INTESTINAL GAS AND VOMITING

what are the 3 things that are considered intestinal gas?

eructation (burping), bloating, and flatulence (farting)

what causes intestinal gas?

minor disruptions of normal physiologic processes or gi flora

what types of food ingredients can cause gas?

dietary sugars, complex carbohydrates, and indestible oligosccharides

what are common symptoms of gas?

excessive belching, abdominal discomfort, abdominal cramping, bloating, and farting

what are exclusions for self treatment of gas?

symptoms that persist more than several days or occur often, sudden change in abdominal pain, increase in frequency, an onset in patients older than 40, abdominal discomfort, change in bowel function, diarrhea, constipation

what is the treatment goal for treating gas?

reduce frequency, intenstiy, and duration of gas

what is non pharmacologic treatment for gas?

avoid gas producing foods, dont rush while eating and chew food thoroughly, avoid overeating, avoid tight fit clothing, avoid lying down after eating, keep food diary

what is simethicone? is it prescription or non prescription?

it is a non prescription medicine that works as a defoaming agent and is in many antacid products

does simethicone reduce or prevent gas?

no it just makes you pass gas 

what does a-galactidose do in terms of gas?

it works as a preventative medication for gas 

when should you administer a-galactidose?

with your first bite of food

what are probiotics used for in terms of gas?

they are non prescription and help with gas

what are possible complications of nausea/vomiting?

dehydration, esophageal tears, aspirations, malnutrition, electrolyte acid base imblance, diaphragmatic herniation, and mallory weiss syndrome

what is the treatment goal for nausea and vomiting?

provide symptomatic relief, identify and correct underlying cause, prevent and correct current complications, and prevent future occurences

what is the treatment approach for nausea and vomiting?

determine if patient can self treat, obtain medical history such as diet medication and family history and then recommend interventions such as prescription or non prescription

what are exclusions for self treatment for nausea and vomiting?

urine ketones, suspected food poisoning, severe abdominal pain in middle or right quadrant, yellow skin/eye and dark urine, stiff neck with or without headache, head injury with n/v, blurry vision, glaucoma, breastfeeding or pregnancy

what are exclusions for self treament in n/v for children?

severe dehydration or caregiver unable/unwillng to manage at home

what is the mechanism of motion sickness?

overstimulation of labyrinth apparatus (responsible for maintaining equilibrium)

what is used to prevent motion sickness?

antiemetics because it targets acetylcholine and histamine 

what are used to treat motion sickness?

antihistamines

which 2 antihistamines are used to treat motion sickness?

meclizine (bonine) and dimenhydrinate (dramamine)

what are side effects of meclizine (bonine) and dimenhydrinate (dramamine)?

dry mouth, dizziness, tremors, constipation, drowsiness

what is a benefit of using meclizine?

it is less sedating

what are drugs you should not take with meclizine or dimenhydrinate?

cns depressants

what are things to do to prevent motion sickness?

avoid reading during travel, focus the line of vision straight ahead, avoid excess food before and during travel, stay where motion is least experienced, avoid strong odors, drive the vehicle

what should be given for nausea and vomiting in pregnancy?

doxylamine, dimenhydrinate, or pyridoxine

what is the dosing for pyridoxine and doxylamine as sometimes they are taken together?

10-25 mg three times daily of pyridoxine and 10 mg three times daily of doxylamine

what are 2 non pharmacotherapy things that can help with nausea and vomiting in pregnancy?

ginger and accupressure

what are things you can do to prevent nausea and vomiting?

eat several dry crackers and relax for 10-15 mins, avoid fluids or soups at meaks, sip carbonated beverages or fruit juice, avoid greasy, fatty, spicy, and acidic foods, eat food that is chilled, eat dry bland high protein foods

how does overeating cause sickness?

you have gut distention and decreased gi emptying which leads to the stimulation of mechanoreceptors

what are symptoms of overeating?

heartburn, indigestion, upset stomach 

what can be given to help with overeating?

dextrose, levulose, phosphoric acid

what are the mechanisms of dextrose, levulose, and phopshoric acid?

they act on the gi tract wall to decrease smooth muscle contraction which delays gastric emptying time

what is acute viral gastroenteritis?

inflammation of stomach and small intestine and presents with acute vomiting and diarrhea

what are signs of dehydration in kids?

dry mouth and tongue, sunken and dry eyes, dark urine, thirst, fast heartbeat, weight loss

when is oral rehydration therapy used?

it is used for dehydration with vomiting or diarrhea

what is the minimal hydration amount after a vomiting episode for children under 10 kg? what about over 10 kg

60-120 ml and 120-140 ml 

what is mild-moderate dehydratoin in children?

50-100 ml/kg over 3-4 hours

what should you do for severe dehydration?

go to ed for iv fluid replacement

what % of fluids lost in the first 24 hours should adults get replaced?

replace 30-50% of fluids lost in the first 24 hours

when should oral rehydration therapy be offered?

it should be offered 10 minutes after last episode of vomiting

how many ml of oral rehydration therapy should be offered to children and how much for adults?

5 ml every 5 min for children and 15 ml every 5 min for older children and adults

what is a non pharmacological therapy for n/v that you can buy at the store? how should it be dosed?

ginger, dose 250 mg qid

how should accupressure be used for n/v?

p6 point on either wrist or wear a wristband for 10 min three times a day or continously

which aromtherapys help with n/v?

peppermint oil and isopropyl alcohol

whats another name for simethicone?

gas x

what is the dosing for simethicone? for ages 2-12?

40 mg po four times a day after meals as needed

what is the dosing for simethicone for kids under 2?

20 mg four times a day after meals at bedtime

what is the dosing of simethicone in adults 12 years and up?

40-360 mg fourt times a day after meals at night as needed. max 500 mg per day 

what are the directions for using simethicone?

shake before use, mix with a little other liquid as possible, may take directly into mouth without diluting in other liquids. when giving to an infant take toward cheek to avoid spitting out.

what is 2 important counseling points for simethicone?

take after meals and avoid carbonated drinks and gas producing foods

what is the moa for simethicone?

defoaming agent that reduces surface tension of gas bubbles in gi

what are important counseling points for meclizine and dimenhydrinate?

more effective if taken 30-60 minutes prior to anticipated motion sickness, can take daily, avoid alcohol and cns depressants, caution in elderly patients