Cyclical vomiting syndrome

Specialties Emergency

Published

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.

Thanks for your quote, Trekfan. Please give an attribute to your source.

wake forest baptist hospital the the doctor that made the passer for gastroparesis is there . and I had it !

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Specializes in ICU & LTAC as RN. FNP.

Coincidently, I was reading about this condition last night in my pediatric diagnoses textbook. Much of this condition is similiar and possibly related to migraines. Forceful, frequent vomiting, up to six times per hour, and lasting up to 72 hours. Abdominal pain occurs. There's more to it than that, but I'm sure you get the idea.

Quick citation...Hay, (2011) Current diagnosis & treatment Pediatrics.

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Sounds related to abdominal migraines. Glad I don't work GI. You just can never actually FIX the GI stuff, half the time you can't even actually diagnose something.

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Yes! I had a pt with this and we de-toxed him. Put him on suboxone and kept him..it did work..but took like 5 days..and it was miserable in the mean time.

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Specializes in ER.

Common in young, mild to moderately non compliant diabetics too. See several of these people a week.

Sometimes a gastric stimulator implant may help, but it takes a motivated patient.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Sounds related to abdominal migraines. Glad I don't work GI. You just can never actually FIX the GI stuff, half the time you can't even actually diagnose something.

I've heard "cyclical vomiting" and "abdominal migraines" used interchangeably. Agree with the GI stuff ... whatever the issues the patient has with seeking vs. pain, it doesn't look like any kind of fun...

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Specializes in CEN, CPEN, RN-BC.

I see a decent amount of CVS around here... seems to be the new Fibromyalgia. They're always the same... retching in triage and making a spectacle of themselves until you IV slam them with Dilaudid about 4 times. Just sayin.

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Specializes in Emergency, Telemetry, Transplant.
I see a decent amount of CVS around here... seems to be the new Fibromyalgia. They're always the same... retching in triage and making a spectacle of themselves until you IV slam them with Dilaudid about 4 times. Just sayin.

I've seen this in a number of cases too...even had one ER doc say to another doc that this was the "next" Fibromyalgia. The disorder sounds and looks terrible. And, like with fibromyalgia, there are people who suffer from the disorder, fight through it, and get tx. when the absolutely need it.

On the other hand, I know of pts (some of our frequent fliers) who are totally non compliant diabetics, who come in with severe vomiting for 24 hrs, severe abd pain, blood sugar greater that 400, possible DKA. We also have pt's with this disorder who have care plans that "prohbit" IV narcs (only PO), but they force themselves to vomit so we have to start an IV and then some docs just "oh well, there's an IV...I guess we will give them IV dilaudid now." These are they types that cause the genuine sufferers of the disorder to be viewed, unfortunately, with skepticism and eye rolls...but, these latter types do exist.

OK, flame away.

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Specializes in ED.

Sorry also forgot to mention 500cc NS bolus.

Pt denied HA or hx of migraine. Pt kept asking for dilaudid by name. I felt bad for her, it's not nice to vomit so much. I advocated pain medication but doc wouldnt give it. Pt was a frequent flyer, and husband known to be a di** to staff. He picked her up on discharge and demanded the medical directors name and number, screaming he wasnt going to pay the bill and that he was going to get us all fired.

In my opinion, there was some psychological aspect to her condition, which played into her symptoms making them worse. It sounded like after the initial vomiting after being brought back from triage, she was wretching, trying to make herself throw up. Just my opinion, and I did speak to my charge nurse a few times about the pt. What got me is that she was telling me to tell the doctor what to order, "i need at least 4 shots of phenergen and 2 shots of dilaudid, plus one of each before i leave for the ride home." Upon discharge, pt refused wheelchair and stormed out angrily, without any s/s witnessed before. And to leave our ED is quite a walk since we are renovating.

Thanks again for all the replies!

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Specializes in pediatrics, public health.

It doesn't surprise me that a patient with a chronic condition might know the medications she has been given in the past by name, and ask for them by name. It may just be that she knows what works for her, not that she's a drug seeking faker. Worth thinking about, at least.

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Specializes in Emergency & Trauma/Adult ICU.
Sorry also forgot to mention 500cc NS bolus.

Pt denied HA or hx of migraine. Pt kept asking for dilaudid by name. I felt bad for her, it's not nice to vomit so much. I advocated pain medication but doc wouldnt give it. Pt was a frequent flyer, and husband known to be a di** to staff. He picked her up on discharge and demanded the medical directors name and number, screaming he wasnt going to pay the bill and that he was going to get us all fired.

In my opinion, there was some psychological aspect to her condition, which played into her symptoms making them worse. It sounded like after the initial vomiting after being brought back from triage, she was wretching, trying to make herself throw up. Just my opinion, and I did speak to my charge nurse a few times about the pt. What got me is that she was telling me to tell the doctor what to order, "i need at least 4 shots of phenergen and 2 shots of dilaudid, plus one of each before i leave for the ride home." Upon discharge, pt refused wheelchair and stormed out angrily, without any s/s witnessed before. And to leave our ED is quite a walk since we are renovating.

Thanks again for all the replies!

See, you fixed her! :rolleyes: You've encountered a seeker, and I think you know it.

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:lol2:

He picked her up on discharge and demanded the medical directors name and number, screaming he wasnt going to pay the bill and that he was going to get us all fired.

Bahaha! Like he was planning to pay the bill anyway....:lol2:

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