Nausea and Vomiting (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Nausea and vomiting definition and facts
- What is nausea? What is vomiting?
- What causes nausea or vomiting?
- Throat and stomach irritants that cause nausea and vomiting
- Nausea and vomiting caused by neurological conditions
- Other diseases and conditions that cause nausea and vomiting
- Nausea and vomiting caused by medications and medical treatments
- Morning sickness nausea and vomiting during pregnancy
- Vomiting in infants
- How do doctors diagnose the cause of nausea and vomiting?
- What natural home remedies help relieve for nausea or vomiting?
- What is the medical treatment for nausea or vomiting?
- When should I call the doctor if I have nausea and vomiting?
What natural home remedies help relieve for nausea or 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 the 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).
What is the medical treatment for nausea or vomiting?
Nausea and vomiting can be treated with medication at the same time as the search for the underlying diagnosis is 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. The nausea makes it difficult to drink fluid, making the dehydration worse, which then increases the nausea. Intravenous fluids may be provided to correct this issue and break the cycle.
There are a variety of anti-nausea medications (antiemetics) that your doctor may prescribe. These drugs can be administered in different ways depending upon the 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.
When should I call the doctor if I have 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.
REFERENCE: Tintinalli J, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th edition. McGraw-Hill Professional 2015.
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