When the ER Blames the Weed: A Cautionary Tale in Metabolic Blind Spots
- Shane Caraway
- Jun 23
- 3 min read
Five days of nausea. Not the kind you sleep off. The kind that creeps in when you’re still, lets up when you move, and returns like clockwork when you stop. Throw in some cognitive chaos—racing thoughts, sudden jolts of agitation—and sudden, almost primal bursts of thirst, and you’ve got a cocktail that should trigger, at minimum, a full metabolic panel, observation, and repeated testing.
Instead, my client got a shrug and a nod. "Probably the weed."
To be clear: he’s not a first-time user. Like many others, he is no stranger to ol' Puff the Magic Dragon, and there is a legitimate time when "probably the weed" is an intelligent assumption. Only he wasn't vomiting in cycles or demanding hot showers like someone with cannabinoid hyperemesis syndrome. He was a Type 2 diabetic with abnormal labs, a suspected kidney infection, and rising blood and urine ketones.
Weed doesn't do that.
The Dismissal Disease
This is what happens when a system gets lazy. You walk into a hospital with a complex, layered presentation, and if you have the wrong label on your chart—THC user, diabetic, anxious—you get slotted into a category and pushed out the door. "It’s the weed." They ran many panels, including drug screens, but missed some of the most critical ones. Sure, they took tests, but I am not so sure that anybody read them. If they had, I wouldn't be writing this post.
Instead of layered, clinical care, he got a wristband, a pat on the back, and a cautionary warning about too much THC. Discharged without any symptom improvement, any kind of direction. It wasn't the weed, and my client had no answers, just fear.
Healthcare isn’t supposed to work like that.
When Ketones Are the Canary
Let’s talk about the numbers. The tests that no one noticed.
A urine ketone score of 40 and a blood ketone of 1.0 in a known diabetic should not be casually dismissed. Especially when the patient hasn’t fasted, isn’t on a ketogenic diet, and is dealing with what doctors suspect is a kidney infection.
This isn’t Diabetic Ketoacidosis (DKA), but it’s also not normal. It’s that shadowy middle ground: ketosis-prone Type 2 diabetes. Yes, it exists. And yes, it can look and feel eerily similar to early DKA or even a hybrid form of HHS (Hyperosmolar Hyperglycemic State) with mild ketotic drift.
Add an infection? That’s a metabolic Molotov cocktail.
What Got Missed
Let’s count:
No serum osmolality
No follow-up on creatinine or eGFR
No blood pH or bicarbonate check
No glucose curve
No urinalysis for nitrates or leukocyte esterase
No insulin testing of any form
No mention of obvious ketone abnormalities in a T2DM patient
No follow-up testing schedule for ketones
No follow-up testing for insulin resistance
No Dietary advice
No exercise prescription
No real discussion at all
And yet: "It’s probably the weed."
Would they have said the same if the patient didn’t have THC in his chart? If he was not a former addict? If he were visibly cachectic? If he had insisted on DKA as a possibility?
Maybe. Maybe not. But that’s the problem.
What You Should Know
If you're diabetic and feeling off (nauseated, disoriented, dry, weirdly energized but exhausted), you have every right to demand:
A serum ketone test
A full electrolyte panel
A conversation that involves your insulin sensitivity, not your THC habits
You are not a walking vice. You're a human being with complex systems that sometimes need more than a generic protocol.
Final Word
This client is recovering now, thanks to a protocol we built after the fact—hydration, nervous system regulation, targeted supplementation, and actual clinical reasoning.
But the fact that he had to leave the hospital to find that care is the whole point.
Let this be the first and last time someone chalks up metabolic distress to "just the weed."
Because when medicine defaults to the most convenient label, it stops being medicine at all.
These are the kinds of reasons I started Evidentia.
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