From the Guidelines
Discharge vomiting should be managed by contacting a healthcare provider immediately, especially if it's severe, contains blood, or is accompanied by fever, severe abdominal pain, or signs of dehydration, as it can lead to serious complications such as dehydration and electrolyte imbalances, which can significantly impact morbidity, mortality, and quality of life 1.
Causes and Risk Factors
Discharge vomiting can occur due to various reasons, including irritation of the stomach lining, reaction to medications, or as a side effect of anesthesia if you've had surgery. According to the ERAS society recommendations, patient, anaesthetic, and surgical factors can contribute to the development of postoperative nausea and vomiting (PONV), with female patients, non-smokers, and those with a history of motion sickness being at particular risk 1. The use of volatile anaesthetic agents, nitrous oxide, and parenteral opiates can also increase the risk significantly.
Management
For mild cases of discharge vomiting, it is recommended to start by resting the stomach for a few hours, then slowly introduce clear liquids like water, diluted sports drinks, or clear broth in small amounts (1-2 tablespoons) every 15 minutes. Gradually progressing to the BRAT diet (bananas, rice, applesauce, toast) as tolerated can also help manage symptoms. Over-the-counter medications like ondansetron (Zofran) 4-8mg every 8 hours or promethazine (Phenergan) 12.5-25mg every 6 hours may help control nausea and vomiting, but should only be used if previously prescribed.
Prevention
A multimodal approach to preventing PONV, which combines non-pharmacological and pharmacological antiemetic techniques, can be effective in reducing the incidence of discharge vomiting. This approach includes the avoidance of emetogenic stimuli, minimal preoperative fasting, carbohydrate loading, and adequate hydration of patients, as well as the use of regional anaesthetic techniques such as epidurals and transversus abdominal plane (TAP) blocks 1.
Monitoring and Follow-up
It is essential to monitor urine output and color to prevent dehydration, which can lead to serious complications. If symptoms worsen or don't improve within 24 hours, seeking medical attention is crucial, as this could indicate complications from recent treatment or an unrelated condition requiring evaluation. Prompt medical attention can significantly improve outcomes and reduce the risk of morbidity, mortality, and decreased quality of life associated with discharge vomiting 1.
From the FDA Drug Label
Masking of Progressive Ileus and/or Gastric Distension Following Abdominal Surgery or Chemotherapy-Induced Nausea and Vomiting:Monitor for decreased bowel activity, particularly in patients with risk factors for gastrointestinal obstruction. ( 5. 5)
The ondansetron drug label warns about the risk of masking progressive ileus and/or gastric distension which can be associated with discharge vomiting in patients with risk factors for gastrointestinal obstruction, particularly after abdominal surgery or chemotherapy-induced nausea and vomiting 2.
- Key points:
- Monitor for decreased bowel activity
- Risk factors for gastrointestinal obstruction
- Abdominal surgery or chemotherapy-induced nausea and vomiting
- Ondansetron may mask symptoms of progressive ileus and/or gastric distension 2.
From the Research
Discharge Vomiting
- Discharge vomiting can be a symptom of various underlying conditions, including gastroenteritis, foodborne illness, acute migraine headaches, vestibular disturbances, early pregnancy, and adverse effects of medication 3.
- The treatment of discharge vomiting depends on the underlying cause, and nonpharmacologic management options include fluid and electrolyte replacement, small, frequent meals, and avoidance of trigger foods 3.
- Antiemetic drugs, such as ondansetron and metoclopramide, can be effective in reducing symptoms of acute nausea and vomiting, but chronic symptoms can be more challenging to treat 4.
- Domperidone, a dopamine-2 receptor antagonist, can be used as an antiemetic and prokinetic agent, and has a favorable safety profile for long-term administration 5.
- A comparison of controlled release metoclopramide and domperidone found that both drugs were effective in reducing symptoms of nausea and vomiting, with no significant differences in efficacy or side effects 6.
- New and improved interventions for nausea and vomiting are becoming available, including bioelectrical neuromodulation, behavioral and surgical therapies, and complementary medicine 7.