The Near‐Fatal Bath: A Case Report With Literature Review of Diagnosis and Management of Cannabinoid Hyperemesis Syndrome

Cannabinoid Hyperemesis Syndrome (CHS) is a severe condition associated with chronic cannabis use, characterized by cyclic vomiting, abdominal pain, and compulsive hot baths for symptom relief. We present the case of a 35-year-old male with at least a decade-long history of cannabis use who presented with recurrent episodes of vomiting and dehydration. He experienced a potentially fatal episode of hypothermia and cardiac arrest after losing consciousness during a prolonged hot bath. Despite extensive diagnostic evaluations after many years, CHS was not identified until it was confirmed based on the Rome IV clinical criteria and elevated urinary cannabinoid levels (449 ng/mL). Management included rehydration, parenteral nutrition, and capsaicin cream targeting the transient receptor potential vanilloid Type 1 (TRPV1), as traditional antiemetics were ineffective, in conjunction with cannabis cessation. This case highlights the need for early recognition of CHS to prevent severe complications and avoid unnecessary diagnostic investigations. Prolonged cannabis abstinence remains the only definitive treatment, requiring a multidisciplinary approach. Increased awareness among clinicians is essential for timely diagnosis and appropriate management.