9: Peds Cyclical Vomiting Syndrome

Question 1

What is the typical age of onset for CVS?

Answer 1

3-7 yo but can occur at any age

Question 2

What happens during the prodromal phase of CVS?

Answer 2

Characterized by nausea or marked abd pain

Question 3

Characterized by recurrent stereotypical spells of vomiting between which the child is completely well.

Answer 3

Cyclical Vomiting Syndrome (CVS)

Question 4

What are 7 triggers for CVS?

Answer 4

1. Anxiety
2. Stress
3. Infx (UTIs, ear infx, flu)
4. Food triggers
5. Exhaustion
6. Hot weather
7. Motion sickness

Question 5

How do you manage CVS?

Answer 5

• Quiet, dark room
• During prodome: lorazepam, antiemetics, ibuprofen, acetaminophen, diphenhydramine, H2 blockers, or PPIs. Triptans may also be used.
• Prophylactic agents (same as migraine) may be used between episodes. Evaluate to r/o other causes.

Question 6

How long does vomiting last with each episode of CVS?

Answer 6

Hours or days

Question 7

6 complications of CVS.

Answer 7

1. Dehydration
2. Electrolyte imbalance
3. Peptic esophagitis
4. Hematemesis
5. Mallory-Weiss tear
6. Tooth decay

Question 8

What are 4 potential diagnostic criteria for CVS?

Answer 8

1. Episodes may last for hours or days, but <1 week.
2. Happens 3 or more times per year, but symptom free between episodes.
3. Each episode is similar in onset, intensity, duration, and frequency.
4. Cause major disability, lost work and school days.

Question 9

What happens during the recovery phase of CVS?

Answer 9

• Color and energy return.
• Able to take PO.