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:
- Correct hydration, electrolyte imbalance, and nutrition.
- Treat the specific life-threatening cause and provide supportive symptom management.
- 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.