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.

Specializes in ER, progressive care.

Interesting, never heard of it. And of course, the moment a patient requests a drug by name they are automatically labeled a drug seeker... :rolleyes:

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Specializes in ER, IICU, PCU, PACU, EMS.

We actually have 2 patients that we see with CVS. It's horrible and my heart goes out to them. We only see them when they're having an attack. I learned quite a bit about it from them since I never heard about that before my encounter. They get so frustrated by this disease.

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We have a couple of these. I do believe that there is a psychological component, but I don't believe that makes it any less real to the patient.

However, in the absence of dehydration, I don't think the ED is the appropriate place to address CVS. This is something that requires outpatient management including medications to prevent flare ups, strategies for home care of flare ups, and psychiatric/psychological counseling/therapy to address anxiety and help the person to develop effective coping mechanisms.

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Specializes in Emergency.

Had a CVS pt the other week. Showed up with pages of information and his mom. Lives local, have never seen him before, last visit to ER was over 3 years ago. Said he tried all prescribed controls (pharm & non-pharm) but they didn't work. This kid looked miserable, that kind of miserable that's hard to fake. Zofran 8, Dilaudid 8 & NS 2 liter bolus worked.

The pt said there's a definite psychological component. He says the primary trigger for him is stress. That sucks. How do you live a stress free life?

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
The pt said there's a definite psychological component. He says the primary trigger for him is stress. That sucks. How do you live a stress free life?

I believe it. We see a lot of soldiers with n/v. How do you tell people with multiple deployments and PTSD and more deployments on the horizon to work on their stress??

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Clearly it's not possible to have a stress free life. However, anxiety and PTSD are treatable. When anxiety/PTSD is at the root of somatic complaints, it's kind of pointless to address the somatic symptoms without addressing the root cause.

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Specializes in ED.

Just to follow up, I got questioned by my manager about the pt And I stated I think we did everything we could have, save giving her dilaudid. I was backed up by coworkers and charge nurse. Good thing I did a risk master just to cover my butt. Pt never cam back later in day like she stated.

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My son was 5 when he was dx with this, it is an awful dx to have. His CVS ended him with a CVL and TPN for the longest time. Now he is 10 and while the CVS is much better, he has chronic migraines...the best way to treat and end a episode is to sleep, so my son was given IV Thorazine to knock him out. Keep in mind, this is not a GI thing, this is all controlled from the brain.

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Sounds like a horrible (and painful) thing to have :(

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Specializes in Emergency Dept. Trauma. Pediatrics.

Had a patient with this that ended up staying on our unit for 12 days. She threatened to sue if we D/C her. She would say that she had not ate anything because she was on clears but then would throw up and it would look like mushed up grahamcrackers. Nothing would help she said. I finally said that we would do suppository anti emetics and did that and after a day she was cured. Did the behind the ear patch too.

So my cure for this is behind the ear and up the rear. :)

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Specializes in Emergency, Telemetry, Transplant.

We actually had a discussion yesterday at work about one of our frequent flyers who has a dx of gastroparesis and CVS. She is a diabetic who comes regularly with intractable N/V and (on some visits) DKA. She has been seen many times walking to the vending machine and buying a candy bar while pushing her IV pole with an insulin gtt running. Unfortunately, it is pts. like this who make a 'joke' out of a real diagnosis that is a serious problem.

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Specializes in ER / ICU.

We have a patient that comes in roughly every 2 weeks because of this problem. He, of course, just so happens to be very close friends with one of our ortho surgeons and has a "prescribed course of treatment" which includes Dilaudid 2 mg & Phen 25 mg. Not all of our ER docs buy into this, however. But yet it amazes me, the patient can sit back in his room and dry heave as loudly and profusely as he possibly can but when the doc refuses to give him anymore dilaudid the patient miraculously stops and is able to walk to the desk and yell at the doctor for not following his prescribed course of treatment. Miraculous, don't you think? I'm not saying the guy doesn't have this particular problem, but this is not a restaurant, we don't take med orders.

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