If symptoms so out of control refer patient to Gastroenterologists for consideration of Oesophago-gastroduodenoscopy. Rule out gastric or duodenal ulcer dyspepsia.
Perform liver and gall bladder USS to rule out gall stones and liver pathology.
One can consider following,
1. Omeprazole 40mg OD
2. Regular cyclizine 50 PO/IV TDS
3. Amitriptyline 10mg OD
4. Buscopan 10 mg IM TDS
5. Magnesium Tricylicate 10mls PO TDS
6. Ranitidine 50mg IV TDS
7. Folic Acid 5mg OD
8. Thiamine 50mg PO OD. (Pabrinex)
Weekly weight monitoring, refer patient to dietitian.
But if patients’ vomiting is still continuing, I would try Ondansetron before steroids 4mg TDS and then 8mg TDS if some help.
If no help one could consider Hydrocortisone 100mg intravenous twice a day for 3 doses. If no improvement, STOP.
If symptoms improve, convert to oral Prednisolone 40 mg OD and continue for 5 days before reducing by 5 mg every week until symptoms recur and then hold at minimum dose
Perform liver and gall bladder USS to rule out gall stones and liver pathology.
One can consider following,
1. Omeprazole 40mg OD
2. Regular cyclizine 50 PO/IV TDS
3. Amitriptyline 10mg OD
4. Buscopan 10 mg IM TDS
5. Magnesium Tricylicate 10mls PO TDS
6. Ranitidine 50mg IV TDS
7. Folic Acid 5mg OD
8. Thiamine 50mg PO OD. (Pabrinex)
Weekly weight monitoring, refer patient to dietitian.
But if patients’ vomiting is still continuing, I would try Ondansetron before steroids 4mg TDS and then 8mg TDS if some help.
If no help one could consider Hydrocortisone 100mg intravenous twice a day for 3 doses. If no improvement, STOP.
If symptoms improve, convert to oral Prednisolone 40 mg OD and continue for 5 days before reducing by 5 mg every week until symptoms recur and then hold at minimum dose
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