What is a good first-line medication for nausea potentially caused by food poisoning from contaminated chicken?

First-Line Medication for Nausea from Suspected Food Poisoning

Metoclopramide (10-20 mg PO/IV every 6 hours) is the recommended first-line medication for nausea potentially caused by food poisoning from contaminated chicken. 1, 2

Treatment Algorithm

First-Line Options:

• Dopamine receptor antagonists are the preferred first-line agents for nausea from suspected food poisoning 1:
  • Metoclopramide (10-20 mg PO/IV every 6 hours) - most effective first-line option 2
  • Prochlorperazine (5-10 mg PO/IV every 6 hours) - alternative first-line option 1
  • Haloperidol (0.5-2 mg PO/IV every 6 hours) - particularly useful for persistent nausea 1

Second-Line Options (if first-line fails):

• 5-HT3 receptor antagonists can be added if first-line treatment is insufficient 1, 2:
  • Ondansetron (4-8 mg PO/IV every 8 hours) - effective for breakthrough nausea 3, 4
  • Granisetron (1-2 mg PO daily) - alternative 5-HT3 antagonist 1

For Refractory Cases:

• Consider adding a corticosteroid such as dexamethasone (4-8 mg PO/IV daily) 1, 2
• Olanzapine (2.5-5 mg PO or sublingual every 6-8 hours) is particularly effective for refractory nausea 2

Administration Recommendations

• Schedule antiemetics around-the-clock rather than as-needed for persistent nausea 1, 2
• Ensure adequate hydration and fluid repletion to prevent dehydration 1
• Consider oral route for mild nausea, but switch to intravenous administration if vomiting prevents oral intake 1, 4

Evidence Strength and Considerations

• Dopaminergic agents (metoclopramide, prochlorperazine) have been shown to effectively target the chemoreceptor trigger zone, which is activated in food poisoning 1
• While ondansetron is commonly used in emergency departments, studies have not shown newer 5-HT3 medications to be superior to older dopaminergic agents for nausea from food poisoning 1, 4
• A Cochrane review found no definitive evidence of superiority of any one antiemetic over others or placebo in emergency department settings, suggesting that choice may be guided by side effect profiles and cost 5

Common Pitfalls and Caveats

• Monitor for extrapyramidal symptoms with metoclopramide, especially at higher doses or with prolonged use 2
• Be aware of potential sedation with antihistamines and olanzapine, particularly in elderly patients 2
• 5-HT3 antagonists like ondansetron can cause constipation, which may worsen overall comfort 2
• If heartburn is mistaken for nausea, consider adding an H2 blocker or proton pump inhibitor 1
• For patients with persistent vomiting despite antiemetic therapy, consider intravenous rehydration to prevent electrolyte abnormalities 1, 5

Special Considerations

• Start with lower doses of olanzapine (2.5 mg) in elderly or debilitated patients to minimize sedation 2
• If nausea persists beyond 24 hours or is accompanied by high fever, bloody diarrhea, or severe abdominal pain, consider further evaluation for more serious foodborne illness 6