R11
DESCRIPTION
There are many possible causes of nausea and vomiting.
Some important causes to exclude are:
- gastro-intestinal disease
- alcohol abuse
- liver disease
- early pregnancy
- renal failure
- medicines
Establish if the vomiting is associated with:
- abdominal pain
- headache
- diarrhoea
- constipation
GENERAL MEASURES
- Maintain adequate hydration with clear fluids. See: Diarrhoea.
- In children, do not stop feeds for more than 1 hour. Restart feeds in smaller and more frequent amounts.
- Exclude pregnancy in women of child bearing age.
MEDICINE TREATMENT
Children
Do not use anti-emetics. Give small volumes of fluids more frequently.
Adults
- Metoclopramide, IM/IV, 10 mg 8 hourly, or
OR
- Metoclopramide, oral, 10 mg 8 hourly
REFERRAL
Urgent
- Severe dehydration.
- Severe pain.
- Shock.
- Wasting.
- Diabetes.
- Jaundice.
- Clinical features of sepsis.
- Associated abdominal tenderness with guarding and rebound tenderness.
- Signs of intestinal obstruction i.e. no stool or flatus passed.
- Infants with projectile vomiting or vomiting everything.
- Vomiting with digested or fresh blood present.