How to manage vomiting caused by upper respiratory infection (URI) due to mucus entering the stomach?

Management of Vomiting Caused by Upper Respiratory Infection

For vomiting caused by upper respiratory infection due to mucus entering the stomach, the recommended first-line treatment is ondansetron, particularly for children over 4 years of age and adolescents, to facilitate oral hydration and prevent dehydration. 1

Understanding the Mechanism

When a person has an upper respiratory infection (URI), excessive mucus production occurs in the nasal passages, sinuses, and throat. This mucus can:

• Drain down the back of the throat (post-nasal drip)
• Enter the stomach, potentially triggering nausea and vomiting
• Exacerbate cough, which can also trigger the gag reflex

Treatment Approach

First-Line Pharmacological Management

1. Antiemetics:

   • Ondansetron (Zofran) is recommended for children >4 years and adolescents with acute gastroenteritis/URI-associated vomiting 1
   • Dosing: 8 mg orally/IV every 8 hours for adults; weight-based dosing for children
   • Benefits: Reduces vomiting episodes and decreases the need for hospitalization or IV rehydration 1
   • Note: May increase stool volume as a side effect 1

2. Inhaled Anticholinergics:

   • Ipratropium bromide is recommended for cough suppression in URI, which can reduce mucus production and associated vomiting 1
   • This is the only inhaled anticholinergic agent recommended for URI cough suppression 1

Hydration Management

Maintaining proper hydration is crucial when vomiting occurs:

1. Oral Rehydration:

   • Use oral rehydration solution (ORS) after each vomiting episode 1
   • For children: 50-100 mL (under 2 years) or 100-200 mL (older children) after each episode 1
   • For adults: As much as desired 1

2. Alternative Fluids:

   • Encourage locally available fluids that prevent dehydration (cereal-based gruels, soup, rice water) 1
   • Avoid soft drinks due to high osmolality 1

3. When to Consider IV Fluids:

   • For severe dehydration, shock, altered mental status, or failure of oral rehydration therapy 1
   • Isotonic solutions like lactated Ringer's or normal saline are recommended 1

Dietary Recommendations

1. Continue Feeding:

   • Infants should continue breastfeeding throughout the illness 1
   • For formula-fed infants with diarrhea, dilute formula with equal volume of clean water until symptoms resolve 1
   • For children >4-6 months: Offer freshly prepared foods every 3-4 hours 1

2. After Recovery:

   • Provide one extra meal daily for a week after symptoms resolve 1

What to Avoid

1. Ineffective Medications:

   • Central cough suppressants (codeine, dextromethorphan) have limited efficacy for URI-related cough 1
   • Albuterol is not recommended for cough not due to asthma 1
   • Zinc preparations are not recommended for acute cough due to common cold 1

2. Contraindicated Agents:

   • Anti-diarrheal agents are contraindicated for diarrheal disease 1
   • Stimulants, steroids, and purgatives are not indicated and may produce adverse effects 1

Monitoring and Follow-up

Monitor for:

• Continued frequent stools
• Excessive thirst
• Sunken eyes
• Fever
• Failure to improve 1

Special Considerations

• First-generation antihistamines may help reduce mucus production in URI, though their primary benefit may be through central nervous system effects rather than direct anticholinergic activity in the airways 1
• Expectorants like guaifenesin have shown inconsistent results in reducing URI-related cough and associated symptoms 1

When to Seek Medical Attention

Advise patients to return to medical care if:

• Vomiting persists despite treatment
• Signs of dehydration develop (decreased urination, dry mouth, sunken eyes)
• Fever develops or worsens
• General condition deteriorates 1

By following this approach, most cases of URI-associated vomiting can be effectively managed while preventing complications like dehydration.