Usually symptoms of underlying illness.

  • First born males in the first few weeks of life.
  • Early exposure to oral erythromycin in some babies (projectile).
  • Infection or feeding problems in infants <1 year old.
  • Pregnancy – always consider in any woman of childbearing age.
  • Meningitis – vomiting w/o other symptoms.
  • Peptic ulcer – usually w/ blood.
  • GI obstruction – vomit w/ fecal smell.
  • Gastroenteritis – usually ass. with cold symptoms.
  • Excessive alcohol intake – vomiting in the morning
  • Aspirin
  • NSAIDs
  • Erythromycin – stimulates stomach contractions.
  • Estrogens
  • Corticosteroids
  • Opioid analgesics.
  • Digoxin toxicity – esp. in elderly people.
  • Dehydration
  • Hypokalemia
  • Metabolic alkalosis
  • Aspiration
  • Rupture of the esophagus.
  • Bleeding secondary to a mucosal tear at gastroesophageal junction.
  • Serum electrolytes
  • Abdominal CT
  • Upper endoscopy
  • MI
  • Motion sickness:
    • Promethazine 25mg at bedtime on night before travelling OR 1-2hrs before travelling.
    • Ginger e.g. ginger biscuits: No drowsiness
  • Pregnancy:
    • Metoclopromide 10mg TDS
    • Doxylamine/pyridoxine 1-2 tabs at bedtime; severe cases: increase one tab in the morning or afternoon.
    • Ginger biscuits
  • GI disease:
    • Domperidone 10mg TDS/ QID 30min before meals.
  • Drug-induced:
    • Metoclopromide :
      • > 60kg:10mg TDS
      • < 60kg : 5mg TDS
      • 9-14yrs: 5mg TDS
      • 5-9yrs: 2.5mg TDS
      • 3-5yrs: 2mg BD/TDS
      • 1-3yrs: 1mg BD
      • <1yr: 1mg BD (daily dose NMT 0.5/kg/day
    • Domperidone 10mg TDS/QID 30min before meals.
  • Cytotoxic drug-induced:
    • Ondansetron
    • Granisetron
    • Palonosetron
    • Tropisetron
  • Cytotoxic/radiotherapy in children:
    • Domperidone 200-400mcg TDS.