Approach to patients with nausea and vomiting in the emergency department

Nausea and vomiting (NV) are common symptoms in emergency medicine, accounting for 3-4% of presentations as chief complaint. Causes of NV are either exogenous (pathogens, drugs, toxins) or endogenous (gastrointestinal, urogenital, cardiovascular, endocrine/metabolic, vestibular, central nervous system) factors. Hence, the differential diagnoses encompass a wide spectrum of disorders. Accompanying symptoms and context play a key role in diagnosis. NV also occurs in specific circumstances, e.g. postoperatively (PONV), chemotherapy-induced (CINV) and in pregnancy (NVP). Vomiting as a protective reflex should be suppressed only on good grounds, e.g. to prevent aspiration. Fluid and electrolyte substitution often leads to sufficient clinical improvement. If feasible, causal treatment should be preferred. In cases requiring antiemetic drug treatment, the choice of drugs should be based on the receptor profile, which should also be taken into account in drug combinations or sequential treatment. Currently, Ondansetron is recommended as first line treatment in acute undifferentiated vomiting. Dimenhydrinate, Metoclopramide, Droperidol, Domperidon, Promethazine, Meclizine (Meclozine) and Doxylamine can be considered.