Manejo de los Vómitos: Interrelación entre la Edad, el Modo de Presentación y la Sintomatología

VÓMITOS

Vomiting is a very common symptom in children. Determining its relationship with potentially dangerous conditions, as well as its diagnosis and treatment depends on both the age of the child and the mode of presentation of this symptom.

The assessment of the impact of this clinical feature on the child’s general state (lack of energy, drowsiness, pallor) and hydroelectrolytic metabolism is decisive. The child usually presents in a stable situation and we are able to conduct a case history and initial examination focusing on the following:

(Figure 1. Interrelation between age, mode of presentation, and symptoms)

Figure 1. Interrelation between age, mode of presentation, and symptoms

Source: Shields & Lightdale, 2018

AETIOLOGICAL APPROACH

The etiology of vomiting (and nausea) to facilitate a price and rapid approach based on the variables shown in Table 1. Pattern by age

It should be noted that the presence of enamel lesions may be an early sign of eating disorders (e.g. anorexia, bulimia) even in children (Uhlen, Tveit, Refsholt Stenhagen, & Mulic, 2014)

CLINICAL GUIDANCE BASED ON THE RESULTS OF THE CASE HISTORY AND EXAMINATION

The first thing to do is to find out if we are dealing with a healthy child or if he or she has any illnesses. The epidemiological environment (e.g. AGE, food poisoning) must be investigated, and any history of head or abdominal trauma (duodenal haematoma) must be taken into account. Toxic ingestion is more likely in children aged 1-5 years and adolescents who present with vomiting accompanied by changes in their level of consciousness, ataxia, and multiorgan or “strange” syndromes; even more so if there is a history of pica, or accidental or intended ingestion. Polyhydramnios is a common previous condition in neonates with congenital bowel obstruction (Shields & Lightdale, 2018) , See Table 2. Clinical guidance 1

Vomiting is nonspecific in childhood and may be caused by a variety of conditions. Once we have evaluated the degree to which the general state of health has been affected, the priority is to rule out the most serious causes of vomiting in children: surgical abdomen, severe non-surgical abdominal conditions, intracranial infection, intracranial hypertension, sepsis, and severe metabolic disorders (Hyams et al., 2016) , See Table 3. Clinical guidance 2.

USEFULNESS OF SOME LABORATORY TESTS

The evidence indicates some tests that are easy to interpret and do not require complex resources, which can guide the diagnostic-therapeutic approach, and which are included in the following table. Table 4. Usefulness of laboratory tests

THERAPEUTIC APPROACH

Beyond the aetiological approach, which is of paramount importance, symptom management often focuses on treatment in the community care setting.

Without evidence of severity, improvement in clinical features is achieved by allowing the bowel to rest and maintaining an adequate level of hydration. The basic pillars of the management of AGE are oral rehydration and early feeding. In the case of infants, early feeding should be maintained and, in the rest of children, the intake of hydroelectrolytes should be ensured in accordance with the losses and without forcing early feeding (Shields & Lightdale, 2018)

Together with this, the use of antiemetic medication encourages the positive progression of the most acute symptoms. There are numerous drugs and therapeutic regimens depending on age, the characteristics of the drug, and the clinical features being addressed (Hyams et al., 2016), (Phillips et al., 2010) ,.

Table 5. Most frequently used medications , summarises the most frequently used medications with the greatest evidence for safe use in clinical settings, including their complications or recommendations for the paediatric setting (Frelich et al., 2018), (Tomasik, Ziółkowska, Kołodziej, & Szajewska, 2016)