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Nausea and vomiting - adults
Definition
Nausea is the feeling of having an urge to vomit. It is often called being sick to your stomach.
Vomiting or throwing up is forcing the contents of the stomach up through the esophagus and out of the mouth.
Alternative Names
Emesis; Vomiting; Stomach upset; Upset stomach
Causes
Many common problems may cause nausea and vomiting:- Food allergies
- Infections of the stomach or bowels, such as the "stomach flu" or food poisoning
- Leaking of stomach contents (food or liquid) upwards (also called gastroesophageal reflux or GERD)
- Medications or medical treatments, such as cancer chemotherapy or radiation treatment
- Migraine headaches
- Morning sickness during pregnancy
- Seasickness or motion sickness
- Severe pain, such as with kidney stones
Nausea and vomiting may also be early warning signs of more serious medical problems, such as:
- Appendicitis
- Blockage in the intestines
- Cancer or a tumor
- Ingesting a drug or poison, especially by children
- Ulcers in the lining of the stomach or small intestine
Home Care
Once you and your doctor find the cause, you will want to know how to treat your nausea or vomiting. You may be asked to take medicine, change your diet, or try other things to make you feel better.
It is very important to keep enough fluids in your body. Try drinking frequent, small amounts of clear liquids.
If you have morning sickness during pregnancy, ask your doctor about the many possible treatments.
The following may help treat motion sickness:
- Lying down
- Over-the-counter antihistamines (such as Dramamine)
- Scopolamine prescription skin patches (such as Transderm Scop) are useful for extended trips, such as an ocean voyage. Place the patch 4 - 12 hours before setting sail. Scopolamine is effective but may produce dry mouth, blurred vision, and some drowsiness. Scopolamine is for adults only. It should NOT be given to children.
When to Contact a Medical Professional
Call 911 or go to an emergency room if:
- You think vomiting is from poisoning
- You notice blood or dark, coffee-colored material in the vomit
Call a health care provider right away or seek medical care if you or another person has:
- Been vomiting for longer than 24 hours
- Been unable to keep any fluids down for 12 hours or more
- Headache or stiff neck
- Not urinated for 8 or more hours
- Severe stomach or belly pain
- Vomited three or more times in 1 day
Signs of dehydration include:
- Crying without tears
- Dry mouth
- Increased thirst
- Eyes that appear sunken
- Skin changes -- for example, if you touch or squeeze the skin, it doesn't bounce back the way it usually does
- Urinating less often or having dark yellow urine
What to Expect at Your Office Visit
Your health care provider will perform a physical examination, and will look for signs of dehydration.
Your health care provider will ask questions about your symptoms, such as:
- When did the vomiting begin? How long has it lasted? How often does it occur?
- Does it occur after you eat, or on an empty stomach?
- What other symptoms are present -- abdominal pain, fever, diarrhea, or headaches?
- Are you vomiting blood?
- Are you vomiting anything that looks like coffee grounds?
- Are you vomiting undigested food?
- When was the last time you urinated?
Other questions you may be asked include:
- Have you been losing weight?
- Have you been traveling? Where?
- What medications do you take?
- Did other people who ate at the same place as you have the same symptoms?
- Are you pregnant or could you be pregnant?
The diagnostic tests may be performed:
- Blood tests (such as CBC with differential, blood electrolyte levels, and liver function tests)
- Urinalysis
- X-rays of the abdomen
Depending on the cause and how much extra fluids you need, you may have to stay in the hospital or clinic for a period of time. You may need fluids given through your veins (intravenous or IV).
References
Malagelada J-R, Malagelada C. Nausea and vomiting. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 14.
Mcquaid K. Approach to the patient with gastrointestinal disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 134.
This article uses information by permission from Alan Greene, M.D., © Greene Ink, Inc.
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
