Chief Complaint: Nausea and Vomiting
| Pivotal Assessment | Findings | |
|---|---|---|
| History | Sudden onset | |
Determining the cause of nausea involves a systematic evaluation of symptoms, history, and sometimes diagnostic tests. Here’s a step-by-step approach commonly used in clinical practice:
Onset: Sudden or gradual?
Duration: How long has it lasted?
Timing: Is it related to meals, waking up, medications, or motion?
Associated symptoms: Vomiting, abdominal pain, headache, dizziness, diarrhea, fever, etc.?
Gastritis, peptic ulcer โ epigastric pain, worsens with food
GERD โ heartburn
Gastroenteritis โ vomiting + diarrhea
Obstruction โ bloating, no bowel movement, severe vomiting
Hepatitis โ right upper quadrant pain, jaundice
Migraine โ headache + photophobia
Increased intracranial pressure โ morning nausea, worse with position changes
Vestibular disorders (e.g., vertigo, Meniere's) โ dizziness, imbalance
Diabetic ketoacidosis โ nausea, fruity breath, confusion
Hypercalcemia โ nausea, constipation, mental status changes
Uremia (renal failure) โ chronic nausea, fatigue
Chemotherapy, opioids, antibiotics (e.g., erythromycin), digoxin
Alcohol, marijuana (esp. chronic use โ cannabinoid hyperemesis syndrome)
Common in first trimester (especially morning nausea)
Anxiety, eating disorders, stress-related functional nausea
Vitals: Fever, hypotension, tachycardia?
Abdomen: Tenderness? Distention? Bowel sounds?
Neurologic exam: Nystagmus? Gait issues?
ENT exam: Inner ear pathology?
Depending on the suspected cause:
CBC โ infection, anemia
Electrolytes, BUN/Creatinine โ metabolic derangements
Liver function tests, amylase/lipase โ liver, pancreas
Pregnancy test (ฮฒ-hCG) โ all women of reproductive age
Abdominal ultrasound or CT scan
Head CT/MRI โ if intracranial issue suspected
GI specialist โ for persistent nausea or reflux
Neurologist โ for suspected central causes
Psychiatrist โ if anxiety/eating disorder is prominent
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