agonists

›Opioids

›Cannabis co exposures

›Alcohol

›Stimulants

Antiemetic risks and interactions

›QT prolongation and sedation risks

›Haloperidol exposure

›Droperidol exposure

›Ondansetron exposure

›Other QT prolonging agents

›Electrolyte depletion

›Contraindications

›Parkinson disease or Lewy body dementia

›Prior neuroleptic malignant syndrome

›Severe dystonia history with dopamine antagonists

04Diet/diet14

Intake and hydration pattern

›Recent intake

›Duration of poor oral intake

›Last tolerated solids

›Last tolerated liquids

›Hydration markers

›Thirst

›Dry mucosa

›Oliguria

›Orthostasis

Dietary triggers and substances

›Exposures

›Caffeine and energy drinks

›High fat meals

›Large meals after fasting

›Alcohol exposure

05Review of Systems/ros21

System review focused

›Constitutional

›Fever

›Chills

›Weight loss

›GI

›Abdominal pain

›Diarrhea

›Constipation

›GI bleeding

›GU

›Dysuria

›Flank pain

›Vaginal bleeding

›Neuro

›Headache

›Focal deficits

›Seizure

›Cardiorespiratory

›Chest pain

›Dyspnea

›Palpitations

06Collateral History and Family History/chafh9

Collateral and reliability

›Source

›Family or friend report of cannabis use pattern

›EMS report of hot shower behavior

›Reliability limitations

Family history

›Relevant conditions

›Migraine

›Cyclic vomiting syndrome

›Early cardiovascular disease

›Inherited metabolic disorders

07Risk Factors/rf16

Exposure and behavioral risks

›Cannabis risk profile

›Daily use

›Early onset use

›High potency THC

›Concentrates

›Withdrawal cycles with relapse

›Dehydration risks

›Limited access to fluids

›Repeated emesis

›Heat exposure from prolonged hot bathing

Medical risks and complications

›Complication risks

›Electrolyte depletion

›Acute kidney injury from volume loss

›Aspiration

›Esophageal injury

›Rhabdomyolysis risk with prolonged agitation or immobility

08Differential Diagnosis/ddx60

Life threatening

›Life threatening vomiting causes

›Bowel obstruction

›Bilious emesis

›Distension

›Obstipation

›Perforated viscus

›Peritoneal signs

›Severe sudden pain

›Upper GI bleeding

›Hematemesis

›Melena

›DKA

›Hyperglycemia

›Ketonemia or ketonuria

›Metabolic acidosis

›Adrenal crisis

›Hypotension

›Hyponatremia

›Hyperkalemia

›Intracranial pathology

›New severe headache

›Focal neurologic deficits

›Papilledema

Common

›Common vomiting causes

›Cannabis hyperemesis syndrome

›Chronic cannabis use

09Past Medical History/pmh15

Relevant chronic conditions

›Chronic conditions

›Cannabis use disorder

›Anxiety

›Depression

›Migraine

›Diabetes mellitus

›Chronic kidney disease

›Prior similar episodes

›Number of prior ED visits

›Prior admissions

›Prior diagnostic imaging results

Surgical and procedural history

›Abdomen related procedures

›Prior abdominal surgery

›Prior endoscopy

›History of bowel obstruction

10Physical Exam/exam22

General and vitals interpretation

›General appearance

›Volume depletion signs

›Toxic appearance

›Agitation and repeated retching

›Hemodynamic assessment

›Orthostatic changes

›Capillary refill delay

›Peripheral perfusion

Abdominal and focused systems

›Abdominal exam

›Tenderness distribution

›Guarding

›Rebound

›Distension

›Bowel sounds

›Neuro and cardiopulmonary

›Mental status

›Focal deficits

›Lung exam for aspiration

›Heart rhythm irregularity

›Skin and temperature exposure

›Hot water burn findings

›Diaphoresis

11Lab Studies/labs23

Core ED labs

›Basic evaluation

›CBC

›Electrolytes

›Creatinine

›Glucose

›Magnesium

›Phosphate

›Targeted labs by differential

›Lipase

›Liver enzymes

›Pregnancy test

›Urinalysis

›Serum ketones if suspected ketoacidosis

Interpretation pearls and pitfalls

›Common abnormalities in severe vomiting

›Hypokalemia

›Hypochloremic metabolic alkalosis

›Elevated creatinine from dehydration

›Alternative physiology patterns

›Metabolic acidosis with ketones in starvation or DKA

›Lactic elevation in shock

›Cannabinoid testing limitations

›Urine THC persistence for days to weeks

›Not confirmatory for CHS

12Imaging/img21

Scoring Systems

›Imaging decision logic framework

›Low imaging yield when classic CHS pattern and benign exam

›Imaging favored when alarm features present

›Imaging favored when first episode or atypical features

MRI

›Neuro imaging considerations

›MRI brain when persistent vomiting with focal neuro deficits

›MRI brain when concern for posterior fossa pathology

›Abdomen pelvis CT considerations

›CT when obstruction concern

›CT when peritoneal signs present

›CT when severe focal tenderness

›CT when new onset vomiting without prior cyclic pattern

›Contrast cautions

›Acute kidney injury risk with dehydration

›Allergy history

Ultrasound

›RUQ ultrasound

›RUQ pain or abnormal liver enzymes

›Suspected cholecystitis or biliary colic

›Pelvic ultrasound

›Pregnancy related pain or bleeding

›Concern for ectopic pregnancy

13Special Tests/spec10

Bedside diagnostics

›Bedside assessment adjuncts

›Point of care glucose

›Orthostatic vitals

›Bladder scan if urinary retention concern

›Pregnancy focused

›Point of care pregnancy test

›Ectopic risk assessment

Substance and tox considerations

›Toxicology adjuncts

›Acetaminophen level when overdose concern

›Salicylate level when mixed ingestion concern

14ECG/ecg7

Indications and safety monitoring

›ECG indications in vomiting presentations

›Electrolyte abnormalities

›Syncope or palpitations

›QT prolonging antiemetic use

›QT related risk mitigation

›Baseline QTc prior to haloperidol or droperidol when feasible

›Repeat ECG after treatment if QTc prolonged or symptoms develop

15Assessment/ax27

Working diagnosis and severity

›Cannabis hyperemesis syndrome

›Cannabis use with other cannabis induced disorder (F12.288)

›Nausea with vomiting (R11.2)

›Vomiting unspecified (R11.10)

›Classic features

›Chronic cannabis exposure

›Hot shower relief

›Recurrent stereotyped episodes

›Severity stratification

›Mild

›Able to tolerate some oral fluids

›No significant electrolyte derangement

›Moderate

›Persistent vomiting

›Requires IV fluids

›Correctable electrolyte derangement

›Severe

›Hemodynamic instability

›Acute kidney injury

›Refractory symptoms despite ED therapy

›QTc prolongation limiting antiemetic options

Diagnostic uncertainty and alternatives

›Alternative diagnoses requiring exclusion

›Pregnancy related vomiting

›Pancreatitis

›Obstruction

›DKA or starvation ketosis

16Plan/plan68

Differential Management

›!Cannabis-induced hyperemesis→

Approach to the critical patient

›First 5 minutes workflow

›Airway and aspiration risk

›Suction readiness

›Lateral positioning if actively vomiting

›Monitoring

›Continuous pulse oximetry

›Cardiac monitor if severe electrolyte derangement or QT risk

›IV access and fluids

›Two IVs if shock or severe dehydration

›Isotonic crystalloid bolus if hypovolemia

›Time critical tests

›Point of care glucose early

›Pregnancy test early in patients with pregnancy potential

›Reassessment loop

›Symptom reassessment every 30 to 60 minutes while in ED

›Repeat vitals after fluids and antiemetics

›Repeat electrolytes after repletion if severe derangements

›Escalate level of care for persistent instability

Fluids and electrolyte correction

›Volume resuscitation

›Normal saline or balanced crystalloid IV

›Bolus 10 to 20 mL per kg for significant dehydration local protocol dependent

›Maintenance IV fluids after bolus based on ongoing losses

›Potassium repletion

›If potassium less than 3.0 mmol per L IV replacement with cardiac monitoring

17Disposition/dispo27

Level of care criteria

›ICU criteria

›Shock requiring vasopressors

›Severe electrolyte derangement with arrhythmia

›Refractory vomiting with airway risk

›Severe metabolic derangement requiring intensive monitoring

›Inpatient admission criteria

›Acute kidney injury not improving with fluids

›Persistent electrolyte abnormalities requiring IV replacement

›Refractory symptoms after ED therapy

›Inability to tolerate oral intake after observation

›Complications

›Aspiration pneumonitis

›GI bleeding

›Observation pathway criteria

›Moderate symptoms responding to ED therapy but not ready for discharge

›Need for repeat labs after repletion

›Need for serial ECG for QTc risk

›Discharge criteria

›Vital signs stable

›Pain controlled

›Tolerating oral fluids

›Electrolytes corrected or mild and stable

›Reliable follow up and cessation counseling plan

Follow up timing

›Outpatient follow up

›Primary care within 3 to 7 days

›Substance use services within 1 to 2 weeks

18Discharge Instructions/di23

Copy discharge instructions

›Diagnosis summary

›Your symptoms are consistent with cannabis related recurrent vomiting

›The most effective treatment is stopping cannabis completely

›Medications

›Take nausea medicine exactly as prescribed

›Do not take extra doses of nausea medicine without medical advice

›Avoid alcohol and sedating drugs while using prescribed anti nausea medications

›Hydration and diet

›Small frequent sips of oral rehydration fluids

›Advance diet slowly as tolerated

›Activity

›Avoid driving if sedated from medications

›Avoid prolonged hot showers due to burn and dehydration risk

›Return to ED now if

›You cannot keep down fluids for 12 hours

›You have severe abdominal pain

›You have blood in vomit or black stools

›You faint or feel like you will faint

›You have chest pain or trouble breathing

›You have fever 38.0 C or higher

›Follow up

›Primary care follow up within 3 to 7 days

›Substance use support follow up within 1 to 2 weeks

19References/r6

Key guidelines and evidence

›Reference list

›American Gastroenterological Association clinical practice update on cannabinoid hyperemesis syndrome 2024

›Rome IV functional gastrointestinal disorders criteria 2016

›ACEP clinical policy on nausea and vomiting symptom management local protocol dependent

›Randomized trial evidence on haloperidol for cannabis hyperemesis syndrome 2020

›Review evidence on topical capsaicin for cannabis hyperemesis syndrome 2020

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

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