What is nausea?

Nausea is the sensation that the stomach wants to empty itself, i.e., feeling as one is just going to vomit, while vomiting (emesis) or throwing up, is the act of forcible emptying of the stomach.

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.

What are the causes of nausea/ vomiting?

There are numerous causes of nausea and vomiting. These symptoms may be due to the following:

• acute gastritis
• central causes (cause lies in the brain)
• association with other illnesses remote from the stomach
• medications and medical treatments
• mechanical obstruction of the bowel

 

Acute gastritis

Acute gastritis (stomach inflammation) is often caused by an offending agent which irritates the lining of the stomach. Examples of these include:

• Infections: Infections are the most common cause whether it is a common virus or an infection that is acquired from travel. There may be associated crampy upper abdominal pain, fever may be present. Common viral infections include noroviruses and rotavirus. Parasitic infections often are associated with diarrhea but may also associated with nausea and vomiting. Infection by bacteria e.g, Helicobacter family H.pylori can also be the infectious agent.
• Food poisoning: Food poisoning may cause significant vomiting and usually is caused by a bacterial toxin. Symptoms begin within a couple hours of eating contaminated food and may last for 2 -3 days. Sources of food poisoning include Salmonella, Campylobacter, Shigella, E. coli, Listeria, or Clostridium botulinum (botulism).
• Other stomach irritants: alcohol, smoking, and non steroidal anti-inflammatory medications such as aspirin and ibuprofen may irritate the stomach lining and cause nausea and vomiting.
• Peptic ulcer disease
• Gastroesophageal reflux disease (GERD, reflux esophagitis): Nausea or vomiting is also associated with irritation of the lining of the esophagus.

Central causes (signals from the brain that cause nausea and vomiting)

• Headache: especially migraine, is associated with nausea and vomiting.
• Inner ear: Motion sickness, labyrinthitis, benign postural vertigo, or Meniere’s disease
• Head injury: Any illness or injury that increases the pressure inside the skull can cause vomiting. This may be due to brain swelling from trauma (for example, concussion or head trauma), infection (meningitis or encephalitis), tumor, or abnormal electrolyte and water balance in the blood.
• Noxious stimulus: Certain smells or sounds can cause centrally mediated nausea and vomiting. For example, the pain of a broken bone or the emotional shock of observing an event, vasovagal events can causenausea symptoms.
• Heat related illness: For example heat exhaustion, extreme sunburn, or dehydration.

Association with illness

• Diabetes: Persons with diabetes may develop nausea because of gastroparesis, in which the stomach fails to empty properly. It is a complication of the disease.People with diabetes can also develop nausea and vomiting should their blood sugars become abnormally high or low (hyperglycemia or hypoglycemia) because the sugar and insulin balance is disturbed.

Other causes:

• hepatitis,
• gallbladder disease,
• pancreatitis
• inflammatory bowel disease
• kidney diseases (for example, kidney stones, infection, kidney failure)
• various cancers.

Vomiting as an atypical symptom of another disease:Some illnesses will cause nausea and vomiting, even though there is no direct involvement of the stomach or gastrointestinal tract. for example,

• Heart attack victims may experience nausea and vomiting as an atypical presentation of angina, especially if the myocardial infarction affects the inferior or lower part of the heart.
• Lung infections, for example, pneumonia and bronchitis.
• 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.

Medications and medical treatments

• Side effects from medications: The side effect of many medications include stomach, nausea and vomiting. Anti-cancer dugs are notorious irritants for stomach . Narcotic pain medications, anti-inflammatory medications, steroids like prednisone and non-steroidal medications like ibuprofen and antibiotics all cause nausea and vomiting.
• Radiation therapy: Nausea and vomiting is associated with radiation therapy.

Bowel obstruction

Abdominal pain and distention, nausea and vomiting, and inability to pass flatus (gas) or have a bowel movement are hallmarks of bowel obstruction.

Pregnancy

Vomiting in pregnancy is especially common in the first trimester and is due to hormone level changes in the bloodstream.

What can I do at home for nausea or vomiting?

It is important to give rest to thee stomach and also avoid dehydration. Clear fluids should be attempted for the first 24 hours of an illness, and then the soft diet should be encouraged as tolerated.

Clear fluids are easy for the stomach to absorb and include water, sports drinks, clear broths, popsicles.

It is important not to take too much fluid at one time since stretching the stomach may cause the nausea to worsen. One to two ounces of fluid at a time should be taken every 10-15 minute.

Milk products should be avoided for the first 48 hours during an episode of nausea and vomiting. The enzyme that helps digest milk is located in cells lining the stomach. With vomiting, the body can become relatively lactose intolerant causing nausea and abdominal pain.

When to call the doctor regarding nausea and vomiting?

If the symptoms last for more than 24 hours, 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.

Infants and children are more prone to dehydration and they have not as much reserve as an adult. If there is concern about dehydration or the inability to tolerate fluids, a healthcare provider should be contacted.

If nausea and vomiting are associated with pain, fever, vomiting blood, or having bloody or black, tarry stools, if patient is having decrease urinary outoup or if the patient is becoming confused or drowsy, medical care should be provided immediately.

Vomiting is a symptom of an illness and is not a disease in itself. If the symptom persists for more than 24-48 hours, it may be wise to contact a doctor immediately.

How is nausea or vomiting treated?

Symptomatic treatment may occur while the underlying illness is being investigated because ideally, nausea and vomiting resolve when the cause of the symptoms is treated.

Nausea and vomiting are often worsen when the patient is 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 should be given to avoid dehydration.

There are a variety of anti-nausea medications (antiemetics) that may be prescribed. They can be administered in different ways depending upon the patient’s ability to take them. Medications are available by pills, syrups, 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 specific situation.

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. Moreover, 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 table salt or baking soda. Mix in 1 liter (1 qt) 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. Symptoms may occur in healthy people.

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