Nausea and vomiting (peds): Difference between revisions
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==Disposition== | ==Disposition== | ||
*If self-limited etiology | |||
**Well appearing | |||
**Tolerating fluids | |||
**Close follow-up as outpatient | |||
*If dangerous etiology or unclear | |||
**IV access | |||
**Continuing resuscitation | |||
**Admit for treatment and/or observation | |||
==See Also== | ==See Also== | ||
Revision as of 01:17, 13 December 2015
Background
- Broad differential: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, Behavioral
- If ill appearing, establish rapid IV access, or if needed IO.
- Rapid finger stick blood sugar
- Point of care pH and electrolytes (iSTAT)
Clinical Features
Differential Diagnosis
| Newborn | |
| Obstructive intestinal anomalies | Esophageal stenosis/atresia, pyloric stenosis, intestinal stenosis/atresia, malrotation ± volvulus, incarcerated hernia, meconium ileus/plug, Hirschsprung disease, imperforate anus, enteric duplications |
| Neurologic | Intracranial bleed/mass, hydrocephalus, cerebral edema, kernicterus |
| Renal | Urinary tract infection, obstructive uropathy, renal insufficiency |
| Infectious | Viral illness, gastroenteritis, meningitis, sepsis |
| Metabolic/endocrine | Inborn errors of metabolism (urea cycle, amino/organic acid, carbohydrate), congenital adrenal hyperplasia |
| Miscellaneous | Ileus, gastroesophageal reflux, necrotizing enterocolitis, milk allergy, GI perforation |
| Infant (<12 mo) | |
| Obstructive intestinal anomalies | Pyloric stenosis, malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, enteric duplications, intussusception, foreign body, bezoars, Meckel diverticulum |
| Neurologic | Intracranial bleed/mass, hydrocephalus, cerebral edema |
| Renal | Urinary tract infection, obstructive uropathy, renal insufficiency |
| Infectious | Viral illness, gastroenteritis, meningitis, sepsis, otitis media, pneumonia, pertussis, hepatitis |
| Metabolic/endocrine | Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis |
| Miscellaneous | Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose |
| Child (>12 mo) | |
| Obstructive intestinal anomalies | Malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, intussusception, foreign body, bezoars, Meckel diverticulum, acquired esophageal stricture, peptic ulcer disease, adhesions, superior mesenteric artery syndrome |
| Neurologic | Intracranial bleed/mass, cerebral edema, postconcussive, migraine |
| Renal | Urinary tract infection, obstructive uropathy, renal insufficiency |
| Infectious | Viral illness, gastroenteritis, meningitis, sepsis, otitis media, pneumonia, hepatitis, streptococcal pharyngitis |
| Metabolic/endocrine | Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis, diabetes mellitus, Reye syndrome, porphyria |
| Miscellaneous | Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose, appendicitis, pancreatitis, gastritis, Crohn disease, pregnancy, psychogenic, cyclic vomiting syndrome |
Diagnosis
Management
- Largely depends on etiology
Disposition
- If self-limited etiology
- Well appearing
- Tolerating fluids
- Close follow-up as outpatient
- If dangerous etiology or unclear
- IV access
- Continuing resuscitation
- Admit for treatment and/or observation