Nausea and vomiting
Nausea is the sensation of being about to vomit. Vomiting, or emesis, is the expelling from the stomach of undigested food through the mouth.
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 in the following instances:
- 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 the following:
Nausea and vomiting are commonly experienced. There are no distinctive patterns of age, gender, or race.
Causes and symptoms
Persistent, unexplained, or recurring nausea and vomiting can be symptoms of a variety of serious illnesses. They can be caused by overeating or drinking too much alcohol. These symptoms 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 people experience nausea after eating spoiled food or foods to which they are allergic. Individuals who suffer migraine headache often experience nausea. Cancer patients receiving chemotherapy are often 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.
When to call the doctor
A doctor should be notified if vomiting is heavy and/or bloody, if the vomitus looks like feces, or if the affected person has been unable to keep food down for 24 hours. Most vomiting episodes should stop in eight to 12 hours of onset. The pediatrician should be consulted if vomiting continues beyond that time, if the child shows signs of dehydration, seems extremely lethargic, or if the child is a very young infant.
An ambulance or emergency response number should be called immediately if the following occurs:
- The child's mouth and tongue are very dry.
- The child has very rapid heartbeat and breathing.
- The child cries but has no tears.
- The child has sunken eyes.
- Diabetic shock is suspected.
- Nausea and vomiting continue after other symptoms of viral infection have subsided.
- The person has a severe headache.
- The person is sweating and having chest pain and trouble breathing.
- The person is known or suspected to have swallowed a drug overdose or poisonous substance.
- The person 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.
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 a careful medical history that includes foods recently eaten, travel, and occupation. In some cases, the doctor may order laboratory tests or imaging studies to determine the presence of drugs or poisonous substances in the person'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 person to a psychiatrist for further evaluation.
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. Cola syrup is another proven remedy.
Vomiting relieves nausea quickly but can cause dehydration. Sipping clear juices, weak tea, and some sports drinks helps replace lost fluid and minerals without irritating the stomach. Infants and small children under age two do best with an oral rehydration solution like Pedialyte. The solution should be given a teaspoon at a time, at frequent intervals, starting 30–60 minutes after vomiting has ceased. Food should be reintroduced gradually, several hours after vomiting stops, 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.
Other drugs that have been developed to treat postoperative or post-chemotherapy nausea and vomiting include ondansetron (Zofran) and granisetron (Kytril). Intravenous administration of supplemental fluid before the operation can lower the risk of nausea after surgery.
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 following:
- 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 an 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 ingested as tea or taken as candy, cookies, or powdered capsules.
Most instances of nausea and vomiting respond well to appropriate treatment, including removing any substance or condition that precipitates the nausea.
Massage, meditation, yoga , and other relaxation techniques can help prevent stress-induced nausea. Antinausea medication taken before traveling can prevent motion sickness. Sitting in the front seat, 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 people to manage stress in healthier ways.
Prolonged vomiting can lead to fluid and electrolyte depletion. Nausea can curtail appetite. Over time, this can lead to nutritional problems.
Parents should be especially concerned about prolonged vomiting in children younger than two years of age. This concern intensifies if the vomiting is accompanied by diarrhea that accelerates fluid and electrolyte depletion. Parents should consult a pediatrician for treatment options if an infant younger than six months of age vomits multiple times within several hours.
Antiemetic drug —A medication that helps control nausea; also called an antinausea drug.
Dehydration —An excessive loss of water from the body. It may follow vomiting, prolonged diarrhea, or excessive sweating.
Diabetic coma —A life-threatening, reduced level of consciousness that occurs in persons with uncontrolled diabetes mellitus.
Emesis —An act or episode of vomiting.
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American Academy of Emergency Medicine. 611 East Wells Street, Milwaukee, WI 53202. Web site: http://www.aaem.org/.
American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211–2672. Web site: http://www.aafp.org/.
American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. Web site: http://www.aap.org/default.htm.
American Academy of Physical Medicine and Rehabilitation. One IBM Plaza, Suite 2500, Chicago, IL 60611–3604. Web site: http://www.aapmr.org/.
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L. Fleming Fallon, Jr., MD, DrPH