Post #60 answers the question as asked. The question underneath it is different.
Persistent vomiting would be much easier to settle if anyone reported the denominator. Almost nobody reports the denominator.
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Safety · Adverse events · continued
Persistent vomiting and the threshold for seeking help posts 61–89
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Collapsed as off-topic by two members at trust level 3 or above
Reporting to regulatory agencies: if you have had a serious event, reporting it to the regulatory agency in your country can help with signal detection across the population.
The rule of thumb is fine; the edge cases are where it earns its keep.
Clear enough that I do not think I have a follow-up, which is unusual.
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s.grimaldi, post #22: No notes. Posting so the count is not one. Go to post
Distinguishing three things in the persistent vomiting discussion that keep getting used interchangeably: the observation, the proposed mechanism, and the recommendation that gets attached to both.
Reporting here and reporting to a national scheme are not alternatives. The second is what feeds safety surveillance.
This is the version I would want a new member to read first.
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On post #66 — agreed on the reasoning, with one qualification.
Severe gastrointestinal events: persistent vomiting, abdominal pain out of proportion, or signs of bowel obstruction warrant urgent evaluation. Mild nausea and constipation are ordinary; severe versions are not.
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The most useful contribution to this subcategory is a completed account: what happened, what was done, and what the outcome was.
I have said this before in a thread nobody could find, so it is worth repeating.
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Two claims get bundled together under persistent vomiting and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.
Almost every disagreement in threads like this one dissolves once you say which of the two you are making.
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policy_reader, post #61: Post #60 answers the question as asked. The question underneath it is different. Persistent vomiting would be much easier to settle if anyone reported the denominator. Almost nobody reports the denominator. Go to post
I read post #69 twice before replying, because I had assumed the opposite.
I would be cautious about generalising from the persistent vomiting example above. It is a good example. It is one example.
Post #69 answers the question as asked. The question underneath it is different.
Medullary thyroid carcinoma is the reason these compounds are contraindicated in people with personal or family history of MTC or multiple endocrine neoplasia type 2. Rodent toxicology showed a signal; human evidence of causation is absent but caution is appropriate.
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What I would check first on persistent vomiting is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph.
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A definition problem is doing most of the work in this persistent vomiting discussion. Once the term is pinned down I suspect the disagreement mostly goes away and what is left is small.
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v.malinowski, post #72: Post #69 answers the question as asked. The question underneath it is different. Medullary thyroid carcinoma is the reason these compounds are contraindicated in people with personal or family history of MTC or multiple endocrine neoplasia type 2. Rodent toxicology showed a signal; human evidence of causation is absent but caution is… Go to post
Everything in post #73 holds. The case it does not cover is the one I have.
Nothing here is medical advice, and in this subcategory the phrase is doing more work than in any other on the site.
Attribution is genuinely hard for a single case and the reporting schemes are designed to work with that. You are not expected to prove causation to file.
That holds under the stated conditions and I have stated them.
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Reading this persistent vomiting thread as someone who came in with a fixed view: the third and seventh replies moved me and the confident ones did not.
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ro.zielinski, post #24: The documentation on persistent vomiting is better than this thread and I say that as someone who has posted in the thread. Go to post
Same experience here, different supplier, so it is at least not unique to one of them.
f.rasmussen, post #68: On post #66 — agreed on the reasoning, with one qualification. Severe gastrointestinal events: persistent vomiting, abdominal pain out of proportion, or signs of bowel obstruction warrant urgent evaluation. Mild nausea and constipation are ordinary; severe versions are not. Go to post
Pancreatitis is a genuine serious adverse event to know: severe epigastric pain, back pain, elevated lipase (≥3× upper limit of normal). If this constellation appears, stopping the drug and seeking urgent evaluation is appropriate.
That is the version I would defend. It is not the version I started with.
Post #80 put the caveat in the right place and I want to underline it.
Reading back through the persistent vomiting threads from last year, the same three questions come up every time and only one of them has ever been answered properly. That seems like a documentation gap rather than a knowledge gap.
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peak_purity, post #5: Reporting to regulatory agencies: if you have had a serious event, reporting it to the regulatory agency in your country can help with signal detection across the population. Go to post
The arithmetic in post #82 is right; the assumption feeding it is the part to check.
Reporting to regulatory agencies: if you have had a serious event, reporting it to the regulatory agency in your country can help with signal detection across the population.
If anyone has run this properly I would rather read that than my own guess.
Practical answer on persistent vomiting, since the theoretical one is upthread: do the simplest check first, write down the result, and only then decide whether the complicated explanation is needed. It usually is not.
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The question underneath persistent vomiting is usually "how would I tell?" rather than "what is true?", and that one has a method attached to it.
Write down what you would expect to see under each hypothesis before you collect anything. If they predict the same observation, collecting it will not help.
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m.radich, post #26: Coming back to post #23, because the follow-up matters more than the original answer. Persistent vomiting: I would want to see the raw numbers rather than the summary before agreeing. Summaries lose exactly the information that would settle this. Go to post
The published trial rates come from supervised populations on defined schedules and are not comparable to rates derived from who chooses to post.
Birkeland, post #82: Post #80 put the caveat in the right place and I want to underline it. Reading back through the persistent vomiting threads from last year, the same three questions come up every time and only one of them has ever been answered properly. That seems like a documentation gap rather than a knowledge gap. Go to post
Narrowing post #86, because the general version has more than one answer.
On persistent vomiting: the maintained page in the documentation commons covers the general case with citations and a review date, which is more reliable than any reply here including this one.
Confirming post #86 from a second method, which matters more than confirming it from a second person.
Severe, persistent abdominal pain, particularly radiating to the back, is not an ordinary gastrointestinal symptom and belongs with a clinician rather than a thread.
The claim is narrower than it sounds, and deliberately so.
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This topic was referenced in
- About the Adverse events categorySafety › Adverse events · 6 replies
- An emergency department visit, described afterwardsSafety › Adverse events · 62 replies
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