View source for Cyclic vomiting syndrome

==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, 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.</ref>
*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<ref>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.</ref>
**At least 5 episodes or minimum of 3 over 6 mo
**[[Nausea and vomiting (peds)|Nausea/vomiting]]episodes 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 <ref>Venkatasubramani N, Venkatesan T, Li BUK. Extreme Emesis: Cyclic Vomiting Syndrome. Practical Gastroenterology. September 2007. 31:21-34.</ref>
**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
*+/-
**[[Abdominal pain]]
**[[Diarrhea]]
**[[Fever]]
**[[Headache]]
**[[Vertigo]]

==Differential Diagnosis==
{{Nausea and vomiting DDX}}

==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
**[[IVF]] with [[dextrose]]
**Place in quiet, dark room +/- sedative

==Disposition==
*If symptoms can be controlled, may discharge
*For intractable vomiting unable to be controlled with medications, admit

==See Also==
*[[Cannabinoid hyperemesis syndrome]]

==External Links==


==References==
<references/>
[[Category:GI]]