What are the management options for vomiting in conditions like travel sickness and mountain sickness?

Management of Vomiting in Travel Sickness and Mountain Sickness

For vomiting associated with travel sickness and mountain sickness, antiemetics such as ondansetron are recommended for symptomatic relief, while addressing the underlying cause through appropriate measures like gradual ascent for mountain sickness or antihistamines for motion sickness.

Travel Sickness (Motion Sickness) Management

Preventive Measures

• Positioning and Environmental Control
  • Sit in the front seat of a car or in the middle of a boat where motion is minimized
  • Fix gaze on a stable horizon point
  • Ensure adequate ventilation
  • Avoid reading or using electronic devices while in motion

Pharmacological Management

• First-line medications:

  • Antihistamines (taken 30-60 minutes before travel):
    • Dimenhydrinate (Dramamine)
    • Meclizine (Bonine)
  • These medications work by suppressing vestibular stimulation and can prevent nausea and vomiting

• For breakthrough vomiting:

  • Ondansetron 4-8mg orally or sublingual for acute symptoms 1
  • Promethazine 25mg orally, rectally, or IM for severe symptoms

Mountain Sickness Management

Prevention

• Gradual ascent is the most effective preventive measure

  • Limit altitude gain to 300-400m per 24 hours for sleeping elevation 2
  • Include rest days during ascent, especially after reaching 3000m

• Prophylactic medications:

  • Acetazolamide 125-250mg twice daily, starting 24 hours before ascent 3
    • Works by increasing arterial oxygen levels and reducing symptoms
  • Dexamethasone 4mg every 6 hours can be used as an alternative 3

Treatment of Vomiting in Acute Mountain Sickness (AMS)

• Mild to moderate symptoms:

  • Stop ascent and rest
  • Acetaminophen/paracetamol for headache
  • Ondansetron 4-8mg for nausea and vomiting 1
  • Ensure adequate hydration

• Severe symptoms with persistent vomiting:

  • Immediate descent is critical - most effective treatment 1
  • Dexamethasone 8mg initially, then 4mg every 6 hours 1, 4
  • Oxygen supplementation if available
  • Acetazolamide 250mg twice daily can help but works more slowly 3
  • Consider combination therapy with acetazolamide and anti-inflammatory medications for enhanced effect 4

Special Considerations

Warning Signs Requiring Medical Attention

• Severe vomiting leading to dehydration 5
• Vomiting accompanied by high fever (>38.5°C) 5
• Blood in vomit
• Severe headache with altered mental status (possible high-altitude cerebral edema)
• Shortness of breath at rest (possible high-altitude pulmonary edema)

Hydration Management

• Maintain adequate fluid intake guided by thirst 5
• Drinks containing glucose (fruit juices, sweet sodas) or electrolyte-rich soups are recommended 5
• Small, light meals as tolerated; avoid fatty, heavy, spicy foods and caffeine 5

Common Pitfalls to Avoid

• Delaying descent in severe mountain sickness - this can be life-threatening 1, 6
• Ascending too rapidly - the most common cause of mountain sickness 2
• Inadequate hydration - worsens symptoms of both travel and mountain sickness
• Ignoring warning signs - severe vomiting can lead to dangerous dehydration and electrolyte imbalances
• Overreliance on medications - drugs help manage symptoms but don't replace proper acclimatization for mountain sickness

Remember that while medications can help manage symptoms, addressing the underlying cause (motion or altitude) is essential for effective treatment of vomiting in these conditions.