Pocket Emergency Medicine (Pocket Notebook Series) 3rd Ed.

NAUSEA AND VOMITING

Definition

• The sensation of or act of ejecting stomach contents through the mouth

Approach

• Common sxs of many dz processes (eg, intra-abdominal dz, metabolic derangements, toxic ingestions, neurologic dz)

• Careful attention to ROS, PMH, previous abdominal surgeries

• Labs: Consider CBC, BMP, UA, LFTs, lipase, hCG

• Treat underlying cause: Antiemetics (eg, ondansetron, promethazine), IVF if not taking PO

Gastroenteritis

Definition: Irritation of the GI tract causing vomiting AND diarrhea usually caused by infections (viruses, bacteria, bacterial toxins, parasites) or due to medications or diet

History: Vomiting AND diarrhea, ±fever

Physical Findings: nl exam or mild diffuse abdominal ttp, tachycardia, dehydration

Evaluation: Consider BMP if clinical concern for significant electrolyte derangement

Management: Supportive care, antiemetics. IVF if not taking PO. Home when tolerating PO.

Pearl: Viral & bacterial toxins (food poisoning) are most common & typically resolve w/o tx in 48 h

Hyperemesis Gravidarum

Definition: Nausea & vomiting that result in weight loss or failure to gain weight

History: Pregnancy (1st trimester, usually week 8–12), nausea, vomiting, inability to PO

Physical Findings: Tachycardia, dehydration

Evaluation: Labs: Electrolytes, UA; often have ketosis & electrolyte derangements

Treatment: IV fluids (w/ dextrose), antiemetics (ondansetron, metoclopramide), Vit B6

Disposition: Home if tolerating PO