Nausea/Vomiting

Common Causes of Nausea and Vomiting

• Motion sickness

• “Morning sickness” in pregnancy (NVP)

• Acute viral gastroenteritis

• “Upset stomach” from overeating, overdrinking, or eating the wrong thing

Motion Sickness is Most Common in _____

Children 2 to 15 years old

Morning Sickness Occurs in What Percent of Pregnant Patients?

70%-80%

When During Pregnancy Does Morning Sickness Typically Occur?

9 to 16 weeks

When During Pregnancy Does Morning Sickness Typically Resolve?

22 weeks

What is Acute Viral Gastroenteritis?

Inflammation of the stomach and small intestines

Common Causes of Acute Viral Gastroenteritis?

Rotavirus and norovirus

What Types of Stimuli Cause Nausea?

• Visceral (gut)

• Vestibular (inner ear) loci

• Chemoreceptor trigger zone (brain) or CTZ

What Mediates Visceral (Gut) Stimuli?

Serotonin and Dopamine

Which Type of Stimuli is Related to the Body’s Motion and Position?

Vestibular (inner ear) loci

What Mediates Vestibular (Inner Ear) Loci Stimuli?

Histamine Type 1 Receptors and Acetylcholine

What Mediates Chemoreceptor Trigger Zone (Brain) or CTZ Stimuli?

Serotonin and dopamine

Vomiting is Mediated by the _____

Autonomic nervous system

Vomiting Occurs After _____

Detection of emetic agents in the blood by chemosensitive receptors

What is Nausea?

Subjective feeling of the need to vomit

What is Vomiting?

• AKA emesis

• Rapid, forceful expulsion of GI tract contents

Acute Complications of Vomiting

• Dehydrations

• Electrolyte imbalances

Exclusions to Self Treatment of Nausea and Vomiting in Children

• Signs of dehydration

  • Restlessness or irritability

  • Tachycardia

  • Dry mouth

  • Sunken or dry eyes

  • Sunken fontanelle

  • Decreased urine output

  • Thirst

  • Absence of tears when crying

• Stiff neck

• Vomiting with each feeding

• Projectile vomiting

• Vomiting occurs with recurrent, severe, acute abdominal pain

Exclusions to Self Treatment of Nausea and Vomiting in Adults

• Severe abdominal pain in the middle or right lower quadrant

• Nausea and vomiting with fever and/or diarrhea

• Severe right upper quadrant pain (gallbladder)

• Blood in the vomitus

• Stiff neck with or without headache

• Head injury with nausea and vomiting, blurry vision, or numbness and tingling

• Pregnancy (severe symptoms)

• Drug Induced

Active Ingredient(s) of Commercial Oral Rehydration Solutions

Sodium, chloride, potassium, citrate, and a carbohydrate

Use of Oral Rehydration Solutions

Dehydration associated with nausea and vomiting

What Defines Minimal Dehydration?

Lose <3% of body weight

Oral Rehydration Solution Dosing for Children <10 kg with Minimal Dehydration

60 to 120 mL of solution after each vomiting episode

Oral Rehydration Solution Dosing for Children >10 kg with Minimal Dehydration

120 to 240 mL of solution after each vomiting episode

What Defines Moderate Dehydration?

Lose between 3% and 9% of body weight

Oral Rehydration Solution Dosing for Children with Mild to Moderate Dehydration

50 to 100 mL/kg over 3 to 4 hours

What Defines Severe Dehydration?

Lose >9% of body weight

Oral Rehydration Solution Dosing for Children with Severe Dehydration

Must refer patient, cannot self treat

Oral Rehydration Solution Dosing or Adults

Gauge amount according to thirst

Common Brand Name of Oral Rehydration Solutions

Pedialyte

When Should Oral Rehydration Solutions Be Given?

10 minutes after the last episode of vomiting

• Allows time for the body to calm down

How Should Oral Rehydration Solutions Be Given?

In small increments

• Children - 5 mL every 5 minutes

• Older children and adults - 15 mL every 5 minutes

Are Sports Drinks, Sodas, and Fruit Juices Recommended for Rehydration?

No

• They do not have the proper electrolyte balance for rehydration

  • e.g. the sugar:sodium ratio is 3:1 in Pedialyte and 15:1 in Gatorade

Nonpharmacologic Ways to Prevent Motion Sickness

• Avoid reading using travel

• Avoid excess food or alcohol before travel

• Sit where motion is least experienced

  • Front of car

  • Near wings of airplane

  • Middle of ship

• Drive the vehicle if possible

Nonpharmacologic Treatment of Morning Sickness

• Eat frequent small meals

• Avoid spicy or fatty foods

• Crackers, high-protein snacks

Pharmacologic Treatment of Motion Sickness

First generation antihistamines (ones that make you drowsy)

Common First Generation Antihistamines

• Meclizine

• Dimenhydrinate

• Diphenhydramine

Adverse Reactions of First Generation Antihistamines

• Dry mouth

• Confusion

• Dizziness

• Constipation

• Drowsiness

Which First Generation Antihistamine Makes You the Least Drowsy?

Meclizine

When Should You Take First Generation Antihistamines?

At least 30-60 minutes before travel, then take regularly for the duration of travel

What Patients Should Avoid First Generation Antihistamines?

• Pediatric patients

  • Especially under 6, cause paradoxical excitation

• Geriatric patients

  • Fall risks

• Lactating patients

  • May affect the milk supply

Generic Name of Bonine

Meclizine

Generic Name of Dramamine

Dimenhydrinate

Generic Name of Benadryl

Diphenhydramine