Cannabinoid hyperemesis syndrome (CHS)—a condition linked to frequent cannabis use that causes constant bouts of vomiting—is a nightmare to endure. A report out this week shows how CHS can sometimes also become life-threatening.
Doctors at Augusta University in Georgia detailed an especially frightening case of CHS in a 15-year-old boy. The condition likely led him to develop an acute neurological disorder triggered by a severe vitamin deficiency, one that left him barely able to walk, talk, and see. Fortunately, doctors were able to treat the boy in time, and he ultimately made a full recovery.
“To our knowledge, this represents one of the earliest reported pediatric cases of Wernicke encephalopathy associated with CHS,” the authors wrote in their paper, published Monday in the Cureus Journal of Medical Science.
The growing horrors of ‘scromiting’
People with CHS will experience cyclical periods of intense cramps, nausea, and vomiting. These episodes are often so excruciating that people will scream out in pain as they’re vomiting, which has led people to nickname the condition “scromiting.”
Scientists don’t know why it happens, but we know the risk of CHS is greater in people who use cannabis for a long period of time. The incidence of CHS also seems to be rising over time, likely due to greater cannabis use among Americans, the higher THC potency of products today, and better awareness (it’s only last year that CHS was even formally recognized with a distinct diagnostic code). A report earlier this month from the U.S. Centers for Disease Control and Prevention shows that emergency room visits for CHS have continued to increase this year, particularly among younger people, some as young as 15.
A rarely seen complication
This latest report involved a 15-year-old who first visited doctors after several days of unrelenting nausea, vomiting, and headache, which soon led to a diagnosis of CHS. He returned weeks later in much worse shape, having lost around 25 pounds of weight. Tests found he had dangerously low levels of sodium in his blood and signs of worsening liver damage, and he was admitted to the hospital.
Upon admission, the boy had slurred speech, mild confusion, and episodes of unresponsiveness, the doctors wrote. And though they treated some of his initial issues, his mental and physical state continued to deteriorate as he stayed mostly bedbound and wasn’t able to walk normally. Soon after, his eyes began to move involuntarily from side to side (a condition called horizontal nystagmus), and he developed blurred vision.
Brain scans, including an MRI, yielded no specific answers. But given his neurological symptoms and preceding CHS, the doctors suspected that he had Wernicke encephalopathy, an acute brain disorder caused by a deficiency in thiamine, also known as vitamin B1. This nutrient helps convert food into energy and is especially important for brain and heart function. If not treated promptly, Wernicke encephalopathy can cause permanent, even fatal, brain damage; it can also cause a dementia-like disorder called Korsakoff syndrome.
The doctors decided to treat the boy with supplemental thiamine while they waited for test results. Within a day of treatment, his neurological symptoms began to improve, and the results confirmed his deficiency, essentially confirming their suspected diagnosis as well. He eventually improved well enough to be discharged from the hospital.
Lessons to be learned
The chronic vomiting caused by CHS can certainly lead to nutritional problems like rapid weight loss and vitamin deficiencies. Yet Wernicke encephalopathy is usually linked to chronic alcohol misuse, not CHS. Stranger still, this is only the second reported case of this condition linked to someone with CHS so young, according to the authors, and perhaps the first ever case that wasn’t clearly identified with an MRI scan.
Unusual as this turn of events might be, the increasing prevalence of CHS, especially in younger people, could make these sorts of cases more common, the authors warn, and doctors should be aware of the possibility of this neurological condition emerging in teens with CHS and be willing to treat it proactively.
“As adolescent THC use continues to rise, clinicians should maintain a low threshold for empiric thiamine supplementation in adolescents with prolonged CHS and any new neurologic findings, regardless of imaging results,” they wrote.
As for the boy, he agreed to stop taking cannabis, after which his CHS stopped. And at his last check-up with his primary care doctor, he appeared to be fully back to normal health.
