Nausea and vomiting: Difference between revisions
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<languages/>
<translate>
</translate>{{AdultPage|nausea and vomiting (peds)}}
{{AdultPregnancyPage|hyperemesis gravidarum}}
<translate>
==Background==
==Background==
Generally classified by GI and Non-GI causes:
==== Inflammatory ====
* Esophagus:
** Esophagitis (reflux, ingestion)
* Stomach:
** Gastritis (EtOH, NSAID's)
* Small Bowel:
** Enteritis (infectious, foodborne)
* Liver:
** Hepatitis
* Pancreas:
** Pancreatitis
=== Non-GI Causes ===
==== CNS ====
* Increased Intracranial Pressure (ICP):
** Meningitis/encephalitis
** Mass lesion
** Pseudotumor cerebri
** CVA/TIA
* Vestibular:
** Labyrinthitis
** Meniere's
* Other:
** Migraine
** Seizure
==== Toxic/Metabolic ====
* Metabolic:
** Acidosis
** Uremia
* Medications:
** Opiates
** Antibiotics
** Chemotherapy
** AED
* Toxins:
** EtOH
** Illicit substances
==== Stressor ====
* Severe Illness:
** MI
** Sepsis
* Other:
** Pain
[[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==
===By organ system ===
 
</translate>
{{Nausea and vomiting DDX}}
<translate>
 
 
===By organ system===
 
 
====GI====
====GI====
*[[Peptic ulcer disease]]
 
*Obstruction
*[[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====
====Neurologic====
*Head injury
 
*[[CVA]]
*[[Special:MyLanguage/Head injury|Head injury]]
*Pseudotumor
*[[Special:MyLanguage/CVA|CVA]]
*Hydrocephalus
*[[Special:MyLanguage/Idiopathic intracranial hypertension|Idiopathic intracranial hypertension]]
*Mass lesion
*[[Special:MyLanguage/Hydrocephalus|Hydrocephalus]]
*[[Meningitis]]
*[[Special:MyLanguage/Intracranial mass|Mass lesion]]
*Migraines
*[[Special:MyLanguage/Meningitis|Meningitis]]
*[[Labyrinthitis]]
*[[Special:MyLanguage/Migraine|Migraine]]
*Meniere disease
*[[Special:MyLanguage/Labyrinthitis|Labyrinthitis]]
*Motion sickness
*[[Special:MyLanguage/Meniere's disease|Meniere's disease]]
*[[Cannabinoid hyperemesis syndrome]]
*[[Special:MyLanguage/Motion sickness|Motion sickness]]
*[[Special:MyLanguage/Cannabinoid hyperemesis syndrome|Cannabinoid hyperemesis syndrome]]
 


====Infectious====
====Infectious====
*Bacterial toxins
 
*[[PNA]]
*[[Special:MyLanguage/Bacteria|Bacteria]]l toxins
*[[SBP]]
*[[Special:MyLanguage/Pneumonia|Pneumonia]]
*[[UTI]]
*[[Special:MyLanguage/SBP|SBP]]
*Viruses (adeno, norwalk, rota
*[[Special:MyLanguage/UTI|UTI]]
*Viruses ([[Special:MyLanguage/adenovirus|adenovirus]], [[Special:MyLanguage/norovirus|norovirus]], [[Special:MyLanguage/rotavirus|rotavirus]])
 
 
====Drugs/Toxins====
====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]]
*[[Antibiotics]]
*[[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]]
*[[Acute radiation syndrome]]
*[[Special:MyLanguage/Acute radiation syndrome|Acute radiation syndrome]]
 


====Endocrine====
====Endocrine====
*Pregnancy
 
*[[Hyponatremia]]
*[[Special:MyLanguage/Pregnancy|Pregnancy]], [[Special:MyLanguage/hyperemesis gravidarum|hyperemesis gravidarum]]
*Adrenal insufficiency
*[[Special:MyLanguage/Hyponatremia|Hyponatremia]]
*[[DKA]]
*[[Special:MyLanguage/Adrenal insufficiency|Adrenal insufficiency]]
*Thyroid/parathyroid disorders
*[[Special:MyLanguage/DKA|DKA]]
*[[Uremia]]
*[[Special:MyLanguage/Thyroid|Thyroid]]/parathyroid disorders
*[[Special:MyLanguage/Uremia|Uremia]]
 


====Miscellaneous====
====Miscellaneous====
*[[ACS]]
 
*Gonadal torsion
*[[Special:MyLanguage/ACS|ACS]]
*[[Nephrolithiasis]]
*[[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]]


===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


==See Also==
==See Also==
*[[Nausea and vomiting (peds)]]


== References ==
*[[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:Peds]]
[[Category:Symptoms]]
</translate>

Latest revision as of 16:21, 15 January 2026

This page is for adult patients. For pediatric patients, see: nausea and vomiting (peds)


Background

Generally classified by GI and Non-GI causes:

Inflammatory

  • Esophagus:
    • Esophagitis (reflux, ingestion)
  • Stomach:
    • Gastritis (EtOH, NSAID's)
  • Small Bowel:
    • Enteritis (infectious, foodborne)
  • Liver:
    • Hepatitis
  • Pancreas:
    • Pancreatitis

Non-GI Causes

CNS

  • Increased Intracranial Pressure (ICP):
    • Meningitis/encephalitis
    • Mass lesion
    • Pseudotumor cerebri
    • CVA/TIA
  • Vestibular:
    • Labyrinthitis
    • Meniere's
  • Other:
    • Migraine
    • Seizure

Toxic/Metabolic

  • Metabolic:
    • Acidosis
    • Uremia
  • Medications:
    • Opiates
    • Antibiotics
    • Chemotherapy
    • AED
  • Toxins:
    • EtOH
    • Illicit substances

Stressor

  • Severe Illness:
    • MI
    • Sepsis
  • Other:
    • Pain
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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