Patient handout

Acute nausea & vomiting (ED triage — undifferentiated adult)

PRODUCTION

1. Your condition

This handout is for acute nausea & vomiting (ed triage — undifferentiated adult). Your care team identified this based on: acute nausea + vomiting without alarm features — usually viral gastroenteritis or functional dyspepsia (quigley acg 2013 pmid 29407306).

Other reasons your team may use this plan: vomiting + crampy abdominal pain + distension + obstipation — small bowel obstruction → route gi.small-bowel-obstruction.core.v1; vomiting + rlq pain + anorexia + fever + leukocytosis — appendicitis → route gi.acute-appendicitis.core.v1; vomiting + epigastric pain radiating to back + lipase elevation — acute pancreatitis → route gi.acute-pancreatitis.core.v1 (tenner acg 2013 pmid 23589549).

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Vomiting + peritoneal signs (rebound, guarding, rigidity) OR free air on imaging — surgical abdomen / perforation; STAT surgery consult + broad antibiotics + CT + OR(life-threatening)
Vomiting + distension + obstipation + prior surgery + CT with transition point ± closed-loop / strangulation signs — SBO; NG decompression + fluids + antibiotics + surgery consult (strangulation = STAT OR)(life-threatening)
Vomiting + RLQ pain + anorexia + fever + leukocytosis (Alvarado ≥7) — appendicitis; appendectomy or selective non-operative (IDSA antibiotic-only protocol in selected); CT or US (peds/pregnancy)
Vomiting + epigastric pain radiating to back + lipase >3× ULN + Ranson/BISAP/APACHE-II severity criteria — acute pancreatitis; aggressive IV fluids (LR), pain control, NPO; severe → ICU (Tenner ACG 2013 PMID 23589549)
Vomiting + RUQ pain + Murphy sign + fever + leukocytosis + US gallbladder thickening — acute cholecystitis; antibiotics + cholecystectomy within 72 h (Charcot triad → cholangitis → emergent ERCP)
Vomiting + glucose >250 + anion gap + ketosis + pH <7.3 OR HCO3 <15 — DKA; insulin infusion + K replacement + IV fluids (route endo.dka.core.v1)(life-threatening)
Vomiting + glucose >600 + osmolality >320 + AMS WITHOUT acidosis — HHS; insulin + fluids (route endo.hhs.core.v1); higher mortality than DKA in elderly(life-threatening)
Vomiting + hypotension + hyperK + hypoNa + chronic steroid use OR known Addison — adrenal crisis; hydrocortisone 100 mg IV STAT + fluids (route endo.adrenal-crisis.core.v1)(life-threatening)
Pregnancy + persistent vomiting + ketosis + >5% weight loss + electrolyte derangement — hyperemesis; IV fluids + thiamine 100 mg + pyridoxine + doxylamine + ondansetron (RCOG NVP PMID 25584725; SOM Canada PMID 28209253)
Vomiting + chest pain/diaphoresis/dyspnea + diabetic/elderly/female — atypical ACS; ECG + troponin + HEART score → cardio.nstemi.core.v1 / cardio.stemi.core.v1(life-threatening)
Vomiting (often projectile/morning) + headache + papilledema + focal neuro deficit — raised ICP / ICH / SAH / mass; STAT NCCT + neurosurgery + osmotic therapy if herniation(life-threatening)
Vomiting + pain out of proportion to exam + lactate ≥4 + elderly vasculopath + AFib — acute mesenteric ischemia; STAT CT angiography + vascular surgery (mortality 70% if delayed)(life-threatening)

5. Follow-up

Outpatient GI for cyclic vomiting / functional / gastroparesis / IBS overlay; OB for hyperemesis; endocrine for adrenal insufficiency / chronic DM; cardiology for atypical ACS post-cath; neurology for migraine prevention; addiction support for CHS / opioids; chemotherapy team for CINV optimization

6. Sources

Guideline: 2013 Quigley ACG nausea/vomiting + 2013 Tenner ACG acute pancreatitis + 2016 RCOG NVP guideline + 2016 SOM Canada NVP + 2018 Habboushe cannabinoid hyperemesis + 2018 Tokyo cholecystitis + 2024 IDSA appendicitis antibiotic-only (CODA) + 2026 ADA DKA/HHS + AHS migraine + ASCO CINV