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:
Pitfalls
- 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:
- EM Cases: Drugs that work and Drugs that don’t: Antiemetics, Angioedema, Oxygen (Anton Helman)
- First10EM: Nausea and vomiting in the ED: Does nothing work? (Justin Morgenstern)
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
gastrointestinal
- Obstruction (e.g., intestinal obstruction, gastric outlet obstruction)*
- *American College of Radiology
ACR Appropriateness Criteria®
Suspected Small-Bowel Obstruction, 2019- Hypomotility (e.g., gastroparesis, ileus)*
- *IBCC chapter & cast – Gastrointestinal hypomotility in critical care
September 14, 2020 by Dr Josh Farkas- Acute gastroenteritis
- Pancreatitis*
- *American College of Radiology
ACR Appropriateness Criteria®
Acute Pancreatitis, 2019- Cholecystitis
- Mesenteric ischemia*
- *American College of Radiology ACR Appropriateness Criteria®
Imaging of Mesenteric Ischemia, 2018- Appendicitis
central nervous system
- Ear and labyrinthine disorders (often associated with vertigo)
- Vestibular neuronitis
- Meniere’s disease
- Otitis media
- Intracranial pressure elevation*
- *Raised intracranial pressure from Radiopaedia accessed 9/17/2020
- *Idiopathic intracranial hypertension from Radiopaedia accessed 9/17/2020
- *Podcast 78 – Increased Intra-Cranial Pressure (ICP) and Herniation, aka Brain Code from Emcrit. July 25, 2012.
- *Podcast 95 – Thomas Scalea on Cutting-Edge ICP Management from EMCrit. April 2, 2013.
- *Increased ICP + Herniation from The Resuscitation Crisis Manual [Not an affiliate link].
- Migraine
- Cyclic vomiting syndrome, cannabinoid hyperemesis syndrome
evaluation of the patient with nausea and vomiting
Start here.
.
