Nausea / Vomiting

Assess Hydration & Tx IV if significant Sx:
  • ↓ Urine Output (inquire); Urine specific gravity >1.030
  • Postural Vital Signs  (↑ pulse occurs before ↓ BP)
Seek Clues to Diagnosis by H&P:
  • Diarrhea  [gastroenteritis]
  • Fever  [pneumonia, pyelo, other infection]
  • Abdominal pain [use as key Sx for differential & W/U]
  • Missed Menses  [pregnancy]
  • Melena  [ulcer]
  • Prominent “Other Sx” (e.g. HA, etc) [use it to structure Dif Dx]
Empiric Dx if no Key Sx except N/V:
  • Day #1 of N/V:  Staph Gastroenteritis
  • Day #2 of N/V:  Rotavirus /  Norovirus Gastroenteritis

>2 Days of N/V (& no diarrhea):  consider Basic Work-Up

  • Urine Pregnancy Test
  • CBC (for infections)
  • Urinalysis (for  (for pyelo)
  • Full Chemistry Panel (for many possible causes *)
  • Lipase (for pancreatitis)
  • Rx high-dose Proton Pump Inhibitor (presumed gastric cause)
  • Follow-Up for results in 1-2 weeks
On Follow-Up  —  Weigh
  • If Sx better, lower PPI dose & Tx for 8 wks.
  • If wt. loss: Abd. CT &/or Endoscopy
  • Ongoing N/V and No Wt. Loss or other Dx:   Functional
    • Seek mood Sx
    • Seek clues to Bulemia: erosion of tooth enamel, parotid enlargement, calluses on the back of the hand

* possible causes of isolated N/V identified by Chemistry Panel

  • Hepatitis
  • Renal / Liver Failure
  • Electrolyte Abnormalities
  • Hypercalcemia
  • Diabetes

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