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==
{{Nausea and vomiting DDX}}
{{Nausea and vomiting DDX}}
===By organ system===
===By organ system===
====GI====
====GI====
*[[Peptic ulcer disease]]
*[[Peptic ulcer disease]]
*Obstruction
*[[Bowel obstruction|Obstruction]]
**Adhesion
**Adhesion
**[[Small bowel obstruction]]/LBO
**[[Small bowel obstruction]]/LBO
***[[SMA syndrome]]
**Gastric outlet obstruction
**Gastric outlet obstruction
**[[Gastric volvulus]]
**[[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 (adeno, norwalk, rota
*Viruses ([[adenovirus]], [[norovirus]], [[rotavirus]])
 
====Drugs/Toxins====
====Drugs/Toxins====
*Toxic doses
*Toxic doses
**Digoxin
**[[Digoxin toxicity]]
**ASA
**[[Aspirin toxicity]]
**APAP
**[[Acetaminophen toxicity]]
*NSAIDs
**[[Ipecac toxicity]]
*Opiates
*[[NSAIDs]]
*ETOH
*[[Opioids]]
*Anticonvulsants
*[[Alcohol]]
*[[Anticonvulsants]]
*[[Antibiotics]]
*[[Antibiotics]]
*Antiarrhythmics
*[[Antiarrhythmics]]
*Toxins
*Toxins
**Organophosphates
**[[Organophosphates]]
**CO
**[[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
*[[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==
===Work-Up===
''Varies widely depending on clinical presentation''
*CBC
*CBC
*Chemistry
*Chemistry
*Urine pregnancy
*Urine pregnancy
*LFTs
*[[LFTs]]
*Lipase
*Lipase
*APAP, ASA, digoxin levels
*APAP, ASA, digoxin levels
*UA
*[[Urinalysis]]
*?Abd xray
*?[[Abdominal xray]]
*?CT
*?CT
*?US
*?[[Ultrasound]]
 
===Evaluation===


==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==


==References==
==References==
<references/>


[[Category:GI]]
[[Category:GI]]
[[Category:Pediatrics]]
[[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

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

  1. Lindblad AJ, Ting R, Harris K. Inhaled isopropyl alcohol for nausea and vomiting in the emergency department. Can Fam Physician. 2018;64(8):580.