Nausea and vomiting: Difference between revisions
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{{Adult top}} [[nausea and vomiting (peds)]]. For nausea and vomiting during pregnancy, see [[hyperemesis gravidarum]].'' | |||
==Background== | ==Background== | ||
[[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]] | [[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Nausea and/or vomiting | |||
*Additional features of underlying process | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 12: | Line 13: | ||
====GI==== | ====GI==== | ||
*[[Peptic ulcer disease]] | *[[Peptic ulcer disease]] | ||
*Obstruction | *[[Bowel obstruction|Obstruction]] | ||
**Adhesion | **Adhesion | ||
**[[Small bowel obstruction]]/LBO | **[[Small bowel obstruction]]/LBO | ||
| Line 51: | Line 52: | ||
====Infectious==== | ====Infectious==== | ||
* | *[[Bacteria]]l toxins | ||
*[[Pneumonia]] | *[[Pneumonia]] | ||
*[[SBP]] | *[[SBP]] | ||
| Line 76: | Line 77: | ||
====Endocrine==== | ====Endocrine==== | ||
*[[Pregnancy]] | *[[Pregnancy]], [[hyperemesis gravidarum]] | ||
*[[Hyponatremia]] | *[[Hyponatremia]] | ||
*[[Adrenal insufficiency]] | *[[Adrenal insufficiency]] | ||
| Line 101: | Line 102: | ||
*APAP, ASA, digoxin levels | *APAP, ASA, digoxin levels | ||
*[[Urinalysis]] | *[[Urinalysis]] | ||
*?Abdominal xray | *?[[Abdominal xray]] | ||
*?CT | *?CT | ||
*?[[Ultrasound]] | *?[[Ultrasound]] | ||
==Management== | ==Management== | ||
*Treat underlying pathology | |||
*Address [[electrolyte derangements]] and [[dehydration]] as needed | |||
*[[Antiemetics]] | |||
*Inhaled isopropyl alcohol (sniffing an alcohol wipe) has been shown to reduce mild to moderate nausea and vomiting<ref>Lindblad AJ, Ting R, Harris K. Inhaled isopropyl alcohol for nausea and vomiting in the emergency department. Can Fam Physician. 2018;64(8):580.</ref> | |||
==Disposition== | ==Disposition== | ||
*Depends on cause | |||
*Most non-specific episodes of acute nausea and vomiting may be discharged, if: | |||
**No emergent/urgent cause identified or suspected | |||
**Patient tolerating fluids after treatment | |||
==Complications== | ==Complications== | ||
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==See Also== | ==See Also== | ||
*[[Nausea and vomiting (peds)]] | *[[Nausea and vomiting (peds)]] | ||
*[[Nausea and vomiting of pregnancy]] | |||
*[[Antiemetics]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
Latest revision as of 22:49, 3 May 2023
This page is for adult patients. For pediatric patients, see: nausea and vomiting (peds). For nausea and vomiting during pregnancy, see hyperemesis gravidarum.
Background
Clinical Features
- Nausea and/or vomiting
- Additional features of underlying process
Differential Diagnosis
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
By organ system
GI
- Peptic ulcer disease
- Obstruction
- Adhesion
- Small bowel obstruction/LBO
- Gastric outlet obstruction
- Gastric volvulus
- Bezoar
- Pancreatitis
- Gastroparesis
- Appendicitis
- Cholecystitis
- Cholangitis
- Acute Hepatitis
- IBD
- Intussusception
- Tumor
- Strangulated hernia
- Volvulus
- Mesenteric ischemia
- Esophageal disorders (e.g. achalasia)
- Functional disorders
- Psychogenic
- IBS
- Pyloric Stenosis
Neurologic
- Head injury
- CVA
- Idiopathic intracranial hypertension
- Hydrocephalus
- Mass lesion
- Meningitis
- Migraine
- Labyrinthitis
- Meniere's disease
- Motion sickness
- Cannabinoid hyperemesis syndrome
Infectious
Drugs/Toxins
- Toxic doses
- NSAIDs
- Opioids
- Alcohol
- Anticonvulsants
- Antibiotics
- Antiarrhythmics
- Toxins
- Acute radiation syndrome
Endocrine
- Pregnancy, hyperemesis gravidarum
- Hyponatremia
- Adrenal insufficiency
- DKA
- Thyroid/parathyroid disorders
- Uremia
Miscellaneous
- ACS
- ovarian/testicular torsion
- Nephrolithiasis
- Pain
- Acute angle-closure glaucoma
- Anorexia nervosa/bulimia nervosa
- Depression
Evaluation
Varies widely depending on clinical presentation
- CBC
- Chemistry
- Urine pregnancy
- LFTs
- Lipase
- APAP, ASA, digoxin levels
- Urinalysis
- ?Abdominal xray
- ?CT
- ?Ultrasound
Management
- Treat underlying pathology
- Address electrolyte derangements and dehydration as needed
- Antiemetics
- Inhaled isopropyl alcohol (sniffing an alcohol wipe) has been shown to reduce mild to moderate nausea and vomiting[1]
Disposition
- Depends on cause
- Most non-specific episodes of acute nausea and vomiting may be discharged, if:
- No emergent/urgent cause identified or suspected
- Patient tolerating fluids after treatment
Complications
- Hypovolemia
- Metabolic alkalosis
- Hypokalemia
- Mallory-Weiss (tear)
- Boerhaave (rupture)
- Aspiration
See Also
External Links
References
- ↑ Lindblad AJ, Ting R, Harris K. Inhaled isopropyl alcohol for nausea and vomiting in the emergency department. Can Fam Physician. 2018;64(8):580.