APPROACH TO

VOMITING INFANT
APPROACH TO A VOMITTING
INFANT
 Vomiting is forceful expulsion of stomach contents through the mouth.
 History of presenting illness
 Duration of symptoms
 Onset and frequency of symptoms
 Associated symptoms example diarrhea, fever, stool frequency,
 Timing in relation to feeds: instantly esophageal obstruction after a while : stomach or
duodenal obstruction
 Color and contents of vomit – bilious and non bilious, bloody
 Other symptoms such as cough, chest discomfort:
 urinary dysuria, hematuria
 CNS irritability, drowsy, altered sensorium
History

 Birth history: including birth weight, term, method of delivery, complications at

birth, apgar score
 Current nutrition : breast milk, formula, recent changes into cow milk food
allergies
 Immunization history
 Any medications
 Family history of allergies
 Recent history of travel
 Family member with similar symptoms
Physical examination

On Physical examination:
Assess the general condition: comparison of weight before and after onset of illness
Conscious level – GCS
 Hydration status – dry mucous membranes, sunken fontanelle, sunken eyes,
prolonged capillary refill time reduced skin turgor, tachycardia, tachypnea
 Abdominal examination: distention, visible peristalsis tenderness, abdominal
masses, bowel sounds
 Central nervous system examination: power, tone, reflexes
 Complete head to toe exam to exclude other etiologies other than abdominal:
respiratory examination
Labaratory studies

 Complete blood count: WBC infection

 Electrolytes determine effects of vomiting - hypokalemia
 High BUN/Cr ratio = dehydration
 Blood glucose levels: exclude DKA, check for hypoglycemia
 Blood gas analysis: acidosis, alkalosis in pyloric stenosis
 Urinalysis
 Lumbar puncture if meningitis is suspected
 LFTs and amylase lipase
 Imaging studies: Abdominal x ray, Abdominal Ultrasound, Abdominal CT,
Abdominal MRI
Management

 Determine underlying cause and treat accordingly.

 Assess the severity of dehydration and rehydrate accordingly. If the patient is in
shock give a bolus of 20mls/kg bolus repeat up to 2 times, then reassess if still in
shock.
 Give pediatric maintenance fluids at 4mls/kg/hr for the first 10kgs, 2mls/kg/hr for
the 2nd 10kgs and 1ml/kg/hr for the remaining kgs.
 Monitor urine output
 Correct electrolyte imbalances metabolic abnormalities and nutritional
deficiencies.
 Antiemetics are not recommended for vomiting of unknown etiology.
REFERENCES

 Neslon textbook of pediatrics 17th Edition part7: Pathophysiology of body fluids

and fluid therapy
 Handbook of hospital pediatrics
THANK YOU