Nausea & Vomiting

Alternative names:

emesis; stomach upset; upset stomach; vomiting

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 much at any one time, and work slowly back to a normal diet.

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 put on 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 or blood differential)
• 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.