Nausea and vomiting initial assessment
Outpatient-first nausea/vomiting approach with dehydration and red-flag escalation checkpoints.
Last reviewed February 7, 2026
Red flags
- Persistent inability to keep fluids down, severe dehydration, or hypotension.
- GI bleeding, severe focal abdominal pain, or altered mental status.
- Chest symptoms, focal neurologic signs, meningism, possible poisoning or diabetic ketoacidosis require the relevant emergency pathway.
Assessment priorities
- Clarify symptom duration, frequency, oral-intake tolerance, and hydration status.
- Review abdominal pain, fever, pregnancy possibility, and medication triggers.
- Screen for complications such as electrolyte disturbance and orthostatic symptoms.
Initial management
- Start oral rehydration strategy and symptom-directed outpatient management when stable.
- Minimize unnecessary testing when red flags are absent and follow-up is reliable.
- Set clear thresholds for escalation if symptoms persist beyond expected course.
Follow-up and escalation
- Reassess within short interval if oral intake remains limited.
- Escalate urgently for worsening dehydration, pain progression, or systemic instability.
- Reinforce return precautions and an individualized hydration plan; confirm oral tolerance and avoid fixed fluid targets in significant renal or cardiac disease.
References
- BC Emergency Health Services Nausea and vomiting (opens in a new tab)
- Emergency Care BC Oral rehydration for adults (2020) (opens in a new tab)
- Emergency Care BC Antiemetic safety (2022) (opens in a new tab)
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