Rationale:
With marijuana legalization, clinicians need to be aware of Cannabinoid Hyperemesis Syndrome (CHS), which may masquerade as other disease states such as uremia.
Presenting concerns of the patient:
A 37-year-old man with bipolar affective disease treated with lithium had progressive renal insufficiency presumably on the basis of interstitial fibrosis. He developed persistent and severe nausea and vomiting which was assumed to be on the basis of uremia. Predating the nausea and vomiting was a history of daily marijuana use.
Diagnoses:
Renal insufficiency, bipolar affective disease, and intractable nausea and vomiting.
Interventions:
Dialysis was initiated but did not improve his symptoms and multiple investigations revealed no other cause. Abstinence from marijuana use resulted in complete resolution of symptoms.
Outcomes:
The patient elected to discontinue dialysis and was still alive 7 months later. We concluded the nausea and vomiting were not on a uremic basis but more likely due to CHS.
Lessons learned:
With more widespread use of marijuana, it is important to be aware of CHS, which may be confused with uremia in patients with concomitant renal insufficiency.