Nausea and Vomiting

Nausea and Vomiting

• History Taking: Important to ask about medications, frequency of vomiting, the nature of vomitus, past medical and surgical history, and symptoms such as abdominal pain, dizziness, headache, weakness, and any specific triggers.
• Physical Examination: Should include an abdominal examination and neurological signs (e.g., eye movements, nystagmus, cerebellar signs).

Common Causes and Treatments:

• Medications and Toxins: Post-chemotherapy/radiation, medications like ASA, NSAIDs, digoxin, hormones, ARVs, theophylline can induce nausea/vomiting. Management includes discontinuing the offending agent when possible and treating symptoms.
• Infectious Causes: Virtually anything from GI infections to neurologic infections, tropical diseases, or sepsis.
• GI Causes: Such as gut obstruction, peptic ulcer, IBS, peritonitis, hepatitis, pancreatitis, cholecystitis, appendicitis.
• Neurological Causes: Migraine, seizure, increased intracranial pressure (IICP), stroke, head trauma, hydrocephalus.
• Vestibular Causes: Motion sickness, labyrinthitis, Meniere's disease, BPPV.
• Psychiatric Causes: Anxiety, anorexia.
• Metabolic Causes: Uremic or hepatic encephalopathy, DKA, electrolyte imbalance, pregnancy.
• Others: Pain-related nausea (post-operative, myocardial infarction, acute glaucoma).

Management Strategies:

1. Correct hydration, electrolyte imbalance, and nutrition.
2. Treat the specific life-threatening cause and provide supportive symptom management.
3. Neurotransmitter-targeted Drug Recommendations:

• Dopamine receptor blockers for gastroenteritis and post-operation nausea: Metoclopramide (Plasil®) 10 mg IV or PO (watch for EPS), Domperidone (Motilium®) 10 mg PO before meals 1-2 tabs three times daily.
• Serotonin receptor blockers for severe cases: Ondansetron (Onsia®) 4-8 mg IV or PO (Max 32 mg/day). Around-the-clock administration may be needed for persistent symptoms, particularly in post-operative or chemotherapy-induced nausea.

Hiccups

• Causes: Can be transient and resolve spontaneously or indicate an underlying condition like gastric distention, infection, neurological disorders, metabolic imbalances, or even psychiatric conditions.
• Management:
• Correct the specific cause when identified (e.g., PPIs for GERD).
• For persistent hiccups without a clear cause, simple maneuvers such as breath holding, Valsalva, or swallowing water might help.
• Pharmacological intervention: Metoclopramide 10 mg IV can be considered.

In both conditions, identifying and treating the underlying cause is crucial, alongside symptomatic treatment to alleviate discomfort.