Cyclical vomiting syndrome

  1. 0
    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.

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  2. 49 Comments...

  3. 9
    Not sure about the diagnosis, but in my world cyclical vomiting gets an NGT.....
    imanedrn, RunnerRN2b2014, canoehead, and 6 others like this.
  4. 0
    Quote from mcleanl
    Not sure about the diagnosis, but in my world cyclical vomiting gets an NGT.....
    Can you explain rationale behind giving a NTG tablet?
  5. 15
    Quote from thelema13
    Can you explain rationale behind giving a NTG tablet?
    NGT = NasoGastric Tube. Not a tablet.
    DBK99, tvccrn, MLMRN1120, and 12 others like this.
  6. 0
    Quote from mcleanl
    Not sure about the diagnosis, but in my world cyclical vomiting gets an NGT.....
    whoops, read your post wrong....
  7. 1
    Great post. Had to look that one up! Genetic huh? So, so there is no 'cure' just 'management'.

    Found this link:
    wooh likes this.
  8. 5
    Sucks to be her. Narcs tend to slow peristalsis so they would be bad in general for gastroparesis. Whether she is seeking or not is not for us to judge. I would doubt she is throwing up her food on purpose, but probably there is an emotional component to her problem. I agree with the other poster that NG tube should be given for gastric rest. Yet another patient that is being poorly managed and coming to the ER in distress. Find a cure for that and I'll be your servant for a year.
  9. 3
    I've had a couple of patients cyclic vomiting syndrome. Most of the time it was all about management to prevent a flare-up, and fluid administration/diet modifications when it did hit. We usually used Zofran instead of Phenergan though, since Phenergan can make patients loopy.
    IowaKaren, wooh, and VivaLasViejas like this.
  10. 3
    I had a pt with that dx. The pts history of psych issues left most of us questioning the need for around the clock Dilauded and Phenergan. Zofran would not do. Especially with only one emesis on admit. Then nothing further.
    I'm not saying the pt was lying. I'm not saying the pt wasn't in pain and nauseous. I am saying this disorder could be used by people who just want some Dilaudid. If there is no emesis, then all the symptoms are subjective.
    Crux1024, wooh, and VivaLasViejas like this.
  11. 0
    That doctor is a _ gastroparesis is veary pain full and a living hell I had gastroparesis from a drug I took THANK GOD I DO NOT HAVE IT ANYMORE . you might try to give her pepseid it help the pain for me from the acid . the acid from vomiting cause a lot of pain. I was in so much pain I had to be pushed around in a wheelchair

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