ER Information Sheet

A one-page reference for emergency providers encountering CHS. Print this and bring it to the ER.

For Emergency Department Providers

CHS is an under-recognized condition frequently misdiagnosed as Cyclic Vomiting Syndrome, gastroparesis, or psychogenic vomiting. Consider CHS in any patient with cyclic vomiting and regular cannabis use.

Diagnostic Criteria (Rome IV)

All of the following must be present:

Stereotypical episodic vomiting resembling cyclic vomiting syndrome in onset, duration, and frequency
Presentation after prolonged, excessive cannabis use
Relief of vomiting episodes after sustained cessation of cannabis use

Supportive criteria: Compulsive hot water bathing with symptom relief

Cardinal Symptoms

Prodromal Phase

Morning nausea
Abdominal discomfort
Fear of vomiting
Normal eating patterns maintained

Hyperemetic Phase

Intense, persistent nausea
Recurrent vomiting (up to 5+/hour)
Diffuse abdominal pain
Compulsive hot bathing
Dehydration, weight loss

Recovery Phase

Symptom resolution
Return of normal eating
Resumption of normal bathing
Occurs with cannabis cessation

Evidence-Based Treatments

Treatment	Dosing	Notes
Capsaicin cream (0.075%)	Apply topically to abdomen	First-line; activates TRPV1 receptors. Can be applied q6h.
IV Fluids	NS or LR bolus as needed	Correct dehydration and electrolyte abnormalities
Haloperidol	2.5-5 mg IV/IM	Effective antiemetic for CHS. Monitor QTc.
Benzodiazepines	Lorazepam 1-2 mg IV	Adjunct for anxiety and agitation
Ondansetron (Zofran)	4-8 mg IV	Often ineffective alone; may use as adjunct

Differentials to Rule Out

Cyclic Vomiting Syndrome (CVS)
Gastroparesis
Superior Mesenteric Artery Syndrome

Pancreatitis
Cholecystitis
Adrenal Insufficiency

Key differentiator: CHS patients exhibit compulsive hot bathing behavior and symptom resolution with cannabis cessation, which are not seen in other conditions.

References

Sorensen CJ, et al. "Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment — A Systematic Review." J Med Toxicol. 2017;13(1):71-87.
Richards JR, et al. "Cannabinoid Hyperemesis Syndrome: Pathophysiology and Treatment in the Emergency Department." J Emerg Med. 2017;52(4):544-551.
Simonetto DA, et al. "Cannabinoid Hyperemesis: A Case Series of 98 Patients." Mayo Clin Proc. 2012;87(2):114-119.
Allen JH, et al. "Cannabinoid Hyperemesis: Cyclical Hyperemesis in Association with Chronic Cannabis Abuse." Gut. 2004;53(11):1566-1570.
Moon AM, et al. "Capsaicin for the Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review." Am J Ther. 2021;28(2):e235-e242.

Cannabinoid Hyperemesis Syndrome (CHS) — ER Quick Reference