Nausea and Vomiting (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Nausea and vomiting facts
- Introduction to nausea and vomiting
- What causes nausea or vomiting?
- Acute gastritis and nausea and vomiting
- Central causes of nausea and vomiting
- Nausea and vomiting associated with illness
- Nausea and vomiting from medications and medical treatments
- Nausea and vomiting and bowel obstruction
- Nausea and vomiting in pregnancy (morning sickness)
- Vomiting in infants
- What are home remedies for nausea or vomiting?
- When should I call the doctor regarding nausea and vomiting?
- How is the source of nausea or vomiting diagnosed?
- What is the treatment for nausea and vomiting?
How is the source of nausea or vomiting diagnosed?
Diagnosis often can be made when the health care professional takes a careful history and performs a physical examination. Any tests that need to be ordered will be based on the direction from the history and physical exam, and sometimes no further testing is required to make the diagnosis.
Laboratory tests and X-rays may be ordered to assess the stability of the patient and not necessarily to make the diagnosis. For example, a patient with food poisoning may need blood tests ordered to measure the electrolytes and other chemicals, since the patient may lose significant amounts of sodium, potassium, and chloride from the body from persistent vomiting and diarrhea.
Urinalysis may be helpful in assessing hydration status. Concentrated, dark urine is associated with dehydration because the kidneys try to preserve as much water as possible in the body. Ketones in the urine are also a sign of dehydration.
What is the treatment for nausea or vomiting?
Nausea and vomiting can be treated with medication at the same time as the search for the underlying diagnosis is being carried out. Ideally, these symptoms should resolve when the underlying illness is treated and controlled.
Nausea and vomiting are often made worse when the patient is dehydrated, resulting in a vicious cycle. The nausea makes it difficult to drink fluid, making the dehydration worse, which then increases the nausea. Intravenous fluids may be provided to correct this issue and break the cycle.
There are a variety of anti-nausea medications (antiemetics) that may be prescribed. They can be administered in different ways depending upon the patient's ability to take them. Medications are available by pill, liquid, or tablets that dissolve on or under the tongue, by intravenous or intramuscular injection, or by rectal suppository.
Common medications used to control nausea and vomiting include:
- promethazine (Phenergan),
- prochlorperazine (Compazine),
- droperidol (Inapsine)
- metoclopramide (Reglan), and
- ondansetron (Zofran).
The decision as to which medication to use will depend on the patient's condition.
REFERENCE: Tintinalli J, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th edition. McGraw-Hill Professional 2010
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