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?<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>}}
❑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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{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 52em; width: 30em; padding:1em;"> '''Do general [[physical examination]]:'''<br>
{{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
❑'''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> *Orthostatic blood pressure drop,tachycardia<ref name="pmid30518346">{{cite journal
}}</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<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 turgor<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>}}
}}</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 | | | | | | | B01 | | | |B01= If patient gives history of}}
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{{familytree  | |,|-|-|-|-|-|+|-|-|-|-|-|v|-|-|-|-|.| | }}
{{familytree  | |,|-|-|-|-|-|+|-|-|-|-|-|v|-|-|-|-|.| | }}
{{familytree  | |!| | | | | |!| | | | | |!| | | | |!| | | }}
{{familytree  | |!| | | | | |!| | | | | |!| | | | |!| | | }}
{{familytree  | D01 | | | D02 | | | | | D04 | | | D05 |D01=<div style="float: left; text-align: left; height: 15em; width: 15em; padding:1em;"> '''History of'''<br>
{{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 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: 15em; width: 15em; padding:1em;"> '''History of'''<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<br><br>❑Photophobia<br><br>
[[Headache]]</div>|D03=D03|D04=<div style="float: left; text-align: left; height: 10em; width: 10em; padding:1em;"> '''History of'''<br>
Sensitivity to sound or smell<br><br> </div>|D03=D03|D04=D04|D05=D05}}
----
❑ [[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 an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
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>
{{familytree/start |summary=PE diagnosis Algorithm.}}
{| class="wikitable" style="margin: 1em auto 1em auto"
{{familytree | | | | | | | | A01 |A01= }}
|+'''[[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>
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
!Mechanism
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}
!Name||Dose||Side effects
{{familytree | | | |!| | | | | | | | | |!| }}
|-
{{familytree | | | C01 | | | | | | | | |!| |C01= }}
|'''[[5-HT3 antagonists]]'''
{{familytree | |,|-|^|.| | | | | | | | |!| }}
|<br>
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}
 
{{familytree | |!| | | | | | | | | |,|-|^|.| }}
*[[Ondansetron]]<br>
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}
*[[Granisetron]]
{{familytree | | | | | | | | | | |!| | | | |!| }}
*[[Palonosetron]]
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}
|<br>4–8 mg q4–8 hours<br>1–2 mg q24 hours<br>0.075–0.25 mg q24 hours<br>
{{familytree/end}}
|
*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==

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]:

Common Causes

Common causes include: [3]

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?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Record the vitals:

Blood pressure

Weight

Body Mass Index

❑Temperature

❑Heart rate

❑Respiratory rate
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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

❑ Abdominal pain

❑ Eating out or eating reheated canned food

❑ Abdominal bloating

❑Passage of loose stool

 
 
History of

Headache
 
 
 
 
History of

Acidosis

Dehydration

 
 
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]

Medications used to treat Nausea and 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

  1. 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. 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.
  3. 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. 4.0 4.1 "Adult Dehydration - StatPearls - NCBI Bookshelf".
  5. 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. 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.
  7. "Vomiting in adults | NHS inform".


Template:WikiDoc Sources


References