VOMITING IS A COMPLEX REFLEX AND INVOLVES BOTH AUTONOMIC AND SOMATIC NEURAL PATHWAYS. NAUSEA-DISCOMFORT AND FEELING OF WANTING TO VOMIT RETCHING-ASSOSCIATED ABDOMINAL MUSCLE CONTRACTIONS MECHANISM-INCREASED ABDOMINAL PRESSURE WITH RELAXATION OF LOWER ESOPHAGEAL SPHINCTERS

1. Topic :- Update on VOMITING (2020)
Dr Rahul JainDr Sharda Jain
for Gynaecologist & Surgery Specialist

2. Over 400 ppts are available on
slideshare.net ***for use of public/Doctors
www.slideshare.net / Lifecarecentre

3. DEFINITION-
• VOMITING IS A COMPLEX REFLEX AND
INVOLVES BOTH AUTONOMIC AND
SOMATIC NEURAL PATHWAYS.
• NAUSEA-DISCOMFORT AND FEELING OF
WANTING TO VOMIT
• RETCHING-ASSOSCIATED ABDOMINAL
MUSCLE CONTRACTIONS
• MECHANISM-INCREASED ABDOMINAL
PRESSURE WITH RELAXATION OF LOWER
ESOPHAGEAL SPHINCTERS.

4. CAUSES-
• ABDOMINAL CAUSES(GOO,GERD,GASTROPARESIS)
• DRUGS(CHEMOTHERAPY)
• TOXINS
• INFECTIONS
• METABOLIC CAUSES(DKA,PREGNANCY,PTH
DISORDER,THYROID DISORDERS,HYPONATREMIA)
• CNS CAUSES(TUMOURS,INFECTIONS,MIGRAINES)
• LABRYINTHINE
DISORDERS(MENIERE’S,LABRYNTHITIS)
• MISC.-ANXIETY,ETHANOL ABUSE,MI,BULIMIA

5. MNEMONIC-
• A-ACUTE RENAL FAILURE
• A-ADDISON’S DISEASE
• B-BRAIN(ICP INC.)
• C-CARDIAC(MI)
• D-DKA
• E-EARS(LABRYINTHITIS,MENIERE’S)
• F-FOREIGN SUBSTANCES(ALCOHOL,DRUGS)
• G-GRAVIDARUM(PREGNANCY)
• H-HYPERCALCEMIA
• I-INFECTIONS(UTI)

6. INVESTIGATIONS
• CBC FOR INFECTIONS
• SERUM ELECTROLYTES FOR ADRENAL RELATED
CAUSES
• ECG(MI)
• SERUM CREATININE(FOR ACUTE RENAL FAILURE)
• RANDOM BLOOD GLUCOSE(FOR DKA)
• SERUM CALCIUM
• ABG(METABOLIC ALKALOSIS)
• URINE ROUTINE(UTI)

7. TREATMENT-
• TREAT THE CAUSE
• ANTI EMETICS-
1. METOCLOPRAMIDE 10MG(DOPAMINE ANTAGONIST)
2. ONDANSETRON 4MG(QT INTERVAL
PROLONGATION)(SEROTONIN ANTAGONIST)
3. APREPITANT(NEUROKIIN-1 RECEPTOR ANTAGONIST)
4. MOTILIN RECEPTOR AGONIST-ERYTHROMYCIN
5. DEXAMETHASONE(POST OP,INCREASED ICP)
6. ANTIPSYCHOTIC-PROCHLORPERAZINE 5MG

8. REVISION-
• JNC8 GUIDELINES
• WHITE COAT HTN
• COMMON CAUSES OF SECONDARY HTN
• METABOLIC SYNDROME
• CONCEPT OF METABOLIC MEMORY
• DAWN AND SOMOGYI PHENOMENON
• HYPOGLYCEMIA SYMPTOMS
• ORS CONCEPT
• TREATMENT OF ESSENTIAL HTN
• HOLIDAY SEGAR RULE

9. JNC8 GUIDELINES-

10. SEC HTN COMMON CAUSES-
• RENOPARENCHYMAL DISEASE
• RENAL ARTERY STENOSIS
• HYPOTHYROIDISM
• HYPERTHYROIDISM
• ADRENAL CAUSES
• PCOS
• OBSTRUCTIVE SLEEP APNOEA

11. METABOLIC SYNDROME-
• 3/5 SHOULD FULFILL
TRIGLYCERIDES>150MG/DL
HDL(MALES<50MG/DL)
(FEMALES<40MG/DL)
FASTING GLUCOSE>=100MG/DL
BP>130/85MMHG
ABDOMINAL GIRTH(MALE->=102,94CM)
(FEMALE->=88,80CM)

12. DAWN AND SOMOGYI PHENOMENON-
• DAWN
• FASTING GLUCOSE MORE
• NIGHT INSULIN
INADEQUATE
• MEASURE 12 AND 3 AM
GLUCOSE LEVELS
• RX-INCREASE INSULIN
DOSE
• SOMOGYI
• FASTING GLUCOSE MORE
• EXCESS NIGHT INSULIN
CAUSING MIDNIGHT
HYPOGLYCEMIA
TRIGGERING EXCESS
COUNTER REGULATORY
HORMONE SECRETION
• RX-DECREASE INSULIN IN
NIGHT

13. • Sweating is most
reliable symptom
of hypoglycemia

14. ORS-
• TECHNIQUE TO
PREPARE
• FOR MILD TO
MODERATE
DEHYDRATION

15. Treatment guidelines-
Young subject Old
patient
(<55yrs) (>55yrs)
A C or D
A+C OR A+D
A+C+D

16. HOLIDAY SEGAR RULE
• 0-10KG=4ML/KG/HR
• 10-20KG=2ML/KG/HR
• >20KG=1ML/KG/HR
• EX-60KG PATIENT(40+20+40=100ML/HR)

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