Cyclical vomiting syndrome

[thelema13]

Anybody encountered a patient with this diagnosis? I had a pt come in the other day, report of vomiting x23 during past 4 hours, severe pain 10/10 in abdomen, letter from GI doctor stating she was diagnosed with cyclical vomiting syndrome and gastroparesis. Pt was begging for phenergen and dilaudid. Pt had previous rx for dilaudid 2mg PO, phenergen 25mg PO, and reglan 10mg PO. I gave her phenergen IV and IM, bentyl IM, protonix IV, tigan IM. Pt seemed to calm down but still begging for pain medication, asking for dilaudid by name. Became irritated when ED doc explained dilaudid may increase n/v and would not be given. (ED doc did not believe report of pain and flagged pt as drug seeker). Pt would only wretch and dry heave when I left the room or when doc was in room talking to pt. She was good enough to walk around and keep asking for pain medication. I witnessed vomiting x3 during 2.5 hour stay, watery undigested food, no bile. Im not sure what to think...........

Any input greatly appreciated.

[LV3677]

Had one of these recently in the ED. Patient had a home medication regimen of the standard antiemetics that weren't resolving symptoms. The patient asked for Emend, which is an anti nausea medication used to premeditate for chemo patients. It worked beautifully for this patient, and was able to discharge home with a script for it.

[mecsjh1]

The information found here is invaluable to me. I have CVS that began 5 years ago, but has just been diagnosed. I absolutely do not like going to the ED, but will have to until we figure out what works for me. I am also a pain patient (since multiple back surgeries in 1995), but am on an extended release medication. My episodes typically present about one hour after rising for the day. I rarely vomit up my pain meds, so when I get to the ER I could care less sbout them, or anything else except getting fluids, stopping the violent vomiting (never dry heaves, but a lot of bile), and getting cleaned up. Unfortunately, for me and my nurses, I become bowel incontinent 80% of the time. I typically get compassionate care, but I spend all my energy in between vomiting, apologizing to any professional that provides any care. I apologize for the mess as well. I feel so bad for anyone who has to help me get cleaned up. My last ED visit happened when they were slow. In fact, I was stunned to fine the ED waiting room completely empty at 8:35 am in a Thursday. The woman caring for me was mad at me for sending my husband away. He has a weak immune system and, as our sole provider, I need him well so I make him leave. Everyone has always understood this, but this last visit she was mad! So mad, after cleanung up my mess & changing the sheet & gown once, she left me sitting in a lot of my waste for well over an hour. Sent me to get an abdominal ultrasound in it, as well as sending me upstairs when I was admitted. Left it to the regular hospital nurses to take care of. All of these other people were astonished this happened to me and, very graciously and with compassion, cleaned me up each time. I feel for the people who have CVS that posted here, and for those who may be unfairly labeled. Once my doctor(s) find what works for me, I assumed if I did have to go to the ED on occasion, that telling them what has worked in the past would be the smart thing to do. However, after reading all of this, I will get a letter from the doc stating what works, or what they are currentky giving me so I can hand it over at the ED to avoid any misconceptions. Thank you to all the nurses and other pros who either do or are trying to understand this horrible illness.

[HEM RN]

I am a RN and have CVSfor 10 years. It took 5 years to find a plan that worked.

I would never and have refused to go to the ED because of the stigma. I am sure that I would be treated negatively, unless I happen to know the nurse.

It's hard for people to understand and being labelled only takes one nurse one time, and others will follow suit.

I have been on IV at home, self administered meds. I switched doctors because the first one wouldn't look outside the box at all. Thank god I found an amazing MD, who worked with me. I am sure I would have died had I had not switched.

I don't envy ED nurses work, but just because somebody knowns the name of a certain drug doesn't mean they are drug seeking. It means they have been through hell and back. And finially have an idea of what works for them.

The new fibromyalgia would truly be a stretch, it is uncommon, likely unheard of by 99 % of health workers, most will likely never see a case.

Compassion, is what we need, not accusations, especially if they can tell you and show you their plan.

Imagine feeling nauseous 90 % of the time, wretching multiple times a day, vomiting at work in any available garbage can.

That is how my life is, it is horrible. Amitryptaline was a mirlacle drug for me for 5 years, nearly eliminated active vomiting episodes, but it has stopped working. Now as I take a break from it, hoping it will work again in the future. I suffer 24/7 , I don't wish this on any person, it life changing.

I am sure that anybody who had mad their way to the ED has attempted everything in their power to abort the vomiting, and certainly are well aware of the stigma about the types of drugs needed to abort, and how others will judge them

[mickeyrose9]

Sometimes smoking excess amts of marajuana can cause cyclical vommiting.

Also, giving a low dose of haldol helps with the vomiting and psych aspect. I personally believe that part of cyclical vommiting can be linked to psych (not always, but often).

[hppygr8ful, ASN, RN, EMT-I]

It is a real diagnosis - I had it for about 3 years before an underlying contributing diagnosis was found. I went to the ER a couple of times and usually got Zofran, Phenergan for it - occasional IV Narcs when it had kept me up overnights and the pain from the underlying condition was bad. It did resolve when the a gastrointestinal Doc found the source of the problem and removed 18 inches on my colon!

Hppy

[hppygr8ful, ASN, RN, EMT-I]

No mention of concurrent drug use - especially marijuana from the posts. Are any of your departments doing drug screens to assess for a drug related component?

What I'm finding with the patients being seen in the departments I'm working in is all these patients are chronic marijuana users.

We throw every anti-emetic at these patients, including Haldol, yet all that seems to ease the symptoms (other than a threat to use only non-parenteral approaches) is a narcotic - which miraculously works the second it is pushed like a switch has been thrown. Certainly leads one to identify these patients as seekers.

When it comes to marijuana use you have to understand that many people with disorder turn to the use of medical marijuana hoping for relief. Not all but some. I know I thought about it but didn't go there.

Hppy

[BostonFNP, APRN]

When it comes to marijuana use you have to understand that many people with disorder turn to the use of medical marijuana hoping for relief. Not all but some. I know I thought about it but didn't go there.

Hppy

This makes it very hard to differentiate CVS from CHS, especially as time passes because its hard to tell which started first the vomiting or the THC.

[wildnursebrendan]

I didn't read through all the pages of responses so maybe someone mentioned this, but sometimes it is Cannabis related. Had a MD print out the literature for us the first time I saw this. The patient wanted to live in the shower because hot water was the only thing that helped.

[BostonFNP, APRN]

I didn't read through all the pages of responses so maybe someone mentioned this, but sometimes it is Cannabis related. Had a MD print out the literature for us the first time I saw this. The patient wanted to live in the shower because hot water was the only thing that helped.

Read back through them to my posts, in adults, Canabinoid Hyperemesis Syndrome is one of the leading causes and the diagnostic factor (for me) is taking hot showers.

[That Guy, BSN, RN, EMT-B]

Read back through them to my posts, in adults, Canabinoid Hyperemesis Syndrome is one of the leading causes and the diagnostic factor (for me) is taking hot showers.

Yup and the bag of air they keep "vomiting" up. But man once they get that haldol and capsaicin it cures it all.

This wasn't supposed to be derogatory towards them, I realized it might have come out that way. We see it way too much here and are met with insane amounts of resistance when we tell people to stop smoking. Classic signs every time they come in though.

[nprosser25]

I am a RN diagnosed with cyclic vomiting syndrome. This is a much misunderstood illness. Anyone with a true diagnosis of cvs IS in severe pain, and definitely runs the risk of being viewed as drug- seeking. I was given dilaudid-ativan combo on my first admission, which cured the episode. In the case of CVS, dilaudid has nausea-relieving effects. Please do not immediately judge people as drug- seekers. Until you walk in another's shoes, do your research and try not to assume. Also, gastropariesis is not the same as CVS and may or may not be associated.

[nprosser25]

Also, there is a separate disorder called Cannabinoid hyperemesis syndrome, mimics CVS but not the same thing. This one is curable by stopping marijuana.