- Nausea and vomiting definition and facts
- What is nausea? What is vomiting?
- What causes nausea and vomiting?
- Gastrointestinal (GI, digestive) causes of anusea and vomiting
- During pregnancy (morning sickness) cuases of nausea and vomiting
- Neurological causes of nausea and vomiting
- Diabetes, diseases, and eating disorders
- Nausea and vomitnig caused by drug side effects
- Vomiting in infants
- How is the cause of nausea and vomiting diagnosed?
- What treatments and drugs help relieve nausea or vomiting?
- What natural home remedies help relieve nausea and vomiting?
- When should I call the doctor for nausea and vomiting?
Nausea and vomiting definition and facts
- Nausea and vomiting are symptoms of a disease or condition, for example:
- The cause of your nausea and vomiting, and any other associated symptoms, for example, a medication, disease, or condition, food, should be identified and treated.
- Natural home remedies for nausea and vomiting include consuming clear fluids, even if the person is not thirsty, for example:
- Drink or consume:
- Once the person is able to keep fluids down, start eating a BRAT diet (bananas, rice, applesauce, and toast).
- Generally, treatment for non-serious causes of nausea and vomiting can be relieved with OTC (over-the-counter) medicine (medication that is available without a prescription from your doctor), or if known, discontinuing the offending cause.
- More severe cases of nausea and vomiting may require medical treatment.
- Never stop taking your prescription drugs without talking with your doctor or health care professional first.
- It is important to control nausea, vomiting, and any other associated symptoms both for comfort's sake and to prevent dehydration since dehydration can worsen your nausea and vomiting.
What is nausea? What is vomiting?
Nausea and vomiting are symptoms of an underlying illness and due to a not a specific disease. Nausea is the sensation that the stomach wants to empty itself, while vomiting (emesis) or throwing up, is the act of forcible emptying of the stomach. The term "dry heaves" (retching) refers to an episode of vomiting where there is no food in the stomach to vomit, and only small amounts of clear secretions are vomited.
Vomiting is a violent act in which the stomach, the esophagus, stomach, and small intestine forcibly expel contents of the stomach (and sometimes the small intestine) in a coordinated fashion.
What causes nausea and vomiting?
There are many causes of nausea and vomiting, for example:
- Acute gastritis (direct irritation of the stomach lining)
- Central causes in which signals from the vomiting center in the brain cause nausea and vomiting
- Other illnesses not due to stomach problems, for example, brain tumors, pancreatitis, and appendicitis
- Medications, medical treatments, and illicit or illegal drugs, drug or alcohol overdose
- Mechanical obstruction of the bowel
Gastrointestinal (GI, digestive) causes of anusea and vomiting
Acute gastritis or esophagitis often caused by something that irritates the lining of the stomach or throat, for example:
- Infections: Infections are often the cause of stomach irritation, whether it is a common virus or another type of infection. There may be associated crampy upper abdominal pain that is associated with nausea and vomiting. Fever and chills may be present. Common viral infections include noroviruses and rotavirus. Infection by bacteria in the Helicobacter family (such as H. Pylori) can also be the infectious agent.
- Stomach flu: Stomach flu (gastroenteritis) is when vomiting and diarrhea occur together and is associated with a viral infection that is outside of the stomach. It should not be confused with the flu (influenza), a viral infection with symptoms include fever, chills, cough, and muscle pain.
- Food poisoning: Food poisoning may cause significant vomiting, and the most common cause is a toxin released by the bacteria Staphylococcus aureus. Symptoms of food poisoning begin within a couple hours of eating contaminated or poorly prepared food. Other bacterial causes of food poisoning include Salmonella, Campylobacter, Shigella, E. coli, Listeria, or Clostridium botulinum (botulism).
- Other stomach irritants: alcohol, smoking, and nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin and ibuprofen may irritate the stomach lining and cause nausea and vomiting.
- Peptic ulcer disease: Peptic ulcer disease can range from mild irritation of the stomach lining to the formation of a defect in the protective lining of the stomach called an ulcer.
- Gastroesophageal reflux disease (GERD, reflux esophagitis): Nausea or vomiting is also associated with GERD (acid from the stomach is refluxed into the esophagus).
During pregnancy (morning sickness) cuases of nausea and vomiting
Vomiting in pregnancy is caused by hormone level changes in the bloodstream. Most women have moderate symptoms of morning sickness, especially during the first trimester. The symptoms of morning sickness during pregnancy usually resolve by the fourth month. Rarely, a woman may experience severe vomiting, dehydration, and weight loss, which is referred to as hyperemesis gravidarum.
Neurological causes of nausea and vomiting
- Headache: especially migraine because it commonly is associated with nausea and vomiting.
- Inner ear: Motion sickness, labyrinthitis, benign positional vertigo, or Meniere's disease
- Increased pressure in the head (intracranial pressure): Any illness or injury that increases the pressure within the skull can cause vomiting.
- Brain swelling due to trauma (includes bleeding within the brain)
- Infection (meningitis or encephalitis)
- Tumors (benign or malignant)
- Abnormal electrolyte concentrations in the bloodstream and associated water imbalance
- Concussion, patients with head injuries do not have to have detectable bleeding in the brain or brain swelling to have symptoms of brain irritation, which can include a headache, nausea, vomiting, changes in vision, confusion, difficulty concentrating, and difficulty sleeping.
- Smells, sounds, and trauma: Certain smells or sounds can cause nausea and vomiting that originates in the brain. Whether it is the pain of a broken bone or the emotional shock of observing an event, vasovagal events can cause significant symptoms. In a vasovagal episode, the vagus nerve (one of the nerves that helps control basic body functions like heart rate, breathing, and blood pressure) is overly stimulated and can cause the heart rate to slow and blood vessels to dilate. This decreases the flow of blood to the brain and can cause fainting (syncope).
- Heat-related illness: For example heat exhaustion, extreme sunburn, or dehydration
Diabetes, diseases, and eating disorders
- Diabetes: Persons with diabetes may develop nausea because of gastroparesis, a condition in which the stomach fails to empty properly and is likely due to the generalized neuropathy (failure of the nerves in the body to send proper signals to and from the brain or regeneration of nerves in the stomach) that is a complication of the disease.
- Diseases, illness, or conditions: Many illnesses associated with the intra-abdominal organs can produce the symptoms of nausea and vomiting. These include digestive organ disease such as:
- Abdominal adhesions. Abdominal pain and distention, nausea and vomiting, and inability to pass flatus (gas) or have a bowel movement are symptoms of intestinal (bowel obstruction). Common causes of bowel obstruction include previous surgery with the formation of adhesions, hernias, abnormal twisting of the GI tract, tumors, and inflammatory bowel disease, or IBD (ulcerative colitis and Crohn's disease..
- Vomiting as an atypical symptom of another disease: Some additional illnesses will cause nausea and vomiting, even though there is no direct involvement of the stomach or gastrointestinal tract.
- Heart attack victims may experience nausea and vomiting as an atypical symptom of angina, especially if the heart attack affects the inferior or lower part of the heart.
- Lung infections, for example, pneumonia and bronchitis, may also cause nausea and vomiting, especially if the area of lung involved is near the diaphragm, the muscle that separates the chest form the abdomen.
- Sepsis: An overwhelming body infection spread through the bloodstream may also be associated with nausea and vomiting.
- Eating disorders: Patients with bulimia will have self-induced vomiting, purging as part of their psychiatric illness
Nausea and vomitnig caused by drug side effects
- Side effects from medications: The side effect of many medications include stomach irritation and/or nausea and vomiting. Anti-cancer drugs used for chemotherapy commonly cause nausea and vomiting that is not easily relieved. Narcotic pain medications, anti-inflammatory medications, steroids, and antibiotics all have nausea and vomiting listed as common side effects.
- Radiation therapy: Nausea and vomiting can be associated with radiation therapy.
- Chemotherapy for cancer
Vomiting in infants
It may be hard to decide if an infant is vomiting or spitting up. If the episodes occur shortly after feeding and only a small amount comes up, this may be spitting up.
- Forceful vomiting: In the first two or three months, if the vomiting is forceful after eating (imagine it flying across the room), this may be a sign of pyloric stenosis, or an abnormal narrowing of the pylorus, the location where the stomach empties into the duodenum (the first part of the small intestine). The vomiting is impressive and is described as a projectile. The diagnosis is often made by history and physical examination, confirmed by ultrasound. The treatment is surgery.
- Vomiting associated with pain: if the infant cries uncontrollably, and if the stool is bloody or red, the diagnosis may be an intussusception (the pushing of one segment of the bowel into an adjacent segment). The stool is classically described as currant jelly, but any blood in the stool is not normal and should always be a cause for concern. It is reasonable to seek medical care for an inconsolable infant.
- Viral infection: If there is vomiting with associated diarrhea that is not bloody, then a viral infection is a possibility. Alternatively, there may be an issue with intolerance to the type of baby formula. Infants and children are at greater risk of dehydration if the vomiting episodes last for more than 24 hours. If dehydration is suspected, seek medical care. Signs and symptoms of dehydration in an infant include dry mouth, lack of sweat in the armpits and groin, sunken eyes, weakness with a poor cry, and decreased muscle tone.
How is the cause of nausea and vomiting diagnosed?
Diagnosis often can be made when the health care professional takes a careful history and performs a physical examination. Any tests that need to be ordered will be based on the information from the history and physical exam, and sometimes no further testing is required to make the diagnosis.
Laboratory tests and X-rays may be ordered to assess the stability of the patient and not necessarily to make the diagnosis. For example, a patient with food poisoning may need blood tests ordered to measure the electrolytes(minerals) and other chemicals, since the patient may lose significant amounts of sodium, potassium, and chloride from the body from persistent vomiting and diarrhea.
Urinalysis may be helpful in assessing hydration status. Concentrated, dark urine is associated with dehydration because the kidneys try to preserve as much water as possible in the body. Ketones in the urine are also a sign of dehydration.
What treatments and drugs help relieve nausea or vomiting?
Nausea and vomiting can be treated with medication at the same time as the search for the underlying diagnosis are being carried out. Ideally, these symptoms should resolve when the underlying illness is treated and controlled.
Nausea and vomiting are often made worse when you are dehydrated, resulting in a vicious cycle. Nausea makes it difficult to drink fluid, making the dehydration worse, which then increases nausea. Intravenous fluids may be provided to correct this issue and break the cycle.
There are varieties of anti-nausea medications (antiemetics) that your doctor may prescribe. These drugs can be administered in different ways depending upon your ability to take them. Medications are available by pill, liquid, or tablets that dissolve on or under the tongue, by intravenous or intramuscular injection, or by rectal suppository.
Common medications used to control nausea and vomiting include:
- promethazine (Phenergan),
- prochlorperazine (Compazine),
- droperidol (Inapsine)
- metoclopramide (Reglan), and
- ondansetron (Zofran).
The decision as to which medication to use will depend on the patient's condition.
What natural home remedies help relieve nausea and vomiting?
It is important to rest the stomach and yet still avoid dehydration. Clear fluids should be attempted for the first 24 hours of an illness, and then the diet should be advanced as tolerated.
Clear fluids are easy for the stomach to absorb and include:
- Sports drinks
- Clear broths
It is important not to take too much fluid at one time since stretching the stomach theoretically may cause nausea to worsen. One to two ounces of fluid at a time, taken every 10-15 minutes, may be all that the stomach will be able to tolerate. In infants and children, the amount may be as little as 5 or 10 cc's or less than a third of an ounce at a time.
Milk products should be avoided for the first 24-48 hours during an episode of nausea and vomiting. If the infection involves the small intestine, the enzyme that helps digest milk is located in cells lining the small intestine can become depleted. This can reduce the tolerance to milk and milk-containing products and lead to, bloating, vomiting, and diarrhea. As the affected individual begins to feel better, they can begin to reintroduce foods, but to help the stomach readjust, health care professionals often recommend limiting the diet to bland foods such as bananas, applesauce, rice, toast (the BRAT diet).
When should I call the doctor for nausea and vomiting?
If the symptoms last for more than 24 hours, if the diagnosis is uncertain, if there is concern about dehydration, or if the patient has underlying medical conditions that make them more fragile, medical care should be accessed sooner, rather than later.
Infants and children are more susceptible to dehydration and may not have as much reserve as an adult. If there is concern about dehydration or the inability to tolerate fluids, a health care professional should be contacted.
If nausea and vomiting are associated with pain, fever, vomiting blood, or having bloody or black, tarry bowel movements, medical care should be sought immediately.
Vomiting is a symptom of an illness, if the symptom persists for more than 24-48 hours, it may be wise to contact a health care professional.
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REFERENCE: Tintinalli J, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th edition. McGraw-Hill Professional 2015.