CASE PRESENTATION: A 34-year-old healthy female presented with epigastric pain, intractable nausea, daily episodes of vomiting and 20 pounds weight loss over last 3 months. She denied fever, chills, cough, urinary symptoms, diarrhea, drug use and risk factors for HIV. Examination revealed a dehydrated, tachycardic female. Extremities failed to show evidence of drug use. There was no localized tenderness, guarding or rigidity on abdominal examination. Laboratory work-up showed pre-renal azotemia and electrolyte abnormalities with metabolic alkalosis (Table 1); markers of liver function were normal. Urine pregnancy test was negative. Imaging studies including CT and ultrasound of the abdomen and pelvis failed to reveal any pathology. Gastroscopy did not show ulcerations or erosions (Fig.1). She was treated with aggressive hydration and electrolyte replacement with improvement in clinical status and laboratory data. Subsequently her urine toxicology was positive for cannabinoids. On re-questioning, she admitted using synthetic marijuana and feeling better after hot water bathing. She was advised to discontinue cannabis use.