Ver el código de «Cyclic vomiting syndrome»

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==Background==

*Recurrent episodes of [[Special:MyLanguage/vomiting|vomiting]], otherwise normal health in between
*32% of patients disabled by illness by time of diagnosis<ref>Fleisher DR, Gornowicz B, Adams K, Burch R, Feldman EJ. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med. 2005 Dec 21. 3:20.</ref>
*Pathophysiology not well understood
*Average age at onset ~21yo
*Females slightly more affected than males
*[[Special:MyLanguage/Marijuana|Marijuana]] use is risk factor



==Clinical Features==

*Pediatric diagnostic criteria<ref>Li BU, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008 Sep. 47(3):379-93.</ref>
**At least 5 episodes or minimum of 3 over 6 mo
**[[Special:MyLanguage/Nausea and vomiting (peds)|Nausea/vomiting]]episodes lasting 1hr-10d, with 1 week in between
**Stereotypical pattern and symptoms 
**Return to baseline health in between
**Symptoms not due to another condition
*Adult – Rome III criteria <ref>Venkatasubramani N, Venkatesan T, Li BUK. Extreme Emesis: Cyclic Vomiting Syndrome. Practical Gastroenterology. September 2007. 31:21-34.</ref>
**Stereotypical episodes of [[Special:MyLanguage/vomiting|vomiting]] with acute onset lasting less than 1 week. 
**At least 3 episodes per year. 
**No nausea/vomiting between episodes. 
**Symptoms not due to another cause
*Symptoms usually begin in early morning or upon waking
*Prodrome of nausea--> vomiting
*Episodes peak/decline over ~8h
*Nausea typically not relieved by vomiting
*+/-
**[[Special:MyLanguage/Abdominal pain|Abdominal pain]]
**[[Special:MyLanguage/Diarrhea|Diarrhea]]
**[[Special:MyLanguage/Fever|Fever]]
**[[Special:MyLanguage/Headache|Headache]]
**[[Special:MyLanguage/Vertigo|Vertigo]]



==Differential Diagnosis==

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{{Nausea and vomiting DDX}}
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==Evaluation==

*Clinical diagnosis of exclusion
*Evaluate for alternate etiologies
*Assess for [[Special:MyLanguage/dehydration|dehydration]], [[Special:MyLanguage/electrolyte abnormalities|electrolyte abnormalities]] if clinically warranted



==Management==

*Avoid triggers
**Many patients have known triggers, such as diet, psychological stressors, sleep deprivation, cannabis, or infection. 
*May be on medications typically used for migraine prophylaxis
*Abortive [[Special:MyLanguage/antiemetics|antiemetics]] therapy
**[[Special:MyLanguage/Ondansetron|Ondansetron]]- works better with [[Special:MyLanguage/benzos|benzos]] or [[Special:MyLanguage/diphenhydramine|diphenhydramine]]
**[[Special:MyLanguage/Promethazine|Promethazine]], [[Special:MyLanguage/prochlorperazine|prochlorperazine]]
**Triptans (e.g. [[Special:MyLanguage/sumatriptan|sumatriptan]])
*Supportive therapy
**[[Special:MyLanguage/IVF|IVF]] with [[Special:MyLanguage/dextrose|dextrose]]
**Place in quiet, dark room +/- sedative



==Disposition==

*If symptoms can be controlled, may discharge
*For intractable vomiting unable to be controlled with medications, admit



==See Also==

*[[Special:MyLanguage/Cannabinoid hyperemesis syndrome|Cannabinoid hyperemesis syndrome]]



==External Links==


==References==

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[[Category:GI]]

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