Cyclic vomiting syndrome
- Recurrent episodes of vomiting, otherwise normal health in between
- 32% of patients disabled by illness by time of diagnosis
- Pathophysiology not well understood
- Average age at onset ~21yo
- Females slightly more affected than males
- Marijuana use is risk factor
- Pediatric diagnostic criteria
- At least 5 episodes or minimum of 3 over 6 mo
- Nausea/vomitingepisodes lasting 1hr-10d, with 1 week in between
- Stereotypical pattern and symptoms
- Return to baseline health in between
- Symptoms not due to another condition
- Adult – Rome III criteria 
- Stereotypical episodes of vomiting with acute onset lasting less than 1 week.
- At least 3 episodes per year.
- No nausea/vomiting between episodes.
- Symptoms not due to another cause
- Symptoms usually begin in early morning or upon waking
- Prodrome of nausea--> vomiting
- Episodes peak/decline over ~8h
- Nausea typically not relieved by vomiting
- Acute radiation syndrome
- Acute gastric dilation
- Acetaminophen toxicity
- Adrenal insufficiency
- Aspirin toxicity
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- CNS tumor
- Digoxin toxicity
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Ruptured viscus
- Testicular torsion/ovarian torsion
- Theophylline toxicity
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Disulfiram effect
- Ipecac toxicity
- Motion sickness
- Narcotic withdrawal
- Peptic ulcer disease
- Renal colic
- Clinical diagnosis of exclusion
- Evaluate for alternate etiologies
- Assess for dehydration, electrolyte abnormalities if clinically warranted
- Avoid triggers
- Many patients have known triggers, such as diet, psychological stressors, sleep deprivation, cannabis, or infection.
- May be on medications typically used for migraine prophylaxis
- Abortive antiemetics therapy
- Supportive therapy
- Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005 Dec 21. 3:20.
- Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008 Sep. 47(3):379-93.
- Venkatasubramani N, Venkatesan T, Li BUK. Extreme Emesis: Cyclic Vomiting Syndrome. Practical Gastroenterology. September 2007. 31:21-34.