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Vomiting, Adult

Vomiting, Adult is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 3 phases:
    • Nausea: Unpleasant sensation prior to vomiting
    • Retching: Rhythmic contractions of diaphragm, abdominal muscles, intercostals that bring gastric contents up the esophagus
    • Vomiting: Forceful retrograde expulsion of gastric contents through the mouth
  • Vomiting center in medulla coordinates vomiting through vagus, phrenic, spinal nerves
  • Irritated by impulses from the GI tract, pharynx, vestibular system, heart, genitalia, or via stimulation of chemoreceptor trigger zone (CTZ) in the area postrema of the brain by medications, toxins, or hormones in circulation
  • CTZ response mediated by dopamine D2, serotonin (5-HT3), cholinergic, and histamine receptors:
    • Medications providing symptomatic treatment of vomiting antagonize these receptors

Etiology

  • GI:
    • Appendicitis
    • Boerhaave syndrome
    • Bowel obstruction or ischemia
    • Cholecystitis, biliary colic
    • Gastric outlet obstruction, gastroparesis
    • Gastritis
    • Gastroenteritis (e.g., infectious)
    • GI bleeding
    • Hepatitis
    • Inflammatory bowel disease
    • Pancreatitis
    • Peptic ulcer disease, dyspepsia
    • Perforated viscus
    • Peritonitis
  • Neurologic:
    • Elevated intracranial pressure (ICP)
    • Intracranial blood
    • Labyrinthitis, vertigo
    • Meningitis
    • Migraine
    • Stroke
    • Tumor
  • Endocrine:
    • Adrenal insufficiency
    • Diabetic ketoacidosis (DKA)
    • Hypoparathyroid, hyperparathyroid
    • Hypothyroid, hyperthyroid
    • Uremia
  • Pregnancy:
    • Hyperemesis gravidarum
    • Nausea/vomiting of pregnancy
  • Drug toxicity:
    • Acetaminophen
    • Aspirin
    • Digoxin
    • Theophylline
  • Therapeutic medication use:
    • Antibiotics
    • Aspirin
    • Chemotherapy
    • Ibuprofen
  • Drugs of abuse:
    • Narcotics/narcotic withdrawal
    • Alcohols
  • Genitourinary:
    • Gonadal torsion
    • Nephrolithiasis
    • UTI/pyelonephritis
  • Miscellaneous:
    • Carbon monoxide or organophosphate poisoning
    • Electrolyte disorders
    • Glaucoma
    • Motion sickness
    • Myocardial infarction/ischemia (MI)
    • Pain
    • Post-procedural (after anesthesia)
    • Self-induced (eating disorders)
    • Sepsis/shock

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Citation

Rosen, Peter, et al., editors. "Vomiting, Adult." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307629/all/Vomiting__Adult.
Vomiting, Adult. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307629/all/Vomiting__Adult. Accessed April 26, 2019.
Vomiting, Adult. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307629/all/Vomiting__Adult
Vomiting, Adult [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307629/all/Vomiting__Adult.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Vomiting, Adult ID - 307629 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307629/all/Vomiting__Adult PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -