Nausea and Vomiting
What is Nausea?
Nausea is a feeling of queasiness or discomfort in the abdomen, which may be accompanied by the urge to vomit. Vomiting is the forceful expulsion of stomach contents through the mouth.
Retching occurs when a person attempts to vomit, but no stomach contents are expelled. It is also called dry heaves. Retching and nausea can occur without vomiting or before vomiting.
Nausea includes uneasiness in the abdomen, but may not lead to vomiting. It may be related to a decrease of the normal motion (motility) in the stomach. Vomiting occurs when a part of the brain receives signals and stimulates action in the stomach and esophagus. Food does not move from the stomach to the intestines as it normally does, but flows back (refluxes) into the stomach. The surrounding muscles contract and the stomach contents are expelled through the mouth. Dry heaves occur when the stomach and its surrounding muscles contract, but the opening at the back of the throat (glottis) remains closed.
People experience occasional bouts of nausea or vomiting for many reasons. Nausea and vomiting are particularly common in infants and children. In most people, nausea and vomiting are symptoms that pass within a day or two. However, in patients with chronic medical or psychiatric conditions, nausea and vomiting may last for a week or longer.
- Dehydration. Prolonged vomiting can lead to loss of fluids in the body, especially when it occurs with diarrhea. Children become dehydrated more quickly than adults and are particularly prone to dehydration from vomiting.
- Electrolyte imbalance. Electrolytes are substances that are necessary for normal body chemistry and functioning. Severe vomiting can result in loss of electrolytes.
- Weight loss and/or malnutrition. Severe vomiting can result in weight loss and malnutrition, particularly if it prevents eating.
- Bruises or tears. Violent retching can occasionally cause bruises or tears in the abdominal wall muscles or in the gastroesophageal junction, where the esophagus and stomach meet. Tears at this junction are called Mallory-Weiss tears.
- Dental disease. Stomach acid in vomit can damage teeth and gums and lead to dental disease. This complication commonly occurs in eating disorders where patients induce vomiting frequently (e.g., bulimia nervosa).
How is it diagnosed?
History: Individuals may complain of fever, dizziness, cramps, diarrhea, and vomiting along with the feeling of nausea. Individuals should be screened for medication use and side effects and the correlation of symptoms with events or emotions that might bring on symptoms. Ingestion of food and beverages that may also precipitate episodes should be considered. In female individuals of childbearing age, pregnancy is a possibility. History of foreign travel and possible related disease should be considered. Chemical and industrial fumes and unpleasant odors can also cause nausea. Individuals should also be screened for possible exposure to hepatitis. Nausea is also a symptom of head injury.
Physical exam Common physical symptoms include abdominal tenderness, abnormal bowel sounds, fever, and distended abdomen. Individuals with hepatitis may have jaundice and liver enlargement. Dark stools may signal ulcer or tumor. Visual disturbances and difficulty with balance and coordination are common with head injury.
Treatment and prevention of nausea & vomiting
Many bouts of nausea and vomiting usually subside within six to 24 hours and may be treated at home. In some cases, stopping or avoiding the food or medication that caused the problem is the only treatment necessary.
There are several ways to control nausea, including:
- Drink clear fluids
- Eat light, bland foods, such as crackers or plain bread
- Do not eat fried, greasy or sweet foods
- Eat and drink slowly
- Eat small meals
- Do not mix hot and cold foods
- Avoid activity after eating
- Avoid brushing teeth shortly after eating
- Drinking fluids to prevent dehydration and an imbalance of electrolytes (substances in the body necessary to maintain body chemistry and function). After vomiting subsides, patients should begin drinking clear fluids in small quantities or sucking on ice chips. Water, carbonated beverages with sugar and broth may help. Oral hydration solutions may be consumed. In severe cases, fluid replacement may be performed intravenously (through a vein) at a medical facility.
- Eating foods to meet nutritional requirements. Patients should avoid eating solid foods until vomiting subsides. Patients who can drink clear fluids without further vomiting can try to eat small amounts of bland foods, including dry crackers, toast, cereal or fruits. In severe cases, a feeding tube can be placed into the patient’s nose and run through the esophagus and stomach into the small intestine.
- Administration of antiemetics. These are medications used in the prevention or treatment of nausea and vomiting. Antiemetics may be prescribed for cancer patients susceptible to nausea and vomiting from chemotherapy or radiation treatment.
- Administration of prokinetics. Patients with gastroparesis may benefit from drugs that can improve gastric emptying.
- Alternative treatments. Acupressure (a traditional Chinese procedure that uses pressure applied to specific points in the body), ginger and vitamin B6 supplements have been used to treat nausea and vomiting related to pregnancy. Electrical stimulation, usually at the wrist, has been used to treat nausea and vomiting experienced after surgery. Hypnosis (a therapeutic technique in which the patient is put in a trance) has been used to treat nausea and vomiting caused by psychological disorders.
- Nausea is accompanied by pain or severe headache
- The patient is unable to drink liquids for 24 hours
- Vomiting lasts longer than two to three days
- The patient shows signs of dehydration, such as excessive thirst, dry mouth, little or no urination, severe weakness, dizziness or lightheadedness
- Vomit resembles coffee grounds or contains blood
In addition, research suggests that individuals who expect to experience nausea generally fare better than those who suddenly experience the symptom.
Medications
Pamelor (Nortriptyline), Sinequan (Doxepin), Tofranil (Imipramine)
Antiemetics: Motilium (Domperidone), Decadron (Dexamethasone), Zofran (Ondansetron), Phenergan (Promethazine), Atarax (Hydroxyzine), Ativan (Lorazepam)
What might complicate it?
Complications include stress, intense pain, fever, infection, cardiovascular disease, or diabetes.
Predicted outcome
With treatment, outcome is good.
Alternatives
Other conditions include allergic reaction, food intolerance, pregnancy, concussion, migraine headache, hepatitis, side effect of cancer therapy (chemotherapy), infection, stress, gallbladder disease, ulcer, heartburn, motion sickness, food poisoning, disturbances of equilibrium, and eating disorders (bulimia, anorexia nervosa).
Appropriate specialists
Gastroenterologist and internist.
Last updated 4 July 2015