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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.

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