Nausea and vomiting: Difference between revisions

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<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==
==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==


== DDX by organ system ==
*Nausea and/or vomiting
===GI===
*Additional features of underlying process
*[[Peptic ulcer disease]]
 
*Obstruction
 
==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
**Adhesion
**[[Small bowel obstruction]]/LBO
**[[Special:MyLanguage/Small bowel obstruction|Small bowel obstruction]]/LBO
***[[Special:MyLanguage/SMA syndrome|SMA syndrome]]
**Gastric outlet obstruction
**Gastric outlet obstruction
*[[Pancreatitis]]
**[[Special:MyLanguage/Gastric volvulus|Gastric volvulus]]
*Gastroparesis
**[[Special:MyLanguage/Bezoar|Bezoar]]
*[[Appendicitis]]
*[[Special:MyLanguage/Pancreatitis|Pancreatitis]]
*[[Cholecystitis]]
*[[Special:MyLanguage/Gastroparesis|Gastroparesis]]
*[[Cholangitis]]
*[[Special:MyLanguage/Appendicitis|Appendicitis]]
*[[Acute Hepatitis]]
*[[Special:MyLanguage/Cholecystitis|Cholecystitis]]
*IBD
*[[Special:MyLanguage/Cholangitis|Cholangitis]]
*[[Intussusception]]
*[[Special:MyLanguage/Acute Hepatitis|Acute Hepatitis]]
*[[Special:MyLanguage/IBD|IBD]]
*[[Special:MyLanguage/Intussusception|Intussusception]]
*Tumor
*Tumor
*Strangulated hernia
*Strangulated [[Special:MyLanguage/hernia|hernia]]
*[[Volvulus]]
*[[Special:MyLanguage/Volvulus|Volvulus]]
*[[Mesenteric ischemia]]
*[[Special:MyLanguage/Mesenteric ischemia|Mesenteric ischemia]]
*Esophageal disorders (e.g. achalasia)
*Esophageal disorders (e.g. [[Special:MyLanguage/achalasia|achalasia]])
*Functional disorders
*Functional disorders
**Psychogenic
**Psychogenic
**[[IBS]]
**[[Special:MyLanguage/IBS|IBS]]
*[[Pyloric Stenosis]]
*[[Special:MyLanguage/Pyloric Stenosis|Pyloric Stenosis]]
 
 
====Neurologic====
 
*[[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]])
 


===Neurologic===
====Drugs/Toxins====
*Head injury
*[[CVA]]
*Pseudotumor
*Hydrocephalus
*Mass lesion
*[[Meningitis]]
*Migraines
*[[Labyrinthitis]]
*Meniere disease
*Motion sickness
*[[Cannabinoid hyperemesis syndrome]]


===Infectious===
*Bacterial toxins
*[[PNA]]
*[[SBP]]
*[[UTI]]
*Viruses (adeno, norwalk, rota
===Drugs/Toxins===
*Toxic doses
*Toxic doses
**Digoxin
**[[Special:MyLanguage/Digoxin toxicity|Digoxin toxicity]]
**ASA
**[[Special:MyLanguage/Aspirin toxicity|Aspirin toxicity]]
**APAP
**[[Special:MyLanguage/Acetaminophen toxicity|Acetaminophen toxicity]]
*NSAIDs
**[[Special:MyLanguage/Ipecac toxicity|Ipecac toxicity]]
*Opiates
*[[Special:MyLanguage/NSAIDs|NSAIDs]]
*ETOH
*[[Special:MyLanguage/Opioids|Opioids]]
*Anticonvulsants
*[[Special:MyLanguage/Alcohol|Alcohol]]
*Abx
*[[Special:MyLanguage/Anticonvulsants|Anticonvulsants]]
*Antiarrhythmics
*[[Special:MyLanguage/Antibiotics|Antibiotics]]
*[[Special:MyLanguage/Antiarrhythmics|Antiarrhythmics]]
*Toxins
*Toxins
**Organophosphates
**[[Special:MyLanguage/Organophosphates|Organophosphates]]
**CO
**[[Special:MyLanguage/Carbon monoxide|Carbon monoxide]]
**Ricin
**[[Special:MyLanguage/Ricin|Ricin]]
===Endocrine===
*[[Special:MyLanguage/Acute radiation syndrome|Acute radiation syndrome]]
*Pregnancy
*[[Hyponatremia]]
*Adrenal insufficiency
*[[DKA]]
*Thyroid/parathyroid disorders
*[[Uremia]]


===Miscellaneous===
 
*[[ACS]]
====Endocrine====
*Gonadal torsion
 
*[[Nephrolithiasis]]
*[[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
*Pain
*Acute glaucoma
*[[Special:MyLanguage/Acute angle-closure glaucoma|Acute angle-closure glaucoma]]
*Anorexia/bulimia
*[[Special:MyLanguage/Anorexia nervosa|Anorexia nervosa]]/[[Special:MyLanguage/bulimia nervosa|bulimia nervosa]]
*Depression
*[[Special:MyLanguage/Depression|Depression]]


==DDx by Severity==
=== Critical ===
*[[Esophageal Perforation|Boerhaave's]]
*Ischemic bowel
*[[ICH]]
*[[Meningitis]]
*[[DKA]]
*[[AMI]]
*[[Sepsis]]


=== Emergent ===
==Evaluation==
*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 Disorders]]
===Nonemergent===
*[[Gastritis]]
*Gastroparesis
*PUD
*Gastroenteritis
*Biliary colic
*Hepatitis
*Thyroid
*Pregnancy
*Erythromycin
*Ibuprofen
*Chemotherapy
*Narcotics/wdwl from
*ETOH
*UTI
*Renal colic
*Motion sickness
*Labyrinthitis


==Diagnosis==
''Varies widely depending on clinical presentation''
===Work-Up===
*CBC
*CBC
*Chemistry
*Chemistry
*Urine pregnancy
*Urine pregnancy
*LFTs
*[[Special:MyLanguage/LFTs|LFTs]]
*Lipase
*Lipase
*APAP, ASA, digoxin levels
*APAP, ASA, digoxin levels
*UA
*[[Special:MyLanguage/Urinalysis|Urinalysis]]
*?Abd xray
*?[[Special:MyLanguage/Abdominal xray|Abdominal xray]]
*?CT
*?CT
*?US
*?[[Special:MyLanguage/Ultrasound|Ultrasound]]


===Evaluation==


==Management==
==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==
==Disposition==


== Complications ==
*Depends on cause
*Hypovolemia
*Most non-specific episodes of acute nausea and vomiting may be discharged, if:
*Metabolic alkalosis
**No emergent/urgent cause identified or suspected
*Hypokalemia
**Patient tolerating fluids after treatment
*Mallory-Weiss (tear)
 
*Boerhaave (rupture)
 
==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
*Aspiration


== Peds ==


{| cellspacing="1" cellpadding="3" border="0" bgcolor="*666666" width="100%"
==See Also==
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
 
| valign="top" bgcolor="*ffffff" class="font12" colspan="2" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | '''Newborn'''&nbsp;
*[[Special:MyLanguage/Nausea and vomiting (peds)|Nausea and vomiting (peds)]]
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
*[[Special:MyLanguage/Nausea and vomiting of pregnancy|Nausea and vomiting of pregnancy]]
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Obstructive intestinal anomalies
*[[Special:MyLanguage/Antiemetics|Antiemetics]]
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Esophageal stenosis/atresia, pyloric stenosis, intestinal stenosis/atresia, malrotation ± volvulus, incarcerated hernia, meconium ileus/plug, Hirschsprung disease, imperforate anus, enteric duplications
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
 
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Neurologic
==External Links==
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Intracranial bleed/mass, hydrocephalus, cerebral edema, kernicterus
 
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Renal
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Urinary tract infection, obstructive uropathy, renal insufficiency
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Infectious
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Viral illness, gastroenteritis, meningitis, sepsis
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Metabolic/endocrine
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Inborn errors of metabolism (urea cycle, amino/organic acid, carbohydrate), congenital adrenal hyperplasia
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Miscellaneous
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Ileus, gastroesophageal reflux, necrotizing enterocolitis, milk allergy, GI perforation
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" colspan="2" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | '''Infant (<12 mo)'''&nbsp;
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Obstructive intestinal anomalies
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Pyloric stenosis, malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, enteric duplications, intussusception, foreign body, bezoars, Meckel diverticulum
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Neurologic
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Intracranial bleed/mass, hydrocephalus, cerebral edema
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Renal
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Urinary tract infection, obstructive uropathy, renal insufficiency
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Infectious
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Viral illness, gastroenteritis, meningitis, sepsis, otitis media, pneumonia, pertussis, hepatitis
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Metabolic/endocrine
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Miscellaneous
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | '''Child (>12 mo)'''&nbsp;
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | &nbsp;
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Obstructive intestinal anomalies
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, intussusception, foreign body, bezoars, Meckel diverticulum, acquired esophageal stricture, peptic ulcer disease, adhesions, superior mesenteric artery syndrome
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Neurologic
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Intracranial bleed/mass, cerebral edema, postconcussive, migraine
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Renal
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Urinary tract infection, obstructive uropathy, renal insufficiency
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Infectious
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Viral illness, gastroenteritis, meningitis, sepsis, otitis media, pneumonia, hepatitis, streptococcal pharyngitis
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Metabolic/endocrine
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis, diabetes mellitus, Reye syndrome, porphyria
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Miscellaneous
| valign="top" bgcolor="*ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose, appendicitis, pancreatitis, gastritis, Crohn disease, pregnancy, psychogenic, cyclic vomiting syndrome
|}


==See Also==
==References==


== References ==
<references/>


[[Category:GI]]
[[Category:GI]]
[[Category:Peds]]
[[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

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.
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