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Vómitos Pediátricos

Vómitos Pediátricos

El vómito, o emesis, es la expulsión oral forzada del contenido gástrico. Los LOS Neisseria vómitos son un síntoma frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pediatría. La frecuencia y las características de los LOS Neisseria vómitos pueden apuntar a una patología concreta, al AL Amyloidosis igual que su presencia puede ser un síntoma más de una situación clínica mayor. La mayoría de los LOS Neisseria vómitos son benignos y autolimitados. Una buena toma de antecedentes y exploración física pueden poner de manifiesto la causa subyacente y el tratamiento. El tratamiento se realiza con antieméticos y tratando la causa subyacente, de ser necesario. Las complicaciones más comunes son la deshidratación y la desnutrición.

Last updated: Jan 17, 2024

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Contents

Definición y Etiología

Definición

El vómito (emesis) se refiere a la expulsión oral forzada del contenido gástrico.

Etiología

  • Neonatos:
    • Atresia Atresia Hypoplastic Left Heart Syndrome (HLHS) esofágica
    • Anillos vasculares
    • Lesiones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el SNC
  • Lactantes:
    • Gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis
    • Estenosis pilórica
    • ERGE
    • Alergias alimentarias
    • Intolerancia a la proteína de la leche
    • Sobrealimentación
    • Errores congénitos del metabolismo
    • Anillos vasculares
  • Niños y adolescentes:
    • Gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis
    • Pielonefritis
    • Infección sistémica
    • Ingesta de tóxicos
    • Apendicitis
    • Úlceras
    • Pancreatitis Pancreatitis Inflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis. The two most common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis. Acute Pancreatitis
    • Embarazo

Presentación Clínica

Antecedentes

Se debe realizar una anamnesis completa para descartar diagnósticos diferenciales de los LOS Neisseria vómitos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un niño.

  • Demografía:
    • Edad
    • Sexo
    • Lugar de residencia (importante en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos de epidemias e intoxicaciones alimentarias)
  • Inicio/duración/progreso de los LOS Neisseria síntomas
  • Asociación de la ingesta de alimentos
  • Equilibrio de líquidos:
    • Número de pañales mojados/micciones al AL Amyloidosis día
    • Aumento en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el consumo o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la solicitud de agua
  • Síntomas asociados:
    • Fiebre
    • Dolor Dolor Inflammation de oídos
    • Cefalea
    • Dolor Dolor Inflammation abdominal
    • Disfagia
    • Dolor Dolor Inflammation torácico (acidez referida en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la esofagitis)
  • Naturaleza del vómito:
    • Proyectil/no proyectil
    • Color
    • Contenido
    • Doloroso/no doloroso
    • La hematemesis Hematemesis Vomiting of blood that is either fresh bright red, or older ‘coffee-ground’ in character. It generally indicates bleeding of the upper gastrointestinal tract. Mallory-Weiss Syndrome (Mallory-Weiss Tear) puede ocurrir en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
      • Síndrome de Mallory-Weiss (que indica vómitos forzados)
      • Coagulopatías
    • Vómitos severos y persistentes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos de:
      • Compromiso del SNC ( meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños, hidrocefalia)
      • Trastorno metabólico
      • Quimioterapia inducida
    • Actividad sexual en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adolescentes mujeres (por posibles vómitos inducidos por el embarazo)

Examen físico

  • Fiebre en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum infecciones gastrointestinales y del SNC
  • Fontanela abultada o hundida:
    • Abombamiento (↑ presión intracraneal)
    • Hundido (deshidratación)
  • Mala alimentación
  • Signos de deshidratación o shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock (terapia de reposición de líquidos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños)
  • Talla y peso bajos para la edad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos de anorexia Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa debido a la pérdida de calorías y nutrientes:
    • Falla en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el desarrollo
    • Desnutrición
  • Nistagmo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum trastornos vestibulares (vértigo)
  • Distensión y sensibilidad abdominal marcada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum apendicitis o abdomen agudo
  • Signos presuntivos de embarazo
Tabla: Grado de deshidratación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños
Leve Moderado Severo
Pérdida de peso
  • < 5% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lactantes
  • < 3% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños mayores
  • 5%–10% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lactantes
  • 3%–9% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños mayores
  • > 10% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lactantes
  • > 9% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños mayores
Mucosa seca (primer signo) – +/- (parece seca) + (parece reseca)
Turgencia de la piel (último signo) + +/– – (tensa)
Depresión de la fontanela anterior – + +/++
Estado mental Normal Fatigado/irritable Apatía / letargo
Enoftalmos – + +
Respiración Normal Profunda, tal TAL Renal Sodium and Water Regulation vez taquipneica Profunda y taquipneica
Frecuencia cardíaca Normal Aumentada Muy aumentada
Hipotensión – + +
Perfusión distal Normal
  • Se siente frío
  • Llenado capilar de 3-4 segundos
  • Acrocianótico
  • Llenado capilar > 4 segundos
Diuresis Disminuida Oliguria Oliguria Decreased urine output that is below the normal range. Oliguria can be defined as urine output of less than or equal to 0. 5 or 1 ml/kg/hr depending on the age. Renal Potassium Regulation Oliguria Oliguria Decreased urine output that is below the normal range. Oliguria can be defined as urine output of less than or equal to 0. 5 or 1 ml/kg/hr depending on the age. Renal Potassium Regulation/ anuria Anuria Absence of urine formation. It is usually associated with complete bilateral ureteral (ureter) obstruction, complete lower urinary tract obstruction, or unilateral ureteral obstruction when a solitary kidney is present. Acute Kidney Injury
Tabla: Características del vómito según el nivel de obstrucción
Naturaleza del vómito Nivel aproximado de obstrucción
Vómito ácido no bilioso Distal al AL Amyloidosis estómago, proximal al AL Amyloidosis duodeno
Vómitos biliosos Distal a la 2da parte del duodeno
Vómito fecaloideo Obstrucción en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el intestino grueso
Contenido de alimentos no digeridos Obstrucción proximal

Diagnóstico y Tratamiento

Pruebas de laboratorio

  • Panel metabólico básico:
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos de deshidratación severa puede aparecer:
      • ↓ Glucosa
      • ↑ Nitrógeno de Urea Urea A compound formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. Urea Cycle (BUN, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
      • ↑ Sodio y cloruro
      • ↓ Bicarbonato
      • ↑ Creatinina
  • Creatina quinasa:
    • Cuando piense en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum rabdomiólisis
    • Elevada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la deshidratación severa

Terapia farmacológica

  • Hidratación intravenosa para:
    • Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock hipovolémico
    • Deshidratación severa
    • Vómitos intratables
  • Antieméticos:
    • Ondansetrón IV u oral (primera línea)
    • Metoclopramida oral o IV
    • Dimenhidrinato por vía oral ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de mareo para mayores de 12 años)

Terapia no farmacológica

  • Rehidratación oral (de elección y de primera línea en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la deshidratación leve o moderada)
  • Intervención quirúrgica por obstrucciones intestinales (i.e., estenosis pilórica)
  • Inhibidores de la bomba de protones (IBP) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la enfermedad péptica (i.e., enfermedad por reflujo gastroesofágico)

Deshidratación de leve a moderada

  • La terapia de rehidratación oral es el tratamiento de primera línea en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la deshidratación leve o moderada.
  • Deben utilizarse soluciones de rehidratación oral con contenidos de electrolitos similares a los LOS Neisseria del líquido perdido:
  • Objetivo: Proporcionar 50-100 mL/kg de líquidos durante 2-4 horas. La vía de administración depende de la edad y la fragilidad del paciente:
    • Alimentación con jeringa o cuchara
    • Sonda nasogástrica
  • +/- Ondansetrón para prevenir los LOS Neisseria vómitos
  • El estado de hidratación clínica debe ser monitoreado frecuentemente.
  • Si no se mejora con la terapia de rehidratación oral, se debe solicitar la hidratación intravenosa.

Deshidratación severa

La deshidratación severa puede causar hipoperfusión del cerebro y de los LOS Neisseria órganos vitales y se considera una emergencia médica que debe ser atendida rápidamente.

  • Fase de reanimación aguda:
    • Objetivo: corregir o prevenir el shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock hipovolémico
    • Expansión rápida de volumen mediante bolos de líquido:
      • 20 mL/kg administrados durante 20 minutos.
      • Puede repetirse hasta 3 veces
      • Monitorizar los LOS Neisseria signos vitales entre cada bolo.
    • Elección del líquido de sustitución:
      • Sólamente líquidos isotónicos
      • La solución salina normal o el lactato de Ringer son adecuados.
    • Control de la glucosa:
      • Monitorización de la hipoglicemia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el punto de atención
      • Debe administrarse glucosa intravenosa.
      • 5-10 mL/kg de dextrosa al AL Amyloidosis 10% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum solución salina normal O 2-4 mL/kg de dextrosa al AL Amyloidosis 25% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum solución salina normal
  • Fase de reanimación:
    • Reposición más lenta de los LOS Neisseria líquidos perdidos durante 24 horas
    • Líquido total para la fase de reanimación = líquidos de mantenimiento + (rehidratación – bolo ya administrado)
    • La rehidratación se divide en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 2 fases:
      • 50% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las primeras 8 horas
      • 50% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las próximas 16 horas
    • Un 5% de dextrosa con un 0,2% de cloruro sódico compensa las necesidades de mantenimiento de sodio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mayoría de los LOS Neisseria niños
  • Después de 24 horas si está clínicamente estable → continuar con los LOS Neisseria líquidos de mantenimiento

Cálculos de sustitución de volumen

  • Bolo estándar:
    • 20 mL/kg/20 minutos
    • Hasta 3 veces
    • Monitoreo de signos vitales.
  • Cálculos de mantenimiento:
    • Regla 4-2-1:
      • 1ros 10 kg = 4 mL/kg/hora
      • 2dos 10 kg = 2 mL/kg/hora
      • Kg. adicional = 1 mL/kg/hora
    • Ejemplo: Para un niño que pesa 37 kg:
      • (10 kg × 4 mL/kg/hora) + (10 kg × 2 mL/kg/hora) + (17 kg × 1 mL/kg/hora) =
      • (40 mL/hora) + (20 mL/hora) + (17 mL/hora) = 77 mL/hora
  • La rehidratación se calcula según el peso y la gravedad de la deshidratación:
    • La cantidad calculada se añade a la cantidad de mantenimiento, repartida a lo largo del día.
    • < 10 kg:
      • Leve: 50 mL/kg/día
      • Moderada: 100 mL/kg/día
      • Severa: 150 mL/kg/día
    • ≥ 10 kg:
      • Leve: 30 mL/kg/día
      • Moderada: 60 mL/kg/día
      • Severa: 90 mL/kg/día

Complicaciones

  • Deshidratación
  • Desnutrición
  • Esofagitis
  • Intususcepción
  • Vólvulo sigmoide
  • Reflujo

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Referencias:

  1. Maqbool, A., Liacouras, C. A. (2020). Major symptoms and signs of digestive tract disorders. In Kliegman, R.M., et al. (Eds.). Nelson textbook of pediatrics, pp. 1902.e.1–1912.e1. Retrieved March 24, 2021, from https://www.clinicalkey.es/#!/content/3-s2.0-B9780323529501003321
  2. Centers for Disease Control and Prevention. (2024). Global Water, Sanitation, and Hygiene (WASH). Retrieved June 17, 2025, from https://www.cdc.gov/global-water-sanitation-hygiene/about/index.html
  3. King, C.K., Glass, R., Bresee, J.S., Duggan, C. (2003). Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep 52(RR-16):1–16. https://pubmed.ncbi.nlm.nih.gov/14627948/
  4. Lorenzo, C. (2020). Approach to the infant or child with nausea and vomiting. UpToDate. Retrieved March 27, 2021, from: https://www.uptodate.com/contents/approach-to-the-infant-or-child-with-nausea-and-vomiting
  5. Mullen, N. (2009). Vomiting in the pediatric age group. Pediatr Health 3(5):479–503. https://www.medscape.com/viewarticle/711641

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