Nausea and Vomiting

 Definitions

Nausea - feeling like vomiting

Vomiting - Forceful expulsion of gastric contents through the mouth.

Regurgitation - involuntary backflow of gastric contents.

Retching - forceful contraction of abdomen but no content comes out.

Common causes

  • Gastritis, Gastroenteritis, Infection with fever, food poisoning
  • Motion Sickness
  • Pregnancy
  • Migraine, MI, Appendicitis, Biliary Colic.

Differential diagnosis

  • Loose motions
  • Alcohol,NSAID, steroid, spicy food
  • Fever - Meningitis
  • Amenorrhea
  • Pain in Abdomen
  • Vertigo, Headache
  • Severe Diabetes
  • Surgical Abdoemen - Peritonitis, Perforation, etc.

General Treatment

  1. General - Cardamom, Ginger and Crushed Ice.
  2. Prokinetic - PERINORM 10MG (Metoclopramide), DOMSTAL 10mg TDS (Domeperidone), Cisapride,Mosapride, Itopride.
  3. For drug induced vomiting and post op vomiting (Chemo,HCQ,Levofloxacin, Antiviral) - ONDANSETRON 4MG TDS
  4. Motion Sickness - PROMETHAZINE 25mg 1/2 tab before travel (Phenargan) and Dicyclomine.

Treatment of different case scenarios

1. Gastritis + Vomiting

  • Tab DOMSTAL 10MG TDS
  • ANTACID GEL OR DIGENE GEL 10ML TDS
  • Tab Pantoprazole 40mg BD

2.Migraine/Giddiness + Vomiting

  • Tab STEMETIL 5MG TDS (Prochlorperazine)
  • Tab STUGERON 25MG TDS (Cinnarizine)
  • Tab VERTIN 8MG TDS or 16MG TDS (Betahistine)

3.Pregnancy + Vomiting

  • Tab Vit B6 (Pyridoxine) 6mg - 30mg OD
  • In hyperemesis gravidarum - Tab ONDEM 4MG 1-1-1

Very important ideas 

  • Most common causes of vomiting is Infection
  • If Nausea >> Vomiting then it's most likely a systemic cause.
  • If Vomiting >> Nausea, then most likely it's a GI cause.
  • Worry if severe headache, perspiration.

*Reference - Youtube video posted on Clinical Guruji YT channel - Nausea and Vomiting.

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