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== | |||
[[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]] | |||
==Clinical Features== | |||
*Nausea and/or vomiting | |||
*Additional features of underlying process | |||
==Differential Diagnosis== | |||
{{Nausea and vomiting DDX}} | |||
===By organ system=== | |||
====GI==== | |||
*[[Peptic ulcer disease]] | |||
*[[Bowel obstruction|Obstruction]] | |||
**Adhesion | |||
**[[Small bowel obstruction]]/LBO | |||
***[[SMA syndrome]] | |||
**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]] | |||
*[[Intracranial mass|Mass lesion]] | |||
*[[Meningitis]] | |||
*[[Migraine]] | |||
*[[Labyrinthitis]] | |||
*[[Meniere's disease]] | |||
*[[Motion sickness]] | |||
*[[Cannabinoid hyperemesis syndrome]] | |||
====Infectious==== | |||
*[[Bacteria]]l toxins | |||
*[[Pneumonia]] | |||
*[[SBP]] | |||
*[[UTI]] | |||
*Viruses ([[adenovirus]], [[norovirus]], [[rotavirus]]) | |||
====Drugs/Toxins==== | |||
*Toxic doses | |||
**[[Digoxin toxicity]] | |||
**[[Aspirin toxicity]] | |||
**[[Acetaminophen toxicity]] | |||
**[[Ipecac toxicity]] | |||
*[[NSAIDs]] | |||
*[[Opioids]] | |||
*[[Alcohol]] | |||
*[[Anticonvulsants]] | |||
*[[Antibiotics]] | |||
*[[Antiarrhythmics]] | |||
*Toxins | |||
**[[Organophosphates]] | |||
**[[Carbon monoxide]] | |||
**[[Ricin]] | |||
*[[Acute radiation syndrome]] | |||
====Endocrine==== | |||
*[[Pregnancy]], [[hyperemesis gravidarum]] | |||
*[[Hyponatremia]] | |||
*[[Adrenal insufficiency]] | |||
*[[DKA]] | |||
*[[Thyroid]]/parathyroid disorders | |||
*[[Uremia]] | |||
====Miscellaneous==== | |||
*[[ACS]] | |||
*[[Ovarian torsion|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<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== | ||
*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== | |||
*[[Nausea and vomiting (peds)]] | |||
*[[Nausea and vomiting of pregnancy]] | |||
*[[Antiemetics]] | |||
==External Links== | |||
==References== | |||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Symptoms]] | |||
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.