How is cyclic vomiting of childhood treated?

Updated: Nov 19, 2019
  • Author: Wendy G Mitchell, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA  more...
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Answer

If mitochondrial cytopathy or organic aciduria is suggested or diagnosed, acute treatment of cyclic vomiting of childhood should be tailored to the underlying disorder. In general, early use of intravenous (IV) fluids containing adequate glucose (to prevent a catabolic state), parenteral or rectal antiemetics, and analgesics may abort the attack. Some patients respond to triptans or ergotamines.

For long-term treatment of cyclic vomiting of childhood, low-dose amitriptyline (or another tricyclic antidepressant) can be effective. Other antimigraine agents (eg, beta blockers, anticonvulsants, and calcium channel blockers) are occasionally useful. If the serum carnitine level is low, consider a trial of supplementation with L-carnitine. Some patients report improvement with mitochondrial cocktails containing high-dose B vitamins and coenzyme Q10. There is no firm evidence for these measures.


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