Case Report A Gut Gone to Pot: A Case of Cannabinoid Hyperemesis Syndrome due to K2, a Synthetic Cannabinoid Anene Ukaigwe, Paras Karmacharya, and Anthony Donato e Reading Health System, 6th Avenue and Spruce Street, West Reading, PA 19611, USA Correspondence should be addressed to Anene Ukaigwe; acukaigwe@yahoo.com Received 23 February 2014; Accepted 21 April 2014; Published 29 April 2014 Academic Editor: Han P. Wu Copyright © 2014 Anene Ukaigwe et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cannabinoid Hyperemesis Syndrome (CHS) was irst described in 2004. Due to its novelty, CHS is oten unrecognized by clinicians leading to expensive workup of these patients with cyclical symptoms. It may take up to 9 years to diagnose CHS. CHS is characterized by cyclical nausea and vomiting, abdominal pain, and an unusual compulsion to take hot showers in the presence of chronic use of cannabinoids. Cannabicyclohexanol is a synthetic cannabinoid, popularly known as K2 spice. It is a popular marijuana alternative among teenagers and young adults since it is readily available as herbal incense. Unlike marijuana, many users know that K2 is not detected in conventional urine drug screens, allowing those users to conceal their intake from typical detection methods. Serum or urine gas chromatography mass spectrophotometry is diagnostic, though not widely available. hus, it is imperative for clinicians to recognize CHS, even with negative UDS, to provide cost-efective care. We present a 38-year-old man with a 10-year history of cannabis, and 1-year history of K2 abuse admitted with 1-week history of episodes of nausea, vomiting of clear luids, and epigastric discomfort. Symptoms are relieved only by hot showers. Extensive laboratory, radiologic, and endoscopic evaluation was unrevealing. CHS was diagnosed, based on proposed criteria by Simonetti et al. 1. Introduction Although the well-documented antiemetic properties of cannabis account for its use in chemotherapy-induced nausea and vomiting, interestingly cannabis and related substances may induce vomiting as in Cannabinoid Hyperemesis Syn- drome (CHS). he broad diferentials of abdominal pain and vomiting and the relative novelty of cannabinoid hyperemesis condition can lead to expensive and unnecessary investiga- tions. Diagnosis can be a challenge especially in patients using synthetic cannabinoids like K2 which are not detected in conventional urine drug screens. his case illustrates CHS with the use of the synthetic cannabinoid, K2, which is less commonly reported [1]. 2. Background Cannabinoids are the commonest illicit drug encountered worldwide [2]. he prevalence is estimated at 3 million cases and has increased in the past decade [3]. Although cannabis is more commonly associated with antiemetic properties, a paradoxical efect that results in cyclic nausea and vomiting has been reported. his paradoxical efect, called Cannabi- noid Hyperemesis Syndrome, was irst described by Allen et al. in 2004. It consists of cyclical abdominal pain, nausea, and vomiting in the setting of chronic cannabinoid abuse. An unusual and unique feature of this disorder is a strong compulsion to bathe or shower in hot water multiple times per day. Recognition of this syndrome is important in order to avoid costly and unnecessary evaluation. Recognizing this presentation also helps the patient understand and break the cycle of drug use. 3. Case Presentation A 38-year-old man with a self-reported long-term history of standard cannabinoid use and K2 (a synthetic cannabis) presented to the emergency room with a 2-week history of nausea, vomiting, and severe abdominal pain. He smoked 3-4 times a day, occasionally up to 10 rolls a day with his last K2 use being the night before admission. He denied any other illicit drug use. He reported having similar episodes Hindawi Publishing Corporation Case Reports in Emergency Medicine Volume 2014, Article ID 167098, 3 pages http://dx.doi.org/10.1155/2014/167098