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
- General - Cardamom, Ginger and Crushed Ice.
- Prokinetic - PERINORM 10MG (Metoclopramide), DOMSTAL 10mg TDS (Domeperidone), Cisapride,Mosapride, Itopride.
- For drug induced vomiting and post op vomiting (Chemo,HCQ,Levofloxacin, Antiviral) - ONDANSETRON 4MG TDS
- 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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