Nausea and vomiting
  • Thorough history and clinical examination needed
  • Symptoms have many causes — range from easily treatable to serious and life-threatening
  • Must identify and treat cause — see Acute assessment of nausea and vomiting

Ask

  • Medical history — frequent vomiting, migraine, abdominal surgery, other serious illness, eg diabetes, CKD
  • Treatments already tried and response
  • How long and how often have been vomiting, amount of vomit, colour and content of vomit
  • Other symptoms — diarrhoea, pain, fever, headache, photophobia (sensitive to light)
  • Ability/interest in taking fluids, urine production — check for dehydration
  • Problems swallowing — do food or liquids get stuck in throat

Check

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL

Do first

  • Medical consult if
    • Moderate/severe dehydration — to consider IV fluids
    • Ketones — diabetic ketoacidosis (DKA)
    • Abnormal electrolytes
    • If severe unresponsive vomiting

Do

  • Mild dehydration — oral fluids
  • Treat with fluids without medicines if uncomplicated
  • Monitor response to treatment

Medicines — adult

  • Antiemetics — Table 7.14
    • Be alert for oculogyric crisis

Medicines — child

  • Medical consult before giving antiemetic to child
    • The younger the child — the harder to find cause and higher the risk of severe dehydration
  • If dehydration — see Fluids for treating dehydration
  • Gastroenteritis — usually vomiting and diarrhoea. Unlikely if vomiting alone especially with significant pain

Table 7.14   Commonly used antiemetics

* Medical consult before giving to children

**Oculogyric crisis

Metoclopramide, prochlorperazine and promethazine can cause an oculogyric crisis

  • Symptoms include stiffness, bending back of head, grimace, twisting back, rolling eyes up
  • Do not use in Parkinson's disease
  • Can happen at any age — more common in children and young women
  • Give benzatropine IM/IV — adult 1mg, child 20microgram/kg/dose up to 1mg — doses — single dose
  • Urgent medical consult