Hypophosphatemia in Users of Cannabis

• Published in: American journal of kidney diseases Vol. 69; no. 1; pp. 152 - 155
• Main Author: Cadman, Peter E., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2017
• Subjects: Adult; Aged; anxiety; Cannabinoid hyperemesis syndrome (CHS); cannabis; case report; drug use; electrolyte abnormalities; Humans; hyperventilation; hypophosphatemia; Hypophosphatemia - chemically induced; Male; Marijuana Abuse - complications; Middle Aged; Nephrology; phosphate redistribution; serum phosphate; tachypnea; vomiting; Young Adult; anxiety; tachypnea; electrolyte abnormalities; hyperventilation; Cannabinoid hyperemesis syndrome (CHS); cannabis; serum phosphate; drug use; case report; phosphate redistribution; hypophosphatemia; vomiting
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2016.06.028

As cannabis use has legalized for medical and recreational use in several states, the medical community has become more aware of the drug’s potential toxicities. First described in 2004, cannabinoid hyperemesis syndrome is increasingly recognized as a cause of hospitalization among drug users. However, little information is available in the medical literature regarding electrolyte abnormalities in this syndrome. Between 2011 and 2014, six men were treated for cannabinoid hyperemesis syndrome at the Veterans Affairs Medical Center in San Diego, CA, and found to have significant hypophosphatemia (phosphate range, <1-1.3 mg/dL). The 6 cases are presented here and possible causes of hypophosphatemia are discussed. In 3 patients, serum phosphate levels normalized spontaneously within hours, suggesting redistribution of phosphate as a potential mechanism. Hyperventilation, which can lead to phosphate redistribution, was observed in 4 of the 6 individuals and may have contributed. Hypophosphatemia is a presenting feature of cannabinoid hyperemesis syndrome in some patients.