As its name implies intractable vomiting is the term used to describe the vomiting that can be suppressed easily with usual treatment used to treat the vomiting.
Usually because this intractable vomiting is accompanied by feeling nausea and occurs repeatedly, patients not able to digest anything may suffer dehydration because of inability to establish the adequate water intake.
Depending on the underlying cause it may be associated with abdominal pain, loose motions and fever.
Table of Contents
What causes it?
There are many causes of vomiting and intractable vomiting. A detailed history and physical examination are needed to establish the exact cause. Your doctor may suggest you some blood tests and other investigations too if required to know the cause or if needed to confirm the consequences and complications of the intractable vomiting.
Acute gastroenteritis
Acute gastroenteritis is a condition in which there is inflammation of the intestinal tract. It may be because of infection or non-infectious causes leading to this condition. Some of the most common organisms associated with intractable vomiting are viral gastroenteritis caused by:
- rotavirus
- norovirus
- Staphylococcus aureus
- E coli
- Salmonella species
Increased ICP
Vomiting is an important sign of increased intracranial pressure. In fact, all patients with vomiting should be examined to see whether they have signs of raised ICP.
The other signs of raised ICP include irregular respiration, tachycardia or bradycardia, unequally dilated pupils, changes in mood and consciousness, hyperreflexia, abnormal posturing of limbs.
Causes of raised ICP can be:
- Space occupying lesions in the brain like tumors, abscesses, tuberculoma
- Infection of meninges called meningitis like tuberculous meningitis, bacterial meningitis, or viral meningitis
- Overdoses of medicines like corticosteroids and vitamin A and vitamin D
Post-operative nausea
Anaesthetic agents and painkillers and some muscle relaxants used during operative procedures are known to cause nausea and intractable vomiting, They may induce gastric regurgitation.
Antiemetics and anticholinergic drugs are used before intraoperative procedures to avoid these consequences. Still, some patients may show signs and symptoms of vomiting and nausea after the operative procedure.
Taking chemotherapy and other medications
Chemotherapies are known to induce vomiting when they are administered. In such cases, antiemetics like ondansetron are used to prevent or stop the intractable vomiting.
Other drugs that can cause gastritis and vomiting include:
- Antibiotics
- Antimalarial drugs
- Pain killers
Gastric outlet obstruction
When we eat food it goes to the part of the intestine called the stomach. It is digested there with acid and passed further to the small intestine for further digestion and absorption into the blood.
If the part of the intestine that connects the stomach to the small intestine, the food rather than going to the intestine is thrown out in the form of vomiting. This condition is called pyloric stenosis.
This is a condition that needs surgical treatment.
Gastroparesis
Paresis is a medical term to describe the decreased power, particularly of the muscle. Here gastroparesis means gastric muscle, which is the smooth muscle that forms the stomach wall and has lost power for some reason.
It fails to function normally and then it can present as vomiting which can occur repeatedly. Some common conditions like diabetes can lead to these complications in some patients.
Hyperemesis gravidarum
Hyperemesis gravidarum is an annoying condition in pregnancy that can specifically occur in the first 9 weeks of the first trimester of the pregnancy.
There is severe nausea and repeated attempts to vomit the stomach contents. This condition can be managed with medicine like Doxinate or severe cases may need injectable medicine and hydration with intravenous fluids.
Chronic nausea vomiting syndrome
This condition is defined as nausea that occurs daily and vomiting that occurs at least once a week and similar symptoms lasting for at least 3 months time duration.
Cyclic vomiting syndrome
Cyclic vomiting syndrome is a condition in which patients show symptoms of nausea and vomiting lasting for 3-6 days occurring intermittently.
Some patients have increased blood pressure while experiencing these episodes. The exact cause of this syndrome is yet not known.
Motion sickness
Motion sickness is the most important cause of vomiting. This type of vomiting may not respond to regular traditional medicines used to treat cases of vomiting.
Motion sickness may occur while you are traveling in a car, or any vehicle on road, water or in air.
You can read further about motion sickness.
What tests are needed to diagnose?
Most of the time history and physical examination hints towards the cause of intractable vomiting.
Your doctor may suggest some tests after examining you to confirm the cause. Sometimes tests are needed to see the consequences and the complications of intractable vomiting like an electrolyte imbalance.
USG abdomen and CT head may be needed to find the underlying cause of the intractable vomiting as needed after the physical examination of the patients.
Treatment for intractable vomiting
Treatment of intractable vomiting aims at treating the dehydration and electrolyte imbalance caused by the vomiting. The treatment also includes controlling the underlying factors causing vomiting.
Hydration
Since vomiting occurs very repeatedly and patients are not able to drink fluids and eat food maintaining hydration is the challenge in this condition.
Patients may need to be treated with IV fluids to reverse the dehydration. The IV fluids may be needed till the time the patient tolerates oral rehydration solution and food, fluids orally.
The amount of IV fluids needed for the patients is guided by the severity of the dehydration of the patient.
Electrolyte imbalance
While or after treating dehydration, the patient is accessed for any electrolyte imbalance and treated to correct that.
Antiemetic drugs
Depending on the underlying cause, patients may need antiemetic drugs like ondansetron and promethazine injections in required dosages.
Underlying cause
Intractable vomiting is a symptom and it’s not a disease by itself. So, the underlying cause should be treated rather than just suppressing the vomiting.