Difference between revisions of "Nausea and vomiting"

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==Complications==
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{{Adult top}} [[nausea and vomiting (peds)]].''
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==Background==
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[[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]]
  
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==Clinical Features==
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*Nausea and/or vomiting
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*Additional features of underlying process
  
1) Hypovolemia
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==Differential Diagnosis==
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{{Nausea and vomiting DDX}}
  
2) Metabolic alkalosis
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===By organ system===
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====GI====
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*[[Peptic ulcer disease]]
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*[[Bowel obstruction|Obstruction]]
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**Adhesion
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**[[Small bowel obstruction]]/LBO
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***[[SMA syndrome]]
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**Gastric outlet obstruction
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**[[Gastric volvulus]]
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**[[Bezoar]]
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*[[Pancreatitis]]
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*[[Gastroparesis]]
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*[[Appendicitis]]
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*[[Cholecystitis]]
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*[[Cholangitis]]
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*[[Acute Hepatitis]]
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*[[IBD]]
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*[[Intussusception]]
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*Tumor
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*Strangulated [[hernia]]
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*[[Volvulus]]
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*[[Mesenteric ischemia]]
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*Esophageal disorders (e.g. [[achalasia]])
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*Functional disorders
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**Psychogenic
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**[[IBS]]
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*[[Pyloric Stenosis]]
  
3) Hypokalemia
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====Neurologic====
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*[[Head injury]]
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*[[CVA]]
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*[[Idiopathic intracranial hypertension]]
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*[[Hydrocephalus]]
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*[[Intracranial mass|Mass lesion]]
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*[[Meningitis]]
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*[[Migraine]]
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*[[Labyrinthitis]]
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*[[Meniere's disease]]
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*[[Motion sickness]]
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*[[Cannabinoid hyperemesis syndrome]]
  
4) Mallory-Weiss (tear)
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====Infectious====
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*[[Bacteria]]l toxins
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*[[Pneumonia]]
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*[[SBP]]
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*[[UTI]]
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*Viruses ([[adenovirus]], [[norovirus]], [[rotavirus]])
  
5) Boerhaave (rupture)
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====Drugs/Toxins====
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*Toxic doses
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**[[Digoxin toxicity]]
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**[[Aspirin toxicity]]
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**[[Acetaminophen toxicity]]
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**[[Ipecac toxicity]]
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*[[NSAIDs]]
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*[[Opioids]]
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*[[Alcohol]]
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*[[Anticonvulsants]]
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*[[Antibiotics]]
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*[[Antiarrhythmics]]
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*Toxins
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**[[Organophosphates]]
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**[[Carbon monoxide]]
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**[[Ricin]]
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*[[Acute radiation syndrome]]
  
6) Aspiration
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====Endocrine====
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*[[Pregnancy]], [[hyperemesis gravidarum]]
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*[[Hyponatremia]]
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*[[Adrenal insufficiency]]
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*[[DKA]]
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*[[Thyroid]]/parathyroid disorders
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*[[Uremia]]
  
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====Miscellaneous====
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*[[ACS]]
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*[[Ovarian torsion|ovarian]]/[[testicular torsion]]
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*[[Nephrolithiasis]]
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*Pain
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*[[Acute angle-closure glaucoma]]
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*[[Anorexia nervosa]]/[[bulimia nervosa]]
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*[[Depression]]
  
==DDX==
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==Evaluation==
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''Varies widely depending on clinical presentation''
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*CBC
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*Chemistry
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*Urine pregnancy
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*[[LFTs]]
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*Lipase
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*APAP, ASA, digoxin levels
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*[[Urinalysis]]
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*?[[Abdominal xray]]
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*?CT
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*?[[Ultrasound]]
  
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==Management==
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*Treat underlying pathology
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*Address [[electrolyte derangements]] and [[dehydration]] as needed
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*[[Antiemetics]]
  
===Critical===
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==Disposition==
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*Depends on cause
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*Most non-specific episodes of acute nausea and vomiting may be discharged, if:
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**No emergent/urgent cause identified or suspected
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**Patient tolerating fluids after treatment
  
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==Complications==
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*[[Hypovolemia]]
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*[[Metabolic alkalosis]]
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*[[Hypokalemia]]
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*[[Mallory-Weiss]] (tear)
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*[[Boerhaave]] (rupture)
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*Aspiration
  
Boerhaave
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==See Also==
 
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*[[Nausea and vomiting (peds)]]
Ischemic bowel
 
 
 
ICH
 
 
 
Meningitis
 
 
 
DKA
 
 
 
AMI
 
 
 
Sepsis
 
 
 
 
 
 
===Emergent===
 
 
 
 
 
Gastric outlet obstruction
 
 
 
Pancreatitis
 
 
 
Cholecystitis
 
 
 
Bowel obstruction/ileus
 
 
 
Ruptured viscus
 
 
 
Appendicitis
 
 
 
Peritonitis
 
 
 
Migraine
 
 
 
CNS tumor
 
 
 
raised ICP
 
 
 
Adrenal insuffciency
 
 
 
Hyperemesis gravidarum
 
 
 
Tylenol
 
 
 
Digoxin
 
 
 
ASA
 
 
 
Theophyline
 
 
 
Gonadal torsion
 
 
 
CO
 
 
 
Electrolyte disorder
 
 
 
 
 
 
===Nonemergent===
 
 
 
 
 
Gastritis
 
 
 
Gastroparesis
 
 
 
PUD
 
 
 
Gastroenteritis
 
 
 
Biliary colic
 
 
 
Hepatitis
 
 
 
Thyroid
 
 
 
Pregnancy
 
 
 
Erythromycin
 
 
 
Ibuprofen
 
 
 
Chemotherapy
 
 
 
Narcotics/wdwl from
 
 
 
ETOH
 
 
 
UTI
 
 
 
Renal colic
 
 
 
Motion sickness
 
 
 
Labyrinthitis
 
 
 
 
 
 
==Source ==
 
 
 
 
 
12/06 DONALDSON (adapted from Rosen)
 
 
 
  
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==External Links==
  
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==References==
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<references/>
  
 
[[Category:GI]]
 
[[Category:GI]]
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[[Category:Symptoms]]

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