Nausea and vomiting
This page is for adult patients. For pediatric patients, see: nausea and vomiting (peds).
Background
Nausea and Vomiting Algorithm
Clinical Features
- Nausea and/or vomiting
- Additional features of underlying process
Differential Diagnosis
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Acetaminophen toxicity
- Adrenal insufficiency
- Appendicitis
- Aspirin toxicity
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Digoxin toxicity
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
- Theophylline toxicity
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Disulfiram effect
- Erythromycin
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Ibuprofen
- Ipecac toxicity
- Labyrinthitis
- Migraine
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
GI
- Peptic ulcer disease
- Obstruction
- Adhesion
- Small bowel obstruction/LBO
- SMA syndrome
- 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
- Bacterial toxins
- Pneumonia
- SBP
- UTI
- Viruses (adenovirus, norovirus, rotavirus)
Drugs/Toxins
- Toxic doses
- NSAIDs
- Opioids
- Alcohol
- Anticonvulsants
- Antibiotics
- Antiarrhythmics
- Toxins
- Organophosphates
- Carbon monoxide
- Ricin
- Acute radiation syndrome
Endocrine
- Pregnancy, hyperemesis gravidarum
- Hyponatremia
- Adrenal insufficiency
- DKA
- Thyroid/parathyroid disorders
- Uremia
Miscellaneous
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
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
References
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