Nausea and Vomiting

Symptoms

Nausea is an unpleasant and painless sensation that can lead to vomiting. Vomiting is an autonomic response of the body in which the stomach contents are expelled through the mouth with contraction of the muscles. Its primary purpose is to protect the body from toxic and inedible foods and harmful substances. Nausea may be accompanied by pale skin, rapid heartbeat, sweating, salivation, and a feeling of cold or warmth. An important complication is potentially dangerous dehydration due to repeated vomiting. Infants, toddlers, and children are especially at risk.

Causes

Nausea is not itself a disease, but a symptom that can be caused by numerous triggers, diseases, and substances. The following list shows a small selection:

  • Gastrointestinal flu (gastroenteritis).
  • Gastrointestinal diseases
  • Infectious diseases
  • Fever
  • Pregnancy
  • Poisonings, toxins
  • Drugs, chemotherapy, radiation therapy – nausea is a very common side effect of drugs.
  • Anesthesia, after surgery
  • Intoxicant abuse, alcohol
  • Food
  • Travel sickness
  • Dizziness
  • Headache, migraine
  • Psychiatric diseases
  • Emotions, fear, smells, expectation
  • Allergies
  • Pain

Serious and life-threatening diseases can also cause nausea and vomiting, for example, cancer, liver inflammation, pneumonia or a heart attack.

Diagnosis

Patients should seek medical attention if they have accompanying symptoms, such as high fever or severe headache. The diagnosis is made on the basis of the patient’s history, physical examination, and possibly laboratory methods and imaging.

Nonpharmacologic treatment

  • Ensure adequate fluid intake. Administer fluids in small amounts, such as by the spoonful.
  • Relaxation techniques
  • Light physical exercise, fresh air
  • Rinse the mouth with water after vomiting
  • Small, easily digestible meals
  • Acupuncture, acupressure

Drug treatment

Whenever possible, treatment should be based on the cause. For example, specific migraine medications may be administered for migraine, and digestive aids may be administered for indigestion. To compensate for fluid and electrolyte loss, oral rehydration solution is recommended. The solution contains water, glucose, sodium, potassium, chloride and citrate. It compensates for disturbances in water and electrolyte balance and is used to prevent and treat dehydration. ORS has been shown to reduce mortality and is one of the first-line agents for vomiting. Multivitamin supplements can be taken during the recovery period to replace lost nutrients. For symptomatic therapy, the so-called antiemetics, i.e. drugs against nausea and vomiting, are used. Their effects are based on antagonism at various neurotransmitter receptors. Antiemetics include: Dopamine antagonists:

1st generation antihistamines: (selection).

  • Dimenhydrinate (eg, Trawell).
  • Diphenhydramine (e.g., Benocten, off-label).
  • Meclozine (Itinerol B6)
  • Dimetindene maleate drops (Feniallerg, off-label).

Phytopharmka and herbal agents:

  • Ginger
  • Cannabis
  • Cannabinoids: dronabinol, nabilone (synthetic).

Vitamins:

  • Vitamin B6 (pyridoxine)

Anticholinergics:

  • Scopolamine (out of commerce in many countries for this indication).

Serotonin antagonists at the 5-HT3 receptor:

NK1 receptor antagonists:

  • Aprepitant (Emend)
  • Fosaprepitant (Ivemend)
  • Netupitant (Akynzeo)
  • Rolapitant (Varubi)

Adjunct:

Alternative medicine (homeopathy):

  • Nux vomica
  • Colchicum
  • Ipecacuanha