Misunderstanding is a sport for me!
Apology for how I wrote things, as I did them in two parts and got confused in between. However, my point still makes sense (to me at least) AND it appears you agree. Just replace "headache" for "vomiting" in my argument. In other words - if I suspect meningitis, whether metoclopramide removes the headache OR the vomiting, it will not "mask" anything sufficiently for me to decide it's NOT meningitis.
If THIS also is not the point, then I apologise even more and I might have to reduce the number of beers I have before replying to the next e-mail...
BTW, I also agree that metoclopramide, other than reducing vomiting, may also mitigate certain headaches (but generally not other pains). I have used it before as a headache treatment, although we generally use procloperazine instead.
> From: [log in to unmask]
> To: [log in to unmask]; [log in to unmask]
> Date: Sun, 11 Apr 2010 06:49:38 -0400
> Subject: RE: "masking" meningitis
> Doc H,
> >When, as you say, the EP makes up their mind based on the signs and symptoms and experience, etc., vomiting will be a factor in that decision. How SENSITIVE the presence of vomiting is for the determination of the need to LP is a percentage which I don't have to hand ;-)... But it does not matter, really...
> The point is what happens to that percentage - to the "weight" of the presence of vomiting in your diagnostic equation - if you know that this vomiting can be helped by an anti-emetic. I honestly don't think that it makes a difference - that is why I asked why you asked... ;-)
> In summary:
> - vomiting is but ONE SIGN which may well tilt me further in the direction of making a diagnosis of "suspected meningitis in need of Rx & LP" as compared to a patient who is not vomiting
> - positive response to antiemetic will not reduce this tilt enough to reverse it!
> -->I think you misunderstood this whole debate...
> I don't care whether or not a person is vomiting...it doesn't figure in my equation when I am thinking meningitis!
> Metoclopramide was not given as an antiemetic but as a treatment for H/A and thus the presence or absence of vomiting hasdnothing whatsoever to do with the drug "masking" meningitis.
> The argument I have heard regarding this dopamine antagonist masking meningitis is that it can mitigate pain, not its effects on the "puke center"...
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