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# Cannabis toxicity and cannabinoid hyperemesis syndrome

Harm from cannabis: acute intoxication, dangerous in young children who eat edibles, and repeated severe vomiting in long-term heavy users.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Stomach](https://durgical.com/en/anatomy/stomach/)
- [Hippocampus](https://durgical.com/en/anatomy/hippocampus/)
- [Esophagus](https://durgical.com/en/anatomy/esophagus-abdominal-part/)
- [Duodenum](https://durgical.com/en/anatomy/duodenum/)
- [Amygdala](https://durgical.com/en/anatomy/amygdaloid-body/)
- [Frontal lobe](https://durgical.com/en/anatomy/superior-frontal-gyrus/)
- [Cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/)
- [Hypothalamus](https://durgical.com/en/anatomy/hypothalamus/)

## Why it happens

- [Drugs of abuse: cocaine, opioids, amphetamines, cannabis](https://durgical.com/en/general-pathology/drugs-of-abuse-cocaine-opioids-amphetamines-cannabis/)
- [Vomiting and its control](https://durgical.com/en/physiology/vomiting-and-its-control/)

## What it is

Two related problems. Acute cannabis intoxication causes euphoria or anxiety, red eyes, fast heart rate and impaired coordination; in young children who eat edibles it can cause drowsiness, ataxia and coma. Cannabinoid (cannabis) hyperemesis syndrome affects long-term frequent users with recurrent episodes of severe nausea, vomiting and abdominal pain, often relieved by hot showers, and resolves only when cannabis is stopped.

## Who gets it

Cannabis is the most used illicit drug in Colombia according to national drug-use surveys, and potent products and edibles are increasing. Emergency visits for hyperemesis syndrome have risen markedly in countries that expanded legal access, and the condition is under-recognised. Paediatric exposures to edibles are also increasing.

## Causes

- Smoking or vaping high-potency cannabis
- Edibles with delayed, unpredictable effects
- Accidental ingestion of edibles by children
- Daily or near-daily long-term use (hyperemesis syndrome)
- Synthetic cannabinoids, which are more toxic

## Risk factors

- Frequent, heavy use over months to years
- High-THC products and concentrates
- Young age at first use
- Edibles accessible to children at home
- Pre-existing anxiety or psychotic disorders (for acute psychiatric reactions)

## Pathophysiology

THC acts on CB1 receptors in the brain ([hippocampus](https://durgical.com/en/anatomy/hippocampus/), [cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/), basal ganglia, cortex) and gut, causing altered perception, memory impairment and incoordination. In children, the dose per kilogram is high, causing CNS depression. In chronic heavy use, CB1 receptors are thought to become downregulated and dysregulated, and the hypothalamic thermoregulation and gut motility controls are disturbed, so cannabis paradoxically causes vomiting instead of preventing it. Relief with hot water may relate to the TRPV1 receptor, the same one activated by capsaicin.

## Classification

- Acute intoxication in adults (euphoria, anxiety, panic, psychosis)
- Paediatric edible ingestion (lethargy, ataxia, coma, sometimes seizures)
- Cannabinoid hyperemesis syndrome: prodromal, hyperemetic and recovery phases
- Synthetic cannabinoid toxicity (agitation, seizures, kidney injury)

## Symptoms and signs

- Red eyes, dry mouth, increased appetite and fast heart rate
- Euphoria or anxiety, panic attacks, paranoia
- Poor coordination, slowed reaction time and memory lapses
- Children: drowsiness, unsteadiness, slow breathing
- Repeated severe vomiting and diffuse abdominal pain
- Compulsive hot showers or baths that ease the nausea

## Red flags

- Coma or slow breathing in a child after possible edible ingestion
- Severe dehydration, low potassium or kidney injury from vomiting
- Haematemesis (possible Mallory–Weiss tear)
- [Chest](https://durgical.com/en/anatomy/region/chest/) pain or arrhythmia after use
- Psychosis, suicidal thoughts or severe agitation

## Diagnosis

**Clinical**
Ask directly about cannabis frequency, potency and route. Hyperemesis syndrome is suspected with weekly or more frequent use for a long time, stereotyped vomiting episodes, relief with hot bathing and resolution after stopping. Rule out surgical and metabolic causes of vomiting.

**Tests**
Electrolytes (potassium), [kidney](https://durgical.com/en/anatomy/kidney/) function, glucose, lipase, [liver](https://durgical.com/en/anatomy/liver/) tests, pregnancy test; urine drug screen can confirm use but not toxicity; in children, glucose and screening for other toxins.

**Imaging**
Usually none; abdominal imaging only when another cause of abdominal pain is suspected.

## Differential diagnosis

- Cyclic vomiting syndrome
- Gastroparesis
- Acute pancreatitis or bowel obstruction
- Diabetic ketoacidosis
- Pregnancy-related hyperemesis

## Goal of treatment

Support the airway in children, correct fluids and electrolytes, relieve vomiting and help the patient stop cannabis use to prevent recurrence.

## Treatment

**Acute**
Acute intoxication: calm environment and reassurance; benzodiazepines for severe anxiety or agitation. Children: observation and airway support; most recover with supportive care.

**Medical**
Hyperemesis: intravenous fluids and potassium replacement; antidopaminergic drugs such as haloperidol or droperidol are often more effective than standard antiemetics; topical capsaicin on the [abdomen](https://durgical.com/en/anatomy/region/abdomen/) can help.

**Follow-up**
ECG for QT when antidopaminergic drugs are used; electrolytes and kidney function. Nursing: fluid balance, fall prevention and aspiration precautions.

**Conservative**
Cannabis cessation is the only definitive treatment; symptoms usually resolve within weeks to months of stopping.

**Lifestyle**
Motivational interviewing and referral to substance-use services; treatment of co-existing anxiety or depression.

## Complications

- Dehydration and acute kidney injury
- Hypokalaemia and other electrolyte disturbances
- Mallory–Weiss tear and oesophagitis
- Burns from very hot showers
- Psychosis and road traffic injuries from acute intoxication

## Prognosis

Acute intoxication resolves within hours, and most children recover fully with support. Hyperemesis syndrome recurs while use continues and resolves after stopping; rare deaths have been linked to severe dehydration and electrolyte disturbance.

## Prevention

- Store cannabis products locked and away from children, avoid heavy daily use, and screen for cannabis use in patients with recurrent vomiting

## Test yourself

Think of the answer, then tap the question to see it.

## What history suggests cannabinoid hyperemesis syndrome?

Long-term frequent cannabis use with recurrent episodes of severe vomiting and relief from hot showers or baths.

## What is the only definitive treatment of cannabinoid hyperemesis syndrome?

Stopping cannabis use.

## Which drug classes help hyperemesis vomiting when standard antiemetics fail?

Antidopaminergic drugs (haloperidol, droperidol) and topical capsaicin.

## How does edible ingestion present in a young child?

Drowsiness, ataxia, slow breathing and sometimes coma or seizures, out of proportion to adult effects.

## Which electrolyte disturbance must be checked in repeated vomiting?

Hypokalaemia (with metabolic alkalosis and kidney injury from dehydration).

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## Related conditions

- [Cannabis use disorder](https://durgical.com/en/conditions/cannabis-use-disorder/)
- [Gastroparesis (delayed gastric emptying)](https://durgical.com/en/conditions/gastroparesis/)
- [Mallory-Weiss syndrome](https://durgical.com/en/conditions/mallory-weiss-syndrome/)
- [Hypokalaemia](https://durgical.com/en/conditions/hypokalaemia/)
- [Acute kidney injury](https://durgical.com/en/conditions/acute-kidney-injury/)
- [Acute pancreatitis](https://durgical.com/en/conditions/acute-pancreatitis/)
- [Schizophrenia](https://durgical.com/en/conditions/schizophrenia/)
- [Generalized anxiety disorder](https://durgical.com/en/conditions/generalized-anxiety-disorder/)
- [Hallucinogen and dissociative drug intoxication (LSD, PCP, ketamine)](https://durgical.com/en/conditions/hallucinogen-and-dissociative-drug-intoxication/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Trends in Emergency Department Visits Involving Cannabis Hyperemesis Syndrome Identified Using a New Diagnosis Code — United States, January 2023–May 2026](https://www.cdc.gov/mmwr/volumes/75/wr/mm7530a2.htm) (Morbidity and Mortality Weekly Report (MMWR), Centers for Disease Control and Prevention, 2026).

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Source: https://durgical.com/en/conditions/cannabis-toxicity-and-cannabinoid-hyperemesis-syndrome/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/cannabis-toxicity-and-cannabinoid-hyperemesis-syndrome/