Nausea and Vomiting

Nausea and Vomiting

 

Definition

Nausea is the sensation of being about to vomit. Vomiting, or emesis, is the expelling of undigested food through the mouth.

Description

Nausea is a reaction to a number of causes that include overeating, infection, or irritation of the throat or stomach lining. Persistent or recurrent nausea and vomiting should be checked by a doctor.
A doctor should be called if nausea and vomiting occur:
  • after eating rich or spoiled food or taking a new medication
  • repeatedly or for 48 hours or longer
  • following intense dizziness
It is important to see a doctor if nausea and vomiting are accompanied by:
  • yellowing of the skin and whites of the eyes
  • pain in the chest or lower abdomen
  • trouble with swallowing or urination
  • dehydration or extreme thirst
  • drowsiness or confusion
  • constant, severe abdominal pain
  • a fruity breath odor
A doctor should be notified if vomiting is heavy and/or bloody, if the vomitus looks like feces, or if the patient has been unable to keep food down for 24 hours.
An ambulance or emergency response number should be called immediately if:
  • Diabetic shock is suspected
  • Nausea and vomiting continue after other symptoms of viral infection have subsided
  • The patient has a severe headache
  • The patient is sweating and having chest pain and trouble breathing
  • The patient is known or suspected to have swallowed a drug overdose or poisonous substance
  • The patient has a high body temperature, muscle cramps, and other signs of heat exhaustion or heat stroke
  • Nausea, vomiting, and breathing problems occur after exposure to a known allergen

Causes and symptoms

Persistent, unexplained, or recurring nausea and vomiting can be symptoms of a variety of serious illnesses. It can be caused by simply overeating or drinking too much alcohol. It can be due to stress, certain medications, or illness. For example, people who are given morphine or other opioid medications for pain relief after surgery sometimes feel nauseated by the drug. Such poisonous substances as arsenic and other heavy metals cause nausea and vomiting. Morning sickness is a consequence of pregnancy-related hormone changes. Motion sickness can be induced by traveling in a vehicle, plane, or on a boat. Many patients experience nausea after eating spoiled food or foods to which they are allergic. Patients who suffer migraine headache often experience nausea. Cancer patients on chemotherapy are nauseated. Gallstones, gastroenteritis and stomach ulcer may cause nausea and vomiting. These symptoms should be evaluated by a physician.
Nausea and vomiting may also be psychological in origin. Some people vomit under such conditions of emotional stress as family arguments, academic tests, airplane travel, losing a job, and similar high-stress situations. In addition, some eating disorders are characterized by self-induced vomiting.

Diagnosis

Diagnosis is based on the severity, frequency, and duration of symptoms, and other factors that could indicate the presence of a serious illness.
Diagnosis is based on the taking of a careful patient history. In some cases, the doctor may order laboratory tests or imaging studies to determine the presence of drugs or poisonous substances in the patient's blood or urine, or evidence of head injuries or abnormalities in the digestive tract. If the nausea and vomiting appear to be related to anxiety, stress, or an eating disorder, the doctor may refer the patient to a psychiatrist for further evaluation.

Treatment

Getting a breath of fresh air or getting away from whatever is causing the nausea can solve the problem. Eating olives or crackers or sucking on a lemon can calm the stomach by absorbing acid and excess fluid. Coke syrup is another proven remedy.
Vomiting relieves nausea right away but can cause dehydration. Sipping clear juices, weak tea, and some sports drinks help replace lost fluid and minerals without irritating the stomach. Food should be reintroduced gradually, beginning with small amounts of dry, bland food like crackers and toast.
Medications that are given to relieve nausea and vomiting are called antiemetics. Meclizine (Bonine), a medication for motion sickness, also diminishes the feeling of queasiness in the stomach. Dimenhydrinate (Dramamine), another motion-sickness drug, is not effective on other types of nausea and may cause drowsiness.
Newer drugs that have been developed to treat postoperative or postchemotherapy nausea and vomiting include ondansetron (Zofran) and granisetron (Kytril). Another treatment that has been found to lower the risk of nausea after surgery is intravenous administration of supplemental fluid before the operation.

Alternative treatment

Advocates of alternative treatments suggest biofeedback, acupressure and the use of herbs to calm the stomach. Biofeedback uses exercise and deep relaxation to control nausea. Acupressure (applying pressure to specific areas of the body) can be applied by wearing a special wristband or by applying firm pressure to:
  • the back of the jawbone
  • the webbing between the thumb and index finger
  • the top of the foot
  • the inside of the wrist
  • the base of the rib cage
Acupuncture is another alternative treatment found to be effective in relieving nausea. A few people, however, experience nausea as a side effect of acupuncture.
Chamomile (Matricaria recutita) or lemon balm (Melissa officinalis) tea may relieve symptoms. Ginger (Zingiber officinale), another natural remedy, can be drunk as tea or taken as candy or powered capsules.

Prevention

Massage, meditation, yoga, and other relaxation techniques can help prevent stress-induced nausea. Anti-nausea medication taken before traveling can prevent motion sickness. Sitting in the front seat,
These illustrations depict the mechanism and causes of vomiting in the human body. An impulse from the brain stimulates the vomiting center (top center) in the brain stem. Nerve impulses sent to the stomach, diaphragm, and abdominal wall (bottom center) result in stomach's contents being expelled. Other causes of vomiting include raised pressure in the skull due to injury or tumor (upper right), and hormonal changes during pregnancy.
These illustrations depict the mechanism and causes of vomiting in the human body. An impulse from the brain stimulates the vomiting center (top center) in the brain stem. Nerve impulses sent to the stomach, diaphragm, and abdominal wall (bottom center) result in stomach's contents being expelled. Other causes of vomiting include raised pressure in the skull due to injury or tumor (upper right), and hormonal changes during pregnancy.
(Illustration by John Bavosi, Custom Medical Stock Photo. Reproduced by permission.)
focusing on the horizon, and traveling after dark can also minimize symptoms.
Food should be fresh, properly prepared, and eaten slowly. Overeating, tight-fitting clothes, and strenuous activity immediately after a meal should be avoided.
Vomiting related to emotional upsets may be avoided by forms of psychotherapy that teach patients to manage stress in healthier ways.

Key terms

Acupuncture — A treatment technique associated with traditional Chinese medicine, in which thin needles are inserted into specific points located along energy channels in the human body known as meridians.
Antiemetic — A preparation or medication that relieves nausea and vomiting. Coke syrup, ginger, and motion sickness medications are examples of antiemetics.
Dehydration — Loss of fluid and minerals following vomiting, prolonged diarrhea, or excessive sweating.
Diabetic coma — Reduced level of consciousness that requires immediate medical attention.
Emesis — The medical term for vomiting.

Resources

Books

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., revised. Washington, DC: American Psychiatric Association, 2000.
Beers, Mark H., MD, and Robert Berkow, MD., editors. "Functional Vomiting." Section 3, Chapter 21 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.
Pelletier, Dr. Kenneth R. The Best Alternative Medicine, Part I: Western Herbal Medicine. New York: Simon and Schuster, 2002.

Periodicals

Ali, S. Z., A. Taguchi, B. Holtmann, and A. Kurz. "Effect of Supplemental Pre-Operative Fluid on Postoperative Nausea and Vomiting." Anaesthesia 58 (August 2003): 780-784.
Cepeda, M. S., J. T. Farrar, M. Baumgarten, et al. "Side Effects of Opioids During Short-Term Administration: Effect of Age, Gender, and Race." Clinical Pharmacology and Therapeutics 74 (August 2003): 102-112.
Chung, A., L. Bui, and E. Mills. "Adverse Effects of Acupuncture. Which Are Clinically Significant?" Canadian Family Physician 49 (August 2003): 985-989.
O'Brien, C. M., G. Titley, and P. Whitehurst. "A Comparison of Cyclizine, Ondansetron and Placebo as Prophylaxis Against Postoperative Nausea and Vomiting in Children." Anaesthesia 58 (July 2003): 707-711.
Quinla, J. D., and D. A. Hill. "Nausea and Vomiting of Pregnancy." American Family Physician 68 (July 1, 2003): 121-128.
Ratnaike, R. N. "Acute and Chronic Arsenic Toxicity." Postgraduate Medical Journal 79 (July 2003): 391-396.
Tan, M. "Granisetron: New Insights Into Its Use for the Treatment of Chemotherapy-Induced Nausea and Vomiting." Expert Opinion in Pharmacotherapy 4 (September 2003): 1563-1571.
Tiwari, A., S. Chan, A. Wong, et al. "Severe Acute Respiratory Syndrome (SARS) in Hong Kong: Patients' Experiences." Nursing Outlook 51 (September-October 2003): 212-219.
Walling, Anne D. "Ginger Relieves Nausea and Vomiting During Pregnancy." American Family Physician 64 (November 15, 2001): 1745.

Organizations

American Gastroenterological Association (AGA). 7910 Woodmont Ave., 7th Floor, Bethesda, MD 20814. (310) 654-2055. http://www.gastro.org/index.html. aga001@aol.com.

Patient discussion about Nausea and Vomiting

Q. What foods and beverages are best to give with cancer/chemo related nausea and vomiting? My father is undergoing chemo for malignant melanoma that has spread to liver/lungs/kidneys. He has constantly nausea and vomits at the drop of a hat. How do I get some nutrition into him? What would help other than prescription meds which he is already on?

A. If he's vomiting, he needs to ask for his anti-sickness meds to be changed or adjusted. They are much better these days, and I found that though I felt nauseous I never vomited.
He should eat whatever he feels he can manage or will make him feel better. Don't worry too much about him getting a healthy or balanced diet, he can put that right when chemo's over. I went through a stage during chemo when I only wanted mashed potatoes; bland carbohydrate was all I fancied, and I ate a lot of them!
I found that ginger in any form helps with nausea - ginger tea, ginger biscuits, crystallized ginger - anything. Cola helped too - some people find it more effective if it's allowed to go flat before drinking it.

Hope your dad gets some relief soon.

More discussions about Nausea and Vomiting
References in periodicals archive ?
7, 2015 /PRNewswire-iReach/ --ACCESS REPORT @ Chemotherapy Induced Nausea and Vomiting - Pipeline Review, H2 2015
Physicians should consider early treatment of nausea and vomiting in pregnancy to prevent progression to hyperemesis gravidarum, according to an updated practice bulletin from the American College of Obstetricians and Gynecologists.
presents new data highlighting a perceptual gap between healthcare professionals and patients in terms of the incidence and impact on patients' daily life of chemotherapy and radiotherapy induced nausea and vomiting (CINV/RINV).
Food and Drug Administration today approved Akynzeo (netupitant and palonosetron) to treat nausea and vomiting in patients undergoing cancer chemotherapy.
Despite decreased abdominal complications than open surgery, one of its significant problems is post-operative nausea and vomiting about 40-70%.
Nausea and vomiting (emesis) are common symptoms associated with ill health and its management--including surgery and cancer therapies--and with early pregnancy.
Tuerke and Parker hope their work will lead to a better understanding of basic neural processes affected by prescribed drugs, with specific applications to controlling nausea and vomiting caused by cancer chemotherapy.
Nausea and vomiting (PONV) remains one of the most common and distressing complications, resulting in pain, hematoma, and wound dehiscence, which require additional resources and may delay in the discharge of patient from hospital.
Chronic nausea and vomiting can be a challenging symptom complex for both the patient and physician for a variety of reasons, including the large number of potential underlying causes, the difficulty of making a specific diagnosis, and the difficulty of adequately treating symptoms.
Individuals receiving chemotherapy experience serious problems with eating due to the unfavourable effects of both their illness and nausea and vomiting, which impair their quality of life.
Nausea and vomiting are major adverse effects of chemotherapy.
Although often viewed together, nausea and vomiting are separate entities and may exist independently.