Nausea / Vomiting

1.ย  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) ๐Ÿกช we send to E.R.
xxxx** Needs same-day work-up, see #4 below

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

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

4.ย  >3 Days of N/V, and no / hardly any diarrhea ๐Ÿกช 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 helpย  ๐Ÿกช likely Psychological cause
    • Seek clues to Bulimia: erosion of tooth enamel, swelling of parotid glands, calluses on the back of the hand

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

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