NAUSEA

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Nausea is an unpleasant, queasy feeling often associated with the urge to vomit. While it is not a disease itself, nausea can be a symptom of various underlying conditions.

Nausea vs Vomiting

Nausea:

• The uneasy feeling in your stomach that often comes before you vomit.

Vomiting:

• The act of forcefully expelling stomach contents through your mouth.

These symptoms can occur together or separately.

Causes of Nausea and Vomiting

They are both symptoms, not diseases, and can be caused by a variety of conditions, including:

1. Medical Conditions:
   • Gallbladder disease
   • Food poisoning
   • Infections (e.g., “stomach flu”)
   • Ulcers
   • Psychological illnesses (e.g., bulimia)
   • Gastroparesis (slow stomach emptying, often seen in diabetics)
2. Other Causes:
   • Motion sickness or seasickness
   • Early pregnancy (nausea in 50%-90% of pregnancies; vomiting in 25%-55%)
   • Ingesting toxins
   • Medication reactions
   • Intense pain
   • Emotional stress (e.g., fear)
   • Alcohol overconsumption
   • Illicit drug use
   • Overeating
   • Reactions to smells or odors

Vomiting in Children

Children are more likely to vomit than adults. Common causes include:

• Viral infections
• Food poisoning
• Milk allergies
• Motion sickness
• Overeating or overfeeding
• Coughing
• High fever from other illnesses

Vomiting in Adults

In adults, common causes include:

• Gastroenteritis:
  • Often referred to as “stomach flu,” it is caused by bacterial gut infections.
• Other Causes:
  • Pregnancy
  • Food poisoning
  • Migraines
  • Labyrinthitis (inner ear infection causing dizziness)
  • Motion sickness
  • Appendicitis

Chronic Stomach Conditions

Long-term issues that can cause vomiting include:

• Food allergies and peptic ulcers:
  • Conditions like GERD, especially after eating quickly, too much, or certain foods.
• Irritable Bowel Syndrome (IBS):
  • Can cause nausea and vomiting due to an overactive gut.
• Crohn’s Disease:
  • An inflammatory bowel disease usually affecting the intestines.

Lifestyle Choices

• Alcohol:
  • Overconsumption irritates the stomach lining, increases stomach acid, and delays emptying, causing vomiting.
• Illicit Drugs:
  • Excessive marijuana use or other drugs can lead to vomiting.
• Overeating:
  • Eating beyond fullness can trigger vomiting.

Eating Disorders

Vomiting can signal an eating disorder, such as:

• Anorexia:
  • Intense fear of gaining weight, leading to extreme calorie restriction and possible self-induced vomiting or laxative use.
• Bulimia:
  • Binge eating followed by vomiting or laxative use due to fear of weight gain.

Other Conditions

Vomiting can also be a side effect of severe illnesses, including:

• Encephalitis
• Meningitis
• Certain cancers
• Heart attack
• Concussion or brain injury
• Brain tumor
• Bowel blockage
• Appendicitis (inflammation of the appendix)

Prevalence of Nausea

Nausea is a common symptom experienced by individuals of all ages. It is particularly prevalent among pregnant women, affecting up to 80% in the early stages. Travelers, those undergoing medical treatments, and individuals with gastrointestinal disorders also frequently report nausea.

Symptoms Associated with Nausea

Nausea itself is a symptom, but it often accompanies other signs, such as:

• Vomiting
• Dizziness
• Sweating
• Abdominal pain
• Diarrhea
• Headache

Nausea With Other Symptoms

COVID-19 and Nausea:

• Nausea can be a symptom of COVID-19, sometimes overlooked.
• Along with nausea, other symptoms include fever and cough.
• COVID-19 may also affect the digestive tract.

Nausea and Headache:

• Nausea accompanied by a headache could indicate a migraine.
• Approximately 60%-90% of migraine sufferers experience nausea during an attack.
• Other migraine symptoms may include aura (visual or sensory disturbances), sensitivity to light, and changes in mood or behavior.
• While the exact connection between nausea and migraines isn’t fully understood, it may occur before the onset of head pain.

Pregnancy and Nausea:

• Nausea, often termed “morning sickness,” is common during the first trimester of pregnancy.
• It can occur at any time of day and is thought to be triggered by an increase in human chorionic gonadotropin (HCG) hormone levels.
• Severe morning sickness, known as hyperemesis gravidarum, is characterized by elevated HCG levels.

Nausea After Eating:

• Post-meal nausea could indicate various conditions:
  • Bacterial or viral infections
  • Food poisoning
  • Food allergies
  • Stress or anxiety
  • Acid reflux
  • Irritable bowel syndrome
  • Overeating
• Timing of nausea after eating can provide clues to the cause:
  • Immediate onset may suggest food poisoning, gastritis, an ulcer, or bulimia.
  • Onset 1-8 hours after eating could indicate food poisoning, with certain bacteria taking longer to produce symptoms.

Nausea and Diarrhea:

• Norovirus, also known as the “stomach flu” or “stomach bug,” is highly contagious and can cause nausea, vomiting, and diarrhea.
• Symptoms can persist for 2 to 3 days, and medical attention may be necessary if they do not improve.

Menstrual Cycle and Nausea:

• Nausea during periods may result from hormonal changes in the body.
• It may also occur with dysmenorrhea (very painful periods) or premenstrual syndrome (PMS).

Vomiting With Other Symptoms

COVID-19 and Vomiting:

• Vomiting, like nausea, can be a symptom of COVID-19.
• Respiratory symptoms such as coughing and difficulty breathing often accompany vomiting, but in some cases, digestive symptoms like vomiting and diarrhea may be the primary manifestations of COVID-19.

Diarrhea and Vomiting:

• Vomiting along with diarrhea is commonly associated with stomach flu or food poisoning.
• Loss of fluids from vomiting and diarrhea can increase the risk of dehydration, particularly in children and older adults.

Vomiting and Headache (Migraine):

• Approximately 50% to 62% of individuals with migraines experience episodes of vomiting.
• For some, vomiting may alleviate migraine symptoms.
• If traditional migraine medication cannot be tolerated due to vomiting, alternative forms such as nasal sprays, dissolving tablets, or suppositories may be prescribed alongside anti-nausea medication.

Vomiting Blood:

• Vomiting blood may indicate bleeding in the esophagus, potentially caused by:
  • Severe coughing
  • Gastritis (inflamed stomach lining)
  • Stomach ulcers
  • Alcohol-related liver disease
  • Heartburn and acid reflux

Harmful Effects of Vomiting:

• While vomiting itself is usually harmless, repeated vomiting over time can lead to complications such as:
  • Damage to the esophagus or tooth enamel due to stomach acid exposure.

Dehydration in Children:

• Children, especially if experiencing vomiting and diarrhea concurrently, are at increased risk of dehydration.
• Signs of dehydration in children include dry lips and mouth, sunken eyes, rapid breathing or pulse, decreased urination, and a sunken fontanelle (soft spot on the baby’s head).

Risk Factors for Nausea

Several factors can increase the likelihood of experiencing this symptom:

• Gender: Women are more prone to hormonal fluctuations, particularly during pregnancy.
• Age: Children are more susceptible to motion sickness and certain viral infections.
• Medical history: A history of migraines, gastrointestinal disorders, or anxiety can elevate risk.
• Travel habits: Frequent travelers might experience motion sickness more often.
• Medication: The use of certain drugs increases the risk of nausea.

Diagnosis

Diagnosing the cause of this symptom typically involves:

1. Medical history: Detailed questioning about the onset, duration, and triggers of nausea.
2. Physical examination: Checking for signs of dehydration, abdominal tenderness, or neurological issues.
3. Laboratory tests: Blood tests, urine tests, and sometimes stool tests to detect infections or metabolic issues.
4. Imaging studies: Ultrasound, CT scan, or MRI to examine internal organs.

Treatments

Medications

• Over-the-counter remedies: Various over-the-counter medications are available for nausea, but consult your doctor before use.
• Prescription Drugs: Prescription medications may be prescribed for nausea related to morning sickness, acid reflux, or pregnancy. Always consult with a healthcare professional before starting any new medication.

Cancer Treatment-Related Nausea:

• Cancer patients often take medications to manage nausea during treatment.

Home Care Tips

• Drink Clear Liquids: Sip on water, ginger ale, or lemonade in small amounts to prevent dehydration.
• Avoid Solid Foods: Refrain from eating solid foods until vomiting subsides.
• Bland Diet: Gradually introduce bland foods like crackers, toast, and gelatin. Progress to foods like cereal, rice, and fruit if tolerated.
• Oral Rehydrating Solution: If vomiting and diarrhea persist for more than 24 hours, consider using an oral rehydrating solution available at drugstores.
• Morning Sickness Management (for Pregnant Women): Eat crackers before getting out of bed and consume a high-protein snack before bedtime to help manage morning sickness.
• Acupressure: Wristbands applying pressure to the P6 acupressure point can help.
• Use ginger: Ginger tea or candies can be soothing.
• Rest: Resting in a comfortable position can help alleviate nausea.

Complications of Nausea and Vomiting

Nutritional Deficiencies:

• Prolonged nausea and vomiting can lead to difficulty obtaining adequate nutrients, resulting in malnutrition and weight loss. Nutritional drinks may be recommended by a doctor to supplement calorie and nutrient intake.

Cyclic Vomiting Syndrome:

• Constant nausea and vomiting may be indicative of cyclic vomiting syndrome, characterized by recurrent attacks of nausea and vomiting without an apparent cause.

Hyperemesis Gravidarum:

• Severe morning sickness during pregnancy, known as hyperemesis gravidarum, involves frequent vomiting, potentially endangering the health of both the mother and fetus due to fluid and mineral imbalances.

Mallory-Weiss Tear:

• Excessive vomiting can cause tears in the esophageal lining, known as Mallory-Weiss tears. In severe cases, esophageal rupture (Boerhaave’s syndrome) may occur, necessitating immediate medical attention as it is a medical emergency.

Prevention of Nausea

Preventing nausea involves lifestyle and dietary adjustments:

• Avoid triggers: Identify and avoid foods or situations that cause nausea.
  • Avoid Greasy Foods: Stay away from greasy or strongly flavored foods that may exacerbate nausea.
  • Avoid Strong Smells and Stimuli: Steer clear of cooking odors, perfume, smoke, flickering lights, and driving if these exacerbate symptoms.
• Eat mindfully: Eat slowly and choose bland, easy-to-digest foods.
• Manage stress: Practice relaxation techniques like deep breathing or meditation.
• Stay hydrated: Drink plenty of fluids throughout the day.
• Motion sickness prevention: Use preventive measures such as motion sickness bands or medication when traveling.
• Eat During Periods of Lesser Nausea: Try to schedule meals during times when you feel less nauseated.

Preventing Vomiting When Nauseated

To prevent vomiting once you feel nauseated, consider these steps:

1. Drink Clear, Sweetened Liquids: Sip on small amounts of clear, sweetened liquids such as soda or fruit juices (avoiding acidic options like orange or grapefruit juice).
2. Rest: Sit or lie down in a propped-up position to ease nausea and prevent vomiting.
3. Preventing Vomiting in Children:
   • Car Motion Sickness: Seat children facing the front windshield to reduce motion sickness, avoiding activities like reading or playing video games while in motion.
   • Eating and Playing: Encourage children not to eat and play simultaneously, as this can contribute to motion-induced vomiting.

When to See a Doctor

Seek medical advice with the guidelines below:

• Duration: If nausea and vomiting persist for more than a few days, particularly if pregnancy is a possibility, it’s advisable to consult a doctor.
• Home Treatment: If home remedies fail to alleviate symptoms, medical attention may be necessary.
• Signs of Dehydration: Seek medical care if signs of dehydration, such as excessive thirst or dark urine, are present.
• Injury: Consult a doctor if nausea and vomiting follow an injury.
• Duration of Vomiting:
  • Adults: If vomiting persists for more than 2 days.
  • Children Under 2: If vomiting lasts more than 24 hours.
  • Babies: If vomiting persists for more than 12 hours.
• Chronic Episodes: Medical evaluation is warranted if episodes of nausea and vomiting occur regularly for longer than a month.
• Unexplained Weight Loss: Consult a doctor if nausea and vomiting are accompanied by unexplained weight loss.

Seeking Medical Care for Children:

• Children Under 6:
  • If vomiting is accompanied by diarrhea or fever.
  • If vomiting persists for more than a few hours.
  • If signs of dehydration are present, such as reduced urine output.
• Children Over 6:
  • If vomiting persists for a full day, particularly if diarrhea is also present.
  • If fever exceeds 102°F (38.9°C).
  • If signs of dehydration are evident, including reduced urine output.

Emergency Medical Attention:

• Severe Symptoms: Seek emergency medical help if nausea and vomiting are accompanied by severe symptoms such as chest pain, serious stomach pain, blurred vision, confusion, high fever, stiff neck, or rectal bleeding.
• Intense Headache: Consult a doctor urgently if nausea is accompanied by an intense headache, especially if this is unusual.
• Signs of Serious Dehydration: Seek immediate medical care if signs of serious dehydration, such as excessive thirst, dark urine, weakness, or dizziness, are present.
• Blood in Vomit: If vomit contains blood or resembles coffee grounds, seek prompt medical attention.

Outlook/Prognosis

The prognosis for nausea varies widely depending on its cause. Most cases of nausea resolve with appropriate treatment or lifestyle changes. However, chronic or severe nausea may require ongoing medical management. Early diagnosis and intervention improve the overall outlook.

Sources

1. Mayo Clinic
2. WebMD
3. Cleveland Clinic
4. American Gastroenterological Association
5. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)