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Nausea and vomiting
Definition Nausea is the sensation leading to the urge to vomit. To vomit is to force the contents of the stomach up through the esophagus and out of the mouth.
Alternative Names Emesis; Vomiting; Stomach upset; Upset stomach
Considerations Dehydration is the biggest concern in most vomiting episodes. The rate with which dehydration takes place depends on the size of the person, the frequency of the vomiting, and whether or not there is also diarrhea . Infants with frequent vomiting and diarrhea are at the greatest risk for dehydration and need immediate medical attention. Signs of dehydration are increased thirst , infrequent urination or dark yellow urine , dry mouth, eyes that appear sunken, crying without tears, and skin that has lost its normal elasticity.
Common Causes
  • medications
  • viral infections
  • seasickness or motion sickness
  • migraine
  • headaches
  • morning sickness
  • during
  • pregnancy
  • food poisoning
  • food allergies
  • chemotherapy
  • in
  • cancer patients
  • bulimia
  • alcoholism
  • Possible causes of vomiting in infants (0 to 6 months):
  • congenital
  • pyloric stenosis , a constriction in the outlet from the stomach (With this disorder, the infant -- usually male, less than 4 months old -- vomits forcefully after each feeding but otherwise appears to be healthy.)
  • disturbed equilibrium from bouncing the baby immediately after feeding
  • food allergies or
  • milk intolerance
  • gastroenteritis
  • (infection of the digestive tract that usually causes vomiting with
  • diarrhea )
  • gastroesophageal reflux
  • hole in bottle nipple may be wrong size
  • infection, often accompanied by a
  • fever or runny nose
  • intestinal obstruction
  • , evidenced by recurring attacks of vomiting, and crying or screaming as if in great pain
  • accidental ingestion of a drug or poison -- Call the doctor IMMEDIATELY or take the child to an emergency care facility!
  • Home Care When the cause of nausea and vomiting is known, it is important to treat the underlying disorder. Whatever the cause, it is important for the person who has vomited a great deal to take in as much fluid as possible without upsetting the stomach any further. Sip clear fluids such as water, ginger ale, fruit juices, or Gatorade. Don’t drink too much at any one time, and work slowly back to a normal diet. Infants who are vomiting repeatedly should be seen be a physician. DO NOT GIVE INFANTS WATER, as this may lead to electrolyte imbalances. Instead, hydration should be maintained by using 1/2 strength formula or oral rehydration solutions such as Pedialyte given in frequent small amounts. Start with 1 teaspoon every 5 minutes and slowly increase the amount. Once full feed amounts are reached and the infant has gone 8 hours without vomiting, return to regular feeding. There is currently no treatment that has been approved by the FDA for morning sickness in pregnant women. Treatment for motion sickness:
  • Lying down can often help.
  • Antihistamines (such as cyclizine, meclizine, or Marezine), which are available over the counter, may help.
  • Scopolamine skin patches (such as Transderm Scop) require a prescription and are useful for extended trips (such as an ocean voyage). In order to prevent the onset of motion sickness, the scopolamine patch should be placed 4 to 12 hours before setting sail. Although scopolamine is effective, it may produce dry mouth,
  • blurred vision , and some drowsiness . Scopolamine is for adults only. It should not be given to children.
    Call your health care provider if
  • there is bleeding (bloody or black vomitus) or severe
  • abdominal pain (call immediately)! Some abdominal discomfort accompanies almost every case of vomiting, but severe pain is not common.
  • a
  • headache and stiff neck are also present.
  • there is
  • lethargy or marked irritability in a young child.
  • there are signs of
  • dehydration .
  • a child is unable to retain any fluids for eight hours or more, or the vomiting is recurrent.
  • an adult is unable to retain any fluids for twelve hours or more.
  • nausea persists for a prolonged period of time (in a person who is not pregnant).
  • What to expect at your health care provider's office A history will be obtained and a physical examination performed. Medical history questions documenting nausea and vomiting in detail may include:
  • quality
  • Are you vomiting fresh blood (
  • hematemesis )?
  • Do you have repeated episodes of
  • vomiting blood ?
  • Are you vomiting
  • coffee ground material?
  • Are you vomiting undigested food?
  • Are you vomiting greenish (bilious) material?
  • Does the vomit contain round worms?
  • Is it mild?
  • Is it severe enough to cause unintentional
  • weight loss ?
  • aggravating factors
  • Is the vomiting self-induced?
  • Have you been traveling? Where?
  • What medication do you take?
  • Have you had
  • chemotherapy ?
  • Did other people that ate at the same location as you experience the same symptoms?
  • Are you
  • pregnant ?
  • time pattern
  • When did the vomiting begin?
  • How long has it lasted?
  • Do you have morning nausea or vomiting?
  • Did it begin recently?
  • Is it recurrent?
  • Does it occur several hours after meals (postprandial)?
  • other
  • What other symptoms are also present?
  • Is there
  • abdominal pain ?
  • Is there a
  • fever ?
  • Is there
  • diarrhea ?
  • Is there
  • poor skin turgor or other signs of dehydration ?
  • Is there
  • abdominal swelling ?
  • Are there
  • headaches ? The physical examination will include examination for signs of dehydration. Diagnostic tests that may be performed include:
  • blood tests (such as
  • CBC with differential and basic electrolytes)
  • urinalysis
  • X-rays of the abdomen
  • Intervention:
  • If dehydration is severe, intravenous fluids may be given. This may require hospitalization, although it can often be done in the doctor’s office. The use of antivomiting drugs is controversial, and they should be used only in severe cases. After seeing your health care provider: If a diagnosis was made by your health care provider related to nausea and vomiting, you may want to note that diagnosis in your personal medical record.

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