Can Cannabis Hyperemesis Syndrome Cause Rhabdomyolysis?
Yes, cannabis hyperemesis syndrome can cause rhabdomyolysis, though this is an uncommon complication that occurs secondary to the severe dehydration, electrolyte abnormalities, and prolonged physical exertion that may accompany CHS episodes. 1, 2, 3
Mechanism of Rhabdomyolysis in CHS
The pathway to rhabdomyolysis in CHS patients is indirect but clinically significant:
Severe dehydration and electrolyte imbalances from intractable vomiting create the metabolic conditions that predispose to muscle breakdown 1, 4
Prolonged physical activity seeking symptom relief can trigger rhabdomyolysis in the setting of volume depletion—one documented case involved a patient who jogged continuously for 15 hours after discovering exercise alleviated his CHS symptoms 2
Acute kidney injury frequently accompanies severe CHS episodes and can be both a cause and consequence of rhabdomyolysis 1, 3
Clinical Evidence
The association is documented in multiple case reports:
A military case report explicitly lists rhabdomyolysis among the complications of CHS, alongside severe dehydration and acute kidney injury 1
A unique case described exercise-induced rhabdomyolysis in a CHS patient who discovered physical activity provided symptom relief, similar to the hot-water bathing behavior 2
Synthetic cannabinoid hyperemesis has been reported to cause rhabdomyolysis leading to acute renal failure, establishing the biological plausibility of this complication 3
Critical Clinical Implications
When evaluating CHS patients in the emergency department:
Check creatine kinase (CK) levels in patients with severe or prolonged vomiting episodes, particularly those with acute kidney injury 1, 3
Monitor for signs of volume depletion aggressively, as this is the primary risk factor for progression to rhabdomyolysis 1, 4
Inquire about compensatory behaviors beyond hot-water bathing—some patients may engage in prolonged exercise or other physical activities that increase rhabdomyolysis risk 2
Assess renal function as acute kidney injury can occur from both the hyperemesis itself and from rhabdomyolysis 1, 5, 3
Management Priorities
Aggressive intravenous fluid resuscitation is essential to prevent or treat both dehydration-related complications and rhabdomyolysis 1, 4
Cannabis cessation remains the only definitive treatment to prevent recurrent episodes and their complications 6, 4
Avoid opioids as they worsen nausea and carry addiction risk without addressing the underlying pathophysiology 7, 6
Common Pitfall
The most critical error is failing to recognize CHS as the underlying diagnosis in chronic cannabis users with cyclic vomiting, which delays appropriate treatment and allows complications like rhabdomyolysis to develop 1, 4. The syndrome mimics many acute surgical and emergency conditions, making it easy to miss without a high index of suspicion in patients with regular cannabis use (>4 times weekly for >1 year) 6.