33- Nausea - Vomiting

If analysis of cause not possible:

1. Domperidone before meals.
2. Domperidone before meals + haloperidol 1.5-5mg daily.
3. Domperidone before meals, + CPM 1-2 tabs 3-4x/day, + Buscopan 1-2tabs 3-4x/day, +/- haloperidol 1.5-5mg daily.

Toxic origin:

·         Cause = Morphinic ? ( tramadol, codeine, too much cough syrup…)

o        Treat with domperidone 1 tab 3x/day, +/- haloperidol 1.5-5mg daily.

·         Cause = Dehydration ? (hyperCa++) (See "8-Dehydration")

o        Hydration +domperidone +/- haloperidol

o        We can decrease calcium with aggressive hydration +KCl + furosemide  but need a good follow-up!)

Stomach origin: (Voltaren, ibuprofen, ulcers…)

Domperidone 1-2tabs 3-4x/day

Digestive origin: (Enteritis, etc.…)

Antihistamine (Promethazine, chlorpheniramine or...) + Anticholinergic (Buscopan 1-2 tab 3-4x/day)

Cerebral origin:

• TOXO, CEREBRAL TB...: (see "19-Neuro")
• (Promethazine/chlorpheniramine)+ Buscopan(2tabs 3x/day)
• RAISED ICP ("easy vomiting" + headache + bradycardia + hypertension)
• Dexa high dose... Furosemide...

Intestinal Obstruction:

• Prednisolone and then dexa increasing dose…
• If high dose doesn't work give: tramadol 1-2tabs 3-4x/day, + Buscopan 1-2tabs 3-4x/day, + haloperidol 5-10mg daily, (+/- diazepam).