Nausea

Nausea

Definition

Nausea is the sensation of having a queasy stomach or being about to vomit. Vomiting , or emesis, is the expelling of undigested food through the mouth.

Description

Nausea is a reaction to a number of causes that include overeating, infection, or irritation of the throat or stomach lining. Persistent or recurrent nausea and vomiting should be checked by a doctor.

A doctor should be called if nausea and vomiting occur:

• after eating rich or spoiled food or taking a new medication
• repeatedly or for 48 hours or longer
• following intense dizziness

It is important to see a doctor if nausea and vomiting are accompanied by:

• yellowing of the skin and whites of the eyes
• pain in the chest or lower abdomen
• trouble with swallowing or urination
• dehydration or extreme thirst
• drowsiness or confusion
• constant, severe abdominal pain
• a fruity breath odor

A doctor should be notified if vomiting is heavy and/or bloody; if the vomitus looks like coffee grounds or feces; or if the patient has been unable to keep food down for 24 hours.

An ambulance or emergency response number should be called immediately if:

• Diabetic shock is suspected.
• Nausea and vomiting continue after other symptoms of viral infection have subsided.
• The patient has a severe headache .
• The patient is sweating and having chest pain and trouble breathing.
• The patient is known or suspected to have swallowed a drug overdose or poisonous substance.
• The patient has a high body temperature, muscle cramps, and other signs of heat exhaustion or heat stroke.
• Nausea, vomiting, and breathing problems occur after exposure to a known allergen.

Causes & symptoms

Persistent, unexplained, or recurring nausea and vomiting can be symptoms of a variety of serious illnesses. It can be caused by simply overeating or drinking too much alcohol. It can be due to stress , certain medications, or illness. For example, people who are given morphine or other opioid medications for pain relief after surgery sometimes feel nauseated by the drug. Such poisonous substances as arsenic and other heavy metals cause nausea and vomiting. Morning sickness is a consequence of pregnancy-related hormone changes. Motion sickness can be induced by traveling in a vehicle, plane, or on a boat. Many patients experience nausea after eating spoiled food or foods to which they are allergic. Patients who suffer migraine headache often experience nausea. Cancer patients on chemotherapy are often nauseated. Gallstones, gastroenteritis , and stomach ulcer may cause nausea and vomiting. Such infectious illnesses as dengue fever and severe acute respiratory syndrome (SARS) may be accompanied by nausea and vomiting. These symptoms should be evaluated by a physician.

Diagnosis

Diagnosis is based on the severity, frequency, and duration of symptoms, and other factors that could indicate the presence of a serious illness.

Treatment

Getting a breath of fresh air or getting away from whatever is causing the nausea can solve the problem. Eating olives or crackers or sucking on a lemon can calm the stomach by absorbing acid and excess fluid. Coke syrup is another proven antiemetic remedy.

Vomiting relieves nausea immediately but can cause dehydration. Sipping clear juices, weak tea, and some sports drinks help replace lost fluid and minerals without irritating the stomach. Food should be reintroduced gradually, beginning with small amounts of dry, bland food like crackers and toast.

Biofeedback

Biofeedback uses exercise and deep relaxation to control nausea.

Acupuncture

Acupuncture is increasingly regarded as a useful adjunct to treating nausea. A growing body of literature shows that acupuncture is effective in treating nausea associated with pregnancy , surgery, and chemotherapy for cancer. The most effective acupuncture point for nausea appears to be PC-6.

A few patients, however, may experience temporary nausea as a side effect of acupuncture. It is not considered a serious side effect.

Acupressure

Acupressure (applying pressure to specific areas of the body) may be helpful in reducing nausea and vomiting and relaxes the gastrointestinal tract. Acupressure can be applied by wearing a special wristband or by applying firm pressures to the:

• back of the jawbone
• webbing between the thumb and index finger
• top of the foot
• inside of the wrist
• base of the rib cage

Nutritional therapy

• Rehydration. It is very important to replace fluid loss through prolonged vomiting. However, patients should take fluid in slowly to prevent shock to the body. Fruit juice or soup are even better than plain water because they also contain glucose and salt, which may also be deficient.
• Avoid eating solids right away. Patients should wait until the body has enough rests and the stomach has a chance to settle down before starting on solid foods.
• Bland foods. To avoid overworking the digestive system too soon, patients should resume eating with bland food such as toast or yogurt. In addition, they should not try to eat too much right away, as this also stresses out the digestive system.
• Lactaid. Lactaid helps prevent upset stomach in persons allergic to milk.

Herbal treatments

There are several herbal remedies that can help alleviate short bouts of nausea and vomiting.

• Chamomile (Matricaria recutita ) or lemon balm (Melissa officinalis ) tea may relieve symptoms.
• Ginger (Zingiber officinale ), a very effective herbal remedy for nausea, can be drunk as tea or taken as candy or powered capsules. Ginger has been shown in several studies to relieve morning sickness associated with pregnancy.
• Peppermint tea is effective in alleviating nausea and vomiting associated with indigestion.
• Stomach tea, a combination of anise seed, fennel , peppermint and thyme , is a good herbal treatment for gas.
• Strong green tea can stop nausea especially if it is caused by eating spoiled foods.

Homeopathy

Depending on a patient's specific condition, a homeopathic practitioner may prescribe one of the following remedies: Arsenicum album, Carbo vegetabilis, Ignatia, homeopathic ipecac , and Nux vomica.

Aromatherapy

Peppermint or lavender oil when inhaled, calms the body and reduces nausea and vomiting.

Allopathic treatment

Meclizine (Bonine), a medication for motion sickness, also diminishes the feeling of queasiness in the stomach. Dimenhydrinate (Dramamine), another motion-sickness drug, is not effective on other types of nausea and may cause drowsiness.

Newer drugs that have been developed to treat postoperative or postchemotherapy nausea and vomiting include ondansetron (Zofran) and granisetron (Kytril). Another treatment that has been found to lower the risk of nausea after surgery is intravenous administration of supplemental fluid before the operation.

Prevention

Massage, meditation, yoga , and other relaxation techniques can help prevent stress-induced nausea. Antinausea medication taken before traveling can prevent motion sickness. Sitting in the front seat, focusing on the horizon, and traveling after dark can also minimize symptoms.

Food should be fresh, properly prepared, and eaten slowly. Overeating, tight-fitting clothes, and strenuous activity immediately after a meal should be avoided.

Resources

BOOKS

"Functional Vomiting." Section 3, Chapter 21 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Chapter 5, "Acupuncture: From the Yellow Emperor to Magnetic Resonance Imaging (MRI)." New York: Simon & Schuster, 2002.

Reader's Digest's Guide to Medical Cures & Treatment: A Complete A to Z Sourcebook of Medical Treatment, Alternative Options and Home Remedies. Canada: The Reader's Digest's Association, 1996:310.

Zand, Janet, Allan N. Spreen, and James B. LaValle. "Nausea and Vomiting." In Smart Medicine for Healthier Living: A Practical A-to-Z Reference to Natural and Conventional Treatments for Adults. Garden City Park, NY: Avery Publishing Group, 1999: 437–439.

PERIODICALS

Ali, S. Z., A. Taguchi, B. Holtmann, and A. Kurz. "Effect of Supplemental Pre-Operative Fluid on Postoperative Nausea and Vomiting." Anaesthesia 58 (August 2003): 780–784.

Brunk, Doug. "Acupuncture Gains Favor as Adjunct. (Controlling Headaches, Nausea, Dizziness)." Pediatric News 35 (December 2001): 1-2.

Cepeda, M. S., J. T. Farrar, M. Baumgarten, et al. "Side Effects of Opioids During Short-Term Administration: Effect of Age, Gender, and Race." Clinical Pharmacology and Therapeutics 74 (August 2003): 102–112.

Chung, A., L. Bui, and E. Mills. "Adverse Effects of Acupuncture. Which Are Clinically Significant?" Canadian Family Physician 49 (August 2003): 985–989.

O'Brien, C. M., G. Titley, and P. Whitehurst. "A Comparison of Cyclizine, Ondansetron and Placebo as Prophylaxis Against Postoperative Nausea and Vomiting in Children." Anaesthesia 58 (July 2003): 707–711.

Ratnaike, R. N. "Acute and Chronic Arsenic Toxicity." Postgraduate Medical Journal 79 (July 2003): 391–396.

Tan, M. "Granisetron: New Insights Into Its Use for the Treatment of Chemotherapy-Induced Nausea and Vomiting." Expert Opinion in Pharmacotherapy 4 (September 2003): 1563–1571.

Tiwari, A., S. Chan, A. Wong, et al. "Severe Acute Respiratory Syndrome (SARS) in Hong Kong: Patients' Experiences." Nursing Outlook 51 (September-October 2003): 212–219.

Treish, I., S. Shord, J. Valgus, et al. "Randomized Double-Blind Study of the Reliefband as an Adjunct to Standard Antiemetics in Patients Receiving Moderately-High to Highly Emetogenic Chemotherapy." Supportive Care in Cancer 11 (August 2003): 516–521.

Walling, Anne D. "Ginger Relieves Nausea and Vomiting During Pregnancy." American Family Physician 64 (November 15, 2001): 1745.

OTHER

"Nutrition Tips for Managing Nausea and Vomiting." Mayo Clinic. http://www.mayohealth.org/mayo/9709/htm/eating5.htm.

Mai Tran

Rebecca J. Frey, PhD