Vomiting resident survival guide: Difference between revisions
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{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 32em; width: 30em; padding:1em;"> '''Ask the following questions about vomiting'''<br> | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 32em; width: 30em; padding:1em;"> '''Ask the following questions about vomiting'''<br> | ||
---- | ---- | ||
❑How long have you had nausea and vomiting | ❑How long have you had [[nausea]] and [[vomiting]]?<br><br>❑How much have you vomitted?<br><br>❑What is the colour of the [[vomitus]]?<br><br>❑Have you had previous episodes like this or this is the first time?<br><br>❑Is there any foul smell of the vomitus?<br><br>❑Is there only food particle or any other mucous/substance present with the vomitus?<br><br>❑Have you notice any blood streaks mixed with [[vomitus]]?<br><br></div>}} | ||
{{Family tree | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 32em; width: 30em; padding:1em;"> '''Ask the related questions'''<br> | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 32em; width: 30em; padding:1em;"> '''Ask the related questions'''<br> | ||
---- | ---- | ||
❑Did your nausea and vomiting occur right after eating?<br><br> ❑Do you have a fever?<br><br>❑Do you take any other medication<br><br>❑Have you recently eaten out?<br><br>❑Have you eaten any canned product?<br><br>❑Have you suffered from headache or photophobia along with this vomiting?<br><br> ❑Did you have any abdominal pain?</div>}} | ❑Did your [[nausea]] and vomiting occur right after eating?<br><br> ❑Do you have a fever?<br><br>❑Do you take any other medication<br><br>❑Have you recently eaten out?<br><br>❑Have you eaten any canned product?<br><br>❑Have you suffered from [[headache]] or [[photophobia]] along with this vomiting?<br><br> ❑Did you have any abdominal pain?</div>}} | ||
{{Family tree | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | |!| | | | | }} | ||
{{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=Sample 10}}{{familytree/start |summary=PE diagnosis Algorithm.}} | ||
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❑ [[Body Mass Index]]<br><br>❑Temperature<br><br>❑Heart rate<br><br>❑Respiratory rate </div>}} | ❑ [[Body Mass Index]]<br><br>❑Temperature<br><br>❑Heart rate<br><br>❑Respiratory rate </div>}} | ||
{{Family tree | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: | {{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 52em; width: 30em; padding:1em;"> '''Do general [[physical examination]]:'''<br> | ||
---- | ---- | ||
❑'''Look for signs of [[dehydration]]'''<ref name="urlAdult Dehydration - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK555956/ |title=Adult Dehydration - StatPearls - NCBI Bookshelf |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><ref name="pmid30518346">{{cite journal | |||
|vauthors=Shaheen NA, Alqahtani AA, Assiri H, Alkhodair R, Hussein MA | |vauthors=Shaheen NA, Alqahtani AA, Assiri H, Alkhodair R, Hussein MA | ||
|title=Public knowledge of dehydration and fluid intake practices: variation by participants' characteristics | |title=Public knowledge of dehydration and fluid intake practices: variation by participants' characteristics | ||
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|url= | |url= | ||
|issn= | |issn= | ||
}}</ref><br><br> | }}</ref><br><br>*Look for sunken eyes<ref name="pmid30518346">{{cite journal | ||
|vauthors=Shaheen NA, Alqahtani AA, Assiri H, Alkhodair R, Hussein MA | |vauthors=Shaheen NA, Alqahtani AA, Assiri H, Alkhodair R, Hussein MA | ||
|title=Public knowledge of dehydration and fluid intake practices: variation by participants' characteristics | |title=Public knowledge of dehydration and fluid intake practices: variation by participants' characteristics | ||
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|url= | |url= | ||
|issn= | |issn= | ||
}}</ref><br><br> * | }}</ref><br><br> *[[Orthostatic blood pressure]] drop,[[tachycardia]]<ref name="pmid30518346">{{cite journal | ||
|vauthors=Shaheen NA, Alqahtani AA, Assiri H, Alkhodair R, Hussein MA | |vauthors=Shaheen NA, Alqahtani AA, Assiri H, Alkhodair R, Hussein MA | ||
|title=Public knowledge of dehydration and fluid intake practices: variation by participants' characteristics | |title=Public knowledge of dehydration and fluid intake practices: variation by participants' characteristics | ||
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|url= | |url= | ||
|issn= | |issn= | ||
}}</ref><br><br>*Light-headedness<br><br> *Dark urine or decreased urine output</div>}} | }}</ref><br><br>*Light-headedness<br><br> *Dark urine or decreased urine output<br><br>*Increased capillary refill time<ref name="urlAdult Dehydration - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK555956/ |title=Adult Dehydration - StatPearls - NCBI Bookshelf |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><br><br>*Poor skin [[turgo]]r<br><br>*Tiredness<br><br>*[[Appetite]]<br><br>❑ '''Perform abdominal examination'''<br><br>*Look for any abdominal [[tenderness]]<br><br>*Presence of [[bowel sound]]</div>}} | ||
{{Family tree | | | | | | | |!| | | | | }} | {{Family tree | | | | | | | |!| | | | | }} | ||
{{Family tree | | | | | | | B01 | | | |B01= If patient gives history of}} | |||
{{Family tree | | | | | | | |!| | | | | }} | |||
{{familytree | |,|-|-|-|-|-|+|-|-|-|-|-|v|-|-|-|-|.| | }} | |||
{{familytree | |!| | | | | |!| | | | | |!| | | | |!| | | }} | |||
{{familytree | D01 | | | D02 | | | | | D04 | | | D05 |D01=<div style="float: left; text-align: left; height: 17em; width: 10em; padding:1em;"> '''History of'''<br> | |||
---- | |||
❑ Abdominal pain<br><br>❑ Eating out or eating reheated canned food <br><br> | |||
❑ Abdominal [[bloating]]<br><br>❑Passage of loose [[stool]]<br><br> </div>|D02=<div style="float: left; text-align: left; height: 5em; width: 10em; padding:1em;"> '''History of'''<br> | |||
---- | |||
❑[[Headache]]</div>|D03=D03|D04=<div style="float: left; text-align: left; height: 10em; width: 10em; padding:1em;"> '''History of'''<br> | |||
---- | |||
❑ [[Acidosis]]<br><br>❑[[Dehydration]]<br><br> </div>|D05=<div style="float: left; text-align: left; height: 10em; width: 10em; padding:1em;"> '''History of'''<br> | |||
---- | |||
❑ Weight loss<br><br>❑Loss of appetite<br><br>❑Abdominal pain </div>}} | |||
{{familytree | |!| | | | | |!| | | | | |!| | | | |!| | | }} | |||
{{familytree | |!| | | | | |!| | | | | |!| | | | |!| }} | |||
{{familytree | |!| | | | |,|^|.| | | | |!| | | |!| | | }} | |||
{{familytree | |!| | | | |!| |!| | | | |!| | | |!| | | }} | |||
{{familytree |D09| |D01| |D02| | | | | |!| | | | |D09=[[Gastroenteritis]]|D01=<div style="float: left; text-align: left; height: 17em; width: 10em; padding:1em;"> | |||
❑[[Photophobia]]<br><br>❑Triggered by smell, light or loud sound<br><br>❑Unilateral headache usually,maybe bilateral which stays for 2-3 days<br><br>❑May have history of taking wine, chocolate<br><br></div>|D02=<div style="float: left; text-align: left; height: 17em; width: 10em; padding:1em;"> | |||
❑Dizziness<br><br>❑Altered behaviour<br><br>❑Vision chnages<br><br>❑Weakness of any part of body/ paralysis<br><br></div>|||| }} | |||
{{familytree | | | | | |!| | | | |!| | |!| | | | |!| | | }} | |||
{{familytree | | | | |a01| | | |b01| | |c02| | | |d09| |a01=Migraine |b01=Tumor |c02=Metabolic disorder |d09=Gastric malignancy | | }} | |||
{{familytree/end}} | {{familytree/end}} | ||
==Treatment== | ==Treatment== | ||
Shown below is | Shown below is the treatment of Vomiting. <ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url= |issn=}}</ref> | ||
{{ | {| class="wikitable" style="margin: 1em auto 1em auto" | ||
|+'''[[Medications]] used to treat Nausea and Vomiting'''<ref name="pmid26770271">{{cite journal |vauthors=Singh P, Yoon SS, Kuo B |title=Nausea: a review of pathophysiology and therapeutics |journal=Therap Adv Gastroenterol |volume=9 |issue=1 |pages=98–112 |date=January 2016 |pmid=26770271 |pmc=4699282 |doi=10.1177/1756283X15618131 |url= |issn=}}</ref> | |||
!Mechanism | |||
{ | !Name||Dose||Side effects | ||
|- | |||
{{ | |'''[[5-HT3 antagonists]]''' | ||
|<br> | |||
*[[Ondansetron]]<br> | |||
*[[Granisetron]] | |||
*[[Palonosetron]] | |||
|<br>4–8 mg q4–8 hours<br>1–2 mg q24 hours<br>0.075–0.25 mg q24 hours<br> | |||
| | |||
*Headache | |||
*[[Fatigue]] | |||
*[[Malaise]] | |||
*[[Constipation]] | |||
|- | |||
|'''[[Benzamides]]''' | |||
|<br> | |||
*[[Metoclopramide]] | |||
*[[Domperidone]] | |||
|<br>10–20 mg q6–8 hours<br>10 mg q8–24 hours<br> | |||
| | |||
*[[Sedation]] | |||
*[[Anxiety]] | |||
*[[Mood]] disturbances | |||
*Sleep disruption | |||
*[[Dystonic]] reactions | |||
*[[Tardive dyskinesia]] | |||
*[[Galactorrhea]] | |||
*Sexual dysfunction | |||
|- | |||
|'''[[Phenothiazines]]''' | |||
|<br> | |||
*[[Prochlorperazine]]<br> | |||
*[[Promethazine]]<br> | |||
*[[Chlorpromazine]]<br> | |||
*[[Perphenazine]] | |||
|<br>5–10 mg q6–8 hours<br>12.5 –25 mg q4–6 hours<br>10–25 mg q4–6 hours<br>4–8 mg q8–12 hours<br> | |||
| | |||
*Extrapyramidal side effects | |||
*[[Tardive dyskinesia]] | |||
*[[Neuroleptic malignant syndrome]] | |||
*[[Hyperprolactinemia]] | |||
*[[QT prolongation]] | |||
|- | |||
|'''[[Cannabinoids]]''' | |||
|<br> | |||
*[[Dronabinol]]<br> | |||
*[[Nabilone]]<br> | |||
|<br>2.5–10 mg q6–8 hours<br>1–2 mg q8–12 hours<br> | |||
| | |||
*[[Palpitations]] | |||
*[[Tachycardia]] | |||
*[[Vasodilation]]/facial [[flushing]] | |||
*[[Euphoria]], abnormal thinking | |||
*[[Dizziness]] | |||
*[[Paranoia,]], [[Depersonalization]],[[Hallucinations]] | |||
*[[Visual changes]] | |||
|- | |||
|'''[[Anticholinergics]]''' | |||
| | |||
*[[Scopolamine]] | |||
|<br> 0.3–0.6 mg q24 hours<br> | |||
| | |||
*[[Tachycardia]] | |||
*[[Confusion]] | |||
*[[Dry mouth]] | |||
*[[constipation]] | |||
*[[Urinary retention]] | |||
|- | |||
|'''[[Antihistamines]]''' | |||
| | |||
*[[Meclizine]]<br> | |||
*[[Diphenhydramine]]<br> | |||
*[[Cyclizine]]<br> | |||
*[[Hydroxyzine]] | |||
|<br>25–50 mg q24 hours<br>25–50 mg q6–8 hours<br>25–75 mg q8 hours<br>25–100 mg q6–8 hours<br> | |||
| | |||
*[[Drowsiness]] | |||
*[[Blurred vision]] | |||
*[[Dry mouth]] | |||
*[[constipation]] | |||
*[[Urinary retention]] | |||
|- | |||
|'''[[Benzodiazepines]]''' | |||
| | |||
*[[Lorazepam]] | |||
*[[Alprazolam]] | |||
|0.5–2 mg <br>0.25–1 mg | |||
| | |||
*[[Ataxia]] | |||
*[[Cognitive dysfunction]] | |||
*[[Depression]] | |||
*[[Dizziness]] | |||
*[[Drowsiness]] | |||
*[[Dysarthria]] | |||
*[[Fatigue]] | |||
*[[Irritability]] | |||
*[[Memory impairment]] | |||
*[[Sedation]] | |||
|- | |||
|'''[[Corticosteroids]]''' | |||
| | |||
*[[Dexamethasone]]<br> | |||
|<br>4–8 mg q4–6 hours<br> | |||
| | |||
*Emotional instability | |||
*[[Acne]] | |||
*[[Bruising]] | |||
*[[Hyperglycemia]] | |||
*[[Adrenal suppression]] | |||
*[[Cushing’s syndrome]] | |||
|- | |||
|'''[[Butyrophenones]]''' | |||
| | |||
*[[Droperidol]]<br> | |||
|<br>0.625–1.25 mg q24hours<br> | |||
| | |||
*[[QTc prolongation]] | |||
*[[Orthostatic hypotension]] | |||
*[[Extrapyramidal symptoms]] | |||
*CNS effects | |||
|- | |||
|'''[[NK-1 Receptor Antagonists]]''' | |||
| | |||
*[[Aprepitant]]<br> | |||
|<br>80–125 mg q24 hours<br> | |||
| | |||
*[[Fatigue]] | |||
*[[Constipation]] | |||
*[[Hiccup]] | |||
|- | |||
|} | |||
==Do's== | ==Do's== | ||
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==Don'ts== | ==Don'ts== | ||
*Patient who is vomiting | *Patient who is vomiting continuously and also has past medical history of Diabetes corrected with Insulin should consult with their physicians before taking insulin as vomiting alters blood sugar levels. | ||
*Renal consultation should be acquired especially with severe hyponatremia | |||
==References== | ==References== |
Revision as of 19:11, 24 November 2020
Vomiting Resident Survival Guide |
---|
Overview |
Causes |
FIRE |
Diagnosis |
Treatment |
Do's |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.
For the WikiDoc page for this topic, click here
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes of vomiting include[1]:
- Head injury
- Bowel obstruction[2]
- Appendicitis[2]
- Meningitis
- Myocardial Infarction
- Brain tumor
- Pancreatitis
Common Causes
Common causes include: [3]
- Gastric outlet obstruction
- Small bowel obstruction
- Irritable bowel syndrome
- Pancreatic adenocarcinoma
- Hepatitis
- Cholecystitis
- Pancreatitis
- Crohn’s disease
- Gastroparesis
- Chronic intestinal pseudo-obstruction
- Post-operative nausea and vomiting
- CNS causes
- Migraine
- Increased intracranial pressure
- Congenital malformation
- Hydrocephalus
- Pseudotumor cerebri
- Seizure disorders
- Demyelinating disorders
- Infectious causes
- Labyrinthine disorders
- Motion sickness
- Labyrinthitis
- Tumors
- Meniere’s disease
- Iatrogenic
- Endocrinological and metabolic causes
- Miscellaneous causes
- Cardiac disease
- Radiofrequency ablation
- Starvation
- Cancer chemotherapy
- Radiation therapy
- Cardiovascular medications
- Antibiotics/Antivirals
- Ethanol Abuse
- Renal infection and renal stone
Diagnosis
Shown below is an algorithm summarizing the diagnosis of Vomiting
Patient comes with vomiting | |||||||||||||||||||||||||
Take complete history | |||||||||||||||||||||||||
Ask the following questions about vomiting ❑How long have you had nausea and vomiting? ❑How much have you vomitted? ❑What is the colour of the vomitus? ❑Have you had previous episodes like this or this is the first time? ❑Is there any foul smell of the vomitus? ❑Is there only food particle or any other mucous/substance present with the vomitus? ❑Have you notice any blood streaks mixed with vomitus? | |||||||||||||||||||||||||
Ask the related questions ❑Did your nausea and vomiting occur right after eating? ❑Do you have a fever? ❑Do you take any other medication ❑Have you recently eaten out? ❑Have you eaten any canned product? ❑Have you suffered from headache or photophobia along with this vomiting? ❑Did you have any abdominal pain? | |||||||||||||||||||||||||
Do general physical examination: ❑Look for signs of dehydration[4][5] *Look for sunken eyes[5] *Dry mouth/tongue, thirst[5] *Dry skin *Dizziness and a lack of focus[5] *Orthostatic blood pressure drop,tachycardia[5] *Light-headedness *Dark urine or decreased urine output *Increased capillary refill time[4] *Poor skin turgor *Tiredness *Appetite ❑ Perform abdominal examination *Look for any abdominal tenderness *Presence of bowel sound | |||||||||||||||||||||||||||||||||||||||||||||||||||||
If patient gives history of | |||||||||||||||||||||||||||||||||||||||||||||||||||||
History of ❑ Weight loss ❑Loss of appetite ❑Abdominal pain | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Gastroenteritis |
❑Photophobia ❑Triggered by smell, light or loud sound ❑Unilateral headache usually,maybe bilateral which stays for 2-3 days ❑May have history of taking wine, chocolate |
❑Dizziness ❑Altered behaviour ❑Vision chnages ❑Weakness of any part of body/ paralysis | |||||||||||||||||||||||||||||||||||||||||||||||||||
Migraine | Tumor | Metabolic disorder | Gastric malignancy | ||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is the treatment of Vomiting. [6]
Mechanism | Name | Dose | Side effects |
---|---|---|---|
5-HT3 antagonists | 4–8 mg q4–8 hours 1–2 mg q24 hours 0.075–0.25 mg q24 hours |
| |
Benzamides | 10–20 mg q6–8 hours 10 mg q8–24 hours |
| |
Phenothiazines | 5–10 mg q6–8 hours 12.5 –25 mg q4–6 hours 10–25 mg q4–6 hours 4–8 mg q8–12 hours |
| |
Cannabinoids | 2.5–10 mg q6–8 hours 1–2 mg q8–12 hours |
| |
Anticholinergics | 0.3–0.6 mg q24 hours |
||
Antihistamines | 25–50 mg q24 hours 25–50 mg q6–8 hours 25–75 mg q8 hours 25–100 mg q6–8 hours |
||
Benzodiazepines | 0.5–2 mg 0.25–1 mg |
||
Corticosteroids | 4–8 mg q4–6 hours |
| |
Butyrophenones | 0.625–1.25 mg q24hours |
||
NK-1 Receptor Antagonists | 80–125 mg q24 hours |
Do's
- Encourage patient to keep taking small sips of water frequently so that they don't become dehydrated.[7]
- Recommend patients to take sweet drink such as fruit juice for replacing lost sugar, although they should avoid sweet drinks if those make them feel sick.
- Recommend to have salty snacks, such as crisps, can help replace lost salt.
Don'ts
- Patient who is vomiting continuously and also has past medical history of Diabetes corrected with Insulin should consult with their physicians before taking insulin as vomiting alters blood sugar levels.
- Renal consultation should be acquired especially with severe hyponatremia
References
- ↑ Hayes B, Murtagh C, Mann GB (August 2008). "A case of life-threatening nausea and vomiting". J Pain Symptom Manage. 36 (2): 206–10. doi:10.1016/j.jpainsymman.2007.10.022. PMID 18495417.
- ↑ 2.0 2.1 Frese T, Klauss S, Herrmann K, Sandholzer H (February 2011). "Nausea and vomiting as the reasons for encounter in general practice". J Clin Med Res. 3 (1): 23–9. doi:10.4021/jocmr410w. PMC 3194022. PMID 22043268.
- ↑ Scorza K, Williams A, Phillips JD, Shaw J (July 2007). "Evaluation of nausea and vomiting". Am Fam Physician. 76 (1): 76–84. PMID 17668843.
- ↑ 4.0 4.1 "Adult Dehydration - StatPearls - NCBI Bookshelf".
- ↑ 5.0 5.1 5.2 5.3 5.4 Shaheen NA, Alqahtani AA, Assiri H, Alkhodair R, Hussein MA (December 2018). "Public knowledge of dehydration and fluid intake practices: variation by participants' characteristics". BMC Public Health. 18 (1): 1346. doi:10.1186/s12889-018-6252-5. PMC 6282244. PMID 30518346.
- ↑ 6.0 6.1 Singh P, Yoon SS, Kuo B (January 2016). "Nausea: a review of pathophysiology and therapeutics". Therap Adv Gastroenterol. 9 (1): 98–112. doi:10.1177/1756283X15618131. PMC 4699282. PMID 26770271.
- ↑ "Vomiting in adults | NHS inform".