The following symptoms and complaints may occur together with vomiting (emesis):
Leading symptom
Accompanying symptoms
- Nausea
- Headache
- Dizziness
Chemotherapy-induced nausea and vomiting (CINE)
This is divided into three phases
- Acute-onset CINE: onset of nausea and/or vomiting within the first 24 h after administration of a chemotherapeutic agent; often occurs after only a few minutes
- Delayed-onset CINE: occurrence at least 24 h after cytostatic drug administration and may persist for up to 120 h after admission
- Anticipatory CINE: This occurs before the application of the antineoplastic agent in patients who have had CINE.
Warning signs (red flags)
- Anamnestic information:
- Diabetes mellitus
- Thyroid disease
- Abdominal pain (abdominal pain) + peritonitis (peritonitis with defensive tension) + impaired general condition (possibly shock) → think of: acute abdomen.
- Cephalgia (headache) → think of: Meningitis (meningitis), brain tumors (due toincreased intracranial pressure), subarachnoid hemorrhage (SAB).
- In women: Dyspnea (shortness of breath), nausea (nausea), upper abdominal pain, and vomiting → think of: Myocardial infarction (heart attack).
Infants and young children
Dehydration (lack of fluids) and shock
The following children are at increased risk:
- Infants with low birth weight
- Infants, with signs of malnutrition
- Children under one year of age, especially children under 6 months.
- Children who have had > 5 diarrheal stools within the last 24 hours
- Children who have vomited more than twice within the past 24 hours
- Children who have not previously received supplemental fluids or have been unable to tolerate them
- Children in whom breastfeeding has been discontinued during the disease.
Warning signs (red flags) in children (= possible indicators of other diagnoses) [NICE recommendations; 1, 2 ]
- Fever > 38 °C in children younger than 3 months of age.
- Fever > 39 °C in children over 3 months of age
- Shortness of breath or tachypnea (“rapid breathing“).
- Changes in consciousness
- Meningismus (painful stiffness of the neck)
- Bulging fontanelle in infants
- Rash that can not be pushed away
- Blood or mucus accumulation in the stool
- Bilious (greenish) vomiting
- Severe or localized abdominal pain
- Distended abdomen or pain on release