Difference between revisions of "Nausea and vomiting"
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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== | ||
| 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]] | ||
==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== | ||
| Line 123: | Line 129: | ||
==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).
Contents
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
- Acetaminophen toxicity
- Adrenal insufficiency
- Appendicitis
- Aspirin toxicity
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Digoxin toxicity
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
- Theophylline toxicity
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Disulfiram effect
- Erythromycin
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Ibuprofen
- Ipecac toxicity
- Labyrinthitis
- Migraine
- 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
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