Nausea and vomiting: Difference between revisions
(Created page with "==Complications== 1) Hypovolemia 2) Metabolic alkalosis 3) Hypokalemia 4) Mallory-Weiss (tear) 5) Boerhaave (rupture) 6) Aspiration ==DDX== ===Critical=== Boerhaav...") |
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<languages/> | |||
<translate> | |||
</translate> | |||
{{Adult top}} | |||
<translate> [[Special:MyLanguage/nausea and vomiting (peds)|nausea and vomiting (peds)]]. For nausea and vomiting during pregnancy, see [[Special:MyLanguage/hyperemesis gravidarum|hyperemesis gravidarum]].'' | |||
==Background== | |||
[[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]] | |||
==Clinical Features== | |||
*Nausea and/or vomiting | |||
*Additional features of underlying process | |||
==Differential Diagnosis== | |||
</translate> | |||
{{Nausea and vomiting DDX}} | |||
<translate> | |||
===By organ system=== | |||
====GI==== | |||
*[[Special:MyLanguage/Peptic ulcer disease|Peptic ulcer disease]] | |||
*[[Special:MyLanguage/Bowel obstruction|Obstruction]] | |||
**Adhesion | |||
**[[Special:MyLanguage/Small bowel obstruction|Small bowel obstruction]]/LBO | |||
***[[Special:MyLanguage/SMA syndrome|SMA syndrome]] | |||
**Gastric outlet obstruction | |||
**[[Special:MyLanguage/Gastric volvulus|Gastric volvulus]] | |||
**[[Special:MyLanguage/Bezoar|Bezoar]] | |||
*[[Special:MyLanguage/Pancreatitis|Pancreatitis]] | |||
*[[Special:MyLanguage/Gastroparesis|Gastroparesis]] | |||
*[[Special:MyLanguage/Appendicitis|Appendicitis]] | |||
*[[Special:MyLanguage/Cholecystitis|Cholecystitis]] | |||
*[[Special:MyLanguage/Cholangitis|Cholangitis]] | |||
*[[Special:MyLanguage/Acute Hepatitis|Acute Hepatitis]] | |||
*[[Special:MyLanguage/IBD|IBD]] | |||
*[[Special:MyLanguage/Intussusception|Intussusception]] | |||
*Tumor | |||
*Strangulated [[Special:MyLanguage/hernia|hernia]] | |||
*[[Special:MyLanguage/Volvulus|Volvulus]] | |||
*[[Special:MyLanguage/Mesenteric ischemia|Mesenteric ischemia]] | |||
*Esophageal disorders (e.g. [[Special:MyLanguage/achalasia|achalasia]]) | |||
*Functional disorders | |||
**Psychogenic | |||
**[[Special:MyLanguage/IBS|IBS]] | |||
*[[Special:MyLanguage/Pyloric Stenosis|Pyloric Stenosis]] | |||
====Neurologic==== | |||
Meningitis | *[[Special:MyLanguage/Head injury|Head injury]] | ||
*[[Special:MyLanguage/CVA|CVA]] | |||
*[[Special:MyLanguage/Idiopathic intracranial hypertension|Idiopathic intracranial hypertension]] | |||
*[[Special:MyLanguage/Hydrocephalus|Hydrocephalus]] | |||
*[[Special:MyLanguage/Intracranial mass|Mass lesion]] | |||
*[[Special:MyLanguage/Meningitis|Meningitis]] | |||
*[[Special:MyLanguage/Migraine|Migraine]] | |||
*[[Special:MyLanguage/Labyrinthitis|Labyrinthitis]] | |||
*[[Special:MyLanguage/Meniere's disease|Meniere's disease]] | |||
*[[Special:MyLanguage/Motion sickness|Motion sickness]] | |||
*[[Special:MyLanguage/Cannabinoid hyperemesis syndrome|Cannabinoid hyperemesis syndrome]] | |||
====Infectious==== | |||
*[[Special:MyLanguage/Bacteria|Bacteria]]l toxins | |||
*[[Special:MyLanguage/Pneumonia|Pneumonia]] | |||
*[[Special:MyLanguage/SBP|SBP]] | |||
*[[Special:MyLanguage/UTI|UTI]] | |||
*Viruses ([[Special:MyLanguage/adenovirus|adenovirus]], [[Special:MyLanguage/norovirus|norovirus]], [[Special:MyLanguage/rotavirus|rotavirus]]) | |||
=== | ====Drugs/Toxins==== | ||
*Toxic doses | |||
**[[Special:MyLanguage/Digoxin toxicity|Digoxin toxicity]] | |||
**[[Special:MyLanguage/Aspirin toxicity|Aspirin toxicity]] | |||
**[[Special:MyLanguage/Acetaminophen toxicity|Acetaminophen toxicity]] | |||
**[[Special:MyLanguage/Ipecac toxicity|Ipecac toxicity]] | |||
*[[Special:MyLanguage/NSAIDs|NSAIDs]] | |||
*[[Special:MyLanguage/Opioids|Opioids]] | |||
*[[Special:MyLanguage/Alcohol|Alcohol]] | |||
*[[Special:MyLanguage/Anticonvulsants|Anticonvulsants]] | |||
*[[Special:MyLanguage/Antibiotics|Antibiotics]] | |||
*[[Special:MyLanguage/Antiarrhythmics|Antiarrhythmics]] | |||
*Toxins | |||
**[[Special:MyLanguage/Organophosphates|Organophosphates]] | |||
**[[Special:MyLanguage/Carbon monoxide|Carbon monoxide]] | |||
**[[Special:MyLanguage/Ricin|Ricin]] | |||
*[[Special:MyLanguage/Acute radiation syndrome|Acute radiation syndrome]] | |||
====Endocrine==== | |||
*[[Special:MyLanguage/Pregnancy|Pregnancy]], [[Special:MyLanguage/hyperemesis gravidarum|hyperemesis gravidarum]] | |||
*[[Special:MyLanguage/Hyponatremia|Hyponatremia]] | |||
*[[Special:MyLanguage/Adrenal insufficiency|Adrenal insufficiency]] | |||
*[[Special:MyLanguage/DKA|DKA]] | |||
*[[Special:MyLanguage/Thyroid|Thyroid]]/parathyroid disorders | |||
*[[Special:MyLanguage/Uremia|Uremia]] | |||
====Miscellaneous==== | |||
*[[Special:MyLanguage/ACS|ACS]] | |||
*[[Special:MyLanguage/Ovarian torsion|ovarian]]/[[Special:MyLanguage/testicular torsion|testicular torsion]] | |||
*[[Special:MyLanguage/Nephrolithiasis|Nephrolithiasis]] | |||
*Pain | |||
*[[Special:MyLanguage/Acute angle-closure glaucoma|Acute angle-closure glaucoma]] | |||
*[[Special:MyLanguage/Anorexia nervosa|Anorexia nervosa]]/[[Special:MyLanguage/bulimia nervosa|bulimia nervosa]] | |||
*[[Special:MyLanguage/Depression|Depression]] | |||
==Evaluation== | |||
''Varies widely depending on clinical presentation'' | |||
*CBC | |||
*Chemistry | |||
*Urine pregnancy | |||
*[[Special:MyLanguage/LFTs|LFTs]] | |||
*Lipase | |||
*APAP, ASA, digoxin levels | |||
*[[Special:MyLanguage/Urinalysis|Urinalysis]] | |||
*?[[Special:MyLanguage/Abdominal xray|Abdominal xray]] | |||
*?CT | |||
*?[[Special:MyLanguage/Ultrasound|Ultrasound]] | |||
==Management== | |||
*Treat underlying pathology | |||
*Address [[Special:MyLanguage/electrolyte derangements|electrolyte derangements]] and [[Special:MyLanguage/dehydration|dehydration]] as needed | |||
*[[Special:MyLanguage/Antiemetics|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== | |||
*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== | |||
=== | |||
*[[Special:MyLanguage/Hypovolemia|Hypovolemia]] | |||
*[[Special:MyLanguage/Metabolic alkalosis|Metabolic alkalosis]] | |||
*[[Special:MyLanguage/Hypokalemia|Hypokalemia]] | |||
*[[Special:MyLanguage/Mallory-Weiss|Mallory-Weiss]] (tear) | |||
*[[Special:MyLanguage/Boerhaave|Boerhaave]] (rupture) | |||
*Aspiration | |||
==See Also== | |||
*[[Special:MyLanguage/Nausea and vomiting (peds)|Nausea and vomiting (peds)]] | |||
*[[Special:MyLanguage/Nausea and vomiting of pregnancy|Nausea and vomiting of pregnancy]] | |||
*[[Special:MyLanguage/Antiemetics|Antiemetics]] | |||
==External Links== | |||
==References== | |||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Symptoms]] | |||
</translate> | |||
Latest revision as of 23:47, 4 January 2026
This page is for adult patients. For pediatric patients, see:
nausea and vomiting (peds). For nausea and vomiting during pregnancy, see hyperemesis gravidarum.
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
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- 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
- Inhaled isopropyl alcohol (sniffing an alcohol wipe) has been shown to reduce mild to moderate nausea and vomiting[1]
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
See Also
External Links
References
- ↑ Lindblad AJ, Ting R, Harris K. Inhaled isopropyl alcohol for nausea and vomiting in the emergency department. Can Fam Physician. 2018;64(8):580.