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Clinician’s Corner: Nausea and Vomiting Treatment

Now that we have had the big “germ exchange” also known as the holiday season, a lot of patients are coming to ask our advice for treatment of nausea and vomiting.  I know of one physician office where they tell the patients to stay home, keep hydrated and stay off work! The nurses won’t even give the adult patients an appointment!  We talked in previous columns about the viruses that cause nausea and vomiting.
The first concern we will always have is that our patient doesn’t get dehydrated. That must be the first, and only concern we should have.  As we discussed before vomiting is our body’s way of getting rid of bacteria, viruses and toxins that shouldn’t be there.  Our goal need not so much be stopping of the vomiting, rather the prevention of dehydration.

Signs and symptoms of DEHYDRATION

  • Dry or sticky mouth
  • Lethargy or coma (severe dehydration)
  • Low blood pressure
  • Low or no urine output, concentrated urine that looks dark yellow. (Consult MD if more than 8 hours)
  • Sunken soft spots (fontanelles) on the top of an infant’s head. (Consult MD)
  • No tears
  • Sunken eyes

We have a couple of products over-the counter that are traditionally used for nausea.  Their efficacy is doubtful.

  • Emetrol®: mixture of dextrose, fructose and phosphoric acid. It works on GI wall to decrease smooth muscle contraction and delay gastric emptying time. Best for food and drink nausea.
  • Cola syrup (Coke®) contains the same sugars and phosphoric acid. Don’t use regular soda, even de-fizzed.
    • 2-12 years old: 5-10 ml every 15minutes  until vomiting stops; not to exceed 5 doses/hr. Not recommended if under 2 years  old
    • >12 years old: 15-30 mL every 15 minutes until vomiting stops; not to exceed 5 doses/hour

Commercially Available Electrolyte Replacements

  • Oral fluids should be replaced quickly, but in a controlled fashion, to prevent the dehydration from becoming more severe. Recommend a teaspoon (5 mL) every five minutes until the patient can tolerate more.
  • Pedialyte®: is an oral electrolyte replacement solution, sold in liters and a variety of flavors: bubble gum, mixed fruit, plain, blue raspberry, cherry punch, grape. Generic formulations are available. Be sure to follow all package instructions. This is the best and most convenient option for treating vomiting, and preventing dehydration.

WHAT TO AVOID: Fluids to be avoided include:

  • fruit juices and drinks have too much sugar, and can cause vomiting.
  • carbonated beverages and caffeine containing beverages,
  • powered gelatin mixes which can make diarrhea worse, and lack the necessary electrolytes.
  • Even our beloved Gatorade diluted with water, still contains too much sugar for treatment of diarrhea. If anything, recommend sugar free Gatorade (G2®)

The return to solid foods:  BRAT diet:

The BRAT diet is a bland-food diet that is often recommended for adults and children. BRAT stands for Bananas, Rice, Applesauce and Toast. The BRAT diet helps recovery upset stomach or diarrhea for the following reasons:

  • It includes “binding” foods. These are low-fiber foods that make stools firmer. It includes bananas, which are high in potassium and help replace nutrients the body has lost because of vomiting or diarrhea.
  • Some clinicians feel this diet lacks adequate protein for long term use.

Your Thompson Pharmacist can be a value resource for the treatment of nausea and vomiting.  Our biggest concern is dehydration.  Using Pedialyte is your best option for children over age 2.  Frequent hand washing is the most beneficial way to prevent the viral gastroenteritis “stomach flu” that is currently running through our community.

Go ahead and ASK—at Thompson Pharmacy it’s all for YOU!