vomiting at night?

[bjolly]

can anyone tell me what they make of this situation? 10 y.o. girl, usually healthy except for bad seasonal allergies, has started throwing up during the night. she wakes up once or twice during the night with severe nausea and vomits. no other symptoms except her throat hurts after she vomits. also she is coughing badly at night which may be related to the allergies? during the day she feels ok except tired from her sleep being disturbed.

she did this every night for a week, fp said it was a virus and gave her 5 days of antinausea medication which seemed to work. then was fine for 2 weeks and last night it started again.

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[hokiedoc2005]

???Cyclic Vomiting vs. Increased ICP???

 

[Noelle]

seizure activity? some type of migraine?

is she having ANY other symptoms? how long has this gone on?

 

[Ursus Martimus]

I'd scan her Noggin

 

[bjolly]

the problem began about 3 weeks ago. 6 nights of vomiting once or twice a night, then 5 days on antinausea meds and no more vomiting episodes till last night. about 2 weeks of vomit-free nights till last night.

she had a slight fever the first couple days of the whole thing, but no other symptoms at all.

 

[gvmatt]

i would also consider reflux with the history of cough and vomitting only at night. however cough could be asthma, and vomitting could also be as mentioned before. is it a little vomit, or lots with projection?

 

[bjolly]

I wondered about reflux. On nights when she vomits, I usually notice her coughing worse than usual as she tries to fall asleep.

It's usually a good amount of vomit, at least the first time she throws up on a given night. If she throws up a second time it's more of a dry heaves kind of thing.

 

[kas23]

If you get any kid coughing enough, they will have emesis. The coughing triggers the gag reflex and then they puke. So, the vomiting is probably due to the coughing, but what is the coughing due to? Is it chronic or is it acute? If it was chronic, I would place my bets on either asthma (classic symptom of asthma=coughing at night) or reflux. If the coughing is acute, I would also blame it on a virus or allergies. Remember not to get stuck in the post-nasal drip excuse. When someone is laying down, due to gravity, post-nasal drip is not much of an issue. This is why allergists focus mostly on coughing at night, as opposed to coughing in general because coughing during the day would probably be post-nasal drip.

 

[Ursus Martimus]

Chronic cough and bronchial asthma are quite common. Indeed, over 85% of these children are allergic to the dust mite (Cook). Feeding irregularities, colic, bloating, and nocturnal emesis are also potential signs of childhood allergy.

From:

TITLE: Pediatric Rhinosinusitis
SOURCE: Grand Rounds Presentation, UTMB, Dept. of Otolaryngology
DATE: May 31, 2000
RESIDENT PHYSICIAN: Russell D. Briggs, M.D.
FACULTY PHYSICIAN: Norman R. Friedman, M.D.
SERIES EDITOR: Francis B. Quinn, Jr., M.D.

 

[kas23]

Take home message: fp should refer pt to allergist.

 

[Bernardo_11]

Allergist? Naw notchet. Sounds to me like this child is suffering from post-tussive emesis due to, at least, mild persistent asthma. She already has a history of an atopic condition. Try to get some pulmonary funtions tests if possible (these can be difficult to obtain with children). Have mom clean out the air conditioner, vacuum the bedroom floor, and wash the bedsheets like twice a week. I'd see how the child does on an albuterol MDI right before bedtime. But more likely than not, she'll need to be started on a low dose inhaled steroid like Flovent.

 

[kas23]

Allergist? Naw notchet. Sounds to me like this child is suffering from post-tussive emesis due to, at least, mild persistent asthma. She already has a history of an atopic condition. Try to get some pulmonary funtions tests if possible (these can be difficult to obtain with children). Have mom clean out the air conditioner, vacuum the bedroom floor, and wash the bedsheets like twice a week. I'd see how the child does on an albuterol MDI right before bedtime. But more likely than not, she'll need to be started on a low dose inhaled steroid like Flovent.

Sorry for the prejudice, but I wouldn't want a fp trying to manage asthma in a child. They usually don't know the current guidelines for children and they don't know how to best teach the child to use their inhaler. Plus, a pediatric allergist can do PFTs right in the office.

 

[vigils]

Sorry for the prejudice, but I wouldn't want a fp trying to manage asthma in a child. They usually don't know the current guidelines for children and they don't know how to best teach the child to use their inhaler. Plus, a pediatric allergist can do PFTs right in the office.

Ridiculous. Like its hard to learn some asthma peds guidlines. How do you use an inhaler, with a spacer or without .. oh I don't know, do you have to breath in it, duh. Pediatric allergist my ass. They don't even know if its asthma. You need to give a better history then at night if you want any good answers, otherwise this is all just bs. So your dictation looks like, Cheif complaint, vomitting at night, awww, nothing else?! Get a better history, do the damn peak flow and spriometry just becuase its so easy and look at the labs. Take that and post me in the morning!

 

[bjolly]

fwiw, the fp's new verdict is reflux as the cause of both the cough and the vomiting. She gave her a prescription for zantac & so far so good.

thanks for all the opinions.