From the Research
Introduction to Emesis Management
Emesis, or vomiting, is a common symptom that can be caused by a variety of organic and nonorganic disorders, both within and outside the gastrointestinal (GI) tract [ 1 ]. The management of emesis is crucial to prevent dehydration, electrolyte imbalances, and other complications.
Assessment and Evaluation
The initial evaluation of a patient with emesis should focus on assessing airway, breathing, and circulation, as well as hydration status and red flag signs [ 1 ]. A thorough history and physical examination can help guide the approach to individual patients. Investigations, such as serum electrolytes and blood gases, renal and liver functions, and radiological studies, may be necessary to diagnose underlying causes, particularly in patients with dehydration or red flag signs [ 1 ].
Management Priorities
Management priorities for emesis include:
- Treatment of dehydration
- Stoppage of oral fluids/feeds
- Decompression of the stomach with a nasogastric tube in patients with bilious vomiting [ 1 ]
- Antiemetic therapy, such as ondansetron (0.2 mg/kg oral; parenteral 0.15 mg/kg; maximum 4 mg), in patients unable to take orally due to persistent vomiting [ 1 ]
Antiemetic Therapy
Antiemetic therapy is indicated in patients with persistent vomiting, post-operative vomiting, chemotherapy-induced vomiting, cyclic vomiting syndrome, and acute mountain sickness [ 1 ]. The choice of antiemetic agent depends on the underlying cause of emesis and the patient's individual needs.
Differential Diagnosis
The differential diagnosis for emesis is broad and includes:
- Gastrointestinal causes, such as gastritis, gastroenteritis, and intestinal obstruction
- Non-gastrointestinal causes, such as meningitis, encephalitis, and toxic ingestions [ 1 ]
- Medication and toxin adverse effects
- Neurologic causes, such as migraines and vestibular disturbances
- Metabolic and endocrine conditions, such as diabetic ketoacidosis and uremia [ 2 ]
Treatment Approach
The treatment approach to emesis depends on the underlying cause and severity of symptoms. For acute, mild symptoms, an empirical trial of antiemetics may be sufficient [ 3 ]. For chronic or moderate-severe symptoms, testing for an underlying cause should be performed, and medication adverse effects, neurologic causes, gastrointestinal diseases, metabolic or endocrine conditions, and psychogenic disorders should be considered [ 3 ].
Nonpharmacologic Management
Nonpharmacologic management options for emesis include:
- Fluid and electrolyte replacement
- Small, frequent meals
- Avoidance of trigger foods [ 2 ]
Pharmacologic Therapy
Pharmacologic therapy for emesis should be used for the shortest time necessary to control symptoms [ 2 ]. Medications may target the suspected cause of symptoms and the neurotransmitters involved in central and peripheral pathways of nausea and vomiting. A serotonin antagonist or dopamine antagonist can be used when a specific etiology is not identified [ 2 ].