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Nausea and vomiting

  • Common ddx

    • gastroenteritis, gallstone, pregnancy, labyrinthitis, otitis
  • Serious ddx

    • electrolyte abnormalities, appendicitis, pancreatitis, cholangitis, obstruction, ileus, intussusception, volvulus, CNS lesion, meningitis, DKA, kidney stone
  • Labs

    • CBC, chem
    • check anion gap, glc if diabetes
    • 3 way film including KUB if obstruction
    • US if gallbladder issue
    • head CT if unequal pupils, papilledema, or head trauma
    • abdominal CT if appendicitis
    • UA if suspect kidney stone
    • consider pregnancy test
    • consider surg consult and endoscopy
    • angiography if mesenteric ischemia
  • Symptomatic tx for nausea

    • 20 mL/kg IV bolus
    • Ondansetron (Zofran) 4-8 mg IV or PO
  • Other tx options

    • Promethazine 25 mg IM or PR q4-6hr
    • Metoclopramide 10 mg IV or IM q6-8hr
    • Meclizine 25 mg PO q6hr for vertigo
  • Pediatric dosing

    • ondansetron 0.15 mg/kg
    • promethazine 0.25-1 mg/kg IM or PR q4-6hr
    • metoclopramide 0.1mg/kg IV or IM q6-8hr
  • GI ddx

    • gastroenteritis, gastritis, PUD, gallstone, cholangitis, pancreatitis, appendicitis, bowel obstruction, ileus
  • Pediatric ddx

    • pyloric stenosis, intussusception, volvulus
  • Neuro ddx

    • migraines, concussion, meningitis, brain tumor, brain hematoma
  • Ear ddx

    • meniere's, labyrinthitis, otitis
  • Renal ddx

    • kidney stone, pyelonephritis, uremia
  • OB ddx

    • pregnancy, hyperemesis gravidarum, GTD
  • Other ddx

    • EtOH, drugs, chemo, strep throat
  • ROS

    • fever
    • rash
    • abdominal pain & location
    • headache, head trauma
    • melenemesis, hematemesis
    • abdominal pain, diarrhea, constipation, blood in stool
    • flank pain, dysuria, hematuria
    • pregnancy, missed menses
    • PMH diabetes, kidney stones
    • recent abdominal surgery
    • recent opiates, EtOH, new meds
    • foreign travel
  • Px

    • mental status
    • skin: jaundice, rash
    • pupils, papilledema
    • abdominal: inspection (distention, guarding), bowel sounds, palpation: pain, mass, rebound tenderness
    • Murphy sign (breathe in while RUQ deeply palpated)
    • psoas sign (right hip flexion)
    • CVA tenderness

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.