Cyclic vomiting syndrome: Difference between revisions
ClaireLewis (talk | contribs) (Created page with "==Background== *Recurrent episodes of vomiting, otherwise normal health in between *32% of patients disabled by illness by time of diagnosis<ref>Fleisher DR, Gornowicz B,...") |
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*May be on medications typically used for migraine prophylaxis | *May be on medications typically used for migraine prophylaxis | ||
*Abortive [[antiemetics]] therapy | *Abortive [[antiemetics]] therapy | ||
**[[Ondansetron]]- works better with | **[[Ondansetron]]- works better with [[benzos]] or [[diphenhydramine]] | ||
**[[Promethazine]], [[prochlorperazine]] | **[[Promethazine]], [[prochlorperazine]] | ||
**Triptans (e.g. [[sumatriptan]]) | **Triptans (e.g. [[sumatriptan]]) | ||
Revision as of 15:30, 5 September 2019
Background
- Recurrent episodes of vomiting, otherwise normal health in between
- 32% of patients disabled by illness by time of diagnosis[1]
- Pathophysiology not well understood
- Average age at onset ~21yo
- Females slightly more affected than males
- Marijuana use is risk factor
Clinical Features
- Pediatric diagnostic criteria[2]
- At least 5 episodes or minimum of 3 over 6 mo
- Nausea/vomitingepisodes lasting 1hr-10d, with 1 week in between
- Stereotypical pattern and symptoms
- Return to baseline health in between
- Symptoms not due to another condition
- Adult – Rome III criteria [3]
- Stereotypical episodes of vomiting with acute onset lasting less than 1 week.
- At least 3 episodes per year.
- No nausea/vomiting between episodes.
- Symptoms not due to another cause
- Symptoms usually begin in early morning or upon waking
- Prodrome of nausea--> vomiting
- Episodes peak/decline over ~8h
- Nausea typically not relieved by vomiting
- +/-
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
Evaluation
- Clinical diagnosis of exclusion
- Evaluate for alternate etiologies
- Assess for dehydration, electrolyte abnormalities if clinically warranted
Management
- Avoid triggers
- Many patients have known triggers, such as diet, psychological stressors, sleep deprivation, cannabis, or infection.
- May be on medications typically used for migraine prophylaxis
- Abortive antiemetics therapy
- Ondansetron- works better with benzos or diphenhydramine
- Promethazine, prochlorperazine
- Triptans (e.g. sumatriptan)
- Supportive therapy
Disposition
See Also
External Links
References
- ↑ Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005 Dec 21. 3:20.
- ↑ Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008 Sep. 47(3):379-93.
- ↑ Venkatasubramani N, Venkatesan T, Li BUK. Extreme Emesis: Cyclic Vomiting Syndrome. Practical Gastroenterology. September 2007. 31:21-34.