Vomiting resident survival guide

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Resident Survival Guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

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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.


Life Threatening Causes

Life-threatening causes of vomiting include[1]:

Common Causes

Common causes include: [3]


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


Body Mass Index


❑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]


*Dark urine or decreased urine output

*Increased capillary refill time[4]

*Poor skin turgor



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

History of



History of

❑ Weight loss

❑Loss of appetite

❑Abdominal pain

❑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


❑Altered behaviour

❑Vision chnages

❑Weakness of any part of body/ paralysis

Metabolic disorder
Gastric malignancy


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

10–20 mg q6–8 hours
10 mg q8–24 hours

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

2.5–10 mg q6–8 hours
1–2 mg q8–12 hours
0.3–0.6 mg q24 hours
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
4–8 mg q4–6 hours
0.625–1.25 mg q24hours
NK-1 Receptor Antagonists
80–125 mg q24 hours


  • 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.


  • 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


  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.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  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.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  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.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  4. 4.0 4.1 "Adult Dehydration - StatPearls - NCBI Bookshelf".<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  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.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  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.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  7. "Vomiting in adults | NHS inform".<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>

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