Nausea and vomiting (peds): Difference between revisions
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==Background== | ==Background== | ||
*Broad differential: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, Behavioral | *Broad differential: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, Behavioral | ||
==Clinical Features== | ==Clinical Features== | ||
Line 72: | Line 69: | ||
==Management== | ==Management== | ||
*Largely depends on etiology | *Largely depends on etiology | ||
*If ill appearing, establish rapid IV access, or if needed IO. | |||
**Rapid finger stick blood sugar | |||
** Point of care pH and electrolytes (iSTAT) | |||
==Disposition== | ==Disposition== |
Revision as of 04:40, 14 December 2015
Background
- Broad differential: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, Behavioral
Clinical Features
- Assess general appearance and behavior
- Evaluate volume status
- Abdominal and genitourinary examinations are important for potential surgical causes
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
- Significantly dehydrated if has 2 or more of the following (LR+ 6.1, CI:3.8-9.8)[1]
- Prolonged capillary refill (>2 sec)
- Dry mucous membranes
- Absence of tears
- Abnormal overall appearance
Management
- Largely depends on etiology
- If ill appearing, establish rapid IV access, or if needed IO.
- Rapid finger stick blood sugar
- Point of care pH and electrolytes (iSTAT)
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
External Links
Pediatric Emergency Playbook -- Vomiting in the Young Child: Nothing or Nightmare
References
- ↑ Gorelick MH et al. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997; 99(5):E6