What is the treatment for a patient experiencing persistent retching (dry heaving)?

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From the Guidelines

For someone who has been dry heaving all night, the most effective treatment approach is to start by ensuring they stay hydrated with small sips of clear fluids like water, diluted sports drinks, or clear broth, as this helps to prevent dehydration and reduce nausea, as noted in studies such as 1. To manage dry heaving, it is essential to address the underlying cause of the condition. Some possible causes of dry heaving include irritation of the digestive tract, activation of the brain's vomiting center, or other factors such as stress, sleep deprivation, or hormonal fluctuations, as discussed in 1. Key steps to take include:

  • Ensuring hydration with small sips of clear fluids
  • Using over-the-counter medications such as dimenhydrinate (Dramamine) 50-100mg every 4-6 hours or meclizine (Bonine) 25mg every 24 hours to reduce nausea
  • Trying natural relief options like ginger in various forms (tea, candies, or capsules of 250mg four times daily)
  • If available, using prescription antiemetics like ondansetron (Zofran) 4-8mg every 8 hours
  • Getting rest and avoiding solid foods until the nausea subsides, then gradually reintroducing bland foods like crackers, toast, or rice, as recommended in 1 and 1. Medical attention is necessary if dry heaving persists beyond 24 hours, is accompanied by severe abdominal pain, fever above 101°F, signs of dehydration (extreme thirst, dark urine, dizziness), or if the person is pregnant or has underlying health conditions, as these can indicate more serious complications, as noted in 1 and 1. It is crucial to identify and address any underlying triggers or causes of dry heaving, such as stress, sleep deprivation, or hormonal fluctuations, to prevent future episodes and improve overall quality of life, as discussed in 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Options

To treat someone who has been dry heaving all night, the following options can be considered:

  • Administering antiemetic medication, such as ondansetron or metoclopramide, to help reduce nausea and vomiting 2
  • Providing oral rehydration instructions to help replace lost fluids and electrolytes 3, 4
  • Encouraging the patient to stay hydrated by drinking small amounts of fluid frequently

Antiemetic Medication

Research has shown that ondansetron and metoclopramide can be effective in reducing nausea and vomiting in adults and children 2, 3, 4

  • A study published in the Annals of Emergency Medicine found that ondansetron and metoclopramide were similar in efficacy to placebo in reducing nausea severity in adult emergency department patients 2
  • Another study published in BMJ Open Quality found that the use of ondansetron in pediatric patients with acute gastroenteritis decreased the need for intravenous fluids and reduced hospitalizations 3
  • A study published in the Irish Medical Journal found that the addition of ondansetron to an oral rehydration protocol for children with acute gastroenteritis reduced the rate of intravenous fluid administration and admissions 4

Oral Rehydration

Oral rehydration is an important aspect of treating dehydration caused by dry heaving 3, 4

  • A study published in BMJ Open Quality found that providing oral rehydration instructions to parents of pediatric patients with acute gastroenteritis improved outcomes and reduced the need for intravenous fluids 3
  • A study published in the Irish Medical Journal found that the use of oral rehydration therapy with ondansetron reduced the rate of intravenous fluid administration and admissions in children with gastroenteritis 4

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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