NAUSEA AND VOMITING
Nausea and vomiting are not diseases, but rather are symptoms of many different conditions, such as infection (“stomach flu”), food poisoning, motion sickness, overeating, blocked intestine, illness, concussion or brain injury, appendicitis and migraines.
Simple causes of vomiting are:
• Alimentary disorders, irritation, inflammation or
mechanical disturbances at any level of GI tract.
• Central nervous system—Increased intracranial pressure, stroke, migraine, infection, toxins and
• Endocrine disorders—Diabetic acidosis, adreno-
cortical crisis, pregnancy, starvation, lactic acidosis. • Drugs—Morphine, Meperidine, Codeine, anticancer
• Psychological disorders—Reaction to pain, fear or
displeasure, chronic anxiety reaction, anorexia nervosa, psychosis.
i Simple acute vomiting following dietary or alco- holic indiscretion or during morning sickness of early pregnancy do not require much of treatment.
-Withhold foods temporarily and give 5 to 10 per cent Dextrose saline solution IV.
-Avoid lukewarm beverages.
-Antiemetics, i.e. Perinorm, Emidoxyn, Avomin are better for preventing vomiting.
-Sedatives alone or with anticholinergic may be helpful with psychogenic vomiting.
-Domperidone is better as it has no parkinsonian side effects.
ii. If symptomatic Injection Perinorm IM.
Injection Stemetil 12.5 mg IM.
Injection Metachlorpramide (Reglan) 10 mg IV or IM.
Tablet Perinorm or Domperidone one tds
Tablet Eskazine 1 mg tds.
Withhold food temporarily and start IV fluids 5 per cent Dextrose or Ringer’s lactate or Glucose saline to correct dehydration.
iii. Eradicate the cause
-If psychogenic vomiting sedatives alone or with
anticholinergics. Injection Phenargan IM.
-If vomiting is following chemotherapy or radiotherapy then tab Oncoden 4-8 mg tds Injection 2 mg/ml.
-If vomiting is green coloured(bilious),if vomit is associated with abdominal distension and colicky pains then suspect ,intestinal obstruction and refer the pagient to a surgeon.
– In a female patient,rule out early pregnancy.
-If there is no nausea, but vomiting ,headache & fever ,rule out meningitis.