phmd 202b nausea and vomiting

what are the main causes of N&V?

GI tract disorders (obstruction, GI irritants, infection, peritoneal irritation, motility) and CNS disorders (vestibular disorder, intercranial pressure, migraine HA, CTZ irritation, infection)

when do you refer patients to a doctor?

if they have severe N&V with pregnancy, are taking medications that cause the N&V, have other medical conditions that can react poorly to OTC antiemetics, signs/symptoms of disease, and head injury

what are the symptoms of dehydration in kids?

restlessness/irritability, rapid/deep breathing, tachycardia, dry mouth and tongue, sunken and or dry eyes, sunken fontanelle, decreased urine output, dark urine, thirst, absence of tears, decreased skin turgor, prolonged capillary refill in fingertip after release of a gentle squeeze, weight loss.

what are the exclusions of self treatment in kids?

signs of severe dehydration, unable to manage childs N&V at home, refusal to drink fluids, decrease body weight, lack of urination, persistent vomiting, vomiting after head injury, suspected poisoning, vomiting after recurrent sever acute abdominal pain, diabetes, CNS disease, hernia

what can you do to combat motion sickness in a car?

drive or sit in front and look out the window

what can you do to combat motion sickness on a boat?

sit midship

what can you do to combat motion sickness on a plane?

sit over the wings

what are some examples of antihistamines for motion sickness?

meclizine (antivert), cyclizine (bonine for kids), dimenhydrinate (dramamine), diphenhydramine (benadryl)

when is it best to take anithistamines for motion sickness and what effects can they have?

before the activity; can have anticholinergic and sedative effects

what OTCs can you use for N&V that occurs because of overeating?

antacids and H2 blockers → help with heartburn!

how is phosphorated carbohydrate solution (emetrol) given?

15-30ml every 15 mins until distress subsides, but not more than 5 doses in an hour

caution in people that have diabetes or fructose intolerance

what are some examples of nonpharmacological treatments for N&V of pregnancy?

take multivitamins starting at least one month before pregnancy

eat crackers in bed before getting up and get up slowly

eat dry toast or crackers before breakfast

eat multiple small meals

try carbonated drinks/fruit juices for nausea

no rich greasy foods!

what are some examples of OTCs for N&V of pregnancy?

pyridoxamine (vit B6): first line!, high doses can limit prolactin secretion

doxylamine: can be used as adjunct therapy to pyridoxamine and can be sedating!

use ginger or acupressure!

if lactating: bismuth subsalicylate alternatives are preferred!

what are some concerns for recommending OTCs for eldery patients?

antihistamines: can cause sedative effects!!

sugar solution (PCS) can be used but make sure the pt does not have uncontrolled blood glucose

not recommended to use pacemakers and acupressure bands together!

what is the preferred form for rehydration for kids?

pedialyte!!!!!!!

dont use sports drinks b/c they have alot of sugar

preferred ratio sugar to sodium is 3:1, but most sports drinks are 15:1

how would you rehydrate a patient who is <10kg and has minimal dehydration?

60-120ml after each vomiting episode

how would you rehydrate a patient if they weigh more than 10 kg and have minimal dehydration?

120-240ml after each vomiting episode

how would you rehydrate a child who has mild to moderate dehydration?

for all kids: 50-100ml/kg every 3-4h

try to replace 30-50% of fluid lost in the first 24h

• 5ml every 5 mins to kids less than 10 kg

• 15 ml every 5 mins for older kids (over 10 kg) and adults