Nausea / Vomiting

Anyone with nausea or vomiting may not be allowed inside a building without a Covid Test. But some patients need to be seen no matter what; every office or clinic has its own mechanism, maybe in a designated exam room, maybe sending them to an Urgent Care or E.R.  If there are no other symptoms besides nausea or vomiting, Covid-19 is very unlikely. The rest of this topic assumes Covid is not a possibility.

1.  Determine if there’s Dehydration (give IV fluids if significant)

  • Not urinating in 6-8 hours (12-24 hours is severe)
  • Pulse rate rises from lying down to abrupt standing (see Postural Vital Signs)
  • ALERT — If dehydrated patient improves with rehydration (IV fluids), must maintain close follow-up to be sure there’s no subsequent worsening. See Precautionary Tale.

2.  Seek Clues to Underlying Cause of N/V by history & exam:

If looks sick / confused, & not dehydrated (or no improvement with IV fluids)  โ†’ we send to E.R.
xxxx** Needs same-day work-up, see #4 below

3.ย  Diagnosis if no significant symptom or clue except N/V:

  • Day #1 of N/V:  Gastroenteritis (“Staphylococcal food poisoning”)
  • Day #2 of N/V:  Gastroenteritis due to Rotavirus /  Norovirus
  • Day #3, if diarrhea becomes prominent, most likely Rotavirus / Norovirus.  BUTโ€ฆ

4.  >3 Days of N/V, and no / hardly any diarrhea  โ†’ needs Work-Up

>>ย  Treatment Trial: high-dose Proton Pump Inhibitor (PPI)ย  [presumed Ulcer / Gastritis]

5. Follow-Up in 1-2 weeks (call sooner if above tests abnormal)

If no Diagnosis from above tests:

  • If symptoms resolved — lower PPI dose & treat for 8 wks.
  • If Weight LossAbdominal CT Scan and/or Endoscopy
  • Ongoing N/V, No Weight Loss, PPI no help   โ†’ likely Psychological cause
    • Seek clues to Bulimia: erosion of tooth enamel, swelling of parotid glands, calluses on the back of the hand (from self-induced vomiting) [see link]

See Nausea / Vomiting โ€” Full Text for more in-depth explanations and discussions.

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