Nausea is an uncomfortable sensation of an urge to vomit.
It is the sensation that the stomach wants to empty itself. Nausea may or may not lead to vomiting.
Vomiting is the actual act of forcible emptying of the stomach contents through the mouth. Retching or dry heaves is the act of vomiting where there is no food in the stomach to vomit out, and only small amounts of clear secretions are vomited.
Nausea and vomiting are not diseases but are symptoms of an underlying disease.
Read more about Gastrointestinal Diseases-Symptoms and Causes
Causes of Nausea
Abdominal Causes
- Gastrointestinal infection or food poisoning (bacterial or viral infection)
- Gastroesophageal reflux disease
- Gastritis
- Peptic ulcer
- Biliary reflux
- Celiac disease
- Non-celiac gluten sensitivity
- Crohn’s disease
- Hepatitis
- Abdominal colic
- Acute abdominal emergencies
- Appendicitis
- Cholecystitis
- Peritonitis
- Pancreatitis
- Intestinal obstruction
- Upper gastrointestinal malignancy
- Pancreatic cancer
Medications
- Chemotherapy drugs used in the treatment of cancer
- Drugs used in general anesthesia
- Ergotamine used for treating migraine
- Antibiotics
- Antiarrhythmics
- Digoxin
- Oral hypoglycemic medications
- Oral contraceptives
Pregnancy
- Nausea or “morning sickness” is very common during the early months of pregnancy and is considered normal.
- In some women, it may continue into the second and third trimesters.
- Severe cases of nausea and vomiting known as hyperemesis gravidarum require treatment
Cardiac causes
- Myocardial infarction
- Cardiac failure
Headache
- Migraine
Inner-ear diseases
- Motion sickness
- Sea-sickness
- Labyrinthitis
- Benign positional vertigo
- Meniere’s disease
- Malignancy
Intracerebral disorders (Raised intracranial tension)
- Hemorrhage
- Abscess
- Hydrocephalus
- Meningitis
- Encephalitis
- Malignancy
Psychiatric diseases
- Anorexia and bulimia nervosa
- Depression
Diabetes
It occurs due to
- Gastroparesis (inability of the stomach to empty properly) which is due to generalized neuropathy that occurs as a complication in diabetes.
- Abnormally high or low blood sugar level.
Other
- Post-surgical vomiting
- Radiotherapy associated vomiting
- Overeating
- A reaction to certain smells or odors
- Alcohol intake
Investigations and Diagnosis
History and Physical Examination
A careful history including associated signs and symptoms and a detailed physical examination should be carried out as they can give a clue to the diagnosis. Based on these, appropriate testing is done. Not all tests are required in every case. At times, history and physical examination are sufficient for arriving at a diagnosis and no tests need to be carried out.
- Onset (acute or chronic): Acute onset of nausea indicates infections, drugs, or toxins. Chronic nausea indicates a chronic long-standing illness.
- Relation with food intake: Nausea occurring within an hour of eating may indicate an obstruction proximal to the small intestine, such as gastroparesis or pyloric stenosis. An obstruction in the lower intestine or colon will result in delayed nausea and vomiting. An infection such as gastroenteritis or food poisoning may cause nausea several hours to days after eating infected food.
Signs
- Signs of dehydration: loss of skin turgor and orthostatic hypotension
- Abdominal examination: Auscultation of the abdomen may provide a clue to bowel obstruction. Pain on pressing the abdomen may indicate an inflammatory cause.
- Signs of increased intracranial pressure: Papilledema, visual field losses, or focal neurological deficits.
Serum electrolytes
In food poisoning, the patient may lose significant amounts of electrolytes from the body due to nausea, vomiting, or diarrhea.
Urine examination
To assess the hydration status. Concentrated, dark yellow colored urine may indicate dehydration as the kidneys try to conserve water in the body. The presence of ketones in the urine also indicates dehydration.
Liver function tests and Pancreatic tests
To identify pancreaticobiliary diseases.
Abdominal X-rays
X-rays showing air-fluid levels can indicate bowel obstruction. Those showing air-filled bowel loops indicate ileus.
Other imaging techniques and procedures
CT scan, MRI, upper endoscopy, colonoscopy, barium enema, etc. may be done depending upon the condition suspected to rule out malignancy, ulcers, etc.
Treatment
It would depend on the underlying cause. Usually, nausea resolves on its own, especially if followed by vomiting.
Treatment for non-serious causes of nausea can be treated at home by following certain self-care tips, discontinuing the causative factor-like strong tastes or odors, or by using over-the-counter medicines. More severe cases of nausea and vomiting, however, require medical treatment including treatment of the underlying disease.
Self-Care Tips and Home Remedies
- Rest: Take adequate rest and avoid strenuous activity.
- Stay hydrated: Dehydration can occur if you are unable to eat or drink due to nausea. Nausea itself is a symptom of dehydration. So it is important to take small sips of cold, clear, fluids, or water regularly at frequent intervals. Oral rehydration solutions can help prevent dehydration.
- Consuming certain food items helps to relieve nausea by improving digestion and soothing the stomach. These include:
- Ginger: It has a role in nausea associated with pregnancy, surgery and motion sickness
- Peppermint tea
- Mint tea
- Chamomile
- Lemon
- Vitamin B6 (pyridoxine): It also has a role in pregnancy-associated nausea.
- Consume light, bland and plain foods: Foods that have strong flavors, odors, are excessively sugary, spicy, or fatty should be avoided as they can worsen nausea or even cause vomiting. BRAT diet (bananas, rice, applesauce, and toast) is good as it is soothing for the stomach.
- Eat small and frequent meals
- Avoid activity after eating
- Avoid factors that can trigger migraine attacks: These include flickering lights, excessive heat, and humidity.
- Avoid strong odors and other triggers: Strong odors like food and cooking smells, smoke, perfume, etc may induce nausea and should be avoided.
- Do not stop prescription medicine: Even if you suspect that a particular medicine is responsible for causing nausea, you should not stop taking the medicine on your own. Always consult your doctor or health care professional before stopping any prescription medicine.
- Shift your mind and focus: Continuously thinking about nausea is likely to make it worse. Hence it is best to divert your attention by engaging yourself in some other activity like reading a book, doing some fun activity, etc. Meditation or taking deep breaths also works in a similar manner by calming the body.
- Avoid sitting in the backseats of a car or bus if you are prone to motion sickness.
- Use over-the-counter drugs: Certain drugs to treat nausea are available without a prescription and can be taken to treat nausea. These medicines are discussed below.
When To Seek Medical Help?
- If nausea lasts for more than a few days and does not settle with home treatment.
- There are signs of dehydration like rapid breathing or increased pulse rate, not passing urine for several hours, etc.
- Presence of serious injury such as head injury.
- Presence of infection or fever.
- Associated severe headache or stiff neck.
- Extreme lethargy or confusion.
- Severe abdominal or chest pain.
- Blood in the vomit.
Medicines Used to Prevent or Treat Nausea
Motion sickness and vertigo
The medicines should be taken before the onset of motion sickness to be effective.
- Antihistamines such as dimenhydrinate (Dramamine) or meclizine
- Anticholinergics such as scopolamine (orally or transdermally as a skin patch)
Gastroenteritis
Serotonin antagonists such as ondansetron
Pregnancy-associated nausea and vomiting
Pyridoxine ( vitamin B6 ) and doxylamine
Post-surgical nausea and vomiting
Dimenhydrinate and scopolamine
Migraine associated nausea and vomiting
Dopamine antagonists such as metoclopramide, prochlorperazine, and chlorpromazine.
Prognosis or Long Term Outlook
Long term outlook depends on the cause.
Nausea and vomiting that settles down within a few hours (once the causative factor is removed), is usually harmless and produces no complications.
Prolonged nausea and vomiting may lead to dehydration or electrolyte imbalance in the body and needs to be treated urgently.
Prognosis of chronic nausea (lasting over several days) especially when associated with other signs and symptoms depends on the underlying disease.
References
- Cruthirds D, Sims PJ, Louis PJ. Review and recommendations for the prevention, management, and treatment of postoperative and postdischarge nausea and vomiting. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115:601–611.
- Choung RS, Locke GR III, Schleck CD, et al. Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population. Am J Gastroenterol. 2012;107:82–88.
- Casey G. Treating nausea and vomiting. Nurs N Z. 2012;18:20–24.
- Scorza K, Williams A, Phillips JD, Shaw J. Evaluation of nausea and vomiting. Am Fam Physician. 2007;76:76–84.
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