Nausea and vomiting: Difference between revisions

(Created page with "==Complications== 1) Hypovolemia 2) Metabolic alkalosis 3) Hypokalemia 4) Mallory-Weiss (tear) 5) Boerhaave (rupture) 6) Aspiration ==DDX== ===Critical=== Boerhaav...")
 
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==Complications==
<languages/>
<translate>
</translate>{{AdultPage|nausea and vomiting (peds)}}
{{AdultPregnancyPage|hyperemesis gravidarum}}
<translate>


==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


1) Hypovolemia
=== Non-GI Causes ===


2) Metabolic alkalosis
==== CNS ====
* Increased Intracranial Pressure (ICP):
** Meningitis/encephalitis
** Mass lesion
** Pseudotumor cerebri
** CVA/TIA
* Vestibular:
** Labyrinthitis
** Meniere's
* Other:
** Migraine
** Seizure


3) Hypokalemia
==== Toxic/Metabolic ====
* Metabolic:
** Acidosis
** Uremia
* Medications:
** Opiates
** Antibiotics
** Chemotherapy
** AED
* Toxins:
** EtOH
** Illicit substances


4) Mallory-Weiss (tear)
==== Stressor ====
* Severe Illness:
** MI
** Sepsis
* Other:
** Pain
[[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]]


5) Boerhaave (rupture)


6) Aspiration
==Clinical Features==


*Nausea and/or vomiting
*Additional features of underlying process


==DDX==


==Differential Diagnosis==


===Critical===
</translate>
{{Nausea and vomiting DDX}}
<translate>




Boerhaave
===By organ system===


Ischemic bowel


ICH
====GI====


Meningitis
*[[Special:MyLanguage/Peptic ulcer disease|Peptic ulcer disease]]
*[[Special:MyLanguage/Bowel obstruction|Obstruction]]
**Adhesion
**[[Special:MyLanguage/Small bowel obstruction|Small bowel obstruction]]/LBO
***[[Special:MyLanguage/SMA syndrome|SMA syndrome]]
**Gastric outlet obstruction
**[[Special:MyLanguage/Gastric volvulus|Gastric volvulus]]
**[[Special:MyLanguage/Bezoar|Bezoar]]
*[[Special:MyLanguage/Pancreatitis|Pancreatitis]]
*[[Special:MyLanguage/Gastroparesis|Gastroparesis]]
*[[Special:MyLanguage/Appendicitis|Appendicitis]]
*[[Special:MyLanguage/Cholecystitis|Cholecystitis]]
*[[Special:MyLanguage/Cholangitis|Cholangitis]]
*[[Special:MyLanguage/Acute Hepatitis|Acute Hepatitis]]
*[[Special:MyLanguage/IBD|IBD]]
*[[Special:MyLanguage/Intussusception|Intussusception]]
*Tumor
*Strangulated [[Special:MyLanguage/hernia|hernia]]
*[[Special:MyLanguage/Volvulus|Volvulus]]
*[[Special:MyLanguage/Mesenteric ischemia|Mesenteric ischemia]]
*Esophageal disorders (e.g. [[Special:MyLanguage/achalasia|achalasia]])
*Functional disorders
**Psychogenic
**[[Special:MyLanguage/IBS|IBS]]
*[[Special:MyLanguage/Pyloric Stenosis|Pyloric Stenosis]]


DKA


AMI
====Neurologic====


Sepsis
*[[Special:MyLanguage/Head injury|Head injury]]
*[[Special:MyLanguage/CVA|CVA]]
*[[Special:MyLanguage/Idiopathic intracranial hypertension|Idiopathic intracranial hypertension]]
*[[Special:MyLanguage/Hydrocephalus|Hydrocephalus]]
*[[Special:MyLanguage/Intracranial mass|Mass lesion]]
*[[Special:MyLanguage/Meningitis|Meningitis]]
*[[Special:MyLanguage/Migraine|Migraine]]
*[[Special:MyLanguage/Labyrinthitis|Labyrinthitis]]
*[[Special:MyLanguage/Meniere's disease|Meniere's disease]]
*[[Special:MyLanguage/Motion sickness|Motion sickness]]
*[[Special:MyLanguage/Cannabinoid hyperemesis syndrome|Cannabinoid hyperemesis syndrome]]




===Emergent===
====Infectious====


*[[Special:MyLanguage/Bacteria|Bacteria]]l toxins
*[[Special:MyLanguage/Pneumonia|Pneumonia]]
*[[Special:MyLanguage/SBP|SBP]]
*[[Special:MyLanguage/UTI|UTI]]
*Viruses ([[Special:MyLanguage/adenovirus|adenovirus]], [[Special:MyLanguage/norovirus|norovirus]], [[Special:MyLanguage/rotavirus|rotavirus]])


Gastric outlet obstruction


Pancreatitis
====Drugs/Toxins====


Cholecystitis
*Toxic doses
**[[Special:MyLanguage/Digoxin toxicity|Digoxin toxicity]]
**[[Special:MyLanguage/Aspirin toxicity|Aspirin toxicity]]
**[[Special:MyLanguage/Acetaminophen toxicity|Acetaminophen toxicity]]
**[[Special:MyLanguage/Ipecac toxicity|Ipecac toxicity]]
*[[Special:MyLanguage/NSAIDs|NSAIDs]]
*[[Special:MyLanguage/Opioids|Opioids]]
*[[Special:MyLanguage/Alcohol|Alcohol]]
*[[Special:MyLanguage/Anticonvulsants|Anticonvulsants]]
*[[Special:MyLanguage/Antibiotics|Antibiotics]]
*[[Special:MyLanguage/Antiarrhythmics|Antiarrhythmics]]
*Toxins
**[[Special:MyLanguage/Organophosphates|Organophosphates]]
**[[Special:MyLanguage/Carbon monoxide|Carbon monoxide]]
**[[Special:MyLanguage/Ricin|Ricin]]
*[[Special:MyLanguage/Acute radiation syndrome|Acute radiation syndrome]]


Bowel obstruction/ileus


Ruptured viscus
====Endocrine====


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


Peritonitis


Migraine
====Miscellaneous====


CNS tumor
*[[Special:MyLanguage/ACS|ACS]]
*[[Special:MyLanguage/Ovarian torsion|ovarian]]/[[Special:MyLanguage/testicular torsion|testicular torsion]]
*[[Special:MyLanguage/Nephrolithiasis|Nephrolithiasis]]
*Pain
*[[Special:MyLanguage/Acute angle-closure glaucoma|Acute angle-closure glaucoma]]
*[[Special:MyLanguage/Anorexia nervosa|Anorexia nervosa]]/[[Special:MyLanguage/bulimia nervosa|bulimia nervosa]]
*[[Special:MyLanguage/Depression|Depression]]


raised ICP


Adrenal insuffciency
==Evaluation==


Hyperemesis gravidarum
''Varies widely depending on clinical presentation''
*CBC
*Chemistry
*Urine pregnancy
*[[Special:MyLanguage/LFTs|LFTs]]
*Lipase
*APAP, ASA, digoxin levels
*[[Special:MyLanguage/Urinalysis|Urinalysis]]
*?[[Special:MyLanguage/Abdominal xray|Abdominal xray]]
*?CT
*?[[Special:MyLanguage/Ultrasound|Ultrasound]]


Tylenol


Digoxin
==Management==


ASA
*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>


Theophyline


Gonadal torsion
==Disposition==


CO
*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


Electrolyte disorder


==Complications==
 
===Nonemergent===
 
 
Gastritis
 
Gastroparesis
 
PUD
 
Gastroenteritis
 
Biliary colic
 
Hepatitis
 
Thyroid
 
Pregnancy
 
Erythromycin
 
Ibuprofen
 
Chemotherapy
 
Narcotics/wdwl from
 
ETOH
 
UTI
 
Renal colic


Motion sickness
*[[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


Labyrinthitis


==See Also==


==Source ==
*[[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]]




12/06 DONALDSON (adapted from Rosen)
==External Links==




==References==


<references/>


[[Category:GI]]
[[Category:GI]]
[[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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