Nausea and vomiting: Difference between revisions
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{{Adult top}} [[nausea and vomiting (peds)]]. For nausea and vomiting during pregnancy, see [[hyperemesis gravidarum]].'' | <languages/> | ||
<translate> | |||
</translate> | |||
{{Adult top}} | |||
<translate> [[Special:MyLanguage/nausea and vomiting (peds)|nausea and vomiting (peds)]]. For nausea and vomiting during pregnancy, see [[Special:MyLanguage/hyperemesis gravidarum|hyperemesis gravidarum]].'' | |||
==Background== | ==Background== | ||
[[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]] | [[File:Nausea_and_vomiting.png|thumb|Nausea and Vomiting Algorithm]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Nausea and/or vomiting | *Nausea and/or vomiting | ||
*Additional features of underlying process | *Additional features of underlying process | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
</translate> | |||
{{Nausea and vomiting DDX}} | {{Nausea and vomiting DDX}} | ||
<translate> | |||
===By organ system=== | ===By organ system=== | ||
====GI==== | ====GI==== | ||
*[[Peptic ulcer disease]] | |||
*[[Bowel obstruction|Obstruction]] | *[[Special:MyLanguage/Peptic ulcer disease|Peptic ulcer disease]] | ||
*[[Special:MyLanguage/Bowel obstruction|Obstruction]] | |||
**Adhesion | **Adhesion | ||
**[[Small bowel obstruction]]/LBO | **[[Special:MyLanguage/Small bowel obstruction|Small bowel obstruction]]/LBO | ||
***[[SMA syndrome]] | ***[[Special:MyLanguage/SMA syndrome|SMA syndrome]] | ||
**Gastric outlet obstruction | **Gastric outlet obstruction | ||
**[[Gastric volvulus]] | **[[Special:MyLanguage/Gastric volvulus|Gastric volvulus]] | ||
**[[Bezoar]] | **[[Special:MyLanguage/Bezoar|Bezoar]] | ||
*[[Pancreatitis]] | *[[Special:MyLanguage/Pancreatitis|Pancreatitis]] | ||
*[[Gastroparesis]] | *[[Special:MyLanguage/Gastroparesis|Gastroparesis]] | ||
*[[Appendicitis]] | *[[Special:MyLanguage/Appendicitis|Appendicitis]] | ||
*[[Cholecystitis]] | *[[Special:MyLanguage/Cholecystitis|Cholecystitis]] | ||
*[[Cholangitis]] | *[[Special:MyLanguage/Cholangitis|Cholangitis]] | ||
*[[Acute Hepatitis]] | *[[Special:MyLanguage/Acute Hepatitis|Acute Hepatitis]] | ||
*[[IBD]] | *[[Special:MyLanguage/IBD|IBD]] | ||
*[[Intussusception]] | *[[Special:MyLanguage/Intussusception|Intussusception]] | ||
*Tumor | *Tumor | ||
*Strangulated [[hernia]] | *Strangulated [[Special:MyLanguage/hernia|hernia]] | ||
*[[Volvulus]] | *[[Special:MyLanguage/Volvulus|Volvulus]] | ||
*[[Mesenteric ischemia]] | *[[Special:MyLanguage/Mesenteric ischemia|Mesenteric ischemia]] | ||
*Esophageal disorders (e.g. [[achalasia]]) | *Esophageal disorders (e.g. [[Special:MyLanguage/achalasia|achalasia]]) | ||
*Functional disorders | *Functional disorders | ||
**Psychogenic | **Psychogenic | ||
**[[IBS]] | **[[Special:MyLanguage/IBS|IBS]] | ||
*[[Pyloric Stenosis]] | *[[Special:MyLanguage/Pyloric Stenosis|Pyloric Stenosis]] | ||
====Neurologic==== | ====Neurologic==== | ||
*[[Head injury]] | |||
*[[CVA]] | *[[Special:MyLanguage/Head injury|Head injury]] | ||
*[[Idiopathic intracranial hypertension]] | *[[Special:MyLanguage/CVA|CVA]] | ||
*[[Hydrocephalus]] | *[[Special:MyLanguage/Idiopathic intracranial hypertension|Idiopathic intracranial hypertension]] | ||
*[[Intracranial mass|Mass lesion]] | *[[Special:MyLanguage/Hydrocephalus|Hydrocephalus]] | ||
*[[Meningitis]] | *[[Special:MyLanguage/Intracranial mass|Mass lesion]] | ||
*[[Migraine]] | *[[Special:MyLanguage/Meningitis|Meningitis]] | ||
*[[Labyrinthitis]] | *[[Special:MyLanguage/Migraine|Migraine]] | ||
*[[Meniere's disease]] | *[[Special:MyLanguage/Labyrinthitis|Labyrinthitis]] | ||
*[[Motion sickness]] | *[[Special:MyLanguage/Meniere's disease|Meniere's disease]] | ||
*[[Cannabinoid hyperemesis syndrome]] | *[[Special:MyLanguage/Motion sickness|Motion sickness]] | ||
*[[Special:MyLanguage/Cannabinoid hyperemesis syndrome|Cannabinoid hyperemesis syndrome]] | |||
====Infectious==== | ====Infectious==== | ||
*[[Bacteria]]l toxins | |||
*[[Pneumonia]] | *[[Special:MyLanguage/Bacteria|Bacteria]]l toxins | ||
*[[SBP]] | *[[Special:MyLanguage/Pneumonia|Pneumonia]] | ||
*[[UTI]] | *[[Special:MyLanguage/SBP|SBP]] | ||
*Viruses ([[adenovirus]], [[norovirus]], [[rotavirus]]) | *[[Special:MyLanguage/UTI|UTI]] | ||
*Viruses ([[Special:MyLanguage/adenovirus|adenovirus]], [[Special:MyLanguage/norovirus|norovirus]], [[Special:MyLanguage/rotavirus|rotavirus]]) | |||
====Drugs/Toxins==== | ====Drugs/Toxins==== | ||
*Toxic doses | *Toxic doses | ||
**[[Digoxin toxicity]] | **[[Special:MyLanguage/Digoxin toxicity|Digoxin toxicity]] | ||
**[[Aspirin toxicity]] | **[[Special:MyLanguage/Aspirin toxicity|Aspirin toxicity]] | ||
**[[Acetaminophen toxicity]] | **[[Special:MyLanguage/Acetaminophen toxicity|Acetaminophen toxicity]] | ||
**[[Ipecac toxicity]] | **[[Special:MyLanguage/Ipecac toxicity|Ipecac toxicity]] | ||
*[[NSAIDs]] | *[[Special:MyLanguage/NSAIDs|NSAIDs]] | ||
*[[Opioids]] | *[[Special:MyLanguage/Opioids|Opioids]] | ||
*[[Alcohol]] | *[[Special:MyLanguage/Alcohol|Alcohol]] | ||
*[[Anticonvulsants]] | *[[Special:MyLanguage/Anticonvulsants|Anticonvulsants]] | ||
*[[Antibiotics]] | *[[Special:MyLanguage/Antibiotics|Antibiotics]] | ||
*[[Antiarrhythmics]] | *[[Special:MyLanguage/Antiarrhythmics|Antiarrhythmics]] | ||
*Toxins | *Toxins | ||
**[[Organophosphates]] | **[[Special:MyLanguage/Organophosphates|Organophosphates]] | ||
**[[Carbon monoxide]] | **[[Special:MyLanguage/Carbon monoxide|Carbon monoxide]] | ||
**[[Ricin]] | **[[Special:MyLanguage/Ricin|Ricin]] | ||
*[[Acute radiation syndrome]] | *[[Special:MyLanguage/Acute radiation syndrome|Acute radiation syndrome]] | ||
====Endocrine==== | ====Endocrine==== | ||
*[[Pregnancy]], [[hyperemesis gravidarum]] | |||
*[[Hyponatremia]] | *[[Special:MyLanguage/Pregnancy|Pregnancy]], [[Special:MyLanguage/hyperemesis gravidarum|hyperemesis gravidarum]] | ||
*[[Adrenal insufficiency]] | *[[Special:MyLanguage/Hyponatremia|Hyponatremia]] | ||
*[[DKA]] | *[[Special:MyLanguage/Adrenal insufficiency|Adrenal insufficiency]] | ||
*[[Thyroid]]/parathyroid disorders | *[[Special:MyLanguage/DKA|DKA]] | ||
*[[Uremia]] | *[[Special:MyLanguage/Thyroid|Thyroid]]/parathyroid disorders | ||
*[[Special:MyLanguage/Uremia|Uremia]] | |||
====Miscellaneous==== | ====Miscellaneous==== | ||
*[[ACS]] | |||
*[[Ovarian torsion|ovarian]]/[[testicular torsion]] | *[[Special:MyLanguage/ACS|ACS]] | ||
*[[Nephrolithiasis]] | *[[Special:MyLanguage/Ovarian torsion|ovarian]]/[[Special:MyLanguage/testicular torsion|testicular torsion]] | ||
*[[Special:MyLanguage/Nephrolithiasis|Nephrolithiasis]] | |||
*Pain | *Pain | ||
*[[Acute angle-closure glaucoma]] | *[[Special:MyLanguage/Acute angle-closure glaucoma|Acute angle-closure glaucoma]] | ||
*[[Anorexia nervosa]]/[[bulimia nervosa]] | *[[Special:MyLanguage/Anorexia nervosa|Anorexia nervosa]]/[[Special:MyLanguage/bulimia nervosa|bulimia nervosa]] | ||
*[[Depression]] | *[[Special:MyLanguage/Depression|Depression]] | ||
==Evaluation== | ==Evaluation== | ||
''Varies widely depending on clinical presentation'' | ''Varies widely depending on clinical presentation'' | ||
*CBC | *CBC | ||
*Chemistry | *Chemistry | ||
*Urine pregnancy | *Urine pregnancy | ||
*[[LFTs]] | *[[Special:MyLanguage/LFTs|LFTs]] | ||
*Lipase | *Lipase | ||
*APAP, ASA, digoxin levels | *APAP, ASA, digoxin levels | ||
*[[Urinalysis]] | *[[Special:MyLanguage/Urinalysis|Urinalysis]] | ||
*?[[Abdominal xray]] | *?[[Special:MyLanguage/Abdominal xray|Abdominal xray]] | ||
*?CT | *?CT | ||
*?[[Ultrasound]] | *?[[Special:MyLanguage/Ultrasound|Ultrasound]] | ||
==Management== | ==Management== | ||
*Treat underlying pathology | *Treat underlying pathology | ||
*Address [[electrolyte derangements]] and [[dehydration]] as needed | *Address [[Special:MyLanguage/electrolyte derangements|electrolyte derangements]] and [[Special:MyLanguage/dehydration|dehydration]] as needed | ||
*[[Antiemetics]] | *[[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> | *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> | ||
==Disposition== | ==Disposition== | ||
*Depends on cause | *Depends on cause | ||
*Most non-specific episodes of acute nausea and vomiting may be discharged, if: | *Most non-specific episodes of acute nausea and vomiting may be discharged, if: | ||
**No emergent/urgent cause identified or suspected | **No emergent/urgent cause identified or suspected | ||
**Patient tolerating fluids after treatment | **Patient tolerating fluids after treatment | ||
==Complications== | ==Complications== | ||
*[[Hypovolemia]] | |||
*[[Metabolic alkalosis]] | *[[Special:MyLanguage/Hypovolemia|Hypovolemia]] | ||
*[[Hypokalemia]] | *[[Special:MyLanguage/Metabolic alkalosis|Metabolic alkalosis]] | ||
*[[Mallory-Weiss]] (tear) | *[[Special:MyLanguage/Hypokalemia|Hypokalemia]] | ||
*[[Boerhaave]] (rupture) | *[[Special:MyLanguage/Mallory-Weiss|Mallory-Weiss]] (tear) | ||
*[[Special:MyLanguage/Boerhaave|Boerhaave]] (rupture) | |||
*Aspiration | *Aspiration | ||
==See Also== | ==See Also== | ||
*[[Nausea and vomiting (peds)]] | |||
*[[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]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Symptoms]] | [[Category:Symptoms]] | ||
</translate> | |||
Latest revision as of 23:47, 4 January 2026
This page is for adult patients. For pediatric patients, see:
nausea and vomiting (peds). For nausea and vomiting during pregnancy, see hyperemesis gravidarum.
Background
Clinical Features
- Nausea and/or vomiting
- Additional features of underlying process
Differential Diagnosis
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
By organ system
GI
- Peptic ulcer disease
- Obstruction
- Adhesion
- Small bowel obstruction/LBO
- Gastric outlet obstruction
- Gastric volvulus
- Bezoar
- Pancreatitis
- Gastroparesis
- Appendicitis
- Cholecystitis
- Cholangitis
- Acute Hepatitis
- IBD
- Intussusception
- Tumor
- Strangulated hernia
- Volvulus
- Mesenteric ischemia
- Esophageal disorders (e.g. achalasia)
- Functional disorders
- Psychogenic
- IBS
- Pyloric Stenosis
Neurologic
- Head injury
- CVA
- Idiopathic intracranial hypertension
- Hydrocephalus
- Mass lesion
- Meningitis
- Migraine
- Labyrinthitis
- Meniere's disease
- Motion sickness
- Cannabinoid hyperemesis syndrome
Infectious
Drugs/Toxins
- Toxic doses
- NSAIDs
- Opioids
- Alcohol
- Anticonvulsants
- Antibiotics
- Antiarrhythmics
- Toxins
- Acute radiation syndrome
Endocrine
- Pregnancy, hyperemesis gravidarum
- Hyponatremia
- Adrenal insufficiency
- DKA
- Thyroid/parathyroid disorders
- Uremia
Miscellaneous
- ACS
- ovarian/testicular torsion
- Nephrolithiasis
- Pain
- Acute angle-closure glaucoma
- Anorexia nervosa/bulimia nervosa
- Depression
Evaluation
Varies widely depending on clinical presentation
- CBC
- Chemistry
- Urine pregnancy
- LFTs
- Lipase
- APAP, ASA, digoxin levels
- Urinalysis
- ?Abdominal xray
- ?CT
- ?Ultrasound
Management
- Treat underlying pathology
- Address electrolyte derangements and dehydration as needed
- Antiemetics
- Inhaled isopropyl alcohol (sniffing an alcohol wipe) has been shown to reduce mild to moderate nausea and vomiting[1]
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
- Hypovolemia
- Metabolic alkalosis
- Hypokalemia
- Mallory-Weiss (tear)
- Boerhaave (rupture)
- Aspiration
See Also
External Links
References
- ↑ Lindblad AJ, Ting R, Harris K. Inhaled isopropyl alcohol for nausea and vomiting in the emergency department. Can Fam Physician. 2018;64(8):580.