APPROACH TO THE INFANT OR CHILD WITH NAUSEA AND VOMITING

Abstract

Patients with acute vomiting, typically for hours to a few days, most often present to an emergency department, whereas patients with chronic symptoms are more often initially evaluated in outpatient office settings. Emergency department clinicians should expeditiously exclude life-threatening disorders such as bowel obstruction, diabetic ketoacidosis, adrenal crisis, toxic ingestion, or increased intracranial pressure (ICP).

In both urgent care and routine outpatient settings, the following three steps should generally be undertaken in patients with nausea and vomiting:

• The etiology should be sought, taking into account the child's age and whether the nausea and vomiting are acute, chronic, or episodic.
• The consequences or complications of nausea and vomiting (eg, fluid depletion, hypokalemia, and metabolic alkalosis) should be identified and corrected.
• Targeted therapy should be provided when possible (eg, surgery for bowel obstruction or insulin for diabetic ketoacidosis). In other cases, the symptoms should be treated.