Bottom line: Patients present with history of episodic, intractable nausea and vomiting that is relieved with bathing in hot water. Exact mechanism for the nausea and vomiting is unknown; one theory is that the hyperemesis is somehow brought about by the neuromodulatory effects of delta-9-tetrahydrocannabi-nol (THC) on the brain. Another is that the syndrome may be associated with some other additive or other chemical used in the preparation of marijuna. Management includes evaluating volume status; rehydration, if needed; cessation of cannabis. Cyclic antiemetics tend to be ineffective.
Fig. 1 presents an algorithm for managing patients presenting with intractable vomiting, using the history and urine drug screen to direct management.