management of nausea/vomiting by etiology

Management

• cerebral cortex
  • increased intracranial pressure -> dexamethasone
  • anxiety -> lorazepam (Ativan)
• vestibular apparatus
  • initial opioid effect -> scopolamine patch
  • vestibular disease -> meclizine (Antivert)
• vomiting center
  • pain -> diphenhydramine (Benadryl)
  • visceral stimuli
    • scopolamine patch
    • ondansetron (Zofran)
• chemoreceptor trigger zone (CTZ)
  • etiology
    • medications
      • digoxin, theophylline, opioids, chemotherapy, antibiotics, others
    • hypercalcemia
    • uremia
  • management
    • discontinue or adjust medications
    • pharmaceutical agents
      • promethazine (Phenergan)
      • haloperidol (Haldol)
      • droperidol (Inapsine)
      • ondansetron (Zofran) ?
• gastric distention due to medications (GI irritants) i.e. NSAIDs, iron supplements, alcohol, antibiotics
  • adjust or discontinue medications
  • substitute trilisate
• gastric damage due to tumor infiltration or radiation injury
  • dexamethasone
• infection
  • Candida esophagitis -> fluconazole (Diflucan)
  • Clostridium colitis -> metronidazole (Flagyl)
• poor motility
  • constipation
    • stimulant/bulk combination (Senokot, Pericolace)
  • obstruction
    • metoclopramide (Reglan)
    • octreotide (Sandostatin)
• intrinsic pressure
  • ascites
    • diuretic (spironolactone)
    • paracentesis

More general terms

• management

Additional terms

• nausea
• vomiting