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 Vomiting

Hyperglycaemia can result in gastric stasis and thus is occasionally a cause of vomiting in patients with illness and poor glycaemic control (particularly in those patients with autonomic neuropathy who have background gastro-paretic symptoms).  If after initial stomach emptying the vomiting or nausea persists in these patients the most effective form of therapy is a gastric motility agent (such as metoclopramide or domperidone)

More commonly however vomiting will be triggered by the illness itself, either as a response to sepsis or inflammation. In these circumstances centrally-acting agents such as prochlorperazine and cyclizine are the first line therapy.

In either circumstance therapy needs to be offered early as for most patients with de-compensated diabetes and vomiting persisting greater than 12hrs this will constitute an admission trigger for IV treatment.

In those who vomit episodically during illness the electrolyte and acid-base balance implications of vomiting need to be considered in assessment of their overall status (K+ and H+ losses may result in ileus and/or masking of acidaemia if measured by pH alone).