@JoePinero – Cannabinoid hyperemesis syndrome (CHS) is a rare diagnosis to make but can save a lot of time and frustration if you can make it. It is typically seen in young males who are frequent users of marijuana, presenting with severe abdominal pain and vomiting, likely with numerous prior visits all with negative work ups. Let’s briefly review CHS

CHS Symptoms
– cyclicaly vomiting
– compulsiv bathing behaviors
– abdominal pain (despite often benign abdomen on physical exam)

CHS Historical Questions to Ask
– hx of chronic marijuana use (unclear how often, but likely needs to be daily to near-daily x 1 year or more)
– symptoms improve with hot bath/shower
– Males > females
– hx of depression, anxiety, and/or other psych diagnosis

CHS Treatment
– cessation of marijuana
– IV or oral hydration
– evaluate for renal failure as some case reports have seen an unexplained significant increase in creatinine (potentially due to severe dehydration)

References: 
Wallace EA, Andrews SE, Jelley MJ et al. Cannabinoid hyperemesis syndrome: literature review and proposed diagnosis and treatment algorithm. South Med J 2011 Sep;104(9):659-64
Nicolson SE, Denysenko L, Chabon B et al. Cannabinoid hyperemesis syndrome: a case series and review of previous reports. Psychosomatics. 2012 May-June;53(3):212-9
Habboushe J, Sedor J. Cannabinoid hyperemesis acute renal failure: a common sequela of cannabinoid hyperemesis syndrome