Table 4 -- Causes of acute nausea and vomiting that require urgent, specific treatment Cause Signs/Symptoms Confirmatory Tests Treatment Myocardial ischemia (especially inferior) Chest pain EKG, cardiac enzymes (troponin, CK) Admission, telemetry Serial EKGs, rule out MI protocol Cholecystitis RUQ, epigastric pain Fever, leukocytosis RUQ ultrasound Antibiotics Surgical consultation Appendicitis Periumbilical, RLQ pain Fever, leukocytosis Abd ultrasound Antibiotics, IV fluids Surgical consultation Pancreatitis Fever, leukocytosis Mid-abdominal pain Abd X-rays, amylase lipase, Abd CT NPO, IV fluids, analgesics IBD Bloody diarrhea, abd pain, fever UGI with SBFT flexible sigmoidoscopy colonoscopy 5-ASA preparation, steroids GI referral Gastric outlet obstruction Emesis of old food Hematemesis, abd pain Upright/supine abd X-rays, endoscopy GI referral Small bowel obstruction Abdominal pain Upright/supine abd X-rays UGI with SBFT NPO, NG suction Surgical consultation Esophageal infection Dysphagia, odynophagia Fever, GI bleeding Oral examination UGI GI referral for endoscopy Acute Hepatitis Jaundice, abd pain Fatigue AST/ALT, bilirubin Viral serologies Supportive care Determine etiology Meningitis Headache, photophobia LP, Head CT Emergent antibiotics Cerebral Vascular Bleed Headache, head trauma Head CT Neurology Neurosurgery referral Increased ICP Headache, HTN papilledema, 6th n. palsy, altered consciousness Head CT Hyperventilation, mannitol dexamethasone nuerosurgery consult Diabetic ketoacidosis wt loss, polyuria, polydipsia, acetone on breath, vague abd pain, hyperventilation anion gap metabolic acidosis, serum ketones Insulin, IV fluids K+ replacement, Phosphate Alcoholic ketoacidosis Dehydration, malnutrition anion gap metabolic acidosis, lactic acidosis D5/1/2 NS IV Adrenal insufficiency weakness, fatigue, anorexia, wt loss, orthostatic hypotension, hyponatremia, shock Cortrosyn simulation test Hydrocortisone 100 mg IV q8 Maintenance: prednisone 5mg PO qAM/2.5mg qPM