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The Cannabinoid Hyperemesis Syndrome (CHS) is a severe abdominal syndrome characterized by abdominal pain and intractable vomiting among long-term cannabis users. The normality of paraclinical examinations, outside of a potential hyperleukocytosis, is one of the diagnostic criteria and rules out other differential diagnosis. Actual diagnosis and therapeutics tests include showers and hot baths to provide relief to these patients. Case report: We are reporting the case of a patient who presented at the emergency department for a CHS. He was also presenting an extremely high hyperlactatemia, known as a marker of severity in emergency medicine. The clinical and biological evolution was favorable after rehydration and a hot shower, which allowed patient discharge. Conclusion: Many cases of severe metabolic manifestations, secondary to cannabis uses, have already been described, but an increase in lactate level after natural cannabis intoxication has never been described. Yet, an increase in lactatemia coupled with the CHS could perhaps enable us to detect patients in need for medical supervision. CASE REPORT Dr Pierre-Luc Hamelin

Heat exhaustion in the emergency department should not be confused with other forms of heat related illness