All ages: acute gastroenteritis, motion sickness, drugs, various infections
Neonates: feeding problems
Children: viral infections/fever, otitis media, UTI
Adults: gastritis, alcohol intoxication, pregnancy, migraine
Serious disorders not to be missed
oesophageal atresia (neonates)
pyloric obstruction <3 months
malignancy (e.g. oesophagus, stomach)
Intracranial disorders: malignancy, cerebellar
haemorrhage, PICA infarction
Acute myocardial infarction (e.g. painless)
Organ failure: liver, kidney (uraemia), heart, respiratory
Labyrinthine disorders: Meniere syndrome, labyrinthitis
Poisoning: food, chemicals
Gut motility disorders: achalasia
Substance abuse (e.g. opioids, ecstasy)
Functional obstruction: diabetic gastroparesis, idiopathic gastroparesis
Thyroid and other endocrine disorders (Addison disease)
Is the patient trying to tell me something?
Possibly: extreme stress and anxiety (e.g. panic attacks). Consider bulimia (self-induced vomiting) and functional (psychogenic).
Nausea and vomiting have a wide range of potential causes emanating from every body system. A careful history is essential with an emphasis on drug intake, possible psychogenic factors including self-induced emesis, weight loss, other GIT symptoms or symptoms suggestive of systemic disease.
If fever is present possible sources of infections (e.g. middle ear, urinary tract and meninges) should be checked
A careful abdominal examination is appropriate in most instances, searching for scars indicative of previous surgery
Consider a neurological examination
Be mindful of the possibility of pregnancy
Always assess the patient’s condition including the level of hydration
Look for the cause and also consider biochemical abnormalities resulting from fluid and electrolyte loss. Consider:
urine analysis and MC
drug toxicity studies
radiology of GIT.
The common cause of acute nausea and vomiting in most age groups is gastroenteritis.