Cannabinoid hyperemesis syndrome with extreme hydrophilia
A 47-year-old African American male with a history of epilepsy and drug addiction presented to the hospital with a seizure complicated by nausea, vomiting, and severe abdominal pain. He was known to be diabetic, hypertensive, and addicted to marijuana for 30 years. He smoked two to three “blunts” (cigar hollowed out and filled with marijuana) most days and occasionally up to eight blunts daily. The drug was last taken on the day of his admission.\nHis examination was unremarkable except for heart rate of 92 bpm, blood pressure of 174/98 mmHg, and mild epigastric tenderness. His laboratory and radiological tests were within normal limits, except for blood sugar of 217 mg/dL and positive urine drug screen for marijuana and opiates. The patient refused electroencephalography.\nHe immediately went to the bathroom and remained under a hot shower with the exception of two 15-minute breaks for the rest of the day. He believed that a warm shower could relieve his nausea and vomiting. He stated that it made him feel better than medication. Intravenous ondansetron was of limited benefit. It was difficult to persuade him to exit the shower for the rounds and physical examination. Receiving medication and eating were problems because of this compulsive showering. The same event of entrenching himself in the shower had happened 2 months prior to his hospitalization for a grand mal seizure. Abstinence from marijuana during the hospital stay made the patient’s nausea, vomiting, and obsessive warm showering resolve after 3 days. He was discharged after 4 seizure-free days and referred for drug rehabilitation.