“Nausea, emesis,and anti-emetics” From Dr Farkas’ Internet Book of Critical Care

In this post, I link to and excerpt from Dr Farkas’ Internet Book of Critical Care of August 17, 2020, Nausea, emesis, and anti-emetics [Link is to the podcast] [Link is to the show notes].*

*As I occasionally remind readers, these excerpt posts are mostly my study aides. And posting in my blog makes it easier to find topics using my blog’s search function or Categories list.

I’ve embedded the podcast here:

Here are excerpts from the show notes:


  • If the patient doesn’t respond to one antiemetic, switching to a different agent may not work (especially to a different agent with a similar mechanism of action).  Rather, it may be more effective to add a second agent that acts at a different receptor.(25841474)
  • Avoid rapid IV pushes of antiemetic agents, as this may increase the risk of side effects (especially QT prolongation with ondansetron, or extrapyramidal side effects with D2 receptor antagonists).
  • Avoid D2 receptor antagonists in patients with Parkinson’s disease.
  • Be extremely cautious about the intravenous use of promethazine (or perhaps avoid this entirely).  Extravasation or inadvertent intra-arterial administration of promethazine can cause tissue necrosis.
Going further:

differential diagnosis of nausea and vomiting

medications which may cause nausea
  • Chemotherapy
  • Analgesics
    • Aspirin
    • NSAIDs
    • Opioids
  • Antibiotics
    • Erythromycin
    • Sulfonamides
    • Acyclovir
  • Cardiovascular
    • Antiarrhythmics
    • Antihypertensives (beta-blockers, calcium channel blockers)
    • Digoxin
    • Diuretics
  • Endocrine
    • Oral contraception
    • Oral antidiabetic agents
  • Neurology
    • Anticonvulsants
    • Parkinson’s disease medications (dopaminergic)
endocrine / metabolic
  • Pregnancy (generally within the first nine weeks of pregnancy)
  • Uremia
  • Fulminant hepatic failure
  • Ketoacidosis (e.g., diabetic ketoacidosis)
  • Hyperparathyroidism, hypoparathyroidism
  • Hyperthyroidism
  • Addison’s disease
central nervous system

evaluation of the patient with nausea and vomiting

Start here.






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