Vomiting and Nausea

Nausea and vomiting are symptoms of pregnancy and numerous conditions.

Vomiting and nausea are common symptoms that accompany many diseases and conditions. Problems with nausea and vomiting are related to the cause. Nausea and vomiting from motion sickness, seasickness, food poisoning, or cancer therapy can result in loss of water and electrolytes, which can lead to dehydration. Vomiting and nausea known as morning sickness may occur during pregnancy.

• Nausea is an unpleasant, queasy feeling in the throat or stomach that may result in vomiting.
• Vomiting is emptying the stomach as a result of strong gagging and retching that leads to throwing up. The stomach's contents are forcefully expelled through the mouth.
• Vomiting can come in waves as the natural movement (muscle contractions of the digestive system known as peristalses) is reversed, and involuntary contractions in the walls of the stomach and esophagus force the stomach contents out.
• Sometimes coughing or spitting up mucus from the lungs is confused with vomiting. Vomiting can only come from the stomach.
• Retching is the reverse movement (peristalsis) of the stomach and esophagus without vomiting. Sometimes this is called the dry heaves.

Nausea and vomiting are controlled by the same parts of the brain that control involuntary bodily functions. Vomiting is actually a reflex triggered by a signal from the brain.

The signal to vomit can result from several stimuli such as smells, taste, various illnesses, emotions (such as fear), pain, injury, infection, food irritation, dizziness, motion, and other changes in the body, specifically:

• Eating disorders (anorexia and bulimia)
• Food poisoning
• Certain viral infections
• Motion sickness (car sickness, seasickness)
• Vertigo (the sensation that the room is spinning around)
• Head injuries (such as a concussion or bleeding injury)
• Gallbladder disease
• Appendicitis
• Migraine (a severe form of headache)
• Brain tumors
• Brain infections (such as meningitis)
• Hydrocephalus (too much fluid in the brain)
• Side effects of anesthesia used for surgery
• Stomach problems such as blockage (pyloric obstruction, a condition that causes forceful spitting up in infants)
• Bleeding into the stomach from different causes
• Infection, irritation, or blockage of the intestines
• Low or high body chemicals and minerals
• Presence of toxins in the body
• Excessive alcohol intake
• Alcohol from beer, wine, and liquor is turned into a chemical (acetaldehyde), which results in the sensation of nausea that is felt the next morning, known as a "hangover."
• Pregnancy—nausea and vomiting occur frequently in pregnancy, and morning sickness usually occurs in the first few months but sometimes can last throughout the pregnancy.

Nausea and vomiting are common side effects of some medications. Usually, nausea is not an allergy to a drug (which is a severe reaction that can include skin rash or trouble breathing), but an unwanted side effect of the medicine. Some medicines such as those used in cancer treatment (chemotherapy), antibiotics like erythomycin, and strong pain killers are well known to cause nausea and vomiting.

• Nausea is a feeling of unease that frequently includes an upset stomach, dizziness, and anxiety. There is often an urge to vomit. This sensation often feels as if it comes from the stomach, but it is mostly controlled by the brain.
• Vomiting, however, frequently improves the sensation of nausea, at least temporarily. Vomiting occurs when the stomach forcefully expels its contents out of the mouth. When vomiting continues after all the food and liquid have been forced out, it is called the dry heaves.
• When vomiting leads to dehydration from loss of fluids, the affected person may have increased thirst, dry lips, and dry mouth. The person may not urinate often or urine will be darker in color. In children, signs of dehydration include dry lips and mouth, sunken eyes, rapid breathing, lethargy, and dry diaper, indicating the child is not producing urine.

Call a doctor if nausea is so severe that the affected individual is unable to care for himself or herself, or if the vomiting is so bad that the person can't keep any liquids down for more than 8 hours.

• Caring for a child, call for medical advice if the child does not urinate (or has dry diapers) in 6 to 8 hours. Signs and symptoms of dehydration in children and dehydration in adults (severe loss of body fluids) include weakness, dizziness, lightheadedness—these symptoms are worse when standing—dry mouth and lips, less urine than normal, dark-yellow, and smelly urine, and severe thirst. Seek immediate medical care if the child is vomiting.

Seek medical attention at a hospital's emergency department if:

• Nausea or vomiting is accompanied by severe abdominal pain.
• Vomiting is accompanied by fever, especially in a child.
• Vomiting blood. Blood may be bright red or dark red. Old blood may look brown (like coffee grounds).
• Vomiting won't stop, and the person is unable to keep any fluids down.
• You have a known head injury before vomiting occurred.
• There are other medical conditions present such as heart disease, kidney disease, liver disease, or diabetes.
• The person is unable to take daily medications for other medical conditions.
• There are any signs of confusion or extreme weakness.
• A new or severe headache is also present.

A doctor will take a thorough medical history and conduct a physical exam to find out the cause of the patient's discomfort and to look for other problems.

Certain tests may be performed:

• Blood tests (to check electrolytes and blood cell count)
• Urinalysis (to check for dehydration and infection)
• X-rays or CT scans may be helpful depending on the doctor's clinical suspicion of the cause of nausea and vomiting
• Ultrasound
• A CT scan of the head may be ordered if there is a new onset headache or head trauma associated with nausea and vomiting

• Fluids are given by mouth if the patient can keep them down, or through a vein into the bloodstream. The IV route is a common way to give fluids back to the body in moderate to severe dehydration.
• Treatment will also be given for the specific cause, if found.

• Rest and drink plenty of fluids.
• Take medication, if prescribed, to combat nausea.
• Avoid excessive motion, strong smells, and anxiety-producing situations.
• Take medicines as directed.

Prescription medications are available for nausea following surgery and from chemotherapy. Talk with a doctor about medications to treat motion sickness for an upcoming trip or cruise (seasickness).

The most commonly prescribed anti-nausea and anti-vomiting medications include (but are not limited to):

• prochlorperazine (Compazine)
• ondansetron (Zofran)
• promethazine (Phenergan)
• metoclopramide (Reglan)
• trimethobenzamide (Tigan)
• hydroxyzine (Vistaril)

Most of the time, nausea and vomiting go away on their own and can be managed at home.

Treatment for nausea and vomiting usually involves medications to decrease the nausea and fluid replacement for dehydration.

The mainstay of home nausea remedies is to drink fluids. Fluid intake helps correct electrolyte imbalance, which may stop the vomiting. Drinking fluids prevents dehydration, which is the main side effect of excessive vomiting.

• Begin with small amounts, such as small sips. Drink only clear liquids (such as clear soup broth, juice, popsicles, jello, and sports drinks).
• Avoid milk and any dairy products, which can worsen nausea and vomiting.
• After 24 hours of tolerating fluids, work up to soft foods, including gelatin, oatmeal, yogurt, and similar soft foods. If vomiting and nausea return, switch back to liquids only and consult a physician.

Ginger may be used to control nausea and vomiting. Studies have shown it to be effective after surgery and for motion sickness. Ginger comes in gelatin capsules, tea, or candied or crystallized ginger.

Consult your doctor before taking any herbal supplements or home remedies for nausea or vomiting.

Dehydration in children: Children should be given oral rehydration solutions such as Pedialyte, Rehydrate, Resol, and Rice-Lyte.

• Water, soda, tea, and fruit juice will not correctly replace fluid or electrolytes lost with the vomiting. Water may dilute electrolytes to the point where the patient suffers seizures.
• In underdeveloped nations or regions without available commercial pediatric drinks, the World Health Organization has established a field recipe for fluid rehydration: Mix 2 tablespoons of sugar (or honey) with ¼ teaspoon of table salt and ¼ teaspoon of baking soda. (Baking soda may be substituted with ¼ teaspoon of table salt.) Mix in 1 liter (1 quart) of clean or previously boiled water.

Dehydration in adults: Although adults and adolescents have a larger electrolyte reserve than children, electrolyte imbalance and dehydration may still occur as fluid is lost through vomiting.

• Initially, adults should eat ice chips and clear, non-caffeinated, non-dairy liquids such as sports drinks, ginger ale, fruit juices, and Kool-Aid or other commercial drink mixes.
• After 24 hours of a liquid diet without vomiting, begin a soft-bland solid diet such as the BRAT diet: bananas, rice, applesauce without sugar, toast, pasta, and potatoes.

Nausea

• Avoid substances or activities known to produce nausea, such as drinking alcohol.
• Nausea after eating can be prevented by eating in moderation and not over-eating.
• For motion sickness due to riding in a boat or automobile, it is often helpful to focus on a stationary object on the horizon. Move to the top or middle of the boat and focus on the horizon or an aisle seat in an airplane where there is less side-to-side movement. Sit in a car (front seat) or train facing forward to keep your eyes and ears sensing the same thing. Look into the distance.
• Over-the-counter medications such as Dramamine may help prevent motion sickness. Follow label instructions.

Vomiting

• Vomiting is a normal reflex in many situations but can become excessive as the result of severe nausea. Sip small amounts of clear fluid and rest in a calm environment.

Dehydration

• Drink as much clear liquids as possible. This may require taking very small amounts at a time.
• For children, the caregiver may need to give small amounts of fluid, ice chips, or popsicles to the child.

Most nausea and vomiting go away without treatment, but depending on the cause, may become severe. Even if the situation leads to dehydration, medicine and fluids can usually correct the problem. If dehydration is not treated soon enough, the person might need to be admitted to the hospital for treatment.