Nausea and vomiting

Complications

1. Hypovolemia
2. Metabolic alkalosis
3. Hypokalemia
4. Mallory-Weiss (tear)
5. Boerhaave (rupture)
6. Aspiration

DDX

Critical

1. Boerhaave
2. Ischemic bowel
3. ICH
4. Meningitis
5. DKA
6. AMI
7. Sepsis

Emergent

1. Gastric outlet obstruction
2. Pancreatitis
3. Cholecystitis
4. Bowel obstruction/ileus
5. Ruptured viscus
6. Appendicitis
7. Peritonitis
8. Migraine
9. CNS tumor
10. raised ICP
11. Adrenal insuffciency
12. Hyperemesis gravidarum
13. Tylenol
14. Digoxin
15. ASA
16. Theophyline
17. Gonadal torsion
18. CO
19. Electrolyte disorder

Nonemergent

1. Gastritis
2. Gastroparesis
3. PUD
4. Gastroenteritis
5. Biliary colic
6. Hepatitis
7. Thyroid
8. Pregnancy
9. Erythromycin
10. Ibuprofen
11. Chemotherapy
12. Narcotics/wdwl from
13. ETOH
14. UTI
15. Renal colic
16. Motion sickness
17. Labyrinthitis

Peds

Newborn
Obstructive intestinal anomalies	Esophageal stenosis/atresia, pyloric stenosis, intestinal stenosis/atresia, malrotation ± volvulus, incarcerated hernia, meconium ileus/plug, Hirschsprung disease, imperforate anus, enteric duplications
Neurologic	Intracranial bleed/mass, hydrocephalus, cerebral edema, kernicterus
Renal	Urinary tract infection, obstructive uropathy, renal insufficiency
Infectious	Viral illness, gastroenteritis, meningitis, sepsis
Metabolic/endocrine	Inborn errors of metabolism (urea cycle, amino/organic acid, carbohydrate), congenital adrenal hyperplasia
Miscellaneous	Ileus, gastroesophageal reflux, necrotizing enterocolitis, milk allergy, GI perforation
Infant (<12 mo)
Obstructive intestinal anomalies	Pyloric stenosis, malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, enteric duplications, intussusception, foreign body, bezoars, Meckel diverticulum
Neurologic	Intracranial bleed/mass, hydrocephalus, cerebral edema
Renal	Urinary tract infection, obstructive uropathy, renal insufficiency
Infectious	Viral illness, gastroenteritis, meningitis, sepsis, otitis media, pneumonia, pertussis, hepatitis
Metabolic/endocrine	Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis
Miscellaneous	Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose
Child (>12 mo)
Obstructive intestinal anomalies	Malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, intussusception, foreign body, bezoars, Meckel diverticulum, acquired esophageal stricture, peptic ulcer disease, adhesions, superior mesenteric artery syndrome
Neurologic	Intracranial bleed/mass, cerebral edema, postconcussive, migraine
Renal	Urinary tract infection, obstructive uropathy, renal insufficiency
Infectious	Viral illness, gastroenteritis, meningitis, sepsis, otitis media, pneumonia, hepatitis, streptococcal pharyngitis
Metabolic/endocrine	Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis, diabetes mellitus, Reye syndrome, porphyria
Miscellaneous	Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose, appendicitis, pancreatitis, gastritis, Crohn disease, pregnancy, psychogenic, cyclic vomiting syndrome

Source

Rosen, Tintinalli