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Nausea and vomiting - adults

Emesis; Vomiting; Stomach upset; Upset stomach; Queasiness

 

Nausea is feeling 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.

Causes

 

Many common problems may cause nausea and vomiting, including:

  • 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)
  • Medicines 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 health care provider find the cause, you will want to know how to treat your nausea or vomiting. You may need 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 provider about possible treatments.

The following may help treat motion sickness:

  • Lying down.
  • Taking over-the-counter antihistamines, such as dimenhydrinate (Dramamine).
  • Using scopolamine prescription skin patches (such as Transderm Scop). These are helpful for extended trips, such as an ocean voyage. Use the patch as your doctor instructs. 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 the vomiting is from poisoning.
  • You notice blood or dark, coffee-colored material in the vomit.

Call a 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 3 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 provider will perform a physical exam and will look for signs of dehydration.

Your 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?
  • Are other symptoms present such as 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 medicines 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 and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 15.

Mcquaid K. Approach to the patient with gastrointestinal disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 132.

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        Review Date: 8/14/2015

        Reviewed By: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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