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.
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