Nausea and vomiting: Difference between revisions
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{{ | {{AdultPregnancyPage|hyperemesis gravidarum}} | ||
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==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]] | ||
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
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.