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A 24-year-old woman presents to your urgent care clinic complaining of nausea and vomiting for the past 4 weeks.
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- What additional questions should you ask to determine the severity of her condition?
- Can you narrow the differential diagnosis of her “nausea and vomiting” through your use of open-ended questions followed by more focused queries?
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Nausea and vomiting are common symptoms experienced across all age groups. Although they are often manifestations of minor self-limited illnesses, these symptoms may also be harbingers of life-threatening disease. Nausea and vomiting cause significant worldwide reductions in worker productivity and increases in healthcare costs, particularly among pregnant women, patients receiving cancer chemotherapy, and patients recovering from surgery. Nausea is frequently, but not always, associated with vomiting.1
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The initial differential diagnosis of nausea and vomiting is broad but may be narrowed significantly by the clinical context.
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The evaluation of an infant or young child who has acute vomiting merits special consideration. For instance, the possibility of a toxic ingestion is much more likely in a child than an adult. Despite a declining incidence, Reye's syndrome remains a consideration in an acutely vomiting child who has had a recent viral infection (and has been given aspirin products).
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Similarly, the differential diagnosis for a recurrently vomiting infant or young child should be expanded to include congenital abnormalities (eg, malrotation, pyloric stenosis, esophageal atresia). Remember, vomiting in infants may simply be regurgitation due to physiologic gastroesophageal reflux.
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A positive family history along with associated neurologic symptoms should raise suspicion for inherited metabolic dis-orders (eg, urea cycle enzyme deficiencies, Wilson's disease) or neurogastrointestinal disorders (eg, cyclic vomiting syndrome).
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