Clinical QuickieGI/Hepatic
Nausea / Vomiting
Antiemetics treat nausea — they do not explain why the patient is vomiting.
Start with the mechanism
GI infection, medication effect, pregnancy, migraine, obstruction, gastroparesis, biliary/pancreatic disease, DKA, CNS disease, vestibular disease, and cannabis-related syndromes all behave differently.
Assess dehydration and metabolic risk
Orthostasis, urine output, renal function, glucose, electrolytes, mental status, and oral tolerance determine urgency.
Choose the antiemetic to fit the patient
QT risk, sedation, EPS, anticholinergic burden, pregnancy, and the likely mechanism should influence medication choice.
Do not mask a surgical/metabolic problem
Distention, obstipation, severe focal pain, GI bleeding, altered mental status, DKA, or neurologic red flags need diagnosis before another antiemetic.
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