Difference between revisions of "Nausea and vomiting"

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''This page is for adult patients; for pediatric patients see [[nausea and vomiting (peds)]]''
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{{Adult top}} [[nausea and vomiting (peds)]].''
 
==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==
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====GI====
 
====GI====
 
*[[Peptic ulcer disease]]
 
*[[Peptic ulcer disease]]
*Obstruction
+
*[[Bowel obstruction|Obstruction]]
 
**Adhesion
 
**Adhesion
 
**[[Small bowel obstruction]]/LBO
 
**[[Small bowel obstruction]]/LBO
 
***[[SMA syndrome]]
 
***[[SMA syndrome]]
 
**Gastric outlet obstruction
 
**Gastric outlet obstruction
 +
**[[Gastric volvulus]]
 
**[[Bezoar]]
 
**[[Bezoar]]
 
*[[Pancreatitis]]
 
*[[Pancreatitis]]
*Gastroparesis
+
*[[Gastroparesis]]
 
*[[Appendicitis]]
 
*[[Appendicitis]]
 
*[[Cholecystitis]]
 
*[[Cholecystitis]]
 
*[[Cholangitis]]
 
*[[Cholangitis]]
 
*[[Acute Hepatitis]]
 
*[[Acute Hepatitis]]
*IBD
+
*[[IBD]]
 
*[[Intussusception]]
 
*[[Intussusception]]
 
*Tumor
 
*Tumor
*Strangulated hernia
+
*Strangulated [[hernia]]
 
*[[Volvulus]]
 
*[[Volvulus]]
 
*[[Mesenteric ischemia]]
 
*[[Mesenteric ischemia]]
*Esophageal disorders (e.g. achalasia)
+
*Esophageal disorders (e.g. [[achalasia]])
 
*Functional disorders
 
*Functional disorders
 
**Psychogenic
 
**Psychogenic
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====Neurologic====
 
====Neurologic====
*Head injury
+
*[[Head injury]]
 
*[[CVA]]
 
*[[CVA]]
*Pseudotumor
+
*[[Idiopathic intracranial hypertension]]
*Hydrocephalus
+
*[[Hydrocephalus]]
*Mass lesion
+
*[[Intracranial mass|Mass lesion]]
 
*[[Meningitis]]
 
*[[Meningitis]]
*Migraines
+
*[[Migraine]]
 
*[[Labyrinthitis]]
 
*[[Labyrinthitis]]
*Meniere disease
+
*[[Meniere's disease]]
*Motion sickness
+
*[[Motion sickness]]
 
*[[Cannabinoid hyperemesis syndrome]]
 
*[[Cannabinoid hyperemesis syndrome]]
  
 
====Infectious====
 
====Infectious====
*Bacterial toxins
+
*[[Bacteria]]l toxins
*[[pneumonia]]
+
*[[Pneumonia]]
 
*[[SBP]]
 
*[[SBP]]
 
*[[UTI]]
 
*[[UTI]]
*Viruses (adenovirus, norovirus, rotavirus)
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*Viruses ([[adenovirus]], [[norovirus]], [[rotavirus]])
  
 
====Drugs/Toxins====
 
====Drugs/Toxins====
 
*Toxic doses
 
*Toxic doses
**Digoxin
+
**[[Digoxin toxicity]]
**Aspirin
+
**[[Aspirin toxicity]]
**Acetaminophen
+
**[[Acetaminophen toxicity]]
 
**[[Ipecac toxicity]]
 
**[[Ipecac toxicity]]
*NSAIDs
+
*[[NSAIDs]]
*Opiates
+
*[[Opioids]]
*Alcohol
+
*[[Alcohol]]
*Anticonvulsants
+
*[[Anticonvulsants]]
 
*[[Antibiotics]]
 
*[[Antibiotics]]
*Antiarrhythmics
+
*[[Antiarrhythmics]]
 
*Toxins
 
*Toxins
**Organophosphates
+
**[[Organophosphates]]
**Carbon Monoxide
+
**[[Carbon monoxide]]
**Ricin
+
**[[Ricin]]
 
*[[Acute radiation syndrome]]
 
*[[Acute radiation syndrome]]
  
 
====Endocrine====
 
====Endocrine====
*Pregnancy
+
*[[Pregnancy]], [[hyperemesis gravidarum]]
 
*[[Hyponatremia]]
 
*[[Hyponatremia]]
*Adrenal insufficiency
+
*[[Adrenal insufficiency]]
 
*[[DKA]]
 
*[[DKA]]
*Thyroid/parathyroid disorders
+
*[[Thyroid]]/parathyroid disorders
 
*[[Uremia]]
 
*[[Uremia]]
  
 
====Miscellaneous====
 
====Miscellaneous====
 
*[[ACS]]
 
*[[ACS]]
*Gonadal torsion
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*[[Ovarian torsion|ovarian]]/[[testicular torsion]]
 
*[[Nephrolithiasis]]
 
*[[Nephrolithiasis]]
 
*Pain
 
*Pain
*Acute glaucoma
+
*[[Acute angle-closure glaucoma]]
*Anorexia/bulimia
+
*[[Anorexia nervosa]]/[[bulimia nervosa]]
*Depression
+
*[[Depression]]
  
 
==Evaluation==
 
==Evaluation==
 +
''Varies widely depending on clinical presentation''
 
*CBC
 
*CBC
 
*Chemistry
 
*Chemistry
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*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]]
  
 
==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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==External Links==
 
==External Links==
 
  
 
==References==
 
==References==

Latest revision as of 05:59, 14 May 2020

This page is for adult patients. For pediatric patients, see: nausea and vomiting (peds).

Background

Nausea and Vomiting Algorithm

Clinical Features

  • Nausea and/or vomiting
  • Additional features of underlying process

Differential Diagnosis

Nausea and vomiting

Critical

Emergent

Nonemergent

By organ system

GI

Neurologic

Infectious

Drugs/Toxins

Endocrine

Miscellaneous

Evaluation

Varies widely depending on clinical presentation

Management

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

See Also

External Links

References