There’s a popular belief that weed can’t kill you.
While it’s almost impossible to overdose on weed by itself, marijuana use can indirectly cause life-threatening complications. A 15-year-old learned this the hard way, a new case study reveals.
His is one of only two recorded cases in teens in which “scromitting,” slang for cannabinoid hyperemesis syndrome (CHS), led to a critical and life-threatening thiamine (vitamin B1) deficiency that affected the brain.
Before doctors identified the cause, he’d lost 25 to 30 pounds from vomiting, a hallmark of CHS. He also developed serious issues with cognition and movement.
With increased access to the marijuana, more teens are using it in various forms, which can lead to problems in school and with friends and psychiatric conditions.
In the 15-year-old’s case, he developed a brain condition that is notoriously hard to identify and diagnose. Here’s how doctors figured it out and saved his life.
What happened to the teen
The teen originally went to the emergency room after spending several days feeling nauseous, with a headache and vomiting. He said he’d been using cannabis for the past three months, but otherwise didn’t say he had used any other drugs and didn’t have any significant past medical history.
He was given anti-nausea drugs, IV fluids, and told to stop using weed — then was sent on his way.
Three weeks later, he went to his primary care doctor with the same symptoms. He had a series of tests and imaging done, including a CT scan, which didn’t reveal anything remarkable.
Another week went by, and his mom took him back to the ER, a month after his initial visit. She said he’d lost 25-30 pounds by this point. A urine test showed he was still using marijuana.
During the assessment, doctors noted he was confused, had slowed speech, and would be unresponsive for a few moments when asked a question.
Doctors scrambled, looking at his digestive system and kidneys, and they gave him something to raise his dangerously low sodium levels. It helped his blood sodium levels return to normal, but his cognition remained impaired.
By the fourth day in the hospital, the teen was still bed-bound. His eyes started moving rapidly and uncontrollably and he was sensitive to light and had trouble walking to the bathroom. Doctors ordered an MRI, which didn’t reveal a cause.
How his condition was identified
A condition known as Wernicke encephalopathy (WE) is associated with three hallmarks: rapid eye movement (nystagmus), ataxia (loss of coordination) and mental changes.
However, this triad of symptoms only appears in a minority of patients with the disorder — making it notoriously hard to diagnose. Most cases are only identified after death, during an autopsy.
WE is caused by dangerously low levels of thiamine (vitamin B1) in the brain. In this teen’s case, the deficiency was caused by the prolonged, excessive vomiting associated with CHS. The leading cause for WE is chronic alcohol use, but malnutrition from things like an eating disorder or cancer can also lead to this deficiency.
It often progresses to Korsakoff syndrome, which causes permanent losses to memory and learning. This develops in up to 85% of survivors.
Wernicke-Korskoff syndrome kills 20% of patients.
In the only other teen case of CHS leading to WE, it was caught via MRI. In the 15-year-old’s case, the MRI missed it.
Doctors didn’t know it was WE for sure. A test to confirm thiamine deficiency would take days to return. But they suspected it, based on the teen’s symptoms, and said that giving him supplemental thiamine was “low risk.”
The teen got thiamine through an IV every eight hours for two days, plus a thiamine pill for four days. Within a day, his eye movements and cognition improved.
With his improvement, he was sent home. CHS can typically be resolved by stopping cannabis use, which the teen agreed to do.
At his most recent checkup, he had regained his weight and returned to normal brain function.
