Nausea and vomiting

Background

Nausea and Vomiting Algorithm

Differential Diagnosis

Nausea and vomiting

Critical

• ACS/MI
• Boerhaave's
• DKA
• Intracranial Hemorrhage
• Ischemic bowel
• Meningitis
• Sepsis

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
• Hyperemesis gravidarum
• Pancreatitis
• Peritonitis
• Ruptured viscus
• Testicular torsion/ovarian torsion
• Theophyline toxicity

Nonemergent

• Biliary colic
• Cannabinoid hyperemesis syndrome
• Chemotherapy
• Disulfiram effect
• Erythromycin
• ETOH
• Gastritis
• Gastroenteritis
• Gastroparesis
• Hepatitis
• Ibuprofen
• Labyrinthitis
• Migraine
• Motion sickness
• Narcotic withdrawal
• Thyroid
• Pregnancy
• Peptic ulcer disease
• Renal colic
• UTI

By organ system

GI

• Peptic ulcer disease
• Obstruction
  • Adhesion
  • Small bowel obstruction/LBO
    • SMA syndrome
  • Gastric outlet obstruction
  • 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
• Pseudotumor
• Hydrocephalus
• Mass lesion
• Meningitis
• Migraines
• Labyrinthitis
• Meniere disease
• Motion sickness
• Cannabinoid hyperemesis syndrome

Infectious

• Bacterial toxins
• pneumonia
• SBP
• UTI
• Viruses (adeno, norwalk, rota

Drugs/Toxins

• Toxic doses
  • Digoxin
  • ASA
  • APAP
• NSAIDs
• Opiates
• ETOH
• Anticonvulsants
• Antibiotics
• Antiarrhythmics
• Toxins
  • Organophosphates
  • CO
  • Ricin
• Acute radiation syndrome

Endocrine

• Pregnancy
• Hyponatremia
• Adrenal insufficiency
• DKA
• Thyroid/parathyroid disorders
• Uremia

Miscellaneous

• ACS
• Gonadal torsion
• Nephrolithiasis
• Pain
• Acute glaucoma
• Anorexia/bulimia
• Depression

Evaluation

Work-Up

• CBC
• Chemistry
• Urine pregnancy
• LFTs
• Lipase
• APAP, ASA, digoxin levels
• Urinalysis
• ?Abdominal xray
• ?CT
• ?Ultrasound

Complications

• Hypovolemia
• Metabolic alkalosis
• Hypokalemia
• Mallory-Weiss (tear)
• Boerhaave (rupture)
• Aspiration

See Also

• Nausea and vomiting (peds)

References

Authors

Ross Donaldson, Jordan Swartz, Daniel Ostermayer, Neil Young, Claire, Meagan Mackey